臨床醫(yī)學(xué)英語Unit7

Unit7ModernSurgeryWordFormationlapar/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.spelectomyadren/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)raperitonealcorpus-(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.axillarymelan/o(black)e.g.melanomasympath/o(sympathetic)rect/o

(rectus)-pexy(tofix)

固定,固定術(shù)e.g.rectopexymetastasis/metastases/metastatic/metastasizeQuestionstoconsider:1.Whatisminimalaccesssurgery?2.Whatisminimalinvasiveprocedure?3.Areyoufamiliarwithlaparoscope/endoscope?WhatisMinimalAccessSurgery?Minimalaccesssurgeryiscompletedwithoneormoresmallincisionsinsteadofalargeincision.Thesurgeonpassesatelescopewithvideocamerathroughasmallincision(usuallyonly1/4"long)intoabodycavity.ThesurgeonthenviewsthesurgeryonaTVmonitor.Surgicalinstrumentsarethenpassedthroughothersimilarlittleincisions.AnoverviewThesurgeonexaminesandoperatesontheareainquestionbyviewingmagnifiedimagesonatelevision.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-articularjointsurgeryCombinedapproachesAdvantageofminimalaccesssurgeryLesstissuetraumaLesspostoperativepainFasterrecoveryFewerpostoperativecomplicationsBettercosmesisDisadvantagesofminimalaccesssurgeryLackoftactilefeedbackIncreasedtechnicalexpertiserequiredPossiblelongerdurationofsurgeryIncreasedriskofiatrogenicinjuriesDifficultremovalofbulkyorgansMoreexpensiveEstablishedminimalaccessproceduresLaparoscopiccholecystectomyDiagnosticlaparoscopyLaparoscopicappendicectomyLaparoscopicfundoplicationLaparoscopic(orthoracoscopic)Heller'smyotomyLaparoscopicadrenalectomyLaparoscopicsplenectomyLaparoscopicrectopexyEquipmentSpecialmedicalequipmentmaybeused,suchasfiberopticcables,miniaturevideocamerasandspecialsurgicalinstrumentshandledviatubesinsertedintothebodythroughsmallopeningsinitssurface.Theimagesoftheinteriorofthebodyaretransmittedtoanexternalvideomonitorandthesurgeonhasthepossibilityofmakingadiagnosis,visuallyidentifyinginternalfeaturesandactingsurgicallyonthem.InstrumentRefinementinfibreoptictechnologyandengineeringhaveproducedinstrumentswhichareusedforso-called‘keyhole’surgery.Finetoolscanbepassedintotheabdominalandchestcavitiessothatmanyoperationswhichpreviouslyrequiredmajorincisionscannowbeperformedthroughquitesmallpuncturewounds.Thisisparticularlywellestablishedingynaecologicalsurgeryandinoperationsuponthegallbladder,andtechniquesarebeingdevisedforsimilaroperationsonotherorgans.Thistechnologyalsoinvolvesthedevelopmentofinstrumentstopassalongeverytubeinthebody,forexampletoremoveobstructionsintheoesophagus,bileducts,bowel,prostate,andmajorbloodvessels.Manyproceduresonjoints—forexample,removalofatorncartilagefromtheknee—cannowbeperformedsafely,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.BenefitsMinimallyinvasive

surgeryshouldhavelessoperativetraumaforthepatientthananequivalentinvasiveprocedure.Itmaybemoreorlessexpensive.Operativetimeislonger,buthospitalizationtimeisshorter.Itcauseslesspainandscarring(疤痕形成),speedsrecovery,andreducestheincidenceofpost-surgicalcomplications,suchasadhesions(粘連).However,minimallyinvasivesurgeryisnotnecessarilyminorsurgerythatonlyregionalanesthesiaisrequired.Infact,mostoftheseproceduresstillrequiresgeneralanesthesia(全麻)tobeadministered

beforehand.RisksMinimallyinvasiveproceduresarenotcompletelysafe,andsomehavecomplicationsrangingfrominfectiontodeath.Risksandcomplicationsincludethefollowing:AnesthesiaormedicationreactionsBleedingInfectionInternalorganinjuryBloodvesselinjuryVeinorlungbloodclottingBreathingproblemsDeath(rare)UnderstandingtheTextPara.11.facilitate----v.tomakesth.possibleoreasier;toimprove促進(jìn),促使

