肿瘤已然手术根治，为么还要做巩固性化疗，非常多人都搞不清楚
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">癌症根治手术，说明肿瘤<span style="color: black;">已然</span>被“根治”了，<span style="color: black;">亦</span><span style="color: black;">便是</span>说肿瘤都被切除了，肿瘤<span style="color: black;">周边</span>的淋巴结<span style="color: black;">亦</span>清扫了，达到了根治。既然做到了根治手术，<span style="color: black;">为何</span>术后还要做巩固性化疗，<span style="color: black;">非常多</span><span style="color: black;">病人</span>会这么问？巩固性化疗有<span style="color: black;">道理</span>吗？今天曾<span style="color: black;">大夫</span>就来给<span style="color: black;">大众</span>科普一下。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">根治性手术真的是完全根治吗？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">大夫</span>所说的根治性手术，可能与<span style="color: black;">公众</span>的理解会有稍微的不同。<span style="color: black;">针对</span>很<span style="color: black;">初期</span>的肿瘤，例如一期的肿瘤，这些<span style="color: black;">初期</span>的癌细胞，有很大的机会，肿瘤细胞只是在局部生长，<span style="color: black;">无</span>扩散到<span style="color: black;">周边</span>的组织、淋巴结<span style="color: black;">或</span>血管里面去。<span style="color: black;">针对</span>这些<span style="color: black;">病人</span>，只<span style="color: black;">必须</span>手术将肉眼看得见的癌症切除就<span style="color: black;">能够</span>了，这是真正的根治，术后不<span style="color: black;">必须</span>做任何的治疗，化疗和放疗都<span style="color: black;">不消</span>做。</p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">还有<span style="color: black;">非常多</span><span style="color: black;">病人</span>，癌症是属于中期的，<span style="color: black;">亦</span><span style="color: black;">便是</span>说肿瘤除了在原发器官生长，还<span style="color: black;">能够</span><span style="color: black;">显现</span>淋巴结转移，例如大肠癌<span style="color: black;">显现</span>肠系膜淋巴结转移，肺癌转移到肺<span style="color: black;">周边</span>的淋巴结。<span style="color: black;">针对</span>这些<span style="color: black;">病人</span>，手术<span style="color: black;">亦</span><span style="color: black;">能够</span>切除肿瘤，清扫<span style="color: black;">周边</span>的淋巴结。<span style="color: black;">亦</span><span style="color: black;">便是</span>说，<span style="color: black;">大夫</span><span style="color: black;">能够</span>将肉眼看得见的癌细胞完全切除，达到“根治”的效果。<span style="color: black;">然则</span>，这有可能不是真正的根治，<span style="color: black;">由于</span>癌细胞的直径<span style="color: black;">尤其</span>小，癌细胞的直径大约是10微米，形成1个毫米<span style="color: black;">体积</span>的癌细胞团，<span style="color: black;">必须</span>100万个癌细胞，而形成1厘米<span style="color: black;">体积</span>的癌细胞肿块，<span style="color: black;">必须</span>10亿个癌细胞。而<span style="color: black;">咱们</span>的眼睛，看不见散在的癌细胞，<span style="color: black;">日前</span>任何的影像学<span style="color: black;">检测</span>手段，<span style="color: black;">亦</span><span style="color: black;">发掘</span>不了这些微小的癌转移灶。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic4.zhimg.com/80/v2-613864a09086ef245459f1ae5200e023_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">因此</span>，<span style="color: black;">针对</span>中期的肿瘤，即使手术做到了“根治”，<span style="color: black;">亦</span>可能有部分<span style="color: black;">咱们</span>肉眼看不见的癌细胞，藏在身体的某些部位，例如远处的，手术<span style="color: black;">没</span>法切除的淋巴结中，<span style="color: black;">或</span>远处的器官中，这些癌细胞就可能<span style="color: black;">引起</span>术后复发和转移。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">那些</span><span style="color: black;">病人</span><span style="color: black;">必须</span>做巩固性的化疗</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">术后巩固性的化疗，又叫做辅助化疗。前面<span style="color: black;">咱们</span>讲了<span style="color: black;">非常多</span>理论上的知识，在<span style="color: black;">平常</span>的医疗实践<span style="color: black;">其中</span>，理论和实践还是有<span style="color: black;">必定</span>差别的。<span style="color: black;">此刻</span>的医疗手段，检测不出来，哪位<span style="color: black;">病人</span>做完手术之后，<span style="color: black;">身体</span>还有少量癌细胞残留。<span style="color: black;">那样</span><span style="color: black;">咱们</span>怎么决定<span style="color: black;">那些</span><span style="color: black;">病人</span><span style="color: black;">必须</span>做化疗呢？