SABIsTON

@u,Aju

BEDAH

tsuku asli berstiker hotogram 3 dimensi

I I
 Kutipan PasalT2z
Sanksi Pelanggaran Undang-Undang Hak Cipta
(Undang-Undang No. l9 Tahun 2002)

i.Barangsiapa dengan sengaja dan tanpa hak melakukan pcrbuatan sebagaimana dimaksud dalam Pasal 2 ayat
(1) dipidana dengan pidana penjara masing-masing paling singkat I (satu) bulan dan/atau denda paling
sedikit Rp.1.000.000,00 (satu juta rupiah), atau pidana penjara paling lama 7 (tujuh; tahun dan/atau denda
paling banyak Rp.5.000.000.000,00 (lima miliar rupiah).
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ciptaan atau barang hasil pelanggaran Hak Cipta atau Hak Terkait sebagaimana dimaksud pada ayat (l)
dipidana dengan pidana penjara paling lama 5 (lima) tahun dan/atau denda paling banyak Rp.500.000.000,00
(lima ratus juta rupiah).

Punrrnc Drxrrauur
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guru.
 SABISTON
mrAi ar

(Essentials of Surgery)
8A6IAN I
Dovid C. Sobislon, Jr., MD
Ahli Bedah Universitas James B. Duke
Kepala Bagian llmu Bedah
Pusat Kedokteran Universitas Duke
' Durham, Carolina Utara

Alih Bahasa:
dr. Petrus Andrianto
dr. Timan l.S.

Editor:
dr. Jonatan Oswari

PENERBIT BUKU KEDOKTERAN

mtr
EGC2I2

SABISTON'S ESSENTIALS OF SURGERY

Translation and adaptation ofthe first English language edition
@ I 987 W.B. Saunders Co. Philadelphia PA l9l 05

BUKUAJARBEDAH
Alih bahasa: .dr. Petrus Andrianto & dr. Timan I.S.
Editor: Jonatan Oswari
Hak cipta terjemahan Indonesia
@ 1992 Penerbit Buku KedokterAn EGC
PO. Box 427 6l Jakart^ 10042
Telepon: 6530 6283

Anggota IKAPI

Desain kulit muka: Yohanes Duta Kurnia Utama

Hak cipta dilindungi Undang-Undang

Dilarang mengutip, memperbanyak dan menerjemahkan sebagian atau
seluruh isi buku ini tanpa izin tertulis dari penerbit'

Cetakan l: 1992
Cetakan II: 1995

Perpustakaan Nasional: Katalog Dalam Terbitan (KDT)

SABISTON, David C.
Buku ajar bedah / David c. Sabiston ; alih bahasa, Petrus Andrianto, Timan LS. ;
editor, Jonatan Oswari. Jakarta : EGC' 1995'
xx,593 hlm. 2 jil.;20'5 -
x27 cm'
Judul asli: Sabistonb essentials of sutgery'
ISBN 979-448-170-X (no. jil. lengkap)
ISBN 979-448-l7l-8 (,i1. l)
L Bctlah, Ilmu. l. Judul. Il' Andrianto' Pelrus' Ill' l'S', Timan'
617

