结肠镜在大肠癌早期筛查诊断中的作用

目的 探讨结肠镜检查作为大肠癌筛查手段评估大肠癌流行病学的价值.方法 对天津市塘沽区符合筛查的常住居民9 658名进行初筛,发现高危人群1478例,行结肠镜检查筛查大肠癌,对检查结果进行分析.结果 经结肠镜及病理诊断大肠癌31例(2.1％);多集中在65～69岁之间;以直肠居多,病理类型以腺癌为多.进展期腺瘤40例,息肉338例.结论 结肠镜对早期筛查诊断大肠癌具有重要意义.     

甲基化芯片技术检测粪便DNA甲基化在海南地区少数民族人群大肠癌筛查中的应用

目的 分析甲基化芯片技术检测粪便DNA甲基化在海南地区少数民族人群大肠癌筛查中的应用价值。方法 选取2020年6月—2022年6月海南省人民医院就诊的大肠癌高危少数民族人群102例。另选取同期该院招募的30例健康志愿者作为对照组。留取所有患者在结肠镜检查前自然排出或服用泻药后的第一段粪便，通过甲基化芯片技术检测粪便DNA甲基化。根据肠镜病理检查结果，将102例患者分为大肠癌组、腺瘤组、增生性息肉组。对比4组粪便DNA中VAV3、IKZF1、RIMS1基因甲基化状态。将肠镜病理检查结果作为金标准，评估粪便DNA中VAV3、IKZF1、RIMS1基因联合检测大肠癌、腺瘤的诊断效能。结果 大肠癌组VAV3、IKZF1、RIMS1基因单独及联合检测甲基化率高于腺瘤组、增生性息肉组、对照组（P <0.05）。腺瘤组与增生性息肉组VAV3、IKZF1、RIMS1基因单独及联合检测甲基化率比较，差异无统计学意义（P>0.05）。VAV3、IKZF1、RIMS1基因联合检测大肠癌的特异性、敏感性、阴性预测值、阳性预测值、准确率最高，分别为100.00%、92.31%、92.59%、100....     

3112例社区居民大肠癌筛查情况分析

目的:分析该社区人群的肠镜检查息肉病理的检出率。方法:选择该社区40~74岁居民3112例,采用危险因素数学模型评估问卷调查和粪便潜血试验(FOBT)相结合的方法初筛,对大便潜血试验阳性和有危险因素的高危人群采用直肠指检及电子肠镜检查复查。结果:大便潜血阳性组141例,危险因素调查阳性组733例,2组的肠镜检查阳性率、炎性息肉及癌的检出率相比无统计学差异。潜血阳性组腺瘤性息肉检出率高于调查阳性组(P﹤0.05),调查阳性组增生性息肉的检出率高于潜血阳性组(P﹤0.05)。结论:危险因素调查是一种有效的大肠癌筛查初筛手段。     

浅谈应用超声和X线钼靶诊断乳腺癌的临床价值

探讨分析应用超声和X线钼靶诊断乳腺癌的临床应用价值。方法：选取2010年1月至2013年12月间我院收治的存在乳腺肿块的患者382例作为研究对象,为其进行超声检查、X线钼靶检查及联合检查,观察对比各项检查结果与病理检查结果的符合率,并将对比的结果及所有患者的临床资料进行回顾性的分析。结果：超声检查的阴性似然比为0.19,阳性似然比为5.02,阳性预测值为83.5%,准确率为83.8%,特异度为83.2%,灵敏度为84.4%;X线钼靶检查的阴性似然比为0.22,阳性似然比为4.12,阳性预测值为84.5%,准确率为89.5%,特异度为82.1%,灵敏度86.9%;联合检查的阴性似然比为0.04,阳性似然比为5.41,阳性预测值为93.2%,准确率为95.6%,特异度为92.1%,灵敏度为97.8%。联合检查在阴性似然比、阳性似然比、阳性预测值、准确率、特异度及灵敏度等方面均明显优于超声检查和X线钼靶检查,其检查结果更接近于病理检查结果,差异显著（P＜0.05）,具有统计学意义。结论：在临床诊断乳腺癌的过程中,超声检查与X线钼靶检查均具有较高的准确率,将两者联合应用进行诊断的检出率更高,具有较高的临床价值。     

