临床医学英语Unit7.ppt

Unit7,ModernSurgery,WordFormation,lapar/o(abdomen)e.g.laparoscopelaparoscopylaparoscopiccholecyst/o(gallbladder)-ectomy(excision/removal)e.g.cholecystectomygynec/o(female)-ology(study)e.g.gynecologyesophag/o(esophagus)e.g.gastro-esophagealsplen/o(spleen)e.g.spelectomy,adren/o(adrenalglands)-tonchylomicronthorac/o(thorax)e.g.thoracoscopicmy/o(muscle)e.g.myotomycol/o(colon)e.g.colectomynephr/o(kidney)e.g.nephrectomygastr/o(stomach)e.g.gastrectomyperitone/o(peritoneum)raperitoneal,corpus-(body)e.g.extracorporeal-oma(tumor)cyt/o(cell)e.g.phaeochromocytomacontra-(against)e.g.contraindicationlymph/o(lymph)-pathy(disease)e.g.lymphadenopathyaxilla-(armpit)e.g.axillary,melan/o(black)e.g.melanomasympath/o(sympathetic)rect/o(rectus)-pexy(tofix)固定,固定术e.g.rectopexymetastasis/metastases/metastatic/metastasize,Questionstoconsider:,1.Whatisminimalaccesssurgery?2.Whatisminimalinvasiveprocedure?3.Areyoufamiliarwithlaparoscope/endoscope?,WhatisMinimalAccessSurgery?Minimalaccesssurgeryiscompletedwithoneormoresmallincisionsinsteadofalargeincision.Thesurgeonpassesatelescopewithvideocamerathroughasmallincision(usuallyonly1/4long)intoabodycavity.ThesurgeonthenviewsthesurgeryonaTVmonitor.Surgicalinstrumentsarethenpassedthroughothersimilarlittleincisions.,Anoverview,Thesurgeonexaminesandoperatesontheareainquestionbyviewingmagnifiedimagesonatelevision.Whenthetelescopeisusedtooperateontheabdomen,theprocedureiscalledlaparoscopy.Whenusedinthechest,theprocedureiscalledthoracoscopy,andwhenusedinajoint,itiscalledarthroscopy.,BackgroundTheintroductionofminimalaccesssurgery(MAS)intocommonpracticebeganin1985,whenlaparoscopiccholecystectomywasfirstperformedtoremoveadiseasedgallbladder.Intheimmediateyearsthereafter,asmallnumberofsurgeonsintheU.S.pioneeredthedevelopmentoflaparoscopictechniquesforthisandothersurgicalapplications.Recognizingtheimportanceoftheirpotentialtoimprovepatientcare,ColumbiaUniversitywasoneoftheveryfirstU.S.academicinstitutionstosupportthedevelopmentofminimalaccesstechnologiesandtechniques.,MAS(ie,laparoscopy)hasbeenusedbygynecologistsformorethan5decades.Itsapplicationtogeneralsurgerybeganwhenthefirstlaparoscopiccholecystectomywasperformedin1985.In1987,thelaparoscopiccholecystectomywaspopularized,andlaparoscopiccholecystectomysoonbecamethestandardofcare.Sincethattime,MAShasbeenappliedtonumerousotherprocedureswithgoodresults.,Idealminimalaccesssurgeryhas:ReducedtraumaassociatedwithaccessNocompromiseofexposureofoperativefieldSurgerycanbeperformedusingthefollowingapproaches:LaparoscopicThoracoscopicEndoluminalIntra-articularjointsurgeryCombinedapproaches,AdvantageofminimalaccesssurgeryLesstissuetraumaLesspostoperativepainFasterrecoveryFewerpostoperativecomplicationsBettercosmesis,DisadvantagesofminimalaccesssurgeryLackoftactilefeedbackIncreasedtechnicalexpertiserequiredPossiblelongerdurationofsurgeryIncreasedriskofiatrogenicinjuriesDifficultremovalofbulkyorgansMoreexpensive,EstablishedminimalaccessproceduresLaparoscopiccholecystectomyDiagnosticlaparoscopyLaparoscopicappendicectomyLaparoscopicfundoplicationLaparoscopic(orthoracoscopic)HellersmyotomyLaparoscopicadrenalectomyLaparoscopicsplenectomyLaparoscopicrectopexy,EquipmentSpecialmedicalequipmentmaybeused,suchasfiberopticcables,miniaturevideocamerasandspecialsurgicalinstrumentshandledviatubesinsertedintothebodythroughsmallopeningsinitssurface.Theimagesoftheinteriorofthebodyaretransmittedtoanexternalvideomonitorandthesurgeonhasthepossibilityofmakingadiagnosis,visuallyidentifyinginternalfeaturesandactingsurgicallyonthem.,InstrumentRefinementinfibreoptictechnologyandengineeringhaveproducedinstrumentswhichareusedforso-calledkeyholesurgery.Finetoolscanbepassedintotheabdominalandchestcavitiessothatmanyoperationswhichpreviouslyrequiredmajorincisionscannowbeperformedthroughquitesmallpuncturewounds.Thisisparticularlywellestablishedingynaecologicalsurgeryandinoperationsuponthegallbladder,andtechniquesarebeingdevisedforsimilaroperationsonotherorgans.,Thistechnologyalsoinvolvesthedevelopmentofinstrumentstopassalongeverytubeinthebody,forexampletoremoveobstructionsintheoesophagus,bileducts,bowel,prostate,andmajorbloodvessels.Manyproceduresonjointsforexample,removalofatorncartilagefromthekneecannowbeperformedsafely,usingtheseminimalaccesstechniques.,Thelaparoscope,afiber-optictelescope,isinsertedthroughoneport(口,孔)andattachedtoacamera.Itsendsimagesfromtheabdominalcavitytotelevisionmonitorsplacedforeasyviewingbyalltheoperatingroompersonnel.Thus,thesurgeonandhisorherassistantscanviewtheabdominalcavityanditscontents.Throughtheremainingports,long-handledinstrumentsareusedtoperformvariousprocedures.,Endoscopyisaminimallyinvasivediagnostictool,usedtoviewtheinsideoforgans,inspectforabnormalitiesandtakebiopsies.Asmallcameraandlightsourcearemounted(fixed)ontoaflexibletubewhichcanbeinsertedintothemouth(toinspecttheesophagus,stomachandduodenum)ortheanus(toinspectthelargebowel).,Whatisaminimallyinvasiveprocedure?Aminimallyinvasiveprocedureisanyprocedure(surgicalorotherwise)thatislessinvasivethanopensurgeryusedforthesamepurpose.Aminimallyinvasiveproceduretypicallyinvolvesuseoflaparoscopicdevicesandremote-controlmanipulationofinstrumentswithindirectobservationofthesurgicalfieldthroughanendoscopeorsimilardevice,andarecarriedoutthroughtheskinorthroughabodycavityoranatomicalopening.,Thismayresultinshorterhospitalstays,orallowoutpatienttreatment.However,thesafetyandeffectivenessofeachproceduremustbedemonstratedwithrandomizedcontrolledtrials.ThetermwascoinedbyJohnEAWickhamin1984,whowroteofitinBritishMedicalJournalin1987.,BenefitsMinimallyinvasivesurgeryshouldhavelessoperativetraumaforthepatientthananequivalentinvasiveprocedure.Itmaybemoreorlessexpensive.Operativetimeislonger,buthospitalizationtimeisshorter.Itcauseslesspainandscarring(疤痕形成),speedsrecovery,andreducestheincidenceofpost-surgicalcomplications,suchasadhesions(粘连).However,minimallyinvasivesurgeryisnotnecessarilyminorsurgerythatonlyregionalanesthesiaisrequired.Infact,mostoftheseproceduresstillrequiresgeneralanesthesia(全麻)tobeadministeredbeforehand.,RisksMinimallyinvasiveproceduresarenotcompletelysafe,andsomehavecomplicationsrangingfrominfectiontodeath.Risksandcomplicationsincludethefollowing:AnesthesiaormedicationreactionsBleedingInfectionInternalorganinjuryBloodvesselinjuryVeinorlungbloodclottingBreathingproblemsDeath(rare),UnderstandingtheText,Para.11.facilitate-v.tomakesth.possibleoreasier;toimprove促进,促使2.miniaturizedvideocameras-微型摄像机3.imagereproduction-影像重现4.procedure5.established-recognized被确认6.validate-vt.testify验证,7.enablingtechnologies-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。