我国胆道外科发展现状及专科医师管理培训的意义

我国是一个胆道疾病高发的国家，随着时代发展，胆道外科疾病的结构发生了明显变化，胆囊结石、胆道恶性肿瘤发生率明显上升；科学技术的发展给胆道外科带来了新的气象，腹腔镜技术、内镜微创技术、机器人辅助外科系统的应用及三维影像重建技术等影像学的发展，使胆道外科手术方式出现了巨大变化，胆道疾病外科诊治观念面临着更新和拓展。因此，胆道外科专科医师的规范化管理培训显得格外重要。     

Hysterectomy throughout history

Hysterectomy, which is one of the most common surgeries performed on women, dates back to ancient times. The history of hysterectomy comprises biographies of many humble men and the significant individual efforts that they made to fight the skepticism of the medical communities of their times. Many of the pioneers were ignored. Although there are a number of alternatives to hysterectomy available, it remains one of the most frequently performed gynaecological operations. The introduction of antisepsis, anaesthesia, antibiotics and blood transfusion made hysterectomy a safe procedure. Nowadays, we distinguish three different surgical approaches to hysterectomy: vaginal, abdominal and laparoscopic. The limitations of conventional laparoscopy have led to the development of robotic surgery, which has evolved over the past decade from simple adjustable arms to support cameras in laparoscopic surgery to more sophisticated four-armed machines now being in use worldwide.     

Plastic surgery in the twentieth century.

Plastic surgical operations are among the oldest and have been developed increasingly from ancient times down to the present. However, the age of medical specialization did not begin until the latter part of the nineteenth century, and the specialty of plastic surgery is largely a child of the twentieth century. Most of the operations we do today have been created by plastic surgeons with the past 50 years, but were made possible only by the rapid developments in other surgical specialties and in all of medicine and science. The relationship with other specialties has been an interdependent one, and this is likely to be the pattern of the future. Plastic surgery, bridging the anatomical specialties as it does, must continue to draw bits of information here and there from them and to synthesize these into major contributions of great benefit to all. The specialty will grow in direct proportion to the success of the innovators within it in fulfilling their crucial role.     

Herophilus of Chalcedon: a pioneer in neuroscience

A review of the history of ancient medicine reveals that most of the knowledge is concentrated in the studies of a few scientists. The best-known names include Hippocrates, Rufus of Ephesus, Celsus, and Galen. The survival of their works throughout the ages has been the most important factor contributing to their popularity. However, there are other scientists who made great contributions to science, but whose writings have been lost or destroyed over the course of time. As a result, their names are not as well known as those of others and the value of their contributions is not appreciated. With the improvement of communication technology in the past 50 years, links between the studies of ancient science can be made more effectively and scientists who have remained hidden under the shade of time have begun, after thousands of years, to receive the appreciation they deserve. In the field of neuroscience, the historical record focuses on Galen of Pergamon. But, when his marvelous works are carefully studied, it is interesting to note two names he frequently referenced: Herophilus (335-280 BC) and Erasistratus (310-250 BC). These two scientists were the first to place scientific value on the dissection of the human body. Herophilus is considered the father of scientific anatomy, and Erasistratus was the first experimental physiologist. Attracted by the prospect of material advancement and eminent students, both migrated from their homes in Asia Minor to Alexandria. The works of Herophilus and Erasistratus have been lost entirely, but some details of their teachings may be recovered from the writings of Galen. In this study, we focus on Herophilus, a master of ancient medicine, whose important discoveries about the human body formed the basis for positive science and the foundation for neuroscience.     

Injuries and diseases of the spine in the ancient times

Spinal injuries and diseases have been diagnosed and treated since antiquity. We attempt to record any available information in this area, starting from the prehistoric period and going up to Roman times. Thus, the main focus is on Hippocrates and Galen, who as the most eminent physicians of the ancient world, are presented through their work on spinal pathology. The epitome of their wisdom is to be found in Galen's works made available via Khun's edition (Leipzig, 1829) written in both ancient Greek and Latin. Galen not only presents the Hippocratic knowledge and comments on it, but adds his own opinions and thoughts.     

