摘要
目的:分析食管癌高发区40~69岁农村居民食管癌内镜筛查结果,探讨食管癌及各级癌前病变的患病及早诊早治情况。方法:2012-2016年在食管癌高发区四川省阆中市采取整群随机抽样的方法,选择行政自然村为基本单元,以全部40-69岁当地农村居民作为筛查对象,对其进行上消化道内镜检查并进行碘染色及指示性活检,以组织病理学诊断作为最终确诊。结果:2012~2016年阆中市的18个乡镇共筛查40~69岁农村居民10102例,各级食管病变检出率为22.73%(2296/10102),食管阳性病例检出率为1.77%(179/10102),食管癌前病变检出率为5.49%(555/10102)。男性食管各级病变总体检出率以及食管癌前病变、阳性病例的检出率分别高于女性(9.36%vs.5.44%,7.03%vs.4.06%,2.34%vs.1.37%);男性食管轻度异型增生、中度异型增生、重度异型增生/原位癌以及食管浸润癌的检出率均分别高于女性(5.81%vs.3.42%,1.22%vs.0.64%,1.83%vs.1.17%,0.38%vs.0.14%),差异有统计学意义(均P<0.05)。食管各级病变总体检出率、食管癌前病变、阳性病例的检出率以及食管轻度异型增生、中度异型增生、重度异型增生/原位癌的检出率均随着年龄的增长呈逐渐升高的趋势,60岁以后增长明显,差异均有统计学意义(均P<0.05)。结论:阆中市食管癌高发区农村居民食管癌内镜筛查及早诊早治工作已初步显示出良好的效果,应重视癌前病变患者的早期诊断、治疗与随访。
Objective: To analyze the endoscopic screening results for esophageal cancer in rural population aged40-69 years in high incidence areas,and to investigate the prevalence,early diagnosis and treatment of esophageal carcinoma and precancerous lesions at all levels. Methods: Cluster random sampling method was adopted to select residents aged 40-69 years from several natural villages as screening objects for upper gastrointestinal endoscopy,iodine staining and biopsy,regarding histopathological diagnosis as final diagnosis in Langzhong,Sichuan Province,from 2012 to 2016.Results: In 2012 ~ 2016,10102 rural residents aged 40 ~ 69 from 18 villages and towns in Langzhong city were screened The detection rate of esophageal lesions at all levels was 22.73%( 2296/10102); the detection rate of positive cases of esophagus was 1. 77%( 179/10102),while the detection rate of precancerous lesions of esophageal carcinoma was 5.49%( 555/10102). All levels of total examination rate of male esophagus and the detection rate of esophageal precancerous lesions,the rate of positive cases were higher than that of female( 9. 36% vs. 5. 44%,7. 03% vs. 4. 06%,2. 34% vs. 1. 37%); The detection rates of mild dysplasia,moderate dysplasia,severe dysplasia/carcinoma in situ and invasive carcinoma of the esophagus were higher in males than that in females( 5. 81% vs. 3. 42%,1. 22% vs. 0. 64%,1. 83% vs. 1. 17%,0. 38% vs. 0. 14%),and the difference was statistically significant( P < 0. 05). The total detection rate of esophageal lesions at all levels,the positive cases of esophageal precancerous lesions,the detection rate of esophageal and mild dysplasia,moderate dysplasia,severe dysplasia/carcinoma in situ detection rate showed an increasing trend with age,and after the age of 60,the increase was obvious,which the differences were statistically significant( P < 0. 05). Conclusion: The work of endoscopic screening,early diagnosis and early treatment of esophageal cancer in rural residents with high incidence of esophageal cancer in Langzhong City has shown good results,and attention should be paid to the early diagnosis,treatment and follow-up of patients with precancerous lesions.
引文
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