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外科学总论
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第9次开课
开课时间： 2025年02月25日 ~ 2025年05月30日
学时安排： 3-4小时每周
进行至第9周，共14周 已有 473 人参加
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spContent=《外科学总论》是外科学习的基础，内容涉及现代外科基本知识（无菌概念、电解质-酸碱平衡及外科肿瘤概论等）、外科基本理论（外科休克、MODS、营养支持等）和手术基本技能（精准解剖学基础上培训规范的外科操作，如：切开-结扎-止血-缝合等）。基础理论与临床实践技能的掌握为医学生进一步学习其它临床医学学科（特别是以手术为主要治疗手段的外科学各个专业，如神经外科、胸心外科、普通外科、泌尿外科、骨科、血管外科等）的学习提供不可或缺的基础。 General surgery learninging is a process through which students can get the surgical theory and basic skills concerning the etiology, clinical manifestation, diagnosis, differential diagnosis and prevention and cure of commonly and frequently encountered surgery diseases, laying a solid foundation for coming clinical surgery learning and practice in future professional career.
《外科学总论》是外科学习的基础，内容涉及现代外科基本知识（无菌概念、电解质-酸碱平衡及外科肿瘤概论等）、外科基本理论（外科休克、MODS、营养支持等）和手术基本技能（精准解剖学基础上培训规范的外科操作，如：切开-结扎-止血-缝合等）。基础理论与临床实践技能的掌握为医学生进一步学习其它临床医学学科（特别是以手术为主要治疗手段的外科学各个专业，如神经外科、胸心外科、普通外科、泌尿外科、骨科、血管外科等）的学习提供不可或缺的基础。 General surgery learninging is a process through which students can get the surgical theory and basic skills concerning the etiology, clinical manifestation, diagnosis, differential diagnosis and prevention and cure of commonly and frequently encountered surgery diseases, laying a solid foundation for coming clinical surgery learning and practice in future professional career.
—— 课程团队
课程概述

《外科学总论》是每个医学生整个学习阶段的必修课程，也是每一名外科医生终身不断学习、思考和临床实践的必修课程。本课程（MOOC）分为两个部分展开：第一部分，通过精炼的理论课程各章节内容讲述，密切结合外科临床实践，使知识的传授做到条理化、系统化及条目化以便于各知识点的掌握。第二部分，根据外科学教学大纲要求的外科基本技能学习训练要点，通过实验动物手术演示、结合模具实验操作等讲解外科基本操作技能，为学习者提供标准化、程序化的实践课样本。课程的应用对象为临床阶段学习外科学的高年级医学生、准备参与职业医师资格考试的“准医师”、一阶段外科住院医师规培生和其他需要提高外科基本技能的外科临床医生。本课程每节10-15分钟，可以在线播放、反复观看并可参与在线讨论和回答相应思考题（讨论区），使学习者能够快速而牢固地掌握相关临床知识要点和外科临床手术技能培训，达到主动、高效学习的目的。

此外，自本学期开始，课程的大纲内容呈现为中英文双语对照形式，以利于学习者掌握相应的专业英语词汇。后续的课程，应广大学习者的要求，教学团队为实现课程双语化而 继续努力。

授课目标

外科学总论是临床外科学的一个重要组成部分，是不可或缺的医学本科阶段的桥梁课程。通过外科学总论的理论教学与外科基本技能培训-实践，内容包括：现代外科学的概念、范畴、外科疾病的特点-共性及外科疾病基本诊疗原则等 外科通识进行理论授课-外科技能培训示范， 使学习者积极主动地开展个性化 学习、牢记和掌握外科学 基本知识、基础理论、基本技能；为进一步展开对外科各论（器官系统）的理论学习、床旁实践学习（见习）和外科生产实习奠定坚实的理论基础和实践能力，外科各论的学习重点是：掌握外科各专业常见病-多发病的病因、发病机理、临床表现、诊断、鉴别诊断和相应的治疗原则等，病情进展严重的几乎所有外科疾病的诊疗原则都在外科学总论的各个章节中有所涉及。