,VirtualReality简介虚拟现实，或虚拟实境(VirtualReality)，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.virtualrealitylaparoscopicsimulator-虚拟的腹腔镜模拟装置Para.21.seachange-巨变2.opticaltelescope-光学望远镜3.unassisted-unaided没有助手4.technicalrepertoire-整个技术,seachange-aprofoundtransformation巨变，突变，突发性彻底转变和其很多出色的英语词汇一样，seachange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（TheTempest）中，莎翁用seachange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seachange。,Para.31.ofchoice-首选的,精选的2.retract-vt.1)缩回,缩近(pullback,drawback)2)撑开,拉开,牵开(useasurgicalinstrumenttoholdopen(theedgesofawoundoranorgan)e.g.Fortheuncircumcisedboy,retracttheforeskinofthepenisandcleanse.(对未作包皮环截术的男孩，要将阴茎前的包皮退上去清洗。),retractorn.(surgicalinstrumentthatholdsbacktheedgesofasurgicalincision)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.softtissueretractor软组织牵开器缩肌,Para.41.Nissenfundoplication-尼森胃底折术2.gastro-esophagealrefluxdisease-胃食管返流病3.sentinelnodebiopsy-前哨淋巴结病理切片;哨位淋巴结活检术4.surgicalroboticssystems-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)(inoncology)todeterminethepresenceandsiteofmetastasesfromaprimarytumourinordertoplantreatment.Inadditiontoclinicalexamination,avarietyofimagingandsurgicaltechniquesmaybeemployedtoprovideamoreaccurateassessment.,WhatisStaging?Stagingistheprocessphysiciansusetoassessthesizeandlocationofapatientscancer.Identifyingthecancerstageisoneofthemostimportantfactorsinselectingtreatmentoptions.Severaltestsmaybeperformedtohelpstagebreastcancerincludingclinicalbreastexams,biopsy,andcertainimagingtestssuchasachestx-ray,mammogram,bonescan,CTscan,andMRIscan.Bloodtestsusedtoevaluateawomansoverallhealthanddetectwhetherthecancerhasspreadtocertainorgansoftenfollowimagingtests.,Gastro-esophagealrefluxdisease胃食管返流病-n.(Abbr.GERD)Achronicconditioninwhichtheloweresophagealsphincterallowsgastricacidstorefluxintotheesophagus,causingheartburn,acidindigestion,andpossibleinjurytotheesophageallining.,fundoplication胃底折术-asurgicaloperationforgastro-oesophagealrefluxdiseaseinwhichtheupperpartofthestomachiswrappedaroundtheloweresophagus.ThecommonesttechniqueisnamedafterRudolfNissen,aSwisssurgeon.,DiagramofaNissenfundoplication.,Dr.RudolphNissenfirstperformedtheprocedurein1955andpublishedtheresultsoftwocasesina1956SwissMedicalWeekly.In1961hepublishedamoredetailedoverviewoftheprocedure.Nissenoriginallycalledthesurgerygastroplication.Theprocedurehasbornehisnamesinceitgainedpopularityinthe1970s.,Inafundoplication,thegastricfundus(upperpart)ofthestomachiswrapped,orplicated,aroundtheinferiorpartoftheesophagusandstitchedinplace,reinforcingtheclosingfunctionoftheloweresophagealsphincter:Wheneverthestomachcontracts,italsoclosesofftheesophagusinsteadofsqueezingstomachacidsintoit.Thispreventstherefluxofgastricacid(inGERD).Afundoplicationcanalsopreventhiatalhernia,inwhichthefundusslidesupthroughtheenlargedesophagealhiatusofthediaphragm.,Para.51.engender-vt.trigger引发,引起2.intermsof-在方面3.postoperativeinpatientstay-术后住院时间4.morbidity-n.