外科学历年英语真题

2002外科学专业英语 A卷（试卷）

普通外科

1. 急性非结石性胆囊炎 acute acalculous cholecystitis

骨科

泌尿外科

胸心外科

2002外科学专业英语 A卷（答案）

普通外科

骨科

泌尿外科

1．精原细胞瘤

2．尿道下裂

3．transitional cell carcinoma

胸心外科

1． Sleeve lobectomy

2． mitral valve replacemen t

3． 胸廓成形术

2002外科学专业英语 (B卷)（试卷）

普通外科

骨科

泌尿外科

胸心外科

1． 电视辅助胸腔镜外科

2． 动脉导管未闭

3． Achalasia of cardia

2002外科学专业英语 (B卷)（答案）

普通外科

骨科

泌尿外科

胸心外科

2002年肿瘤英译中 （一）

Radiation resistant squamous cell carcinoma of the head and neck cell line JSQ -3 carries a

mutant form of tumor suppressor gene p53. Treatment of these cells with an adenoviral vector

containing wild -type p53 (Av1p53) was able to inhibit their growth in vitro and in vivo while having no

effect on norm al cells. More significantly, introduction of wtp53 also reduced the radiation -resistance

level of this cell line in vitro, in a viral dose -dependent manner. Furthermore, this radiosensitization

also carried over to the in vivo situation where the response of JSQ -3 cell -induced mouse xenografts

to radiotherapy was markedly enhanced after treatment with Av1p53. Complete, long -term regression

of the tumors for up to 162 days was observed when a single dose of Av1p53 was administered in

combination with ionizi ng radiation, demonstrating the effectiveness of this combination of gene

therapy and conventional radiotherapy. This sensitization of tumors to radiation therapy by

replacement of wtp53 could significantly decrease the rate of recurrence after radiation t reatment.

Since radiation is one of the most prevalent forms of adjunctive therapy for a variety of cancers, these

results have great relevance in moving toward an improved cancer therapy. Gene therapy involves

the introduction of genetic material (DNA) in patient cells, in order to produce therapeutic effect after

expression of the new gene. New insights in head and neck tumor etiology and the development of

genetic engineering techniques made the gene transfer a reality . This article gives a brief ove rview of

investigations leading to clinical application of gene therapy in head and neck tumors. A good

therapeutic response in more than 50% patients has been reported in literature. These results and

future potential o f gene therapy are discussed .

Axillary lymph node status is important for staging and planning therapy prior to neoadjuvant

chemotherapy in patients with locally advanced breast cancers (LABC). The objective of this study

was to evaluate the use of axilla ry ultrasonography coupled with fine needle aspiration biopsy (US -

FNAB) to determine lymph node status prior to initiation of neoadjuvant chemotherapy. METHODS:

Patients with a LABC, defined as a breast cancer clinically larger than 3.0 cm or a cytology pos itive

axillary lymph node, were evaluated by clinical examination followed by ultrasonographic evaluation.

Lymph nodes were categorized as suspicious for malignancy based on size >1.0 cm, decrease in the

fatty hilum, or parenchymal echogenicity. US -FNAB wa s performed on all patients. Most pa tients

received neoadjuvant chemotherapy followed by definitive surgery. Axillary surgery consisted of

axillary lymph node dissection. Axillary status by clinical examination and US -FNAB was compared

with that obtained b y axillary node dissection. RESULTS: From January 1998 to May 2001, 26 patients

(27 axillae) presented with LABC to our institution. The median age of these patients was 48 years.

The sensitivity and specificity of US-FNAB for evaluating axillary metastatic disease in patients with

LABC were 100% and 100%, respectively. CONCLUSIONS: In patients with locally advanced breast

cancer, axillary ultrasonography coupled with fine needle aspiration biopsy can accurately stage the

axilla. It is particularly useful and should be used more frequently in p atients undergoing neoadjuvant

chemotherapy. The use of ultrasonography to stage the axilla in patients who present with small breast

cancers should be explored.

Several recent trials have demonstrated that neoadjuva nt chemotherapy can allow more patie nts

to successfully undergo breast -conserving treatment (BCT), and does not confer a survival

disadvantage compared with standard adjuvant chemotherapy. In addition, the pathological response

of primary breast tumors to neoadjuvant chemotherapy appears to be a surrogate marker for patient

outcome. In our series, during the period from May 1995 to December 2000, 86 patients with tumors

between 3.1 and 6.0 cm in diameter received epirubicin -based neoadjuvant chemotherapy. T here

were 55 (64.0%) responders and ultimately 64 patients (74.4%) were treated with BCT. The margin

positive rate was 14.1%(9/64), similar to the rate after BCT for early -stage breast cancers, the largest

diameter of which was smaller than 3 cm. At a medi an follow -up of 30 months, only 3 pa tients in the

BCT group have developed local recurrence; the local recurrence rate appears to be comparable to

that after BCT for early stage breast cancers. Long term follow -up is required, however, to establish

whether this procedure is a safe alternativ e to mastectomy for patients with large breast cancers.

2002年肿瘤英译中 （二）

Initial investigations into p53 gene expression in head and neck s quamous cell carcinoma

( HNSCC ) indicated that about 60% mutation this gene, which was substantiated by many of the later

reports. Furthermore, mutation of this gene was found to correlate with a very poor outcome in a group

of HNSCC patients. Despite adv ances in surgery, radiotherapy, and chemotherapy, survival of patients

with HNSCC has not significantly improved over the past 30 years. Locally recurrent or refractory

disease is particularly difficult to treat. Repeat surgical resection and/or radiothera py are often not

possible, and long -term results for salvage chemotherapy are poor. A high incidence of locoregional

failure contributes to the poor overall survival rate of around 50% for patients with HNSCC.Recent

advances in gene therapy have been appli ed to recurrent HNSCC. Many of these techniques are now

in clinical trials and have shown some efficacy. This article discusses the techniques employed in gene

therapy and summarizes the ongoing protocols that are currently being evaluated in clinical

trials.Locoregionally recurrent HNSCC is a logical target for direct delivery of gene therapy

approaches. Because the protein p53 plays a role in cell cycle regulation and in apoptosis, p53 gene

transfer was initially tested in head and neck cancer patients by injecting the primary or regional tumor

with an adenoviral vector possessing wild -type p53. Adenoviral p53 was demonstrated to be safe and

well tolerated; furthermore, activity was observed. Several randomized studies of adenoviral p53 are

now under way i n patients with HNSCC to determine its role as a surgical adjuvant in untreated

disease and in combination with DNA -damaging agents including ionizing radiation and cytotoxic

drugs .

Over the past three decades significant advances have been made in the ad juvant treatment of

breast cancer. Despite and increasing incidence of breast cancer, mortality has undergone a gradual

decline. This decline in mortality is likely due to numerous factors, including earlier stage at diagnosis,

advances in local therapy, a nd advances in systemic treatment of breast cancer. Breast conserving

surgery is now the preferred option in stage I or II breast cancer. Breast conserving surgery

( lumpectomy and quadrantectomy ) involves excision of the primary tumor and the minimum of

surrounding tissue. Overall, it is associated with a low incidence of recurrence, improved cosmetic

results and few complications compared to mastectomy. Moreover, combining breast conserving

surgery with radiotherapy significantly improves disease free su rvival compared with surgery alone.

Lumpectomy produces better cosmetic results than quadrantectomy, but is associated with a higher

incidence of recurrence. Neoadjuvant treatment involves the preoperative administration of hormonal

treatment or cytotoxic chemotherapy in order to achieve local disease control before surgery. This is

reputed to: improve disease -free survival, and reduce the need for mastectomy. Although not yet

standard practice, preliminary clinical experience indicates that this technique may prove extremely

valuable in patients with early breast cancer.

All women with stage I or II node -positive breast cancer should receive adjuvant treatment.

Adjuvant treatment is used postoperatively to eradicate residual tumour cells. Meta -analysis of 1 33

randomised clinical studies involving 75,000 woman worldwide has shown that adjuvant treatment

reduces recurrence and improves survival. The major treatment option are: hormonal treatment,

radiotherapy, cytotoxic chemotherapy and chemoendocrine treatmen t. Generally, adjuvant treatment

is indicated for all node -positive women with stage I or II disease. Surgery alone will effectively cure

70% of women with node -negative desease. Hormonal treatment antiestrogens are the adjuvant drugs

of choice in postmeno pausal women with ER -positive disease. The aim of adjuvant hormonal

treatment in breast cancer is to suppress estrogen –mediated micrometastatic proliferation, thereby

reducing the incidence of recurrence and prolonging survival. About 60% of all breast ma lignancies

are ER -positive, and roughly 60% of these will respond to endocrine manipulation. Although

antiestrogens have been shown to prolong disease -free survival in all patients, they are most effective

in postmenopausal women with ER -positive disease. In this group, both disease -free and overall

survival are extended. Current evidence indicates that adjuvant tamoxifen treatment should be

continued for 2~5 years. Adjuvant radiotherapy produces a similar reduction in the incidence of

recurrence to cytotox ic chemotherapy but, in contrast, does not improve survival. Adjuvant cytotoxic

chemotherapy, although not curative, has been shown to reduce mortality and recurrence incidences

by 11 and 26%, respectively,compared with no chemotherapy. This modality is th e treatment of choice

for premenopausal node -positive woman; although less effective, it is also indicated in

postmenopausal woman who have ER - and –negative disease. The most widely used regiment is

CMF ( cyclophosphamide, methotrexate and 5 -fluorouracil ) for 6 months. In women under 50, CMF

reduces recurrence and mortality by 45 and 32%, respectively.

Preoperative chemoradiation therapy is used widely in the treatment of rectal cancer. The

predictive value of response to neoadjuvant remains uncertain . We retrospectively evaluated the

impact of response to preoperative and, specifically, of T -level downstaging, nodal downstaging, and

complete pathologic response after chemoradiation therapy on oncologic outcome of patients with

locally advanced rectal cancer. METHODS: There were 88 patients with ultrasound Stage T3/T4

midrectal (n = 37) and low rectal (n = 51) cancers (63 males; mean age 62.6 years). All patients were

treated by preoperative 5-fluorouracil -based chemotherapy and pelvic radiation followe d by surgical

resection in six weeks or longer (56 sphincter -preserving resections). RESULTS: T-level downstaging

after neoadjuvant treatment was demonstrated in 36 (41 percent) of 88 patients, and complete

pathologic response was observed in 16 (18 percent) of the 88. Of the 42 patients with ultrasound -

positive nodes, 27 had no evidence of nodal involvement on pathologic evaluation (64 percent). The

overall response rate (T-level downstaging or nodal downstaging) was 51 percent. At a median follow -

up of 33 months, 86.4 percent of patients were alive. The overall recurrence rate was 10.2 percent

(three patients had local and six had metastatic recurrences). Patients with T -level downstaging and

complete pathologic response were characterized by significantly better disease -free survival (P =

0.03, P = 0.04) and better overall survival (P = 0.07, P = 0.08), according to Wilcoxon's test comparing

Kaplan -Meier survival curves. None of the patients with complete pathologic response developed

recurrence or died during the follow -up period. CONCLUSION: T -level downstaging and complete

pathologic response after preoperative chemoradiation therapy followed by definitive surgical

resection for advanced rectal cancer resulted in decreased recurrence and improved disease -free

survival. Advanced rectal cancers that undergo T -level downstaging and complete pathologic

response after chemoradiation therapy may represent subgroups that are c haracterized by better

biologic behavior.

2003外科学专业英语 (A卷)（试卷）

2003外科学专业英语 (A卷)（答案）

2003外科学专业英语 (B卷)（试卷）

8、LHRH Agonist Can Be Used To Treat Prostate Cancer

2003外科学专业英语 (B卷)（答案）

2002年肿瘤英译中（ 一）

MOLECULAR TARGETED AGENTS USING COMBINATION WITH RADIOTHERAPY

Malignant transformation of normal cells rise from acquisition of a series of specific genetic changes

that act to override the anticancer pathways. The se mechanisms include the regulation of signal

transduction, cell differentiation, apoptosis, DNA repair, cell cycle progression, angiogenesis, and

cellular adhesion. Application of a molecular framework to the study of radiobiology in recent years

has tra nsformed our understanding of tumor radioresistance and the cellular response to ionizing

radiation (IR). Several biologic agents designed to target these molecular processes have exhibited

both radiosensitizing and antiproliferative activities in preclini cal models of human cancers. These

agents can therefore modify a number of radiobiologic factors that determine the successful

eradication of tumor clonogens after curative radiotherapy (RT). These agents include inhibitors of

intracellular signal transduc tion molecules, modulators of apoptosis, inhibitors of cell cycle

checkpoints control, antiangiogenic agents, and cyclo -oxygenase -2 (COX -2) inhibitors. Molecular

targeted agents can have direct affects on the cytoprotective and cytotoxic pathways implicat ed in the

cellular response to ionizing radiation. These pathways involve cellular proliferation, DNA repair, cell

cycle progression, nuclear transcription, tumor angiogenesis, and prostanoid -associated inflammation.

