浙醫(yī)二院外科主任醫(yī)師彭淑牖教授，為中國的外科臨床醫(yī)療、教學(xué)、科研拼搏了半個世紀(jì)，作出了突出貢獻(xiàn)，如今74歲的他依然每天工作10多個小時，依然堅持一年做200臺手術(shù)。

“魔術(shù)刀”顛覆傳統(tǒng)外科手術(shù)

無影燈下，“主刀”大夫正緊張地切、割、吸、縫、扎，并不停地伸出手來轉(zhuǎn)換器械，助手們不時地向他遞上所需的器械，豆大的汗珠從他的額頭上不斷沁滴下來，旁邊的護(hù)士不停地為他拭汗……，這是我們經(jīng)?？吹降慕?jīng)典式的傳統(tǒng)外科手術(shù)場景。如今，這種繁雜的場景正在悄悄地消失，那種令人眼花繚亂的刀、械交響曲正被一把比圓珠筆稍長一點的刮吸刀所代替……

這是一把被外國同行稱為“魔術(shù)刀”的手術(shù)器械，他的發(fā)明人正是彭淑牖教授。

20年前的一天，一位年輕的特警被送到浙醫(yī)二院，病情嚴(yán)重，必須馬上手術(shù)，外科主任彭淑牖走上手術(shù)臺。

但是患者的腹腔打開了又被縫上，他患了肝尾葉癌，這在世界外科領(lǐng)域?qū)儆谑中g(shù)禁區(qū)。

“眼看著一個年輕的生命在自己面前逝去，作為醫(yī)生我心里非常難受。”20年后，彭淑牖在回顧這一經(jīng)歷時仍感痛楚。

肝癌系癌中之王，肝癌死亡率高的原因是手術(shù)切除率低，而切除率低的原因是肝癌有許多手術(shù)禁區(qū)。比如肝尾葉癌，肝臟血管密集交錯，血供豐富，若腫瘤長在大血管上，切除時易傷及血管造成大出血而危及生命。因此，傳統(tǒng)的切除術(shù)一旦遇到腫瘤長在密布大血管的肝尾葉上就束手無策。

有什么方法既能切除組織又不傷及血管呢？受超聲刀震碎肝組織的啟發(fā)，彭淑牖想到，能否采用刮耙的方法將肝組織刮碎？他用圓珠筆桿、聽診器金屬管做成耙樣，然后試著在肝組織上刮耙，肝組織被一層層剝落，果然，一條條血管顯露出來了，彭淑牖創(chuàng)造的刮吸手術(shù)解剖法誕生了。不過，肝組織刮下來馬上要用吸引器吸走，遇到小血管須更換器械進(jìn)行電凝，這在傳統(tǒng)外科手術(shù)中手術(shù)刀、止血鉗、鑷子得要幾十把，現(xiàn)在能否將這些功能全部集中在一起呢？

智慧之門一旦開啟，成功便迎面而來。經(jīng)過彭淑牖的一次次努力，他終于將電切、電凝、吸引、剝離四大功能以及將手術(shù)臺上的“七刀八剪”全部凝聚成一把刀的多功能手術(shù)解剖器誕生了！就是說手術(shù)者手持一把刀，就能完成除縫合以外的所有操作。

他的這一發(fā)明改變了世界外科手術(shù)的方法，使被列為禁區(qū)的疑難手術(shù)變成常規(guī)手術(shù)，并讓手術(shù)時間縮短40%，出血量減少50%，使許多被判死刑的患者得以起死回生，這在世界外科史上史無前例！

彭淑牖的發(fā)明在世界外科領(lǐng)域引起震動，小小一把手術(shù)刀引發(fā)了一場世界外科手術(shù)革命，外國專家稱這一成果是“世界外科領(lǐng)域劃時代的進(jìn)步”，國外許多專家紛紛到中國學(xué)習(xí)“彭氏刮吸手術(shù)解剖法”。