2.miniaturizedvideocameras----微型攝像機(jī)

3.imagereproduction----影像重現(xiàn)

4.procedure5.

established----recognized被確認(rèn)

6.validate----vt.testify驗(yàn)證

7.enablingtechnologies----使能技術(shù)/支撐技術(shù)/促成科技enabling----a.授權(quán)的,使成為可能的“使能技術(shù)”：使其它工藝能夠運(yùn)行的技術(shù)基本上用于：1-實(shí)現(xiàn)某種功能的技術(shù)。例：電子管、晶體管、集成電路之于電子計(jì)算機(jī)。電子計(jì)算機(jī)之于自動(dòng)限制。軟件之于硬件。2-使人具備某種本事、賜予人某種便利的技術(shù)。例：互聯(lián)網(wǎng)之于電子商務(wù)。數(shù)字技術(shù)之于電影絕技?；蚣夹g(shù)之于生物開發(fā)。VirtualReality簡介虛擬現(xiàn)實(shí)，或虛擬實(shí)境(VirtualReality)，簡稱VR技術(shù)，也稱靈境技術(shù)或人工環(huán)境，是利用電腦模擬產(chǎn)生一個(gè)三度空間的虛擬世界，供應(yīng)運(yùn)用者關(guān)于視覺、聽覺、觸覺等感官的模擬，讓運(yùn)用者猶如身歷其境一般，可以剛好、沒有限制地視察三度空間內(nèi)的事物。運(yùn)用者進(jìn)行位置移動(dòng)時(shí)，電腦可以立刻進(jìn)行困難的運(yùn)算，將精確的3D世界影像傳回產(chǎn)生臨場感。該技術(shù)集成了計(jì)算機(jī)圖形(CG)技術(shù)、計(jì)算機(jī)仿真技術(shù)、人工智能、傳感技術(shù)、顯示技術(shù)、網(wǎng)絡(luò)并行處理等技術(shù)的最新發(fā)展成果，是一種由計(jì)算機(jī)技術(shù)幫助生成的高技術(shù)模擬系統(tǒng)。8.virtualrealitylaparoscopicsimulator----虛擬的腹腔鏡模擬裝置

Para.21.seachange----巨變

2.opticaltelescope----光學(xué)望遠(yuǎn)鏡

3.unassisted----unaided沒有助手

4.technicalrepertoire----整個(gè)技術(shù)

sea

change----aprofoundtransformation

巨變，突變，突發(fā)性徹底轉(zhuǎn)變和其很多精彩的英語詞匯一樣，sea

change的靈感同樣出自莎士比亞大師之手。莎翁的最終一部傳奇劇作《暴風(fēng)雨》（The

Tempest）中，莎翁用sea

change來表示一種根本的、徹底的變更，就像某物長期沉沒在水中所發(fā)生的變更一樣。其實(shí)，從莎翁的年頭到今日，英語本身也閱歷了sea

change。

Para.31.ofchoice----首選的,精選的2.retract----vt.1)縮回,縮近(pullback,drawback)2)撐開,拉開,牽開(useasurgicalinstrumenttoholdopen(theedgesofawoundoranorgan)e.g.Fortheuncircumcisedboy,retracttheforeskinofthepenisandcleanse.(對(duì)未作包皮環(huán)截術(shù)的男孩，要將陰莖前的包皮退上去清洗。)

retractorn.(surgicalinstrumentthatholdsbacktheedgesofasurgicalincision)①牽開器,牽引器;外科撐開器：牽開切口邊緣以及將下方器官和組織拉向后方，以便保持手術(shù)暴露區(qū)的器械；有很多種形態(tài)、大小和類型e.g.softtissueretractor軟組織牽開器②縮肌Para.41.Nissenfundoplication----尼森胃底折術(shù)2.gastro-esophagealrefluxdisease----胃食管返流病3.sentinelnodebiopsy----前哨淋巴結(jié)病理切片;哨位淋巴結(jié)活檢術(shù)