lsi di luar tanggung iawab percelakan

 Kats Pengantar
Edisi Bahasa Inggris
Mempelaiai fenomena penyakit tanpa buku dikatakan
belnjar di laut tanpa peta; sementara mempelaiari
buku tanpa kesabaran berarti sarna sekali tiduk ber-
laYar'
osrer
Selama beberapa waktu, penerbit mendorong agar
buku teks lebih ringkas bagi mahasiswa kedokteral
dikembangkan berdasarkan standar yang telah diten-
tukan Textbook of Surgery: The Biological Basis of
Modem Surgical Practice. Setelah survei luas yang
dilakukan di antara mahasiswa kedokteran dan fakul-
tas di Amerika Serikat dan luar negeri, jelas terlihat
kebutuhan bagi teks yang lebih padat. Walau-
pun responden menekankan bahwa diperlukan teks
yang lebih singkat, namun diharuskan agar teks me-
nampilkan karya menyeluruh dengan cakupan dalam
bagi dasar, konsep serta uraian deskriptif adekuat bagi
ilmu bedah. Karena alasan ini, persiapan Pokok-pokok
Ilmu Bedah dimulai dan dikumpulkan kelompok pe-
nyumbang naskah terkemuka. Subjek yang ditampil-
kan dicakup dalam teks standar; tetapl perhatian
primer ditempatkan pada prinsip bedah dengan pe-
nekanan atas pencakupan semua informasi yang di-
nggap esensial bagi semua mahasiswa kedokteran
tanpa memandang karier yang dipilih. Dengan penun-
tun ini, dikembangkan teks yang mendekati setengah
ukuran edisi standar dengan maksud mencakup subjek
yang umumnya diharapkan dipahami oleh semua ma-
hasiswa kedokteran. Spesialisasi bedah yang mencakup
bedah cardiothorax, bedah saraf, bedah plastik dan
maxillofacial, ortopedi, otolaringologi dan urologi, ma-
sing-masingnya ditampilkan seperri juga ginekoiogi.
Kebijaksanaan yang telah ditetapkan sebelumnya
untuk mendapatkan penyumbang naskah paling ahli
diteruskan sebagai tujuan terpenting da-n yang berpar-
tisipasi dalam edisi ini merupakan tokoh terkenal
dalam bidangnya masing-masing. Uraian singkat per-
kembangan sejarah subjek ini ditampilkan secara
sistematik dalam tiap bagian dengan pencakupan hanya
data yang berhubungan yang diperlukan bagi pema-
haman menyeluruh subjek ini. Teks ini berkonsep da-
sar pada presentasi secara berurutan segi anatomi,
patologi, fisiologi, farn.rakologi, biokirnia dan imuno-
logi penyakit. Pengalaman selama beberapa dasawarsa
yang lalu telah diteruskan untuk menekankan pening-
katari hubungan antara ilmu dasar dalam kedokteran
dan pasangan kliniknya dalam memahami dasar diag-
nosis dan penatalaksanaan penyakit.
Dengan kepercayaan kuat bahwa gambar yang
tepat menjelaskan bahkan masalah yang terumit,
maka teks ini menunjang tanda versi besarnya dengan
pemilihan gambar terbaik yang tersedia dalam kepusta-
kaan. Kepustakaan berhubungan diberikan untuk
tiap bagian dan di samping itu, menyebutkan ruiukan
terpilih dengan uraian singkat isinya dalam urutan
yang membuat mahasiswa bisa mengenal sokongan
lebih penting dalam kepustakaan.
Dalam kesimpulan, Pokok-pokok llmu Bedah
talah dipersiapkan dengan tujual spesifik penyusun
agar informasi diharapkan telah didapat oieh maha-
siswa kedokteran sebelurn wisuda. Editor berterima
kasih bagi kesempatan yang diberikan oleh tantangan
ini dan peraaya tujuannya telah dicapai.
DAVID C. SABISTON. Jr.
 Penulis I{askah
JOSEPH F. AMARAL, M.D.
Assistant Instructor, Department of Surgery, Brown
University, Division of Biology and Medicine, Prov-
idence, Rhode Island. Surgical Fellow, Rhode Island
Hospital, Providence.
Fluid and Electrolyte Management
DANA K. ANDERSEN, M.D.
Associate Professor of Medicine and Surgery, State
University of NeW York, Health Science Center at
Brooklyn. Attending Surgeon, State University Hos-
pital and Kings County Hospital Center, Brooklyn.
Consultant in Surgery, Veterans Administration
Medical Center, Brooklyn.
The Pancreas
BRADLEY AUST, M.D., Ph.D.
Professor and Chairman, Department of Surgery,
The University of Texas Health Science Center at
San Antonio. Chief of Surgery, Bexar County Hos-
pital District Hospitals. Consultant, Brooke Army
Medical Center, Fort Sam Houston; Methodist Hos-
pital, Veterans Administration Hospital, San Anto-
nio State Chest Hospital, Humana Hospital San
Antonio and Metropolitan.
Surgical Disorders of the SmaII Intestine
ERLE H. AI.JSTIN, M.D,
Associate Professor, Section Head, Pediatric Cardiac
Surgery, Division of Cardiac Surgery, Department of
Surgery, East Carolina University School of Medi-
cine, Greenville, North Carolina. Attending Physi-