中山市小榄镇无症状人群结直肠癌普查

目的探讨粪便隐血试验结合大肠镜检查作为大肠癌普查方式的可行性。方法自2007年4月～2009年4月,对中山市小榄镇无症状≥50岁的人群行免疫组化粪便隐血试验,对任何1次粪便隐血阳性（包括弱阳性）的患者行全结肠镜检查。同时对发现息肉的数量及病理结果进行统计。结果受检者共4238例,粪便隐血试验阳性者328例,阳性率7．7％,共108例患者发现了147枚结肠息肉,包括腺瘤性息肉94枚、炎性息肉32枚、增生性息肉21枚,发现肠癌8例。结论粪便隐血试验结合大肠镜检查对无症状的人群进行普查能较早发现结肠息肉。     

全结肠镜诊断大肠肿瘤1 593例分析

目的 评价全结肠镜对大肠腺瘤性息肉及大肠癌的诊断价值以及大肠腺瘤性息肉摘除术对预防大肠癌发生的作用。方法 统计1990～2002年我院消化内镜室检出的大肠腺瘤性息肉及大肠癌。结果 10750例全结肠镜检查中，成功插入回盲部10568例，成功率为98．3％，检出大肠腺瘤性息肉965例，检出率为8．9％，大肠癌628例，检出率5．8％。结论 全结肠镜检查是发现大肠腺瘤性息肉及大肠癌的最佳方法。而大肠腺瘤性息肉摘除术可减少大肠癌的发生。     

64层螺旋CT 3D成像与MRCP成像技术对胆道梗阻性疾病的诊断价值

目的探讨64层螺旋CT 3D成像与MRCP成像技术对胆道梗阻性疾病的诊断价值。方法选择2015年6月～2018年6月于我院影像科检查的梗阻性黄疸患者80例,行64层螺旋CT 3D成像与MRCP成像技术检查。计算两种检查方法的灵敏度、特异度、约登指数、阳性似然比、阴性似然比。结果 CT 3D检查灵敏度91.18%(31/34),特异度91.30%(42/46),约登指数0.825,阳性似然比10.48,阴性似然比0.096,CT 3D检查与病理检查结果具有较高的一致性(Kappa=0.794);MRCP检查灵敏度94.12%(32/34),特异度93.48%(43/46),约登指数0.876,阳性似然比14.44,阴性似然比0.063,MRCP检查与病理检查结果具有较高的一致性(Kappa=0.872)。CT 3D与MRCP检查灵敏度、特异度比较,差异无统计学意义(P0.05)。结论 64层螺旋CT 3D成像与MRCP成像技术对胆道梗阻性疾病诊断均具有较高的灵敏度与特异度,与病理诊断结果均有较高的一致性,临床上可根据患者具体情况选择最佳的辅助诊断方法。     

动态喉镜诊断声带息肉价值评价

目的：评价动态喉镜临床诊断声带息肉的准确性。方法：采用双盲法,按照诊断标准,对患者动态喉镜检查录像进行诊断,诊断结果与活检病理结果相对照。应用临床流行病学诊断试验的公式计算灵敏度、特异度、漏诊率、误诊率、正确诊断指数及阳性似然比等。结果：动态喉镜诊断声带息肉的灵敏度为96．67％,漏诊率3．33％,特异度66．67％,误诊率33．33％,阳性似然比2．90,阴性似然比0．05,阳性预测值89．23％,阴性预测值87．5％,验前比2．52,验后比7．3,验后概率87．96％,符合率88．89％,调整一致率85．02％,观察一致性88．89％,机遇一致性64．56％,实际一致性24．33％,Kappa（值）0．63。结论：动态喉镜诊断声带息肉有较高的灵敏度和特异度,有利于提高声带息肉临床诊断的准确性。     

