本书主要介绍外科无菌技术、外科手术基本技术、围手术期处理及重症监护、常见外科小手术、换药技术、外科穿刺技术、常用外科手术和微创手术基础，使留学生牢固树立无菌观念，初步掌握手术技术，复习局部解剖，了解一些常用手术的适应证、手术技术和围手术期处理方法。

Part Ⅰ Theory Chapter 1 Introduction ..........................................3 The history of operative surgery .........................3 Methods and expectations for learning operative surgery ...................................................5 Classifications of surgical operations..................6 Classification of incision and the degree of incision healing...................................................7 Factors that affect wound healing .......................8 The effects of an operation on the body .............8 Chapter 2 Aseptic Technique..............................10 Basic concepts of aseptic technique...................10 Source of bacteria in operative site....................10 Methods of sterilization for operative supplies and instruments................................11 Chemical Disinfection .........................................12 Preparation of the operation...............................12 Function and position of operative staff...........19 Operative Theater ................................................19 Chapter 3 Operative Instruments....................20 Scalpel ...................................................................20 Scissors .................................................................22 Thumb Forceps.....................................................23 Haemostatic Forceps............................................24 Allis Forceps ........................................................25 Towel Clips ..........................................................25 Sponge-holding forceps .....................................25 Needle Holder .....................................................25 Retractors...............................................................26 Needle....................................................................27 Suture materials ...................................................28 Modern instruments............................................30 Chapter 4 Basic Operative Technique ...........31 Incision...................................................................31 Dissection ..............................................................32 Haemostasis..........................................................33 Tying Knots...........................................................36 Suture.....................................................................43 Cutting and removing suture.............................47 Surgical drainage .................................................48 Chapter 5 Perioperative Period ........................50 Preoperative..........................................................50 Intraoperative .......................................................51 Anesthesia .............................................................51 Postoperative ........................................................54 Treatment of postoperative complications ......55 Chapter 6 Paracentesis Technique...................56 Abdominocentesis................................................56 Thoracentesis ........................................................58 Lumbar Puncture .................................................59 Bone marrow aspiration .....................................61 Chapter 7 Wound and Debridement...............64 Classification of wound ......................................64 Basic principles of wound management...........64 Wound healing stages .........................................65 Types of Wound Healing....................................65 Debridement .........................................................66 Principles of wound treatment...........................66 General Measure ..................................................67 Pebridement procedures.....................................67 Chapter 8 Dressing Change ...............................70 Purpose of dressing change................................70 Clinical indications for a dressing change........70 Timing of the dressing changes .........................70 Dressing change necessities................................71 Preparation of dressing change supplies..........72 Dressing change procedure................................73 Dressing change when the wound is sutured.....74 Key points .............................................................74 Chapter 9 Tracheotomy ........................................75 Concept..................................................................75 Indication and contraindication.........................75 Anatomy of trachea .............................................75 Classification of a tracheotomy..........................76 Attention of preoperative, posture and anesthesia ..........................................................77 Tracheotomy procedure......................................77 Complications of tracheotomy and prevention .........................................................79 Tracheotomy management ................................80 Other emergency airway procedures................80 Chapter 10 Vascular Surgery.............................82 High ligation and stripping of varicose veins of the great saphenous vein .................82 Venotomy..............................................................84 Exposure of the femoral artery ..........................85 Chapter 11 Anterior Abdomina Wall and Abdominal Incision .....87 Review of anatomy ..............................................87 Abdominal incisions............................................92 Chapter 12 Splenectomy.......................................94 Introduction to the spleen...................................94 Anatomy of the spleen ........................................94 Indications for a splenectomy ............................95 Procedure for a splenectomy..............................96 Postoperative care................................................98 Chapter 13 Partial Resection and Anastomosis of Small Intestine ..............................................100 Summary of anatomy........................................100 Classification of anastomosis............................101 Inspection and examination .............................101 Procedures (end-to-end anastomosis).............101 Chapter 14 Appendectomy................................104 Appendix anatomy summary ..........................104 Appendectomy indications ..............................104 Appendectomy procedure................................105 Appendectomy risks and complications ........107 Laparoscopic appendectomy............................107 Chapter 15 Surgical Repair of Inguinal Hernias............................110 Introduction to inguinal hernia........................110 Classification of inguinal hernias ....................110 Indication for an inguinal hernia surgery ......111 Non surgical treatment......................................111 Anatomy of the inguinal region.......................111 Surgical procedure of open inguinal hernia repair................................................................112 Laparoscopic procedures for inguinal hernias..............................................................115 Using mesh..........................................................115 Postoperative care..............................................116 Chapter 16 Minimally Invasive Surgery and Surgical System.....................117 Minimally invasive surgery..............................117 Laparoscopic cholecystectomy.........................119 Introduction of a surgical system ....................122 Part Ⅱ.Practice Chapter 17 Guideline for Practice Experiments....................................129 Experiment 1 Introduction of Operative Instruments.........................................................129 Objectives and requirements............................129 Experimental instruments for each group......129 Operative instruments.......................................129 Practice.................................................................131 Questions.............................................................131 Experiment 2 Aseptic Technique ................131 Objectives and requirements............................131 Necessary surgical supplies for each group......131 Preparation before surgery...............................131 Questions.............................................................134 Experiment 3 Basic Operative Technique....134 Objectives and requirements............................134 Necessary surgical supplies for each group...134 Tying knots .........................................................134 Hemostasis with hemostatic forceps (practiced by two students) ..........................135 Cutting suture (practiced by two students) ...135 Removing suture................................................136 Experiment 4 Laparotomy.............................136 Objective and requirements..............................136 Necessities of each group..................................136 Procedure for a laparotomy..............................136 Experiment 5 Debridement...........................137 Objective and requirements..............................137 Necessary surgical supplies for the operation .........................................................137 Experimental procedure....................................138 Attention points..................................................140 Postoperative treatment....................................140 Questions.............................................................140 Experiment 6 Tracheotomy...........................140 Objectives and requirements............................140 Necessary surgical supplies for the operation .........................................................140 Experimental procedure....................................140 Attention points..................................................141 Questions.............................................................142 Experiment 7 Exposure of the Femoral Artery....................................................................142 Objectives and requirements............................142 Necessary surgical supplies for the operation .........................................................142 Experimental procedure....................................142 Attention points..................................................142 Question ..............................................................142 Experiment 8 Splenectomy............................142 Objectives and requirements............................142 Necessary surgical supplies for the operation .........................................................142 Experimental procedure....................................143 Attention points..................................................144 Questions.............................................................144 Experiment 9 Mimic a Human Body Appendectomy..................................................144 Objectives and requirements............................144 Necessary surgical supplies for the operation .........................................................144 Experimental procedure....................................144 Attention points..................................................145 Questions.............................................................146 Experiment 10 Resection and Anastomosis of the Small Intestine ............146 Objectives and requirements............................146 Necessary surgical supplies for the operation .........................................................147 Experimental procedure....................................147 References ........................................................................150 Theory