Transcript Unit 7 Modern Surgery
Unit 7 Modern Surgery
Word Formation
lapar/o
( abdomen) e.g. laparo
scope gynec/o
( female) laparo
scopy
laparo
scopic cholecyst/o
( gallbladder)
-ectomy ( excision/removal)
e.g. cholecystectomy
-ology
( study) e.g. gynecology
esophag/o
( esophagus) e.g. gastro-esophageal
splen/o
( spleen) e.g. spelectomy
adren/o -on
( adrenal glands) e.g. proton chylomicron
thorac/o
( thorax) e.g. thoracoscopic
my/o
(muscle) e.g. myo
tomy col/o ( colon)
e.g. colectomy
nephr/o
( kidney) e.g. nephrectomy
gastr/o
( stomach) e.g. gastrectomy
peritone/o
( peritoneum) e.g. intraperitoneal
corpus-
( body) e.g. extracorporeal
-oma
( tumor)
cyt/o
( cell ) e.g. phaeochromocytoma
contra-
(against) e.g. contraindication
lymph/o
( lymph)
-pathy
( disease) e.g. lymphadenopathy
axilla-
( armpit ) e.g. axillary
melan/o
( black ) e.g. melanoma
sympath/o
( sympathetic )
rect/o -pexy
(rectus) ( to fix )
固定
,
固定术
e.g.
rectopexy metastasis /metastases/metastatic/metastasize
Questions to consider:
1. What is minimal access surgery ?
2. What is minimal invasive procedure ?
3. Are you familiar with laparoscope / endoscope ?
An overview
What is Minimal Access Surgery?
Minimal access surgery is completed with one or more small incisions instead of a large incision. The surgeon passes a telescope with video camera through a small incision (usually only 1/4" long) into a body cavity. The surgeon then views the surgery on a TV monitor. Surgical instruments are then passed through other similar little incisions.
The surgeon examines and operates on the area in question by viewing magnified images on a television. When the telescope is used to operate on the abdomen, the procedure is called laparoscopy . When used in the chest, the procedure is called thoracoscopy , and when used in a joint, it is called arthroscopy .
Background The introduction of minimal access surgery (MAS) into common practice began in 1985, when laparoscopic cholecystectomy was first performed to remove a diseased gallbladder. In the immediate years thereafter, a small number of surgeons in the U.S. pioneered the development of laparoscopic techniques for this and other surgical applications. Recognizing the importance of their potential to improve patient care, Columbia University was one of the very first U.S. academic institutions to support the development of minimal access technologies and techniques.
MAS (ie, laparoscopy) has been used by gynecologists for more than 5 decades. Its application to general surgery began when the first laparoscopic cholecystectomy was performed in 1985. In 1987, the laparoscopic cholecystectomy was popularized, and laparoscopic cholecystectomy soon became the standard of care. Since that time, MAS has been applied to numerous other procedures with good results.
Ideal minimal access surgery has :
Reduced trauma associated with access
No compromise of exposure of operative field Surgery can be performed using the following approaches :
Laparoscopic
Thoracoscopic
Endoluminal
Intra-articular joint surgery
Combined approaches
Advantage of minimal access surgery
Less tissue trauma
Less postoperative pain
Faster recovery
Fewer postoperative complications
Better cosmesis
Disadvantages of minimal access surgery
Lack of tactile feedback
Increased technical expertise required
Possible longer duration of surgery
Increased risk of iatrogenic injuries
Difficult removal of bulky organs
More expensive
Established minimal access procedures
Laparoscopic cholecystectomy
Diagnostic laparoscopy
Laparoscopic appendicectomy
Laparoscopic fundoplication
Laparoscopic (or thoracoscopic) Heller's myotomy
Laparoscopic adrenalectomy
Laparoscopic splenectomy
Laparoscopic rectopexy
Equipment Special medical equipment may be used, such as fiber optic cables, miniature video cameras and special surgical instruments handled via tubes inserted into the body through small openings in its surface. The images of the interior of the body are transmitted to an external video monitor and the surgeon has the possibility of making a diagnosis, visually identifying internal features and acting surgically on them.
Instrument Refinement in fibreoptic technology and engineering have produced instruments which are used for so called ‘keyhole’ surgery. Fine tools can be passed into the abdominal and chest cavities so that many operations which previously required major incisions can now be performed through quite small puncture wounds. This is particularly well established in gynaecological surgery and in operations upon the gall bladder, and techniques are being devised for similar operations on other organs.