课程大纲
外科学绪论（访谈录）
课时目标：走进外科学，了解掌握外科学的概念、内涵及发展史等。Introduction of surgery history,focus on the beginnings of modern surgery.Surgery category:General surgery,Thoracic surgery,Cardiac surgery,Organ transplantation,etc.Surgeons: Neurosurgeons,Orthopedists,Plastic surgeons,Otorhinolaryngologists, Ophthalmologists,Anesthesiologists, etc.
一、重点理解怎样学习外科学。 How to study surgery and become a clinic surgeon.
二、理解外科学范畴,外科学和其他学科的关系。The management of surgical disorders requires not only the application of technical skills and training in the basic sciences to the problems of diagnosis and treatment but also a genuine sympathy and indeed love for the patient.
三、掌握外科学发展史、包括我国外科历史，培养、拓展学生自学能力，加强临床思维与科学精神的锻炼。The surgeon must be a doctor in the old-fashioned sense, an applied scientist, an engineer, an artist, and a minister to his or her fellow human beings. Because life or death often depends upon the validity of surgical decisions, the surgeon's judgment must be matched by courage in action and by a high degree of technical proficiency.
外科病人的水、电解质平衡管理
课时目标：一、掌握等渗性、低渗性、高渗性缺水的概念、特点、缺水程度的判断及治疗原则；低钾血症的病因、临床表现及静脉补钾的基本原则；代谢性酸中毒的发生机制、临床特点、诊断要点、治疗原则、补碱公式的应用及注意事项。The concept and feature of isotonicity, hypotonicity, hypertonicity hydropenia; the judgment and treatment principles of the dehydration degree; the etiology, clinical manifestation of hypokalemia; the basic principle of intravenous supplement of potassium; the mechanism, clinic feature, diagnosis point, treatment principle of metabolic acidosis; the application of base supplement formula; the matters needing attention during base supplement。 二、熟悉正常体液平衡及酸碱平衡的调节机制及重要性；高钾血症的紧急处理方法；代谢性碱中毒、呼吸性酸中毒、呼吸性碱中毒病因、临床表现、处理要点。水、电解质及酸碱失衡的综合处理原则。Be familiar with the regulatory mechanism and importance of normal fluid balance and acid-base balance; the emergency treatment method of hyperpotassemia; the etiology, clinical manifestation, treatment points of metabolic alkalosis, respiratory acidosis and respiratory alkalosis; the comprehensive treatment principle for water, electrolyte and acid-base unbalance.三、了解低钙血症的神经肌肉兴奋性的表现及处理方法；高钙血症的危害及处理方法；镁、磷代谢异常的基本概念。功能性、非功能性细胞外液的基本概念。 Understanding the manifestation and treatment process of neuromuscular excitability of hypocalcemia; the hazard and treatment process of hypercalcemia; the basic concept of abnormal metabolism of magnesium, phosphorus; the basic concept of functionality and non-functionality extracellular fluid.
一、正常体液平衡及酸碱平衡的维持。Maintain normal fluid balance and acid-base balance.
二、等渗性缺水的病因、病理、临床表现、诊断要点、治疗原则，尤其是快速恢复血容量的重要性及平衡盐溶液的临床应用。Etiology, pathology, clinical manifestation, diagnosis point, treatment principle of isotonicity hydropenia, especially the importance of restoring blood volume quickly and the clinical application of balanced salt solution.
三、低渗性缺水的病因，重点讲述低渗性缺水的临床分度，根据临床表现或血钠浓度进行补钠的临床应用。Etiology of hypotonicity hydropenia, highlight the clinical classification of hypotonic dehydration, clinical application of sodium replenishment according to clinical manifestations or natremia concentration.
四、高渗性缺水的分度及补液的方法。The classification of hypertonicity hydropenia and the method of fluid replacement therapy.
五、低钾血症的病因、临床表现及诊断要点。治疗原则及静脉补钾的基本原则。Etiology, clinical manifestations, diagnostic points and treatment principles of hypokalemia. Basic principles of intravenous potassium supplementation.
六、高钾血症病因、临床表现、治疗原则，重点强调高钾血症的紧急处理。Etiology, clinical manifestation, treatment principles of hyperpotassemia, highlight emergency management of hyperpotassemia.
七、简单讲解低钙血症的临床表现特点及处理方法。Briefly explain the clinical features and treatment of hypocalcemia.
八、用酸碱平衡公式讲解四种酸碱平衡失调的基本概念。Explain four basic concepts of acid-base imbalance by using acid-base equilibrium formula.
九、代谢性酸中毒的病因、临床特点、诊断要点、治疗原则，经验性补碱或公式计算补碱的应用及注意事项。Etiology, clinical features, diagnostic points and therapeutic principles of metabolic acidosis. Application and precautions of empirical base supplement or formula calculating base supplement.
十、水、电解质、酸碱平衡的综合处理原则，强调生理需要量、额外损失量及累计损失量在补液中的重要性。Principle of comprehensive treatment of water, electrolyte and acid-base balance. Emphasize the importance of physiological requirements, additional loss and cumulative loss in fluid replacement. Explain with examples of the calculation method of 24-hour fluid intake and liquid selection.
外科休克
课时目标：一、掌握休克的病理生理学基础；低血容量性休克、感染性休克临床特点。 Pathophysiology basis of shock; clinic features of hypovolemic shock, infectious shock. 二、熟悉休克的诊断、监护手段和治疗原则。 Be familiar with diagnosis, monitoring measures and treatment principle of shock. 三、了解休克导致脏器继发性损害的病理生理基础和临床表现。 Pathology physiological basis and clinical manifestation of secondary organ lesion caused by shock.
一、掌握休克分类、临床表现、诊断、治疗原则（重点为低血容量性休克和感染性休克）；掌握外科休克发生机制、微循环特征；能够将休克的临床表现与其病理生理学基础相联系。Classification, clinical manifestation, diagnosis and treatment principles of shock (mainly hypovolemic shock and infectious shock); master mechanism, microcirculation feature of surgical shock; can relate clinical manifestation of shock with its pathophysiology basis.
二、熟悉纠正休克常用药物，如血管活性药物、心肌正性肌力药物、抗凝药物、糖皮质激素等。Clinic common shock rectification drugs, such as Colloidal and crystalline fluids, vasoactive drugs, myocardium positivity myodynamia drugs, anticoagulants and glucocorticoid hormone, etc.
三、熟悉早期目标性复苏理念以及休克抢救程序。
Knowing early target- resuscitation principle and shock salvage program.
四、熟悉休克监测方法、指标（基本生命体征）及临床意义。
Understanding monitoring method for patient with shock , index (basic vital signs) and clinic meaning of shock situation.
五、了解肺动脉导管、中心静脉导管、胃粘膜氧张力计监测要点；了解血流动力学和氧和功能指标临床意义以及相关监测与目标性治疗相互关系。
Monitoring points of oxygen tensometer for pulmonary artery catheter, Picco monitor, central venous catheter, gastric mucosa; understand clinic meaning of hemodynamics and oxygen and function index as well as relationship between relevant monitoring and target treatment.
无菌术
课时目标：一、掌握基本无菌概念、原则与操作技术； 二、熟悉常用的灭菌法和消毒法；Be familiar with how to carry out boiling sterilization and liquid medicine immersion sterilization, and how to use steam pot sterilization. 三、手术室规章制度和管理。The rules for entering the operating room and the setting requirements of the operating room,and understand the current commonly used handb rushing fluid and hand brushing methods in the operating room.