Computer-assisted tridimensional preoperative planning in hip revision surgery

It is often difficult to obtain excellent clinical results in complex cases of hip replacement surgery. Over recent years, in order to improve the success rate of this type of surgery, prosthetic implants that are more ductile and more reliable have been developed. At the same time, important progress has been made in improving the accuracy of surgical method. A great deal of effort has been made to improve methods of preoperative planning. The world over, computerized systems that aid the surgeon in his or her clinical practice (CAOS systems) have been developed. The authors present Hip-op, a new CAOS type system, for preoperative planning. In particular, the use of Hip-op in some very complex cases of hip revision surgery is reported. Based on clinical experience, it is believed that Hip-op is a useful system, one that is easy to use, and that it is capable of improving the accuracy of surgery.     

Morio Kasai: a remarkable impact beyond the Kasai procedure

Morio Kasai is one of the most influential Japanese pediatric surgeons. He is best recognized in the United States for his pioneering efforts in the field of biliary atresia. His work revolutionized the treatment of infants born with biliary atresia throughout the world. Less is known about his remarkable impact in the fields of general surgery and pediatric surgery. This review highlights some of Dr Kasai's major contributions and highlights the influence he had in the establishment of pediatric surgery as a field.     

Forum: dermopigmentation or medical tattooing. History of tattooing]

Tattooing has been performed all over the world since prehistoric times, as indicated by numerous ancient relics. The significance of tattoos has differed at times and in different civilisations (means of communication, social identification mark, religious origin). Today, it is performed by real artists who have inspired its medical applications. Medical dermopigmentation was initially used in the context of breast reconstruction (nipple areola complex) and, with subsequent refinements, its indications have been extended to the treatment of residual scars and to the permanent make-up.     

Long-term biliary complications after liver surgery leading to liver transplantation

Chronic biliary obstruction with repeated bouts of cholangitis adversely affects quality of life and may lead to secondary biliary cirrhosis with liver failure. We reviewed our experience with chronic biliary complications after surgical treatment of various diseases that at the end needed a liver transplantation. Twelve patients with previous biliary surgery developed secondary biliary cholangitis, secondary biliary cirrhosis, or both. Seven had surgery for liver hydatid disease by Echinococcus granulosus, another four had complicated biliary surgery unrelated to hydatid disease, and one had a history of a traffic accident with liver trauma and hepatectomy with chronic biliary fistula. The repeated cholangitis attacks and in two cases of hydatid disease the development of biliary-bronchial fistulas made these patients' lives miserable. All had had previous surgical procedures that made the transplantation procedure more difficult. Nevertheless, patient survival and graft actuarial survival after liver replacement were 75.0% and 69.2%, respectively, at 5 years.     

LEECHES IN MEDICINE

Leeches have been used in medicine for blood-letting since ancient times. Leeching has varied in popularity over the years. It reached its zenith during the early decades of the 19th century with a gradual decline by the end of the century. Since the 1980s leeches have been introduced to remove blood where its accumulation may interfere with healing, particularly after plastic tissue-flap surgery. The history and current use of medicinal leeches in Australia is examined.     

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??Controversy and consensus on diagnosis and treatment of benign diseases of biliary tract TANG Zhao-hui, JIN Long-yang, WEI Miao-yan, et al.Department of General Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
Corresponding author: TANG Zhao-hui,E-mail:tangzhaohui@
yahoo.com
Abstract With the application and development of new ideas and new technologies, great progress has been made in the diagnosis and treatment of benign biliary diseases. Surgical treatment of benign biliary tract disease mostly have a consensus, but there is still controversy, such as the timing of surgery of cholecystolithiasis complicated with acute cholecystitis, surgery of congenital biliary dilatation, cholangioenterostomy of recurrent extrahepatic bile duct stones, the value judgment in the treatment of bile duct injury, the choice of endoscopic therapy and surgery of benign tumors of ampulla. In view of the current dispute, biliary surgeon should establish the multidisciplinary team diagnosis and treatment model, then reach consensus and conduct multi center and large sample clinical research,finally propose the guidelines that can provide clinicians with reasonable,standardized therapeutic schemes and provide patients with the best, personalized treatment.     

