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作者们基于自己的经验，论述了胃癌手术中的三个问题：１）当今胃癌手术原则变更，早期胃癌中粘膜内癌、分化型、无溃疡形成者，依不同部位、不同大小，可行各种缩小的手术。进行期胃癌的外科治疗原则仍是扩大切除术。着重提出胃癌行胰头十二指肠切除术，胃上、中部癌联合尾侧半胰切除术适应证的变更。２）胃癌淋巴结转移的临床研究①淋巴结转移与癌浸润胃壁深度有明显正相关关系。胃壁内粘膜肌与浆膜对胃癌淋巴结转移似有屏障作用；②淋巴结转移的计量学与分级研究，根据转移枚数与转移距离（站）分为五级。其中Ⅰ、Ⅱ级为淋巴结清除术的良好适应证。Ⅲ级行Ｄ３清除术亦可获较好疗效。但Ⅳ、Ⅴ级转移，即使行Ｄ２、Ｄ３清除术，疗效亦明显不佳。外科医师术中确定淋巴结清除范围与估计预后时，必需根据转移分级才能做出正确的决策；③淋巴结转移的分型，分为大结节融合型与小结节孤立型。前者貌似转移严重，实际上多较限局，后者转移严重而广泛。３）胃癌腹腔脱落癌细胞的检测与杀灭方法的现状：①胃癌脱落癌细胞是进行期胃癌一个独立的预后不良因素，胃癌根治术后腹膜转移者占４０％～５０％。手术操作造成的损伤、出血以及ＣＥＡ的分泌释放，更为脱落癌细胞形成腹膜转移提供了条件；②腹腔脱落细胞的?
Based on their own experience, the authors discussed three issues in the surgery of gastric cancer: 1) Current principles of gastric cancer surgery, early gastric cancer, intramucosal cancer, differentiated, and ulcer-free, depending on the site, size, and feasibility Shrinking surgery. The principle of surgical treatment of gastric cancer is still extended resection. Focus on the proposed pancreatic head and duodenal resection of gastric cancer, gastric and central cancer combined with caudal hemi-pancreatic resection indication changes. 2) Clinical study of lymph node metastasis in gastric cancer. There is a positive correlation between lymph node metastasis and the depth of gastric cancer infiltration. Intramural mucosal muscle and serous membranes may play a barrier role in lymph node metastasis of gastric cancer. 2 Metabolic and grading studies of lymph node metastasis can be divided into five grades based on the number of metastases and the metastatic distance (station). Among them, grades I and II are good indications for lymph node dissection. Grade III D3 clearance can also achieve better results. However, IV, V grade metastases, even if D2, D3 removal surgery, the effect is also significantly poor. When surgeons determine the range of lymph node clearance and estimate the prognosis during operation, it is necessary to make a correct decision based on the grade of metastasis. 3 The classification of lymph node metastasis can be divided into large nodule fusion type and small nodule isolated type. The former seems to be seriously diverted. In fact, there are many more limited bureaus, and the latter is serious and extensive. 3) The current status of detection and killing methods of gastric cancer cells with peritoneal exfoliation: 1 Gastric cancer exfoliated cancer cells are an independent prognostic factor for advanced gastric cancer, and peritoneal metastasis after radical gastrectomy accounts for 40% to 50%. The injury caused by surgical operations, bleeding, and the release of CEA secretion provide conditions for the formation of peritoneal metastases from exfoliated cancer cells; 2 Abdominal cavity exfoliated cells?