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浙医二院外科主任医师彭淑牖教授,为中国的外科临床医疗、教学、科研拼搏了半个世纪,作出了突出贡献,如今74岁的他依然每天工作10多个小时,依然坚持一年做200台手术。
“魔术刀”颠覆传统外科手术
无影灯下,“主刀”大夫正紧张地切、割、吸、缝、扎,并不停地伸出手来转换器械,助手们不时地向他递上所需的器械,豆大的汗珠从他的额头上不断沁滴下来,旁边的护士不停地为他拭汗……,这是我们经常看到的经典式的传统外科手术场景。如今,这种繁杂的场景正在悄悄地消失,那种令人眼花缭乱的刀、械交响曲正被一把比圆珠笔稍长一点的刮吸刀所代替……
这是一把被外国同行称为“魔术刀”的手术器械,他的发明人正是彭淑牖教授。
20年前的一天,一位年轻的特警被送到浙医二院,病情严重,必须马上手术,外科主任彭淑牖走上手术台。
但是患者的腹腔打开了又被缝上,他患了肝尾叶癌,这在世界外科领域属于手术禁区。
“眼看着一个年轻的生命在自己面前逝去,作为医生我心里非常难受。”20年后,彭淑牖在回顾这一经历时仍感痛楚。
肝癌系癌中之王,肝癌死亡率高的原因是手术切除率低,而切除率低的原因是肝癌有许多手术禁区。比如肝尾叶癌,肝脏血管密集交错,血供丰富,若肿瘤长在大血管上,切除时易伤及血管造成大出血而危及生命。因此,传统的切除术一旦遇到肿瘤长在密布大血管的肝尾叶上就束手无策。
有什么方法既能切除组织又不伤及血管呢?受超声刀震碎肝组织的启发,彭淑牖想到,能否采用刮耙的方法将肝组织刮碎?他用圆珠笔杆、听诊器金属管做成耙样,然后试着在肝组织上刮耙,肝组织被一层层剥落,果然,一条条血管显露出来了,彭淑牖创造的刮吸手术解剖法诞生了。不过,肝组织刮下来马上要用吸引器吸走,遇到小血管须更换器械进行电凝,这在传统外科手术中手术刀、止血钳、镊子得要几十把,现在能否将这些功能全部集中在一起呢?
智慧之门一旦开启,成功便迎面而来。经过彭淑牖的一次次努力,他终于将电切、电凝、吸引、剥离四大功能以及将手术台上的“七刀八剪”全部凝聚成一把刀的多功能手术解剖器诞生了!就是说手术者手持一把刀,就能完成除缝合以外的所有操作。
他的这一发明改变了世界外科手术的方法,使被列为禁区的疑难手术变成常规手术,并让手术时间缩短40%,出血量减少50%,使许多被判死刑的患者得以起死回生,这在世界外科史上史无前例!
彭淑牖的发明在世界外科领域引起震动,小小一把手术刀引发了一场世界外科手术革命,外国专家称这一成果是“世界外科领域划时代的进步”,国外许多专家纷纷到中国学习“彭氏刮吸手术解剖法”。
2002年4月15日,第十届全国肝胆外科学术会议暨第一届中国国际肝胆外科论坛在重庆召开,彭淑牖教授作为嘉宾受邀进行“刮吸手术解剖法”的专题讲座和示范。在第三军医大学西南医院的手术室里,彭淑牖教授用他发明的手术刀为一位肝癌晚期病人施行切除手术。只见他拿起手中的“魔术刀”,时而切开肝组织,时而电凝出血点,时而吸走肝创面上的血水,手术中的“推”、“剥”、“切”、“凝”、“吸”等操作一气呵成,癌肿被干净利落地切除,淋巴等软组织碎屑也被彻底扫清。这使通过现场录像观摩了手术全过程的国内外肝胆外科专家们惊叹:“彭教授做手术简直就是艺术表演!”美国外科教授克莱克·霍夫曼(H·Clark·Hoffman)这样评价彭淑牖:“这是继200年前镊钳发明以来外科器械最伟大的发明,在外科史上具有划时代的意义。”