These pathways can also converge to alt er RT -induced apoptosis, terminal growth arrest, and

reproductive cell death. Pharmacologic modulation of these pathways may potentially enhance tumor

response to RT through inhibition of tumor repopulation, improvement of tumor oxygenation,

redistribution during the cell cycle, and alteration of intrinsic tumor radiosensitivity. Combining RT and

molecular targeted agents is a rational approach in the treatment of solid tumors.

ADJUVANT TREATMENT FOR RECTAL CANCER

The article summarizes practical guidelin es for the management of rectal cancer. Colorectal cancer

alone accounts for about 100,000 death in Europe and 75,000 in the US each year. The current

cornerstones of treatment are surgery, radiotherapy (for rectal cancer only) and chemotherapy. At

diagnos is the most important factor predicting treatment outcome is the stage of disease. Patients

with rectal carcinoma should be classified according to the stage of the disease, including endorectal

ultrasound and biopsy of the lesion. Five years after diagnos is, survival reaches about 50%. For early

stage disease, surgery remains the standard treatment, but patients with lymph node -negative T3 or

T4 lesions or with any lymph node -positive cancer should receive adjuvant radiotherapy and

chemotherapy following t he surgery. Pelvic radiation therapy decreases local recurrence; the addition

of systemic chemotherapy further enhances local control and improves the survival. In patients with

T3 or T4 rectal carcinoma the pre -operative therapy (radiation therapy combine d with systemic

chemotherapy) has potential advantages, including the decreased tumor, less acute toxicity compared

with postoperative therapy, increased radio sensitivity due to more oxygenated cells, and enhanced

sphincter preservation. During a 5 -year p eriod 35 of 150 patients were selected for preoperative

irradiation. In the non -irradiated patients the local recurrence rate after a median follow -up period of

870 (range 51 -1903) days was17.3 per cent (twenty of 115 patients), compared with 5.7 per cent (two

of 35 patients) in those chosen for irradiation. Sixty patients (52.2 per cent) who were not irradiated

were node positive. The local recurrence rate for the whole group was 14.7 per cent. Postoperatively,

pelvic irradiation and 5 -fluorouracil -based c hemotherapy have been used to improve local control and

survival for high -risk patients after local excision, as well as for patients undergoing abdominoperineal

or low anterior resection.

ADJUVANT TREATMENT FOR BREAST CANCER

Over the past three decade s significant advances have been made in the adjuvant treatment of breast

cancer. Despite and increasing incidence of breast cancer, mortality has undergone a gradual decline.

This decline in mortality is likely due to numerous factors, including earlier s tage at diagnosis,

advances in local therapy, and advances in systemic treatment of breast cancer. Breast conserving

surgery is now the preferred option in stage I or II breast cancer. Breast conserving surgery

( lumpectomy and quadrantectomy ) involves ex cision of the primary tumor and the minimum of

surrounding tissue. Overall, it is associated with a low incidence of recurrence, improved cosmetic

results and few complications compared to mastectomy. Moreover, combining breast conserving

surgery with radi otherapy significantly improves disease free survival compared with surgery alone.

Lumpectomy produces better cosmetic results than quadrantectomy, but is associated with a higher

incidence of recurrence. Neoadjuvant treatment involves the preoperative adm inistration of hormonal

treatment or cytotoxic chemotherapy in order to achieve local disease control before surgery. This is

reputed to: improve disease -free survival, and reduce the need for mastectomy. Although not yet

standard practice, preliminary cli nical experience indicates that this technique may prove extremely

valuable in patients with early breast cancer.

2002年肿瘤英译中（二）

Nasopharyngeal carcinoma (NPC) is one of the most prevalent cancers occurring in the Souther

Chinese. Guangzhou city is among the areas with t he highest age -adjusted incidence rates (11.62

and 4.89 per 100,000 persons for men and women, respectively, in 1972~1983. After first radical

radiotherapy recurrent rate is about 20~40% in nasopharynx or/and neck lymph node, while distant

metastasis rate is about 20~50 percent of 5 year died patients. Nasopharyngeal carcinoma (NPC) is

a malignant disease of the head/neck region, with a 5 -year survival level of approximately 65%.

Radiation therapy is the mainstay of treatment for NPC, primarily because of a natomic constraints

and a mild degree of radiosensitivity. The overall actuarial 5 - and 10 -year survival rates of patients

with NPC are 39%~70% and 28%~43%, respectively, according to results of studies (3 -8) with more

than 1,000 patients. Although early -stage NPC is highly curable with radiation therapy, the treatment

results of local -regionally advanced NPC have been disappointing. Unfortunately, most patients with

NPC have late -stage disease at presentation. Tumor stage has been found to affect the local control

rate and to be an important determinant of survival. According AJCC staging system, T4 is a tumor

stage that indicates skull -base destruction, intracranial invasion, cranial nerve palsy, or any

combination of these.

Gene therapy involves the intr oduction of genetic material (DNA) in patient cells, in order to produce

therapeutic effect after expression of the new gene. New insights in head and neck tumor etiology and

the development of genetic engineering techniques made the gene transfer a realit y. This article gives

a brief overview of investigations leading to clinical application of gene therapy in head and neck

tumors. A good therapeutic response in more than 50% patients has been reported in literature. These

results and future potential of g ene therapy are discussed..

Axillary lymph node status is important for staging and planning therapy prior to neoadjuvant

chemotherapy in patients with locally advanced breast cancers (LABC). The objective of this study

was to evaluate the use of axillary ultrasonography coupled with fine needle aspiration biopsy (US -

FNAB) to determine lymph node status prior to initiation of neoadjuvant chemotherapy.METHODS:

Patients with a LABC, defined as a breast cancer clinically larger than 3.0 cm or a cytology positi ve

axillary lymph node, were evaluated by clinical examination followed by ultrasonographic evaluation.

Lymph nodes were categorized as suspicious for malignancy based on size >1.0 cm, decrease in the

fatty hilum, or parenchymal echogenicity. US -FNAB was p erformed on all patients. Most patients

received neoadjuvant chemotherapy followed by definitive surgery. Axillary surgery consisted of

axillary lymph node dissection. Axillary status by clinical examination and US -FNAB was compared

with that obtained by a xillary node dissection.RESULTS: From January 1998 to May 2001, 26 patients

(27 axillae) presented with LABC to our institution. The median age of these patients was 48 years.

The sensitivity and specificity of US -FNAB for evaluating axillary metastatic di sease in patients with

LABC were 100% and 100%, respectively.CONCLUSIONS: In patients with locally advanced breast

cancer, axillary ultrasonography coupled with fine needle aspiration biopsy can accurately stage the

axilla. It is particularly useful and sh ould be used more frequently in patients undergoing neoadjuvant

chemotherapy. The use of ultrasonography to stage the axilla in patients who present with small breast

cancers should be explored.

Several recent trials have demonstrated that neoadjuvant chem otherapy can allow more patients to

successfully undergo breast -conserving treatment (BCT), and does not confer a survival disadvantage

compared with standard adjuvant chemotherapy. In addition, the pathological response of primary

breast tumors to neoadju vant chemotherapy appears to be a surrogate marker for patient outcome.

In our series, during the period from May 1995 to December 2000, 86 patients with tumors between

3.1 and 6.0 cm in diameter received epirubicin -based neoadjuvant chemotherapy. There we re 55

(64.0%) responders and ultimately 64 patients (74.4%) were treated with BCT. The margin positive

rate was 14.1%(9/64), similar to the rate after BCT for early -stage breast cancers, the largest diameter

of which was smaller than 3 cm. At a median foll ow-up of 30 months, only 3 patients in the BCT group

have developed local recurrence; the local recurrence rate appears to be comparable to that after

BCT for early stage breast cancers. Long term follow -up is required, however, to establish whether

this p rocedure is a safe alternative to mastectomy for patients with large breast cancers.

2004外科学专业英语 (A卷)（试卷）

Intra -abdominal and Retroperitoneal Infections

Most serious intra -abdominal infections require surgical intervention for resolution.

In this context , surgical intervention includes percutaneous drainage of intra -abdominal

abscesses. The specific exceptions to the requirement for surgical intervention i nclude

pyelonephritis, salpingitis, amebic liver abscess, enteritis, spontaneous bacterial

peritoniti s, some cases of diverticulitis, and some cases of cholangitis. However, all of

these exceptions can be diagnosed presumptively with a rapid initial evalua tion. If the

diagnosis of one of these exceptions cannot be made, a patient with fever and

abdominal pain should not be given antibiotics without a plan leading to operation or

other drainage procedure. The administration of antibiotics in this setting bef ore

diagnosis may obscure subsequent findings and delay diagnosis and will certainly

delay definitive operative management. If the patient is too sick to go without antibiotic

therapy, he or she is also too sick to avoid operative intervention and definiti ve

diagnosis and treatment.

Despite modem antibiotics and intensive care, mortality from serious intr a-

abdominal or retroperitoneal infection remains high (5% to 50%) and morbidity is

substantial. The systemic response to intra -abdominal or retroperitoneal infection is

accompanied by fluid shifts similar to those seen in patients with major bums. Fever,

tachycardia, and hypotension are common, and a severe hypermetabolic, catabolic

response is universal. If a corrective operation and effective antibiotics are not

employed promptly, th e sequence of events termed multiple -organ failure syndrome

may ensue and cause the death of the patient even after the primary focus of infection

has been controlled. Regardless of the initial antibiotic choice and operative procedure

there is a significa nt chance that a change in antibiotics may be required and that a

reopera tion may be necessary. The physician caring for a patient with intra -abdominal

infection must be alert to these possibilities and diligent in following and re -examining

the patient so this decision can be made at the earliest possible time. Outcome is

improved by early diagnosis and treatment. The risk of death and of complications

increases with increased age, pre -existing serious underlying diseases, and

malnutrition. The risk of dea th or failure to control the abdominal source of infection is

also relate d to the normal homeostatic balance of the patient at the time of diagnosis

and initiation of definitive therapy. This balance can be measured by scales designed

to quantitate the num ber of physical findings and laboratory tests that are abnormal.

One of t he most widely used scales is the Acute Physiology And Chronic Health

Evaluation (APACHE) scoring system, so The higher the score, the more abnormal

tests and findings are present, and the greater the risk of death.

2004外科学专业英语 (A卷)（答案）

2004外科学专业英语 (B卷)（试卷）

Steps In The Initial Resuscitation

Airway. The crucial first step in managing an injured patient is securing an

adequate airway. The mec hanical removal of debris and the chin lift or jaw thrust

maneuvers, both of Which pull the tongue and oral musculature forward from the

pharynx, are often useful in clearing the airway of less severely injured patients.

However, if there is any question a bout the adequacy of the airway, if there is evidence

of severe head injury, or if the patient is in profound shock, more definitive airway

control is appropriate. In the vast majority of patients this involves endotracheal

intubation. Unfortunately, contr ol of the airway is sometimes more complex than simply

placing an endotracheal tube. The presence of cervical spine injury in the unconscious

patient is always a possibility, and injudicious movement of the neck in the process of

endotracheal intubation ca n be devastating.

Breathing. It there is decreased respiratory drive or an unstable chest wall,

assisted ventilation is usually necessary. The three most common reasons for

ineffective ventilation following successful placement of an airway are malpositio n of

the endotracheal tube, pneumothorax, and hemothorax. Therefore, palpation and

auscultation of the chest are necessary diagnostic adjuncts at this point. A supine

(anteroposterior [AP]) chest x -ray examination can validate the physical examination

and better define chest wall and plural abnormalities. Although there is usually time to

perform a chest radiograph prior to invasive therapeutic procedures, in the patient with

profound hemodynamic instability and a high suspicion of tension pneumothorax, a

needle catheter decompression can be both diagnostic and therapeutic. Under these

circumstances decompression of the chest before the radiograph is appropriate.

Circulation. When possible, control of the hemorrhage precedes placement of

the intravenous line s. This may be as simple as a compressive dressing over a bleeding

wound or large vessel or may require broader compression, such as application of a

pneumatic antishock garment in the patient who has an obvious pelvic fracture.

