中国实用外科杂志

中国实用外科杂志 ›› 2009, Vol. 29 ›› Issue (09): 728-732.

• 专题笔谈 • 上一篇    下一篇

结直肠癌肝转移的现代治疗策略

叶颖江，王 杉   

  1. 北京大学人民医院外科，北京100044
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2009-09-01 发布日期:2009-09-01

  • Received:1900-01-01 Revised:1900-01-01 Online:2009-09-01 Published:2009-09-01

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摘要：

肝脏是结直肠癌最常见的远处转移部位。手术治疗是结直肠癌肝转移病人惟一可能获得治愈的方法。随着肝转移癌治疗经验的积累、相关学科的发展,肝转移癌手术适应证逐渐扩大，切除标准不断完善，其中多学科专家组（MDT）治疗模式是确保结直肠癌肝转移病人获得最佳治疗策略的根本。相关学科专家的参与使更多肝转移癌能获得切除机会，并保证了外科治疗的效果。放射诊断学是保证R0切除的重要手段，其中术中超声的应用提高了肝转移灶的检出率，增加了手术切除的安全性。术前化疗是使结直肠癌肝转移不可切除病人获得手术切除机会的重要方法，术后辅助治疗降低了术后复发率和转移率。肿瘤射频消融与手术联合应用，使初始不可切除肝转移癌病人获得长期生存机会。

关键词: 结直肠癌, 肝转移

Abstract:

Treatment strategies for management of colorectal cancer liver metastases YE Ying-jiang, WANG Shan. Department of Gastroenterology Surgery, Peking University People’s Hospital, Beijing 100044, China Corresponding author:YE Ying-jiang, E-mail:yjye101@yahoo.com.cn Abstract Liver metastases is the most common distant metastasis of colorectal cancer. Surgical resection is believed the only effective treatment for metastatic hepatic cancer currently. With increased experience and multiple disciplines development, the surgical indication for metastatic liver cancer has been expanded gradually, and the standard of hepatic surgery has also been improved constantly. Importantly, multidisciplinary team (MDT) model remains the fundamental for optimal treatment for liver metastasis from colorectal cancer. The participation of MDT brings more opportunities for metastatic liver cancer, and improves the surgery outcomes indirectly. Diagnostic radiology is an important way for R0 resection of metastatic liver cancer; the intraoperative ultrasound increases metastatic liver cancer detection rate and surgery safety. Preoperative chemotherapy brings operation opportunity for those patients with initially unresectable lesions, and postoperative adjuvant therapy contributes to reduce the post-operation recurrence and metastasis. Radiofrequency ablation combined with hepatic resection provides unresectable metastatic liver cancer the best opportunity for long term survival.