This technology also involves the development of instruments to pass along every tube in the body, for example to remove obstructions in the oesophagus, bile ducts, bowel, prostate, and major blood vessels. Many procedures on joints — for example, removal of a torn cartilage from the knee — can now be performed safely, using these minimal access techniques.
The laparoscope , a fiber-optic telescope, is inserted through one port (
口
,
孔
) and attached to a camera. It sends images from the abdominal cavity to television monitors placed for easy viewing by all the operating room personnel. Thus, the surgeon and his or her assistants can view the abdominal cavity and its contents. Through the remaining ports, long-handled instruments are used to perform various procedures.
Endoscopy is a minimally invasive diagnostic tool, used to view the inside of organs, inspect for abnormalities and take biopsies. A small camera and light source are mounted (fixed) onto a flexible tube which can be inserted into the mouth (to inspect the esophagus, stomach and duodenum) or the anus (to inspect the large bowel).
What is a minimally invasive procedure ?
A minimally invasive procedure is any procedure (surgical or otherwise) that is less invasive than open surgery used for the same purpose. A minimally invasive procedure typically involves use of laparoscopic devices and remote-control manipulation of instruments with indirect observation of the surgical field through an endoscope or similar device, and are carried out through the skin or through a body cavity or anatomical opening.
This may result in shorter hospital stays, or allow outpatient treatment. However, the safety and effectiveness of each procedure must be demonstrated with randomized controlled trials. The term was coined by John EA Wickham in 1984, who wrote of it in British Medical Journal in 1987.
Benefits Minimally invasive surgery should have less operative trauma for the patient than an equivalent invasive procedure. It may be more or less expensive. Operative time is longer, but hospitalization time is shorter. It causes less pain and scarring(
疤痕形成
), speeds recovery, and reduces the incidence of post-surgical complications, such as adhesions (
粘连
). However, minimally invasive surgery is not necessarily minor surgery that only regional anesthesia is required. In fact, most of these procedures still requires general anesthesia(
全麻
) to be administered beforehand.
Risks Minimally invasive procedures are not completely safe, and some have complications ranging from infection to death. Risks and complications include the following:
Anesthesia or medication reactions
Bleeding
Infection
Internal organ injury
Blood vessel injury
Vein or lung blood clotting
Breathing problems
Death (rare)
Understanding the Text
Para. 1
1. facilitate
---- v. to make sth. possible or easier; to improve
促进
,
促使
2. miniaturized video cameras-
---
微型摄像机
3. image reproduction-
---
影像重现
4. procedure 5. established
---- recognized
被确认
6. validate-
---vt. testify
验证
7. enabling technologies ----
使能技术 /支撑技术 /促成科技
enabling ---- a.
授权的
,
使成为可能的 “使能技术”：使其它工艺能够运行的技术 基本上用于：
1-
实现某种功能的技术。例：电子管、晶体管、集成 电路之于电子计算机。电子计算机之于自动控制。 软件之于硬件。
2-
使人具备某种本领、给予人某种便利的技术。例： 互联网之于电子商务。数字技术之于电影特技。 基因技术之于生物开发。
Virtual Reality
简介 虚拟现实，或虚拟实境(Virtual Reality)，简称VR 技术，也称 灵境技术 或 人工环境 ，是利用电脑模拟产 生一个三度空间的虚拟世界，提供使用者关于视觉、 听觉、触觉等感官的模拟，让使用者如同身历其境一 般，可以及时、没有限制地观察三度空间内的事物。 使用者进行位置移动时，电脑可以立即进行复杂的运 算，将精确的3D世界影像传回产生临场感。该技术集 成了计算机图形(CG)技术、计算机仿真技术、人工智 能、传感技术、显示技术、网络并行处理等技术的最 新发展成果，是一种由计算机技术辅助生成的高技术 模拟系统。
8. virtual reality laparoscopic simulator ---
虚拟的腹腔镜模拟装置
Para. 2 1. sea change----
巨变
2. optical telescope----
光学望远镜
3. unassisted--- unaided
没有助手
4. technical repertoire----
整个技术
sea change -- a profound transformation
巨变，突变，突发性彻底转变 和其很多出色的英语词汇一样，sea change的灵 感同样出自莎士比亚大师之手。莎翁的最后一部 传奇剧作《暴风雨》（The Tempest）中，莎翁用 sea change来表示一种根本的、彻底的变化，就 像某物长期淹没在水中所发生的变化一样。其实， 从莎翁的年代到今天，英语本身也经历了
sea change
。
Para. 3 1. of choice ---
首选的
,
精选的
2. retract ---vt. 1)
缩回
,
缩近
( pull back, draw back ) 2)
撑开
,
拉开
,
牵开
( use a surgical instrument to hold open (the edges of a wound or an organ) e.g. For the uncircumcised boy, retract the foreskin of the penis and cleanse. (
对未作包皮环截术的男孩，要将阴茎前的包皮 退上去清洗。
)
retractor n. ( surgical instrument that holds back the edges of a surgical incision)
① 牵开器
,
牵引器
;
外科撑开器 ：牵开切口边缘以及将 下方器官和组织拉向后方，以便保持手术暴露区的器 械；有许多种形状、大小和类型
e.g. soft tissue retractor
软组织牵开器 ②缩肌
Para. 4 1. Nissen fundoplication----
尼森胃底折术
2. gastro-esophageal reflux disease----
胃食管返流病
3. sentinel node biopsy----
前哨淋巴结病理切片
;
哨位淋巴结活检术
4. surgical robotics systems----
外科机器人技术
5. fuel---- vt.