<span style="color: black;">咱们</span><span style="color: black;">此刻</span>看病都讲究证据，需不<span style="color: black;">必须</span>化疗，用证<span style="color: black;">据述</span>话。</p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">以结肠癌为例，做完根治性手术后，怎么决定<span style="color: black;">那些</span><span style="color: black;">病人</span><span style="color: black;">必须</span>化疗呢？在国际和国内，<span style="color: black;">已然</span>开展了<span style="color: black;">海量</span>的临床<span style="color: black;">实验</span>，将有相同分期的癌症<span style="color: black;">病人</span>，随机的分成两个组，一个组做化疗，一个组不做，比较两组<span style="color: black;">病人</span>的术后复发率和<span style="color: black;">存活</span>率，<span style="color: black;">瞧瞧</span>有<span style="color: black;">无</span>差别，如果化疗组<span style="color: black;">存活</span>期更高，复发率更低。<span style="color: black;">那样</span>，以后这个分期的所有<span style="color: black;">病人</span>都<span style="color: black;">必须</span>做化疗。<span style="color: black;">根据</span><span style="color: black;">日前</span>的指南，结肠癌术后，高危的二期、三期和四期的<span style="color: black;">病人</span>，术后都<span style="color: black;">必须</span>做化疗，<span style="color: black;">由于</span>这些<span style="color: black;">病人</span><span style="color: black;">能够</span>从术后的辅助化疗中获益。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">现行<span style="color: black;">方法</span>的<span style="color: black;">坏处</span>端</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">前面<span style="color: black;">咱们</span>讲到，决定<span style="color: black;">那些</span><span style="color: black;">病人</span>术后<span style="color: black;">必须</span>化疗，<span style="color: black;">重点</span>看病理分期，分期早的<span style="color: black;">病人</span>，癌细胞<span style="color: black;">出现</span>潜在转移的<span style="color: black;">危害</span>很小，术后不<span style="color: black;">必须</span>化疗。中晚期的癌症，癌细胞<span style="color: black;">出现</span>转移的概率大， <span style="color: black;">必须</span>化疗。这些都是基于大数据的结果，<span style="color: black;">每一个</span>人的癌症<span style="color: black;">状况</span>，不可能完全<span style="color: black;">同样</span>。有小部分<span style="color: black;">初期</span>的<span style="color: black;">病人</span>，术后<span style="color: black;">亦</span>会<span style="color: black;">显现</span>复发和转移，这部分<span style="color: black;">病人</span>应该接受化疗，但却<span style="color: black;">无</span>；有<span style="color: black;">有些</span>中晚期的<span style="color: black;">病人</span>，术后没做化疗，<span style="color: black;">亦</span>有可能不复发，<span style="color: black;">倘若</span>这些<span style="color: black;">病人</span>接受了化疗，<span style="color: black;">实质</span>上是过度治疗。<span style="color: black;">日前</span>的医疗水平，还<span style="color: black;">不可</span>做到真正的<span style="color: black;">精细</span>医疗，<span style="color: black;">不可</span>检测<span style="color: black;">病人</span><span style="color: black;">身体</span><span style="color: black;">可否</span>有少量爱细胞残留，<span style="color: black;">不可</span>非常准确的预测<span style="color: black;">病人</span>复发和转移的概率。<span style="color: black;">日前</span>，<span style="color: black;">咱们</span>还做不到个体化治疗，还<span style="color: black;">必须</span>依赖医学的进步。</p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">综上所述，并不是所有人都<span style="color: black;">必须</span>做巩固性的化疗，<span style="color: black;">大夫</span>会<span style="color: black;">按照</span><span style="color: black;">病人</span>的术后病理<span style="color: black;">状况</span>，术后分期，决定<span style="color: black;">可否</span><span style="color: black;">必须</span>做化疗，<span style="color: black;">然则</span><span style="color: black;">亦</span>存在<span style="color: black;">必定</span>的<span style="color: black;">坏处</span>端，做不到<span style="color: black;">精细</span>医疗。<span style="color: black;">倘若</span>想要咨询，请将术后的病理结果发过来，<span style="color: black;">这般</span><span style="color: black;">才可</span>判断，<span style="color: black;">可否</span><span style="color: black;">必须</span>化疗。</p>
我完全同意你的观点，说得太对了。 期待更新、坐等、迫不及待等。 感谢你的精彩评论，带给我新的思考角度。 我们有着相似的经历，你的感受我深有体会。
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