Gradually deepen and improve. 65438-2009 Modern surgery was founded in the 1940s, which solved the problems of operation pain, wound infection, hemostasis and blood transfusion.
Surgical pain is one of the important factors hindering the development of surgery. 1846 Morton in the United States first used ether as a general anesthetic, and used ether anesthesia to assist Warren in many major operations. Since then, ether anesthesia has been widely used in surgery. 1892, Schleich, Germany first advocated the use of cocaine as local infiltration anesthesia, but it was quickly replaced by procaine because of its high toxicity, and it is still a safe and effective local anesthetic.
Wound "suppuration" was one of the biggest problems faced by surgeons more than 0/00 years ago. At that time, the mortality rate after amputation was as high as 40% ~ 50%. 1846, Semmelweis of Hungary first proposed to wash hands with bleach before examining parturients, which reduced the maternal mortality rate he treated from 10% to 1%, which was the beginning of antibacterial technology. 1867 Liszt in England cleaned the surgical instruments with carbolic acid solution, covered the wound with gauze soaked in carbolic acid solution, and amputated it.
The mortality rate of limb surgery decreased from 40% to 15%, thus laying the basic principle of antibacterial surgery. 1877, Bogman treated 15 patients with penetrating injury of knee joint, and cleaned and disinfected around the wound and bandaged it. 12 patients recovered and saved their lower limbs. He thinks it is more important not to treat all wounds as infections and not to pollute them again. On this basis, he used steam sterilization, and studied the sterilization measures of cloth, dressing and surgical instruments, and established the aseptic technology of modern surgery. 1889 german Furbringer put forward the arm disinfection method, 1890 American halsted advocated wearing rubber gloves, thus perfecting the aseptic technology. Surgical bleeding is another important factor that hinders the development of surgery. 1872, Wells in Britain introduced the hemostatic forceps. 1873, Esmarch in Germany advocated the use of tourniquets in amputation. They are the founders of solving surgical bleeding. 190 1 year, the blood type was discovered in Landsteiner, USA, and blood loss during operation can be compensated by blood transfusion. At first, it was direct blood transfusion, but the operation was complicated and the amount of blood transfusion was difficult to control. 19 15 In Germany, Lewisohn put forward the indirect blood transfusion method of mixing sodium citrate solution to prevent blood coagulation, and later the establishment of blood bank made blood transfusion simple and easy.
1929, penicillin was discovered in Fleming, England; 1935, Domagk, Germany, advocated the use of Bluntoxicam (sulfonamides). Since then, countries have developed a series of antibacterial drugs, which has opened up a new era for the development of surgery. With the continuous improvement of anesthesia, blood transfusion and fluid replacement are paid more and more attention, which further expands the scope of surgery and increases the safety of surgery. In the early 1950s, the successful research of hypothermic anesthesia and cardiopulmonary bypass paved the way for open heart surgery. Since 1960s, the progress of microsurgery technology has promoted the progress of trauma, plastic surgery and transplantation surgery. Since 1970s, the appearance of various fiber optic endoscopes and the rapid development of imaging medicine (from B-ultrasound, CT, MRI and DSA to SPECT and PET) have greatly improved the level of diagnosis and treatment of surgical diseases. Especially with the development of interventional radiology, superselective vascular intubation with microcatheter can not only diagnose but also treat the internal structure of the lesion. In addition, bioengineering technology is playing a newer role in medicine, and the progress of medical molecular biology, especially the study of oncogenes, has penetrated into the surgical field. There is no doubt that surgery will eventually undergo great changes in many aspects. With the rapid development of modern surgery in breadth and depth, a surgeon cannot master all surgical knowledge and skills. In order to continuously improve the level, there must be a division of labor. Therefore, surgery should be further divided into several specialties; Some are based on the parts of the human body, such as abdominal surgery and chest surgery; Some follow the human body system, such as orthopedics, urology, neurosurgery and vascular surgery; Some are based on the age characteristics of patients, such as pediatrics and geriatric surgery, and some are based on surgical methods, such as reconstruction surgery, microsurgery and transplantation; Others are based on the nature of the disease, such as tumor surgery and emergency surgery. Especially due to the increasing development of the scope of surgery, the requirements for anesthesia are getting higher and higher, and anesthesia specialty is needed; The intensive care unit was established to achieve the same goal.
