松江区石湖荡镇居民大肠癌筛查结果、镜检依从性及影响因素分析

目的 了解松江区石湖荡镇居民大肠筛查结果，大肠镜检率和依从性，分析潜在的影响因素，以采取相应改善措施。方法 采用整群抽样法，将石湖荡镇11个行政村和2个街道的年龄≥40岁居民作为调查对象，经知情同意后共调查9 086人。结果 9 086名居民中，男性4 250人（46.78%），女性4 836人（53.22%）；最小年龄40岁，最大年龄82岁，平均年龄（59.26±7.81）岁。危险度判定阳性率11.07%，粪便潜血检查阳性率30.57%，3 707名高危对象实际镜检率12.49%，组织活检确诊大肠癌9例（大肠癌检出率99.05/10万），多因素分析显示，年龄是影响居民大肠癌镜检率的主要因素，年龄越大，镜检率越高（OR = 1.99, 2.17）；未镜检的原因主要包括自己认为没有必要（68.46%），担心不适（31.47%）。结论 松江区石湖荡镇居民大肠癌危险因素暴露率和FOTB阳性率高，同时大肠镜检率偏低，大肠癌检出率存在低估。建议政府加大宣传力度，提高居民对大肠癌筛查镜检的认识，改进操作手法，推广无痛肠镜技术，提高镜检接受度和筛查效果，提高大肠癌早期诊断率。

An investigation of the colorectal cancer screening,compliance of colonoscopy and related influencing factors among residents in Shihudang sub-district of Songjiang,Shanghai

Objective This work was to learn the colorectal cancer screening condition, colonoscopy rate and compliance condition and related influencing factors among residents in ShiHuDang sub-district, so as to implement intervention measures accordingly. Methods Cluster sampling was applied to select residents over 40 years old from the 11 villages and 2 communities in ShiHuDang sub-district. Informed consent was applied in advance and 9086 residents were interviewed finally. Results 9086 residents included 4250 males (46.78%) and 4836 females (53.22%). The youngest was 40 years and the oldest was 82 years, with an average age of 59.26 years old. The positive rate of colorectal cancer risk identification was 11.07%, and the FOTB positive rate was 30.57%. The actual colonoscopy rate among 3707 high risk residents was only 12.49%, and 9 colorectal caner was verified by tissue biospy finally (the colorectal cancer identification rate was 99.05 per 100 thousand). Logistic regression analysis indicated that the acceptance rate of colonoscopy was mainly influenced by age, the older the higher acceptance rate among residents (OR=1.99, 2.17). The reasons for low rate of colonoscopy included unnecessary (68.46%) and worrying about pain during procedures (31.47%). Conclusion Both of the exposure rate of colorectal cancer risky factors and the FOTB positive rate were high among residents in ShiHuDang sub-district, but the colonoscopy rate was very low and the colorectal cancer identification rate was obviously underestimated. We suggested that education should be strengthened to improve the recognition and acceptance rate of colonoscopy among residents. Operation schedule should be improved and painless colonoscopy technique should be adopted to promote the acceptance rate and improve screening effect, and finally increase the early diagnosis rate of colorectal cancer.