73岁肿瘤专家患癌，抗癌一年逝去，他临终前的一个反思，震耳发聩
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">本文来自香港综合肿瘤中心审核：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">在我国，平均每分钟有8人患上癌症癌，5人会因癌而<span style="color: black;">离开</span>。有多少人会真正明白，当癌症来临时，<span style="color: black;">病人</span><span style="color: black;">到底</span>会经历<span style="color: black;">怎么样</span>的内心<span style="color: black;">波涛</span>与痛苦体会？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1. <span style="color: black;">作为</span><span style="color: black;">病人</span>后，我才明白癌症的痛</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">华益慰是北京军区总医院原外一科<span style="color: black;">专家</span>，从事癌症防治工作，做过数不清的手术。他<span style="color: black;">晓得</span>患癌很痛苦，却坦言自己<span style="color: black;">亦</span><span style="color: black;">没</span>法感同身受。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">直到他自己被确诊胃癌。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic1.zhimg.com/80/v2-b40ae317dc52948cc3d5f4c039f032d8_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;">因为</span><span style="color: black;">发掘</span>时<span style="color: black;">已经是</span>胃癌晚期，华益慰只能<span style="color: black;">根据</span>常规处理，做了全胃切除手术。手术后，华益慰返流非常严重，食道被烧得生疼，嗓子和耳咽管<span style="color: black;">亦</span>受到<span style="color: black;">剧烈</span>刺激，只能<span style="color: black;">长期</span>半卧在床上。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">为了<span style="color: black;">掌控</span>癌细胞的扩散，华益慰接受了腹腔热化疗。做腹腔热化疗时，他<span style="color: black;">必要</span>纹丝不动躺一个半小时，腹腔温度会<span style="color: black;">上升</span>到41℃，<span style="color: black;">全部</span>人大汗淋漓。每次做完热疗，他都腹痛得死去活来，只能<span style="color: black;">吃下</span><span style="color: black;">止疼片</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">如此痛苦的体验，他<span style="color: black;">一月</span>要经历8次。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">化疗结束，华益慰的病情<span style="color: black;">无</span>好转，恶心、呕吐症状反而更加严重，<span style="color: black;">乃至</span><span style="color: black;">没</span>法<span style="color: black;">摄食</span>，最后连鼻饲营养液都进不去，全身水肿。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic3.zhimg.com/80/v2-8b32222da2dbfdc4c5100c24a7664322_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;">没</span>奈之下，华益慰只好接受第二次手术。可是手术之后，他<span style="color: black;">出现</span>了严重的腹腔感染，存活<span style="color: black;">期盼</span>逐渐消失。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">抗癌一年后，在生命最后的日子里，73岁的华益慰浑身上下插满了管子，躺在病床上<span style="color: black;">不可</span><span style="color: black;">活动</span>，感慨道：“我以前给病人做了<span style="color: black;">那样</span>多手术，从来没想到<span style="color: black;">她们</span>会这么痛苦，直到我自己<span style="color: black;">亦</span>躺在病床上……”</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2. 深刻反思，癌症晚期真的<span style="color: black;">必须</span>手术吗？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">接受治疗<span style="color: black;">时期</span>，华益慰回想起自己做过的手术，对学生说到：“全胃切除太痛苦，如果不是没办法，哪怕是留一点点胃<span style="color: black;">亦</span>比全切强。<span style="color: black;">咱们</span>当<span style="color: black;">大夫</span>的，不要只想着消灭<span style="color: black;">疾患</span>，还要为病人着想，<span style="color: black;">思虑</span>生活质量。”</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">癌症发展到晚期，<span style="color: black;">存活</span>率已大大下降，有的<span style="color: black;">大夫</span>会<span style="color: black;">意见</span>手术，<span style="color: black;">控制</span>癌细胞扩散。<span style="color: black;">那样</span>，癌症晚期还有<span style="color: black;">无</span>必要做手术呢？这是个很难回答的问题。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">首要</span>，要<span style="color: black;">思虑</span>手术能<span style="color: black;">不可</span><span style="color: black;">处理</span><span style="color: black;">实质</span>问题，可不<span style="color: black;">能够</span>减轻症状，<span style="color: black;">加强</span>生活质量。<span style="color: black;">倘若</span>答案<span style="color: black;">可否</span>定的，那就<span style="color: black;">无</span>必要再<span style="color: black;">增多</span>痛苦了。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">其次，还要看手术<span style="color: black;">危害</span>高不高。任何手术都有<span style="color: black;">危害</span>，<span style="color: black;">针对</span>癌症晚期<span style="color: black;">病人</span><span style="color: black;">来讲</span>，身体<span style="color: black;">可否</span>能够承受手术带来的创伤、并发症？<span style="color: black;">倘若</span>不行，<span style="color: black;">那样</span><span style="color: black;">意见</span>放弃手术。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">最后，还要尊重<span style="color: black;">病人</span>的个人意愿。<span style="color: black;">病人</span>自己愿意接受手术吗？