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目的探讨结直肠癌肝转移灶的分布特点及其与原发肿瘤部位的关系。方法回顾性分析我院2010年1月至2012年4月期间的105例结直肠癌伴肝转移患者的多排螺旋CT图像及临床资料,记录肿瘤原发部位、CT图像中转移灶数目、位置及肠系膜下静脉(IMV)汇入门静脉的解剖位置。结果①肿瘤原发灶位于右半结肠组及左半结肠组,转移灶位于肝右叶与肝左叶的比例分别约为2∶1、1.2∶1,2组间构成比差异有统计学意义(χ2=8.709,P=0.003)。②肿瘤原发灶位于左半结肠组中,其IMV汇入脾静脉(SpV)组、汇入肠系膜上静脉(SMV)组及汇入SMV与SpV汇合处组,转移灶位于肝右叶与肝左叶的比例分别为65∶98、116∶52及13∶15。3组间构成比差异有统计学意义(χ2=28.575,P=0.000),进一步比较前2组间构成比,差异有统计学意义(χ2=27.951,P=0.000)。③IMV汇入SpV组中,76.0%(19/25)的病例其转移灶主要分布在肝左叶(P=0.001);IMV汇入SMV组中,73.5%(25/34)的病例其转移灶主要位于肝右叶(P=0.000)。结论右半结肠癌转移灶主要分布在肝右叶,而左半结肠癌中其IMV汇入SpV者转移灶主要分布在肝左叶,汇入SMV者转移灶主要分布在肝右叶。该分布规律,一方面对肝转移癌患者寻找肠道原发病变有指导意义,另一方面也有助于在初诊及随访时提高结直肠癌肝转移的检出率。
Objective To investigate the distribution of liver metastases in colorectal cancer and its relationship with the primary tumor site. Methods We retrospectively analyzed multislice spiral CT images and clinical data of 105 patients with colorectal cancer with liver metastasis from January 2010 to April 2012 in our hospital. The location of tumor, the number of metastases in CT images, And the superior mesenteric vein (IMV) into the portal vein anatomical location. Results ① The primary tumors were located in the right colon and the left colon. The metastatic lesions located in the right lobe and the left lobe of the liver were about 2:1 and 1.2:1 respectively. There was significant difference in the constituent ratio between the two groups (χ2 = 8.709, P = 0.003). (2) The primary tumor was located in the left colon, and its IMV was introduced into the splenic vein (SpV) group and then into the superior mesenteric vein (SMV) and into the confluence of SMV and SpV. The metastasis was located in the right lobe of the liver and the liver Left lobe ratio was 65:98,116:52 and 13:15.3 respectively, there was significant difference between the two groups (χ2 = 28.575, P = 0.000). The differences between the two groups were statistically significant Significance (χ2 = 27.951, P = 0.000). (3) IMV was introduced into the SpV group, and 76.0% (19/25) cases were mainly located in the left lobe of liver (P = 0.001); IMV was introduced into the SMV group, 73.5% (25/34) Mainly in the right lobe of the liver (P = 0.000). Conclusion The metastatic tumors in the right colon are mainly located in the right lobe of the liver. However, the metastatic lesions of the IMV in the left colon are mainly located in the left lobe of the liver. The metastatic lesions in the metastatic SMV mainly distribute in the right lobe of the liver. The distribution of law, on the one hand, liver metastases in patients with primary pathological lesions of the gingival guidance, on the other hand also help to improve the colorectal cancer liver metastases in the initial diagnosis and follow-up detection rate.