Intravenous cannulas are us ually placed percutaneously in the arm or groin. They

should be large bore, and a minimum of two should be placed. Lines should not be

inserted distal to extremity wounds with potential vascular injury. Alternatives are cut -

down by either the antecubital o r saphenous route, or intraosseus in children under the

age of 3. With the exception of the use of the large introducer catheter, subclavian

venipuncture is not a rapid route for fluid administration and is best reserved for

monitoring response to fluid th erapy. Fluid resuscitation begins with a 1000 -ml. bolus

of lactated Ringer's solution for an adult, or 20 mi. per kg. For a child. Response to

therapy is monitored by skin perfusion, urinary output, and central venous pressure

readings when that line has b een placed.

2004外科学专业英语 (B卷)（答案）

2005外科学专业英语 (A卷)（试卷）

BASIC NOTIONS OF CLINICAL EVIDENCE AND THE METHODOLOGIC

FOUNDATIONS OF CLINICAL RESEARCH

Ideas or hypotheses about causes of disease and usefulness of treatment arise

from a variety of activiti es within medical science, at both the microscopic and the

macroscopic levels. Once generated, these ideas need to be substantiated or tested

to derive clinical evidence of validity and usefulness for patient care. Clinical evidence

is based on observation s of patients. Observations are differentiated by whether or not

reliable techniques were utilized at the data acquisition stage to control for variables

that can impose ambiguity in the interpretation of results. The prospective, randomized,

double -blind, controlled clinical trial is the consummate clinical experiment, which

averts such ambiguity by ensuring equity of comparison groups at the time of their

assembly and by controlling for bias that could be imposed during treatment and

observation. It is wi dely regarded as the most powerful and sensitive tool for comparing

therapies and regimens of care. Despite the strengths of the method, the time and

expense required to implement such trials make it impossible to use them to investigate

every medical inte rvention or diagnostic test for clinical use. Furthermore, not all clinical

questions can be addressed through this experimental format. Much of what is known

and what will be known in medicine has and will be learned from patient experiences

that were eit her unplanned or deliberately not controlled for bias at the data acquisition

stage. Consequently, such quasi -experimental methods (commonly referred to as

epidemiologic methods), which include cohort studies, case -control studies, and case

series, are reg arded as less powerful techniques for testing therapeutic hypotheses

than RCTs. To make up for the absence of control for bias at the data acquisition stage,

these quasi -experimental methods employ techniques that control for bias at the

analysis stage. Al though they do not offer the same level of confirmation as controlled

clinical trials, these techniques have special value in generating and supporting

hypotheses. These techniques can be applied to the evaluation of clinical data

deliberately collected fo r research, as well as data routinely collected in the care of

patients. (hospital charts), in the processing of health care services (administrative

databases), or in the regulation of professional activities (statewide quality assurance

programs). Over t he years, both clinical trials and quasi -experimental methods have

been used to compare the broader array of outcomes that are germane to patient care,

including mortality, morbidity, quality of life, and cost. These outcome measures each

have their own th eories of measurement and calculus, which have developed

considerably, in the last 30 to 40 years.

With the advancement and proliferation of these methods, clinical investigators

have generated a wealth of clinical studies to address important clinical iss ues.

Unfortunately, not all these studies are conclusive, often because not enough patients

were evaluated. Occasionally, the results of clinical investigations conflict with existing

pieces of evidence, and this may lead to even more studies to attempt to resolve the

conflicts. All too often, this process contributes more evidence to the chain rather than

resolving the conflict. Statistical techniques that quantitatively combine the results of

different experiments (meta -analysis) have been under developme nt since the turn of

the century and have entered the medical mainstream in the last 10 years. These

techniques have been useful for summarizing current states of medical knowledge and

providing pooled estimates of effect with sufficient statistical power to support

conclusions that can resolve conflicts in the existing data or at least explain why they

exist.

2005外科学专业英语 (A卷)（答案）

主意或假定大约疾病和治疗的有用引起在医学的科学里面从多种活动出现 , 在两者的那

显微镜的而且巨观消除。 一次产生 ,这些主意需要被实体化或测试为病人照料源自临床

对于有效性的证据和有用。 临床的证据以病人的观察为基础。 观察被区别被是否可靠

的技术被利用在数据获得为能强加结果的解释不明确的变数控制的阶段。 预期者 ,随机

化, 进退维谷 ,受约束的临床试验是无上的临床实验 ,藉由在他们 的集会时候确定比较团

体的公正和藉由为可能在治疗和观察期间被强加的偏见控制避免如此不明确。 资讯科

技广泛地被为比较照料的治疗和摄生视为最有力的和敏感的工具。 尽管方法的力量， 必

需实现如此的试验时间和费用使使用他们为临床的使用调查每一医学的干涉或诊断的

测试是不可能的。 此外，不是所有的临床问题经过这 个实验的格式被向～演说。 许多

的什么是已知的和什么将会被知道在药有和将会不是非计划性的就是故意地在数据获

得阶段不为偏见控制被从忍耐的经验得知。结果 , 如此的类似 - 实验的方法 (普遍称为

epidemiologic 方法), 包括群组研究 ,情形- 控制学习，而且情形系列 , 被视为当做超过

RCTs 尝试治疗的假定比较不有力技术。 为了要在数据获得阶段为偏见弥补缺少控制 ,

这些类似 - 实验的方法雇用技术控制对于偏见在分析阶段。 虽然他们不提供如受约束的

临床试验的相同程度的证实 , 但是这些技术在产生而且支援假定 方面有特别的价值。这

些技术能被适用于为研究故意地被收集的临床数据的评估 ,连同数据通常在病人的照料

方面收集。 (医院图解 ), 在健保的处理人中维修 (管理的数据库 ), 或在专业活动 (州全体

的质量保证计画 ) 的规则中 .(州全体的质量保证规划 ) 在数年以来，临床的试验和类似 -

实验的方法已经用来比较有密切关系的结果较宽广的排列和忍耐的照料 ,包括必死的命

运，病态，生活的质量 , 而且花费。 这些结果措施每个有测量的他们自己理论和微积分

学, 已经发展非常地 ,在最后 30 到 40 年内。

藉由这些方法的进步和增殖，临床 的调查员已经产生很多的临床实验向重要的临床议题

发表演说。 不幸地 , 不是所有的这些研究决定性的 , 时常因为评估的不是充足的病人。

有时候，临床调查的结果以现有个的证据争执，而且这可能对甚至更多的研究带领尝试

解决冲突。 所有的经常，这一个程序有助于对链的较多证据不愿解决冲突。 数量地联

合不同实验 (meta -分析) 的结果统计的技术已经是自从世纪的旋转以后在发展之下而

且在最后 10 年内已经进入医学的主流。 这些技术已经对概述有用医学知识的现在状

态而且提供充份的统计力量给告发了效果的估计支援能解决现有的数据冲 突或至少解

释他们为什么存在的结论。

2005外科学专业英语 (B卷)（试卷）

Clinical Trials in Surgery

The methodology of clinical trials has advanced considerably in the last 40 years,

largely through the process of pharmaceutical development, for which FDA regulation

has provided a framework requiring RCTs. However, there is no analogous regulatory

structure for clinical procedures, including surgical procedures. As discussed in greater

detail below, there are som e real practical and conceptual difficulties regarding the use

of RCTs in evaluating surgical procedures. Consequently, there are fewer clinical trials

in the surgical literature. The delay in engaging in randomized surgical trials can also

be attributed t o the fact that early investigations in surgical treatment, in the form of

case series, often demonstrated such dramatic patient responses that formal trials

were unnecessary. However, as our efforts increasingly focus on the treatment of

diseases that are not immediately life threatening, dramatic and unequivocal patient

responses are not seen as often, and the need to engage in rigorous studies to

demonstrate efficacy has become important. Significantly, the failure to engage in

clinical trials early in t he evaluation of a new surgical procedure often causes the loss

of the opportunity to perform such a trial; once a new procedure is in widespread use,

even when this use is based on inadequate evidence of efficacy, it is nearly impossible

to motivate inves tigators and patients to engage in a randomized trial. Examples of

treatments that have become standard practice in the absence of controlled clinical

trials include radical mastectomy, laparoscopic cholecystectomy, and cesarean section

for fetal distress.

Patients' difficulty with accepting random assignment of treatment has also

contributed to the slow development of clinical trials in surgery. This is especially true

when the experimental and control treatments are radically different, such as the

compar ison of amputation and limb -sparing therapy for osteogenic sarcoma of an

extremity. In a conventional randomization scheme, patients would need to be willing

to consent, in advance, to either losing or saving a limb. They would then learn their

fate after what amounts to a roll of the dice. Alternatives, such as the randomized

consent design, allow the patient a choice after randomization, and yet establish

equally constituted groups with respect to the risk of the outcome event. In this scheme,

patients ar e randomized to a consent group or a no -consent group. The noconsent

group receives standard therapy, as if they were not in the trial. However, they actually

serve as the control group for the trial. Those patients assigned to the consent group

are given a choice between the experimental and the standard therapy. The consent

group and the no -consent group have equal probabilities of the study outcome, and it

is the outcomes of these two groups that are compared. With this design, not all the

patients in th e consent group receive the experimental treatment, and the degree to

which this happens determines the statistical efficiency of the design. However, this

may be compensated for by the fact that the randomized consent design may attract

more patients into the trial than would be the case with conventional consent

procedures.

Another important difference between surgical and pharmaceutical trials is that

surgical procedures often undergo extensive refinement, and later achievements

usually far surpass those of the first experimental operations. Consequently, the results

of a comparative clinical trial of a new surgical intervention depend on when th e

comparison was made. This poses a problem in selecting the optimal time to bring a

surgical procedure to trial: waiting too long often results in widespread use of the

procedure and a loss of the opportunity to perform a trial, and proceeding too early c an

mean that a procedure is not fully developed and does not reflect the procedure that

may eventually go into widespread use .

2005外科学专业英语 (B卷)（答案）

临床试验的方法学已经在最后 40 年内非常地前进 , 主要地透过药学发展的程序 ,

为哪一食品药物管理局规则已经提供一个需要 RCTs 的结构。 然而,为临床的程序没有

类似的管制结构 ,包括外科的程序。 如在下面较棒的细节所讨论，在评估外科的程序方

面有关于 RCTs 的使用一 些真正的实际和概念上的困难。 结果,有外科的文学比较少的

临床试验。 延迟在动人的在随机化外科的试验也能被归因于事实外科的治疗早调查 ,以

情形系列的形式 , 时常示范如此戏剧性的忍耐反应正式的试验是不必要的。 然而，同样

地我们的努力逐渐地把重心集中在不立刻生活胁迫的，戏剧性的和不含糊的忍耐反应的

疾病治疗没被见到当做时常 , 和需要专注严厉的研究示范效能有变成很重要。 重要地，

专注早的临床试验的失败在新的外科程序的评估方面时常导致机会的损失运行一个如

此试验 ; 一次一个新的程序是在广大的使用中 ,即使当这一种使用以不充分 对于效能的

证据为基础 ,给与动机调查员和病人专注被随机化的试验是几乎不可能。 已经缺乏受约

束的临床试验变得标准的练习治疗的例子为胎儿的苦恼包括急进的 mastectomy ，

laparoscopic cholecystectomy 和剖腹生产术区段。

由于接受治疗的任意任务也已经成为外科手术的临床试验的慢发展的因素病人的

困难。这尤其真实何时那实验的而且控制治疗如切断和宽恕四肢的治疗比较对于极端的

osteogenic 肉瘤是根本地不同的 , 如此的。 在一个传统的随机化方案中， 病人会需要愿

意同意 , 预先, 到或损失的或解救四肢。 然后他们在会之后学习他们的命运什么总计到

骰子的一个卷物。 像被随机化的同意设计这样的替代选择 ,允许在随机化后的病人选择 ,

而且仍然相等地建立构成有关于结果事件的危险团体。 在这一个方案中， 病人被随机化

到一个同意团体或一不 同意团体。 noconsent 团体接受标准的治疗 ,好像他们不在试验

中。 然而，他们对于试验实际上视为控制团体。 那些被指定给同意团体的病人有那实

验的和标准的治疗之间的选择。同意聚集和那不 -同意团体已经等于研究结果的可能性，

而且它是这二个被比较的团体结果。 藉由这设计,不是同意团体的所有病人实验的治疗 ,

和程度到这发生决定设计的统计效率。然而，这可能被偿还为被被随机化的同意设计比

会是有传统的同意程序的情形可能吸引较多的病人进试验之内的事实。

在外科的和药学的试验之间的另外重要的不同是，外科的程序时常遭受广泛的精

致，而且稍后成就通常远超越第一个的实验操作。 当比较被做的时候，结果，新的外科

干涉的比较临床试验的结果仰赖。 这在选择最佳的时间带着一个外科的程序到试验方

面造成一个问题 :太久时常等候造成程序的广大使用而且造成机会的一个损失运行试验，

而且进行太早能意谓一个程序 不完全被发展并且不反映可能最后进入广大的使用程序。

2008科学专业英语 (A卷)（试卷）

Cardiovascular failure, or shock , can be caused by (1)depletion of the vascular

volume ,(2)compression of the heart or great veins,(3)intrinsic failure of the heart

itself.(4)lo ss of autonomic control of the vasculature (5)severe untreated systemic

inflammation ,and (6)severe but partially compensated systemic inflammation .If the

shock is decompensated ,the blood pressure or the cardiac output will be inadequate

for peripheral p erfusion ;in compensated shock, the perfusion will be adequate but only

at the expense of excessive demands on the heart .Depending on the type and severity

of cardiovascular failure and on response to treatment ,shock can go on to compromise

other organ s ystems .