目前多功能手术解剖器已在全国500家医院使用,不仅肝、胆、胰、脾、胃等普通外科采用了这把“神刀”,骨科、妇科、泌尿外科、胸外科、脑外科等医生也被这把简单易用的手术器械所吸引,众多的名医纷纷“换刀”。此外,他还积极开展高难度的肝尾状叶及邻近第一、二、三肝门肿瘤外科治疗,突破了肝外科的“禁区”,并在国内首先进行了第八肝段切除术等高难度手术。
2001年2月1日,国家科技奖励大会在北京人民大会堂举行。凭着《刮吸手术解剖法的建立与多功能手术解剖器的研制》项目的雄厚实力,彭淑牖从国家领导人手中接过了国家技术发明二等奖的大红证书,这是浙江省医学界近几年来获得的最高等级的科学大奖。
2002年5月15日在美国匹兹堡举行的“世界新发明新技术展示会”上,彭淑牖的“刮吸手术解剖法和刮吸手术解剖器”荣获了医学类唯一的一等奖。与会的外国专家对彭教授这项发明的创新性、先进性、实用性给予了高度评价,认为这是外科手术及手术器械上的一项重大突破,是对世界外科学的巨大贡献,应向全球医学界推广。2004年,该器械通过了美国FDA认证,作为中国人的自主创新产品,进入了美国医疗器械市场。
一字之差解世界难题
1953年从浙江医学院毕业的21岁的彭淑牖,到浙二医院做了实习医生。在浙二医院他目睹了中国第一例胰腺癌切除手术,操刀者是他的老师余文光。当切除胰的癌灶部分后,手术者将小肠和胰腺直接缝合在一起,以维持食物和营养的正常运行。切除手术很成功,然而可怕的事情却发生了:病人出现了胰漏。
这意味着什么呢?胰液原本应该进入肠道,它与肠液混合在一起便成为具有强烈的腐蚀性消化液消化食物。而现在它从肠道和胰腺缝合的地方漏出来进入到腹腔,这就相当于硫酸进入腹腔,流到哪里烂到哪里,病人经常会出现血管壁被腐蚀而大出血死亡。
中国第一例胰漏手术给彭淑牖留下了深刻印象,后来他才知道,从1935年美国进行世界上第一例胰腺癌切除手术以来,胰漏问题一直都没有很好的解决办法。
全世界都在寻找解决胰漏的方法,彭淑牖也一直在寻找。1995年开始,他几乎放弃了一直擅长的肝癌切除手术,专心致志研究这个问题。“一开始我也在‘缝’字上下工夫,可很快我就发现这条路走不通。因为要避免空隙,就要增加缝合密度,而增加缝合密度,就增加了针孔,这互相矛盾。”这时的彭淑牖脑子里突然又“转了个弯”,他大胆设想:能不能不用缝合的方法把两个器官接起来,这样就可以避免针孔的问题。
“绑!”这个字在他脑海中跳了出来。从没做过裁缝的他,开始在动物身上尝试各种新的“捆绑”方法。用通俗的话说,胰腺是‘实心’的,像一块软软的肉,而肠子是空心的,它就像有衬里的西装袖子一样。共有好几层。彭淑牖尝试着缝合时先把这“袖子”卷起一截来,然后把这块“肉”塞进“袖口”,与“袖子”的“衬里”缝起来。然后再把“袖子”翻回来时,这样外表那一层就没有针孔了。
1995年12月27日,彭淑牖在萧山医院第一次使用了这种方法,术后果然没有发生胰漏,后来彭淑牖在浙二医院和邵逸夫医院施行了300例胰腺癌手术,均无一发生胰漏!
成功了!从“缝”变成“绑”,一字之差解决了70多年来未能攻克的世界难题。
这一项目获得国家科技进步二等奖、浙江省科技进步一等奖。美国著名外科教授克莱克说:“他的技术和创造在外科史上具有时代意义。”

永不言退的“空中飞人”
“人生七十古来稀”,在一般人眼里今年74岁的彭淑牖教授应该是享受含饴弄孙乐趣的时候了,可在他身上燃烧的是青春的激情。
彭淑牖教授1932年出生于广东梅县一个医生世家,父亲彭致达是梅城名医,三位叔叔分别行医,也是当地名医。受家庭的熏陶,他的兄弟姐妹对医学都有深厚的兴趣,对治病救人有一种神圣的使命感,大姐彭淑兆在香港是著名病理学专家,二姐彭淑意是华西医大内科著名教授,弟弟彭淑觉是位放射科医生,对彭淑牖影响最大的是他的大哥彭淑干,“早年大哥在上海中山医院外科工作,上世纪50年代参加抗美援朝,接着随军赴新疆克拉玛依油田医院工作。”彭教授说:“有一次大哥胃大出血需要输血,当广播向市民发出通知后,许多工人和家属纷纷自发献血,都说要保住这位好医生。这件事对我影响很大。大哥对病人无私的奉献精神是我的榜样。”

