引用文本：姜武, 吕广钊, 陈功. 结直肠癌腹膜转移的诊治进展与挑战[J/CD]. 消化肿瘤杂志（电子版）, 2025, 17(4): 477-483.

作者：姜武，吕广钊，陈功

单位：中山大学肿瘤防治中心结直肠科，华南恶性肿瘤防治全国重点实验室，广东省恶性肿瘤临床医学研究中心， 广东 广州 510060

Authors：Jiang Wu, Lyu Guangzhao, Chen Gong

Unit：Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Clinical Research Center for Cancer, Guangzhou 510060, Guangdong, China

摘要：

结直肠癌腹膜转移（peritoneal metastasis of colorectal cancer, PM-CRC）是结直肠癌远处转移中预后最差的亚型。近年来，影像组学、人工智能及成纤维细胞活化蛋白抑制剂（fibroblast activation protein inhibitor, FAPI）-正电子发射计算机断层显像（positron emission tomography-computed tomography, PET/CT）等新技术显著提升了隐匿病灶的检出率，但其敏感度与特异度仍需提高。腹膜癌指数（peritoneal cancer index, PCI）作为肿瘤细胞减灭术（cytoreductive surgery, CRS）决策的核心量化工具，因未对解剖区域加权而限制了其精准度。CRS联合腹腔热灌注化疗（hyperthermic intraperitoneal chemotherapy, HIPEC）是实现局部控制的标准组合，关键在于通过精准分层筛选真正获益人群。此外，加压腹腔气溶胶化疗和微小残留病变动态监测正在为个体化治疗和复发预警提供新手段。本文系统梳理了PM-CRC诊断评估、手术及局部治疗的最新证据，剖析现存挑战，旨在为临床科学决策与综合管理提供参考。

关键词：结直肠癌；腹膜转移；细胞减灭术；腹腔热灌注化疗；精准治疗

Abstract：

Peritoneal metastasis of colorectal cancer (PM-CRC) is the most aggressive and prognostically unfavorable form of distant dissemination in colorectal cancer. Recent advances in imaging, molecular diagnostics, systemic therapies and surgeries have improved early detection and stratified management of PM-CRC. Emerging modalities such as artificial intelligence, radiomics, and fibroblast activation protein inhibitor (FAPI)-positron emission tomography-computed tomography (PET/CT) outperform conventional CT in identifying peritoneal metastases, though further refinement in sensitivity and specificity is needed. The peritoneal cancer index (PCI) remains central to cytoreductive surgery (CRS) planning, yet its lack of regional weighting limits its application. CRS combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is pivotal for locoregional control, with accurate patient selection being key to survival benefit. Novel techniques including pressurized intraperitoneal aerosol chemotherapy (PIPAC) and minimal residual disease (MRD) monitoring are paving the way for individualized therapy and early recurrence detection. This review summarizes recent advances in diagnosis and treatment of PM-CRC and discusses current challenges to guide evidence-based and personalized management strategies.

Key words：Colorectal cancer; Peritoneal metastasis; Cytoreductive surgery; Hyperthermic intraperitoneal chemotherapy; Precision therapy

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