粪便隐血筛查联合肠镜复查在洞头海岛居民结直肠癌早期筛查中的应用价值

Application Value of Fecal Occult Blood Test Combined with Colonoscopy in Early Screening for Colorectal Cancer among Residents of Dongtou Island

摘要: 目的：本研究旨在评估在洞头海岛居民中实施“粪便隐血筛查(Fecal Occult Blood Test, FOBT)初筛 + 肠镜复查”策略的有效性与可行性，并为未来在类似地区的推广提供理论依据和实践参考。方法：选取洞头海岛地区50~74周岁居民开展结直肠癌筛查，首先进行FOBT检测，对阳性者行肠镜检查，对可疑病变做病理学检测。通过比较不同检测方法的阳性率、确诊率以及病变分期，评价该联合筛查策略的临床价值。结果：2022年~2024年连续三年FOBT检测阳性率分别为20.82%、13.75%和17.85%，FOBT与镜检结果的一致率分别为56.58%、75.00%和55.56%；癌前病变率在三年中均超过三成以上(34.11%, 47.50%, 33.33%)，显示腺瘤在该人群中的检出仍较为常见，尤其进展期腺瘤占有较高比重；三年结直肠癌确诊率分别为0.05%、0%、0.049%，且性别和年龄是结直肠新生物独立危险因素。结论：在洞头海岛居民中推行FOBT联合肠镜的结直肠癌筛查模式，不仅能提高CRC的早期检出率，同时降低不必要的肠镜检查率，类似海岛地区具有较高的可行性和推广价值。

Abstract: Objective: This study aims to evaluate the effectiveness and feasibility of implementing the “Fecal Occult Blood Test (FOBT) screening + colonoscopy follow-up” strategy among island residents in Dongtou, and to provide theoretical and practical references for future promotion in similar regions. Methods: Residents aged 50~74 years old in the Dongtou Island area were selected for colorectal cancer (CRC) screening. FOBT was performed as the initial test, followed by colonoscopy for those with positive results. Suspicious lesions were subjected to pathological examination. The clinical value of this combined screening strategy was assessed by comparing the positivity rates, diagnostic rates, and lesion staging of different detection methods. Results: The FOBT positivity rates from 2022 to 2024 were 20.82%, 13.75%, and 17.85%, respectively, while the concordance rates between FOBT and colonoscopy results were 56.58%, 75.00%, and 55.56%. The detection rate of precancerous lesions exceeded 30% in all three years (34.11%, 47.50%, and 33.33%), indicating that adenomas remain prevalent in this population, with a high proportion of advanced adenomas. The annual CRC detection rates were 0.05%, 0%, and 0.049%, respectively, and both gender and age were identified as independent risk factors for colorectal neoplasms. Conclusion: The implementation of an FOBT-based colorectal cancer screening strategy combined with colonoscopy in the Dongtou Island population not only enhances the early detection rate of CRC but also reduces unnecessary colonoscopies. This screening model demonstrates high feasibility and promotion value in similar island regions.