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近年来，微小残留病灶（MRD）在实体瘤中的应用受到广泛关注，一般是指在接受根治性治疗，如手术切除等手段后影像学无法发现的残留癌灶，术后MRD阳性状态与肿瘤复发风险升高明显相关。在结直肠癌中，循环肿瘤DNA（ctDNA）是评估MRD的有效标志物，其在非转移性（Ⅰ~Ⅲ期）结直肠癌中的应用尤为重要，作为一种实时、准确和便捷的生物标志物，能够有效预警肿瘤复发，指导术后辅助化疗决策，并为复发监测提供重要信息。ctDNA检测技术的应用前景广阔，有望为结直肠癌患者带来更为精准的个体化治疗方案。本文综合分析了ctDNA在检测非转移性结直肠癌患者MRD中的应用进展，详细探讨并梳理了其在临床治疗决策中的指导作用，同时展望了该领域的未来发展方向。

In recent years, the application of minimal residual disease (MRD) in solid tumors has gained widespread attention. MRD typically refers to the presence of residual cancer cells that remain undetectable by imaging after curative treatments, such as surgical resection. The presence of MRD post-surgery is significantly associated with an increased risk of tumor recurrence. In colorectal cancer, circulating tumor DNA (ctDNA) serves as an effective marker for assessing MRD, particularly in non-metastatic (stages I-III) colorectal cancer. As a real-time, accurate, and convenient biomarker, ctDNA can effectively predict tumor recurrence, guide postoperative adjuvant chemotherapy decisions, and provide crucial information for recurrence monitoring. The application prospects of ctDNA detection technology are vast, promising more precise and individualized treatment plans for colorectal cancer patients. This article comprehensively analyzes the progress in the application of ctDNA for detecting MRD in non-metastatic colorectal cancer patients, elaborates on its guiding role in clinical treatment decisions, and envisions the future development directions in this field.