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目的目前,参与国家结肠癌筛查项目的内镜医师数量较少,而初级保健医生可以填补这一空缺,本研究旨在探讨初级保健医生进行结肠癌筛查的安全性和有效性。方法系统检索Medline和EMBase数据库中与初级保健医生结肠癌筛查安全性和有效性有关的文献,检索时间均为建库至2007年12月;同时手动检索纳入文献的参考文献,以查补缺漏。由两名研究员独立进行资料提取,采用随机效应模型计算各指标结果及95%CI。结果共检索到文献590篇,纳入合格文献12篇。涉及初级保健医生18 292例,其中50.5%为女性,中位年龄为59岁。初级保健医生的腺瘤检出率为28.9%〔95%CI(20.4%,39.3%)〕,腺癌检出率为1.7%〔95%CI(0.9%,3.0%)〕,盲肠癌检出率为89.2%〔95%CI(80.1%,94.4%)〕。患者的主要并发症发生率为0.04%〔95%CI(0.01%,0.07%)〕;无死亡病例。结论初级保健医生进行结肠癌筛查的安全性和有效性较高,符合美国胃肠道内窥镜学会、美国胃肠病学协会及美国胃肠内镜外科医师学会的推荐标准。
PURPOSE At present, the number of endoscopists participating in the national colon cancer screening program is small, and the primary care physician can fill the gap. This study aimed to explore the safety and efficacy of primary care physicians in screening colon cancer. Methods The documents related to the safety and efficacy of primary care physicians screening for colon cancer in the Medline and EMBase databases were searched systematically and the retrieval time was from the establishment of the database to December 2007. At the same time, the references of the included articles were searched manually to check the gaps . Data were extracted independently by two researchers and random effects model was used to calculate the outcome of each index and 95% CI. Results A total of 590 articles were retrieved and 12 were included in the literature. A total of 18 292 primary care physicians were involved, of whom 50.5% were female and their median age was 59. The prevalence of adenomas in primary care physicians was 28.9% [95% CI (20.4%, 39.3%)], adenocarcinoma detection rate was 1.7% (95% CI, 0.9%, 3.0% The rate was 89.2% [95% CI (80.1%, 94.4%)]. The major complication rate was 0.04% [95% CI (0.01%, 0.07%)]; no deaths were reported. Conclusion Primary care physicians screening for colon cancer is safe and effective and meets the recommended standards of the American Gastrointestinal Endoscopy Society, American Society of Gastroenterology and American Society of Gastrointestinal Surgery.