原发灶不明的颈部淋巴结转移癌的治疗

目的 探讨原发灶不明的颈部转移癌的治疗方式。方法 分析81例病例资料，采用治疗方法为手术(S)、手术加放疗(S R)、手术加化疗(S C)、单纯放疗(R)、放化疗(R C)。结果 (S)11例，(S R)18例，(S C)5例，(R)19例，(R C)28例。手术包括单侧颈清30例，双侧颈清2例，局部切除2例。放射治疗剂量为40Gv～75Gv。全组5年总生存率为59．26％。中上颈部转移者5年生存率65．7％，其中转移性低分化癌的治疗方式为以放疗为主的综合治疗；转移性鳞癌则以手术为主；转移性腺癌以手术为主，其中的乳头状腺癌采用甲状腺癌联合根治术式，其5年生存率分别为62．5％、71．43％、62．5％。锁骨上区转移癌以化疗及放疗为主，5年生存率为28．57％。转移灶的部位、N分期、综合治疗及放疗范围影响5年生存率。结论 对原发灶不明的颈部转移癌的治疗，应根据淋巴结转移的部位和病理类型决定。

Treatment of cervical lymph nodal metastases of unknown primary sites

Objective To ascertain the management of cervical nodal metastases of unknown primary sites.Methods The clinical data of 81 patients were retrospectively analyzed.Management included surgery alone,surgery plus radiotherapy,surgery plus chemotherapy,radiotherapy alone,radiotherapy plus chemotherapy,radiotherapy plus chemotherapy.Results The data covered 11 patients by surgery alone,18 cases by surgery plus radiotherapy,5 by surgery plus chemotherapy,19 by radiotherapy alone,28 by radiotherapy plus chemotherapy.For patients who received surgery,ipsilateral cervical dissection in 30 patients,bilateral cervical dissection in 2 and regional lymophadenectomy in 2 have been done.The overall 5-year survival rate was 59.26%.The 5-year survival rate of the upper and/or middle cervical metastatic carcinoma was 65.7%.Combination of radiotherapy with surgery was best way for patients with poorly-differentiated carcinoma.Surgery was the major choice for patients with squamous cell carcinoma.The cases with adenocercinoma have been treated with surgery,while papillary adenocercinoma was treated by combined radical thyroidectomy.Their 5-year survival rates were 62.5%,71.43%,62.5%.For whom metastatic masses in the supraclavicular region,combination of radiotherapy with chemotherapy was choosed in all patients,and 5-year survival rate was 28.57%.Conclusion For Patients with cervical lymph node metastases from unkown primary sites,the management should be given according to the location of lymph node involved and histopathologic type of the tumor.