相比起家属的想法，<span style="color: black;">病人</span>的求生<span style="color: black;">认识</span>更<span style="color: black;">要紧</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">必须</span>强调的是，癌症晚期<span style="color: black;">没</span>法手术，不<span style="color: black;">表率</span>没救了。以胃癌为例，<span style="color: black;">病人</span><span style="color: black;">倘若</span><span style="color: black;">没</span>法手术，还<span style="color: black;">能够</span><span style="color: black;">选取</span>放疗、化疗、靶向治疗、免疫治疗、射频消融等手段，<span style="color: black;">掌控</span>癌细胞转移，缩小肿瘤，再进行手术。<span style="color: black;">日前</span>，化疗仍然是晚期胃癌的最<span style="color: black;">重点</span>治疗手段。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic2.zhimg.com/80/v2-984d6c35e17a1ee35a35922891fc77e9_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;">总而言之，癌症晚期要不要手术，<span style="color: black;">必定</span>要反复<span style="color: black;">思虑</span><span style="color: black;">危害</span>和收益。<span style="color: black;">倘若</span>收益大于<span style="color: black;">危害</span>，即使<span style="color: black;">病人</span>的意愿不强，<span style="color: black;">大夫</span>和家属<span style="color: black;">亦</span>应该好好劝说，鼓励<span style="color: black;">病人</span>接受手术，勇敢地活下去。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3. 别等到晚期，才<span style="color: black;">发掘</span>胃癌</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">我国是“胃癌大国”，据统计，2020年我国胃癌新发47.8万例，死亡37.3万例，发病数位列所有肿瘤第三位。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">胃癌的早诊率较低，经常被误以为是胃炎、胃溃疡等胃病，<span style="color: black;">引起</span>确诊时<span style="color: black;">已经是</span><span style="color: black;">发展</span>期，即使进行手术，5年<span style="color: black;">存活</span>率<span style="color: black;">亦</span>不到30%。然而，胃癌<span style="color: black;">倘若</span>能<span style="color: black;">初期</span><span style="color: black;">发掘</span>，其5年<span style="color: black;">存活</span>率<span style="color: black;">达到</span>90%以上，<span style="color: black;">乃至</span>实现治愈。</p>
<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;">咱们</span>要对胃癌症状有所<span style="color: black;">认识</span>，避免与普通胃病混淆。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic1.zhimg.com/80/v2-12902f11db3163872ce14138ccbdd7ec_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;">初期</span>胃癌缺乏<span style="color: black;">显著</span>症状，<span style="color: black;">因此呢</span>较难被<span style="color: black;">发掘</span>。<span style="color: black;">通常</span>而言，胃癌的<span style="color: black;">平常</span>症状<span style="color: black;">包含</span> ： </p>消化不良或胃灼热 腹部<span style="color: black;">病痛</span>或不适 <span style="color: black;">摄食</span>后胃胀 恶心和呕吐，<span style="color: black;">尤其</span>是<span style="color: black;">摄食</span>后不久呕吐固体<span style="color: black;">食品</span> 腹泻或便秘食欲不振<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">晚期胃癌的症状可能<span style="color: black;">包含</span>：</p>体重<span style="color: black;">没</span>故下降虚弱和疲劳吐血和便血<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">胃癌的病征与胃病、胃炎<span style="color: black;">类似</span>，容易令人混淆。即使<span style="color: black;">显现</span>以上病征，<span style="color: black;">也</span>未必<span style="color: black;">必定</span>是患上胃癌。<span style="color: black;">不外</span>，倘若<span style="color: black;">显现</span>以上任何一种症状，便应该立即求医，进行<span style="color: black;">仔细</span><span style="color: black;">检测</span>。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic4.zhimg.com/80/v2-d752061af6041cad4191e5bad2837e77_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic4.zhimg.com/80/v2-4f24b0dc46f704148d1904954e01cc73_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">预防胃癌</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">远离胃癌威胁，这些成因要<span style="color: black;">晓得</span>！</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">胃癌成因</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">吸烟及饮酒</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">吸烟人士患上胃癌的<span style="color: black;">危害</span>比非吸烟者高达100%。<span style="color: black;">长时间</span>摄取酒精可破坏胃壁黏膜细胞的DNA，令其产生恶性病变。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">感染幽门螺旋杆菌</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">幽门螺旋杆菌会损害胃壁黏膜<span style="color: black;">引起</span>溃疡，<span style="color: black;">引起</span>胃细胞产生变化，<span style="color: black;">长时间</span>的慢性感染可能令病变的胃细胞逐步演化成癌症。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">膳食</span>习惯</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">高盐、腌 制、 熏 烤 <span style="color: black;">食品</span>经过胃的消化<span style="color: black;">功效</span>，会产生致癌物亚硝酸胺；高盐<span style="color: black;">成份</span>会损害胃壁并<span style="color: black;">引起</span>细胞病变而逐步演变成胃癌。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">胃腺性息肉</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">绝大<span style="color: black;">都数</span>胃瘜肉都不会有恶性病变，若胃腺性瘜肉大于两厘米，其中28-40%会有恶性变化，有机会演变成癌症。