外科的未来
1.There must be a final limit to the development of manipulative surgery.The knife cannot always have fresh fields for conquest; and although methods of practice may be modified and varied, and even improved to some extent, it must be within a certain limit.
—— John Erichsen, 1818——1896
【译文】以技术讨巧的外科发展一定有最后的极限。手术刀不可能总是有新的疆域可征服。尽管手术方法可以改良和花样翻新，甚至进行较大程度改进，但一定是有限度的。
2.The paradigm shift in surgical truths was from vehemence-based and eminence-based medicine, to evidence-based medicine.
—— David Dent
【译文】外科真理的范式已从以激情和声望为基础的医学转向以证据为基础的医学，即循证医学。
【点评】这是一种从感性到理性的转变。
3.It is less important to invent new operations and new techniques of operating than to find ways and means to avoid surgery.
—— Bernhard von Langenbeck, 1810——1887
【译文】与其发明新手术和新手术技术，还不如想办法避免手术。
【点评】此话没错，问题是远水难解近渴。比如当前大多数的实体肿瘤，在有效的非手术治疗手段问世之前还得在手术方式和技巧方面下功夫。
4.As medicine has advanced, the role of surgery has decreased.The day will certainly come when surgery will be done only to correct the effects of trauma and congenital abnormalities.
—— R.H.Meade
【译文】随着医学的进步，手术的作用已经下降。外科只负责矫治创伤和先天畸形的那一天肯定会到来。
【点评】正如大师所言，如今像“迷走神经切断术治疗消化性溃疡”“甲亢的甲状腺大部分切除”等已经基本为非手术治疗所替代，但离这位大师所期待的那一天还很遥远。
5.What should we beg the boffin to produce for us? The first is a contrast medium excreted by the pancreas——that will give a reasonably accurate estimate of pancreatic function, and allow the demonstration of obstruction to the ducts and of tumors at an early stage.The second is some systemic hemostatic that will arrest the bleeding from small vessels divided at operation.
—— William Heneage Ogilvie, 1887——1971
【译文】我们应该请求研究人员为我们生产什么？首先是经胰腺分泌的造影剂——有助于我们科学准确地评估胰腺功能，并能早期发现胰管阻塞和肿瘤；其次是一些全身止血药，可以阻止手术中小血管出血。
【点评】目前，各种MRI影像技术应该接近第一目标了。至于止血剂，尤其是只作用于局部出血的小血管而不影响全身的止血剂目前效果仍不够理想。
6.Manual skill has not appreciably improved in the last 50 years, and cannot improve much further, but manual skill is not the whole of surgery.
—— William Heneage Ogilvie, 1887——1971
【译文】过去50年，并无多少值得称赞的手工技术改进，能改进的空间也不大，重要的是手中技巧并非外科手术的全部。
【点评】可以告慰这位大师的是，您离开我们后的这50年里，有好几项值得称道的外科操作技术的革命，至少各种微创外科技术、手术机器人应该算吧。此外今天的器官移植、心脏外科，甚至常规手术所用的各种新器械也是50年前所不能比的。
7.Surgery of the future will not tolerate the divorce of the hand from the brain and the surgery of the future will not be merely handicraft.
—— Isidor S.Ravdin, 1894——1972
【译文】未来的手术将不会容忍（外科医生）手与脑的分离，未来的手术也不会只追求操作技艺。(https://www.daowen.com)
【点评】不允许手脑分离必将是外科医生永恒的原则。
8.In the surgery of the future the individualist will be left by the roadside, for after all surgery is part of that broader field of experimental pathology to which all the medical sciences belong.
—— Isidor S.Ravdin, 1894——1972
【译文】在未来的外科中，个人英雄主义将被摒弃，因为毕竟外科只是医学科学这个整体中广义实验病理学的一部分。
【点评】 在医学科学不断向纵深发展的今天，这种警醒尤为重要。MDT诊疗模式的应用与推广就是这种理念最好的实践样板。
9.Everything which can be done within the anatomical limits of the human body has been done.Nothing is left to be done.Nothing is left to be dared.With great satisfaction we can sit back since we have reached the peak of surgery.
—— Jean–Louis Faire
【译文】一切能在人体解剖范畴内做的事情都已做完了，没啥可做的了、没啥不敢做的了。既然已经抵达外科手术的巅峰，我们可以心满意足坐享其成了。
【点评】大师是在反讽那些对现代医学科学进步无所贡献的外科医生吗？
10.The craft of surgery has in truth nearly reached its limit in respect both of range and safety.
—— Berkeley Moynihan, 1865——1936
【译文】实际上，就手术技艺而言，其范围和安全性几近达到极限。
11.Phase 1 was the era of horror: cutting off, cutting open (butcher's trade).Phase 2 was the era of extensive surgery.(I call it kilogram surgery.) Phase 3 is the era of "tissue——sparing operations" (patient——friendly surgery), in which we are,I believe, right now——another phase (Phase 4) will follow where common surgery has ended.Possibly surgeons will then be responsible for trauma only.The surgeon will probably be referred to as a "tissue engineer" who manipulates cells and tissue instead of resecting organs, as suggested by Sir James Black, the Nobel Prize winner.
—— Hans Troidl
【译文】（外科的）第一阶段是恐怖时代：切掉、切开（屠夫营生）；第二阶段是扩大手术时代（我称为“论斤手术”）；第三阶段是“组织保留手术”时代（患者友好型手术）。我相信，目前另一个新时代（第四阶段）即将到来——那时不再需要这些普通手术，外科医生可能只负责外伤。正如诺贝尔奖得主詹姆斯·布莱克爵士（Sir James Black）所描述：外科医生将被称之为“组织工程师”，主要工作就是捣鼓捣鼓细胞和组织，而无需要切除器官。
【点评】但愿预言早日成真！
12.The abdomen, chest, and brain will forever be closed to operations by a wise and humane surgeon.
—— John Erichsen, 1818——1896
【译文】腹腔、胸腔以及颅脑将永远对智慧又仁慈的外科医生关闭。
13.A surgeon who tries to suture a heart wound deserves to lose the esteem of his colleagues.
—— Theodor Billroth, 1829——1894
【译文】任何企图缝合心脏伤口的人必将失去同事的尊敬。
【点评】预测未来是一件有相当风险的事。您看这12、13两句圣人级大师的预言，不禁让我们大跌眼镜，真愿意相信是编辑错误。巧合的是国人所熟知的《克氏外科学》（第19版）第一章“外科史”的最后一段正好引用了这两句令人大跌眼镜的外科预言来说明未来一切皆有可能。书中说：“鉴于对错综复杂外科发展史的了解，似乎很难预测未来会发生什么。1874年伦敦的John Erichsen刚写下‘the abdomen, chest, and brain will forever be closed to Operations by a wise and humane surgeon’, 没隔几年Theodor Billroth又说‘A surgeon who tries to suture a heart wound deserves to lose the esteem of his colleagues’，因此，最好还是不要去占卜外科的未来了吧。”
14.Never scope tomorrow what you can scope today.
【译文】永远不要用今天的目光看明天的事。