Hypovolemic shock is most often caused by bleeding, but it can also be a

consequence of protracted vomiting or diarrhea, sequestration of fluid in the gut lumen,

or loss of plasma into injured or burned tissues. The body’s response to the shock,

however, is the same, no matter what the cause. Aldosterone and vasopressin are

released; sodium and water are actively reabsorbed from the glomerular filtrate,

Adrenergically mediated constriction of the arterioles in the skin, skeletal muscle, gut,

pancre as, spleen, and liver diverts blood flow away from organs that can withstand

ischemia for longer periods of time to those that cannot. The physical findings

associated with these compensatory mechanisms can be subtle .In mild hypovolemic

shock, the only fi ndings will be postural hypotension, cutaneous vasoconstriction,

collapse of neck veins ,and oliguria .If the shock is caused by blood loss, the hematocrit

will decrease with administration of fluids.

Resuscitation of patients in hypovolemic shock ,either hemorrhagic or

nonhemorrhagic ,begins with making sure that the airway is secure ,by ensuring that

ventilation and oxygenation are adequate ,and ,in the case of hemorrhagic shock ,by

controlling bleeding. External bleeding is controlled by application of p ressure over the

bleeding areas or surgical control. Vascular access is best obtained with

percutaneously placed in superficial veins in the upper extremities, in central veins at

the thoracic outlet, or in the femoral veins. Initial fluid resuscitation b egins with a

warmed crystalloid solution .Either normal saline or lactated Ringer’s solution can be

used. Bleeding patients will often need blood, but, if possible, transfusions should be

withheld until the bleeding is controlled. Bank blood administered d uring continuing

hemorrhage can end up in the suction canisters in the operating room, depleting the

supply of blood that might be needed later on. If blood has to be given and it there is

no time for a full crossmatch, type -specific non -crossmatched cells , which can usually

obtained within 10 minutes ,are used .The risk of a transfusion reaction is negligible

compared with the risks of inadequate oxygen delivery to the tissues. If type -specific

cells are not available , Rh-negative type O cells reconstitute d in normal saline are used.

Albumin -containing solutions should not be used in the initial resuscitation of patients

in hypovolemic shock. Shock is associated with a generalized increase in

microvascular permeability, which results in extravasations of protein, including

administered protein, into the interstitial space. The protein in the interstitium can only

be returned can only be returned to the blood volume via the lymphatic, which have

limited flow capabilities .Mobilization of this edema can take h ours or even days. The

protein -poor edema produced by crystalloid resuscitation does not rely on lymphatic

drainage and is much easier to mobilize .

2008科学专业英语 (A卷)（答案）

44、 thyroid crisis 或thyroid storm 或thyrotoxic crisis

50、 Video -assisted thoracic （或 thoracoscopic ） surgery

心脏血管 衰竭，或休克，能由血管的体积消耗，心或大静脉的压迫所引起 ，心本身

的本质失败。脉管构造的自主神经控制的损失严格的未经处理的全身性发炎 ，和严格的

但是部份地偿还了全身性发炎。如果休克被代谢失调 ，血压或心脏的产量将会对周边的

灌流是不充分的； 在偿还的休克中， 灌流将会是适当的但是只牺牲在心方面的过度要求。

仰赖类型和心脏血管失败的严重，而且在回应上到治疗，休克能继续妥协处理其他的器

官系统。

低血容性休克最时常被藉由出血引起，但是它进入伤害或燃烧组织之内也可能是

拖延呕吐或腹泻的结果 ，肠管流明的液体隔离 ，或血浆的损失。对休克的身体回应 ，然

而，是相同的 ，无论什么因素。醛类脂醇和后叶加 压素被释放；钠和水从肾小球的滤液

积极地被再吸收 ，肾上腺素激导性地斡旋了皮肤，骨骼肌，肠管，胰，脾的小动脉的缢

痕，而且肝将血流程之远从能为时间的较长期数抵抗局部缺血到那些那的器官移开不能

够。与这些赔偿的机制有关的实际调查结果可能是敏感的。在温和的低血容性休克中，

唯一的调查结果将会是姿势的低血压，皮肤的血管收缩，颈部静脉的虚脱和少尿症。如

果休克由失血所引起 ，血球容积血将会以液体的行政减少。

低血容性休克的患者复苏 ，或出血性的或非出血性的 ，由确定气道是安心的开始 ，

藉由确定那一个供氧和氧合是适当的和在出血性的休克情 况，藉由控制出血。外侧出血

被在出血区或外科的控制上的压力敷贴控制。在胸部的出口中央的静脉中血管的通路经

皮地最好地一起获得放在上面的骨端表浅的静脉之内 ，或在股静脉中。起始液体复苏开

始一温暖结晶状的溶液。或生理盐水或分泌乳汁 Ringer's 的溶液能被用。出血患者将会

时常需要血 ，但是，如果可能的 ，转输应该是扣留直到出血被控制。银行在连续的出血

期间被管理的血能在操作房间中的吸罐中结束 ，耗尽可能在稍后被需要的血补给。如果

血必须有，而且它没有完整的 交叉配血 的时间，打字-能通常在 10分钟内获得的特定非

交叉配血 细胞被用。输 血反应的危险是可以忽略的与对组织的不充分氧递送的危险相

较。如果类型 -特性的细胞不是可得 ，Rh-否定类型在生理盐水中被再构成的细胞被用。

包含蛋白素的溶液不应该被用于低血容性休克的患者开始复苏。休克与被推广的增加微

脉管的通透性有关 ，造成蛋白质的外渗 ，包括管理了蛋白质 ，进入空隙的腔隙之内。 间

质蛋白质才能只被退还能在经由 淋巴被回到血体积 ，已经限制流程能力。这一个水肿的

动员能轮流数小时或甚至每天。 被结晶状复苏生产的蛋白质 -贫穷的水肿不仰赖淋巴的引

流术而且是非常容易动员。

2008科学专业英语 (B卷)（试卷）

54、 Extensive Devascularization Around The Cardia 贲门周围血管离断术

cholangiopancreatography

SURGICAL TUMOR

Definition

So what tumor r eally is? Well, a tumor is an abnormal proliferation of cells which

represent reaction of an organism to different oncological agents in its environment.

Tumor means swelling, and was originally applied to all masses, especially those

caused by inflammatio n, but today it is used to denote a neoplasm. It can be benign or

malignant.

Classification

Neoplasm may be classified into benign or malignant according to the clinical

behavior of the tumor. Benign tumors have lost normal growth regulations but do not

metastasize, such as lipoma and adenoma. While malignant tumors do, for instance,

according to the organ in which the carcinoma arises. There is renal cell

adenocarcinoma, bronchogenic squamous cell carcinoma, and cervical squamous cell

carcinoma.

Grading and staging of tumors

Grading of a tumor is a histological determination and refers to the degree of cellular

differentiation . The system of grading is not precise, however, some tumors being given

glades of I to IV with increasing anaplasia. And tumor staging establishes the extent of

disease which has proved to be of more clinical Value .These two systems have been

devised to better define cancers, especially for the purpose of comparison of the results

of treatment. They ensure that comparisons are c arried out not only among cancers of

the same histological type and differentiation, but also among patients at comparable

clinical stages of the disease.

Curative surgery

Surgical resections with curative inten t can be divided into three categories :

resection of primary lesion, resections of isolated metastases, and the resections of

metastatic deposits. In each of these cases, the clinician must strive to reach a balance

between the chance for cure and the morbidity of the procedure. Each situation must

be evaluated individually, and the patient ’s wishes must be paramount. In the resection

of a primary lesion, the tumor type guides the extent of the resection. Various tumors

require different diseases -free margins in order to achieve optimal chances for a cure.

The regional lymph nodes represent the most prevalent site of metastases for solid

tumors. For this reason, the removal of the regional lymph nodes is performed at the

time of resection of the primary cancer.

Hematologic malignancies are typically treated by chemotherapy ,radiation, or

both ,with surgery used primarily for diagnosis and staging .On the other hand, surgery

is the primary treatment for nonhematologic malignancies , although there are some

exceptions .Anal cancer is cured in approximat ely 80% of patients with Nigro

protocol ;5 -fu/mitomycin -C and radiation therapy, as first line treatment.

Although all visible tumors may be removed at the time of surgery, microscopic

tumor deposits may still be present locally or may have spread to dista nt locations.

Chemotherapy is most effective against very small tumors and microscopic rumor

deposits. Therefore, adjuvant chemotherapy is often given to improve the likelihood of

cure after surgical resection.

Neoadjuvant chemotherapy is usually given to facilitate surgical resection by

shrinking the primary tumor, or it may convert an unresectable tumor into a respectable

tumor .In some cases, this has been shown to prolong survival.

2008科学专业英语 (B卷)（答案）

64、 endoscopic retrograde cholangiopancreatography

外科肿瘤

定义

什么是肿瘤 ?一个肿瘤是一个对它的环境不同的致瘤因子表现一个生物体的反应细

胞的反常增殖。 肿瘤意谓肿胀 , 而且本来被适用于所有的块 , 尤其那些引起被发炎 , 但

是它用来指示一个瘤的今天。 资讯科技可能是良性的或有恶意的。

分类

瘤可能被分类进入良性的之内或有恶意的依照肿瘤的临床行为。 良性的肿瘤已经遗

失正常的生长规则但是不转移 ,像是脂肪瘤和腺瘤。 有恶意的肿瘤做 , 举例来说 , 依照癌

发生的器官。 有肾的细胞腺癌，支气管鳞状细胞癌和颈椎鳞状细胞癌。

定等级而且肿瘤的上演

一个肿瘤的定等级是一个组织学的决定并且提及细胞分化的程度。 等级的系统然而

不是精确的我被给予林间空地的一些肿瘤到 4 由于逐渐增加的退行发育。 而且肿瘤举

行建立已经证明是比较临床价值的疾病范围。 这二个系统已经被设计更定义癌症 ,尤其为

了治疗的结果比较。 他们确定比较被实行不只有在相同组织学的类型和分化的癌症之

中, 但是也在疾病的可比较临床阶段的患者之中。

治病的外科

和治病的意图外科的切除术能被区分为三个阶元 : 下疳的切除术， 隔离转移病变的切

除术和转移性存款的切除术。 在每一个这些情形中，临床医生一定努力为治疗和步骤的

病态达成在机会之间的平衡。 每种情形一定个别地被评估，而且患者的希望一定是最重

要的。 在下疳的切除术中，肿瘤类型指导切除术的范围。 各种不同的肿瘤为了要为治疗

达成最佳的机会 ，需要不同的无疾病边缘。 地方的淋巴结为坚硬的肿瘤表现转移病变的

最普遍位点。 因为这一个理由 ,地方的淋巴结的移动在原发的癌症切除术的时候被运行。

血液恶性典型地被化学疗法， 辐射或两者对待 ，藉由对于鉴别主要地被用的外科而且

举行。另一方面，外科是实体肿瘤恶性的原发治疗 , 虽然有一些例外。肛门的癌症在大

约 80% 的患者中被 Nigro 程序治疗 ;5-fu/丝裂素-C和放射疗法 ,如第一线治疗。

虽然所有的看得见的肿瘤可能在外科的时候被移 动, 但是显微镜的肿瘤存款可能地

方性地仍然是礼物或可能已经传布到远的位置。 化学疗法是反对非常小的肿瘤和显微镜

的谣言存款有效的大部分。因此，辅助的化学疗法时常有改善在外科的切除术后的治疗

可能。

新辅助化学疗法通常藉由收缩原发的肿瘤有促进外科切除术 , 或它可能把一个可肿

瘤不切除转换成一个值得尊重的肿瘤。在一些情形中，这已经被显示延长生存。

2009科学专业英语 (A卷)（试卷）

1. The continuum of illness severity that encompasses MODS spans a wide range

of clinical presentations. Organ dysfunction, as opposed to organ failure, is not an all -