一、基本无菌概念、原则与操作技术；常用的灭菌法和消毒法。
二、常用外科洗手法、穿手术衣和戴无菌手套、更换手术衣和手套；不同手术区域的皮肤准备、消毒范围、铺盖无菌手术单技术；无菌操作（手法）技巧。
The basic soap brush method and how to wear surgical gown and gloves.
外科病人的营养支持
课时目标：一、掌握营养支持适应证、途径、目标；基本营养需要量；围手术期代谢特点和营养支持时机。Indication, approach and target of nutrition support; the requisite amount of basic nutrition; the metabolic characteristics during perioperative period and opportunity for nutrition support. 二、熟悉人体的基本营养代谢；营养和代谢状态的评估；肠内、外营养支持并发症的防治。 Be familiar with basic nutrition metabolism of human body; evaluation of nutritional and metabolic status; prevention and treatment of complications of enteral, parenteral nutrition support. 三、了解营养支持监测指标及方法；特殊营养物的作用；肠内、外营养支持治疗常用制剂选择；营养制剂配方的种类、热卡总量及糖、脂肪、含氮热卡的比例；电解质、维生素、微量元素的补充要求。三升袋（全合一）的临床使用。 The monitoring indicators, methods of nutrition support; effect of special nutrients; selection of common nutritional agents for enteral, parenteral nutrition support; types of nutritional formula, total calories  and the ratio of sugar, fat and nitrogenous calorie; supplementary requirements for electrolytes, vitamins and microelements. Clinic application method of three-liter bag (all-in-one).
一、外科营养支持的地位及目标。The role and objective of nutrition support.
二、人体的基本营养代谢，营养状态和代谢状态的评定。Focus on basic nutrition metabolism of human body, evaluation of nutrition and metabolic status.
三、人体基础能量代谢的概念及基础需要量。Concept of basic energy metabolism of human body and the requisite amount of basic nutrition.
四、重点掌握外科肠内、肠外营养支持的适应证、并发症、支持治疗途径及围手术期时机选择。In detail of the indications, complications of enteral, parenteral nutrition support,  the approach and opportunity for nutrition support during perioperative period.
五、熟悉营养支持病人的监测及方案的调整。Introduce the monitoring of nutrition supporting patient and how to adjus the program.
外科手术器械识别与应用方法
课时目标：常用外科手术器械及其正确使用方法；了解手术器械清理与保管。 Be familiar with the names and usage of common surgical instruments. How cleaning and storage of surgical instruments.
一、常用外科手术器械及其正确使用方法。
二、手术器械清理与保管；手术室相关规章制度和管理。
外科打结法
课时目标：掌握各种外科常用的打结技术（手法）。 How to do knotting (methods) in operation.
外科基本打结手法：单手打结法、双手打结法及器械打结法等，熟练掌握外科方结、三叠结及器械打结法，掌握外科结的手法，了解其适应证。
Concept of knot tying:the methods of knot tying and ligation are divided into single-hand knot tying,two-hand knot tying and instrument tying.Knot buckles commonly used in surgery:square knot,surgical knot and triple knot.
多脏器功能障碍综合征及外科危重症的检测与诊疗原则
课时目标：一、掌握多器官功能障碍综合征的基本概念、防治原则。Over all of the concept, control principle of multiple organ dysfunction syndrome. 二、熟悉多器官功能障碍综合征的发病基础、诊断指标；急性呼吸窘迫综合征概念、发病基础、临床表现、诊断和治疗原则。急性肾衰竭的基本概念、临床表现、诊断、鉴别诊断和预防；各脏器功能监测与评价。Understanding what leading to the morbidity , diagnosis index of multiple organ dysfunction syndrome; concept, morbidity basis, clinical manifestation, diagnosis and treatment principle of acute respiratory distress sydrome. Basic concept, clinical manifestation, diagnosis, differential diagnosis and prevention of acute renal failure; monitoring and evaluation of every organ function. 三、了解多器官功能障碍综合征发病机制、临床表现；急性肾衰竭的病因、分类以及少尿期、多尿期的治疗原则；了解应激性溃疡和急性肝衰竭概念、发病基础和诊治原则。 Understanding of the MODF's( Multiple Organ Dysfunction Syndrome) pathogenesis, clinical manifestation; etiology, classification of multiple organ dysfunction syndrome ,and as well as treatment principle of oliguric stage, diuresis stage; understand concept, morbidity basis, diagnosis and treatment principle of stress ulcer and acute hepatic failure.
Multiple Organ Dysfunction Syndrome，MODS
一、多器官功能障碍综合征概念及演变，强调该综合征在外科疾病中的重要性和危险性。Concept and evolution of multiple organ dysfunction syndrome, emphasizing importance and risk of multiple organ dysfunction syndrome in surgical diseases.
二、多器官功能障碍综合征发病基础，结合临床实践说明哪那些原发病可导致MODS。Morbidity based on of multiple organ dysfunction syndrome, further knowing by the typical cases with primary diseases which can cause multiple organ dysfunction syndrome.
三、多器官功能障碍综合征的发病机制，其共同的病理生理变化，即全身性炎症反应和（或）组织缺血—再灌注损伤。Pathogenesis of multiple organ dysfunction syndrome, fully explaining that although different idiopathic causes of multiple organ dysfunction syndrome, whose pathology physiological change is similar, i.e. systemic inflammatory response and/or tissue ischemia -reperfusion injury.
四、多器官功能障碍综合征的分型、临床表现及特点，重点掌握MODS的诊断指标。Grouping, clinical manifestation and features of multiple organ dysfunction syndrome, highlighting diagnosis index of multiple organ dysfunction syndrome.
五、强调多器官功能障碍综合征诊断突出快速、及时、针对性采取辅助检查，强调早期发现、早期治疗，阻断其病理连锁反应对挽救生命的重要性。Emphasize on that diagnosis of multiple organ dysfunction syndrome shall be fast, timely, and targeted accessory check adopted; emphasize it is important for saving lives to implement early finding, early treatment and block its pathology chain reaction.
六、重点讲述预防多器官功能障碍综合征的基本要点。Highlight on essential points of prevention against multiple organ dysfunction syndrome.
七、急性呼吸窘迫综合征、急性肾衰竭的基本概念，发病机制，临床表现；急性呼吸窘迫综合征、急性肾衰竭病因及分类。The concept, pathogenesis, clinical manifestation of acute respiratory distress sydrome, acute renal failure; introduce etiology and classification of acute respiratory distress sydrome, acute renal failure.
八、急性呼吸窘迫综合征、急性肾衰竭诊断依据、方法和步骤，肾前性、肾性与肾后性肾衰竭的鉴别要点。Diagnosis (steps) of acute respiratory distress sydrome, acute renal failure, highlighting identification points of prerenal, renal and postrenal renal failure.
九、急性呼吸窘迫综合征、急性肾衰竭的预防要点，急性呼吸窘迫综合征、急性肾衰竭的处理原则及注意事项。Preventing points of acute respiratory distress sydrome, acute renal failure, highlighting principle of management and notice of acute respiratory distress sydrome, acute renal failure.
心肺复苏
课时目标：一、掌握心跳-呼吸停止的及时确诊、人工呼吸及胸外按压的正确方法。Early timing diagnosis of heartbeat-respiratory arrest, classic technics of recovering the artificial-respiration with chest compression. 二、熟悉复苏的程序、心脏按压的原理、后期复苏处理原则。Familiar with procedure of resuscitation, principle of cardiac compression, principle of late resuscitation. 三、了解简易呼吸器应用方法。
