文章摘要
刘希永,郑树,张苏展,丁杏芬,沈永洲,沈高飞,孙其荣,李卫东.直肠息肉摘除对直肠癌预防的前瞻性评价[J].中华流行病学杂志,2000,21(4):245-248
直肠息肉摘除对直肠癌预防的前瞻性评价
Reducing incidence and mortality from rectal cancer by polypectomy: A prospective cohort study
收稿日期:2000-03-10  出版日期:2014-09-16
DOI:
中文关键词: 结/直肠肿瘤;息肉;内窥镜检查;死亡率;发病率
英文关键词: Colon/rectum neoplasm;Polyps;Endoscop;Incidence;Mortality
基金项目:“七五”,(75610217);“八五”,(8591401)国家科技攻关课题资助
作者单位
刘希永 海宁市肿瘤防治研究所 
郑树 海宁市肿瘤防治研究所 
张苏展 海宁市肿瘤防治研究所 
丁杏芬 浙江大学肿瘤研究所流行病学研究室, 杭州 310009 
沈永洲 浙江大学肿瘤研究所流行病学研究室, 杭州 310009 
沈高飞 浙江大学肿瘤研究所流行病学研究室, 杭州 310009 
孙其荣 浙江大学肿瘤研究所流行病学研究室, 杭州 310009 
李卫东 浙江大学肿瘤研究所流行病学研究室, 杭州 310009 
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中文摘要:
      目的 评估直肠镜在人群中筛检效果,验证直肠息肉摘除能否阻断直肠癌的自然史,降低直肠癌的发病率及死亡率。方法 1977~1980年间在海宁市分两次对30岁以上23余万人群进行15 cm肠镜筛检,对检出的4 076例肠息肉进行镜下摘除后定期肠镜随访。结果 肠息肉患者经20年定期肠镜随访,共计肠镜随访到并摘除肠腺瘤952例次,非腺瘤性息肉417例次,另外还随访检出肠癌27例。直肠镜筛检检出的直肠癌的生存率显著高于同期非经筛检或随访检出的直肠癌的生存率(P<0.001),筛检使肠癌生存期延长了7.89年。海宁市1977~1996年的直肠癌的标化发病率与标化死亡率均有下降趋势;受干预人群的20年累积直肠癌发病率与死亡率分别降低为:68.6%与82.4%。结论 应用15 cm肠镜在人群中进行筛检,可提高直肠癌的生存率,对筛检检出肠息肉进行摘除并定期进行肠镜随访,可阻断直肠癌的自然史,从而降低直肠癌的发病率与死亡率。
英文摘要:
      Objective To address the hypothesis that colorectal cancers often arise from precursor lesion(s), either adenomas or non-adenomatous polyps. Methods A population-based mass screening for rectal cancer using 15cm rigid endoscopy was conducted in Haining County, Zhejiang province, from 1977 to 1980. Of over 230 000 participants, 4 076 of them were diagnosed with precursor lesions, either adenomas or non-adenomatous polyps, which were then removed. All individuals with precursor lesions were followed and re-examined by endoscopy every two to five years through 1998.Results After the initial screening, 952 metachronous adenomas and 417 non-adenomatous polyps were detected and removed from the cohort. Furthermore, 27 cases of colorectal cancer were detected and treated. Log-rank tests showed that the years of survival significantly increased among those cancer patients who had undergone mass screening compared to other rectal cancer patients (P<0.001).According to the population-based cancer registry in Haining County, both age-adjusted incidence and mortality rates from rectal cancer decreased from 1977 to 1996. Observed accumulative incidence and mortality rates decreased to 68.6% and 82.4% comparing with expected numbers during the last 20 years. Conclusion Mass rectal cancer screening in the general population followed by routine endoscopy for high-risk patients could decrease both rectal cancer incidence and mortality rates.
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