or-none phenomenon. Gradations of organ dysfunction, therefore, are sometimes used

to ide ntify MODS and to provide a relative severity score. Unfortunately, such scoring

systems based on commonly measured laboratory or physiologic parameters are not

sensitive enough to detect organ hypoperfusion and organ dysfunction at the very

earliest stage s when there is probably the greatest chance to make potentially

beneficial therapeutic interventions. As our understanding of MODS improves, so will

our ability to describe organ dysfunc tion at an earlier point on the continuum. The

development of MODS, a nd its subsequent clinical course in a given patient, depends

on a number of factors, including the presence of pre -existing disease or advanced

age, the nature and intensity of the inciting event and of the second hit, and the

presence of sepsis. The numb er of organs involved continues to be a prognostic

indicator of mo rtality as is the existence of particular combinations of dysfunctional

organs (e.g., liver and lung). Sequential organ f ailure is the classic description that

characterizes this syndrome. P ulmonary failure, followed by hepatic, gastrointestinal,

and renal failure predictably occurs in that order, unless pre -existing organ dysfunction

is present. With the current emphasis on organ dysfunction, rather than failure, this

sequence may no longer be applicable when describing the evolution of MODS

Pulmonary dysfunction, however, still appears at an early stage of MODS. The acute

lung injury in MODS reflects the pathophysiologic pu lmonary manifestations of a

systemic inflammatory process. Recruitmen t of leukocytes into the pulmonary vascular

bed occurs early. A complex interaction of activated neutrophils, macrophages,

platelets, endothelial cells, and inflammatory mediators ensues, resulting in pulmonary

capillary endothelial injury. The increase in microvascular permeability leads to

interstitial edema. Alveolar injury occurs secondary to ischemia and the -activation of

inflammatory mediators, causing progressive alveolar edema, los s of surfactant, and

alveolar collapse. The clinical consequence of t hese changes is the development of

ARDS. ARDS is characterized by ventilation -perfusion abnormalities, noncardiogenic

pulmonary edema, decreased functional residual capacity, refractory h ypoxemia,

diffuse infiltrates on chest x -rays, and decreased lung com pliance. Treatment is largely

supportive, including the use of mechanical ventilation. The mortality for ARDS exceeds

50%, but progression of MODS, rather than hypoxemia, accounts for the majority of

fatalities.

2. Infection continues to be a major source of morbidity and a disconcerting source

of mortality in surgical patients. A patient who is badly injured or who undergoes a major

operation and survives despite the development of secon dary shock and electrolyte

disturbances is at very high risk for seri ous infection. During preoperat ive evaluation,

the patient should be protected from any patient with extramural or hospital -acquired

infections. The proposed operative site should washed with an appropriate antiseptic

agent several times before operation, and shaving should be done eith er as close to

the time of operation as is feasible or not at all, substituting either clipping or depilatory

agents when removal of hair is desired.

2009科学专业英语 (A卷)（答案）

广。（2.5分）与器官衰竭对应的器官功能障碍不是一种 “全或无 ”现象。（1.5分）因此，

可对器官功能障碍进行分级并有时用于鉴别 MODS和为疾病严重程度提供一个相对的

分值。（2.5分）遗憾的是，这种评分系统是基于衡量通常的实验室或生理学指标，对最

早期发现器官 低灌注和功能障碍不够敏感， 而那时可能是进行有效治疗的最好时机。 （3.5

分）随着对 MODS理解的深入， 我们在这种疾病序贯性事件的较早期发现器官功能障碍

的能力也会提高。 （2.5分）对于一个具体病人， MODS的发展及其临床进程取决于一系

列因素，包括先前存在的疾病或老龄、原发病和第二次打击的性质与强度以及脓毒症的

存在。（4.0分）如同是否存在特定的功能障碍器官组合 (如肝和肺 )一样，所涉及的器官

数目仍然是死亡率的一个预后因素。 （3.0分）序列性器官衰竭是此综合征的典型特点。

（1.5分）除非先前存在器官功能障碍，可以预 测在肺功能衰竭之后会顺序发生肝、胃

肠道和肾衰。 （2.5分）现在更重视器官功能障碍而不是衰竭，因此随着对 MODS进展

的进一步了解，这个顺序可能也就不再 适用了，但无论如何肺功能衰竭仍将发生在

MODS的早期。（3.5分）MODS时的急性肺损伤反映了全身性炎性反应病理生理的肺

部表现。（2.0分）早期即发生肺血管床白细胞的浸润，激活的白细胞、巨噬细胞、血小

板、内皮细胞和炎性介质的复杂的相互作用，导致肺毛细血管内皮损伤。 （2.5分）微血

管通透性的增加引起肺间质水肿。 （1.5分）肺泡损伤继发于缺血和炎性介质的激活，造

成肺泡的进行性水肿、表面活性物质丢失和肺泡塌陷。 （2.5分）这些改变的临床结果就

是发生 ARDS。（1.5分）ARDS的特点是通气 —灌流比率不正常、非心源性肺水肿、功

能性残气量减少、顽固性低血压、 x线胸片为弥漫性浸润以及肺顺应性降低。 （3.5分）

治疗主要是支持性的， 包括应用机械通气。 （2.5分）ARDS的死亡率超过 50％，但MODS

的进一步发展是导致死亡的主要原因．而不是缺氧。 （3.0分）

管继发休克和电解质紊乱但活下来的病人都面临严 重感染的危险。 （ 4.0分）在术前准备

期间，应与任何院外院内感染病人隔离。 （ 3.0分）手术部位应在术前用适当的抗菌剂清

洗数次， 去除体毛应尽可能地临近手术时间或干脆不去除， 而以剪除或使用脱毛剂代之。

（4.0分）

2009科学专业英语 (B卷)（试卷）

Inflammation is the first stage of wound healing. After tissue injury, vessels

immediately constrict, thromboplastic tissue products are exposed, and the coagulation

and complemen t cascades are initiated. Platelets trapped in the wound degranulate,

releasing a cadre of biologically active substances that are important for wound repair.

At least three types of storage organelles are involved in platelet degranulation: (1)

alpha granules contain growth factors such as platelet -derived growth factor (PDGF),

transforming growth fa ctor-beta (TGF -β), and insulin -like growth factor -1 (IGF -1), as

well as adhesive glycoproteins such as fibronectin, fibrinogen, thrombospondin, and

von Willebr and's factor; (2) dense bodies store vasoactive amines such as serotonin,

which increase microvas cular permeability; and (3) lysosomes contain hydrolases and

proteases. Coagulation and platelet activation limit loss of blood and generate

biologically activ e products that convert fibroblasts and endothelial ceils into a

reparative mode. The coagulation mechanisms activate prothrombin to thrombin, which

converts fibrinogen to fibrin. Fibrin is then polymerized into stable clot. If the clot is

exposed to air i t will desiccate, forming a scab as a temporary wound cover. Fibrin and

fibronectin within the cl ot provide the provisional matrix for early cell migration into the

wound.

Products of the coagulation cascade regulate the cells in the injury area. Intact

thrombin functions as a potent growth factor for fibroblasts and endothelial cells.

Degraded thromb in fragments stimulate monocytes and platelets. Fibrinogen contains

growth -promoting peptide sequences, and some fibrinopeptides are chemoattractant

to monocyt es. The clot also induces angiogenesis with directed capillary endothelial

cell ingrowth. This co mplex pattern of interactions is easier to understand when one

realizes that many growth factor peptides involved in wound healing are contributed by

several s ources.

As thrombus is formed, hemostasis in the wound is achieved. After the transient,

vasocons triction, local small vessels dilate in response to kinin, complement

components, and prostaglandins. White blood cells (first neutrophils, later monocytes)

and plasma proteins enter the wound site. The early neutrophil infiltrate scavenges

cellular debris , dirt, and bacteria. Activated complement fragments such as C5a attract

neutrophils and aid in bacterial killing. Of note, healing may progress normally in th e

absence of neutrophils in a clean wound.

Monocytes infiltrate later at the wound site and diffe rentiate into macrophages that

are crucial in the orchestration of tissue repair. Most wound macrophages are

converted monocytes that are recruited from the ci rculation, but some are tissue

macrophages that can proliferate locally. Macrophages continue to consume tissue and

bacterial debris but, more important, secrete a plethora of growth factors. These

peptide growth factors attract and activate local endothelial cells, fibroblasts, and

epithelial cells to their respective repair functions and initiate th e next phase of wound

repair ----granulation tissue formation. Depletion of monocytes and macrophages

causes a severe alteration in wound healing, with poor debridement, delayed fibroblast

proliferation, and inadequate angiogenesis. If wound conditions warr ant, macrophages

continue to recruit additional inflammatory cells. Lymphocytes enter the wound much

later, and their role in wound repair is unclear. Interleukin -1 is a lymphocyte may be

involved in collagen remodeling.

2009科学专业英语 (B卷)（答案）

炎症反应是伤口愈合的第一步。 （1分）组织损伤后，血管立即收缩，促凝血的组织

产物释放出来 ，凝血和补体连锁反应启动。 （2.5分）聚集于伤口的血小板脱粒，释放出

一系列对伤口修复有重要意义的生物活性物质。 （2.5分）至少有三种贮存的细胞器参与

了血小板的脱粒 （1.5分）：(1)a-颗粒含有多种生长因子，如血小板来源的生长因子

(PDGF)、转化生长因子 -β(TGF-β)和胰岛素样生长因子 -1(IGF -1)，还有多种粘附性糖蛋

白，如纤连蛋白、纤维蛋白原、血小板反应蛋白和血管性血友病因子 （3.0分）；(2)浓聚

小体，贮存有血管活性胺 ,如增加微血管的通透性的 5-羟色胺（2.5分）；(3)含有水解酶

和蛋白酶的溶酶体。 （1.5分）凝血和血小板活化可以减少血液丢失，并且产生使成纤维

细胞和内皮细胞进入修复状态的生物学活性物质。凝血机制将前凝血酶活化成凝血酶，

后者使纤维蛋白原转变成纤维蛋白。 （3.5分）纤维蛋白聚合成稳定的血凝块。 （1.5分）

如果这个血凝块暴露于空气，它将干燥成痂，作为伤口的临时被盖。 （2.0分）血凝块内

的纤维蛋白和纤连蛋白为早期细胞移入伤口提供了临时性的基质。 （2.5分）

凝血连锁反应的产物 调控位于损伤创面的细胞。 （1.5分）完整的凝血酶是成纤维细

胞和内皮细胞强效的生长因子。 （1.5分）降解的凝血酶片段也能刺激单核细胞和血小板。

（1.5分）纤维蛋白原含有生长促进肽序列，而一些纤维蛋白肽则是单核 细胞的化学诱

引剂。（2.0分）血凝块借助直接的毛细血管生长促进血管生成。 （2.0分）当认识到参与

创伤愈合的许多生长因子多肽具有多种来源时。 就容易理解这一复杂的反应方式了。 （2.5

分）

一旦血栓形成，创伤便达到了稳态。 （1.5分）在短暂的血管收缩后，由于对激 肽、

补体成分和前列腺素的反应，局部小血管开始扩张。 （2.5分）白细胞 (起初为中性粒细

胞，后来为单核细胞 )和血浆蛋白进入创伤部位。 （2.0分）早期中性粒细胞浸润清除细胞

碎片、污垢和细菌。 （2.0分）活化的补体片段如 C5a能吸引中性粒细胞并协助杀死细

菌。（2.0分）值得注意的是，在清洁伤口，缺少中性粒细胞愈合仍能正常进行。 （1.5分）

后期单核细胞浸润到创伤部位并分化成对组织修复这一复杂过程产生重要影响的

巨噬细胞。 （2.0分）伤口的大部分巨噬细胞是不断从血循环中的单核细胞转化而来，但

也有一些是组织来源的能局部增殖 的巨噬细胞。 （2.5分）巨噬细胞继续清除组织和细菌

碎片，但更重要的是，分泌大量的生长因子。 （2.5分）这些肽生长因子吸引和活化局部

的内皮细胞、成纤维细胞和上皮细胞以发挥它们各自的修复功能，并启动创伤修复的下

一阶段即肉芽组织形成。 （1.5分）缺乏单核细胞和巨噬细胞会导致伤口愈合的不利变化，

清创能力差，成纤维细胞增生延迟和血管增生不足。 （2.0分）如果伤口条件允许，巨噬

细胞会继续补充更多的炎症细胞。 （1.5分）淋巴细胞更晚些时候进入伤口，它们在伤口

修复中的作用还不清楚。 （0.5分）白细胞介素 -1是一个可调节胶原 酶活性的淋巴细胞产

物，因此淋巴细胞可能参与了胶原重塑的过程。 （1.0分）

2009年专业英语备用题

2010年外科学专业英语 A卷（试卷）

136、 Transjugular intrahepatic portacaval stent shunt

BOUNDARIES OF MINIMAL ACCESS SURGERY

Minimal access surgery has crossed all traditional boundaries of specialities and

disciplines. Shared, borrowed and overlapping technologies and information are

encouraging a multidisciplinary approach that serves the whole patient rather than a

specific organ system. Broadly speaking, minimal access techniques can be

categorized as follows.