支持
,
刺激
6. stage----v. (
癌症的
)
分期
( grade
分级
) (in oncology) to determine the presence and site of metastases from a primary tumour in order to plan treatment.
In addition to clinical examination, a variety of imaging and surgical techniques may be employed to provide a more accurate assessment.
What is Staging?
Staging is the process physicians use to assess the size and location of a patient’s cancer. Identifying the cancer stage is one of the most important factors in selecting treatment options. Several tests may be performed to help stage breast cancer including clinical breast exams, biopsy, and certain imaging tests such as a chest x-ray, mammogram, bone scan, CT scan, and MRI scan. Blood tests used to evaluate a woman's overall health and detect whether the cancer has spread to certain organs often follow imaging tests.
Gastro-esophageal reflux disease
胃食管返流病
----n. (Abbr. GERD) A chronic condition in which the lower esophageal sphincter allows gastric acids to reflux into the esophagus, causing heartburn, acid indigestion, and possible injury to the esophageal lining.
fundoplication
胃底折术
----a surgical operation for gastro-oesophageal reflux disease in which the upper part of the stomach is wrapped around the lower esophagus. The commonest technique is named after Rudolf Nissen, a Swiss surgeon.
Diagram of a Nissen fundoplication.
Dr. Rudolph Nissen first performed the procedure in 1955 and published the results of two cases in a 1956 Swiss Medical Weekly. In 1961 he published a more detailed overview of the procedure. Nissen originally called the surgery " gastroplication ." The procedure has borne his name since it gained popularity in the 1970's.
In a
fundoplication
, the gastric fundus (upper part) of the stomach is wrapped, or plicated, around the inferior part of the esophagus and stitched in place, reinforcing the closing function of the lower esophageal sphincter: Whenever the stomach contracts, it also closes off the esophagus instead of squeezing stomach acids into it. This prevents the reflux of gastric acid (in GERD). A fundoplication can also prevent hiatal hernia, in which the fundus slides up through the enlarged esophageal hiatus of the diaphragm.
Para. 5 1. engender --- vt. trigger
引发
,
引起
2. in terms of ---
在
…
方面
3. postoperative inpatient stay ---
术后住院时间
4. morbidity
----
n
. 不健康状态
Morbidity (from Latin morbidus: sick, unhealthy) refers to a diseased state, disability, or poor health due to any cause. The term may be used to refer to the existence of any form of disease, or to the degree that the health condition affects the patient. Among severely ill patients, the level of morbidity is often measured by ICU scoring systems.
