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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2025, Vol. 14 ›› Issue (06) : 813 -821. doi: 10.3877/cma.j.issn.2095-3232.2025.06.002

述评

同时性结直肠癌肝转移手术策略
蔡建珊, 陈进宏†()   
  1. 200040　上海，复旦大学附属华山医院普通外科
  • 收稿日期:2025-05-23 出版日期:2025-12-10
  • 通信作者: 陈进宏
  • 基金资助:
    国家自然科学基金面上项目(82272836); 上海市优秀学术带头人项目(22XD1400300)

Surgical strategy for synchronous colorectal liver metastasis

Jianshan Cai, Jinhong Chen†()   

  1. Department of General Surgery, Huashan Hospital Fudan University, Shanghai 200040, China
  • Received:2025-05-23 Published:2025-12-10
  • Corresponding author: Jinhong Chen
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蔡建珊, 陈进宏. 同时性结直肠癌肝转移手术策略[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(06): 813-821.

Jianshan Cai, Jinhong Chen. Surgical strategy for synchronous colorectal liver metastasis[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(06): 813-821.

约50%的结直肠癌会发生肝转移，同时性肝转移是指结直肠癌确诊前或确诊时发现的肝转移，目前手术切除仍是同时性结直肠癌肝转移（CRLM）患者唯一的潜在治愈手段。随着医疗技术的进步，原发灶和转移灶的手术策略包括分期切除和同期切除。分期切除中原发灶和转移灶手术切除顺序的选择，同期切除中手术时机的选择，仍存在争议。肝转移灶治疗有多种手术方式，为了提高CRLM患者的R0切除率，常见的有保实质肝切除术、二步肝切除术以及肝移植术，同时手术联合局部治疗手段如射频消融、微波消融和立体定向放射治疗同样也可达到无疾病证据状态的治疗目标。本文将结合国内外研究进展，探讨CRLM精准有效的最佳手术策略。

关键词: 结直肠癌, 肝转移, 分期切除, 同期切除, 局部治疗

Approximately 50% of colorectal cancer patients will develop liver metastases. Synchronous colorectal liver metastasis (CRLM) refers to liver metastasis identified before or upon the diagnosis of colorectal cancer. At present, surgical resection remains the only potential cure for patients with synchronous CRLM. With the advancement of medical technology, surgical strategies for primary and metastatic lesions include staged resection and simultaneous resection. The selection of surgical resection sequence for primary and metastatic lesions in staged resection and the selection of surgical opportunity in simultaneous resection are still controversial. Multiple surgical methods are employed to treat liver metastases. To improve the R0 resection rate of CRLM patients, parenchyma-preserving hepatectomy, two-step hepatectomy and liver transplantation are commonly adopted. Meantime, surgery combined with local treatments such as radiofrequency ablation, microwave ablation and stereotactic radiotherapy can also achieve the therapeutic goal of no evidence of disease. In this article, research progress at home and abroad was reviewed to investigate the optimal surgical strategy for CRLM.

Key words: Colorectal cancer, Liver metastases, Staged resection, Simultaneous resection, Local treatments
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