因?yàn)檗D(zhuǎn)移癌細(xì)胞經(jīng)門靜脈血流進(jìn)入肝臟，門靜脈右支平直，左支迂曲，所以癌細(xì)胞多數(shù)進(jìn)入右肝，推測(cè)結(jié)直腸癌肝轉(zhuǎn)移多數(shù)為右肝轉(zhuǎn)移。查閱相關(guān)文獻(xiàn)：streamline effect
1、Relationship between primary?colorectal?tumour and?location?of?colorectal?liver metastases，ANZ J Surg?2016 May ;86(5)? IF=1.586
探討原發(fā)腫瘤位置與肝轉(zhuǎn)移位置相關(guān)性的研究，入組的891例患者，其中379例患者只出現(xiàn)右肝轉(zhuǎn)移，156例左肝轉(zhuǎn)移，356例雙側(cè)肝轉(zhuǎn)移。
左半結(jié)腸癌肝臟轉(zhuǎn)移的位置，與右半結(jié)腸肝臟轉(zhuǎn)移的位置，無(wú)明顯差異。
2、Location of liver metastases reflects the site of the primary colorectal carcinoma.?Scand. J. Gastroenterol.?2008 ;43(2) IF=2.629
發(fā)現(xiàn)左半結(jié)腸癌與右半結(jié)腸癌，肝轉(zhuǎn)移的部位不完全相同。178例入組病例，35例右半結(jié)腸癌，143例左半結(jié)腸癌（主要為乙狀和直腸吧？）。35例右半結(jié)腸癌中，右半肝：左半肝轉(zhuǎn)移比例為3.6:1，而左半結(jié)腸癌中，右半肝：左半肝=2.1:1。統(tǒng)計(jì)方法不同：計(jì)數(shù)左半肝和右半肝轉(zhuǎn)移瘤個(gè)數(shù)，而參考文獻(xiàn)1則分為三類：左半肝轉(zhuǎn)移、右半肝轉(zhuǎn)移和雙側(cè)肝轉(zhuǎn)移三類。
結(jié)論：右半結(jié)腸癌更容易轉(zhuǎn)移至右半肝，而左半結(jié)腸癌轉(zhuǎn)移至左肝和右肝幾率差不多。
The overall incidence of metastases located in the right lobe of the liver was 70.1% compared with 29.9% located in the left hemiliver.
Forty metastases (78.4%) from 35 carcinomas inthe right hemicolon were found in the right lobeof the liver, whereas 11 metastases (21.6%) werelocated in the left hemiliver. The results for the 143left-colon and rectum primaries were 145 metastases(68.1%) in the right hemiliver and 86 (31.9%) in theleft hemiliver. Accordingly, the ratio of metastasesinvolving the right and left lobe of the liver was 3.6:1for right-sided primary tumors (p<0.002) comparedwith 2.1:1 for left-sided primary tumors (p=NS) (Table I).
3、Streamline flow of the portal vein affects the lobar distribution of colorectal liver metastases and has a clinical impact on survival?Ann Surg Treat Res?2017 May ;92(5) if=1.233
總體來(lái)說(shuō)，右肝轉(zhuǎn)移率61%，左肝轉(zhuǎn)移率 39%。右半結(jié)腸癌，右：左=123:56，而左半結(jié)腸癌，右：左=275:198。兩者轉(zhuǎn)移模式顯著不同。本文進(jìn)一步討論了對(duì)預(yù)后的影響，如果是左半結(jié)腸癌，初診只發(fā)現(xiàn)右半肝有轉(zhuǎn)移，很有可能左半肝已經(jīng)有潛在未發(fā)現(xiàn)的轉(zhuǎn)移灶，將來(lái)復(fù)發(fā)概率高，預(yù)后差。而右半結(jié)腸癌，初診時(shí)發(fā)現(xiàn)右肝轉(zhuǎn)移，放心切除即可，因?yàn)橛野虢Y(jié)腸癌左半肝轉(zhuǎn)移幾率低，將來(lái)復(fù)發(fā)少，預(yù)后好一些。
Due to the relatively higher rate of metastasis to the left hemiliver, left-sided CRC has a higher risk of undetected metastasis in the left hemiliver at the time of right hemihepatectomy compared to right-sided colon cancer. Our data also showed that patients who underwent right hemihepatectomy for solitary metastasis had different rates of hepatic recurrence depending on primary tumor location.
4、Colorectal carcinoma metastases to the liver. Does primary tumor location affect its lobar distribution? Cancer 1996 Jun 01 ;77(11) IF=6.537
右半結(jié)腸癌 右肝轉(zhuǎn)移29個(gè)病灶，3個(gè)左肝轉(zhuǎn)移；而左半結(jié)腸癌，106右肝轉(zhuǎn)移，57左肝轉(zhuǎn)移。結(jié)論同上：左半和右半結(jié)腸癌，肝轉(zhuǎn)移位置模式是不同的，右半結(jié)腸癌更多的右肝轉(zhuǎn)移，而左半結(jié)腸癌兩側(cè)肝轉(zhuǎn)移基本持平。