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">胃癌检测</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">胃癌能自测出来吗？有什么<span style="color: black;">检测</span><span style="color: black;">办法</span>？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">一次胃镜能保几年<span style="color: black;">安全</span>？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">胃镜<span style="color: black;">检测</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">检测</span>时，<span style="color: black;">大夫</span>会将一条幼而富弹性的喉管伸入口中，<span style="color: black;">大夫</span>会利用胃镜<span style="color: black;">检测</span>食道、胃部及十二指肠。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic2.zhimg.com/80/v2-a28b5280d9395a2036624f46f7803ea5_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;">胃镜<span style="color: black;">检测</span>（日、韩）</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">■ 亚洲属于胃癌的高发地区，<span style="color: black;">包含</span>日本、韩国。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">■ 在最新版《日本胃癌筛查指南》中，<span style="color: black;">举荐</span>筛查的<span style="color: black;">初始</span>年龄为 50 岁，并未规定终止年龄。依据过去日本和韩国的<span style="color: black;">关联</span><span style="color: black;">科研</span>，将筛查间隔设为 2-3 年。据报告，日本每年大<span style="color: black;">大概</span> 11% 的人去做了胃镜<span style="color: black;">检测</span>，平均每五年就相当于有 50% 的人<span style="color: black;">最少</span>做了一次胃镜<span style="color: black;">检测</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">■ 在日本，超过50%<span style="color: black;">病人</span>确诊时尚算<span style="color: black;">初期</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">■ 韩国<span style="color: black;">亦</span>于1999年<span style="color: black;">起始</span><span style="color: black;">意见</span>40岁或以上人士每隔两年接受胃镜<span style="color: black;">检测</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">■ 普查<span style="color: black;">起始</span>之后，大概46%到67%<span style="color: black;">病人</span>于<span style="color: black;">初期</span>确诊。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">五年<span style="color: black;">存活</span>率由1993-1995年的43%<span style="color: black;">提升</span>到2006-2011年的69%。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic3.zhimg.com/80/v2-ba43b3c7b40ba89e7ce59bb66b1b21de_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">胃镜<span style="color: black;">检测</span>（内地）</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">按照</span>《中国<span style="color: black;">初期</span>胃癌筛查流程专家共识意见》（草案），年龄 ≥ 40 岁且符合以下 5 条中任一条者<span style="color: black;">意见</span><span style="color: black;">做为</span>胃癌高危人群<span style="color: black;">意见</span><span style="color: black;">做为</span>筛查对象：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">①胃癌高发地区人群；</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">②幽门螺杆菌感染者；</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">③既往<span style="color: black;">身患</span>慢性萎缩性胃炎、胃溃疡、胃息肉、手术后残胃、肥厚性胃炎、恶性贫血等胃癌前<span style="color: black;">疾患</span>；</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">④胃癌<span style="color: black;">病人</span>一级亲属；</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">⑤存在胃癌其它高危<span style="color: black;">原因</span>（高盐、腌制<span style="color: black;">膳食</span>、吸烟、重度饮酒等）。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">针对</span>胃病<span style="color: black;">病人</span><span style="color: black;">来讲</span>，<span style="color: black;">意见</span>定期进行胃镜<span style="color: black;">检测</span></p><span style="color: black;">通常</span>性慢性萎缩性胃炎，每3年做1次胃镜；不完全性结肠型肠上皮化生伴轻度不典型增生，每年做1次胃镜；伴中度不典型增生，每3个月做1次胃镜；伴重度不典型增生者、上皮内瘤变，可<span style="color: black;">思虑</span>手术切除病灶。<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">即便是治癌<span style="color: black;">数年</span>的<span style="color: black;">大夫</span>，<span style="color: black;">亦</span><span style="color: black;">仅有</span>在患癌时才体会到<span style="color: black;">病人</span>的痛苦。此时尚健康的<span style="color: black;">咱们</span>，还有什么理由不做好预防呢？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">参考资料：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">《你不<span style="color: black;">晓得</span>的肿瘤故事都在<span style="color: black;">这儿</span> ，<span style="color: black;">大夫</span>亲历：患癌这么痛苦！| 肿瘤世相》.健康时报. 2018-09-12</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">《癌症晚期，还有<span style="color: black;">无</span>必要做手术？你<span style="color: black;">必须</span><span style="color: black;">认识</span>这些……》.中国癌症<span style="color: black;">恢复</span>与姑息治疗. 2020-04-29</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">《胃癌症状难察觉，<span style="color: black;">怎样</span><span style="color: black;">才可</span>早预防？》.人卫健康. 2018-01-03</p>
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