腹腔镜肝切除术是结直肠癌肝转移的常见治疗方法。以往在腹腔镜肝切除术中需要保留足够数量的功能性肝组织，而肝硬化患者的剩余肝容积应大于40％，非肝硬化患者则是大于30％。由于特定肝段如S2和S7的切除暴露和难度导致的出血、胆汁漏或肝功能衰竭的高发生率降低了肝切除的成功率。目前，微波消融主要应用于经皮切入的治疗肝转移，难以识别隐藏部位或小病灶。对于某些肝段，如S7的经皮穿刺可能穿过胸腔，而邻近膈肌的S2则可能损伤膈肌和心脏；这些问题限制了经皮消融在结直肠癌肝转移中的应用。鉴于多个病灶，本研究采用了腹腔镜微波消融联合肝切除的方法。在腹腔镜下，经造影超声确定了病灶的位置，并识别了手术前难以检测到的小病灶。对于直径小于3厘米且难以切除的散在病灶，采用了消融替代肝切除。这种技术有助于更明确地定位肿瘤，简化手术程序，降低了出血和胆汁漏等并发症的风险，缩短了手术时间，加速了术后恢复，显著提高了手术成功率，通过手术切除改善了结直肠癌肝转移的临床预后。

Laparoscopic hepatectomy is a common treatment for colorectal cancer liver metastasis. Previously, a sufficient number of functional liver masses had to be maintained during laparoscopic hepatectomy, with a residual liver volume of >40% in cirrhotic patients and >30% in non-cirrhotic patients. The high incidence of complications such as bleeding, bile leakage, or liver failure due to the exposure and difficulty of the resection of specific liver segments such as S2 and S7 reduces the success rate of liver resection. At present, microwave ablation is mainly applied in the treatment of liver metastasis using a percutaneous approach, which makes it difficult to identify hidden parts or small lesions. For some liver segments, the percutaneous puncture of liver segment 7 (S7) is likely to pass through the thoracic cavity, and the percutaneous puncture of liver segment 2 (S2) adjacent to the diaphragm is likely to injure the diaphragm and heart; these issues restrict the application of percutaneous ablation in colorectal cancer liver metastasis. Considering multiple lesions, laparoscopic microwave ablation combined with hepatectomy was performed in this study. The location of the lesions was determined by contrast-enhanced ultrasound under laparoscopy, and small lesions that were difficult to detect before the operation were identified. For the scattered lesions, which had diameters less than 3 cm and were difficult to resect, ablation was adopted to substitute hepatectomy. This technique helped to more explicitly locate the tumors, simplified the operation procedures, reduced the risk of complications such as bleeding and bile leakage, shortened the operation time, accelerated the postoperative recovery, significantly improved the success rate of operation, and enhanced the clinical prognosis of colorectal cancer liver metastasis by surgical resection.