四象限定位法在原发灶不明的颈部转移癌诊治中的临床意义  

Clinical significance of four quadrant localization in the diagnosis and treatment of metastatic carcinoma of the neck with unknown primary

作　　者：高延永[1] 陈晓红[2] 

机构地区：[1]桂林医学院附属医院耳鼻咽喉头颈外科,广西桂林541001 [2]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科

出　　处：《临床耳鼻咽喉头颈外科杂志》2017年第11期858-862,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：北京市卫生系统高层次卫生技术人才培养计划资助(No:2013-03-054)

摘　　要：目的:探讨四象限定位法在原发灶不明的颈部转移癌诊治中的临床意义。方法:对30例原发灶不明的颈部转移癌首次治疗时均未发现原发灶的患者进行四象限定位,即以颈部中线为纵轴,环状软骨下缘为横轴,将颈部分为四个象限。颈部转移癌出现在左右上象限,原发灶排查部位和放疗野从颅底到颈根部;出现在左右下象限时,原发灶排查部位和放疗野从颈部到上胸纵隔,左下还包括腹部以下原发灶寻找。同时出现双侧颈部转移癌,重点在中线附近检查原发灶。具体治疗策略包括患侧全颈清扫及上述放疗野的根治性放疗。结果:颈部转移癌位于左上颈部4例,右上颈部5例,左下颈部7例,右下颈部8例,混合区域6例。随诊中有33.3%(10/30)的颈淋巴结转移癌患者发现原发灶,全部符合四象限定位法,根据病理类型及原发灶部位做个体化处理。结论:四象限定位法定位原发灶准确,个性化的综合治疗是提高疗效的关键。Objective：The aim of this study is to investigate the clinical significance of four quadrant localiza tion in the diagnosis and treatment of unknown primary cervical metastases. Method; The clinical data with un known primary cervical metastases, were analyzed retrospectively. All the patients have not been found the original site in the initial treatment. There are four quadrants in the neck, the neck line as the longitudinal axis, and edge of cricoid cartilage as the horizontal axis. When cervical metastasis occurred in the left and right upper quad- rant, the primary tumor site and radiotherapy from the skull base to the root of the neck; when appear in left and right lower quadrant, the primary investigation site and radiotherapy from neck to thoracic mediastinum, left lower abdomen also includes following primary search. At the same time, bilateral cervical metastasis cancers, focusing on the central line near the primary focus. Specific treatment strategies include ipsilateral total neck dissection and radical radiotherapy of the above radiotherapy site. Result：Left upper neck in 4 cases, right upper neck in 5 cases, left lower neck in 7 cases, lower right neck in 8 cases and mixed area in 6 cases. Only 10 of 30 patients（33.30//00） with primary sites were found in the follow up period. In accordance with the four quadrant localization, the medi- an time was 6 months. Conclusion：Four quadrant localization to locate the primary site is accurate, and individual- ized comprehensive treatment is the key to improve the curative effect.

关 键 词：四象限定位法 肿瘤转移 原发灶不明 诊断 治疗 

分 类 号：R739.31[医药卫生—肿瘤]