整合干部保健医学模式对老年人群消化道早癌的筛查与诊治

目的探讨整合干部保健医学模式对老年人群消化道早癌筛查及诊治的临床指导意义。方法回顾性分析南京军区南京总医院干部保健系统近10年来因消化道症状就诊,或者常规体检行胃肠镜检查的老年患者(≥70岁)3 970例,按时间分近5年和前5年两组,其中近5年2 462例,前5年1 508例;常规胃肠镜检查,病理组织学确诊,其中浸润癌均给予外科手术治疗,早癌均给予内镜下切除,术后1、6和12个月复查胃肠镜,以后酌情每年随访。结果共筛查出消化道早癌95例(2.39%,95/3 970),其中胃早癌41例,肠早癌54例;浸润癌7例(0.176%,7/3 970)。前5年组早期癌31例(2.05%,31/1 508),其中胃早癌15例,肠早癌16例;浸润癌7例(0.46%,7/1 508)。近5年组早期癌64例(2.59%,64/2 462),其中胃早癌26例,肠早癌38例,浸润癌0例。两组相比较,消化道早癌检出率有显著提高(P<0.05)。95例消化道早癌患者均行内镜下治疗,前5年组单次切除25例、多次切除6例;后5年组单次切除60例、多次切除4例。两组相比较,一次性手术切除率显著提高(P<0.05)。结论整合医学对于规范与优化干部保健和服务流程、提高消化道早癌的检出率,有一定积极意义,符合未来医学的发展方向。

Integrated cadre health care medical model in the screening diagnosis and treatment of early gastrointestinal carcinoma in elderly population

Objective To examine the clinical significance of the integrated cadre health medical mode in the screening , diagnose and treatment of the elderly gastric cancer. Methods Retrospective analysis of the clinical data of 3,970 elderly people (≥ 70 years old) from the Cadre Health Department who were treated with routine gastrointestinal endoscopy between 2006 and 2016. These people were divided into two groups according to the time. (group A:2006.01-2010.12;group B:2011.01-2016.01). Gastrointestinal endoscopy and histopathological examine were performed,then the diagonosis was given The confirmed early carcinoma was resected under endoscope. The patients receiving gastrointestinal endoscopy were followed up at 1,6,12 months after resection. Results Among the 3,970 cadre,95 cases were diagnosed as early gastrointestinal carcinoma (2.39%,95/3,970). Among them,the early gatric cancer (41),the early intestinal cancer (54),7 cases of infiltrating carcinoma (0.176%,7/3,970) were received operations. In group A,31 cases were diagnosed as early carcinoma(2.05%,31/1,508),7 cases were infiltrating carcinoma(0.46%, 7/1,508). In group B,64 cases were diagnosed as early carcinoma (2.59%,64/2,462),while none was infiltrating carcinoma. The diagnosisrate of early gastrointestinal carcinoma were significantly higher in group B (P < 0.05). All 95 cases with early carcinoma received endoscopic treatment.In group B,25 cases received single resection,6 cases received multiple resection. In Group A,60 cases received single resection,4 cases received multiple resection. Compared to group A,the rate of single resection in the past 5 years (group B) had been improved significantly (P < 0.05). Conclusion Integral medicine is meaningful for standardize the cadre health care and service process,can improve the early diagnosis of digestive system cancer.