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虽然胃癌的主要治疗手段为手术切除,但原发灶切除后并不意味着治疗的结束,相反,对不少病例来说,却是综合疗法中另一种治疗的开始。术后是否需要用药?用什么药?如何用法?这些都是外科医生经常遇到的问题,也是涉及巩固手术疗效,延长患者术后生存期的重要问题。现就有关胃癌术后化疗问题讨论如下。一、术后化疗的基本概念肿瘤手术切除后加用化疗是综合疗法中的手段之一,近年来在国际上很受重视,称之为辅助化疗。根据Jones等(1977)的意见,辅助化疗是指对“微小残余癌灶的手术后治疗”或“微转移灶的根除性治疗”。临床上即使是被认为比较彻底的手术也常常不可避免地余留下肉眼看不到的微小残余癌灶,或在病理切片中观察到切缘仍有癌细胞。至于微转移灶,甚至在所谓的“早期”局限性癌瘤中也仍有几乎二分之一的病例出现了。因此,术后化疗主要是针对残留的癌细胞而设计的。
Although the main treatment for gastric cancer is surgical resection, removal of the primary lesion does not mean the end of treatment. On the contrary, for many cases, it is the beginning of another treatment in combination therapy. Do you need medication after surgery? What medicine is used? How to use it? These are all problems that surgeons often encounter. They are also important issues concerning the consolidation of surgical outcomes and prolonged postoperative survival. The discussion on postoperative chemotherapy for gastric cancer is as follows. First, the basic concept of postoperative chemotherapy After tumor resection plus chemotherapy is one of the means of comprehensive therapy, in recent years in the international community has received great attention, called adjuvant chemotherapy. According to Jones et al. (1977), adjuvant chemotherapy refers to “post-surgical treatment of small residual cancer lesions” or “micro-metastasis eradication therapy.” Clinically, even if the surgery is considered to be thorough, it often inevitably leaves tiny residual lesions that are invisible to the naked eye, or in the pathological section, it is observed that there are still cancer cells in the margin. With regard to micrometastases, almost half of the cases have even appeared in so-called “early” localized carcinomas. Therefore, postoperative chemotherapy is designed primarily for residual cancer cells.