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中华结直肠疾病电子杂志

中华结直肠疾病电子杂志 ›› 2015, Vol. 04 ›› Issue (03) : 296 -301. doi: 10.3877/cma.j.issn.2095-3224.2015.03.15

所属专题： 文献；

论著

不同部位结直肠癌肝转移瘤肝内分布规律分析
李金平1, 王彦民1, 李大庆1, 王海波1, 姜慧杰1,†(), 舒圣捷1   
  1. 1. 150086　哈尔滨医科大学附属第二医院CT室
  • 收稿日期:2015-04-30 出版日期:2015-06-25
  • 通信作者: 姜慧杰
  • 基金资助:
    黑龙江省教厅基金项目(12531251)

The analysis of distribution of colorectal liver metastases from different cancer sites

Jin-ping LI1, Yan-min WANG1, Da-qing LI1, Hai-bo WANG1, Hui-jie JIANG1,†(), Sheng-jie SHU1   

  1. 1. Department of Computed tomography, Second Affiliated Hospital of Harbin Medical University.Colorectal Cancer Institute of Harbin Medical University, Harbin 150086, China
  • Received:2015-04-30 Published:2015-06-25
  • Corresponding author: Hui-jie JIANG
  • About author:
    Corresponding author: JIANG Huijie, Email:
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李金平, 王彦民, 李大庆, 王海波, 姜慧杰, 舒圣捷. 不同部位结直肠癌肝转移瘤肝内分布规律分析[J/OL]. 中华结直肠疾病电子杂志, 2015, 04(03): 296-301.

Jin-ping LI, Yan-min WANG, Da-qing LI, Hai-bo WANG, Hui-jie JIANG, Sheng-jie SHU. The analysis of distribution of colorectal liver metastases from different cancer sites[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2015, 04(03): 296-301.

目的

探讨不同部位结直肠癌肝转移灶肝内的分布规律。

方法

收集90例结直肠癌肝转移临床资料，对原发灶部位，肝转移瘤的位置、数目、不同时相CT值及肠系膜下静脉回流汇入门静脉的位置进行记录。

结果

90例结直肠癌肝转移瘤患者转移灶实性部分平扫及增强三期CT值如下：平扫(35.05±8.04)HU、动脉期(50.24±10.91)HU、门脉期(55.77±14.86)HU、延迟期(58.14±12.07)HU，表现为明显的持续上升型。CT平扫及三期增强图像中，门脉期检出病灶比率最多96.94%(634/654)。右半大肠癌肝转移患者，肝右叶优势占77.78%(28/36)，肝转移灶在肝左右叶分布差异具有统计学意义(P＝0.003)。左半大肠癌肝转移患者，转移灶在肝脏右叶、左叶分布差异无统计学意义(P＝0.853)。左半大肠癌肝转移患者，IMV汇入SPV组有71.43%(15/21)患者转移灶主要分布在肝左叶，转移灶在肝左、肝右叶的分布差异有统计学意义(P＝0.001)。IMV汇入SMV组有71.43%(20/28)患者转移灶位置主要分布在肝右叶，转移灶在肝左、肝右叶的分布差异有统计学意义(P＝0.003)。IMV汇入SPV与SMV汇合处时，转移灶在肝左、肝右叶的分布差异无统计学意义(P＝0.080)。右半大肠癌患者与左半大肠癌患者相比，肝右叶与肝左叶转移瘤分布构成比差异具有统计学意义(χ2＝7.113，P＝0.000)。

结论

左右半大肠癌原发灶位置对肝转移灶分布可能有一定的预测作用，有助于在初诊及随访时提高结直肠癌肝转移的检出率。

关键词: 结直肠肿瘤, 肿瘤转移, 体层摄影术，X线计算机
Objective

To investigate distribution of colorectal liver metastases from different location.

Methods

Clinical data of 90 cases of colorectal liver metastases was recorded, including the site of the primary tumor, metastasis number, the CT values of different time and the location about mesenteric venous input into portal vein of liver metastases.

Results

The plain and enhanced CT values of 90 cases of colorectal cancer metastases were as follows: plain scan was(35.05±8.04)HU, and arterial phase was 50.24±10.91 HU, portal phase was 55.77±14.86 HU, and delayed phase was 58.14±12.07 HU, showing a clear rising type.The detection rate of portal phase was 96.94 percent(634/654), and about 77.78percent(28/36)liver metastases of right lobe advantage were from right side of colorectal cancer.The distribution of liver metastases was statistically different in left and right lobe(P=0.003). There was no statistical difference of the distribution of liver metastases from left side of colorectal cancer(P=0.853). For liver metastases from left side of colon cancer, IMV input into SPV was 71.43%(15/21), the liver metastases were mainly located in the left lobe of liver, and there was statistical difference of distribution of liver metastases from left side of colorectal cancer(P=0.003). There was no statistical difference of the distribution of liver metastases when IMV input into SPV and SMV(P=0.080). The distribution of liver metastases in right lobe and the left lobe were significantly different(χ2=7.113, P=0.000).

Conclusions

The location of the primary colorectal cancer might be used to predict the distribution of liver metastasis, and to improve the detection rate of colorectal liver metastases.

Key words: Colorectal neoplasms, Neoplasm metastasis, Tomography, X-Ray computed
表1 90例结直肠癌患者肝脏右叶、左叶转移灶分布情况表(例)
发生部位 右半大肠癌 左半大肠癌 合计
肝右叶优势 28 28 56
平均组 1 2 3
肝左叶优势 7 24 31
合计 36 54 90
χ2 9.115 12.584 ?
P 0.003 0.853 ?
图1 右半结肠癌肝转移患者中，右优势明显者的CT不同时期检查图像
表2 54例左半大肠癌患者肝转移灶的分布情况表(例)
IMV汇入处 肝右叶优势 平均组 肝左叶优势 合计 χ2 P
SPV 6 0 15 21 7.258 0.001
SMV 20 2 6 28 9.291 0.003
SPV与SMV汇合处 2 0 3 5 11.274 0.080
合计 28 2 24 54 ? ?
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