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中华结直肠疾病电子杂志 ›› 2025, Vol. 14 ›› Issue (05) : 398 -411. doi: 10.3877/cma.j.issn.2095-3224.2025.05.004

指南与共识

结直肠癌肝转移诊断和综合治疗指南(V 2025)
中国医师协会外科医师分会, 中华医学会外科分会胃肠外科学组, 中华医学会外科分会结直肠外科学组, 中国抗癌协会大肠癌专业委员会, 中国医师协会结直肠肿瘤专业委员会, 中国临床肿瘤学会结直肠癌专家委员会, 中国医师协会外科医师分会结直肠外科医师委员会, 中国医师协会肛肠医师分会肿瘤转移委员会, 中华医学会肿瘤学分会结直肠肿瘤学组, 中国医疗保健国际交流促进会转移肿瘤治疗学分会, 中国医疗保健国际交流促进会结直肠病分会   
  • 收稿日期:2025-07-13 出版日期:2025-10-25
  • 基金资助:
    国家卫生健康委员会四大慢病重大专项项目(No. 2024ZD0520300)

Guideline for diagnosis and comprehensive treatment of colorectal liver metastases (Version 2025)

Chinese College of Surgeons, Section of Gastrointestinal Surgery, Branch of Surgery, Chinese Medical Association, Section of Colorectal Surgery, Branch of Surgery, Chinese Medical Association, Colorectal Cancer Professional Committee, Chinese Anti-Cancer Association, Colorectal Cancer Professional Committee of the Chinese Medical Doctor Association, Colorectal Cancer Expert Committee, Chinese Society of Clinical Oncology, Chinese Society of Colon & Rectal Surgeons, Chinese College of Surgeons, Chinese Medical Doctor Association, Metastasis Research Committee, Anorectal Branch of Chinese Medical Doctor Association, Section of Colorectal Oncology, Oncology Branch, Chinese Medical Association, Branch of Metastatic Tumor Therapy, China International Exchange and Promotive Association for Medical and Health Care, Branch of Colorectal Disease, China International Exchange and Promotive Association for Medical and Health Care   

  • Received:2025-07-13 Published:2025-10-25
引用本文:

中国医师协会外科医师分会, 中华医学会外科分会胃肠外科学组, 中华医学会外科分会结直肠外科学组, 中国抗癌协会大肠癌专业委员会, 中国医师协会结直肠肿瘤专业委员会, 中国临床肿瘤学会结直肠癌专家委员会, 中国医师协会外科医师分会结直肠外科医师委员会, 中国医师协会肛肠医师分会肿瘤转移委员会, 中华医学会肿瘤学分会结直肠肿瘤学组, 中国医疗保健国际交流促进会转移肿瘤治疗学分会, 中国医疗保健国际交流促进会结直肠病分会. 结直肠癌肝转移诊断和综合治疗指南(V 2025)[J/OL]. 中华结直肠疾病电子杂志, 2025, 14(05): 398-411.

Chinese College of Surgeons, Section of Gastrointestinal Surgery, Branch of Surgery, Chinese Medical Association, Section of Colorectal Surgery, Branch of Surgery, Chinese Medical Association, Colorectal Cancer Professional Committee, Chinese Anti-Cancer Association, Colorectal Cancer Professional Committee of the Chinese Medical Doctor Association, Colorectal Cancer Expert Committee, Chinese Society of Clinical Oncology, Chinese Society of Colon & Rectal Surgeons, Chinese College of Surgeons, Chinese Medical Doctor Association, Metastasis Research Committee, Anorectal Branch of Chinese Medical Doctor Association, Section of Colorectal Oncology, Oncology Branch, Chinese Medical Association, Branch of Metastatic Tumor Therapy, China International Exchange and Promotive Association for Medical and Health Care, Branch of Colorectal Disease, China International Exchange and Promotive Association for Medical and Health Care. Guideline for diagnosis and comprehensive treatment of colorectal liver metastases (Version 2025)[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2025, 14(05): 398-411.

肝脏是结直肠癌血行转移最主要的靶器官,而且结直肠癌肝转移是结直肠癌治疗的重点和难点之一。为了提高我国结直肠癌肝转移的诊断和综合治疗水平,各学组自2008年起联合编写《中国结直肠癌肝转移诊断和综合治疗指南》并后续进行了七次修订,以期指导对患者进行全面评估,精准地制定个体化的治疗目标,开展综合治疗,达到预防肝转移发生、提高肝转移灶局部毁损率、延长长期生存和改善生活质量的目的。本次修订后的2025版《指南》对以往结直肠癌肝转移的诊断和随访、预防、MDT作用、手术等毁损治疗、新辅助和辅助治疗、综合治疗等六部分内容进行更新,强调基于基因分子分型的精准治疗,尤其推荐错配修复缺陷/微卫星高度不稳定(dMMR/MSI-H)患者行免疫检查点抑制剂治疗,并丰富了局部治疗手段,如肝移植、钇-90微球选择性内放射治疗等。总体内容汇集总结国内外先进经验和最新成果,内容详尽,可操作性强。

The liver is the main target organ for hematogenous metastases of colorectal cancer, and colorectal liver metastasis is one of the most difficult and challenging situations in the treatment of colorectal cancer. In order to improve the diagnosis and comprehensive treatment in China, the guidelines have been edited and revised for seven times since 2008, including the overall evaluation, personalized treatment goals and comprehensive treatments, to prevent the occurrence of liver metastases, increase the local damage rate of liver metastases, prolong long-term survival, and improve quality of life. The revised guideline version 2025 includes the diagnosis and follow-up, prevention, multidisciplinary team, surgery and local ablative treatment, neoadjuvant and adjuvant therapy, and comprehensive treatment. The revised guideline emphasizes precision treatment based on genetic molecular typing, especially recommending immune checkpoint inhibitors for mismatch repair defects/microsatellite instability-high(dMMR/MSI-H) patients, and enriched local treatment methods, such as liver transplantation, yttrium-90 microsphere selective internal radiotherapy, etc. The revised guideline includes state-of-the-art experience and findings, detailed content, and strong operability.

图1 结直肠癌确诊时肝转移的诊断
图2 结直肠癌肝转移的预防
图3 结直肠癌确诊时合并可切除肝转移的治疗
图4 结直肠癌确诊时合并不可切除肝转移的治疗
图5 结直肠癌根治术后发现肝转移的治疗
图6 不可切除结直肠癌肝转移的治疗
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