目的  通过对温州医科大学附属第一医院 3 例晚期胃癌患者维持治疗全程观察，探讨手术干预（时机及方式选 择）、低剂量化疗及营养治疗在晚期胃癌患者维持治疗中的作用。方法  对3 例确诊为胃癌晚期的患者，在病程不同阶段采 取手术干预、低剂量化疗及营养治疗（以肠内免疫营养制剂方案为主）作为维持治疗措施。维持治疗的化疗药物连续应用 14 天，停药7 天，以 21 天为1 个周期，用药剂量为普通剂量的50%~75%。根据患者对上一轮治疗方案的胃肠道反应VAS 评分变化、骨髓抑制程度（血常规）及脏器损伤程度调整本轮治疗措施（调整幅度±25%）；根据患者对头一天的肠内营 养耐受 VAS 评分调整营养方案（以肠内营养为主，不足的量用肠外营养补充）；根据胃肠道梗阻是否影响患者饮食及营养 状况，决定是否进行手术。结果  3 例患者维持时间分别为30 个月、15 个月、22 个月；3 例患者对低剂量化疗及营养治疗 依从性良好（VAS 评分7 分以上，总分10 分）。在治疗期间均经过手术治疗，手术目的不一，例1 因幽门梗阻早期行胃 肠短路术，其目的是为了畅通消化道（总存活30 个月，术后存活30 个月）；例2 因原发病灶及盆腔转移病灶有所退缩， 行“姑息性全胃切除术，Roux-Y 吻合”，目的为切除肿瘤（总存活 15 个月，术后存活 12 个月）；例 3 因出现癌性肠梗阻 行剖腹探查，行“姑息性全胃切除、食道 - 空肠Roux-Y 吻合+ 全结肠切除、回肠造瘘术”，目的是在减除梗阻的同时， 达到减瘤的目的（总存活22 个月，术后存活4 个月）。结论  在晚期胃癌患者中低剂量化疗及营养治疗联合应用并根据病 情变化及时调整方案，可以在延长患者生存时间及改善生活质量上发挥一定作用；合适的手术时机及手术方式对延长患 者生存时间有一定的作用，但过于复杂的手术不一定能达到预期目的，并且可能因手术创伤带来的不利影响缩短患者的生 存时间。

Objective Discuss surgical intervention (timing and option) and the effects of maintenance therapy with low dose chemotherapy and nutritional support in patients with advanced gastric cancer by observing 3 cases from the first affiliated hospital of wenzhou medical university. Methods 3 patients with advanced gastric cancer were treated by surgical intervention, low dose chemotherapy and nutritional therapy at different stages as maintenance therapy. Maintenance treatment of chemotherapeutic drugs lasted for 14 days, 7 days interval, 21 days for a cycle, with the 50%~75% dose of the average; the dose was adjusted in next cycle (the adjusted range ± 25%) according to the VAS score (visual analogue scale) of gastrointestinal reaction in the previous cycle and the degree of myelosuppression (blood routine test) and organ injuries; the nutrition program was adjusted (mainly enteral nutrition, supplementally parenteral nutrition) according to the VAS score of enteral nutrition tolerance in the previous day. Results 3 patients lived for 30 months, 15 months, and 22 months respectively; 3 patients had a good compliance to chemotherapy and nutritional treatment (VAS score of 7 points or more, total score of 10 points) and all performed surgery with different purposes. The first patient performed gastrointestinal short circuit operation on the early stage because of gastric intestinal obstruction, and survived total 30 months; the second patient, total survival of 15 months and the postoperative survival 12 months, performed the Palliative total gastrectomy, Roux-Y operation when imaging and anal examination showed primary lesions and pelvic metastases were regression after a period of chemotherapy; the third patient, total survival of 22 months and postoperative survival of 4 months, performed the operation of palliative total gastrectomy and esophageal jejunal Roux-Y anastomosis, total colectomy and ileostomy for malignant obstruction in the late stage for the purpose of reducing the tumor and disengage obstruction. Conclusions Low dose chemotherapy and nutritional support, with the plan adjusted according to the condition changes, can play a certain role in prolonging the survival time and improving the life quality of the advanced gastric cancer patients; the appropriate timing of operation and operative methods have certain effect to prolong the survival time of the patients, but the excessive surgery is not always able to achieve the desired objective, and maybe bring adverse effects due to surgical trauma.