The problems that surgery often deals with include trauma, various chest and abdomen emergencies, congenital/acquired deformities, malignant tumors, organ transplantation and so on. In clinical application, it is closely related to anesthesiology, special nursing, pathology, radiology, oncology and other medical specialties. With the development of medicine, early diagnosis technology and other medical technologies (such as interventional radiology), the treatment of many diseases has turned to non-surgical treatment. However, surgery is still an indispensable defense support for the ineffectiveness or complications of these treatments, and the field of minimally invasive surgery (endoscopic surgery) is also booming. (1) Injuries caused by violence or other injury factors, such as visceral rupture, fracture, burns, etc. Surgery or other surgical treatments are usually needed to repair tissues and restore functions.
(2) Infected pathogenic microorganisms or parasites invade the human body, causing damage, destruction, necrosis and abscess of tissues and organs. This localized infection is suitable for surgical treatment, such as gangrenous appendectomy, incision and drainage of liver abscess, etc.
(3) Most tumors need surgical treatment. Benign tumor resection has good curative effect; For malignant tumors, surgery can achieve radical cure, prolong survival time or relieve symptoms.
(4) Deformity congenital malformation, such as cleft lip and palate, congenital heart disease, anorectal atresia, etc. , need surgery. Acquired deformities, such as scar contracture after burn, also need surgical repair to restore function and improve appearance.
(5) Organ obstruction is common in other diseases, such as intestinal obstruction and urinary tract obstruction; Blood circulation disorders such as varicose veins of lower limbs and portal hypertension; Stone formation, such as gallstones and urinary calculi; Endocrine dysfunction, such as hyperthyroidism, often requires surgical treatment to correct it.
Modern surgery not only includes the knowledge and skills of diagnosis, prevention and treatment of the above diseases, but also studies the occurrence and development of diseases. Therefore, modern surgery must involve the basis of experiment and natural science.
The categories of surgery and internal medicine are relative. As mentioned above, surgery generally focuses on diseases that need to be treated mainly by surgery or manipulation, while internal medicine generally focuses on diseases that are treated mainly by drugs. However, surgical diseases do not always require surgery, and often only need surgery at a certain stage of development, such as suppurative infection. Drugs are usually used first in the early stage, and incision and drainage are needed when abscess is formed. However, some medical diseases also need surgical treatment at a certain stage, such as perforation or massive bleeding caused by gastroduodenal ulcer, which often requires surgical treatment. Moreover, due to the progress of medical science, some diseases that should have been operated can be treated by non-surgical therapy. For example, most urinary calculi can be crushed and discharged by extracorporeal shock wave. Some diseases that were originally inoperable have created effective surgical treatments. For example, most congenital heart diseases have been treated by hypothermia anesthesia or cardiopulmonary bypass, which can be corrected by surgery. Especially due to the rapid development of interventional radiology, surgery has a tendency to cross with internal medicine and other majors. Therefore, with the development of medicine and the improvement of diagnosis and treatment methods, the scope of surgery will be constantly updated and changed.
Surgery is a subject of modern medicine, which mainly studies how to remove pathogens from patients by surgical methods, so that patients can be treated. Surgery, like all clinical medicine, needs to know the definition, etiology, manifestations, diagnosis, staging, treatment and prognosis of diseases. It pays more attention to surgical indications, preoperative evaluation and nursing, surgical skills and methods, postoperative nursing, surgical complications and prognosis.