作为首屈一指的专家,彭教授有做不完的手术,很多是省外一些大医院邀请的。他曾经在7天里奔波于杭州、北京、南昌、乌鲁木齐四地,先后做了7台大手术,救了7条命,平均每台都要四五个小时。有时为了抢救病人,彭教授刚下飞机就做手术,以高尚的医德和精湛的医技挽救了无数病人的生命。
飞来飞去多了,人们送彭教授一个“空中飞人”外号。彭教授蛮爱听这个雅号,他说飞多了,眼界高了,创新思维就更多了。他拉开办公桌的一只抽屉给笔者看,原来里面放满了民航登机牌,他不无得意地说:“我是中国民航事业的积极支持者。”
70多岁了,很多人关心彭教授在手术台前还能站几年?彭教授说,他没想过,但他会向吴孟超看齐的,80多岁了还在为病人手术。
“我从没想过退的时候,即使我做不动,我还可以写,写不了我还可以说……”彭教授补充道。
彭淑牖教授自1955年浙江医学院医学系毕业至今,几十年来已做了上万例手术,有多少人被他从死神手里救回来,这连他自己也记不清了。
从医50年间,他取得了国家科技进步二等奖、国家发明二等奖、何梁何利科技进步奖、两次获浙江省科技进步一等奖以及省部级以上奖励12项,国家专利15项。
2004年,鉴于他为当今世界外科领域所作的巨大贡献,美国外科学院授予他为荣誉院士。
“我很珍惜这个荣誉,它是世界对中国外科发展水平的肯定。”彭淑牖说。
Magic Surgical Instrument Saves Lives
By Xue Jianguo
Professor Peng Shuyong, a chief surgeon at the second hospital affiliated to Zhejiang University, is a world-class surgeon. At the age of 75, he is still the most wanted surgeon at the hospital and does 250 surgeries a year. That is, averagely speaking, he works more than 10 hours a day.
Peng’s reputation rests largely on his innovative approaches to surgery. He is the inventor of an all-purpose surgical scalpel which makes many impossible surgeries possible. In a classical scene of an operating room, a surgeon needs a few assistants to hand him numerous instruments during a complicated surgery. The scene is vanishing now. Peng’s epoch-making invention has made these tools obsolete.
His invention started twenty years ago. One day, a critically sick young policeman was on the operating table. But the abdomen was opened and closed again because he had lobus caudate cancer, which was inoperable at that time. As a doctor, Peng felt terribly sad about the dying young man. For a long while, liver cancers were inoperable, for the surgery-caused hemorrhage was fatal. Take the lobus caudatus for example. This part of the liver is home to a maze of blood vessels.

Peng began to seek a new method to operate on the liver. If cutting was not possible, he reasoned, could scrapping work? With a shaft of a ball pen and part of a stethoscope, he made an experimental scraper. It worked in experiments. It scrapped away the liver tissues layer by layer to expose blood vessels there. Thus was born his new procedure of liver surgery.
After numerous trials and errors, Peng came up with a single surgical instrument that can perform electrocision, electrocoagulation, suction, ablation and many other functions. The scalpel can do all the things in a surgery except sutures. This invention has made impossible liver surgeries possible.
On April 15, 2004, an international surgery forum convened in Chongqing, a city directly under the central government in southwestern China’s Sichuan Province. He gave a lecture on his new instrument and new method for his liver surgery. The next day, he demonstrated for participating surgeons by doing a surgery on a patient with advanced liver cancer. Surgeons from home and abroad were totally amazed by the inventive instrument and Peng’s art of handling it.
Nowadays, surgeons in more than 500 hospitals across the country have adopted this multiple-purpose surgical instrument. It is used in surgeries on liver, gallbladder, pancreas, spleen, and stomach. What is more, surgeons in other fields have begun to use this new instrument in complicated operations on heart, brain, and reproductive organs, etc. In 2004, the FDA issued approval for the use of the instrument in America. Peng has won numerous honors for his epoch-making invention.

Peng is prominent not just for his epoch-making invention but also for his ingenious ways for liver and related surgeries.
One of his best contributions to world-class surgical science is his successful solution to pancreatic leakage.
After graduation from Zhejiang Medical University at 21, he first worked as an intern at the second hospital affiliated to the university. It was during his internship that he witnessed the first pancreatic leakage. The pancreatic cancer was removed and the pancreas and the large intestine was sutured together to maintain the system’s smooth function. But the unexpected pancreatic leakage killed the patient. Later Peng learned that since the first successful surgical removal of pancreatic cancer in the USA, the leakage problem had been harassing surgeons all over the world.
The year 1995 witnessed Peng make serious efforts to solve the problem. His first idea was to find a better suture approach. But it went nowhere because highly corrosive digestive juice would seep out into the abdomen through the suture holes. Then he tried to find other options. Was there a way to put together two organs without suture? He asked himself. He hit upon one option: binding. He made experiments on animals. Then he found a way to link the two organs together without letting the digestive juice corrode the sutures.
On December 27, 1995, Peng applied his method for the first time to a patient at a hospital in Xiaoshan, a suburban city of Hangzhou. No pancreatic leakage occurred. Peng operated on 300 patients using the same technique and none of them suffered from the leakage problem. A problem that had been disturbing surgeons all over the world has been solved by Peng’s new technique.
Nowadays, Peng runs a very busy schedule. He operates not only in Hangzhou but also in cities across the country. His record is seven surgeries in four cities across the country within seven days, when he saved seven lives. He is known as “airman”among his colleagues. One of his desk drawers is full of boarding cards, which bear witness to his numerous flights across the country. Peng jokes that he is an active supporter for the country’s civil aviation.
For his 50-year surgery career, Peng has won numerous honors and he holds 15 state patents. In 2004, he was awarded as an honorary academician by the American College of Surgeons. Peng comments that he cherishes this honor because it confirms the world-class surgery our country has achieved.
(Translated by David)