1. Laparoscopy. A rigid endoscope is introduced throu gh a port in the abdominal

wall into the peritoneal cavity, which has been inflated with carbon dioxide

(pneumoperitoneum). Further ports are then placed in the abdominal wall, through

which operating instruments can be introduced. Laparoscopic cholecystec tomy has

revolutionized the surgical management of cholelithiasis and is now the mainstay in its

management. As a result of improved instruments and increasing experience, Nissen

fundoplication, hiatal and inguinal hernia repair, appendicectomy, and colore ctal

surgery are now performed laparoscopically.

2. Thoracoscopy. A rigid endoscope is introduced through an incision in the chest

to gain access to the thoracic contents. The lung is deflated, producing a natural cavity

without the need for gas insufflati on. A common thoracoscopic procedure is

sympathectomy for hyperhydrosis.

3. Endoluminal endoscopy. Flexible or rigid endoscopes can be introduced into

hollow organs or systems for diagnosis and therapy. Examples are the urinary tract

(cystoscopy), upper ( oesophagogastroduodenoscopy) or lower gastrointestinal tract

(colonoscopy), respiratory tract (bronchoscopy) and vascular systems.

4. Perivisceral endoscopy. Body planes can be accessed even in the absence of

a natural cavity. Examples are mediastinoscopy , retroperitoneoscopy, and

retroperitoneal approaches to the kidney, aorta and lumbar sympathetic chain. A recent

example is subfascial ligation of incompetent perforators in varicose vein surgery.

5. Arthroscopy and intm -articular joint surgery. Orthopaed ic surgeons have long

used arthroscopic access to the knee and have now extended the techniques to other

joints, including the shoulder, wrist, elbow, hip and ankle. Apart from diagnosis,

therapeutic procedures include meniscectomy.

6. Neurosurgeons employ minimal access procedures within the cranial cavity

and the spinal canal.

7. Combined approaches. A diseased organ may be visualized and treated using

a combination of endoluminal and extraluminal endoscopes and other imaging devices.

COMPARISON OF SURGIC AL TRAUMA FROM OPEN AND LAPAROSCOPIC

SURGERY

1. Most of the trauma of an open procedure stems from the need for a wound

large enough to give exposure for safe dissection at the target site. The wound is often

the cause of morbidity, including infection, de hiscence, bleeding, herniation and nerve

entrapment. Wound pain prolongs recovery time and, by reducing mobility, contributes

to increased incidence of pulmonary collapse, chest infection and deep venous

thrombosis.

2. Mechanical and human retractors exert additional trauma. Body wall retractors

tend to inflict localized damage, which may be as painful as the wound itself. By

contrast, during laparoscopy the body wall is retracted by the low pressure

pneumoperitoneum, giving a diffuse force applied gently a nd evenly over the whole

body wall, causing minimal trauma.

3. Exposure of any body cavity to the atmosphere is harmful because of loss of

heat and loss of body fluid by evaporation. There is evidence from the surgical literature

that the incidence of post surgical adhesions is reduced in laparoscopic compared with

open procedures because there is less damage to the delicate serosal coverings.

Handling of intestinal loops reduces peristaltic activity and provokes adyna mic ileus;

this is reduced following laparoscopic surgery.

2010年外科学专业英语 A卷（答案）

微创手术的界定（ 1分）

微创手术已跨越了所有技术和学科的传统藩篱（ 1分）。共享的、借鉴的和重复交

叉的技术以及信息激励着一种跨学科的方式（ 1分），用以处理患者整体而非某个特定

的器官系统（ 1分）。一般而言，微创技术能以以下方式进行归类（ 1分）。

分），此前需将腹膜腔充满二氧化碳（气腹术）。随后会放置更多的插口于腹壁，经此

伸入外科操作器械（ 1分）。经腹腔镜胆囊切除术已彻底改革了胆石症的外 科处理方式，

现已成为其主流治疗手段（ 1分）。随着器械发展和经验积累，胃底折叠术、食管裂孔

疝和腹股沟疝修复、阑尾切除术、以及结直肠手术，现在都能经腹腔镜进行（ 2分）。

肺已排气，形成一个天然的空腔，无需注入气体（ 1分）。一个常见的胸腔镜操作既是

为治疗多汗症而行的交感神经节切除术（ 1分）。

断及治疗（ 1分）。例如尿路（膀胱镜）（ 1分）、上或下胃肠道（食管 -胃-十二指肠镜

或结肠镜）（ 1分）、呼吸道（支气管镜）（ 1分）和血管系统（ 1分）。

分）。例如纵膈镜（ 1分）、后腹腔镜（ 1分）、以及能够触及肾、主动脉（ 1分）和腰

椎交感神经链（ 1分）的后腹膜路径。最近的例子就是静脉曲张手术中对穿孔的肌膜下

结扎（ 1分）。

分），现在还将此技术扩展至其他关节，包括肩、腕、肘、髋和踝（ 2分）。除了诊断，

还能进行包括半月板切除的治疗性操作（ 1分）。

的内窥镜以及其他影像设备进行治疗（ 2分）。

开放和腹腔镜手术的手术创伤比较（ 1分）

剖（1分）。切口常常引起并发症，包括感染（ 1分）、裂开（ 1分）、出血（ 1分）、

疝气（ 1分）和神经卡压（ 1分）。切口疼痛会延长愈合时间（ 1分），并且通过减少患

者活动来增加肺萎陷（ 1分）、胸部感染（ 1分）和深静脉血栓（ 1分）等并发症的发生

率。

能会和切口同样疼痛（ 1分）。相比之下，腹腔镜手术中体壁仅由低压的气腹进行牵引

（1分），弥漫的压力温和且均匀的作用于整个体壁，将创伤降至最低（ 1分）。

分）。有外科文献的证据显示，腹腔镜手术术后粘连的发生率比开放操作低，因为浆膜

覆盖表面的损伤更小（ 1分）。处理小肠肠袢会减少蠕动活力（ 1分），并引起麻痹性肠

梗阻（ 1分）；而在腹腔镜手术后该现象会减少。

2010年外科学专业英语 B卷（试卷）

Causes of shock

1. Reduced venous return following haemorrhage is the commonest cause of shock

in traumatized patients. Bleeding may be occult, collecting in the large spaces of the

thorax, ab domen and pelvis. As well as the potential spaces intrapleurally and within

the retroperitoneum, blood may be lost into muscles and tissues around longbone

fractures; in addition, intravascular volume may be reduced as a result of leakage of

plasma into th e interstitial spaces. This can account for up to 25% of the volume of

tissue swelling following blunt trauma. The rate of blood returning to the heart depends

on the pressure gradient created by the high hydrostatic pressure in the peripheral

veins and lo w hydrostatic pressure in the cardiac right atrium . Any reduction in this

gradient, as from tension pneumothorax, cardiac tamponade or increasing right atrial

pressure, reduces venous return to the heart. External compression on the thorax or

abdomen can h ave a similar action in obstructing the venous ret urn.

2. Cardiogenic shock from ischaemic heart disease and cardiac contusions have

negative inotropic effects. Nevertheless, it does not occur unless more than 40% of the

left ventricular myocardium is dea d or severely damaged. In cardiogenic shock the

compensatory sympathetic and catecholamine responses only serve to increase the

myocardial oxygen demand and further increase ischaemia. Certain dysrhythmias

alone, from pre -existing cardiac ischaemia or foll owing cardiac contusion, significantly

reduce card iac performance. Be aware that all antiarrhythmic agents may have

negative inotropic effects, impeding the patient's physiological response to the injury.

Cardiac tamponade not only prejudices venous return but also restricts ventricular

filling.

3. Reduce d arterial tone complicates spinal injury above T6 by impairing

sympathetic nervous system outflow from the spinal cord below that level.

Consequently, both the reflex tachycardia and vasoconstriction respo nses to

hypovolaemia are restricted to a degree pr oportional to the level of sympathetic block.

Generalized vasodilatation, bradycardia and loss of temperature control can follow high

level spinal injuries, producing neurogenic shock; additional nervous da mage may

result from the reduced blood supply to t he spinal column. Any associated

haemorrhage from the injury aggravates this situation, further reducing spinal blood

flow. In addition, these patients are very sensitive to any vagal stimulation. For examp le,

pharyngeal suction can aggravate the bradycard ia, leading to cardiac arrest.

4. Septic shock results when circulating endotoxins, commonly from Gram -negative

organisms, produce vasodilatation and impair energy utilization at a cellular level.

Hypoxia c an devlop even with normal or high oxygen delivery rates, because the tissue

oxygen demand is extremely high and there is impaired oxygen uptake by the cells. In

addition, endotoxin makes the capillary walls leaky at the site of infection; this becomes

more generalized, allowing sodium and water to move from the interstitial to the

intracellular space. This eventually leads to hypovolaemia, making it indistinguishable

from hypovolaemic shock. Further cellular damage by endotoxins causes the release

of proteolytic enzymes, which paralyse precapillary sphincters, enhance capillary

leakage and increase hypovolaemia. The situation is aggravated by the endotoxin

acting as a negative inotrope on the myocardium. It follows that in the late stage of

sepsis there are several causes of the shock state.

2010年外科学专业英语 B卷（答案）

休克的原因（ 1分）

1．由出血导致的静脉回心血量减少（ 1分）是使创伤患者休克的最常见原因（ 1分） 。

出血可以是隐性的（ 1分） ，积聚在胸腔（ 1分） 、腹腔（ 1分）和盆腔（ 1分）的巨大空

间中。如同出血可以积聚在胸膜腔和腹膜后的潜在腔隙（ 1分） ，在长骨骨折中（ 1分） ，

失血也可以积聚在肌肉和周围组织中（ 1分） ；另外，血管内容量可以由于血浆渗出到组

织间液中而减少（ 1分） 。在钝器伤 中（1分） ，组织肿胀液体体积的 25%来自于此（ 1

分） 。回心血液的流速取决于外周静脉高静水压和右心房低静水压之间的压力梯度（ 2

分） 。任何导致该压力梯度减小的因素（ 1分） ，如张力性气胸（ 1分） 、心包压塞（ 1分）

或右心房压力增高（ 1分）均会导致静脉回流减慢。对胸部或腹部的外力压迫也能对阻

止静脉回流产生相似的作用（ 1分） 。

2．由缺血性心脏病（ 1分）和心脏挫伤导致（ 1分）的心源性休克具有负性变力效应

（1分） 。但是，除非超过 40%的左心室心肌坏死或严重损伤（ 1分） ，该情况一般不会

发生。在心源性休克中（ 1分） ，交感和儿 茶酚胺（ 1分）的代偿反应只会增加心肌氧自

由基损伤（ 1分） ，并进一步加重缺血。之前存在的心脏缺血或心脏挫伤导致的某种特定

的心律失常可显著减少心脏做功（ 1分） 。尤其需警惕所有的抗心律失常药物均可具有负

性变力效应（ 1分） ，从而阻碍患者对损伤的正常生理反应（ 1分） 。心包压塞不仅可以减

少静脉回心血量（ 1分） ，而且可限制心室充盈（ 1分） 。

3．T6节段以上的脊髓损伤由于损害了从该水平以下的脊髓传出的交感神经系统而

使得动脉张力降低（ 2分） ，因而变得更为复杂（ 1分） 。结果，低血容量引起的反射性心

跳加速 （ 1分） 和血管收缩 （ 1分） 均会由于交感阻滞的水平受到不同程度的限制 （ 1分） 。

高位脊髓损伤可导致全身血管扩张（ 1分） 、心动过缓（ 1分）和温度调节失控，从而导

致神经源性休克（ 1分） ；此外，脊柱供血减少又可导致进一步神经损伤（ 1分） 。任何损

伤相关的出血均会加重这种情形（ 1分） ，从而进一步减少脊髓供血（ 1分） 。另外，这些

患者对任何迷走神经的刺激都非常敏感（ 1分） 。例如，咽部负压吸引可加重心动过缓，

从而导致心跳骤停（ 1分） 。

4．当通常由革兰氏阴性菌（ 1分）产生的循环内毒素（ 1分）导致血管扩张和细胞水

平的能量利用受损时（ 1分） ，感染性休克即发生了（ 1分） 。由于组织需氧量大大增加并

且细胞摄氧能力受损（ 1分） ，故甚至当氧气扩散率正常或升高时缺氧亦可发生（ 1分） 。

此外，内毒素可使得感染部位的毛细血管壁渗漏（ 1分） ；使得钠和水从组织间液向细胞

内空间渗漏（ 1分） 。这最终将导致低血容量，从而与低血容量休克很难鉴别（ 1分） 。内

毒素引起的进一步细胞损伤会导致蛋白水解酶的释放（ 1分） ，从而麻痹毛细血管前括约

肌（1分） ，增加毛细血管漏出而加重低血容量症（ 1分） 。当内毒素作为一种负性肌力物

质作用于心肌时该情形会进一步加重（ 1分） 。在败血症的晚期，导致休克的多种原因会

同时存在（ 1分） 。 .

