食管、胃与十二指肠
1.The esophagus is a difficult surgical field ...for its inaccessibility, is lack of serous coat, and its enclosure in structures where infection is especially dangerous and rapid.
—— Ivor Lewis, 1895——1982
【译文】食管是一个困难的手术部位……因为它难以接近，无浆膜层覆盖，并且环绕其周围的那些结构一旦感染就特别危险且进展迅速。
2.Esophagus: as a result of the muscle being loosely knit, anastomosis implies suturing the unsuturable ...
—— Ivor Lewis, 1895——1982
【译文】食管：因其肌肉组织排布松散，吻合实际意味着在无法缝合的地方进行缝合……
3.(On esophageal perforations): When it (occurs) it can be recognized but it cannot be remedied by the medical profession.
—— Herman Boerhaave, 1668——1738
【译文】（关于食管穿孔）：食管穿孔可诊断，但无法进行医学救治。
【考注】据称Hermann Boerhaave博士是第一个报道食管穿孔病例的医生。1724年他描述了荷兰海军元帅Jan van Wessenaer男爵在催吐后发生了食管破裂并瞬即死亡。所以，Boerhaave说：“当（发生）食管穿孔时，可以被识别，但无法获得医学救治。”直到1947年，Barrett才成功地进行了第一例的食管穿孔修补术[Tex Heart Inst J.2001；28（1）： 65-68.]。从能诊断食管穿孔到能做食管穿孔修补术经历了漫长的223年！
4.Separate a man's desire for food from his ability to ingest it and you have dysphagia.Interrupt the pathway from the mouth to belly and you have an alarming symptom for which a patient usually seeks advice without delay
—— P.B.Nelson
【译文】想吃而咽不下去，那么你就是吞咽困难，即从口腔到腹部这段的通路受阻，通常这是一个促使患者应尽早去看医生的警觉症状。
5.Any foreign body which traverses the cricopharyngeus will negotiate the rest of the gastrointestinal tract.
—— Ivor Lewis, 1895——1982
【译文】任何通过了环咽肌的异物都将给胃肠道的其余部分带来麻烦。
6.It is an interesting fact that practically every operative procedure which has been advocated as a method of therapy for bleeding esophageal varices has a small percentage of salvaged cases.
—— R.Cohn
【译文】一个有趣的事实是，实践中几乎所有被用作治疗食管曲张静脉出血的手术都只能挽救一小部分患者的生命。
【点评】因为除了肝移植以外，这些手术都是治标不治本。
7.Cancerous disorganization of the stomach, in some instances, gives no indication of its existence, sufficiently distinct to render its detection possible,during life, even by the most compelling and careful observers.
—— Elisha Bartlett, 1804——1855
【译文】有时候，即便是最令人叹服和最细心的观察者也很难发现癌变的胃在其整个病程中有任何足够明显、能提醒我们应察觉其存在的征兆。
【点评】在那个X线都还没发现的年代，人们只能“望癌兴叹”。
8.The history of gastric surgery is littered with interpositions, pouches, and attempts to make the gastric reconstruction similar to the underground railway in Vienna.
—— David Dent
【译文】胃外科手术史上充斥着各种接驳方式、各种储袋，以及试图用类似于维也纳地铁网的方式实现胃的重建。
【点评】这比喻真不假，有些胃肠重建的手术图谱真像错综复杂的立交桥。
9.After proximal gastrectomy with esophagogastric anastomosis the reflux is such that the patients lean over to kiss their wives, with green bile running down the corners of their mouth like blood does from Dracula's.
—— David Dent
【译文】近端胃部分切除后的食管-胃吻合术所导致的胃-食管返流会让患者在俯身亲吻其妻子时，绿色胆汁像吸血僵尸的血一样顺着其嘴角流下来。
【点评】尽管这个描述有些夸张，但近端胃部分切除-食管胃吻合术后的胃-食管返流症状的确让患者苦不堪言。
尽管消化性溃疡手术目前已经很少做了，但了解其历史对我们认识其他疾病会有所帮助，更重要的是其外科学原则在其他类似的病理生理状况依然适用。
10.The gastric juice is a fluid somewhat transparent, and a little saltish or brackish to the taste.
—— John Hunter, 1728——1793
【译文】胃液是一种有点透明、味道有点咸或苦涩的液体。
【点评】想要知道梨子的滋味，就要亲口尝一尝。
11.Etiology of an ulcer: either a naughty or irregular diet or the ill disposition of entrails.
