飞行人员结直肠癌13例分析及航空医学问题探讨
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摘要
目的探讨飞行人员结直肠癌(colorectal carcinoma,CRC)的预防、筛查、航空医学鉴定原则及卫勤保障。方法分析空军特色医学中心(原空军总医院)2002—2017年间收治的13例结直肠癌飞行人员病史和医学鉴定资料,复习国内外相关文献。结果本组病例发病平均年龄为44.5岁,粪便潜血均为阳性,出现临床症状者11例。1例结肠早期癌行肠镜下息肉根部周边黏膜剥离治疗,余12例行外科手术及术后化疗/放化疗。2例死亡,3例恢复飞行,6例暂时飞行不合格,2例达最高飞行年限予以停飞。结论飞行人员结直肠癌发病年龄早于筛查起始年龄,卫勤保障应注重降低结直肠癌发病的危险因素,注意粪便潜血阳性的病因分析,及早处理癌前病变。航空医学鉴定则应根据结直肠癌的临床分期、检查结果、治疗效果及不良反应,并结合飞行人员的个人飞行意愿、体能情况,飞行机种、飞行职务综合评定。
Objective To investigate the prevention, screening, aeromedical evaluation principles and health support related to colorectal carcinoma(CRC) in pilots. Methods The medical history and data of 13 pilots with colorectal carcinoma admitted to the Center of Clinical Aviation Medicine(or Air Force General Hospital) between 2002 and 2017 were retrospectively analyzed and related literature was reviewed. Results The average age of these pilots was 44.5 years old. Their fecal occult blood tests were all positive and 11 of them had clinical symptoms. One patient with early colorectal carcinoma was treated with endoscopic submucosal dissection, while the rest were treated with resection, chemotherapy and radiation therapy. Two of these patients died, three resumed flight, six were temporarily grounded, and the other two were grounded permanently due to their flying age limits. Conclusion The average age of pilots with CRC is younger than the suggested screening age for CRC. Medical service should focus on reducing risk factors, probing the causes of positive results of fecal occult blood test and treating precancerous lesions as soon as possible. Conclusions about the eligibility for flight after the whole therapy should be drawn according to the clinical stage of CRC, examination results, therapeutic effect and adverse reactions while taking into consideration the willingness of pilots to fly, physical capacity, aircraft types and flight duty.
Objective To investigate the prevention, screening, aeromedical evaluation principles and health support related to colorectal carcinoma(CRC) in pilots. Methods The medical history and data of 13 pilots with colorectal carcinoma admitted to the Center of Clinical Aviation Medicine(or Air Force General Hospital) between 2002 and 2017 were retrospectively analyzed and related literature was reviewed. Results The average age of these pilots was 44.5 years old. Their fecal occult blood tests were all positive and 11 of them had clinical symptoms. One patient with early colorectal carcinoma was treated with endoscopic submucosal dissection, while the rest were treated with resection, chemotherapy and radiation therapy. Two of these patients died, three resumed flight, six were temporarily grounded, and the other two were grounded permanently due to their flying age limits. Conclusion The average age of pilots with CRC is younger than the suggested screening age for CRC. Medical service should focus on reducing risk factors, probing the causes of positive results of fecal occult blood test and treating precancerous lesions as soon as possible. Conclusions about the eligibility for flight after the whole therapy should be drawn according to the clinical stage of CRC, examination results, therapeutic effect and adverse reactions while taking into consideration the willingness of pilots to fly, physical capacity, aircraft types and flight duty.
引文
[1]陈万青,郑荣寿,张思维,等.2013年中国恶性肿瘤发病和死亡分析[J].中国肿瘤,2017, 26(1):1-7.
[2]Department of the Air Force. Air Force waiver guide[S].Washington:USAF School of Aerospace Medicine, 2015.
[3]孙宁东,郭徐林,张宁玲,等.飞行人员恶性肿瘤术后安全放飞指征的临床研究[J].中华航空航天医学杂志,2010, 21(3):218-223.
[4]徐蜀宣,徐先荣,郑军.飞行人员重复癌复飞一例[J].中华航空航天医学杂志,2009, 20(4):301.
[5]杜鹏,杨昌林,罗丽华,等.空军飞行人员膳食结构与血脂异常相关营养调查[J].中华健康管理学杂志,2011,5(6):338-341.
[6]Bal Y, Xu C, Zou DW, et al. Diagnostic accuracy of features predicting lower gastrointestinal malignancy:a colonoscopy database review of 10, 603 Chinese patients[J]. Colorectal Dis,2011, 13(6):658-662.
[7]Sung JJ, Ng SC, Chan FK, et al. An updated Asia Pacific Consensus Recommendations on colorectal cancer screening[J]. Gut, 2015, 64(1):121-132.
[8]Wong MC, Lam TY, Tsoi KK, et al. A validated tool to predict colorectal neoplasia and inform screening choice for asymptomatic subjects[J]. Gut, 2014, 63(7):1 130-1 136.
[9]陈琼,刘志才,程兰平,等.2003-2007年中国结直肠癌发病与死亡分析[J].中国肿瘤,2012, 21(3):179-182.
[10]中华医学会消化内镜学分会,中国抗癌协会肿瘤内镜学专业委员会.中国早期结直肠癌筛查及内镜诊治指南(2014)[J].中华消化内镜杂志,2015, 32(6):341-360.
[11]中华人民共和国卫生和计划生育委员会医政医管局,中华医学会肿瘤学分会.结直肠癌诊疗规范(2015年版)[J].中华外科杂志,2015, 53(12):881-894.
[2]Department of the Air Force. Air Force waiver guide[S].Washington:USAF School of Aerospace Medicine, 2015.
[3]孙宁东,郭徐林,张宁玲,等.飞行人员恶性肿瘤术后安全放飞指征的临床研究[J].中华航空航天医学杂志,2010, 21(3):218-223.
[4]徐蜀宣,徐先荣,郑军.飞行人员重复癌复飞一例[J].中华航空航天医学杂志,2009, 20(4):301.
[5]杜鹏,杨昌林,罗丽华,等.空军飞行人员膳食结构与血脂异常相关营养调查[J].中华健康管理学杂志,2011,5(6):338-341.
[6]Bal Y, Xu C, Zou DW, et al. Diagnostic accuracy of features predicting lower gastrointestinal malignancy:a colonoscopy database review of 10, 603 Chinese patients[J]. Colorectal Dis,2011, 13(6):658-662.
[7]Sung JJ, Ng SC, Chan FK, et al. An updated Asia Pacific Consensus Recommendations on colorectal cancer screening[J]. Gut, 2015, 64(1):121-132.
[8]Wong MC, Lam TY, Tsoi KK, et al. A validated tool to predict colorectal neoplasia and inform screening choice for asymptomatic subjects[J]. Gut, 2014, 63(7):1 130-1 136.
[9]陈琼,刘志才,程兰平,等.2003-2007年中国结直肠癌发病与死亡分析[J].中国肿瘤,2012, 21(3):179-182.
[10]中华医学会消化内镜学分会,中国抗癌协会肿瘤内镜学专业委员会.中国早期结直肠癌筛查及内镜诊治指南(2014)[J].中华消化内镜杂志,2015, 32(6):341-360.
[11]中华人民共和国卫生和计划生育委员会医政医管局,中华医学会肿瘤学分会.结直肠癌诊疗规范(2015年版)[J].中华外科杂志,2015, 53(12):881-894.