Dynamic biliary manometry: display modelling and graphic interpretation

Tendencies of development of biliary manometry have been analyzed. Key advantages and problems of manometric investigation of biliary tracts have been summarized. New method of graphic registration and pressure monitoring in biliary tracts called biliary manometry has been suggested. Characteristic types of manometric curves were determined using stand modelling, their physical and mathematical analysis was conducted, clinical analogues have been suggested. The emphasis has been made on expediency of its further elaboration and clinical application.     

A history of the bilioenteric anastomosis

The bilioenteric anastomosis has played an integral role in the surgical management of biliary tract disease during the past century. A wide variety of techniques for suturing a portion of the biliary tract to the digestive tract have been described since von Winiwarter's first cholecystoenterostomy. Many types of biliary stents have also been developed, although their exact role remains controversial. Many advances in preoperative and postoperative care have contributed to the low morbidity and mortality of current reconstructive biliary tract surgery.     

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??Consensus and controversies on protection of sphincter of Oddi during biliary surgery YIN Xiao-Yu. Department of Pancreatobiliary Surgery,the First Affiliated Hospital,Sun Yat-Sen University,Guangzhou510080??China
Abstract Sphincter of Oddi is one complicated and finely-regulated apparatus. It consists of common bile duct sphincter, pancreatic duct sphincter and ampulla of Vater sphincter. Recently, with better understanding in the anatomical structure and physiological function of sphincter of Oddi, its pivotal roles in maintaining the intra-ductal pressure within biliary tract and pancreatic duct, hydrodynamics of bile and pancreatic juice, aseptic condition within biliary tract and pancreatic duct, and preventing duodenal reflux have been identified. Hence, the importance in protecting the sphincter of Oddi has been recognized among contemporary biliary surgeons.     

Xenotransplantation in China: Present status

The main obstacle to organ transplantation is the shortage of organs from deceased individuals. Especially in China, the ratio of patients on the waiting list versus the transplant recipients is 30:1. Therefore, there is an urgent need for organ donors. Genetically modified pig organs have proved to be a new source for xenotransplantation, and Chinese scientists have made considerable progress in this area during recent years. In this paper, we review four important aspects of the xenotransplantation field in China. First, a large variety of genetically modified pigs have been generated by Chinese scientists: all these genetically modified pigs and the purpose of these modifications will be summarized. Second, the preclinical research in pig‐to‐nonhuman primate xenotransplantation is outlined. The survival time and major biochemical parameters for the xenografts are summarized. Third, regarding the bench‐to‐bed approach, more suitable organs have been developed for xenotransplantation in humans, and in particular, pig islet transplantation into diabetic patients as well as pig‐to‐human cornea and skin transplantation. Fourth, we briefly address the regulations and prospects for recruiting xenotransplantation experts in China. Based on recent progress, we anticipate that genetically modified pigs will offer suitable organs for the treatment of end‐stage organ diseases in humans in the near future. Given the recent influx of world‐renowned scientists in xenotransplantation to China, our country will definitely become one of the major centers of xenotransplantation research and development in the world.     

