外科引流
1.Drainage is a confession of imperfect surgery.
—— Howard Kelly, 1858——1943
【译文】引流是对欠完美手术的默认。
2.No drainage is better than the ignorant employment of it.
—— William Stewart Halsted, 1852——1922
【译文】不知道如何留置引流管还不如不引流。
3.A drain invariably produces some necrosis of the tissue with which it comes in contact, and enfeebles the power of resistance of the tissues toward organisms.
—— William Stewart Halsted, 1852——1922
【译文】引流不可避免地会导致与其接触的组织出现一些坏死, 从而削弱组织对微生物的抵抗力。
【点评】有时甚至导致较大血管的溃破引起大出血。
4.The more imperfect the technique of the surgeon the greater the necessity for drainage.
—— William Stewart Halsted, 1852——1922
【译文】外科医生的手艺越不完美越显得引流的重要。
5.If you have to use drains to take care of post-operative hemorrhage then you did not finish the operation.
【译文】如果你出于术后出血的考虑留置引流管, 那就意味着你这台手术还没有结束。
6.The first and most important result of the war in the surgical world will be the abandonment once and for all of the drainage tube.Its day is past, and soon it will only be seen, where it should be, in the museum.
—— F.Hathaway, ?——1918
【译文】在手术世界里，第一个也是最重要的战果将是最终彻底地放弃引流。引流管的时代已经过去，很快我们只能够也只应该在博物馆里看到它了。
【点评】很遗憾，一百年过去了，博物馆里有引流管，但外科医生保险箱里的引流管更多。
7.After draining the axillary abscess of Queen Victoria: "It occurred to me that in this deep and narrow incision, the lint, instead of serving as a drain, might have acted like a plug".
—— Joseph Lister, 1827——1912
【译文】为维多利亚女王做完腋窝脓肿引流后：“我突然想到，在这个又深又窄的切口里，那个纱布引流条，不但达不到引流目的，其作用更像一个瓶塞”。
【点评】现在，我查房时依然经常可见到这种瓶塞般的引流条。
8.Drainage of the general peritoneal cavity is a physical and physiological impossibility.
—— J.L.Yates, ?——1905
【译文】无论物理上还是生理上都不可能引流全部腹腔。(https://www.daowen.com)
【点评】须记住，这是各种引流措施的死穴。
9.That you call something a drain does not guarantee that it actually drains.
—— Rick Paul
【译文】所谓的引流不保证能真正起到引流作用。
10.When in doubt drain.
—— Robert Lawson Tait, 1845——1899
【译文】心存疑虑时就该留置引流。
11.There are those who ardently advocate it, there are those who in great part reject it, there are those who, Laodicean——like, are lukewarm concerning it, and finally, some who, without convictions, are either for or against it … as chance or whim, not logic may determine.
—— Joseph Price, 1853——1911
【译文】（关于引流）有人热捧，有人极力反对，有人则像老神仙（Laodicean）一样——对其不冷不热，最后，也有些人，不置可否，或赞成，或反对……或者因心情而异、此一时彼一时，无逻辑可言。
【考注】Laodicean 本应翻译为“老底嘉”，该词原指早期的基督徒，后衍生为对宗教事务持冷淡态度的人。由于文化的差异，此处笔者转译为处事圆滑、不轻易表态的“老神仙”不知是否合适？
12.Drainage of the peritoneum though one of the most important subjects in abdominal surgery, is yet one which stands in a most uncertain position.
—— Charles Bingham Penrose, 1862——1925
【译文】腹腔引流虽然是腹部手术中最重要的话题之一, 但其地位依然十分不明确。
13.Although more than five million surgical drains are used each year in the United States, their effectiveness, therapeutic indications, and efficiency remains an unsolved controversy.
—— J.P.Moss
【译文】尽管美国每年使用各种外科引流管超过500万根，但其有效性、应用指证和效果仍存争议。
14.Despite the dictum that it is impossible to effectively drain the peritoneal cavity, drains are still commonly used and misused.
—— Moshe Schein
【译文】尽管有权威意见说腹腔引流不可能有效，但引流依然常用甚至滥用。
15.Never ask the following questions: Would you drain it? Should you drain it? Did you drain it?
—— Leo A.Gordon
【译文】绝不要问：你愿意放引流吗？你应该放引流吗？你放了引流吗？
【点评】本章共收集有关外科引流的格言15条，面对“术后留置引流管”问题大致分三种观点：其一，尽管目前无确切证据证实引流管是否有效，但实践中还是应用广泛，11～15条是也；其二，由于受各种因素制约，引流管的实际引流效果有限，7～10条是也；最后，1～6条，是引流管的极力反对者，似乎只要留置引流管就是外科医生的不称职。我想只要干过几天临床的外科医生都有自己对引流管的个人经验，时间到了21世纪的今天，莫说引流管进博物馆，反倒是国内外不少外科名家仍然在亲力亲为地设计各种引流管，改良引流方式，可见引流的存与废并不那么简单。译者认为：“When in doubt drain.”百年前外科前辈留下的这句话依然受用。