—— Ambroise Paré, 1510——1590
【译文】消化性溃疡的病因：瞎折腾、不规律饮食或机体内源性的某些异常特质。
【点评】几百年过去了，虽然当今我们认为胃十二指肠溃疡的发病机制主要与胃酸分泌过多、幽门螺杆菌感染和黏膜防御机制减弱有关。但“瞎折腾、不规律饮食或机体内源性的某些异常特质”这三大病因似乎依然正确。
12.The brain secretes thought as the stomach secretes gastric juice, the liver bile, and the kidneys urine.
—— Karl Vogt, 1817——1895
【译文】大脑往外冒思想就像胃分泌胃液、肝脏分泌胆汁和肾脏产生尿液一样。
【考注】或许只有Karl Vogt 这位德国19世纪著名的科学家、同时又是哲学家和政治学家才会这样武断地将人类思想的产生简单类比为“胃分泌胃液……”这一论断最大的破绽是无法解释为什么人类的胃液、胆汁和尿液的化学成分都大同小异，而人类的思想却千差万别。
13.No acid, no ulcer.
—— K.Schwartz, ?——1910
【译文】没有酸就没有溃疡。
【点评】尽管现在观点认为“消化性溃疡是诸多致病因素综合作用的结果”，但胃酸的过度分泌依然是消化性溃疡形成的一个重要因素。
14.Too much or too little of anything is not good, including wine, other things and perhaps acid.
【译文】任何东西太多或太少都不好，包括葡萄酒和其他东西，也许还包括胃酸。
15.It may really be a compliment to acquire a peptic ulcer; the great genius,the poet, the philosopher are always the most susceptible.
—— George Washington Crile, 1864——1943
【译文】患消化性溃疡者可能真值得庆贺；伟大的天才、诗人、哲学家都是该病的高度易感人群。
16.Osler referred to duodenal ulcer as "the wound stripe of civilization".Perhaps we are becoming less civilized.
—— Edward R.Woodward
【译文】Osler曾把十二指肠溃疡称为“文明的伤痕”。也许我们正在变得不那么文明了。(https://www.daowen.com)
17.I believe that peptic ulcer is undoubtedly developed by a combination of local chemical effects, possibly causing prolonged vessel spasm or claudication, a counterpart of Raynaud's disease or scleroderma, or by direct interference with the circulation through infarction by emboli of bacteria, chemically and mechanically active in the tissues and thereby lowering the local resistance to the action of digestive fluids.
—— Charles H.Mayo, 1861——1939
【译文】我相信，消化性溃疡无疑是多因素综合作用的结果，即局部化学作用、可能引发了类似于雷诺病或硬皮病样的长时间血管痉挛或“间歇性跛行”，也可能是由组织中兼具化学和机械双重活性的细菌栓子所导致的梗死直接干扰了（局部）循环，从而降低了对消化液的局部抵抗力。
【点评】百年来，Mayo教授关于消化性溃疡形成机制的这一假设逐步得到证实。
18.(In perforated peptic ulcers): It must be remembered that the exudate in the early cases is sterile or nearly so, and the peritoneal reaction is a response to chemical irritation by the gastric and duodenal contents rather than the result of bacterial invasion.
—— John Blair Deaver, 1855——1931
【译文】（消化性溃疡穿孔）：须记住，早期溢出的液体是无菌或近乎无菌的，腹膜反应是胃和十二指肠内容物所引发的化学刺激反应所致，而非细菌入侵的结果。
19.When the blood is fresh and pink and the patient is old, it is time to be active and bold.When the patient is young and the blood is dark and old, you can relax and put your knife on hold.
—— Moshe Schein
【译文】老年患者，出血新鲜而粉红应积极、大胆地手术；年轻患者，出血陈旧而暗红色，可暂缓手术也不用那么紧张。
20.Perforated ulcer: there is a hole in my bucket … how should I mend it?Just patch it!
—— A.folk song
【译文】溃疡穿孔的治疗犹如民谣所唱：我的桶有个洞，怎么修？补上它。
21.We have no responsibility to such patients but to save their lives.Any procedure, which aims to do more than this, can quite significantly be considered meddlesome surgery.We have no responsibility during the surgery to carry out any procedure to cure the patient of his original duodenal ulcer.
—— Roscoe R.Graham, 1890——1948
【译文】除挽救生命，对这些患者我们没有其他责任。任何以做得更多为目的的手术完全可以被认为是惹是生非。溃疡穿孔手术期间我们没有任何责任去进行任何企图治愈十二指肠溃疡原发病灶的手术。
22.Every doctor, faced with a perforated ulcer of the stomach or intestine,must consider opening the abdomen, sewing up the hole, and averting a possible or actual inflammation by careful cleansing of the abdominal cavity.