2002年4月15日，第十屆全國肝膽外科學(xué)術(shù)會議暨第一屆中國國際肝膽外科論壇在重慶召開，彭淑牖教授作為嘉賓受邀進(jìn)行“刮吸手術(shù)解剖法”的專題講座和示范。在第三軍醫(yī)大學(xué)西南醫(yī)院的手術(shù)室里，彭淑牖教授用他發(fā)明的手術(shù)刀為一位肝癌晚期病人施行切除手術(shù)。只見他拿起手中的“魔術(shù)刀”，時而切開肝組織，時而電凝出血點，時而吸走肝創(chuàng)面上的血水，手術(shù)中的“推”、“剝”、“切”、“凝”、“吸”等操作一氣呵成，癌腫被干凈利落地切除，淋巴等軟組織碎屑也被徹底掃清。這使通過現(xiàn)場錄像觀摩了手術(shù)全過程的國內(nèi)外肝膽外科專家們驚嘆：“彭教授做手術(shù)簡直就是藝術(shù)表演！”美國外科教授克萊克·霍夫曼（H·Clark·Hoffman）這樣評價彭淑牖：“這是繼200年前鑷鉗發(fā)明以來外科器械最偉大的發(fā)明，在外科史上具有劃時代的意義。”

目前多功能手術(shù)解剖器已在全國500家醫(yī)院使用，不僅肝、膽、胰、脾、胃等普通外科采用了這把“神刀”，骨科、婦科、泌尿外科、胸外科、腦外科等醫(yī)生也被這把簡單易用的手術(shù)器械所吸引，眾多的名醫(yī)紛紛“換刀”。此外，他還積極開展高難度的肝尾狀葉及鄰近第一、二、三肝門腫瘤外科治療，突破了肝外科的“禁區(qū)”，并在國內(nèi)首先進(jìn)行了第八肝段切除術(shù)等高難度手術(shù)。

2001年2月1日，國家科技獎勵大會在北京人民大會堂舉行。憑著《刮吸手術(shù)解剖法的建立與多功能手術(shù)解剖器的研制》項目的雄厚實力，彭淑牖從國家領(lǐng)導(dǎo)人手中接過了國家技術(shù)發(fā)明二等獎的大紅證書，這是浙江省醫(yī)學(xué)界近幾年來獲得的最高等級的科學(xué)大獎。

2002年5月15日在美國匹茲堡舉行的“世界新發(fā)明新技術(shù)展示會”上，彭淑牖的“刮吸手術(shù)解剖法和刮吸手術(shù)解剖器”榮獲了醫(yī)學(xué)類唯一的一等獎。與會的外國專家對彭教授這項發(fā)明的創(chuàng)新性、先進(jìn)性、實用性給予了高度評價，認(rèn)為這是外科手術(shù)及手術(shù)器械上的一項重大突破，是對世界外科學(xué)的巨大貢獻(xiàn)，應(yīng)向全球醫(yī)學(xué)界推廣。2004年，該器械通過了美國FDA認(rèn)證，作為中國人的自主創(chuàng)新產(chǎn)品，進(jìn)入了美國醫(yī)療器械市場。

一字之差解世界難題

1953年從浙江醫(yī)學(xué)院畢業(yè)的21歲的彭淑牖，到浙二醫(yī)院做了實習(xí)醫(yī)生。在浙二醫(yī)院他目睹了中國第一例胰腺癌切除手術(shù)，操刀者是他的老師余文光。當(dāng)切除胰的癌灶部分后，手術(shù)者將小腸和胰腺直接縫合在一起，以維持食物和營養(yǎng)的正常運行。切除手術(shù)很成功，然而可怕的事情卻發(fā)生了：病人出現(xiàn)了胰漏。

這意味著什么呢？胰液原本應(yīng)該進(jìn)入腸道，它與腸液混合在一起便成為具有強烈的腐蝕性消化液消化食物。而現(xiàn)在它從腸道和胰腺縫合的地方漏出來進(jìn)入到腹腔，這就相當(dāng)于硫酸進(jìn)入腹腔，流到哪里爛到哪里，病人經(jīng)常會出現(xiàn)血管壁被腐蝕而大出血死亡。

中國第一例胰漏手術(shù)給彭淑牖留下了深刻印象，后來他才知道，從1935年美國進(jìn)行世界上第一例胰腺癌切除手術(shù)以來，胰漏問題一直都沒有很好的解決辦法。

全世界都在尋找解決胰漏的方法，彭淑牖也一直在尋找。1995年開始，他幾乎放棄了一直擅長的肝癌切除手術(shù)，專心致志研究這個問題?！耙婚_始我也在‘縫’字上下工夫，可很快我就發(fā)現(xiàn)這條路走不通。因為要避免空隙，就要增加縫合密度，而增加縫合密度，就增加了針孔，這互相矛盾。”這時的彭淑牖腦子里突然又“轉(zhuǎn)了個彎”，他大膽設(shè)想：能不能不用縫合的方法把兩個器官接起來，這樣就可以避免針孔的問題。