一、讲授复苏的概念，讲授判断心跳呼吸停止的方法。介绍人工呼吸的原理，介绍各种人工呼吸法，呼吸器的应用。着重讲解简易呼吸器的应用方法。讲授心脏按压的原理，胸外心脏按压法。
Concept of resuscitation, methods identifying heartbeat, respiratory arrest. Introduce principle of artificial respiration, various methods of artificial respiration, application of respirator. Emphasize application method of simple respirator. Teach principle of cardiac compression, method of extrathoracic compression.
二、讲授后期复苏处理的原则：包括呼吸道的管理、监测、药物、液体治疗及电除颤。
Principle of late resuscitation: including management, monitoring, drug, liquid treatment and electric defibrillation of respiratory tract.
全身麻醉
课时目标：一、掌握全身麻醉的概念，全麻基本要素。The concept of general anesthesia, classification, indications, and applications of clinical anesthesia.二、熟悉气管插管、辅助和控制呼吸的方法；常用吸入麻醉药、静脉麻醉药和肌松药的药理，及其在麻醉中的应用。The performance of endotracheal intubation, assistant and controlled ventilation.三、了解全身麻醉的并发症及其处理。The complications of general anesthesia and treatments for them.
一、全身麻醉的要素。General anesthesia during operation.
二、全身麻醉药:
1. 吸入麻醉药：理化性质与性能、常用吸入麻醉药。Inhalation induction by haothane,etc
2. 静脉麻醉药：理化性质与性能、常用静脉麻醉药。Rapid-Sequnce induction by thiopental,etc.
3. 肌肉松弛药：分类、常用肌肉松弛药。Depolarizing muscle relaxant (eg.succinylcholine)
4. 其他药物。Others.
三、麻醉机结构介绍。Anesthesia equipment.
四、气管插管术。The performance of endotracheal intubation, assistant and controlled ventilation.
五、全身麻醉的实施。Maintaining General Anesthesia.
六、麻醉深度的判断。Signs indicating depth of anesthesia.
七、全身麻醉并发症( Complications and treatments)：返流误吸(aspiration of gastric contents)、呼吸道梗阻(obstruction of air way)、通气量不足(inadequate ventilation)、低血压(hypotension)、恶性高热（malignant hyperthemia)等。
椎管内麻醉
课时目标：Spinal & Epidural Blocks 一、掌握椎管内解剖和生理。The anatomy and physiology of epidural & subarachnoid space.二、熟悉椎管内阻滞的管理特点、椎管内麻醉的方法与常见并发症的防治。Spinal anesthesia and its complicatons. 三、了解药物作用部位及神经纤维阻滞顺序。Pharmacologic principle and neuromuscular blockers,local anesthetic drugs.
Performance of regional anesthesia techniques, evaluation and monitoring. 一、椎管内麻醉的定义、分类、解剖基础、机制以及对生理的影响。Overall of the spinal (lumbar intrathecal space) anesthesia
二、蛛网膜下腔阻滞：定义、穿刺技术和并发症等。Definition of the subarachnoid block，technic and complications include hypotension , bradycardia, post–dural puncture headache, transient radicular neuropathy, backache, urinary retention, etc.
三、硬膜外阻滞：定义、穿刺方法及并发症。Overall of epidural (extraural) anesthesia.
四、腰硬联合麻醉。Combined spinal-epidural anesthesia.
围手术期管理
课时目标：一、掌握术前准备的基本内容；术后处理基本原则。Basic content of preoperative preparation; basic principle of postoperative management. 二、熟悉术后并发症处理原则。 Principle of management for postoperative complications. 三、了解主要脏器（循环、心脏、肺）功能的基本评价方法。Basic evaluation methods of functions of major organs (circulatory, heart, lung).
一、重点学习病人在术前的准备，包括：一般准备：心理、生理；特殊准备：营养评估、心血管评估、肺功能评估、肾功能评估、血糖及凝血障碍调整以及下肢深静脉血栓的预防。
Preoperative preparation of patient, including: general preparation: psychology, physiology; special preparation: nutrition evaluation, cardiovascular evaluation, pulmonary function evaluation, renal function evaluation, regulation of blood sugar and disturbance of blood coagulation as well as prevention against thrombosis in vena profunda on lower extremity.
二、术后处理：常规处理、卧位、各种不适的处理以及病人的活动、饮食和缝线拆除时间。
Postoperative management, including: conventional treatment, clinostatism, treatment of indispositions as well as time of activity, diet and stitch removal of patient.
三、术后并发症的防治与处理，包括：出血、发热与低体温、感染以及切口裂开等。
Prevention and the key of cure of the postoperative complications, including: hemorrhage, pyrexia and hypothermia, infestation as well as disruption of wound.
外科换药基本技术
课时目标：一、掌握伤口换药的基本原则及拆线基本技术（掌握切口的分类原则）。The principles of wound dressing and basic technology of taking out stitches.Master the principles of incision classification. 二、熟悉伤口的观察要点。Be familiar with the observation points of wounds. 三、了解影响伤口愈合因素。To understand factors which affecting wound healing.
一、换药基本操作流程：
1．事先根据伤口情况准备物品。Prepare items before hand based on the wound condition.
2．能走动的病人，均应在换药室换药，不能走动的病人可在床边换药。Patients who are able to move around will change their dressingin the dressing exchange room, while those who are unable to move around may change their dressingat the bedside.
3．根据病人是无菌或有菌伤口，分别在无菌或有菌换药室换药。Depending on whether the patient has a sterile or bacterial wound, the dressing is changed in a sterile or bacterial dressing room, respectively.
4．换药时要戴好帽子和口罩。Wear a cap and facemask when you changing dressing.
5．换药时要注意伤口情况，详细记录。Keep an eye on the wound and record it in detail when changing the dressing.
6．换药时间：感染重的、分泌物多的应每天换药。随着分泌物减少，可隔日一次或隔2日一次。Dressing change time:those with heavy infection and many secretions should be changed everyday.As the dischargereduction,you can change dressing once or every 2 days to go once.
7．具体步骤；Specificsteps
（1）实行无菌术原则：用两把镊子，两者不可混用。The principle of asepsis:use two tweezers,the two can not be mixed.
（2）先消毒皮肤。Disinfect the skin first.
（3）用等渗盐水棉球擦拭伤口。去除坏死组织和脓液。Wipe the wound with an isotonic saline cotton ball.Remove necrotic tissue and pus.
（4）可选用适当的药剂和引流物充填，外敷无菌纱布，胶布固定或绷带包扎。Fill with appropriat emedicament and drainage,apply sterile gauze externally,fix with tape or bandage.
二、伤口分类：
1．对无菌伤口，术后不痛，不发热，不必更换敷料或检查。头颈可提前2～3天，肢体和胸部推迟2～3天，老年人或癌症，全身情况较差病人可适当延迟拆线时间。减张缝线14天拆除。橡皮引流或烟卷引流一般在24～48小时内取出，以免感染。For sterile wounds,the reisnopost operative pain,no fever,and no need to change the dressing or check.Head and neck can be advanced by 2 to 3days,limbs and chest delayed by 2 to 3days,the elderly or cancer,poor general condition patients canbe properly delayed stitches removal time.The tension-reducing suture canbe removed in 14 days.The rubber drain or cigarette draini sgenerally removed within 24 to 48 hours to avoid infection.
2．切口分为清洁切口用Ⅰ代表，污染切口用Ⅱ代表，感染切口用Ⅲ代表。切口愈合用甲表示愈合良好，乙表示有渗出未化脓，丙表示切口有化脓感染。Incisions are divided intoⅠfor clean incisions,Ⅱ for contaminated incisions,and Ⅲ for infected incisions.For wound healing,A indicated good healing,B indicated exudation without suppuration,and C indicated suppuration and infection of the incision.
三、拆线：
1．消毒。Disinfection.