Para. 6 1. accompanied by ---…
同时
2. a surge of ---
涌现
3. indications ---
有迹象表明
4. NHS ---
英国国家卫生服务体系
5. proton pump inhibitors ---
质子泵抑制剂
其他医疗体制模式
-
“
英国模式” ：是指英国国家卫生服务体系(National Health System，NHS)，政府举办和管理医疗机构，居 民免费获得医疗服务；医疗服务体系是典型的从上到 下的垂直体系；服务体系是双向转诊体系；医疗经费 80%以上来自政府的税收，其余来自私人医疗保险。 -
“
德国模式 ”：即全民医疗保险制度，医疗保障和医 疗服务体系分离，雇主和雇员向作为第三方的医疗保 险机构缴费，保险机构与医疗机构(公立、私立都可以) 签约以提供服务，不能参保者才由政府提供医疗服务。
-
“
美国模式” ：美国是发达国家中唯一没有全民保险 制 度的国家，其医疗制度，无论是财源确保方式还是医 疗供给方法都是以私营为主。个人医疗保险，除个人 单独购买的保险外，主要是雇主自发地给雇员及其扶 养者提供的群体性健康保险。
美国总统奥巴马2010年3月23日在白宫签署了医疗保险 改革法案。法案首次明文规定，几乎所有美国人都应 在2014年前拥有医疗保险。对于年收入低于43320美元 的个人和低于73240美元的三口之家，联邦政府将给予 医保补贴。 根据新的医改法案，美国将建立以州为基础的医疗保 险交易所，小企业和个人可以在交易所里通过联合议 价，享受与大公司员工或联邦政府雇员同样优惠的保 险费率。 小企业为员工购买医疗保险还将享受政府税收减免。 与此同时，政府还将对高收入群体加征个人所得税 并对高额保单加征消费税，作为医改资金的重要来源。
此外，医改法案加强了对保险行业的监管。根据法案， 政府可以通过一系列奖惩措施敦促企业向雇员提供医 保；保险公司不得以投保者的过往病史为由拒保或者 收取高额保费，不得在投保人患病后单方面终止保险 合同，不得对投保人的终身保险赔付金额设置上限等。 医改实施后，无医保者将是医改最大受益者。目前， 全美约4600万人没有医保，医改将使其中3200万人 获保，从而使医保覆盖率从85％升至95％，距离全民 医保只有一步之遥。对于低收入人群来说，这个法律 极大地扩大了医疗救助范围。此外，很多有工作的穷 人赖以生存的社区医疗中心也会得到更多的资金支持。
Para. 7 1. manometry----
（
食管）压力测定
2. pH monitoring ---
Para. 8 1. cost savings of … over ---
成本低于
2. justify ----vt. 3. inconvenience and morbidity of surgery ---
外科手术所带来的不便和不健康状态
4. collaborative trial 5. University of Aberdeen
阿伯丁大学简介（University of Aberdeen）
阿伯丁大学位于风景优美的苏格兰东岸，成立于1495 年，500多年历史，是英国最古老的六所大学之一， 是英国仅次于牛津、剑桥及伦敦大学之后的第四古老 大学。学校位于英国东北海滨城市Aberdeen的市中心， 校内国王学院有一座俯瞰海景的15世纪的教堂塔楼， 整个校园古典而肃穆，处处洋溢着古典名校的气息。
Para. 9 1. Heller’s myotomy ---
海勒肌切开术
Other names: cardiomyotomy----
贲门肌切开术
Heller’s operation----
海勒手术
2. rectopexy ---
直肠固定术
rect/o
直肠
-pexy
固定
,
固定术
Para. 10 1. hernia repair ---
疝修补
2. gamma probe ---
伽马探头
3. duodenal perforation ---
十二指肠穿孔
Para. 11 Para. 12 1. tension-free mesh repair----
无张力补片
(
网片
)
修补术
2. Lichenstein repair 3. Shouldice repair 4. on-lay mesh
Lichtenstein 疝中心是美国唯一一个集研究、教学和 手术为一体的腹外疝机构（腹股沟疝，股疝，脐疝，腹 疝和切口疝）。 1984 年， Lichtenstein 疝中心的世 界级疝专家首次在该中心发明和推广革命性的 疝补片无 张力修补手术 。今天， Lichtenstein 无张力疝修补术 不仅被全世界的医生广泛接受，而且被美国医师协会尊 称为疝修补手术的金标准。在美国政府资助下，美国医 师协会作过比较性实验，结果发表在 2004 年 5 月份的 “新英格兰医学杂志“上。
该实验结果中称 “ Lichtenstein 无张力疝修补术 就 修补原发性疝来说优于腹腔镜手术”。 这一手术方法不是简单地把疝缺损的边缘强行缝合在 一起，而是用一张补片覆盖缺损的部位。 该手术在局麻下进行，为日间手术，不用住院。 2-3 个星期内，病人自身组织生长入补片的网孔中，使网 片成为自身组织的一部分。
The Lichtenstein Hernia Institute is the only facility in the United States devoted exclusively to research, teaching and surgery of abdominal wall hernias (inguinal hernia, femoral hernia, umbilical hernia, ventral hernia or incisional hernia). In 1984, for the first time, internationally recognized hernia experts at the Lichtenstein Hernia Institute originated and popularized their revolutionary "tension free" mesh technique, which is now accepted worldwide and considered the gold standard of hernia repair by the American College of Surgeons.
