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目的 采用我国结直肠癌序贯筛查方案,调查天津市东丽区老年人群结直肠癌及结肠息肉的检出率,并分析结直肠息肉特点及相关影响因素.方法 筛查人群为2012年11月至2013年4月天津市东丽区60 ～ 74岁的常住人口,共46 743人,通过问卷调查结合粪便隐血试验筛查出结直肠癌高危人群,而后进行结肠镜检查,分析结直肠癌及结直肠息肉的检出率,以及不同性别人群的结直肠息肉病理类型、发病部位、大小等的特点.结果 通过问卷调查结合粪便隐血试验共筛查出高危人群2 880例,占调查人数的6.16％(2 880/46 743).高危人群中434例完成了全结肠镜检查.检出结直肠息肉165例(男105例,女60例),占高危人群的5.73％(165/2 880),其中进展期息肉51例,占高危人群的1.77％ (51/2 880);结直肠癌4例,占高危人群的0.14％ (4/2 880).本次筛查结直肠息肉检出率为0.35％(165/46 743),结直肠癌检出率为8.6/10万(4/46 743).左半结肠息肉多于右半结肠息肉,管状腺瘤多于其他病理类型,＜0.5 cm的息肉多于0.5 cm以上的息肉.男性的结直肠息肉、进展期息肉的检出率均显著高于女性[45.45％(105/231)比29.56％(60/203),16.02％(37/231)比6.90％(14/203),P值均＜0.01].与女性相比,男性更易出现多发性息肉及＞1.0 cm的息肉,右半结肠息肉发生率更高,中重度不典型增生检出率更高(P ＜0.05或P＜0.01).结论 老年人群有较高的结直肠息肉发生率,结直肠癌序贯筛查方案对于降低老年人群结直肠息肉和结直肠癌的发病率有重要意义.

Objective To evaluate the detection rates of colorectal polyps and cancer in the elderly and characterize the pathological features of the colorectal neoplasm in DongLi District in Tianjin.Method Totally,46 743 subjects aged 60-74 were recruited from the national colorectal cancer screening program,including subjects registered from November 2012 to April 2013 in DongLi District in Tianjin.Each subject completed a questionnaire and a fecal occult blood test.Colonoscopies were conducted in 434 subjects with high risk for colorectal cancer.Results Among all the subjects,2 880 were at high risk for colorectal cancer which accounts for 6.16％ (2 880/46 743) of the total subjects.Among the subjects who underwent the colonoscopy,165 (men:105,women:60) were colorectal polyps accounting for 5.73％ (165/2 880)in the total risk,with 51 subjects (1.77％) advanced neoplasms and 4 subjects (0.14％) cancer.The detection rates of colorectal polyps is 0.35％ (165/46 743),and colorectal cancer is 8.6/105(4/46 743).More polyps were found on the left colon compared with the right.More tubular adenoma was found compared with the other pathological types.Most of the polyps were smaller than 0.5 cm.Colorectal polyps and advanced neoplasms were more frequent in men than women [45.45％ (105/231) vs 29.56％ (60/203),16.02％ (37/231) vs 6.90％ (14/203),all P ＜ 0.01].Multiple polyps (P ＜ 0.05) and polyps with diameter larger than 1.0 cm (P ＜ 0.01) were more often in men than in women.Men tended to have more colorectal polyps in right colon and higher detection rate for moderate or sever atypical hyperplasia than women(all P ＜ 0.05).Conclusion There is a higher incidence of colorectal polyps in the elderly.It is important to establish the national sequential colorectal cancer screening program for the early diagnoses of colorectal polyps and cancer in the elderly.