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临床技术和研究逐步发展完善和规范了周围脏器浸润性结直肠癌的外科治疗,但仍存在许多争议。虽然,联合脏器整块切除术(enbloc multivisceral resection,MVR)以及联合远处转移灶根治性切除的创伤较大,并发症发生率及病死率较高,但严格掌握手术指征,选择恰当的手术切除范围,遵循无瘤原则,仍可获得满意的R0切除率,疗效肯定,使病人获得长期生存。术前判断肿瘤与周围脏器粘连的性质仍是目前亟待解决的难点;术中保证R0切除的同时避免盲目扩大切除范围是MVR成功实施的评价标准,既可改善病人远期生存又能保证较好的生活质量。腹腔镜实施MVR仍处于探索阶段,安全性和有效性均有待观察。预后因素尚存在一定争议,必须依照最新TNM分期对病人进行分组并评价。周围脏器浸润性结直肠癌(Ⅳ期)病例,其手术方式的选择仍存争议,推荐对此类病人进行多学科团队(MDT)讨论,制定合理规范的综合治疗方案,定期随访、评估,从而提高原发灶和远处转移病灶的根治性切除机会,延长病人的生存期。
Clinical technology and research gradually develop and improve and regulate the surgical treatment of peripheral organs of invasive colorectal cancer, but there are still many controversies. Although enbloc multivisceral resection (MVR) combined with radical resection combined with distant metastases has a higher incidence of trauma and higher morbidity and mortality, strict indications of surgical indications and appropriate selection of Surgical resection scope, follow the principle of tumor-free, can still get a satisfactory R0 resection rate, efficacy is positive, so that patients with long-term survival. Preoperative judgment of the nature of the tumor and the surrounding organs is still the most urgent problems to be solved; intraoperative R0 excision while avoiding the blind expansion of the excision range is MVR successful implementation of the evaluation criteria, both to improve the long-term survival of patients and to ensure that the more Good quality of life. Laparoscopic MVR is still in the exploratory stage, and its safety and efficacy needs to be observed. There are still some controversial prognostic factors, patients must be grouped according to the latest TNM staging and evaluation. Surgical options are still controversial in the treatment of patients with infiltrative colorectal cancer of the surrounding organs (stage Ⅳ). MDT discussions are recommended for such patients and rational and comprehensive treatment plans are developed. Regular follow-up, assessment, Thereby enhancing the primary and distant metastatic lesions of radical resection opportunities to extend the patient’s survival.