Cohort study of surgical bypass to the gallbladder or bile duct for the palliation of jaundice due to pancreatic cancer

OBJECTIVE: To compare patterns in mortality and the use of subsequent biliary drainage interventions (surgical, endoscopic, and percutaneous) associated with the different types of biliary bypass. SUMMARY BACKGROUND DATA: Surgical palliation of obstructive jaundice due to pancreatic cancer is often accomplished with an intestinal bypass to either the gallbladder or the bile duct. It is not known whether a gallbladder bypass, which is a simpler operation and more amenable to laparoscopic surgery, performs as well as a bypass to the bile duct. METHODS: The authors conducted a retrospective cohort study of 1,919 patients 65 years of age or older who had a surgical biliary bypass for pancreatic cancer diagnosed between 1991 and 1996 using Medicare claims data and the Surveillance, Epidemiology and End Results (SEER) database. RESULTS: At 1, 2, and 5 years, 7.5%, 17.4%, and 26.0% of 945 patients initially treated with a gallbladder bypass had additional biliary interventions, as compared with 2.9%, 11.0%, and 13.3% of 974 patients initially treated with a bile duct bypass. Patients who initially had a gallbladder bypass were 4.4 times as likely to have additional biliary surgery and 2.9 times as likely to have any subsequent biliary intervention as were patients who initially had a bile duct bypass. Median survival was longer following bile duct bypass. The adjusted hazard ratio for death associated with gallbladder bypass was 1.2. CONCLUSIONS: Compared to patients whose initial biliary bypass was to the bile duct, the risk of having one or more additional surgical, endoscopic, or percutaneous biliary drainage procedures is substantially greater in patients whose initial bypass was to the gallbladder.     

Progress and problems in pediatric surgery--a study group on congenital biliary atresia

Japanese Study Group on Biliary Atresia was founded to make a standard classification of biliary atresia in 1975. The proposal of a new classification was made in the second meeting. Since then, annual meetings have been held to promote studies on biliary atresia. Various results have been obtained as follows: The diagnosis has been made more easily and accurately by use of new methods. As the operation have been performed more securely, the incidence of the disappearance of postoperative jaundice has risen to 80 percent, and more than 30 percent of the patients have been surviving for a long time. The patients who have had good outcome by the revision of the anastomosed region have increased. The endoscopic embolisation therapy was applied for the patients with postoperative esophageal varices. Various procedures preventing postoperative ascending cholangitis have been developed but there are no methods to prevent this complication completely. So the treatment of the ascending cholangitis remains one of the most important problems to be dissolved.     

胆道良性疾病诊治中的若干争议及共识

随着各种新理念和新技术的应用与发展,胆道良性疾病的诊断和治疗取得了重大进展。胆道良性疾病的外科诊治大多已有共识,但仍然存有争议,如胆囊结石并发急性胆囊炎的手术时机,先天性胆管扩张症的手术方式,复发性肝外胆管结石的胆肠吻合治疗,胆管损伤内镜治疗的价值判断,壶腹部良性肿瘤的内镜治疗与外科手术的选择等。针对目前存在的争议,应通过多学科综合治疗协作组（MDT）模式达成共识,后续开展多中心大样本临床研究,最终形成指南,为临床医师提供合理、规范的治疗方案,从而使病人获得最佳的个体化诊疗效果。     

BILIARY ATRESIA: REVIEW OF EXPERIENCE WITH TWENTY-THREE PATIENTS

Prior to the Kasai procedure of hepatic porto-enterostomy in 1959, biliary atresia was a bleak chapter in paediatric surgery. It was only after many years, however, that the procedure became widely accepted. During the past 8 years 23 cases of biliary atresia have been treated at the Royal Alexandra Hospital for Children (RAHC). Twenty-one had the noncorrectable type of atresia. Sustained drainage was obtained in ten patients, all of whom had the noncorrectable type anomaly. Nine are still alive, eight having survived more than one year after operation and all are free from jaundice. Cholangitis has been a problem in six of these patients and six have evidence of fibrosis or cirrhosis on subsequent liver biopsy. Two patients have shown improvement in liver histology since operation. Sustained biliary drainage is related to age at operation, the size of biliary ductules at the porta and the subsequent development of cholangitis. Long term prognosis still remains uncertain.