2．左手用镊子提起缝线的一头，轻轻提起，右手用并拢的剪刀轻轻压下皮肤，使埋于皮下的缝线露出皮外。贴近皮肤剪断缝线发白处、然后用并拢的剪刀压住对侧皮肤，轻轻将线拔出。With the left hand, lift the end of the suture and gently lift it, and with the right hand, gently press down the skin with the scissors together, so that the suture buried under the skin is exposed. Cut the white part of the suture close to the skin, then press the pair of scissors against the skin on the opposite side,and gently pull out the suture.
外科感染
课时目标：一、掌握外科感染的基本特点、临床处理原则；全身性外科感染的概念。Characteristics, clin proc principle of surgical infection; concept of general surgical infection. 二、熟悉脓毒症病理生理学基础、病因、诊断、临床表现、治疗原则；影响外科感染因素。常见致病菌引起外科感染的临床特点；常用抗菌药物的使用原则与合理使用。疖、痈、蜂窝织炎、丹毒、急性淋巴结炎、脓肿、甲沟炎和化脓性指头炎诊断、治疗原则。 Be familiar with the basis, etiology, diagnosis, clinical manifestation, treatment principle of pyemia pathophysiology; factors affecting surgical infection. Clinic features of surgical infection caused by common pathogen; application principle and reasonable use of common antibacterials. Diagnosis, treatment principle of furuncle, carbuncle, phlegmon, erysipelas, acte lymphadenitis, abscess, paronychia and agnail. 三、了解全身炎症反应综合征和局部炎症反应的病理生理学差别与联系、不同临床表现、转归差异；革兰阳性细菌、革兰阴性细菌、真菌感染的临床不同特点、治疗原则。破伤风和气性坏疽的临床表现特点、诊断、治疗原则；艾滋病与外科感染病因、诊断、临床表现和预防治疗原则。 Difference and relation of physiopathology between systemic inflammatory response syndrome and local inflammatory response, different clinical manifestation, difference of metastasis and development; different clinic features, treatment principles of Gram positive bacteria, Gram negative bacteria and mycotic infection. Clinical manifestation, features, diagnosis, treatment principle of tetanus and gas gangrene; etiology, diagnosis, clinical manifestation, prevention and treatment principle of AIDS and surgical infection.
通过学习，重点领会外科感染基本概念，特别是全身性外科感染、脓毒症、菌血症的基本概念。
一、外科感染的特点、发生和发展规律、转归，介绍条件性感染、二重感染、医院感染的概念。
Introduce features, law of occurrence and development, metastasis and development of surgical infection, and concept of nosocomial infection.
二、影响外科感染的全身性及局部性因素。
Systemic and locality factors affecting surgical infection.
三、引起外科感染的常见致病菌之临床特点。
Clinic features of surgical infection caused by common pathogen.
四、外科感染的分类，重点讲授临床表现及治疗原则，强调外科引流通畅的重要性。介绍一般化脓性感染鉴别诊断、治疗原则。
Classification of surgical infection, highlight clinical manifestation and treatment principle.
五、重点：全身性外科感染的临床表现，不同类型全身性感染的特点、诊断方法及治疗原则（菌血症、脓毒症基本概念和特点）。
Highlight clinical manifestation of systemic surgical infection, features, diagnosis method and treatment principle of different types of systemic infection, basic concept and features of bacteremia and pyemia.
六、破伤风的病因、病理生理，讲解破伤风的临床特点、诊断方法、预防措施、处理原则，尤其是控制肌肉痉挛的方案及并发症的防治。
Etiology, pathology physiology of tetanus, teach clinic features, diagnosis methods, preventive measures, principle of management of tetanus, especially control scheme of muscle cramp and prevention and cure of complications.
七、介绍常用抗生素的种类及使用原则。
Introduce the kinds and applicating principle of the antibiotics.
胃（肠）穿孔修补术 动物试验课
课时目标：一、掌握胃或肠壁的切口和止血方法。Incision and hemostasis method of the stomach or intestinal wall. 二、熟悉胃肠道伤口的缝合原则和方法。Be familiar with the principles and methods of gastrointestinal wound suture. 三、了解剖腹探查术的程序。Grasping the procedure of exploratory laparotomy.
一、实验动物的准备（备皮、麻醉等）。Preparing the operating animal,etc.
二、手术操作步骤：Steps:
1．器械：刀、剪、直（弯）血管钳等。Instruments:knife,scissors,straight (curved) vessel forceps,etc.
2．外科刷手，手术区域消毒、铺无菌巾，穿手术衣等。Disinfection,sterile towels,etc.
3．切口：取右上腹直肌切口，进腹腔后上腹膜巾（保护手术切口）。Incision:Make an incision in the right upper rectus abdomin is muscle and enter the abdominal cavity after the upper peritoneal towel.
4．找到胃（或肠）后，将胃（或肠）提出腹腔外，用盐水纱布垫在周围。After finding a stomach or intestinal stomach or intestinal abdominal cavity is put forward,with saline gauze pad in the surrounding.
5．用刀在胃（或肠）上做一切口（2cm左右），结扎止血。Use a knife to make all incisions in the stomach (orintestines) and ligation to stop bleeding.
6．间断缝合胃（或肠）伤口。Sew the stomach (orbowel)wound.
7．缝合全层。Sew the full layer.
8．缝合浆肌层。Suture the seromucosal layer.
9．将内脏放回腹腔，检查有无活动性出血，清点纱布、器械。Place the viscera back into the abdominal cavity and count the gauze,instruments.
10．缝合腹膜、肌层和皮肤。Suture the peritoneum,musclelayer,and skin.
家兔阑尾切除术 动物实验课
课时目标：一、掌握切开、止血、结扎及缝合基本操作。Operative skills of how to do the incision,hemostasis,ligation and suture. 二、熟悉剖腹术的操作方法，阑尾切除的手术步骤。Be familiar with the operation methods of laparotomy.Surgical procedures for appendectomy. 三、了解肠脂垂固定包埋阑尾残端和荷包缝合技术。To understand the techniques of appendectomy and purse-string suture for appendectomy.
一、家兔阑尾切除术演示采用常用的顺行法，即先游离阑尾。然后再切断其根部。 Appendectomy:commonly procedure be used with an terograde method,that is,first freed the appendix,and then cut off its root. ..
二、手术器械准备：刀、剪、手术镊、1号丝线等。 Instruments: knife,scissors,surgical tweezers,etc.
三、操作步骤：
1．切口：下腹正中切口或右腹直肌旁切口。Incision: A median lower abdominal incision or right para-rectus incision.
2．耳缘静脉注射麻醉。Anesthesia is given throug have in at the edge of the ear.
3．麻醉后，将兔平放和束缚于手术台上，剃毛。After anesthesia,the rabbit is laid flat and rest rained on the operating table and shaved.
4．刷手、穿手术衣、套无菌手套。Brush your hands,wear as urgical gown,and put on dry gloves.
5．以脐为中心消毒皮肤、铺无菌单。Sterilize its skin centered on its umbilicals.Lay out a sterile sheet.
6．切开皮肤、换刀片、切开皮下、结扎出血点。Cut the skin open, change the blade, cut the skin under the skin, and ligation the bleeding point.
7．切开腹直肌前鞘。Open the anterior rectus sheath.
8．沿腹直肌纤维方向，用刀柄分开腹直机，暴露腹直肌后鞘。Expose the posterior rectus sheath by separating the rectus abdominis machine with a knife hand lein the direction of the rectus fiber.
9．剪开腹膜。Cut open the peritoneum.
10．暴露阑尾。Expose its appendix.
11．依次分离、钳夹、切断、结扎阑尾系膜，游离阑尾至其根部0.5cm。Isolate the appendix.
12．钳夹、切除阑尾，残端结扎。Remove the appendix.
13．荷包包埋阑尾残端，表面浆肌层间断缝合。Purse string stitches.
14．去除纱布，清点器械无误后，缝合腹膜、肌层及皮肤，纱布覆盖切口。After removing the gauze and checking the instruments to be correct, the peritoneum,muscular layer and skin are sutured.
创伤
