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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: To investigate the clinical significance of four-quadrant positioning in the diagnosis and treatment of primary cervical cancer with unknown origin. Methods: Thirty patients with primary tumor who had no primary tumor were studied by four-quadrant method in the first treatment of neck metastatic carcinoma of unknown origin. The median longitudinal axis of the neck and the horizontal axis of the annular cartilage were taken as the horizontal axis, For four quadrants. Neck metastases appear in the upper quadrant of the upper and lower quadrant of the primary tumor investigation and radiotherapy field from the base of the skull to the root of the neck; appear in the lower quadrant, the primary tumor investigation and radiotherapy field from the neck to the upper mediastinum, Including the abdomen to find the following primary hair. At the same time bilateral neck metastasis, focusing on the central line near the examination of the primary tumor. Specific treatment strategies include ileal full neck dissection and radical radiotherapy of the radiotherapy field. Results: The metastatic carcinoma of the neck was located in 4 cases in the left upper neck, 5 cases in the right upper neck, 7 cases in the left lower neck, 8 cases in the right lower neck and 6 cases in the mixed area. Follow-up in 33.3% (10/30) of cervical lymph node metastases found in patients with primary tumor, all in line with the four quadrant positioning method, according to the pathological type and the location of the primary tumor to do individual treatment. Conclusion: The four-quadrant localization method is the key to improve curative effect by locating the accurate and personalized comprehensive treatment of primary tumor.