手术操作与技巧
1.In the part of medicine that cures by hand, it is obvious that all improvement comes chiefly from this, even if assisted somewhat in other ways.
—— Celsus, 25 BC——50 AD
【译文】很明显，在用手治病的医学领域里，尽管其他因素也不是无所助益，但最终结果的改善还主要取决于手的表现。
【点评】尽管操作只有25%的重要性，但没有这25%的功底也会功亏一篑。外科医生真不容易！——心灵手巧，缺一不可。
2.Surgery should be a merciful art; the cleaner and gentler the act of operating,the less the patient suffers.
—— Berkeley Moynihan, 1865——1936
【译文】外科手术是一种仁慈的艺术，每一个动作越利落、越轻柔，患者遭罪就越少。
3.The human body is a work of art and artistry is needed in dealing with its delicate tissues.
—— Berkeley Moynihan, 1865——1936
【译文】人体是艺术的杰作，在处理其精致的组织结构时需要有艺术的技巧。
4.The lack of dexterity may account for almost as much post-operative morbidity and post-operative mortality as does lack of knowledge.
—— Hugh Devine, 1878——1959
【译文】技术不熟练所造成的术后并发症和死亡率不亚于知识缺乏所导致的。
5.Technical difficulties are rarely insurmountable with practice, ingenuity, and the passage of time.
—— Elliott Carr Cutler, 1888——1947
【译文】没有通过实践、才智和时间的代价克服不了的技术难题。
【点评】世上无难事，只要肯登攀。
6.It's not practice that makes perfect.It's perfect practice that makes perfect.
—— Vince Lombardi
【译文】不是多练就能完美，只有完美的多练才能造就完美。
【点评】简单的、拙劣的重复只能固化拙劣，只有手脑并用，用心反复练习方可造就完美。
7.Actual operative skill cannot be gained by observation, any more than skill in playing the violin can be had by hearing and seeing a virtuoso performing on that instrument.
—— Allen O.Whipple, 1881——1963
【译文】实际操作技能不可能仅凭观察获得，就像小提琴演奏技能无法通过耳听和目睹小提琴家的演奏获得一样。
8.Medical illustrators are optimists ...
—— Asher Hirshberg
【译文】医学插图画家都是乐观主义者……
【点评】纸上谈兵当然无所忧虑。
9.To any operative video you watch add a pint of blood and sweat; then you'll get the reality.
【译文】在你观看的任何一段手术录像中，加入一品脱的血和汗，你就有了身临其境的感觉。
10.Now a surgeon should be youthful or at any rate nearer youth than age;with a strong and steady hand which never trembles and ready to use the left hand as well as the right.
—— Celsus, 25 BC——50 AD
【译文】现在的外科医生要年轻，或者至少不会太老，有一双稳定而有力的手，从不颤抖，随时准备“左右开弓”。
【点评】年龄或许不一定有特别的界定，但体力强壮、精力充沛无疑是一名优秀外科医生的基本要求。
11.He should have well-formed limbs, especially the hands, the fingers long and slender, agile and not trembling; all the other limbs strong, in order to be able to execute in manly fashion.
—— Henri de Mondeville, 1260——1320
【译文】外科医生应该四肢健壮，尤其是手，手指细长、灵巧而不颤抖，其他肢体也要强壮，这样才能够以男子汉的方式行事。
12.For the difficult surgery of today, a sturdy pair of legs is also an indispensable necessity!
—— Owen H.Wangensteen, 1898——1981
【译文】为了当今的高难度手术，强健的双腿绝对是不可少的！
13.To intrude an unskilled hand into such a piece of devine mechanism as the human body is indeed a fearful responsibility.
—— Joseph Lister, 1827——1912
【译文】一只笨拙的手侵入人体这样一个神圣的机体，的确是一种可怕的责任。
14.The finger is superior to all instruments.Covered with parts soft and supple, it causes little pain, it can be placed in narrow spaces; flexible, it conforms to various parts; sensitive, it permits the appreciation of the variations in resistance of the parts percussed.