4.surgicalroboticssystems----外科機(jī)器人技術(shù)5.fuel----vt.支持,刺激6.stage----v.(癌癥的)分期(grade分級(jí))(inoncology)todeterminethepresenceandsiteofmetastasesfromaprimarytumourinordertoplantreatment.Inadditiontoclinicalexamination,avarietyofimagingandsurgicaltechniquesmaybeemployedtoprovideamoreaccurateassessment.WhatisStaging?Stagingistheprocessphysiciansusetoassessthesizeandlocationofapatient’scancer.Identifyingthecancerstageisoneofthemostimportantfactorsinselectingtreatmentoptions.Severaltestsmaybeperformedtohelpstagebreastcancerincludingclinicalbreastexams,biopsy,andcertainimagingtestssuchasachestx-ray,mammogram,bonescan,CTscan,andMRIscan.Bloodtestsusedtoevaluateawoman'soverallhealthanddetectwhetherthecancerhasspreadtocertainorgansoftenfollowimagingtests.Gastro-esophagealrefluxdisease胃食管返流病----n.(Abbr.GERD)Achronicconditioninwhichtheloweresophagealsphincterallowsgastricacidstorefluxintotheesophagus,causingheartburn,acidindigestion,andpossibleinjurytotheesophageallining.fundoplication胃底折術(shù)----asurgicaloperationforgastro-oesophagealrefluxdiseaseinwhichtheupperpartofthestomachiswrappedaroundtheloweresophagus.ThecommonesttechniqueisnamedafterRudolfNissen,aSwisssurgeon.DiagramofaNissenfundoplication.Dr.RudolphNissenfirstperformedtheprocedurein1955andpublishedtheresultsoftwocasesina1956

SwissMedicalWeekly.In1961hepublishedamoredetailedoverviewoftheprocedure.Nissenoriginallycalledthesurgery"gastroplication."Theprocedurehasbornehisnamesinceitgainedpopularityinthe1970's.Inafundoplication,thegastricfundus(upperpart)ofthestomachiswrapped,orplicated,aroundtheinferiorpartoftheesophagusandstitchedinplace,reinforcingtheclosingfunctionoftheloweresophagealsphincter:Wheneverthestomachcontracts,italsoclosesofftheesophagusinsteadofsqueezingstomachacidsintoit.Thispreventstherefluxofgastricacid(inGERD).Afundoplicationcanalsopreventhiatalhernia,inwhichthefundusslidesupthroughtheenlargedesophagealhiatusofthediaphragm.Para.51.engender----vt.trigger引發(fā),引起2.intermsof----在…方面3.postoperativeinpatientstay----術(shù)后住院時(shí)間

4.morbidity----n.不健康狀態(tài)

Morbidity(fromLatinmorbidus:sick,unhealthy)referstoadiseasedstate,disability,orpoorhealthduetoanycause.Thetermmaybeusedtorefertotheexistenceofanyformofdisease,ortothedegreethatthehealthconditionaffectsthepatient.Amongseverelyillpatients,thelevelofmorbidityisoftenmeasuredbyICUscoringsystems.Para.61.accompaniedby----…同時(shí)2.asurgeof----涌現(xiàn)3.indications----有跡象表明4.NHS----英國國家衛(wèi)生服務(wù)體系

5.protonpumpinhibitors----質(zhì)子泵抑制劑其他醫(yī)療體制模式-“英國模式”：是指英國國家衛(wèi)生服務(wù)體系(NationalHealthSystem，NHS)，政府舉辦和管理醫(yī)療機(jī)構(gòu)，居民免費(fèi)獲得醫(yī)療服務(wù)；醫(yī)療服務(wù)體系是典型的從上到下的垂直體系；服務(wù)體系是雙向轉(zhuǎn)診體系；醫(yī)療經(jīng)費(fèi)80%以上來自政府的稅收，其余來自私人醫(yī)療保險(xiǎn)。

-“德國模式”：即全民醫(yī)療保險(xiǎn)制度，醫(yī)療保障和醫(yī)療服務(wù)體系分別，雇主和雇員向作為第三方的醫(yī)療保險(xiǎn)機(jī)構(gòu)繳費(fèi)，保險(xiǎn)機(jī)構(gòu)與醫(yī)療機(jī)構(gòu)(公立、私立都可以)簽約以供應(yīng)服務(wù)，不能參保者才由政府供應(yīng)醫(yī)療服務(wù)。