“綁！”這個字在他腦海中跳了出來。從沒做過裁縫的他，開始在動物身上嘗試各種新的“捆綁”方法。用通俗的話說，胰腺是‘實心’的，像一塊軟軟的肉，而腸子是空心的，它就像有襯里的西裝袖子一樣。共有好幾層。彭淑牖嘗試著縫合時先把這“袖子”卷起一截來，然后把這塊“肉”塞進(jìn)“袖口”，與“袖子”的“襯里”縫起來。然后再把“袖子”翻回來時，這樣外表那一層就沒有針孔了。

1995年12月27日，彭淑牖在蕭山醫(yī)院第一次使用了這種方法，術(shù)后果然沒有發(fā)生胰漏，后來彭淑牖在浙二醫(yī)院和邵逸夫醫(yī)院施行了300例胰腺癌手術(shù)，均無一發(fā)生胰漏！

成功了！從“縫”變成“綁”，一字之差解決了70多年來未能攻克的世界難題。

這一項目獲得國家科技進(jìn)步二等獎、浙江省科技進(jìn)步一等獎。美國著名外科教授克萊克說：“他的技術(shù)和創(chuàng)造在外科史上具有時代意義。”

永不言退的“空中飛人”

“人生七十古來稀”，在一般人眼里今年74歲的彭淑牖教授應(yīng)該是享受含飴弄孫樂趣的時候了，可在他身上燃燒的是青春的激情。

彭淑牖教授1932年出生于廣東梅縣一個醫(yī)生世家，父親彭致達(dá)是梅城名醫(yī)，三位叔叔分別行醫(yī)，也是當(dāng)?shù)孛t(yī)。受家庭的熏陶，他的兄弟姐妹對醫(yī)學(xué)都有深厚的興趣，對治病救人有一種神圣的使命感，大姐彭淑兆在香港是著名病理學(xué)專家，二姐彭淑意是華西醫(yī)大內(nèi)科著名教授，弟弟彭淑覺是位放射科醫(yī)生，對彭淑牖影響最大的是他的大哥彭淑干，“早年大哥在上海中山醫(yī)院外科工作，上世紀(jì)50年代參加抗美援朝，接著隨軍赴新疆克拉瑪依油田醫(yī)院工作。”彭教授說：“有一次大哥胃大出血需要輸血，當(dāng)廣播向市民發(fā)出通知后，許多工人和家屬紛紛自發(fā)獻(xiàn)血，都說要保住這位好醫(yī)生。這件事對我影響很大。大哥對病人無私的奉獻(xiàn)精神是我的榜樣?！?/p>

作為首屈一指的專家，彭教授有做不完的手術(shù)，很多是省外一些大醫(yī)院邀請的。他曾經(jīng)在7天里奔波于杭州、北京、南昌、烏魯木齊四地，先后做了7臺大手術(shù)，救了7條命，平均每臺都要四五個小時。有時為了搶救病人，彭教授剛下飛機就做手術(shù)，以高尚的醫(yī)德和精湛的醫(yī)技挽救了無數(shù)病人的生命。

飛來飛去多了，人們送彭教授一個“空中飛人”外號。彭教授蠻愛聽這個雅號，他說飛多了，眼界高了，創(chuàng)新思維就更多了。他拉開辦公桌的一只抽屜給筆者看，原來里面放滿了民航登機牌，他不無得意地說：“我是中國民航事業(yè)的積極支持者?！?/p>

70多歲了，很多人關(guān)心彭教授在手術(shù)臺前還能站幾年？彭教授說，他沒想過，但他會向吳孟超看齊的，80多歲了還在為病人手術(shù)。

“我從沒想過退的時候，即使我做不動，我還可以寫，寫不了我還可以說……”彭教授補充道。

彭淑牖教授自1955年浙江醫(yī)學(xué)院醫(yī)學(xué)系畢業(yè)至今，幾十年來已做了上萬例手術(shù)，有多少人被他從死神手里救回來，這連他自己也記不清了。

從醫(yī)50年間，他取得了國家科技進(jìn)步二等獎、國家發(fā)明二等獎、何梁何利科技進(jìn)步獎、兩次獲浙江省科技進(jìn)步一等獎以及省部級以上獎勵12項，國家專利15項。

2004年，鑒于他為當(dāng)今世界外科領(lǐng)域所作的巨大貢獻(xiàn)，美國外科學(xué)院授予他為榮譽院士。

“我很珍惜這個榮譽，它是世界對中國外科發(fā)展水平的肯定?！迸硎珉徽f。

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)