Surgery

[wài k ē]

Medical classification

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Surgery is a science that studies the occurrence, development law and clinical manifestations of surgical diseases, as well as diagnosis, prevention and treatment. It is a professional department that takes surgical resection and repair as the main means of treatment.

along with Microsurgical techniques Surgery has been greatly developed. The specialty setting principle of surgery in each hospital is similar to that of internal medicine, and usually corresponds to that of internal medicine. Surgical diseases are divided into five categories: trauma , infection tumour , deformity and dysfunction 。

Chinese name: Surgery
Foreign name: surgery
Pinyin: wàì k ē

Properties: Medical branch, and internal medicine Correspondence
Classification: trauma 、 Infected 、 tumour 、 malformation etc.
Disciplines involved: Surgery, modern surgery

catalog

one developing process
two Traditional Chinese Medicine Surgery
three Surgical classification
▪ General surgery
▪ Urology Surgery
▪ Cardio-Thoracic Surgery

developing process

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Surgery

Surgery is modern medicine A subject of, mainly studying how to use surgical operation Methods To remove the pathogen of the patient, so that the patient can be treated. Surgery and all clinical medicine Similarly, we need to understand the definition, etiology, manifestations, diagnosis, staging, treatment prognosis And surgery pays more attention to surgical indication , preoperative evaluation and care, surgical techniques and methods, postoperative care, surgical complications and prognosis and other issues related to surgery.

As early as Ancient Egypt Unearthed mummy You can find the surgical trace of the skull. As early as 2000 years ago, China has summarized some practical experience of surgery from the practice of war, production and life. Modern surgery was founded at the end of the 19th century. At first, it was often performed by trained barbers - the so-called "barbersurgeon" Commonwealth country surgeon Be called "Mister" instead of "Doctor". At the beginning of the 20th century, with disinfection anaesthesia With the emergence and progress of hemostasis, transfusion and other technologies, modern surgery has gradually deepened and improved. The foundation of modern surgery was laid in the 1840s, which successively solved the surgical pain wound infection And hemostasis, blood transfusion, etc.

Surgical pain was once one of the important factors hindering the development of surgery. In 1846, American Morton first adopted Ether As a whole body anesthetic And assist Warren in using Ether anesthesia Implemented a lot Major operation 。 Since then, ether anesthesia has been widely used in surgery. In 1892, Schleich of Germany first advocated cocaine do Local infiltration anesthesia However, due to its high toxicity procaine Instead, procaine is still safe and effective Local anesthetic 。

The wound "festered" more than 100 years ago surgeon The biggest Difficult problems One, at that time, after amputation mortality Up to 40%~50%. 1846 Hungary Semmelweis first proposed to use bleaching powder Wash your hands with water, So make The maternal mortality rate he treated dropped from 10% to 1%, which is the beginning of antibacterial technology. Adopted by British Lister in 1867 Carbolic acid Solution flushing Surgical instruments , and covered the wound with gauze soaked in carbolic acid solution, so that the mortality rate of the sterilization, hemostasis, amputation operation he performed decreased from 40% to 15%, thus establishing Antibacterial technique Of basic principle 。 In 1877, Bergmann, Germany, compared 15 cases Knee joint The patients with penetrating injuries were bandaged after only cleaning and disinfection around the wound, and 12 patients recovered and saved their lower limbs. He believed that all wounds should not be regarded as infected, and the wound should not be allowed to be infected again contamination More important. On this basis, he used steam sterilization, and studied sterilization measures for cloth sheets, dressings, surgical instruments, etc Aseptic operation 。 In 1889, Germany Furbringer proposed the arm disinfection method, and in 1890, the United States Halsted It is suggested to wear rubber gloves, so as to improve the aseptic technique. Surgical bleeding has also been another important factor hindering the development of surgery. 1872 British Wells Hemostatic forceps In 1873, German Esmarch advocated amputation tourniquet They are the initiators to solve the problem of surgical bleeding. In 1901, Landsteiner in the United States discovered the blood type, and since then, blood transfusion can be used to compensate for the blood loss during surgery. Initial adoption Direct transfusion , but the operation is complex and the blood transfusion volume is difficult to control; In 1915, Lewis ohn of Germany proposed the idea of mixed addition Sodium citrate Solution, an indirect blood transfusion method that makes blood not coagulate, and later Blood Bank The establishment of blood transfusion is simple and easy.

In 1929, Fleming found penicillin In 1935, German Domagk advocated A hundred waves and many interests （ Sulfonamides ）Since then, various countries have developed a series of Antibacterials , which opened a new era for the development of surgery.