Clinical surgery has a clear division of labor according to the different treatment objectives, which can be divided into general surgery (now referring to various abdominal cavity, breast, thyroid and simple skin surgery), cardiac surgery, thoracic surgery (both of which can cooperate with satisfactory thoracic surgery), vascular surgery, neurosurgery (sometimes called brain surgery), head and neck surgery, urology, plastic surgery, orthopedics (that is, orthopedics), pediatric surgery, transplantation surgery and so on. Surgery in a broad sense can also include ophthalmology, otolaryngology, obstetrics and gynecology, dentistry (oral and maxillofacial surgery) and so on. Although modern surgery has been introduced to China for hundreds of years, it has been in a backward state in old China. Large hospitals with surgical equipment are located in a few big cities, and slightly larger operations such as subtotal gastrectomy, cholecystectomy or nephrectomy can only be performed in several big hospitals in several big cities; There are few surgeons, and many surgical specialties are not formed. After the founding of People's Republic of China (PRC), China established a relatively complete surgical system. There are more and more surgical teams in medical colleges and universities in China. It has successively set up surgical specialties such as anesthesiology, abdominal surgery, cardiothoracic surgery, orthopedics, orthopedics, urology, neurosurgery and pediatric surgery. Surgical technology is not only popularized, but also improved significantly on the basis of popularization. Popularization: there are surgical specialties in county hospitals all over the country, and the equipment and technical conditions are constantly improving; And many grass-roots hospitals below the county level have also carried out surgical work. Improvement: cardiovascular surgery, microsurgical techniques, organs and other new surgical fields have been developing vigorously and achieved gratifying results. In addition, important surgical instruments such as extracorporeal circulation machine, artificial kidney, pacemaker, fiber endoscope, artificial blood vessel, artificial heart valve, artificial joint, microvascular instrument and shock wave lithotripsy device can be designed and produced by ourselves. Due to the implementation of the policy of traditional Chinese medicine, the combination of traditional Chinese and western medicine has also made many achievements in the field of surgery. The combination of traditional Chinese and western medicine has achieved good results in treating some surgical acute abdomen, such as acute pancreatitis, bile duct stones and adhesive intestinal obstruction. The combination of traditional Chinese and western medicine in the treatment of fractures uses the principle of dynamic and static combination, and uses small splints for local external fixation, which not only shortens the fracture healing time, but also restores limb function. Others, such as internal hemorrhoids, anal fistula and vascular vasculitis, are more effective than simple western medicine.
Since the founding of the People's Republic of China, the majority of surgeons have made great efforts to rescue diseases and injuries that seriously endanger people's health, and have made outstanding achievements. Since 1985 successfully treated a worker with extensive burns, the level of treatment for extensive burns has been continuously improved, and many cases of third-degree burns with an area of over 90% have been reported. Has entered the international leading ranks. 1963, after a worker successfully transplanted his right forearm for the first time, thousands of cases of severed fingers, palms and limbs were transplanted all over the country. Limbs amputated for 36 hours, replantation of upper limbs amputated for three times, and transplantation of the same limb have all achieved success and are in a leading position in the world. Over the years, Chinese surgeons have performed splenectomy on tens of thousands of patients with advanced schistosomiasis in endemic areas left over from the old society on both sides of the Yangtze River in the simple operating room in rural areas, which has restored their health and re-entered production posts. The prevention and treatment of cancer are also developing rapidly. A survey of esophageal cancer, gastric cancer and breast cancer was conducted among hundreds of thousands to millions of people, which not only enabled these cancers to be found early, but also investigated the relationship between these cancers and various environmental factors in high-incidence areas, and put forward new research topics. It must be admitted that every major in the world, ancient and modern, at home and abroad, has experienced a lot of research and discussion and accumulated very rich information. The same is true of surgery. All the surgeons who worked hard to relieve patients' pain in history have made beneficial contributions to the enrichment and perfection of surgery, which is worth inheriting and learning. Chinese medicine surgery, the name of Chinese medicine surgery began in Song Dynasty. See Wu Qiyu's New Works of Surgery in Song Dynasty, which is a special book on surgery. Before the Song Dynasty, most surgeons chose the name of doctor. It is a specialized subject that studies the etiology, pathology, syndrome, diagnosis, treatment and medical technology of superficial diseases and syndromes. Include carbuncle, gangrene, sore, ulcer, scabies, tinea, injury, etc. After the Song Dynasty, most books devoted to this kind of diseases were named after science. About the origin of surgery
The surgical instruments used today are exactly the same as those designed by a Muslim surgeon named Zahrawi in the 10 century. Another Arab doctor described the concept of blood circulation in the13rd century, 300 years before William Harvey.