中国癌症杂志 ›› 2016, Vol. 26 ›› Issue (12): 996-1003.doi: 10.19401/j.cnki.1007-3639.2016.12.006

• 论著 • 上一篇    下一篇

基于社区的早期肺癌低剂量螺旋CT扫描筛查上海实践初探

罗晓阳1,刘 权2,王升平2,李 媛3,沈 磊3,#br# 李国栋4,李文涛4,赵燕萍5,许慧琳5,方 红5,邵贵强6,#br# 储继志7,孙君雷8,朱洪其9,李志勇10,蒋良华11,凌建良12,#br# 赵伟忠13,王 晶14,刘小华14,李 斌1,张裔良1,叶 挺1,#br# 潘云建1,胡 鸿1,王 瑞1,孙艺华1,杨海燕14,许 速15,陈海泉1   

  1. 1. 复旦大学附属肿瘤医院胸外科,复旦大学上海医学院肿瘤学系,上海 200032 ;
    2. 复旦大学附属肿瘤医院放射诊断科,复旦大学上海医学院肿瘤学系,上海 200032 ;
    3. 复旦大学附属肿瘤医院病理科,复旦大学上海医学院肿瘤学系,上海 200032 ;
    4. 复旦大学附属肿瘤医院介入科,复旦大学上海医学院肿瘤学系,上海 200032 ;
    5. 上海市闵行区疾病预防与控制中心,上海 201100 ;
    6. 上海市闵行区吴泾医院,上海 201100 ;
    7. 上海市闵行区古美社区卫生服务中心,上海 201100 ;
    8. 上海市闵行区莘庄社区卫生服务中心,上海 201100 ;
    9. 上海市闵行区吴泾社区卫生服务中心,上海 201100 ;
    10. 上海市闵行区浦江社区卫生服务中心,上海 201100 ;
    11. 上海市闵行区江川社区卫生服务中心,上海 201100 ;
    12. 上海市闵行区颛桥社区卫生服务中心,上海 201100 ;
    13. 上海市闵行区马桥社区卫生服务中心,上海 201100 ;
    14. 上海市闵行区卫生和计划生育委员会,上海 201100 ;
    15. 上海市卫生和计划生育委员会,上海 200125
  • 出版日期:2016-12-30 发布日期:2017-01-23
  • 通信作者: 陈海泉 E-mail: hqchen1@yahoo.com
  • 基金资助:
    上海申康医院发展中心慢性病综合防治项目(SHDC12012308);上海卫生系统重要疾病联合攻关重大项目(2013ZYJB0301);上海市科委长三角科技联合攻关领域项目(14495810800)。

Shanghai community-based practice of early lung cancer screening with low-dose spiral computed tomography

LUO Xiaoyang1, LIU Quan2, WANG Shengping2, LI Yuan3, SHEN Lei3, LI Guodong4, LI Wentao4, ZHAO Yanping5, XU Huilin5, FANG Hong5, SHAO Guiqiang6, CHU Jizhi7, SUN Junlei8, ZHU Hongqi9, LI Zhiyong10, JIANG Lianghua11, LING Jianliang12, ZHAO Weizhong13, WANG Jing14, LIU Xiaohua14, LI Bin1, ZHANG Yiliang1, YE Ting1, PAN Yunjian1, HU Hong1, WANG Rui1, SUN Yihua1, YANG Haiyan14, XU Su15, CHEN Haiquan1   

  1. 1. Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; 2. Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; 3. Department of Pathology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; 4. Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; 5. Center for Disease Control and Prevention, Minhang District, Shanghai 201100, China; 6. Wujing Hospital, Minhang District, Shanghai 201100, China; 7. Gumei Community Health Center, Minhang District, Shanghai 201100, China; 8. Xinzhuang Community Health Center, Minhang District, Shanghai 201100, China; 9. Wujing Community Health Center, Minhang District, Shanghai 201100, China; 10. Pujiang Community Health Center, Minhang District, Shanghai 201100, China; 11. Jiangchuan Community Health Center, Minhang District, Shanghai 201100, China; 12. Zhuanqiao Community Health Center, Minhang District, Shanghai 201100, China; 13. Maqiao Community Health Center, Minhang District, Shanghai 201100, China; 14. Health and Family Planning Commission of Minhang District, Shanghai 201100, China; 15. Shanghai Municipal Health and Family Planning Commission, Shanghai 200125, China
  • Published:2016-12-30 Online:2017-01-23
  • Contact: CHEN Haiquan E-mail: hqchen1@yahoo.com

摘要: 背景与目的:作为中国最常见的恶性肿瘤,肺癌的发病率及死亡率长期保持在较高水平。而有效改善肺癌预后,关键在于早期诊断和规范治疗。本研究密切结合上海社区医疗服务发展现状,整合各级医疗机构优势资源,探索基于上海社区的早期肺癌低剂量螺旋CT筛查路径模式。方法:2013年8月—2014年8月,针对上海市闵行区部分试点社区,以低剂量螺旋CT作为肺癌初步筛查手段,在高危人群中开展肺癌早期诊断,并结合以微创手术治疗为主的多学科综合治疗模式,构建涵盖肺癌预防、诊断、治疗、康复及随访等医疗服务措施的综合治疗立体网络。结果:筛查总人数为11 332人(男性7 144人,女性4 188人)。其中,明确诊断恶性肿瘤29例,包括原发性肺癌27例、转移性肺癌1例和乳腺癌1例;筛查原发性肺癌发病率为238.26×10-5;0~Ⅰ期肺癌共22例,在原发性肺癌中占81.48%。结论:基于上海社区的早期肺癌低剂量螺旋CT筛查路径模式提高肺癌早期诊断率,具有可行性及有效性,可在有条件的社区及医疗卫生机构推广。

关键词: 肺癌, 低剂量螺旋CT, 筛查

Abstract: Background and purpose: As one of the most fatal malignant tumors in China, the morbidity and mortality of lung cancer remain high. Early diagnosis and normative treatment is the key to improve the prognosis of lung cancer. The aim of this study was to explore the practice of early lung cancer screening with low-dose spiral computed tomography (CT) based on the current situation in community health service, with integration of superior resources of medical institutions at all levels in Shanghai. Methods: From Aug. 2013 to Aug. 2014, we screened high-risk population in selected communities of Minhang District, Shanghai, for early diagnosis of lung cancer with low-dose spiral CT combined with multidisciplinary comprehensive treatment models including minimally invasive surgery, exploring the medical service network covering prevention, diagnosis, treatment, rehabilitation and follow-up. Results: Screening population is 11 332 (male 7 144, female 4 188); Twenty-nine cases with pathological diagnosis of malignant tumor, including 27 cases of primary lung cancer, 1 case of lung metastasis, 1 case of breast cancer. The morbidity of primary lung cancer is 238.26×10-5. There were 22 cases of Stage 0-Ⅰ lung cancer accounting for 81.48% of all diagnosed primary lung cancer. Conclusion: Based on community health service, screening with low-dose spiral CT could improve the early diagnosis rate of lung cancer with feasibility and validity, which could be applicable in qualified eligible medical center and community in China.

Key words: Lung cancer, Low-dose spiral CT, Screening