目的 探索建立三级联动下（一级医院-二级医院-三级医院）的北京市乡村结直肠癌中西医并重“一级预防”及“二级预防”模式，为构建中西医慢病防治网络、推动中西医并重癌症防控工作提供参考依据。方法 依托当地村委会，充分发挥三甲医院带动能力，培训构建一支以“村支书”为核心的乡村“早防早筛”队伍：中医养生操组、中医健康防癌知识宣传小组配合进行结直肠癌早防，结直肠癌高危风险人群（即高危人群）问卷调查小组配合结直肠癌高危人群初筛。在“三级联动”模式下建立“绿色转诊”通道，根据高危人群初筛结果进行全结肠镜检查明确诊断，根据诊断结果进行药物或非药物干预。结果 经四年探索实践，该结直肠癌中西医并重一、二级预防模式初步成型，形成了较为科学规范的结直肠癌早筛早诊早治工作流程，初步形成了中西医并重结直肠癌防控方案。在该模式指导下，已在全村1717名常住人口中完成了1174例结直肠癌高危人群初筛，发现高危人群118例（阳性率10.05%），结直肠癌6例且均在该模式建立前发病。结论 由乡村吹哨，通过动员乡村骨干力量进行结直肠癌早筛，能够使结直肠癌筛查工作真正做到全覆盖，极大提高筛查效率，降低筛查成本。推广一条以“三级联动”为依托，以乡村骨干为主要早防早筛力量的中西医并重“一级预防”及“二级预防”慢病管理模式是有效可行的。
Objective To explore and establish the “primary prevention” and “secondary prevention” mode of colorectal cancer under the three-level linkage (first level hospital - second level hospital - third level hospital) in Beijing rural areas, so as to provide reference for the construction of chronic disease prevention and control network and cancer prevention and control work of both traditional Chinese medicine (TCM) and Western medicine.Methods Relying on the local village committee, giving full play to the driving ability of the third level hospital, training and building a rural “early prevention and screening” team centered on “Village Branch letter”: TCM health exercise group and TCM health and cancer prevention knowledge publicity group cooperate with the team to carry out early prevention of colorectal cancer, and questionnaire survey team cooperate with the team to carry out preliminary screening of colorectal cancer high-risk groups. In the “three-level linkage” mode, the “green referral” channel is established, and the diagnosis is confirmed by colonoscopy according to the preliminary screening results of high-risk groups, and the drug or non drug intervention is carried out according to the diagnosis results.Results After four years of exploration and practice, the primary and Secondary prevention model of colorectal cancer with attaching equal importance to TCM and Western medicine was initially formed, forming a relatively clear workflow of early screening, early diagnosis and early treatment of colorectal cancer, and initially forming a prevention and control plan of colorectal cancer with attaching equal importance to TCM and Western medicine.Under the guidance of this model, a total of 1174 permanent residents from 1717 permanent residents in the village have been screened for colorectal cancer high-risk population, and 118 cases of high-risk population (positive rate 10.05%) have been found. Six cases of colorectal cancer occurred before the establishment of the model.Conclusion Through the whistle blowing in rural areas and the mobilization of rural backbone for early screening of colorectal cancer, it can make colorectal cancer screening work truly achieve full coverage, greatly improve the efficiency of screening, reduce the cost of screening. It is effective and feasible to popularize a management mode of chronic diseases, which is based on "three-level linkage" and with rural backbone as the main force of early prevention and early screening.