结直肠癌肝转移诊断和综合治疗指南(2025版)
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国家卫生健康委员会四大慢病重大专项基金资助项目(2024ZD0520300)。


Chinese guidelines for the diagnosis and comprehensive treatment of colorectal liver metastases (2025 edition)
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    摘要:

    为进一步规范和提升我国结直肠癌肝转移的诊疗水平,《结直肠癌肝转移诊断和综合治疗指南(2025版)》在以往版本基础上,结合近年来国内外研究进展和临床经验,进行了系统更新。新版指南在优化诊断流程、加强多学科团队协作的基础上,全面升级了治疗策略,涵盖可达到无疾病证据状态(NED)患者的外科手术、辅助与新辅助治疗,及无法达到NED状态患者的综合治疗方案;同时拓展了基因检测内容,引入多种局部毁损新技术,强调规范随访与长期管理,力求实现治疗个体化、精准化,最终改善患者预后。指南旨在为全国医疗机构在结直肠癌肝转移的临床实践中提供循证、实用的参考依据。

    Abstract:

    To further standardize and improve the management of colorectal liver metastases (CRLM) in China, the Chinese guidelines for the diagnosis and comprehensive treatment of colorectal cancer liver metastases (2025 edition) have been systematically updated based on previous versions and the latest international and domestic evidence. The updated guideline refines diagnostic pathways, strengthens multidisciplinary team collaboration, and comprehensively upgrades therapeutic strategies-including surgical resection, neoadjuvant and adjuvant treatments for patients eligible for no evidence of disease (NED) status, and systemic therapy for those who are not. It also expands the scope of genetic testing, incorporates innovative local ablative therapies, and emphasizes standardized follow-up and long-term management. The guideline aims to promote individualized and precision-based treatment, ultimately improving clinical outcomes and patient survival. It serves as a practical, evidence-based reference for healthcare providers managing CRLM across China.

    图1 结直肠癌确诊时肝转移的诊断Fig.1 The diagnosis of liver metastasis at the time of colorectal cancer diagnosis
    图2 结直肠癌肝转移的预防Fig.2 Prevention of liver metastasis in colorectal cancer
    图3 结直肠癌确诊时合并可切除肝转移的治疗Fig.3 The treatment of colorectal cancer with resectable liver metastases at the time of diagnosis
    图4 结直肠癌确诊时合并不可切除肝转移的治疗Fig.4 The treatment of colorectal cancer with unresectable liver metastasis at the time of diagnosis
    图5 结直肠癌根治术后发现肝转移的治疗Fig.5 The treatment of liver metastasis after radical resection of colorectal cancer
    图6 不可切除结直肠癌肝转移的治疗Fig.6 Treatment of liver metastases from unresectable colorectal cancer
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.结直肠癌肝转移诊断和综合治疗指南(2025版)[J].中国普通外科杂志,2025,34(8):1565-1588.
DOI:10.7659/j. issn.1005-6947.250402

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  • 收稿日期:2025-07-17
  • 最后修改日期:2025-07-20
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  • 在线发布日期: 2025-10-11