中国实用外科杂志

中国实用外科杂志

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肝切除治疗结直肠癌肝转移预后影响因素研究进展

史艳龙，蔚    玮，陈    亮，江    飞，余宏铸   

  1. 安徽医科大学附属阜阳医院普外科，安徽阜阳 236000
  • 出版日期:2020-12-01 发布日期:2020-12-21

  • Online:2020-12-01 Published:2020-12-21

摘要： 结直肠癌是我国最常见的恶性肿瘤之一。临床上，结直肠癌病人首次确诊时已有15%～25%发生肝脏转移，中位生存期约为6个月，然而行手术切除肝转移灶后5年存活率可达60%。近年来，虽然在新辅助化疗和外科技术等方面取得迅速发展，使得病人获得较长的生存时间，但肝切除仍是治愈结直肠癌肝转移（CRLM）病人的主要治疗方式。肝切除术能够改善病人预后，手术应做到R0切除或者达到无疾病证据状态（NED）；若有复发应积极施行二次手术；原发病灶部位以及淋巴结转移情况对预后影响尚有待研究；结直肠癌确诊至发生肝转移时间间隔越长预后较好（＞2年）。然而，肝转移灶的大小、数目、部位情况等，并不是影响手术预后的主要因素。总之，肝切除对CRLM病人具有良好的预后，同时需要结合病人的切缘状态、残余肝体积、原发病灶及淋巴结转移等因素综合考虑。

关键词: 结直肠癌, 肝转移, 预后因素, 肝切除术

Abstract: Progress in the study of prognostic factors of hepatectomy in the treatment of colorectal cancer liver metastasis        SHI Yan-long,WEI Wei,CHEN Liang,et al. Department of General Surgery, Fuyang Hospital Affiliated to Anhui Medical University, Fuyang 236000, China
Corresponding author: YU Hong-zhu,E-mail：hongzhu.620929@
aliyun.com
Abstract    Colorectal cancer is one of the most common malignant tumors in China. Clinically，about 15% to 25% of patients with colorectal cancer had developed liver metastasis at the time of first diagnosis，and the median survival time was about 6 months. However，the 5-year survival rate after surgical resection of liver metastasis could reach 60%. Recently，although rapid progress has been made in neoadjuvant chemotherapy and surgical techniques，enabling patients to have a longer survival time，liver resection is still the main treatment for patients with colorectal cancer liver metastases（CRLM）. Hepatectomy can improve the prognosis of patients，the surgery should be R0 resection or reached the state of no evidence of disease（NED）. If there is recurrence，two operations should be performed actively.The effect of primary lesion location and lymph node metastasis on prognosis are still to be studied. The longer the interval between colorectal cancer and liver metastasis，the better prognosis（＞2 years）.However，the size，number and location of liver metastases are not the main factors affecting the prognosis of surgery. In conclusion, hepatectomy has a good prognosis for patients with CRLM. At the same time, it is necessary to consider the factors such as the state of resection margin, residual liver volume, primary lesion and lymph node metastasis.

Key words: colorectal cancer, liver metastasis, prognostic factors, hepatectomy