物理检查与高频超声检查在诊断患者半月板撕裂中的作用

目的:探讨物理检查和高频超声检查在半月板撕裂患者诊断中的价值。方法:选取110例初步确诊为半月板撕裂的患者,分别进行物理检查和高频超声检查,并在3 d内以膝关节镜检查为最终科学标准,对检查的特异度、灵敏度、阳性预测值、阳性似然比、阴性预测值、阴性似然比进行评价。结果:结合关节镜检查结果,110例患者最终有40例患者被确诊为半月板撕裂,高频超声检查的特异度为98.2%,灵敏度为93.1%,阳性预测值为96.4%,阳性似然比35.12,阴性预测值96.33%,阴性似然比为0.09;物理检查的特异度为86.5%,灵敏度为94.3%,阳性预测值为81.1%,阳性似然比为7.71,阴性预测值96.89%,阴性似然比为0.05。物理检查和高频超声检查比较有显著统计学差异(P<0.05)。结论:在半月板撕裂的诊断中,高频超声检查优于物理检查。     

64层螺旋CT冠状动脉成像技术诊断冠心病的临床价值分析

目的探讨64层螺旋CT冠状动脉成像技术对诊断冠心病的临床价值。方法选取本院2006年接受64层螺旋CT冠状动脉成像检查,并在1个月内接受选择性冠状动脉造影检查的113例患者,将CT检查结果与冠状动脉造影结果进行比较分析。结果共计收集113例患者的可评价节段910个。64层螺旋CT诊断冠心病的灵敏度为73．8％,特异度为97．0％,一致率93．2％,阳性预测值为82．7％,阴性预测值为95．0％,阳性似然比24．4。结论64层螺旋CT冠状动脉成像具有较高的特异度、阴性预测值、阳性似然比,用于诊断冠心病有较高的准确性。     

上海某社区人群大肠癌伺机性筛查结果分析

目的了解社区人群大肠癌危险因素现况,验证分析序贯模式的伺机性筛查效率。方法上海欧阳社区50～85岁常住居民问卷调查和粪便潜血试验（FOBT）初筛,阳性者行肛指、血清肿瘤标记物和结肠镜精筛。结果1206人完成初筛,FOBT总阳性率4％（45／1206）,评估为高危176人,阳性率15％,均接受后续精筛,结肠镜顺应率100％。结肠息肉检出率9％（15／176）,大肠癌检出率5％（8／176）,其中结肠癌5例（63％）,直肠癌3例（37％）。结论社区人群大肠癌高危因素聚焦在遗传背景、腹型肥胖和体力活动缺乏。序贯模式的伺机性筛查顺应性好、效率高、成本低,适合社区人群大肠癌筛查应用。     

粪便脱落细胞学与粪隐血试验联合检测在结直肠癌诊断的临床意义

目的:通过分析粪便脱落细胞学与粪便隐血在结直肠癌发生、发展中的规律,进而评判粪便脱落细胞学与粪便隐血试验在结直肠癌诊断中的临床意义。方法:对243例患者粪便脱落细胞学与粪便隐血试验与癌胚抗原(CEA)的关系进行分析。结果:243例患者中,粪便隐血试验阳性率为79.5%;粪便脱落细胞学阳性率83.5%;CEA检出率为45.4%或52.9%。结论:粪便脱落细胞学与粪便隐血试验对结直肠癌的诊断有重要的临床意义,是结直肠癌筛检的重要手段,所以在临床应用中,采取两者互补的方法,可大大提高结直肠癌的检出率,且阳性率优于CEA。     