课时目标：一、掌握创伤分类、诊断、临床表现、处理原则；清创术的目的和步骤。Principles of trauma classification, diagnosis, clinical manifestations, and management; The purpose and steps of debridement. 二、熟悉创伤病史询问方法，体检的要点及意义，合理选择辅助检查；开放性创伤的伤口分类和处理方法；影响伤口修复的因素，伤口修复过程。Familiar with the medical history of trauma, key points and significance of physical examination, and reasonable selection of auxiliary examinations; Wound classification and management methods for open wounds; Factors that affect wound repair and the process of wound repair.
一、讲授损伤与创伤、多发伤与复合伤概念、创伤分类、创伤病理生理改变、现代创伤特点和治疗原则。The concepts of injury and trauma, multiple and composite injuries, trauma classification, pathological and physiological changes in trauma, modern trauma characteristics, and treatment principles.
二、重点讲授创伤的临床表现和发生机制，创伤的并发症。Focus on teaching the clinical manifestations and mechanisms of trauma, as well as the complications of trauma.
三、以局部创伤性炎症反应的病理为基础重点讲授创伤的组织修复过程，伤口愈合分期及影响因素。Based on the pathology of local traumatic inflammatory response, we will focus on teaching the tissue repair process, wound healing stages, and influencing factors of trauma.
四、从现代创伤特点的角度讲述创伤病史询问、体格检查、辅助检查特点。Describing the characteristics of trauma history inquiry, physical examination, and auxiliary examination from the perspective of modern trauma characteristics.
五、从紧急生命支持角度讲授创伤急救；从局部创伤性炎症反应角度讲授创伤局部处理；从全身应激反应角度讲授创伤后全身支持治疗。or patient with trauma，saving aid from the perspective of emergency life support; Teaching local trauma management from the perspective of local traumatic inflammatory response; Teaching the traumatic systemic support therapy from the perspective of systemic stress response.
六、讲授伤口的分类和处理方法选择，介绍清创术的步骤及引流物的选择。The classification and treatment method selection of wounds, introduce the steps of debridement and the selection of drainage materials.
烧伤
课时目标：一、掌握烧伤临床分期、面积计算、深度估计、程度判断、治疗原则。Clinical BURN staging, area calculation, depth estimation, degree identification and treatment principle of burns. 二、熟悉现场急救、转送与早期处理；烧伤早期休克的诊断和治疗；烧伤全身感染的诊断；烧伤并发症、补液方法及全身感染的防治。Be familiar with field first-aid, transfer and early treatment; diagnosis and treatment of early burn shock; diagnosis of systemic burn infection; complications of burn, fluid replacement method, prevention and cure of systemic infection.
一、烧伤的概念、致病因素，重点讲授烧伤面积的估算和深度识别，烧伤严重性分度和并发症；介绍吸入性损伤的特点。Concepts, pathogenic factors of burns, highlight area estimation and depth identification of burns, seriousness grading and complications of burns; introduce features of aspiration injury.
二、从病理生理角度讲授烧伤局部病变，全身反应和临床分期。From the view point of pathology physiology, teach local patholoic change, systemic reaction and clinical staging of burns.
三、讲授烧伤的治疗原则，现场急救，转送和初期处理，创面处理。Treatment principle of burns, field first-aid, transfer and early treatment, treatment of surface of wound.
四、结合临床病例重点讲授烧伤早期休克特点和临床表现以及补液方法、监测。According to key points of clinic cases, teach features and clinical manifestation, fluid replacement method and monitoring of early burn shock.
五、烧伤全身感染的发生与发展，诊断和防治。Occurrence, development, diagnosis, prevention and cure of systemic burn infection.
六、介绍不同深度烧伤的处理方法及进展。Introduce treatment process and development of different depth burns.
七、自学电烧伤、化学烧伤的特点，急救和处理原则。
九、自学冻伤的分类和防治。
清创术 模具试验课
课时目标：一、掌握伤口清创术的基本原则。The principles of wound debridement. 二、熟悉伤口清创术的步骤。Be familiar with the steps of wound debridement. 三、了解清创术后注意事项。Understanding the precautions after debridement.
一、清创术基本原则。Basic principles of debridement
二、软组织清创术步骤: Soft tissue debridement procedures:
1．清洗祛污：Cleaning and removing stains:
（1）用纱布保护好伤口，剪去毛发。Protect the wound with gauze and cut the hair.
（2）除去污垢油腻。Remove dirt and greasy.
（3）用清水冲洗周围皮肤。Rinse the surrounding skin with clean water.
（4）用等渗盐水冲洗伤口，去除伤口内异物及血凝块。Rinse the wound with isotonic saline to remove foreign bodies and blood clots in the wound.
2．清理伤口：Clean the wound:
（1）用3％碘酒及75％酒精消毒皮肤。Disinfect the skin with 3% iodine and 75% alcohol.
（2）置无菌单。Place a sterile sheet.
（3）根据创伤的部位和程度选择适当的麻醉方式（局部麻醉或全身麻醉）。Choose the appropriate type of anesthesia(local anesthesia or general anesthesia)according to the location and degree of trauma.
（4）伤口不清洁可用双氧水擦拭或冲洗，然后再用等渗盐水冲洗。If the wound is not clean,it canbe wiped or rinsed with hydrogenperoxide,and then rinsed with isotonic saline.
（5）去除异物、血凝块。Remove foreign bodies and blood clots.
（6）剪除坏死组织，修整皮缘。The necrotic tissue was cut off and the skin edge was trimmed.
（7）为处理伤口深部，可适当扩大伤口和切开筋膜，直至伤口清洗和血循环较好的组织存留。In order to manage the deep part of the wound,the wound canbe enlarged and the fascia canbe cut properly until the tissue with good wound cleaning and blood circulation remains.
3．缝合伤口：
（1）更换无菌单、器械及手套。Change the sterile sheet,instruments and gloves.
（2）重新消毒。Resterilize.
（3）彻底止血。Stop bleeding completely.
（4）根据伤口情况可留置引流物（引流管、引流条等）。According to the condition of the wound,drainage materials (drainage tube,drainage strip,etc.) canbe placed.
（5）根据伤口情况可I期缝合各层组织。或二期缝合伤口，只缝合深部组织、待1～4日再缝合皮下组织和皮肤。缝合时注意组织层的对合，勿残留死腔。According to the condition of the wound,each layer of tissue canbe sutured in one stage.Or the wound canbe sutured in the second stage,only the deep tissue canbe sutured,and the subcutaneous tissue and skin canbe sutured after 1 to 4 days.During suture,attention should be paid to the alignment of tissue layers,so that nodead space remains.
（6）伤口包扎。Wrap the wound.
兔后肢静脉切口置管术 动物试验课
课时目标：一、掌握家兔后肢静脉切开置管术的手术操作方法。Operative procedure of venous angiotomy of rabbit hind limb. 二、熟悉血管损伤的基本处理方法。熟悉静脉输液装置的安置和使用。Be familiar with the basic treatmen tof vascul arinjury.Be familiar with the placement and use of intravenous infusion devices.三、了解锁骨下静脉穿刺术。Knowing how, why to do the subclavian vein puncture in clinics.
一、试验动物及手术输液装置的准备。
二、步骤：
1．术前准备：Preoperative preparation
（1）手术动物当日禁食，捕捉、绑缚、称重。Animals were fasted,captured,bound,and weighed on the day of surgery.
（2）清点手术器械，麻醉动物。The surgical instruments were counted and the animals were anesthetized.
（3）将动物绑扎固定、剃毛，消毒、铺无菌巾。The animals were bound and fixed,shaved,disinfected,andcovered with sterile towels.
2．切口选择及静脉显露。Incision selection and vein exposure.
3．血管的分离：Separation of blood vessels
（1）切开皮肤、分离皮下筋膜组织，显露股动、静脉。The skin was cut,the subcutaneous fascia tissue was separated,and the femoral artery and vein were exposed.
（2）结扎剪断分支静脉。The branch veins were ligated and cut.
（3）游离静脉。Free the vein.
4．血管带线。Blood vessels are threaded.
