未知来源骨转移癌病人的诊断.DOCVIP

临床医学论文-未知来源骨转移癌病人的诊断 ??????????? ?? 作者：汤小东，郭卫，杨荣利，唐顺，杜志业? 【摘要】? ［目的］ 通过对不明来源骨转移癌病例的原发瘤进行规范诊断，并对诊断策略进行评估，为寻找骨转移癌原发肿瘤提供合理方案。［方法］ 2003年6月～2006年12月共收治无既往恶性肿瘤病史，来源不明的骨转移癌125例。初诊时骨转移部位主要包括，脊柱57例，骶骨24例，骨盆16例，股骨15例，肱骨7例。通过常规体检、实验室检查、胸部平片和（或）CT，腹部和盆腔B超和（或）CT，以及病理活检等方法对原发肿瘤进行诊断。［结果］在70.4%的病例中发现了原发肿瘤，来源分布肺脏40%、肾脏8%、前列腺5.6%、肝脏4.8%、乳腺4%、甲状腺和胃各2.4%，其他3.2%。各种检查方法中，体检仅发现9.6%的原发病灶，43.2%的病例存在肿瘤特异抗原异常。60%的病例经影像学检查发现原发肿瘤。病理检查结果中能够明确或提示诊断的占66.4%。发现原发肿瘤病例的1年生存率58.57%；未发现原发肿瘤病例的1年生存率22.93%。［结论］无明确恶性肿瘤病史的骨转移癌病例经规范检查后大部分可以诊断原发肿瘤，接受适当治疗后生存时间得到延长。 【关键词】? 未知来源肿瘤； 骨转移； 诊断； 活检 ??? Abstract: ［Objective］To evaluate the diagnostic strategy for bone metastasis from unknown primary. ［Method］One hundred and twenty five patients with unknown primary bone metastasis were treated from June 2003 and December 2006. The distribution of bone metastasis while initial diagnosis mainly focused on spine, sacrum, pelvis, femur and humerus. The diagnostic strategy contained a series of physical examination, laboratory test, imaging study and pathological examination.［Result］The primary tumor was found in 70.4% cases, while 40% was in the lung, 8% in kidney, 5.6% in prostate, 4.8% in liver, 4% in breast, both 2.4% in thyroid and gastric, and 3.2% in other visceras. The physical examination revealed the occult primary site of the malignant tumor in only 9.6% cases. Although, 43.2% patients had higher level of tumor antigen, but most of them were non-specific. Sixty percent of primary tumor was found by various imaging studies including plain radiograph, computed tomography and ultrasound. The pathological result after biopsy or operation identified or suggested the primary tumor in 66.4% cases. The one year survival rates after diagnosis were 58.57% and 22.93% in patients of bone metastasis with known and unknown origin, respectively.［Conclusion］The primary tumor can be diagnosed in most bone metastasis patients with no cancer history after careful examination, and patients will get benefit on survival time for tar