外科治疗同时性结直肠癌肝转移病人选择.doc

外科治疗同时性结直肠癌肝转移病人选择 　　摘 要 结直肠癌肝转移（CRLM）的手术治疗可以使经选择的病人受益，并明显改善其生存。但是，只有10%～20%的CRLM为可切除的肝转移，因而筛选适合手术治疗的病人至关重要。影像学技术可用于判别病变的特性，并为手术提供依据。满足手术切除的同时性CRLM，要求根治性切除原发病灶和R0切除已知的全部肝转移灶，同时保持足够的预期剩余肝脏（FLR）。有限的、可切除的肝外转移不再被认为是CRLM病人的手术禁忌。我们对同时性结直肠癌肝转移术前病人的选择，围手术期需考虑的相关因素等进行综述 关键词 结直肠癌肝转移 肝切除术 术前选择 中图分类号：R735.3； R730.56 文献标识码：A 文章编号：1006-1533（2017）09-0045-05 Preoperative selection of patients with synchronous colorectal carcinoma liver metastasis for hepatic resection WU Gang*， CAI Duan （Department of General Surgery， Huashan Hospital， Fudan University， Shanghai 200040， China） ABSTRACT Selected patients of colorectal liver metastases （CRLM） can be benefited from hepatectomy and its survival rate can be significantly improved. Unfortunately， only 10% to 20% of CRLM patients are candidates for resection， thus preoperative selection of patients for surgical treatment is essential. The imaging technique can be used to judge the characteristics of the lesions and provide the basis for the operation. To meet the surgical resection of the simultaneous CRLM， a radical resection of the primary lesion and R0 resection of all known liver metastases are required， while the future liver remnant（FLR） is a crucial factor in patient selection. The presence of limited and resectable extrahepatic metastases is no longer a surgical contraindication in patients with CRLM. In this review， we explore the preoperative selection of patients with colorectal liver metastases for hepatectomy and the related factors to be considered before the operation. KEy WORDS colorectal cancer liver metastases； hepatectomy； preoperative selection ?Y直肠癌（colorectal cancer，CRC）是很多国家最常见的三大恶性肿瘤之一，约占所有恶性肿瘤的9.7%[1]。肝脏是CRC最常见的转移靶器官，也是30%～40% CRC的唯一扩散部位。CRC在初诊时约有15%～25%的病人同时合并肝脏转移（colorectal liver metastases，CRLM），但是，80%～90%却无法手术切除[2]。与异时性肝转移相比，同时性肝转移往往预后更差。与许多其他类型的恶性肿瘤不同，肝转移的存在并不完全排除CRLM的有效治疗。未经治疗的CRLM病人中位生存期和5年体生存分别为8个月和0个月[3]，同时合并肝外转移时预后更差。随着结合多学科团队（multidisciplinary team，MDT）治疗模式的持续进步，细致的病例选择和手术技术的改进和提高