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尽管已经有一些随机对照研究,但结直肠癌肝转移的诊治还存在很多争议。并非所有可切除病人都能从新辅助化疗中获益,应该选择高危病人进行新辅助化疗;对不可切除病人,除了全身化疗,肝动脉灌注(HAI)有望成为重要的转化手段;对于无法达到根治性切除(R0切除)的病人,如果能行R1切除也是有意义的;合并不可切除肺转移灶不再是肝转移灶切除的绝对禁忌;联合肝脏分隔和门静脉结扎的二步肝切除(ALPPS)由于其高并发症发生率和高病死率,应该客观看待。
Although there have been some randomized controlled studies, there is still much controversy over the diagnosis and treatment of colorectal cancer liver metastases. Not all resectable patients can benefit from neoadjuvant chemotherapy. Neoadjuvant chemotherapy should be selected for high-risk patients. In unresectable patients, hepatic arterial perfusion (HAI) is expected to be an important means of conversion in addition to systemic chemotherapy. For patients who can not achieve radical Resection (R0 resection) of the patients, if the line R1 resection is also meaningful; combined with unresectable lung metastases is no longer an absolute contraindication for liver metastases; combined with liver isolation and portal vein ligation of two-stage hepatectomy (ALPPS) due to The high incidence of complications and high mortality should be objective.