上海市金山区某社区大肠癌筛查效果评估

目的 评估社区大肠癌筛查工作现况,为完善大肠癌社区筛查工作提供理论参考。 方法 选取2013年5月—2015年1月期间在上海市金山区朱泾社区卫生服务中心进行大肠癌筛查的40岁以上社区居民的筛查资料,采用SPSS 19.0统计软件对这些居民的大便潜血检查结果、危险度评估结果与肠镜检查和活检的最终结果进行一致性分析。 结果 2013年5月—2015年1月期间共计7 787例辖区居民进行大肠癌社区初筛,筛出1 727例阳性,检出率22.4%;其中,大便潜血阳性1 447例,检出率为18.8%,问卷危险度评估阳性438例,阳性率为5.7%,2种方法检出的阳性重复病例为158例,重复率为9.15%。转诊818例(47.37%),确诊病例303例(37.04%),大便潜血和危险度评估确诊率分别为36.24%、39.90%。经检验,2种办法与诊断结果一致性也并不显著(P＞0.05)。 结论 我国社区目前在大肠癌初筛过程中所使用的危险度评估和大便潜血检验方法,筛查效能相当且重复率较低,这就保障了卫生资源的充分利用。多种低重复、高效度筛查指标协同配合可有效提高社区人群大肠癌筛查的早发现、早诊断,但人群转诊依从性有明显限效作用需进一步提高。      

Faecal occult blood screening: knowledge, attitudes, and practice in four Hong Kong primary care clinics

OBJECTIVES. To assess primary care patients for their awareness, knowledge, and attitude towards colorectal cancer and screening, to report on the uptake of faecal occult blood test screening and the results of screening, and explore predictors of screening uptake. DESIGN. Cross-sectional study. SETTING. Four primary care clinics in Hong Kong. PATIENTS. A total of 1664 patients aged 50 to 74 years attending the clinics in the period July 2006 to July 2007. MAIN OUTCOME MEASURES. Percentage of subjects who were aware that colorectal cancer is common and curable at an early stage, and who knew that faecal occult blood test or colonoscopy is useful for screening; relevant knowledge score; uptake rate of faecal occult blood testing; rate of testing positive; and factors predicting uptake. RESULTS. A total of 1645 questionnaires were collected. In all, 89% (95% confidence interval, 88-91%) were aware that colorectal cancer is common, 95% (94-96%) believed faecal occult blood test and colonoscopy are useful for screening, and 58% (56-61%) achieved a knowledge score of 50% or above. The uptake rate of the faecal occult blood test was 35%. Uptake was higher among those with a positive family history (odds ratio=1.57; 95% confidence interval, 1.08-2.27; P=0.02), those who were more aware that colorectal cancer is common (1.86; 1.29-2.69; P=0.001), and that colorectal cancer is potentially curable at an early stage (1.76; 1.32-2.36; P=0.0001). Rate of testing positive was 2.1% (95% confidence interval, 0.9-3.3%); no colorectal cancer was detected and the neoplasia detection rate (for cancers and adenomas) was 5.1 per 1000 subjects screened. CONCLUSIONS. Patients were aware that colorectal cancer is common in our community, and faecal occult blood test or colonoscopy is useful for screening. The uptake of screening was low, though relatively higher for those with a positive family history and greater awareness of the high frequency and potential for cure of colorectal cancer. Faecal occult blood test positivity rate was 2.1%, and neoplasia detection rate 5.1 per 1000 screened.     