—— Henri A.Hartmann, 1860——1952
【译文】手指优于所有器械，其顶端柔软、灵活，更少引起（患者）疼痛，可伸入狭小空间随意转动，适用于身体各个部位，触觉敏感，可以感知其所触击部位的各种阻力变化。
【点评】手指优于一切器械的常识是不需要论证的。
15.The index finger is still the best instrument.
【译文】食指依然是最好用的手术器械。
【点评】即使今天那可以5400 旋转的达·芬奇机器人手腕在某些方面已超过了上帝赋予我们的手，但在灵敏的感觉和力度反馈方面还有相当的差距。
16.With a knife, pair of scissors, a few clamps, a few fingers and a suture, you can do anything.
【译文】凭借一柄刀、一把剪、几把血管钳，几个手指和一根缝线，你就能做任何事情。
【点评】的确，传统外科手术在手术台上对“高大上”设备的依赖是最少的，全凭外科医生一双巧手。
17.Just as there are no great one-handed lovers, there are no great one-handed surgeons.
—— Howard Mc Collister
【译文】就像没有伟大的单相思情人一样，同样没有伟大的一只手外科医生。
18.There is no cavity that cannot be reached with a number 14 needle and a good strong arm.
—— Samuel Shem
【译文】一根14G的穿刺针外加一只强有力的手臂则没有穿不透的腔隙。
【点评】这句话是在嘲讽那些力大过牛的外科医生（也许是麻醉医生）做穿刺操作时野蛮用劲的粗鲁行为。Acta Anaesthesiol Scand杂志（2011，55:765）曾以这句话为标题报道过一个罕见病例：一例左侧颈内静脉留置有一根透析导管的患者，后来因抢救的需要又在其左锁骨下静脉再穿刺一条中心静脉压导管，后者竟然不偏不倚地穿透析导管而过，直到最后拔管困难时才发现。
19.Five things are proper to the duty of chirurgeon: to take away that which is superfluous; to restore to their places such things as are displaced; to separate those things which are joined together; to join those that are separated ; and to supply the defects of nature.
—— Ambroise Pare, 1510——1590
【译文】外科医生就干这五件事：去除冗余、修复移位、分离粘连、缝合断裂或（和）裂口以及填补自然缺损。
20.There are only two things in surgery: cut and sew.(https://www.daowen.com)
【译文】手术就两件事：切和缝。
21.I can recognize a good surgeon, not by how he cuts, but how he sews.
—— Johan Mikulicz-Radecki, 1850——1905
【译文】我评价一名优秀外科医生不是看他如何切，而是看他如何缝。
【点评】个人认为“切”与“缝”孰轻孰重难分伯仲，尤其是恶性肿瘤手术。
22.If it looks good, it might work.If it does not look good, it will never work.
—— William Siler
【译文】看着顺眼的才可能好用，看上去不顺眼的一定不好用。
【点评】同意，直觉很重要。
23.If you do not know what you are cutting, don't cut it!
【译文】如果你不知道你在切什么，不要切它！
24.When you don't know what you are doing: be extremely careful.
【译文】当你不知道自己在做什么时：务必非常小心。
25.If an operation is difficult, you are not doing it properly.
—— Robert E.Gross, 1905——1988
【译文】如果手术很困难，说明做得不对。
【点评】其实这是一条非常有用的经验。当手术进展特别困难时，往往是发生了某种错误，应停下来想想，是解剖的层面、入路不对，还是手术的时机不对？
26.Go to the heart of danger and there you will find safety.
—— Kenneth L.Mattox
【译文】深入危险中心，你就找到了安全。
【点评】手术中当你总在危险区域外围踟蹰不前，或者找不到进入危险地带的入路时反倒是最危险的。譬如在裸化肝门部门静脉、肝动脉时，你不敢直接切开血管鞘，只是在其外围东切一点，西分一点的时候是最危险的，一旦进入血管鞘，就势如破竹，进入了最安全的地带。
27.It is well to wax the twisted thread so that it does not cut the flesh.