2011年外科学专业英语 A卷（试卷）

Most serious intra -abdominal infections require surgical intervention for

resolution. In this context, surgical intervention includes percutaneous drainage of intra -

abdominal abscesses. The specific excepti ons to the requirement for surgical

intervention include pyelonephritis, salpingitis, amebic liver abscess, enteritis,

spontaneous bacterial peritonitis, some cases of diverticulitis, and some cases of

cholangitis. However, all of these exceptions can be d iagnosed presumptively with a

rapid initial evaluation. If the diagnosis of one of these exceptions cannot be made, a

patient with fever and abdominal pain should not be given antibiotics without a plan

leading to operation or other drainage procedure. The administration of antibiotics in

this setting before diagnosis may obscure subsequent findings and delay diagnosis and

will certainly delay definitive operative management. If the patient is too sick to go

without antibiotic therapy, he or she is also too sick to avoid operative interventi on and

definitive diagnosis and treatment.

Despite modern antibiotics and intensive care, mortality from serious intra -

abdominal or retroperitoneal infection remains high(5% to 50%) and morbidity is

substantial. The syst emic response to intra -abdominal or retroperitoneal infection is

accompanied by fluid shifts similar to those seen in patients with major burns. Fever,

tachycardia, and hypotension are common, and a severe hypermetabolic, catabolic

response is universal. I f a corrective operation and effect ive antibiotics are not

employed promptly, the sequence of events termed multiple -organ failure syndrome

may ensue an cause the death of the patient even after the primary focus of infection

has been controlled. Regardles s of the initial antibiotic choice and operative procedure

there is a significant chance that a change in antibiotics may be required and that a

reoperation may be necessary. The physician caring for a patient with intra -abdominal

infection must be alert t o these possibilities and diligent in following and re -examining

the patient so this decision can be made at the earliest possible time. Outcome is

improved by early diagnosis and treatment. The risk of death and of complications

increases with increases a ge, pre -existing serious underlying disesese, and

malnutrition. The risk of death or failure to control the abdominal source of infection is

also related to the normal homeostatic balance of patient at the time of diagnosis and

initiation of definitive the rapy. This balance can be measured by scales designed to

quantitate the number of physical findings and laboratory tests that are abnormal. One

of the most widely used scales is the Acute Physiology And Chronic Health

Evaluation(APACHE) scoring system. The higher the score, the more abnorma l tests

and findings are present, and the greater the risk of death.

When a patient is diagnosed with intra -abdominal infection, initial treatment

consists of cardiorespiratory support, antibiotic therapy, and operative i ntervention. In

most cases, the res ponsible bacteria are not known for at least 24 hours, and sensitivity

information is not available for 48 to 72 hours after cultures are obtained during the

operative procedure. Because most intra -abdominal infections yield three to five

different aerobic and anaerobic pathog ens, specific, targeted antibiotic therapy is not

possible at first and the initial choice must be empiric, designed to cover arrange of

possible organisms .

2011年外科学专业英语 A卷（答案）

185、 Fracture of the distal radius(distal radial fractures)

大多数严重的腹腔内感染需 要外科手段来解决 （3分）。在这里，外科手段包括腹

腔内脓肿的经皮引流 （3分）。不需要外科手段的特殊情况包括肾盂肾炎、输卵管炎、

阿米巴肝脓肿、肠炎，自发性细菌性腹膜炎，某些憩室炎和某些胆囊炎，然而所有这些

例外情况都应通过迅速初步的评估而诊断出来，如果对这些例外情况中的任何一种不能

作出诊断，那么一个发热和腹痛的病人就应有计 划地进行手术或其他引流措施而不应只

给抗生素 （6分）。在作出诊断前就使用抗生素的情况下可以掩盖随后的临床表现，延

误诊断和某些必要的手术措施 （4分）。如果一个病人病情严重到不得不接受 抗生素治

疗，那么 他或她也不能够避免手术治疗和必要的诊断及治疗 （4分）。

尽管有现代化的抗生素和监护手段，严重腹腔内感染或腹膜后感染的死亡率还是

很高（ 5％～10％），发病率也相当高 （4分）。腹腔内感染或腹膜后感染的全身反应伴

有体液的转移，这与严重烧伤的病人相似，发热、心动过速、低血压很常见，严重的高

代谢、高分解代谢普遍存在，如果没有及时采取正确的手术和有效的抗生素治疗，即使

最初关注的感染被控制住了，也会发生多器官功能衰竭综合征并可以导致病人死亡 （6

分）。不管最初选择了哪种抗生素和手术治疗，都很可能要更换抗生素和进行必要的再

次手术（4分）。负责监护腹腔内感染病人的内科医生必须注意到这种可能性，随诊和

复查病人要很仔细，以便在尽可能早的时间里做出决定 （4分）。早期诊断和治疗可以

改善预后，年龄的增加 、事先存在严重的潜在病变和营养不良可以增加死亡与并发症发

生的危险 （4分）。死亡或不能控制腹腔感染源的危险性也与诊断和开始治疗 时病人正

常的机体平衡状态有关，这种平衡状态可以用设计好的检测方法通过所检测到的异常的

物理检查和实验室检查值计算出来 （4分）。应用最广泛的检测方法之一是 急性生理和

慢性健康评估（ APACHE ）计分系统，计分越高，异常的化验和物理检查结果越多，死

亡的危险性越大 （4分）。

当病人被诊断为腹腔内感染时，最初的治疗包括心肺支持、抗生素和手术治疗 （4

分）。大多数情况下，手术中所获得的细菌培养在 24小时以后才能知道致病菌种类，

48～72小时以后才能得到药物敏感性结果，由于大多数腹腔内感染有 3～5种不同的需

氧和厌氧的致病菌， 开始时就采用特异性和有针对性的抗生素治疗是不太可能的， 因此，

最初的抗生素选择必须是经验性的，并能覆盖可能的致病菌 （6分）。

2011年外科学专业英语 B卷（试卷）

This analysis of nat ional Medicare data shows that average hospital volumes in

the United States have increased for several high -risk operations, particularly complex

cancer resections. In most cases, rising hospital volumes were driven not only by an

overall increase in the number of procedures performed nationally but also by a higher

concentration of procedures in a smaller number of hospitals. In addition to patients’

being referred from lower - to higher -volume centers, hundreds of U.S. hospitals

stopped performing major c ancer resections and AAA repair. For esophagectomy, the

increase in average hospital volumes was explained entirely by market concentration.

For CABG and carotid endarterectomy, hospital volumes decreased dramatically,

largely as a result of fewer patients nationwide undergoing treatment.

Previous studies have described increasing regionalization of high -risk cancer

resections. In California, the proportion of patients undergoing esophagectomy,

pancreatectomy, and hepatectomy at high -volume hospitals incre ased by 17%, 31%,

and 23%, respectively, from 1990 through 2004. Hollenbeck et al. noted increasing

concentration of radical cystectomies in high -volume teaching hospitals from 1988

through 2000 . These studies suggest that trends toward consolidating high-risk cancer

resections at high -volume hospitals were under way well before the period of this

analysis and, more specifically , before the efforts of the Leapfrog Group, which started

in 2000.

It is not surprising that some procedures have become more concentrated in high -

volume centers than have others. In our a nalysis, trends toward an increasing

concentration of procedures in high -volume hospitals were most pronounced for

pancreatectomy, esophagectomy, and cystectomy, which are procedures with

particularly strong direct relationships between volume and outcome. These

procedures are also relatively uncommon, thus the financial penalty is minimized for

smaller hospitals that refer patients to higher volume centers. At the same time, the

number of hospitals performing CABG procedures increased, although the overall

volume of the procedure declined. This proliferation of hospitals may be related to both

the financial incentives for hospitals to be involved in cardiac surgery and their need to

provide backup for interventional cardiologists.

From 1999 through 2008, r isk-adjusted operative mortality fell between 8% and

36% for the eight procedures that we examined, which is consistent with several

previous studies reporting trends toward declining mortality in association with high risk

surgery. For example, mortality for CABG and carotid endarterectomy fell steadily

during the 1990s. Operative mortality associated with elective AAA repair has fallen,

largely because of the increasing use of endovascular surgery. Finally, other studies

also have documented declines in operative mortality in association with major cancer

operations during the previous decade.

In this study, the contribution of increasing hospital volume to declining mortality

varied considerably according to procedure . Not surprisingly, the greatest increases in

hospital volume during the study period were attributed to pancreatectomy,

esophagectomy, and cystectomy procedures, which are associated with particularly

strong direct relationships between volume and outcome. Conversely, hospit al volume

played little role for cardiovascular procedures, for which direct associations between

hospital volume and outcome are considerably weaker.

