结直肠癌脑转移的临床特征及诊断治疗

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。 

Clinical characteristics,diagnosis, and treatment of brain metastases from colorectal cancer

Given that colorectal cancer rarely metastasizes to the brain, only few studies have examined this disease in the past. The incidence of brain metastases increases along with the advances in the comprehensive treatment of such disease and the increased patient survival rates. Several single-center studies have retrospectively reviewed the clinical and pathological characteristics of pa-tients with brain metastases from colorectal cancer and have explored the mechanism and treatment modality of brain metastases. Brain metastases usually occur in the late course of the disease. The primary tumor is frequently localized in the left side of the colon, and most patients have developed metastases in other organs, especially in their lungs. Hematogeneous metastasis is considered the main route of brain metastasis, but its mechanism remains unclear. Early diagnosis depends on the screening of high-risk patients by contrasted MRI. In conclusion, brain metastases from colorectal cancer usually have poor prognosis, and clinicians must comprehen-sively consider the performance status and life expectancy of the patient, the location of the tumor, and the number of metastatic sites to mlake decisions in treatment. Aggressive surgical resection may increase the survival rate of selected patients.