第八十一章 疝
1.You can judge the worth of a surgeon by the way he does a hernia.
—— Thomas Fairbank, 1876——1961
【译文】看他如何处理疝，你就能判断一名外科医生的价值。
2.The history of hernia is the history of surgery.
—— Loyd Nyhus & Robert E.Condon
【译文】疝的历史就是一部外科史。
【点评】完全同意。“疝”病虽小，但却能充分体现一名外科医生的外科基本知识、基本理论和基本操作技能；同时人们对疝的认识与处理也很具代表性地反映了一部恢宏的外科发展史。
3.Dr.Erle Peacock (——1926) ruled: "a hernia is an abnormal protrusion of an organ through an opening!" Whereupon the intern stuck out his tongue at Dr.Peacock saying, "so would this be a hernia, sir?"
—— Peter Bradshaw
【译文】埃尔勒·皮科克博士说：“疝是一个器官经某个开口突出来的异常突起！”于是，实习医生向皮科克医生伸出舌头：“那么这是疝吗，先生？”
【点评】这孩子真够调皮的啦！不过逻辑倒是没毛病。
4.There is no doubt that the first appearance of the mammal, with his unexplained need to push his testicles out of their proper home into the air, made a mess of the three layered abdominal wall that had done the reptiles well for 200 million years.
—— William Heneage Ogilvie, 1887——1971
【译文】毫无疑问的是，只有哺乳动物才第一次出现这种现象，即它莫名其妙地把自己的睾丸从一个舒适的家推到了外面，结果把三层的腹壁弄得一团糟，而这一小小演变竟然让这种爬行动物出色地生存了2亿年。
【点评】的确，这一进化还是很令人费解的，或许是为了出来凉快凉快、还是显摆显摆呢？
5.For the understanding of the etiology, the pathology, the clinical manifestations and, particularly, the surgical repair of an indirect inguinal hernia, a profound knowledge of the anatomy of this region is indispensable.
—— Frank Netter
【译文】为了搞懂腹股沟斜疝的病因、病理、临床表现，特别是手术修补，深刻理解该区域的解剖学知识是必不可少的。
6.No disease of the human body, belonging to the province of the surgeon,requires in its treatment a better combination of accurate anatomical knowledge,with surgical skill, than a hernia in all its variety.
【译文】没有哪一种外科疾病，比治疗各种各样的疝需要更好地把精确的解剖学知识和外科技术结合起来的了。(https://www.daowen.com)
【点评】其实每一种外科手术都离不开精确解剖知识和外科技术的完美结合，疝只不过是这方面的一个典型代表而已。
7.Always explore in cases of persistent vomiting if a lump, however small, is found occupying one of the abdominal rings and its nature is uncertain.
—— Augustus Charles Bernays, 1854——1907
【译文】有持续呕吐的患者，如果在腹部某个疝环处有个包块，即使很小，并且其性质不确定，都应该仔细检查。
【点评】不仅是呕吐，所有急腹症鉴别诊断时都不要忘了这些区域。
8.When a rupture occurs in the groin, and part of the intestine and omentum comes down into the scrotum ...let him lie on his back ...and ...hold his breath till the intestine ...comes out; then put it back with your finger, then below the hernia over the pubic bone, mark a semicircle...then heat a cautery ...when it is white hot and emits sparks ...have the assistant put his hand over the place to prevent the exit of the intestine ...then apply the cautery to the mark ...and hold it until it reaches the bone ...if you do not bring the cauterization down to the bone your operation will not be successful ...the patient should lie on his back for forty days so that the wound may cicatrise.
—— Albucasis, 936——1013
【译文】当腹股沟组织缺损破裂时，部分肠和大网膜进入阴囊……让他仰卧……然后……屏住呼吸直到肠道……（从阴囊）退出来，并用你的手指将其送回腹腔，然后在耻骨上的疝环下面，标记一个半圆……然后加热烧灼器……当它达到白热并冒火花时……助手用手堵在那儿以防肠道脱出……在标记的地方灼烧，持续直至深达骨头……如果烧灼不能深达骨头，手术就不会成功……最后，让患者仰卧四十天，这样伤口才能愈合。
【点评】读完这段话后的感觉如何？是惊悚到浑身颤抖，还是佩服得五体投地？无论如何，我总算知道了百年前的先辈们是如何进行腹股沟疝还纳修补术的了。
9.In order to achieve a radical cure (of inguinal hernia) it is absolutely essential to restore those conditions in the area of the hernial orifice, which exist under normal conditions.
—— Edoardo Bassini, 1844——1924
【译文】为了彻底治愈（腹股沟疝），恢复那个“疝孔”区域的正常结构是绝对必要的。
【点评】这就是疝修补术的基本原理。古往今来种类繁多的疝修补术都是为了恢复这个区域的正常结构，越接近正常结构的术式效果越近完美。
10.What is the use of opening the sac? I know of none except to explore the intestine and omentum, to remedy complications it there are any.
—— Jean Louis Petit, 1674——1750
【译文】打开疝囊干嘛？除非需要探查疝入其内的小肠和网膜，或者有并发症需要处理，否则没有必要。
【点评】当然，疝囊巨大，准备旷置或需要翻转部分远端疝囊时也是需要打开疝囊的。准确的表达应该是一般情况下不需要打开进入阴囊内的远端疝囊。
11.No altered or mortified part should be returned loose to the belly.
—— Percival Pott, 1714——1788
【译文】任何不正常或受到损害的疝内容物都不应送回腹腔。