“美國模式”：美國是發(fā)達(dá)國家中唯一沒有全民保險(xiǎn)制度的國家，其醫(yī)療制度，無論是財(cái)源確保方式還是醫(yī)療供應(yīng)方法都是以私營為主。個(gè)人醫(yī)療保險(xiǎn)，除個(gè)人單獨(dú)購買的保險(xiǎn)外，主要是雇主自發(fā)地給雇員及其扶養(yǎng)者供應(yīng)的群體性健康保險(xiǎn)。美國總統(tǒng)奧巴馬2010年3月23日在白宮簽署了醫(yī)療保險(xiǎn)

改革法案。法案首次明文規(guī)定，幾乎全部美國人都應(yīng)

在2014年前擁有醫(yī)療保險(xiǎn)。對(duì)于年收入低于43320美元

的個(gè)人和低于73240美元的三口之家，聯(lián)邦政府將賜予

醫(yī)保補(bǔ)貼。

依據(jù)新的醫(yī)改法案，美國將建立以州為基礎(chǔ)的醫(yī)療保

險(xiǎn)交易所，小企業(yè)和個(gè)人可以在交易所里通過聯(lián)合議

價(jià)，享受與大公司員工或聯(lián)邦政府雇員同樣實(shí)惠的保

險(xiǎn)費(fèi)率。

小企業(yè)為員工購買醫(yī)療保險(xiǎn)還將享受政府稅收減免。

與此同時(shí)，政府還將對(duì)高收入群體加征個(gè)人所得稅

并對(duì)高額保單加征消費(fèi)稅，作為醫(yī)改資金的重要來源。此外，醫(yī)改法案加強(qiáng)了對(duì)保險(xiǎn)行業(yè)的監(jiān)管。依據(jù)法案，政府可以通過一系列獎(jiǎng)懲措施敦促企業(yè)向雇員供應(yīng)醫(yī)保；保險(xiǎn)公司不得以投保者的過往病史為由拒?；蛘呤杖「哳~保費(fèi)，不得在投保人患病后單方面終止保險(xiǎn)合同，不得對(duì)投保人的終身保險(xiǎn)賠付金額設(shè)置上限等。醫(yī)改實(shí)施后，無醫(yī)保者將是醫(yī)改最大受益者。目前，全美約4600萬人沒有醫(yī)保，醫(yī)改將使其中3200萬人獲保，從而使醫(yī)保覆蓋率從85％升至95％，距離全民醫(yī)保只有一步之遙。對(duì)于低收入人群來說，這個(gè)法律極大地?cái)U(kuò)大了醫(yī)療救助范圍。此外，很多有工作的窮人賴以生存的社區(qū)醫(yī)療中心也會(huì)得到更多的資金支持。Para.71.manometry----（食管）壓力測定2.pHmonitoring----Para.81.costsavingsof…over----成本低于

2.justify----vt.3.

inconvenienceandmorbidityofsurgery----

外科手術(shù)所帶來的不便和不健康狀態(tài)

4.

collaborativetrial5.

UniversityofAberdeen阿伯丁高校簡介（University

of

Aberdeen）阿伯丁高校位于風(fēng)景美麗的蘇格蘭東岸，成立于1495年，500多年歷史，是英國最古老的六所高校之一，是英國僅次于牛津、劍橋及倫敦高校之后的第四古老高校。學(xué)校位于英國東北海濱城市Aberdeen的市中心，校內(nèi)國王學(xué)院有一座俯瞰海景的15世紀(jì)的教堂塔樓，整個(gè)校內(nèi)古典而肅穆，到處洋溢著古典名校的氣息。

Para.91.Heller’smyotomy----海勒肌切開術(shù)Othernames:cardiomyotomy----賁門肌切開術(shù)Heller’soperation----海勒手術(shù)2.rectopexy----直腸固定術(shù)rect/o

直腸-pexy固定,固定術(shù)Para.101.herniarepair----疝修補(bǔ)

2.gammaprobe----伽馬探頭3.duodenalperforation----十二指腸穿孔

Para.11Para.121.tension-freemeshrepair----無張力補(bǔ)片(網(wǎng)片)修補(bǔ)術(shù)

