检索历史 清除

肝脏是结直肠癌转移最常见的靶器官.因此,结直肠癌肝转移(CRLM)的治疗引起国际医疗界广泛关注,并成立了专门的学术组织、制定了诊治共识.我国于2008年和2010年也先后制订了《结直肠癌肝转移诊断和综合治疗指南(草案)》和《结直肠癌诊疗规范》,以指导我国CRLM的诊断与治疗.但笔者发现,我国医生目前对指南的相关建议的认识尚不够充分,执行过程中易出现偏差.对此,笔者有如下几点思考:(1)积极推广CRLM核心治疗理念,即手术是CRLM唯一有可能治愈的手段；(2)辩证看待新辅助化疗在可切除CRLM治疗中的地位；(3)重视多学科专家组模式(MDT):MDT是CRLM科学规范治疗的基础；(4)扭转CRLM原发癌治疗观念,即对可切除CRLM的原发癌要遵循根治原则；(5)重视CRLM合并肺转移的手术治疗；(6)推崇手术作为CRLM首选治疗方法的同时,不可忽视患者的安全性.国内外CRLM治疗指南的推行势必使更多的CRLM患者受益,但在日常诊疗过程中,我们需要对以上几点引起重视,以确保CRLM治疗科学化和规范化地进行.

The liver is the most common site of colorectal cancer metastasis(CRLM).The importance of how to treat CRLM has attracted attention from doctors world wide and specific academic organization and expect consensus has been established.Relative principals of treatment of CRLM also developed in China,for example,guideline of diagnosis and treatment of colorectal cancer liver metastasis (draft) and standard for diagnosis and treatment of colorectal cancer,which were established in 2008 and 2010, respectively.However,we found that the Chinese doctors still understand these treatment policies inadequatly, and easily produce deviation on the treatment progress.Based on the problems of current CRLM treatment, we have some thoughts or suggestions as follows: (1)Promoting the core conception of CRLM treatment actively: surgery is the only method to achieve possible cure of the CRLM.(2) Evaluating the status of new adjuvant chemotherapy for CRLM dialectically.(3)Paying attention to multi-disciplinary team(MDT): MDT is the scientific treatment foundation of CRLM.(4)Changing the treatment conception of primary tumor of CRLM: radical resection of primary tumor is essential for the resectable CRLM.(5)Emphasizing the surgical treatment of CRLM combined with lung metastasis.(6)Do not neglect the safety of patients, when we emphasize the surgery is the optimal treatment of CRLM.These guides of treatment of CRLM will improve the outcomes of CRLM around the world,but we still need pay attention to above mentioned points in order to insure the standardization and scientification of CRLM therapy.