5．血管结扎与牵引。Blood vessel ligation and traction.
6．静脉切开置管。Vein incision and tube placement.
7．导管的留置固定。In dwelling fixation of the catheter.
8．消毒皮肤切口，固定输液管。Sterilize the skin incision and secure the infusion line.
外科肿瘤概论及常见体表肿瘤
课时目标：一、掌握常见体表肿瘤的诊断和治疗。Definition, etiology, pathological classification, tertiary prevention and follow-up of tumors. 二、熟悉肿瘤的临床表现、诊断程序、分期及治疗原则。Clinical manifestations, laboratory examination, imaging and endoscopic diagnosis of solid tumorsIII.Be familiar with with tumor stagingIV. 三、了解肿瘤的定义、分类、病因、病理及预防。Be familiar with the principles, methods and treatment principles of surgical treatment, chemotherapy, radiotherapy and biotherapy of solid tumors.
一、熟悉肿瘤的临床表现，包括：局部及全身表现；肿瘤的诊断程序， 包括病史采集、体格检查、实验室检查、影像学检查、内镜检查，肿瘤的TNM分期及肿瘤的治疗原则。
The concept of tumor and the pathogenesis of molecular biology, including oncogene, theories of tumor suppressor gene, mismatch repair gene, microsatellite instability and telomerase; Common chemical, biological, physical and radioactive carcinogenic factors; The classification of epithelial and mesenchymal tumors, the pathological characteristics and biological behavior of benign and malignant tumors.
二、掌握肿瘤的定义、各种分类方法以及常见体表肿瘤。
Clinical manifestations, tumor markers, genetic testing, significance of common solid tumors from different sources, and the methods and indications of X-ray, ultrasound, CT, MRI, PET-CT and endoscopy.
三、自学肿瘤的病因、病理诊断要点及三级预防。
Be familiar with the principles and methods of tumor TNM staging
Knowing the principles and indications of different treatment strategy for solid tumors, including surgery, chemotherapy, radiotherapy and biotherapy, and complications or adverse reactions of various treatment methods.
皮下肿瘤切除活检术 模具试验课
课时目标：一、掌握体表肿块穿刺取样活检术及手术活检的操作方法。The operative technique of biopsy of superficial soft tissue mass. 二、熟悉体表肿块穿刺取样活检术及手术活检的禁忌证，适应证。Be familiar with the contraindications and indications for technique of biopsy of superficial soft tissue mass. 三、了解体表肿块穿刺取样活检术及手术活检的准备工作。Understanding the preparation for technique of biopsy of superficial soft tissue mass.
一、手术适应证：
体表可扪及的任何异常肿块，都可穿刺活检及手术活检。例如乳腺肿块、淋巴结等。Needle biopsy and surgical biopsy can be performed for any abnormal mass palpable on the body surface.Examples include breast masses,lymphnodes,etc.
二、手术禁忌证：
1．凝血机制障碍。Disorders of the coagulation mechanism.
2．非炎性肿块局部有感染。The non-inflammatory mass has local infection
;3．穿刺及手术活检有可能损伤重要结构。Needle and surgical biopsies may damage important structures.
三、试验流程-准备：
1．穿刺部位皮肤准备，如剃毛。Skin preparation at the piercing site,such as shaving.
2．器械准备：消毒的穿刺针、手术包及注射器、碘酒、酒精、局部麻醉药及标本处理器皿等。Equipment preparation:disinfection of needle,kits and syringe,iodine,alcohol,local anesthetics and specimen processing vessel and soon.
四、试验流程-操作方法：
1．粗针穿刺（自学）：
（1）碘酒，酒精消毒穿刺局部皮肤。
（2）穿刺点作局部浸润麻醉。
（3）术者戴无菌手套后，左手拇指和食指固定肿块，右手持尖刀作皮肤戳孔。
（4）穿刺针从戳孔刺入达肿块表面，然后用活检枪激发获取组织标本，
（5）将切割针前端叶片间或取物槽内的肿块组织取出，用福尔马林固定液固定，送组织学检查。
2．细针穿刺（自学）：
（1）碘酒、酒精消毒穿刺局部皮肤及术者左手拇指和食指。
（2）术者左手拇指与食指固定肿块，将穿刺针刺入达肿块表面。
（3）用力持续抽吸形成负压后刺入肿块，并快速进退数次，直至见到有吸出物为止。
（4）负压下拔针，将穿刺物推注于玻片上，并推片，不待干燥，立即用95％酒精固定5～10分钟，送细胞病理学检查。囊性病变则将抽出液置试管离心后，取沉渣检查。
（5）术后穿刺部位盖无菌纱布，用胶布固定。
3．浅表软组织切除（取）活检术（在模具练习操作）
（1）取适当体位，皮肤消毒，铺无菌巾。局部浸润麻醉或区域阻滞麻醉。Take an appropriate position, disinfect the skin, and spread a sterile towel. Local infiltration anesthesia or regional block anesthesia.
（2） 病变位于皮肤时，沿肿瘤周围约0.5cm做肿瘤完整切除（如选择进行切取活检术则一般取肿物或溃疡质地较硬隆起不规则部位且与正常组织交界处，切取组织1.0cm×1．5cm）。The lesions in the skin,usually take the mass or ulcer a hard bump irregular parts and normal tissue,for organization by 1.0cm×5cm.
（3）如组织位于皮下深层者，应逐层切开皮肤、皮下组织、暴露肿块、将肿瘤完整切除（或用尖刀楔形切取一块组织）。切取后即装入盛有10％甲醛的瓶内固定，送病理检查。The organization is located in the deep,should cut the skin,subcutaneous tissue,exposed step by step a lump,with as harp knife wedge cut out a piece of tissue.Cut out after loading with in the bottle containing 10% for maldehy defixed and pathologic examination.
对于疑为高度恶性肿瘤时，如恶性黑色素瘤、睾丸精母细胞瘤等，不应作切取活组织检查，而应将病灶扩大切除后送病理检查。When a highly malignant tumor is suspected,such as malignant melanoma or testicular seminoma,biopsy should not be performed,and the lesion should be resected and sent for pathological examination.
兔肠切除吻合术 动物实验课
课时目标：一、掌握肠吻合的方法。Master the method of intestin alanastomosis. 二、熟悉胃肠道吻合的两种缝合方法，间断全层缝合和间断浆肌层缝合。Familiar with the two suture methods of gastrointestinal anastomosis,interruptedfull-thickness suture and interrupted seromuscular suture. 三、熟练外科手术器械的使用。The skills practe training of using surgical instruments.
一、手术前准备：树立无菌概念、备齐手术器械等。Prepare the equipment and preoperation planing.
二、肠切除、肠吻合术（家兔）的操作流程。Intestinal resection and anastomosis(rabbit).
1．将兔麻醉后，绑缚于手术台上。After the rabbitis be anesthetized,it is bound to the operating table.
2．参加手术者常规刷手、穿手术衣、戴手套。Participants routinely brush their hands,wea rsurgical gowns and gloves.
3．取右侧经腹直肌切口，消毒手术区皮肤。Make a right transrectus abdomin isincision and sterilize the skin in the surgical area.
4．切开皮肤、皮下组织、止血，用纱布保护皮肤切口边缘。Cut open the skin,subcutaneous tissue,stop bleeding,and protect the edge of the skin incision with gauze.
5．切开腹直肌前后鞘及腹膜。Open the anterior and posterior rectus sheath and peritoneum.
6．用自动拉钩将切口牵开，取出小肠—段。Use an automatic retractor to pull the incision open and remove out a loop of the small bowel.
7．切断、结扎、剪断肠系膜。Cut,tie,and snip the mesentery of the intestinal ioop planed to resected.
8．在两肠钳间切断肠管。Cut the bowel tube between the two bowel forceps.
9．肠断端擦拭消毒。Wipe and disinfect the broken end of the bowel.
10．肠管端端吻合（开放式）。Bowel anastomosis end to end (open).
11．缝合后（浆肌层）壁。Suture the posterior (seromuscularlayer) wall.
12．缝合全层。Sew the full layer.
13．缝合前壁浆肌层。吻合毕检查吻合是否通畅。Sew the front wall.Check for patency after the anastomosis.
14．缝合肠系膜裂孔，再次检查吻合口无活动性出血、肠漏后，将肠回纳腹腔。The mesenteric hiatusis sutured and the bowel is returned to the abdominal cavity.
15．清点纱布、器械无误，缝合腹膜、腹直肌后鞘、腹直肌前鞘、皮下组织及皮肤，敷料覆盖切口。The gauze and instruments were counted correctly,and the posterior rectus sheath,peritoneum,anterior rectus sheath,subcutaneous tissue and skin were sutured.Cover incision wtth asepsised gauzes.
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预备知识

