肠梗阻
1.The jejunum is more exempt from morbid conditions than any other portion of the alimentary canal.
—— William Withey Gull, 1816——1890
【译文】空肠是整个消化道中最少发生病变的一段肠管。
2.I have finally come to conclusion that a good reliable set of bowels is worth more to a man than any quantity of brain.
—— Henry Wheeler Shaw, 1818——1885
【译文】我终于明白，对一个人而言，一副好肠胃胜过任意一个精明的头脑。
【点评】作者并非医生，而是19世纪美国著名的幽默作家。
3.In ileus the belly becomes hard, there are no motions, the whole abdomen is painful, there are fever and thirst and sometimes the patient is so tormented that he vomits bile ...Medicines are not retained and enemas do not penetrate.It is an acute and dangerous disease.
—— Hippocrates, 460——377 BC
【译文】肠梗阻时，腹壁变硬、运动受限，全腹疼痛，伴发热和口渴，有时患者被折磨得呕吐胆汁……吃进去的药物存不住，灌肠也灌不进去，这是一种急性而危险的疾病。
【点评】两千多年前人类就对急性肠梗阻的临床表现有如此详细而全面的描述， 难得！
4.My work essentially has been that of plumber of the alimentary canal.I have worked on both ends, but largely in between.
—— Owen H.Wangensteen, 1898——1981
【译文】我的工作基本上就是一名消化道管道工，我在其两端都工作过，但主要还是在两端之间干活。
5.The suggestion that radiography should be employed in the diagnosis of intestinal obstruction one which should be condemned whole-heartedly ...I prefer the seeing eye of a living human clinician to the scientific eye of a dead machine.
—— H.J.Paterson, 1932
【译文】借助于X线片诊断肠梗阻的建议应予以彻头彻尾的谴责……相比于机器的科学眼而言，我更喜欢临床医生活生生的眼睛。
【考注】这是1932年发表在《英国医学杂志》上的“急性肠梗阻”一文中的一句话，作者主要是针对有些临床医生过分依赖辅助检查作诊断这种倾向时说这句话的。时至今日，“不可过分依赖机器的辅助检查结果”的理念依然正确，但不可否认越来越精细、生动的影像诊断技术已远远超越我们裸眼的能力。
6.Scout films taken 8 or 24 hours after a half ounce of oral barium are invaluable in managing intestinal obstruction.
—— Ivor Lewis, 1895——1982
【译文】 口服半盎司（约14g）钡剂8h或24h后，在X线机上摄几张片对肠梗阻的处理是非常有价值的。
【点评】怀疑肠梗阻时口服钡剂拍片常会加重肠梗阻，不过那个年代可能也没有其他更好的办法。
7.Intestinal adhesions are the refuge of the diagnostically destitute!
—— Sir William Osler, 1849——1919
【译文】“肠粘连”常被用作难以做出合适诊断时的托词。
【点评】临床上导致肠梗阻的原因很多，应尽量从多个角度寻找其原因，不能简单以“肠粘连”敷衍了之。
8.The only thing predictable about small bowel obstruction is its unpredictability.
—— Moshe Schein
【译文】小肠梗阻唯一可以预测的就是它的不可预测性。
9.The truth is that most patients (with early postoperative intestinal obstruction) will improve without you ever knowing whether it was a mechanical obstruction or "just" an ileus.
—— Moshe Schein
【译文】事实上，大多数患者（尤其是术后早期肠梗阻）常常在还没分清是机械性肠梗阻或者“只是”肠麻痹时，病情就已经开始好转。
10.It is almost impossible to further increase the current mortality associated with acute mesenteric ischemia.
—— Moshe Schein
【译文】当前，与急性肠系膜缺血相关的病死率已经高得不能再高了。
11.Occlusion of the mesenteric vessels is regarded as one of those conditions of which the diagnosis is impossible, the prognosis hopeless, and the treatment almost useless.(https://www.daowen.com)
—— A.Cokkins, ?——1921
【译文】肠系膜血管闭塞被认为是一种难以获得及时诊断、预后不佳、治疗几乎无效的疾病。
【点评】随着影像诊断和介入治疗技术的进步，“肠系膜血管闭塞”的诊断与治疗都有了很大改观，但依然是一种易误诊、预后差的十分凶险的急腹症。
12.Subjects with acute intestinal obstruction die from the phenomena of septic poisoning.
