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神经外科手术中对抗失血:哈维·库欣对电外科手术的接受

Battling blood loss in neurosurgery: Harvey Cushing's embrace of electrosurgery.

作者信息

Voorhees Jennifer R, Cohen-Gadol Aaron A, Laws Edward R, Spencer Dennis D

机构信息

Department of Neurological Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.

出版信息

J Neurosurg. 2005 Apr;102(4):745-52. doi: 10.3171/jns.2005.102.4.0745.

Abstract

For his pioneering spirit, definitive work, and unparalleled devotion to conquering neurosurgery's toughest obstacles, Harvey Williams Cushing inarguably has earned the title, "The Father of Neurosurgery." His revolutionary incorporation of electrosurgical techniques in neurosurgery was not exceptional, but part of a pattern of recognizing, embracing, and establishing the use of medical technologies with great potential. Until 1910, Cushing had systematically reduced neurosurgery's primary complications--infection and the effects of intracranial pressure--to decrease mortality rates. Hemostasis had always been a concern of William Halsted's surgical protégé, but only after 1910 could Cushing primarily focus on it. In fact, Cushing's crucial collaboration with William T. Bovie and his electrosurgical apparatus conquered this major obstacle in 1926. The nature of their collaboration--two experts in their respective fields who were passionate about their work, working side by side in the operating room--resulted in progress that surpassed all predecessors in the field. Cushing never did learn the physics behind one of the most important advances of his career. Nonetheless, he did know that by greatly reducing blood loss, electrosurgery allowed him to operate in patients whose tumors had been previously deemed inoperable and on the entire spectrum of neurosurgical patients more safely.

摘要

因其开拓精神、决定性的工作以及征服神经外科最棘手难题的无与伦比的奉献精神,哈维·威廉姆斯·库欣当之无愧地赢得了“神经外科之父”的称号。他在神经外科领域对电外科技术的革命性应用并非个例,而是认识、接纳并确立具有巨大潜力的医疗技术这一模式的一部分。到1910年,库欣已系统性地降低了神经外科的主要并发症——感染和颅内压的影响——以降低死亡率。止血一直是威廉·霍尔斯特德的外科门徒库欣所关注的问题,但直到1910年之后,库欣才能够将主要精力集中于此。事实上,库欣与威廉·T·博维及其电外科设备的关键合作在1926年攻克了这一重大障碍。他们合作的性质——两位各自领域的专家,对工作充满热情,在手术室并肩作战——带来了超越该领域所有前辈的进展。库欣从未了解过他职业生涯中最重要进展之一背后的物理学原理。尽管如此,他确实知道,通过大幅减少失血,电外科使他能够为那些之前被认为无法手术的肿瘤患者以及各类神经外科患者更安全地进行手术。

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