Surgery

Continuous improvement of surgical hemostatic forceps, blood transfusion and fluid infusion This has further expanded the scope of surgery and increased the safety of surgery. In the early 1950s, Hypothermic anesthesia The success of cardiopulmonary bypass and cardiopulmonary bypass has opened up a development path for open heart surgery. Since the 1960s Microsurgical techniques The progress of orthopedics and transplantation surgery has been promoted. Since the 1970s, various fiber beams Endoscope The appearance of, plus Imaging medicine The rapid development of (from B-mode ultrasound 、 CT 、 MRI 、 DSA SPECT, PET) has greatly improved the diagnosis and treatment of surgical diseases; especially Interventional Radiology The application of micro catheters for superselective vascular intubation will not only diagnose, but also treat the internal structure of the lesions. In addition, bioengineering technology It is having a renewed impact on medicine, and medicine molecular biology Progress, especially for Oncogene The research of the new method has gone deep into the field of surgery. There is no doubt that there will be great changes in surgery in many aspects.

With the rapid development of modern surgery in breadth and depth, it is impossible for any surgeon to master all the knowledge and skills of surgery; In order to continue to improve the level, there must be division of labor. Therefore, surgery should be further divided into several specialties; Some are based on human body parts, such as abdominal surgery, chest Cardiac surgery ； Some are based on human system, such as orthopedics Urology Surgery , Brain neurosurgery 、 Vascular surgery ； Some are based on the characteristics of the patient's age, such as Pediatrics , geriatric surgery, some of which are based on surgical methods, such as plastic surgery Microsurgery Transplantation surgery; Others are based on the nature of the disease, such as tumor surgery, emergency surgery, etc. Especially because of the growing development of the scope of surgery and the increasing requirements for anesthesia, anesthesia specialty is needed; The establishment of the ICU is also for the same purpose.

Related Bibliography

Clinical Surgical Basis Treatment objectives There is a clear division of labor for the differences between the two, which can be divided into general surgery (now specifically referring to various abdominal cavity, breast, thyroid and simple Dermatology ）、 Cardiac surgery Thoracic surgery (both are satisfactory Thoracic Surgery ）、 Vascular surgery Neurosurgery (sometimes referred to as neurosurgery) Brain surgery ）、 Head and Neck Surgery 、 Urology Surgery 、 Plastic surgery 、 orthopedic surgery (i.e Orthopeadic Surgery ）、 Pediatric surgery , transplantation surgery, etc. Surgery in a broad sense can include Ophthalmology Department , ENT Obstetrics and Gynecology Department , dentistry (oral and maxillofacial surgery), etc.

The problems that surgery often deals with include trauma, various thoracic and abdominal emergencies, congenital/acquired Sexual malformation 、 Malignant tumor 、 organ transplant In clinical application and Anesthesiology , Super Nursing 、 Pathology Radiology oncology And other medical specialties. With the development of drugs, early diagnosis technology and other medical technologies (such as interventional radiology), the treatment of many diseases has changed to non-surgical treatment. However, surgery is still an indispensable posterior support for these ineffective treatments or complications Minimally invasive surgery The field of endoscopic surgery is also booming.

Traditional Chinese Medicine Surgery

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Traditional Chinese Medicine Surgery , subject name. Traditional Chinese medicine began in the Song Dynasty when it was named after surgery. See Song Dynasty Wu Qiyu New Book of Surgery is a special book of eye saving surgery. Most of the surgeries before the Song Dynasty were Ulcer doctor And so on. It is to study the etiology, pathology, syndrome, diagnosis, treatment medical technology Specialized subjects such as. It includes carbuncle, gangrene, sore, ulcer, scabies, ringworm, injury and fracture, etc. After the Song Dynasty, most of the specialized works on such diseases were named after surgery.

Surgical classification

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Surgery is mainly divided into general surgery (general surgery for short), cardiothoracic surgery Hepatobiliary surgery 、 Urology Surgery 、 orthopedic surgery 、 neurosurgery 、 burn 、 Plastic surgery department 、 Microsurgery Etc.

General surgery

Mainly for abdominal diseases, such as appendicitis 、 Lymphadenitis , breast tumor Splenic trauma 、 intussusception 、 Renal failure 、 cholecystitis 、 mastitis 、 empyema 、 External abdominal hernia 、 onychia lateralis 、 Gallstone 、 Hepatic trauma 、 gangrene 、 Hemangioma Etc.

Urology Surgery

Main treatment scope: various Urolithiasis And complexity renal calculus ； Kidney and Bladder tumor ； Hyperplasia of prostate and prostatitis ； testis the epididymis Inflammation and tumor; testis Hydrocele of spermatic cord ； various Urinary system Damage; Urinary system Congenital malformation as Hypospadias 、 Cryptorchidism 、 Stricture of ureteropelvic junction Caused by Hydronephrosis wait.

Cardio-Thoracic Surgery

It mainly treats thoracic diseases, including heart, lung, esophagus, diaphragm, etc.

neurosurgery

It mainly treats brain and spinal diseases.

Plastic surgery

It is a branch of surgery, also known as reconstructive surgery or plastic surgery. Its treatment scope mainly includes skin, muscle and bone injuries, diseases, congenital or acquired tissue or organ defects and malformations. Treatment includes repair and reconstruction. All kinds of autologous operations Tissue transplantation As the main means, heterologous, heterologous tissue or Organizational substitutes To repair tissue defects or deformities caused by various reasons for improvement or recovery physiological function And appearance.