本课程主要由外科学总论和总论阶段临床动物（模具）实验二部分组成。其中外科学总论主要介绍外科基础理论、基本知识，实验操作部分以培养外科基本技能为主要内涵。在学习外科总论时，对外科常见疾病的病因、临床表现、诊断、鉴别诊断以及治疗原则等方面内容进行详解；在实验课程中，通过对接近 真实的临床对象（动物模型、模具）进行学习，将理论与实践相结合，加深对外科基本技能的理解与认知与掌握。

学习好外科学总论的知识储备包括：解剖学、病理学、病理生理学以及组织胚胎学等。

参考资料

王宇 姜洪池 主编： 全国高等医学院校教材《外科学》第2版，北京大学医学出版社.

陈孝平 汪建平 赵继宗 主编：国家卫生健康委“十三五”规划教材《外科学》 人民卫生出版社

吴阶平主编 . 《黄家驷外科学》第 7 版，北京：人民卫生出版社， 2008.

《克氏外科学》十九版 . 北京 : 人民卫生出版社 ,2008.

常见问题


Q : 外科学的相关专业有哪些？ Surgery category

A : 现代外科学涉及神经外科、普外科、胸心外科、泌尿外科、骨科、整形外科、移植外科等专业，包括颈部与乳腺疾病、胸部损伤与肿瘤、心脏疾病、腹部损伤、消化系统良性疾病与肿瘤、泌尿系结石与肿瘤、前列腺癌增生、骨折、骨关节损伤、骨肿瘤等外科常见疾病。 


Modern surgery now was divided into: Departent of General surgery,Thoracic surgery,Cardiac surgery,Organ transplantation,etc.And,Surgeons were named with: Neurosurgeons, Orthopedists, Plastic surgeons,Otorhinolaryngologists, Ophthalmologists,Anesthesiologists, etc.

Q：外科休克的临床分类（常见）？Surgical Shock

A:在临床实践中，常根据病因将外科休克分为低血容量性休克、感染性休克、心源性休克及神经源性休克等。 Relate clinical manifestation of shock with its pathophysiology basis，the commonly shock were hypovolemic shock，infectious shock，etc.

首都医科大学
15 位授课老师
张立军

张立军

主任医师 教授

李彤

李彤

主任医师

张明珠

张明珠

主任医师

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