不健康状态Morbidity(fromLatinmorbidus:sick,unhealthy)referstoadiseasedstate,disability,orpoorhealthduetoanycause.Thetermmaybeusedtorefertotheexistenceofanyformofdisease,ortothedegreethatthehealthconditionaffectsthepatient.Amongseverelyillpatients,thelevelofmorbidityisoftenmeasuredbyICUscoringsystems.,Para.61.accompaniedby-同时2.asurgeof-涌现3.indications-有迹象表明4.NHS-英国国家卫生服务体系5.protonpumpinhibitors-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(NationalHealthSystem，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.71.manometry-（食管）压力测定2.pHmonitoring-,Para.81.costsavingsofover-成本低于2.justify-vt.3.inconvenienceandmorbidityofsurgery-外科手术所带来的不便和不健康状态4.collaborativetrial5.UniversityofAberdeen,阿伯丁大学简介（UniversityofAberdeen）,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.91.Hellersmyotomy-海勒肌切开术Othernames:cardiomyotomy-贲门肌切开术Hellersoperation-海勒手术2.rectopexy-直肠固定术rect/o直肠-pexy固定,固定术,Para.101.herniarepair-疝修补2.gammaprobe-伽马探头3.duodenalperforation-十二指肠穿孔,Para.11Para.121.tension-freemeshrepair-无张力补片(网片)修补术2.Lichensteinrepair3.Shouldicerepair4.on-laymesh,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。,TheLichtensteinHerniaInstituteistheonlyfacilityintheUnitedStatesdevotedexclusivelytoresearch,teachingandsurgeryofabdominalwallhernias(inguinalhernia,femoralhernia,umbilicalhernia,ventralherniaorincisionalhernia).In1984,forthefirsttime,internationallyrecognizedherniaexpertsattheLichtensteinHerniaInstituteoriginatedandpopularizedtheirrevolutionarytension-freemeshtechnique,whichisnowacceptedworldwideandconsideredthegoldstandardofherniarepairbytheAmericanCollegeofSurgeons.,Infact,accordingtotheAmericanCollegeofSurgeonscomparativetrials(governmentgrant)publishedintheNewEnglandJournalofMedicine,May2004,theLichtensteintension-freerepairissuperiortothelaparoscopictechniqueformeshrepairofprimaryhernias.”,Thetension-freemeshtechniquewaspioneeredbytheLichtensteinHerniaInstitutein1984,andiscurrentlyconsideredthegoldstandardofherniarepairbytheAmericanCollegeofSurgeons.Inthisprocedure,repairisachievedbycoveringtheopeningoftheherniawithapatchofmesh,insteadofsewingtheedgeoftheholetogether,Thesurgeryisperformedunderlocalanesthesiaandonanoutpatientbasis.Withinonlytwotothreeweeks,thepatientsowntissuegrowsintothemesh,makingitapartofthepatientsbodyOn-laytechnique(intraabdominalplacementofthematerialsontheperitoneum);Sub-laytechnique(intraabdominalplacementofthematerialspreperitoneal);In-laytechnique(extraperitonealplacementofthematerials),Para.131.bilateral/unilateral2.unscarred-无疤痕,Para.141.demanding-adj.2.invest-vt.3.expertise-n.专门技术4.portsite-手术切口处5.multi-centreprospectiverandomizedtrials-多中心前瞻性随机性试验6.inprogress-underway7.poseachallengeto-,Para.151.impetus-推动力2.peritonealcavity-腹膜腔3.aproprietarysleeveandcuff-一种专用套管4.pneumoperitoneum-气腹5.specimen-样本6.extracorporealanastmosis-体外接合,Pneumoperitoneum,Thepresenceofairorgasintheperitonealcavityasaresultofdiseaseorforthetreatmentofcertainconditions.Apneumoperitoneumisdeliberatelycreatedbythesurgicalteaminordertoperformlaparoscopicsurgery.Thisisachievedbyinsufflatingtheabdomenwithcarbondioxide.,Para.161.massivelyenlargedspleens-脾大2.ultrasonicdissector-超声剥离器3.atraumaticgrasper-无损伤抓取器,Para.171.reservations-保留意见2.contraindication-禁忌症3