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目的 评估直肠镜在人群中筛检效果 ,验证直肠息肉摘除能否阻断直肠癌的自然史 ,降低直肠癌的发病率及死亡率。方法 1977～ 1980年间在海宁市分两次对 30岁以上 2 3余万人群进行 15cm肠镜筛检 ,对检出的 40 76例肠息肉进行镜下摘除后定期肠镜随访。结果 肠息肉患者经 2 0年定期肠镜随访 ,共计肠镜随访到并摘除肠腺瘤 95 2例次 ,非腺瘤性息肉 417例次 ,另外还随访检出肠癌 2 7例。直肠镜筛检检出的直肠癌的生存率显著高于同期非经筛检或随访检出的直肠癌的生存率 (P <0 .0 0 1) ,筛检使肠癌生存期延长了 7.89年。海宁市 1977～ 1996年的直肠癌的标化发病率与标化死亡率均有下降趋势 ;受干预人群的 2 0年累积直肠癌发病率与死亡率分别降低为 :6 8.6 %与82 .4%。结论 应用 15cm肠镜在人群中进行筛检 ,可提高直肠癌的生存率 ,对筛检检出肠息肉进行摘除并定期进行肠镜随访 ,可阻断直肠癌的自然史 ,从而降低直肠癌的发病率与死亡率
Objective To evaluate the effectiveness of rectal screening in the population and to verify whether the removal of rectal polyps can block the natural history of rectal cancer and reduce the incidence and mortality of rectal cancer. METHODS: From 1977 to 1980, 15 cm colonoscopy was performed on more than 23,000 people over the age of 30 in Haining City, and 40 76 cases of intestinal polyps were examined by colonoscopy. Results The enteral polyps were followed-up for 20 years by colonoscopy. A total of 952 cases of intestinal adenomas were removed and 417 non-adenomatous polyps were removed by colonoscopy. Twenty-seven cases of colon cancer were also detected. The survival rate of rectal cancer detected by rectal screening was significantly higher than that of rectal cancer without screening or follow-up at the same time (P < 0.01). Screening prolonged the survival of intestinal cancer by 7.89. year. The standardized incidence and standardized mortality of rectal cancer decreased from 1977 to 1996 in Haining City; the cumulative incidence and mortality of rectal cancer in the intervention population were reduced to 68.6 % and 82.4 respectively. %. Conclusion The use of 15cm colonoscopy screening in the population can improve the survival rate of rectal cancer. The removal of intestinal polyps after screening and regular colonoscopic follow-up can block the natural history of rectal cancer and reduce the risk of rectal cancer. Morbidity and mortality