Microsurgery

It is a discipline to study the use of optical amplification equipment and microsurgical equipment for fine surgery. One of the important conditions is to use optical amplification equipment for surgery. In a broad sense, microsurgery is not unique to a certain specialty, but a surgical technology that can be used by all specialties of the surgical discipline. It can even be divided into special branches from this specialty, such as gynecological microsurgery, uromicrosurgery, neuromicrosurgery, etc.

Surgical disease

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The scope of surgery has expanded to all parts of the body and is difficult to develop. Therefore, surgery has to carry out a more detailed division of labor. In addition to general surgery (including abdominal surgery), in the scope of surgery, brain and thorax have been established respectively, cardiovascular , urology, orthopedics, plastic surgery, trauma, burn ， tumour Pediatric surgery, neurosurgery, and some microsurgery organ transplant Etc.

Urology Surgery

Bladder cancer Bladder leukoplakia Bladder agenesis and hypoplasia Bladder tuberculosis Bladder calculus Squamous cell carcinoma of bladder Bladder fistula Bladder urethra foreign body Leiomyoma of bladder Leiomyosarcoma of bladder Diverticulum of bladder 　 Upper internal hernia of bladder Damp heat of bladder Pheochromocytoma of bladder 　 Vesicoureteral reflux

Anorectal surgery

White line hernia whipworm disease Hair hiding disease Intestinal wind adult umbilical hernia Puborectalis syndrome Hernias through peritoneum due to worm syndrome Fecal incontinence Colorectal cancer Colorectal malignant lymphoma Colorectal obstruction Colorectal carcinoid Colorectal polyps Fecal discharge in children Fecal roundworm disease

orthopaedics

chance fracture CM1 Gangliosidosis Friedreich Ataxia 　 Maffucci syndrome 　 Morton's plantar headache 　 Poncet syndrome Ahong disease carcinomatous arthritis Barton fracture Meniscus injury 　 Hemivertebra deformity Closed spinal cord injury due to atlantoaxial anterior dislocation of nasal bone fracture with odontoid process fracture Injury of brachial plexus Flatfoot

Trauma Department

septicemia Explosive deafness 　 Barotrauma of paranasal sinuses Nasal furuncle Acinetobacter infection 　 Ulnar nerve injury 　 Traumatic epistaxis 　 Traumatic perforation of nasal septum 　 Traumatic pneumothorax 　 Traumatic shock 　 Traumatic asphyxia 　 traumatic asphyxia syndrome Replantation of severed finger after electric injury of fracture at the base of the first metacarpal bone Multiple system organ failure

Burn Department

Electric shock, electric burn, frostbite, frostbite, non freezing cold injury, hemolytic anemia caused by high temperature, chemical burn, immersion, excessive sodium foot, thermal burn, burn Burn infection 　 Acute renal failure after burns 　 Post burn cardiac dysfunction 　 Burn sepsis

organ transplant

Nezelot syndrome: excessive sodium in replantation of severed limbs Contrast nephropathy

Breast surgery

Bozhe disease Puerperal infection 　 Puerperal mastitis Multibreast Nonlactating areola fistula Paramammary breast cancer acute suppurative mastitis 　 Menopausal breast cancer 　 Breast cancer in the elderly 　 Hypermastia in men 　 Male breast cancer 　 Intraductal papilloma of breast Echinococcosis of breast Tuberculosis of breast Deficiency of breast Neurofibroma of breast

Hand surgery

Brachial plexus injury ulnar nerve injury Toxic nodular goiter 　 Toxic diffuse goiter Replantation of severed fingers with polydactyly Acute suppurative tenosynovitis Paronychia and subungual abscess Open hand injury 　 Coles fracture Ulnar collateral ligament injury abscess of thumb metacarpophalangeal joint

surgical treatment

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Surgical treatment means AD Or its complication In principle, all type A (proximal type) should consider operation type B (distal type) medication When there is a surgical indication surgical treatment 。 With the development of surgical technology, it is possible to build a ileal storage chamber or capsule, Ileoanal anastomosis Will decrease Permanent For ileostomy, every patient should consider this kind of restorative surgery.

Surgical examination

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Lymph nodes: superficial lymph gland Whether there is abnormal increase, etc.

Skin: observe the color, elasticity, bleeding papule 、 Mottle , Scar.

Spine of four limbs: whether there is any deformity in appearance and dysfunction in function.

Thyroid gland: early detection cyst , tumor, etc.

Female breast: early detection Lobular hyperplasia , breast cancer, etc.

Anal: early hemorrhoids Anal fistula , tumor, etc.

External genitalia : Whether the development is normal.

Surgical research

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Surgery is an international Chinese journal focusing on the latest progress in the field of surgery Hans Press Issuance. It mainly publishes papers on the occurrence, development, clinical manifestations, diagnosis, prevention and treatment of surgical diseases at home and abroad. This magazine supports ideological innovation Academic innovation , advocating science, prospering academia, integrating academic Ideological As a whole, it aims to provide scientific and technological support to scientists, scholars Scientific researchers Provide an exchange platform for spreading, sharing and discussing problems and development in different directions in the field of surgery^[1] 。