2011年外科学专业英语 B卷（答案）

这项国家医疗保险的数据分析显示在美国几个高风险手术的平均住院量有所增

加，尤其是复杂的肿瘤切除手术 （3分）。大多数情况下，住院量增加不但表现为全国

性的手术数量的增加而且手术多集 中在少数医院 （3分）。另外由于病人从低住院量医

疗中心向高住院量的中心的转移，美国许多医院已经停止开展大的肿瘤切除手术和主

动脉瘤修补手术 （3分）。对于食管切除术这类平均住院量的增加则完全是市场资源集

中的原因，而冠状动脉旁路移植和颈动脉内膜切除术的急剧减少则是由于全国范围内

需要治疗的病人的数目锐减所致 （5分）。

既往研究显示，逐渐认识到肿瘤切除的风险 （1分）。在加州，从 1990至2004

年间，在高住院量医院施行食管切除术、胰腺切除和肝叶切除术患者的比例分别增加

了17%、31%和23%（4分）。Hollenbec k等注意到从 1988年至 2000年根治性胆

囊切除术越来越多的集中在高住院量医院 （2分）。这些研究提示高风险癌症切除手术

向高住院量医院集中的趋势 ，在研究分析以前就已经形成，更具体地说是在 2000年

Leapfrog Group 开始启动之前就已形成 （5分）。

一点也不奇怪 ，有些手术变得更加集中在 高住院量的中心 ,而非其它 （2分）。在

我们的分析中 ，高住院量医院手术强度增加的趋势主要体现在 胰腺切除术 、食管癌切

除术及胆囊 切除术，这些手术都具有强烈的住院量和疗效间的线性关系 （5分）。这些

手术相对 少见，小医院由于 经济处罚 少而导致 病人选择高住院量的 中心（3分）。与此

同时，施行冠状动脉 旁路手术的医院的数量增加 ，虽然总手术量在减少 。这种扩大趋

势可能与两个因素相关，与心脏外科带来的经济利益驱动以及需要为心脏介入医师提

供技术支持 （5分）。

从1999年到 2008年，对于我们检测的 8类手术，其风险调整后的 手术死亡率下

降在 8%和36%之间（3分）。这与几个以前的研究报告的 相关的高风险手术死亡率 的

下降趋势是一致的 。例如，冠状动脉 旁路手术和颈动脉内膜 切除术的死亡率 在1990年

代持续下降 （3分）。与择期 AAA修补手术相关的 死亡率已经下降， 这主要是由于日

益广泛使用的血管内手术 （2分）。最后 ,其他的研究也有 论述，在过去的十年中，主

要肿瘤手术相关的手术死亡率的下降 （3分）。

在这项研究中 ，医院住院量的增加对于 死亡率下降 的贡献缘于各类业务（ 3

分）。不足为奇 ，在研究期间， 医院住院量最明显的增加，缘于 胰腺切除术 、食管癌

切除术和胆囊切除术，而且住院量和疗效 之间具有明显 的线性关系（3分）。相反，医

院住院量在 心血管手术中的作用很小，医院住院量 和疗效之间的直接关系 相当微弱（ 2

分）。

历年真题

急性非结石性胆囊炎 acute acalculous

cholecystitis

壶腹周围癌 periampullary carcinoma

膈下脓肿 subphrenic abscess

急性蜂窝织炎 acute cellulitis

原发性腹膜炎 primary peritonitis

经内镜鼻胆管引流术 endoscopic nasobiliary

drainage

膈疝 diaphragmatic hernia

冻伤 frostbite

肠间脓肿 interloop abscess

肠扭转 volvulus

腰椎间盘突出症 the lumber disc

herniation /protrusion

髋内翻 coxa vara

血源性骨髓炎 hematogenous osteomyelitis

网球肘 tennis elbow

精原细胞瘤 seminoma

尿道下裂 hypospadias

移行细胞癌 transitional cell carcinoma

袖状肺叶切除术 sleeve lobectomy

二尖瓣瓣膜置换术 mitral valve replacement

胸廓成形术 thoracoplasty

急性梗阻性化脓性胆管炎

acute obstructive suppurative cholangitis

糜烂性胃炎 erosive gastritis

十二指肠憩室 duodenal diverticulum

机会性感染 opportunistic infection

脾功能亢进 hypersplenism

肠套叠 intussusception

吻合口溃疡 stromal ulcer

纤维黄色瘤 fibroxanthoma

肝性脑病 hepatic encephalopathy

经颈静脉肝内门体分流术

transjugular intrahepatic portosystemic

shunt

骨形态发生蛋白 bone morphogenetic protein

骨质疏松 osteoporosis

髋外翻 coxa vara

粉碎性骨折 comminute fracture

不育症 infertility 阳痿 impotence

尿失禁 incontinence

电视辅助胸腔镜外科 video -assisted

thoracoscopic surgery

动脉导管未闭 patent ductus arteriosus

贲门失弛缓症 achalasia of cardia

急性梗阻性化脓性胆管炎

acute obstructive suppurative choleangitis

多发性内分泌肿瘤 multiple endocrine

neoplasm

直肠脱垂 rectal prolapse

代谢性碱中毒 metabolic alkalosis

股疝 femoral hernia

脊髓损伤 spinal cord injury

植骨 bone graft

肾动脉狭窄 renal artery stenosis

肾移植 kidney /renal transplantation

慢性缩窄性心包炎 chronic constrictive

pericarditis

胆管扩张 cholangi ectasis

腹横筋膜 transversalis fascia

里急后重 tenesmus

贲门周围血管离断术

extensive devascularization around the

cardia

海蛇头 caput medusa

先天性高肩胛骨 congenital high scapula

脊柱侧凸 scoliosis

双侧睾丸切除 bilateral orchiectomy

体外冲击波碎石术 extracorporeal shock wave

lithotripsy

纵隔扑动 mediastinal flutter

肠系膜上动脉 superior mensenteric artery

经内镜逆行胰胆管造影

endoscopic retrograde

cholangiopancreatography

萎缩性胃炎 erosive gastritis

难复性疝 irreducible hernia

美克尔憩室 Meckel’s diverticulum

股骨头骺滑脱 slipped capital femoral

epiphysis

骨骺固定术 epiphysi odesis

睾丸切除 orchiectomy

膀胱镜检查 cystoscopy

胸廓成形术 thoraco plasty

急性非结石性胆囊炎 acute acalculous

cholecystitis

甲沟炎 paronychia

联合腱 conjoined tendon

胆道出血 hemobilia

倾倒综合征 dumping syndrome

脊柱前凸 lordosis

股骨头缺血坏死 avascular necrosis of

femoral head

促黄体激素释放激素激动剂可以用于治疗前列腺

癌

LHRH agonist can be used to treat prostate

cancer

移行细胞癌 transitional cell carcinoma

主动脉缩窄 coarctation of aorta

白线疝 hernia of linea alba

贲门周围血管离断术

extensive esophagogastric

devascularization.

胆道蛔虫症 biliary ascariasis

腹膜后血肿 retroperitoneal hematoma

肝性脑病 hepatic encephal opathy

间叶性软骨肉瘤 mesenchymal

chondrosarcoma

佝偻病性驼背 ricketic kyphosis

移植肾排异 renal allograft rejection

肾错构瘤 hamartoma of the kidney

心脏停跳液 cardioplegia

肠套叠 intussusception

低钾血症 hypokalemia

肛裂 anal fistula

黑色素瘤 melanoma

难复性疝 irreducible hernia

交感型颈椎病 sympathetic cervical

spondylosis

创伤性窒息 traumatic asphyxia

肾血管性高血压 renal vascular hypertention

尿潴留 retention of urine 肺大疱切除术 bullectomy

胆管结石 choledocho lithiasis

甲沟炎 paronychia

原发性甲状旁腺功能亢进 primary

hyperparathyroidism

丹毒 erysipelas

动静脉畸形 arteriovenous malformations

弥散性血管内凝血 disseminated

intravascular coagulation

肱骨髁上骨折 supracondylar fracture of

humerus

睾丸非精原细胞瘤 non-germinal cell tumor of

the testis

神经源性膀胱 neurogenic bladder

肺不张 atelectasis

肛瘘 anal fistula

破伤风 tetanus

十二指肠憩室 duodenal diverticulum

胰岛素瘤 insulinoma

壶腹周围癌 periampullary adenocarcinoma

骨筋膜室综合征 osteofascial compartment

syndrome

脊髓休克 spine cord shock

经尿道前列腺切除术 transurethral resection

of prostate

尿道狭窄 urethral stricture

二尖瓣关闭不全 mitral regurgitation

急性蜂窝织炎 acute cellulitis

动脉硬化性闭塞症 angiosclerosis obliterans

膈疝 diaphragmatic hernia

门静脉高压性胃病 portal hypertensive

gastropathy

突眼性甲状腺肿 exophthalmic goiter

粉碎性骨折 comminuted fracture

强直性脊柱炎 ankylosing spondylitis

附睾炎 epididymitis

膀胱镜检查 cystoscopy

支气管扩张 bronchiectasis

胆道蛔虫病 biliary ascariasis

低氯血症 hypochloremia

冻疮 chilblain

谷氨酰胺 glutamine

内镜下鼻胆管引流 endoscopic nasobiliary

drainage

骨折延迟愈合 delayed union

骨性关节炎 osteoarthritis

肾盂造口术 pyelostomy

残余尿 residual urine

主动脉夹层动脉瘤 dissecting aneurysm of

aorta

白线疝 hernia of linea and alba

低磷血症 hypo phosphatemia

分流术 shunts

肝棘球蚴病 echinococcus disease of liver

冷沉淀 cryo precipitate

神经源性间歇性跛行 neurological intermittent

claudication

转子间骨折 intertrochanteric fracture

压力性尿失禁 stress incontinence

静脉尿路造影 intravenous urogram

激光心肌血运重建术

transmyocardial laser revascularization

急性出血性肠炎 acute hemorrhagic enteritis

病人自控镇痛 patient control analgesia

肠系膜上静脉血栓形成

superior mesenteric venous thrombosis

膈下脓肿 subphrenic abscess

吻合口溃疡 stromal ulcer

特发性脊柱侧凸 idiopath ic scoliosis

坐骨神经损伤 injury of sciatic nerve

良性前列腺增生 benign prostatic hyperplasia

急性尿潴留 acute retention of urine

根治性全肺切除术 radical pneumonectomy

动脉硬化性闭塞症 arteriosclerosis obliterans

胆管扩张 cholangiectasis

肝包虫病 hydatid disease of liver / hepatic

echinococcosis

错构瘤 hamartoma

肝性脑病 hepatic encephalopathy

应力性骨折 stress fracture

青枝骨折 greenstick fracture

肾离体手术 bench surgery of kidney

腹膜后淋巴结切除术 retroperitoneal lymphaden ectomy

自发性气胸 spontaneous pneumothorax

肠套叠 intussusception

蜂窝组织炎 cellulitis

黑色素瘤 melanoma

甲状腺危象 thyroid crisis

新辅助化疗 neoadjuvant chemotherapy

压痛 tenderness

爪形手 claw hand

肾积水 hydronephrosis

肾部分切除术 partial nephrectomy

电视胸腔镜手术 video -assisted thoracic

surgery

动静脉畸形 arteriovenous malformations

破伤风梭菌 clostridium tetani

清创术 debridement

贲门周围血管离断术

extensive devascularization around the

cardia

甲沟炎 paronychia

骨摩擦音 bony crepitus

肘管综合征 cubital tunnel syndrome

间质性膀胱炎 interstitial cystitis

肾错构瘤 angiomyolipoma of kidney

系统淋巴结清扫 systemic nodal dissection

代谢性碱中毒 metabolic alkalosis

膈疝 diaphragmatic hernia

急性出血性肠炎 acute hemorrhagic enteritis

内镜逆行胰胆管造影

endoscopic retrograde

cholangiopancreatography

萎缩性胃炎 erosive gastritis

半月板 meniscus

锤状指 mallet finger

肾结核 renal tuberculosis

根治性膀胱切除术 radical cystectomy

袖式切除 sleeve resection

畸形 deformity

破伤风 tetanus

迷走神经干切断术 truncal vagotomy

便秘 constipation

熊去氧胆酸 ursodeoxycholic acid

鹅去氧胆酸 chenodeoxycholic acid

癌旁综合征 paraneoplastic syndrome

肠套叠 intussusception

气腹 pneumoperitonem

急性化脓性胆管炎 acute suppurative

cholangitis

血栓闭塞性脉管炎 thromboangitis obliterans

经腹腔外疝修补术 extraperitoneal

herniorrhaphy

经腹腔内疝修补术 intraperitoneal

herinorrhaphy

绞窄性肠梗阻 strangulated intestinal

obstruction

麻痹性肠梗阻 paralytic ileus

选择性迷走神经切断术 selective vagotomy

断流术 devascularization

分流术 shunts

壶腹周围癌 periampullary adenocarcinoma

直肠脱垂 rectal prolapse

全直肠系膜切除术 total mesorect um

异种移植 xeno transplantation

同种移植 allotransplantation

姑息性切除术 palliative resection

实性假乳头状瘤 solid -pseudopapil lary tumor

粘液性囊腺癌 mucinous cystadenoma

浆液性囊腺癌 serous cystadenoma

自发性腹膜炎 spontaneous peritonitis

继发性腹膜炎 secondary peritonitis

腹股沟滑动疝 inguinal sliding hernia

急性中毒性巨结肠 acute toxic megacolon

胆囊切除术 cholecystectomy

畸形 deformity

迷走神经干切除术 truncal vagotomy

便秘 constipation

熊去氧胆酸 ursodeoxycholic acid

癌旁综合征 paraneoplastic syndrome

尿道狭窄 urethral stricture

尿道扩张 urethral dilation

尿潴留 retention of urine

交感型颈椎病 sympathetic cervical

spondylosis

截肢术 amputation 胸膜外全肺切除术 extrapleural

pneumonectomy

断流术 devascularization

壶腹周围癌 ampullary adenocarcinoma

全直肠系膜切除术 totally mesorectum

resection

实性假乳头状瘤 solid pseudopapillary tumor

自发性腹膜炎 spontaneous peritonitis

肾绞痛 renal colic

无痛性血尿 painless hematuria

断指再植 digital replantation

腰椎管狭窄 lumber canal stenosis

恶性胸腔积液 malignant pleural effusions

破伤风 tetanus

腹股沟滑动性疝 inguinal sliding hernia

鹅去氧胆酸

肠套叠 intussusception

气腹 pneumo peritonem

体外冲击波碎石 extracorporeal shock wave

lithotripsy

输尿管结石 ureteral calculi

狭窄性腱鞘炎 stenosing tenosynovitis

化脓性骨髓炎 pyogenic osteomyelitis

纵隔淋巴结清扫术 mediastinal lymph node

dissection

分流术 shunts

直肠脱垂 rectal prolapse

异种移植 xenotransplantation

急性中毒性巨结肠 acute toxic megacolon

胆囊切除术 cholecystectomy

导尿 urethral catheterization

尿频 frequency

脊髓空洞症 syringomyelia

骨巨细胞瘤 giant cell tumor of bone

胸腺瘤 thymoma

少突胶质瘤 oligodendroglioma