—— Johan Mikulicz-Radecki, 1850——1905
【译文】每位医生面对胃或肠溃疡穿孔时，必须考虑打开腹部，修补穿孔，并通过仔细清洗腹腔以避免可能或实际已发生的炎症。
【点评】现在大多数研究认为，对胃穿孔患者进行大量腹腔冲洗的弊大于利。
23.As to the type of operation [for perforated peptic ulcer], much depends on the state of the patient and upon the experience of the surgeon.The occasional operator may have to contend himself with simple suture of the perforation, but the more experienced surgeon, will, if he is wise, add a gastro-enterostomy and thus ensure better results; while the specialist in abdominal surgery may even venture resection or pyloroplasty...
—— John Blair Deaver, 1855——1931
【译文】至于（消化性溃疡穿孔）的手术类型，很大程度上取决于患者的状况和外科医生的经验。有时，当一名术者还在满足于简单的穿孔缝合术时，经验更丰富的外科医生，如果明智的话，他会加一个胃-空肠吻合术以确保更好的结果；而腹部外科专家甚至可能冒险做（胃部分）切除或幽门成形术……
【点评】“消化性溃疡穿孔的手术方式选择”是20世纪中后叶一个热门的学术话题。
24.I do not know any operation in surgery which gives better results.which gives more complete satisfaction, both to the patient and his surgeon, than gastroenterostomy for chronic ulcer of the stomach.
—— Berkeley Moynihan, 1865——1936
【译文】无论对于患者还是外科医生，我不知道还有什么手术能取得比胃-空肠吻合治疗慢性胃溃疡更好、更满意的效果。
【点评】这是Moynihan那个时代的认识。严格意义上讲，没做胃窦切除，或者胃迷走神经切断术的单纯胃-空肠吻合术是无法治愈慢性胃溃疡的。
25.If anyone should consider removing half of my good stomach to cure a small ulcer in my duodenum, I would run faster than he.
—— Charles H.Mayo, 1865——1939
【译文】如果有人要切除我一半的正常胃来治愈我十二指肠的一个小溃疡，我会跑得比他快。
【点评】如今终于废除了这个不完美的手术！
26.In ten-fifteen years when the final bad results of vagotomy will have been evaluated, the operation will be in the same category as gastroenterostomy.
—— Alton J.Oschner, 1896——1981
【译文】在未来10～15年，当（胃）迷走神经切断术的最终不良结果得到评估时，则会把该手术与胃空肠吻合术归在同一类。
【点评】作者的预言得到了应验。曾盛极一时的迷走神经切断术和胃空肠吻合手术都已几近废止。
27.About gastrectomy for duodenal ulcer: in this operation ...a segment of an essentially normal stomach is removed to treat the disease next door in the duodenum.It is like taking out the engine to decrease noise in the gear box.
—— Francis D.Moore, 1913——2001
【译文】关于十二指肠溃疡的胃切除术：这个手术，为了治疗与之相邻的十二指肠溃疡却切掉了一段基本正常的胃，这就像通过取出发动机来减少齿轮箱中的噪声一样。
【点评】可当时缺乏有效降低胃酸分泌的办法啊！
28.Doing a gastrectomy for an ulcer is to produce another disease.
—— Moshe Schein
【译文】溃疡患者行胃部分切除术后会引发另一种疾病。
【点评】比如：叶酸缺乏性贫血、维生素D缺乏等。
29．Those who always do a Billroth II never learned how to do a Billroth I.
—— Moshe Schein
【译文】那些总做Billroth II式（手术）的人从来不学习如何做Billroth I式手术。
【点评】总是有些外科医生乐意根据个人的喜好选择手术方式，而不是病情的需要。
30.With proper Kocherization you can bring the duodenum through the mouth and by dividing the lesser omentum and the gastrocolic omentum you can bring the stomach out the ass.Thus, if you want you can do a Billroth I between your stomach and my duodenum without tension, so why do a Billroth II?
—— Moshe Schein
【译文】通过合适的Kocher游离，你可以将十二指肠提到腹部切口；切断小网膜和胃结肠上的大网膜后你可将胃拉到臀部去。因此，如果你能在没有张力的情况下完成胃与十二指肠之间的Billroth I式手术，那么为什么要做Billroth II式手术呢？
【点评】的确如此。本人是在做了胃癌根治手术后才明白这个道理的。
31.In the era of Helicobacter pylori doing a gastrectomy for peptic ulcer is like doing a lobectomy for pneumonia.
—— Asher Hirshberg
【译文】 在幽门螺杆菌时代，因消化性溃疡而行胃部分切除就像为肺炎患者做肺叶切除一样。
【点评】正因为如此，目前胃部分切除已不再作为单纯消化性溃疡的治疗手段，除非有与之相关的癌变或其他并发症。