In fact, according to the American College of Surgeons' comparative trials (government grant) published in the
New England Journal of Medicine
, May 2004, the Lichtenstein tension-free repair is "superior to the laparoscopic technique for mesh repair of primary hernias.”
The "tension-free" mesh technique was pioneered by the Lichtenstein Hernia Institute in 1984, and is currently considered the gold standard of hernia repair by the American College of Surgeons. In this procedure, repair is achieved by covering the opening of the hernia with a patch of mesh, instead of sewing the edge of the hole together
The surgery is performed under local anesthesia and on an outpatient basis. Within only two to three weeks, the patients own tissue grows into the mesh, making it a part of the patient's body
On-lay technique (intraabdominal placement of the materials on the peritoneum); Sub-lay technique (intraabdominal placement of the materials preperitoneal); In-lay technique (extraperitoneal placement of the materials )
Para. 13 1. bilateral/unilateral 2. unscarred----
无疤痕
Para. 14 1. demanding ---adj. 2. invest ---vt. 3. expertise ---n.
专门技术
4. port site ---
手术切口处
5. multi-centre prospective randomized trials ---
多中心前瞻性随机性试验
6. in progress --- under way 7. pose a challenge to ---
Para. 15 1. impetus ---
推动力
2. peritoneal cavity ---
腹膜腔
3. a proprietary sleeve and cuff ---
一种专用套管
4. pneumoperitoneum ---
气腹
5. specimen ---
样本
6. extracorporeal anastmosis ---
体外接合
Pneumoperitoneum
The presence of air or gas in the peritoneal cavity as a result of disease or for the treatment of certain conditions.
A pneumoperitoneum is deliberately created by the surgical team in order to perform laparoscopic surgery. This is achieved by insufflating the abdomen with carbon dioxide.
Para. 16 1. massively enlarged spleens----
脾大
2. ultrasonic dissector----
超声剥离器
3. atraumatic grasper----
无损伤抓取器
Para. 17 1. reservations----
保留意见
2. contraindication----
禁忌症
3. para-aortic lymphadenopathy----
主动脉侧淋巴结病
4. consensus ---(
意见的
)
一致
;
舆论
5. transperitoneal----
经腹膜
6. approach--- (
手术
)
入路 e.g.
1) Selection of operative
approach
for acetabular fracture
髋臼骨折手术入路的选择
2) Selection of procedure
approach
for skull base tumor
颅底肿瘤手术入路的选择
7. breach n.
违反
,
不履行
;
破裂
vt.
冲破
,
攻破
e.g. Emergent treatment and nursing care of 15 cases of spontaneous breach in primary liver cancer
原发性肝癌破裂出血
15
例急救与护理
8. capsule n.
包膜
e.g. Nursing for patients with advanced liver carcinoma complicating liver capsule hemorrhage and liver hemorrhage
晚期肝癌合并肝包膜下出血或肝破裂出血的护理
Para. 18 1. full axillary dissections----
乳腺全切除
2. axillary nodes----
腋窝淋巴结
(axillary lymph node dissection
Or:
axillary clearance
) 腋淋巴结清扫术
3. in conjunction with--- 4. radioisotope tracers----
放射性同位素示踪剂
5. drain----
引流
6. metastases----
转移
7. delineation----
勾画
,
描绘
;
划定
Para. 19 1. primary tumour--- 2. on an outpatient basis--- 3. settings----
Phrases in the Text
1. Minimal access surgery 2. Laparoscopic cholecystectomy/ rectopexy 3. Abdominal and thoracic operations 4. Nissen fundoplication 5. gastro-esophageal reflux disease 6. Setinel node biopsy 7. Minimally invasive surgery/procedure 8. Postoperative inpatient stay
9. Proton pump inhibitors 10. Esophageal manometry 11. Diagnostic accuracy / laporoscopy 12. Heller’s myotomy 13. Inguinal hernia repair 14. Gamma probe 15. Duodenal perforation 16. Hepatic resection
17. tension-free mesh repair 18. Long term recurrence rates 19. Bilateral / unilateral hernias 20. Unscarred tissues 21. multi-centre prospective randomized trials 22. Surgical community 23. Hand assisted surgery 24. Peritoneal cavity
25. Extracorporeal anastomosis 26. Massively enlarged spleens 27. Ultrasonic dissector 28. Atraumatic grasper 29. para-aortic lymphadenopathy 30. Full axillary dissections 31. Radioisotope tracer 32. On an outpatient basis