2.Lichensteinrepair3.Shouldicerepair4.on-laymeshLichtenstein疝中心是美國唯一一個(gè)集探討、教學(xué)和手術(shù)為一體的腹外疝機(jī)構(gòu)（腹股溝疝，股疝，臍疝，腹疝和切口疝）。1984年，Lichtenstein疝中心的世界級(jí)疝專家首次在該中心獨(dú)創(chuàng)和推廣革命性的疝補(bǔ)片無張力修補(bǔ)手術(shù)。今日，Lichtenstein無張力疝修補(bǔ)術(shù)不僅被全世界的醫(yī)生廣泛接受，而且被美國醫(yī)師協(xié)會(huì)尊稱為疝修補(bǔ)手術(shù)的金標(biāo)準(zhǔn)。在美國政府資助下，美國醫(yī)師協(xié)會(huì)作過比較性試驗(yàn)，結(jié)果發(fā)表在2004年5月份的“新英格蘭醫(yī)學(xué)雜志“上。該試驗(yàn)結(jié)果中稱“Lichtenstein無張力疝修補(bǔ)術(shù)就修補(bǔ)原發(fā)性疝來說優(yōu)于腹腔鏡手術(shù)”。這一手術(shù)方法不是簡潔地把疝缺損的邊緣強(qiáng)行縫合在一起，而是用一張補(bǔ)片覆蓋缺損的部位。該手術(shù)在局麻下進(jìn)行，為日間手術(shù)，不用住院。2-3個(gè)星期內(nèi)，病人自身組織生長入補(bǔ)片的網(wǎng)孔中，使網(wǎng)片成為自身組織的一部分。TheLichtensteinHerniaInstituteistheonlyfacilityintheUnitedStatesdevotedexclusivelytoresearch,teachingandsurgeryofabdominalwallhernias(inguinalhernia,femoralhernia,umbilicalhernia,ventralherniaorincisionalhernia).In1984,forthefirsttime,internationallyrecognizedherniaexpertsattheLichtensteinHerniaInstituteoriginatedandpopularizedtheirrevolutionary"tension-free"meshtechnique,whichisnowacceptedworldwideandconsideredthegoldstandardofherniarepairbytheAmericanCollegeofSurgeons.Infact,accordingtotheAmericanCollegeofSurgeons'comparativetrials(governmentgrant)publishedinthe

NewEnglandJournalofMedicine,May2004,theLichtensteintension-freerepairis"superiortothelaparoscopictechniqueformeshrepairofprimaryhernias.”The"tension-free"meshtechniquewaspioneeredbytheLichtensteinHerniaInstitutein1984,andiscurrentlyconsideredthegoldstandardofherniarepairbytheAmericanCollegeofSurgeons.Inthisprocedure,repairisachievedbycoveringtheopeningoftheherniawithapatchofmesh,insteadofsewingtheedgeoftheholetogetherThesurgeryisperformedunderlocalanesthesiaandonanoutpatientbasis.Withinonlytwotothreeweeks,thepatientsowntissuegrowsintothemesh,makingitapartofthepatient'sbodyOn-laytechnique(intraabdominalplacementofthematerialsontheperitoneum);

Sub-laytechnique(intraabdominalplacementofthematerialspreperitoneal);

In-laytechnique(extraperitonealplacementofthematerials)Para.131.bilateral/unilateral2.unscarred----無疤痕

Para.141.demanding----adj.2.invest----vt.3.expertise----n.特地技術(shù)4.portsite----手術(shù)切口處5.multi-centreprospectiverandomizedtrials----多中心前瞻性隨機(jī)性試驗(yàn)6.inprogress----underway7.poseachallengeto----Para.151.impetus----推動(dòng)力

2.peritonealcavity----腹膜腔

3.aproprietarysleeveandcuff----一種專用套管4.pneumoperitoneum----氣腹

5.specimen----樣本

6.extracorporealanastmosis----體外接合Pneumoperitoneum

Thepresenceofairorgasintheperitonealcavityasaresultofdiseaseorforthetreatmentofcertainconditions.Apneumoperitoneumisdeliberatelycreatedbythesurgicalteaminordertoperformlaparoscopicsurgery.Thisisachievedbyinsufflatingtheabdomenwithcarbondioxide.Para.161.massivelyenlargedspleens----脾大

2.ultrasonicdissector----超聲剝離器

3.atraumaticgrasper----無損傷抓取器

Para.171.reservations----保留看法2.contraind