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[结直肠癌肝转移的标准化诊断与治疗]

[Standardized diagnosis and treatment of colorectal liver metastasis].

作者信息

Yao Hongwei, Zhang Zhongtao

机构信息

Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, and National Clinical Research Center for Digestive Diseases, Beijing 100050, China.

出版信息

Zhonghua Wei Chang Wai Ke Za Zhi. 2017 Jul 25;20(7):753-757.

Abstract

Colorectal cancer is one of the most common malignancies. The liver is the most common site of distant metastasis, and liver metastasis is the leading cause of death in the patients with colorectal cancer. In recent years, the concept of diagnosis and treatment in colorectal liver metastasis (CLM) and the liver surgery techniques developed rapidly, the standardization of clinical practice elevated obviously, and the survival outcomes of more and more patients were significantly improved. Standardization of diagnosis and treatment in CLM comprised overall assessment of patients' condition and local tumor status based on multidisciplinary team collaboration and then institution of treatment strategy. Standardization of CLM diagnosis should be carried out by abdominal enhancement CT, or liver ultrasound to evaluate the hepatic metastasis. As for suspected CLM, serum AFP and liver MRI are recommended. When resectability is assessed, both surgery techniques (procedures, liver preservation, and resectable lesions outside of liver) and oncology items (synchronism, heterochronism, invasion and progression) must be considered. Due to complicated illness and different prognosis, CLM patients should be carefully classified to receive associated treatment. For CLM patients with resectable or potentially resectable lesions, the aim of treatment is to increase the R0 resection rate and survival. For those with unresectable lesions, the aim is to improve tumor-associated symptoms and maintain the quality of life.

摘要

结直肠癌是最常见的恶性肿瘤之一。肝脏是远处转移最常见的部位,肝转移是结直肠癌患者的主要死亡原因。近年来,结直肠癌肝转移(CLM)的诊治理念和肝脏手术技术迅速发展,临床实践的规范化程度明显提高,越来越多患者的生存结局得到显著改善。CLM的规范化诊治包括基于多学科团队协作对患者病情和局部肿瘤状况进行全面评估,然后制定治疗策略。CLM诊断的规范化应通过腹部增强CT或肝脏超声来评估肝转移情况。对于疑似CLM,建议检测血清甲胎蛋白(AFP)并进行肝脏磁共振成像(MRI)检查。在评估可切除性时,必须同时考虑手术技术(手术步骤、肝脏保留以及肝脏外可切除病灶)和肿瘤学因素(同时性、异时性、侵犯和进展情况)。由于病情复杂且预后各异,CLM患者应仔细分类以接受相应治疗。对于具有可切除或潜在可切除病灶的CLM患者,治疗目的是提高R0切除率和生存率。对于那些具有不可切除病灶的患者,治疗目的是改善肿瘤相关症状并维持生活质量。

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