社区糖尿病患者大肠癌筛查结果分析

背景　随着现代生活方式的改变,糖尿病和大肠癌发病率均呈逐渐上升趋势。糖尿病与大肠癌的相关性研究证明,糖尿病是大肠癌的高危因素,该人群应定期进行大肠癌筛查。目的　分析糖尿病患者参与大肠癌筛查的结果,为今后社区糖尿病慢性病管理工作提供更多的技术参考。方法　选取2016-2018年上海市白玉社区卫生服务中心所辖社区中参与大肠癌筛查的糖尿病患者319例,研究初期发放两份调查问卷表,一份是基于体检要求本中心自行设计的健康体检表,主要调查参与筛查的居民有无确诊糖尿病史。另一份为上海市大肠癌筛查项目组统一编制的《上海市社区居民大肠癌筛查危险度评估表》,内容包括基本情况（性别、年龄、婚姻状况、文化程度、职业）、大肠癌危险因素（慢性腹泻史、慢性便秘史、黏液血便史、慢性阑尾炎或阑尾切除史、慢性胆囊炎或胆囊切除史、肠息肉史、血吸虫病史、癌症史、一级亲属肿瘤史、精神创伤史）,记录初筛结果（便隐血试验阳性、危险度评估阳性,任一阳性为初筛阳性）。研究后期针对初筛阳性者发放本中心自行编制的调查问卷表,内容包括是否行肠镜检查、肠镜检查结果、对肠镜检查相关认知（对肠镜检查害怕、认为自己不会有问题、担心检查后出现不适后果、担心查出问题有心理负担、没时间没兴趣、肠镜检查有益处）。结果　319例患者年龄以60~69岁居多（45.8%）,婚姻状况以已婚为主（91.2%）,文化程度以中专/中学为主（57.1%）,职业以国有企业为主（39.8%）。大肠癌危险因素以慢性阑尾炎或阑尾切除史、肠息肉史、慢性胆囊炎或胆囊切除史占比较高,分别为14.7%、13.8%、13.5%。便隐血试验阳性率6.6%（21/319）,危险度评估阳性率18.2%（58/319）,双阳性率6.0%（19/319）。79例初筛阳性患者中,有23例进行了肠镜检查,其中无病变者占39.1%、肠炎者占26.1%、息肉者占21.7%。79例初筛阳性患者中39例认为肠镜检查有益处,22例对肠镜检查害怕。结论　约25%的社区糖尿病患者大肠癌初筛阳性,尤其关注有慢性阑尾炎或阑尾切除史、慢性胆囊炎或胆囊切除史、肠息肉史的患者。     

上海某社区结合体质辨识的大肠癌筛查危险因素分析

目的 研究社区人群大肠癌危险因素现况与高危人群的中医体质类型的分布规律。 方法 以2016年1—12月上海浦兴社区50~74岁常住居民为调查对象,进行问卷调查和粪便潜血试验(FOBT)初筛,判定为高危人群者进行中医体质辨识分析并随访肠镜检查结果。 结果 4 136人完成初筛,1 102人判定为高危人群,阳性率为26.64%(95%CI:25.30%~27.99%),1 006人FOBT结果为阳性,占24.90%(95%CI:23.57%~26.23%)。接受后续精筛228人,结肠镜顺应率为20.69%(228/1 102),结肠息肉检出率为24.56%(56/228),大肠癌检出率为1.31%(3/228)。中医体质辨识结果最高为平和质,占37.9%(418/1 102),偏颇体质以痰湿质[28.9%(319/1 102)]、气虚质[12.8%(142/1 102)]、阳虚质[9.6%(106/1 102)]为主。 结论 中老年人群中大肠癌高危人群占比较高,肠镜结果以息肉多见,值得引起重视。中医体质辨识平和质最高,提示中老年人大肠癌高危人群具有较高隐匿性,开展大肠癌筛查具有必要性。偏颇体质以痰湿、气虚、阳虚为主,提示中老年人群应高度重视大肠癌早期防治,通过中医干预进行防治有一定研究价值,治疗原则可以从健脾、益气、温阳入手。      

371例结直肠息肉患者临床特征及其与粪便隐血和血CEA之间的关系

目的 研究371例结直肠息肉患者基本临床特征及其与粪便隐血和血癌胚抗原(CEA)之间的关系.方法 回顾性分析371例结直肠息肉住院病例,探讨不同年龄患者在性别、息肉数量及息肉解剖学部位之间的关系,并通过1.5~3.0年的随访,分析粪便隐血及CEA与息肉癌变之间的关系.结果 371例结直肠息肉患者随着年龄增长,女性患者逐渐增多,单发息肉逐渐减少;由于年龄不同,息肉发生部位的差异有统计学意义(χ2 =9.759,P=0.045);3个年龄段患者中息肉癌变者的分布差异均有统计学意义(χ2 =5.138、4.107、13.153,P<0.05).粪便隐血实验阳性及CEA异常升高者均随着年龄增长而逐渐增多(χ2 =15.544、11.959,P<0.01);随着息肉个数增多,粪便隐血实验阳性的患者呈升高趋势(χ2 =14.043,P=0.001);粪便隐血实验阳性及CEA异常升高的结直肠息肉患者其癌变率明显高于粪便隐血实验阴性及CEA在正常范围内的患者(χ2 =40.165、43.249, P<0.01).结论 粪便隐血实验及CEA检测的结果对预防结直肠息肉癌变的随访具有一定的意义.     