—— Jean Yperman, 1260——1310
【译文】捻制线浸蜡不错，它可减少对组织的切割。
【点评】捻制线属于多股线范畴，与编织线相比其主要缺点是：结构松散，易绽线，易藏匿细菌。在可以“按外科手术要求合成缝线”的今天已不需要再用捻制的多股线了。
28.Use as thin a ligature as seems consistent with the required strength.
—— Augustus Charles Bernays, 1854——1907
【译文】结扎用线的粗细应该与看上去所需要的力度相匹配。
【点评】不少基层医院的外科医生习惯用粗线，不知是他们医院设备科采购的品种不够齐全还是外科医生觉得越粗的线结扎效果越可靠？
29.Tie a suture like you embrace the one you love: firmly but tenderly.
—— Rick Paul
【译文】打结要像拥抱你所心爱的人那样：坚定但不失温柔。
30.Not every little artery needs tying; a clamp left on for a few minutes often suffices and avoids a foreign substance in the wound.
—— Augustus Charles Bernays, 1854——1907
【译文】并非每个小动脉都需结扎，通常止血钳多夹几分钟即可止血，这样可减少伤口中的异物。
【点评】在能量止血器械无处不在的今天这个技巧已毫无价值。记得20世纪80年代，做一个普通上腹正中切口皮下脂肪层切开时少说要用10 把止血钳，目的就是对皮下组织内的小血管进行暂时的压榨止血。
31.Have seen another surgeon of excellent repute place the handle of his knife in his mouth for safe-keeping while he was busy tying ligatures.
—— Thomas S.Cullen, 1868——1953
【译文】我见过另一位名声显赫的外科医生，在他忙于打结时，为了安全起见，竟然把刀柄衔在嘴里。
【点评】洗手护士干吗去了？
32.When tissues must be cut, a knife is probably the best tool to use.and blunt dissection is usually bad surgery.
—— William Heneage Ogilvie, 1887——1971
【译文】如需切断组织，刀或许是最好的工具，多数情况下钝性解剖是个不良手术习惯。
【点评】同意，很多情况下锐性解剖更精准、有效。
33.In my humble opinion dissection with the hook is like eating soup with a fork.
—— Pieter Prinsloo
【译文】依我之拙见，用钩子分离组织就像用叉子喝汤。
【点评】Pieter Prinsloo医生是澳大利亚的一位做腹腔镜结直肠手术的普外科医生，此处的钩子一定是腹腔镜用的电钩。我想不一定所有腹腔镜外科医生都同意他的观点。
34.All instruments ought to be well suited for the purpose in hand as regards their size, weight, and delicacy.
—— Hippocrates, 460——377 BC
【译文】所有器械的尺寸、重量和精致程度都应该正好适合于所进行的操作。
【点评】工欲善其事，必先利其器，得心应手的手术器械对外科医生而言至关重要。
35.[About using the anastomotic button he invented]: It takes about as long to describe the operation as to perform it.
—— John B.Murphy, 1857——1916
【译文】（关于使用他自己所发明的吻合钮时Murphy说）：讲述如何操作所花时间和做这个手术的时间一样长。
【点评】没想到的是这个首先描述急性胆囊炎“墨菲（Murphy）征”的爱尔兰籍美国医生早在百年前就研制出了“吻合钮”。
36.Staplers are not a quick road to surgery for the untrained and will not turn a neophyte into a virtuoso.
—— Mark M.Ravitch, 1910——1989
【译文】对于未经训练的人来说，吻合器并不是手术的捷径，也不可能让新手变巧匠。
【点评】不可能指望1～2件新的手术器械提高手术操作技能。
37.It is my understanding that the stapler is rarely to be blamed in mishaps.The surgeon has the greater share of blame.The learning curve about staplers is about not asking the stapler to manage situations beyond its capacity and applicability.
—— P.O.Nystrom
【译文】以我的理解，出纰漏时很难去指责吻合器，需反省的是外科医生自己。所谓吻合器的学习曲线并不是让你用吻合器来处理超出它能力和适用范围的那些情形的。
【点评】是的，我们经常指责吻合器质量有问题时或许是因为我们选择不当。当然，有时也的确存在质量问题。