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结直肠癌脑转移的发病率很低,既往较少受到关注。但是随着结直肠癌综合治疗手段的提高,患者生存期逐渐延长,出现脑转移的几率逐渐增加。目前国内外报道大多来自单中心的回顾性病例分析,描述脑转移患者的临床病理特征,并对其转移机制和治疗模式进行相应的探索。结直肠癌脑转移好发于左半结肠,多发生在病程晚期,多数合并肺转移。血行转移是最主要的转移途径,具体机制尚不明确。临床表现缺乏特异性,早期诊断主要依靠对高危患者进行头颅增强磁共振成像筛查。这部分患者总体预后较差,治疗方式的选择通常需综合考虑患者的一般状态、脑转移瘤的数量和部位、颅外转移情况、预期生存时间等,而针对特定患者行积极的手术治疗可很大程度上改善预后,延长生存。本文将从结直肠癌脑转移的临床特征、转移机制、诊断治疗等方面分别进行综述,以期为结直肠癌脑转移的临床诊治提供参考。
The incidence of colorectal cancer brain metastases is very low, less attention in the past. However, with the improvement of comprehensive treatment of colorectal cancer, the survival of patients gradually extended, the probability of brain metastases increased gradually. At present, most of the reports from home and abroad come from a single-center retrospective case analysis, describing the clinicopathological features of patients with brain metastases, and exploring their metastatic mechanisms and treatment patterns accordingly. Colorectal cancer brain metastases occur in the left colon, occurred in the late course of the disease, the majority of lung metastasis. Hematogenous metastasis is the most important way to transfer, the exact mechanism is not clear. Lack of specificity of clinical manifestations, early diagnosis mainly rely on high-risk patients with skull enhanced MRI screening. This part of the patients overall poor prognosis, the choice of treatment usually need to take into account the general status of patients, the number and location of brain metastases, extracranial metastases, the expected survival time, and for specific patients with positive surgical treatment can be very To a large extent improve the prognosis and prolong survival. This article reviews the clinical features, metastasis mechanism, diagnosis and treatment of brain metastases of colorectal cancer and so on, respectively, in order to provide a reference for the clinical diagnosis and treatment of colorectal cancer brain metastases.