Periodic health examination, 1994 update: 2. Screening strategies for colorectal cancer. Canadian Task Force on the Periodic Health Examination.

OBJECTIVE: To make recommendations on the effectiveness of screening for colorectal cancer in asymptomatic patients over 40 years of age. OPTIONS: Multiphase screening that begins with test for fecal occult blood, uniphase screening with sigmoidoscopy and uniphase screening with colonoscopy. Options included screening repeated at different intervals and different procedures for patients with selected risk factors. OUTCOMES: Rates of death, death from cancer and cancer detection; compliance, feasibility and accuracy of each manoeuvre. EVIDENCE: A MEDLINE search for articles published between January 1966 and June 1993 with the use of MeSH terms "screening" and "colorectal neoplasia," a check with the reference sections of review articles published before June 1993 and a survey of content experts. Articles were weighted according to the Canadian Task Force on the Periodic Health Examination levels of evidence. VALUES: The highest value was assigned to manoeuvres that lowered the rate of death from cancer and had a low rate of false-positive results and acceptable cost and compliance. Recommendations were determined by consensus of the authors, members of the task force and colorectal cancer experts. BENEFITS, HARMS AND COSTS: There is evidence that annual fecal occult blood testing with the use of the rehydrated Hemoccult test has a small but significant benefit in lowering the rate of death from cancer after more than 10 years of screening; however, the high rate of false-positive results (9.8%) and the poor sensitivity of annual (49%) and biennial (38%) screening make this a poor method for detecting colorectal cancer. There is fair evidence that screening with sigmoidoscopy may improve survival rates; however, this may be due to volunteer bias. The high cost of and poor compliance with colonoscopic screening make this an unfeasible strategy.     

Two-phase test of fecal occult blood screening for colorectal cancer

The detection of colorectal cancer in an early curable stage has become the focus of considerable interest recently. A two-phase test using both guaiac test and Hemolex latex immuno-agglutination test was applied for fecal occult blood screening of colorectal cancer. A total of 4,725 veterans aging 60 to 69 years were registered, and 2,176 persons (average age 66 years) completed the test giving a compliance rate of 46%. The positive rates of both tests were accounted 20.5% and 6.7% respectively. Five hundred and forty five persons had positive reaction for at least one of the tests. Of these, 90 had a follow up diagnosis with colonoscopy or combined with barium enema. Three rectal adenocarcinomas were detected, of which only one was positive by guaiac test, but two by Hemolex test. A rectal carcinoid was found by rectodigital examination. It was negative by both tests. Nineteen cases were detected to have one or more polyps in colon or rectum, of which only 6 were positive by guaiac test, but 18 by Hemolex test. Hemolex test using antibody against human hemoglobin is based on latex agglutination reaction. It is more sensitive and specific than guaiac test. Moreover, no dietary restriction is required. In the view point of cost-effectiveness, mass screening for colorectal cancer in general public is not recommended, but hospital-based screening for high risk group is still worthwhile to study.     

Accuracy and value of the Hemoccult test in symptomatic patients

Hemoccult faecal occult blood testing is widely advocated as a screening test for colorectal cancer but few studies have shown its correlation with conventional methods of investigation for colorectal disease. In a prospective study of 802 symptomatic patients with suspected colorectal disease there was good patient compliance (92.5%) and a high specificity for colorectal cancer (85.4%). The false positive rate was 8.6% (12 of 140 patients with positive results), and while the test result was positive in 22 of 26 colonic cancers the false negative rate for rectal cancer (45.4%) should not detract from its value as a screening test if proper digital anorectal and proctosigmoidoscopic examination are widely practised. A positive Hemoccult test result is a useful indicator for the need to proceed to full colorectal investigation, including colonoscopy.