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在临床实践中发现有此胃癌病人在术前较长一段时间内处于相对平稳状态.未发现腹膜转移及肝转移。而在术后较短时间内发生了腹膜转移、肝转移。因此.有此病人对手术有所担心.经常向我提出这样的问题:手术能不能伤“元气”?手术能不能将癌“切飞了”?人们的这种担心不无道理。所谓“元气”可以理解为机体的免疫力。一个肿瘤在人体内发生、发展过程中.始终受到机体免疫力的限制.处于相对平衡的状态。接受一个手术的打击后.就可能改变机体与肿瘤的比势.破坏了机体的免疫屏障.即伤了“元气”.而使癌症复发、转移。另一方面.由于术中不注意无瘤操作技术.使癌细胞脱落造成腹膜播种.癌细胞沿血_道、淋巴道扩散成了肝转移、淋巴结转移等。所谓“切飞了”。大部分外科医生的无菌观念已经形成.而无瘤观念淡薄。对于恶性肿瘤的手术.无瘤观念比无菌观念更为重要.因为无菌观念不强造成的是局部感染.可以采用某此措施加以控制.而无瘤观念不强.将造成复发、转移.危及病人的生命。当然.作为一名外科医生两者都应高度重视.在实践操作中兼顾两者尚有一定的矛盾.如胃癌手术中应尽快将病变切除.消化道重建在最后进行.可能就会产生无菌的无瘤术的矛盾。下面以胃癌手术为例.谈谈胃癌手术过程中无瘤操作的技术和方法。
In clinical practice found that patients with gastric cancer in a relatively long period of time before surgery in a relatively stable state found no peritoneal metastasis and liver metastases. In a short period of time after the occurrence of peritoneal metastasis, liver metastases. Therefore, there are patients who are worried about the surgery.I often ask such questions: surgery can not hurt “strength”? Surgery can not cancer “cut fly”? People’s concern is not unreasonable. The so-called “strength” can be understood as the body’s immunity. A tumor in the human body occurs during the development process has always been limited by the body’s immune system in a relatively balanced state. After receiving an operation of the blow, it may change the body and the tumor than the potential damage to the body’s immune barrier that is hurt the vitality, leaving cancer recurrence and metastasis. On the other hand, due to intraoperative pay no attention to tumor-free operation of technology so that cancer cells shed peritoneal seeding cancer cells along the blood road, lymph node spread into liver metastasis, lymph node metastasis. The so-called “cut fly.” Most surgeons have formed a sterile concept, while the concept of no tumor weak. The concept of tumor-free surgery is more important than the sterile concept, because the concept of aseptic infection is not caused by a localized infection, some measures can be used to control the concept of tumor-free is not strong, will cause recurrence and metastasis. Endanger the patient’s life. Of course, as a surgeon should attach great importance to both.In practice there are some contradictions between the two, such as gastric cancer surgery should be removed as soon as possible.Diagnostic reconstruction in the final may be generated sterile Tumor-free contradictions. The following gastric cancer surgery as an example to talk about the operation of gastric cancer-free operation of the technology and methods.