目的:探讨原发灶不明的侵及皮肤的巨大颈部转移癌的手术方法、手术技巧及修复方法。方法:原发灶不明的侵及皮肤的巨大颈部转移癌患者16例,行根治性颈淋巴结清扫术,术中切除足够的受侵皮肤,妥善解决暴露、止血、颈内静脉上下极的处理、颈动脉、迷走神经、颈交感神经干、膈神经及臂丛神经的保护等问题,应用肌皮瓣修复颈部巨大皮肤缺损,术后给予同期放化疗。结果:16例患者术中无颈动脉破裂大出血,2例因与颈总动脉粘连紧密分离时颈总动脉外膜破裂给予直接缝合修复血管;1例颈总动脉切除约1.5cm,游离动脉后无张力给予端端吻合;1例术中证实颈内动脉已闭塞给予切除;2例切除部分迷走神经,1例行迷走神经端端吻合,1例胸长神经移植吻合;2例切除膈神经;16例均保留颈交感神经干及臂丛神经;16例颈部皮肤缺损均用胸大肌皮瓣修复。手术时间200~300min,术中失血量190~350ml。胸大肌皮瓣全部存活,无1例坏死。手术放化疗后随访3~50个月,死亡8例,死亡时间距离发病时间最长48个月。死于肺转移4例,骨转移2例,颈部复发1例,鼻咽大出血1例;其中3例发现原发灶,分别为鼻咽癌、扁桃体癌及食管癌。结论:原发灶不明的侵及皮肤的巨大颈部转移癌的手术是安全的,胸大肌皮瓣修复皮肤缺损疗效满意,不影响术后放化疗,可以提高局部控制率和患者的生存质量。 Objective: To investigate the surgical methods, surgical techniques and repair methods of unknown primary tumor invading the huge neck metastases of the skin. Methods: Twenty-six patients with huge neck metastasis who had unknown primary tumor invading the skin were treated with radical cervical lymph node dissection. All the affected skin were excised during operation, and the exposure, hemostasis and upper and lower jugular vein were properly treated , Carotid artery, vagus nerve, cervical sympathetic trunk, phrenic nerve and brachial plexus. Myofascial flap was used to repair the giant skin defect in the neck. Chemoradiotherapy was given after surgery. Results: In the 16 patients, there was no hemorrhage of carotid artery rupture in operation. Two cases were directly sutured to repair the external carotid artery rupture due to the close separation of the common carotid artery. One case of common carotid artery was excised about 1.5cm, Tension was given end-to-end anastomosis; 1 case was confirmed intracranial artery occlusion given resection; 2 cases of excision of some vagus nerve, 1 case of vagus nerve end-to-end anastomosis, 1 case of thoracic long nerve transplantation anastomosis; 2 cases of phrenic nerve resection; 16 cases Cervical sympathetic trunk and brachial plexus nerves were preserved. Sixteen patients with cervical skin defect were repaired with pectoralis major myocutaneous flap. Surgery time 200 ~ 300min, intraoperative blood loss 190 ~ 350ml. Pectoralis major flap all survived, no necrosis. After operation and radiotherapy and chemotherapy, the patients were followed up for 3 to 50 months and died of 8 cases. The duration of death was the longest 48 months. 4 died of lung metastases, 2 cases of bone metastases, 1 case of neck recurrence, and 1 case of nasopharyngeal hemorrhage. Among them, 3 cases had primary tumors, which were nasopharyngeal carcinoma, tonsillar carcinoma and esophageal carcinoma. CONCLUSIONS: The operation of unknown primary tumor invading the huge neck metastasis of the skin is safe. The effect of pectoralis major myocutaneous flap repair skin defect is satisfactory. It does not affect the postoperative radiotherapy and chemotherapy, and can improve the local control rate and quality of life .