—— Frederick Treves, 1853——1923
【译文】急性肠梗阻患者多因败血症而死亡。
【点评】那个年代尚没形成准确的“败血症”概念，但“the phenomena of septic poisoning”说的应该就是“败血症”的概念。
13.It is now accepted by everybody that the chief cause of death in simple obstruction of the small bowel ...is circulatory failure due to loss of water and electrolytes.
—— W.D.Gatch & C.G.Culbertson，?——1939
【译文】现在大家都已认识到单纯性小肠梗阻的主要死因是水和电解质丢失所导致的循环衰竭。
14.It is obvious from the physiological consequences that if all patients with mechanical obstruction are operated upon as soon as the diagnosis is made, the operative mortality will be high.If there are signs of ischemia, immediate operation is indicated, otherwise allow time to replenish water and electrolyte deficits.
—— G.Thomas Shires, 1925——2007
【译文】从生理学结果很容易看出，如果所有机械性肠梗阻患者一经确诊就立即手术，手术死亡率一定高。除非有缺血迹象应立即手术外，否则应留出时间补充水和电解质的不足。
【点评】认识到液体复苏在急腹症处理中的重要作用是现代外科学一个巨大进步。
15.The frequent necessity of resection for the relief of intestinal obstruction is a sombre commentary on the diagnostic ability of the profession.In the very large majority of cases delay is responsible rather than the primary cause of ileus.
—— William J.Mayo, 1861——1939
【译文】如果经常需切除（肠段）来缓解肠梗阻，只能说明其专业诊断能力令人担忧。绝大多数肠切除的原因是延误诊断导致了肠坏死而不是肠梗阻的初始病因。
16.In cases of intestinal obstruction, when the physician's art has failed to give relief, the surgeon's and is occasionally requested and it would be well for the medical mind to recognize that in a large proportion of cases this aid is sought too late a period.
—— Thomas Bryant, 1824——1914
【译文】肠梗阻时，当内科医师未能使病情缓解时，就应想到求助于外科医生，并且就医学思维而言最好能认识到，在多数情况下，这个时候寻求帮助都为时太晚。
17.Never let the sun set or the dawn rise over a complete intestinal obstruction.
【译文】完全性肠梗阻患者的手术时机拖延绝不要超过12h。
【点评】完全性肠梗阻有发生肠绞窄的风险，需要及时手术。尽管当下有不少先进的辅助检查手段，但要及时准确鉴别哪些患者是完全性肠梗阻，可能存在肠绞窄仍然有一定困难。外科医生应综合评估做出自己的判断。
18.It is less dangerous to leap from the Clifton Suspension Bridge than to suffer from acute intestinal obstruction and decline operation.
—— Fredrick Treves, 1853——1923
【译文】患急性肠梗阻，又拒绝手术者，比从克利夫顿悬索桥上跳下的危险更大。
【考注】跨越英国西部布里斯托Avon峡谷的克里夫顿悬索桥是世界上最早的大跨径悬索桥之一，它是由天才的设计师、维多利亚时代的工程师布鲁·耐尔（I.K.Brunel）设计于19世纪30年代，在他去世后的1864年才建成通车。桥面距水面落差245英尺（约74.68m），据称克里夫顿悬索桥是现代蹦极跳的发源地。
19.Lysis of all small bowel adhesions is not required because I believe that the bowel is "locked in the open position" by these chronic adhesions.
—— Timothy Fabian
【译文】没有必要对所有小肠的粘连进行松解，因为我相信这些慢性粘连不会影响肠管的通畅。
20.Would it be not better to make an incision and draw out the strangulated intestine with fingers, than leave the patient in danger of his life?
—— Paul Barbette, 1632——1704
【译文】做个切口，用手指把被勒住的小肠捋顺，难道不比让患者等在那冒生命危险来得好吗？
21.(About intestinal anastomosis): The uniform continuity of the peritoneal surfaces, and the ready disposition of these surfaces to assume the adhesive inflammation, are the means provided by nature for the reparation of intestinal wounds and injuries.
—— Benjamin T.Travers, 1783——1858
【译文】（肠吻合时）：尽量保持浆膜面完整的连续性、让表面对合良好，以确保其容易形成黏着性炎症，这是利用机体自然修复力修复肠道伤口和损伤的好方法。
【点评】肠道吻合时所用缝线的主要作用是将吻合的两端分层对合在一起，愈合则是靠自身的愈合能力。正如著名的法国外科医生巴雷（Ambroise Pare，1510——1590）所言：“我包扎伤口，上帝使其愈合。”因此，良好的血供、适当的松紧度、吻合两端相匹配的口径与厚度是最大限度发挥组织自我愈合能力的重要前提。