结直肠癌肝转移同期切除适应证及并发症防治

Indication of synchronous resection of colorectal liver metastases and management of its complications

结直肠癌肝转移手术策略的选择是结直肠癌治疗的热点和难点之一。同期肝切除手术因其具有避免多次手术打击、不会中断连续的系统化疗等优点,受到越来越多学者的青睐。对于一般状况较好,原发灶可切除,肝转移灶小且多位于周边或局限于半肝,肝切除范围较小时,肝外转移可切除的病人,可考虑同期肝切除手术。认真进行术前评估,严格筛选合适病例,提高手术操作水平并加强围术期管理有助于减少并发症的发生,改善病人预后。

The surgical strategy of colorectal liver metastases is one of the most controversy issues of the treatment of colorectal cancer. Synchronous hepatectomy is favored by more and more surgeons due to its advantages of avoiding repeated surgical strike, not interrupting the continuity of system chemotherapy. Synchronous hepatectomy is recommended for patients whose general condition is good, primary cancer is resectable, hepatic metastases are small, and locate in the periphery of liver or are confined to the hemiliver, liver resection volume is small, and extrahepatic metastases are resectable. Careful preoperative assessment, strict screening for suitable cases, enhancing the surgical techniques and strengthening the perioperative management are conductive to reducing complications and improving patients＇ prognosis.