不明原发灶的颈部淋巴结转移癌的治疗探讨(附25例报告)

目的探讨不明原发灶的颈部转移癌的治疗方式。方法回顾分析我院2003～2009年收治的25例不明原发灶的颈部淋巴结转移癌的病例资料,采用治疗方法为手术(S)、放疗(R)、化疗(C)、手术加放疗(S+R)、手术加化疗(S+C)、放化疗(R+C),手术加放化疗(S+R+C)。结果全组5年总生存率为48%,其中转移性低分化癌的治疗方式为以手术+放疗为主,转移性鳞癌则以手术+化疗为主,转移性腺癌以手术+化疗为主,其中的乳头状腺癌采用甲状腺癌联合根治术式,锁骨上区转移癌以化疗及放疗为主。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、N分期、病理类型及患者的身体状况等多种因素决定,应选择综合治疗。

Objective To ascertain the treatment of cervical lymph nodal metastases of unknown primary sites.Methods The clinical data of 25 patients were retrospectively analyzed. Anagement included surgery（S）,radiotherapy（R）,chemotherapy（C）,surgery plus radiotherapy（S-t-R）,surgery plus chemotherapy（S-I-C）,radiotherapy plus chemotherapy（R-I-C）,surgery plus radiotherapy and chemotherapy （S-FR＋C）.Results The overall 5--year survival rate was 48%.Combination of radiotherapy with surgery was the best way for patients with poorly--differ--entiated carcinoma.Surgery plus chemotherapy was the major choice for patients with squamous cell carcinoma. The cases with adeno--carcinoma have been treated with surgery plus chemotherapy,while papillary adeno--carcinoma was treated by combined radical thyroidectomy.For whom metastatic masses in the supraclavicular region,combination of radiotherapy with chemotherapy was choosed in all patients. Conclusion For Patients with cervical lymph node metastases from unkown primary sites,the treatment should be given according to the location of lymph node involved,N degree,histopathologic type of the tumor and the health of the patients,comprehensive treatment should be choosed.