cian, Cardiothoracic Surgery, Pitt County Memorial
Hospital, Greenville.
Disorders of Pulmonary Venous Return: Total
Anomalous Pulmonary Venous Connection
ROBERT W. BARNES, M.D.
Professor and Chairman, Department of Surgery,
University of Arkansas for Medical Sciences, Little
Rock. Staff Surgeon, University of Arkansas, Mc-
Clellan Memorial Veterans Administration Hospital,
and Arkansas Children's Hospital, Little Rock.
'The
Arterial System
DOUGLAS M. BFHRENDT, M.D.
Professor of Surgery, University of Michigan Medical
School, Ann Arbor. Staff, Section of Thoracic Sur-
gery, University of Michigan Medical Center, Ann
Arbor.
Transplantation
KIRBY I. BLAND, M.D.
Professor and Associate Chairman, DePartment of
Surgery, University of Florida Collgge of Medicine,
Gainesville, Florida. Staff, Shands Hospital, Gaines-
ville Veterans Administration Medical Center, and
Lake City Veterans Administration Medical Center.
The Breast
DANI P. BOLOGNESI, Ph.D.
James B. Duke Professor of Experimental Surgery,
Department of Surgery; Director, Surgical Virology
Laboratory, Duke University Medical Center, Dur-
ham, North Carolina.
Surgical Aspects of Viral Hepatitis and the Acquired
Immune Deficiency Syndrome (AIDS)
MURRAY F. BRENNAN, M.D.
Professor of Surgery, Cornell University Medical
College, New York, New York. Alfred P. Sloan
Professor of Surgery, Chairman, Department of Sur-
gery, Memorial-Sloan-Kettering Cancer Center,
New York.
Nutrition and Metabolism in Surgical Patients
DENNIS E. BULLARD, M.D.
Assistant Professor of Neurosurgery and Pathology,
Duke University Medical Center, Durham, North
Carolina.
Neurosurgery
JOHN L. CAMERON, M.D.
Professor arid Chairman, Section of Surgical Sci-
ences, The Johns Hopkins University School of Med-
icine, Baltimore, Maryland. Chief of Surgery, The
Johns Hopkins Hospital, Baltimore.
The Biliary System
DARRELL A. CAMPBELL, Jr., M.D.
Associate Professor of Surgery, Univeisity of Michi-
gan Medical School, Ann Arbor. Director of Trans-
plantation, Section of General Surgery, University of
Michigan Medical Center, Ann Arbor.
Transplantation
W. RANDOLPH CHITWOOD, Jr., M,D.
Professor, Division of Cardiac Surgery, East Carolina
.University School of Medicine, Greenville, North
Carolina. Chief of Cardiac Surgery, Pitt County
Memorial Hospital, Greenville.
The Diagnosis and Management of Myasthenia
Gravis
ORLO H. CLARK, M.D.
Professor of Surgery, University of California Medi-
cal Center, San Francisco. Staff, Veterans Adminis-
tration Medical Center, University of California
Medical Center, and Letterman General Hospital,
San Francisco, and David Grant Medical Center,
Travis. California.
The Pituitary and Adrenal Glands
VII
 JOHN J. COLEMAN III, M.D.
Associate Professor of Surgery, Emory University
School of Medicine, Atlanta, Georgia. Chief of Plas-
tic Surgery, Atlanta Veterans Administration lv{edi-
cal Center. Wadley R. Glenn Chair of Surgery,
Emory University. Atlanta.
The Head and Neck
REX B. CONN, M.D.
Professor of Pathology and Laboratory Medicine,
School of Medicine, Emory University, Atlanta,
Georgia. Director, Clinical Pathology Laboratories,
Emory University Hospital, Atlanta.
Normal Values
EDWARD M. COPELAND III, M.D.
The Edward R. Woodward Professor and Chairman.
Department of Surgery, University of Florida College
of Medicine, Gainesville, Florida. Chief of Surgery,
Shands Hospital at the University of Florida, Gaines-
ville.
The Breast
ROBERT J. CORRY, M.D.
Professor and Head, Department of Surgery, The
University of Iowa College of Medicine, Iowa City.
Chief of Surgery, University of Iowa Hospitals and
Clinics. Consultant, Surgical Services, Iowa City Vet-
erans Administration Medical Center.
Surgical Complications
PETER J. E. CRUSE, M.B., CH. B.,
F.R;C.S. (E&C)
Professor and Head, University of Calgary, Alberta,
Canada, Head, Department of Surgery, Foothills
Hospital. CalgarY.
Wound Healing and Management
P. WILLIAM CURRERI, M.D.
Professor and Chairman, Department of Surgery,
University of South Alabama College of Medicine,
Mobile. Chief of Surgery, University of South Ala-
bama Medical Center, Mobile.
Management of the Acutely Injured Person
DONALD C. DAFOE, M.D.
Assistant Professor of Surgery, University of Michi-
gan Medical School, Ann Arbor. Staff, Section of
General Surgery, University of Michigan Medical
Center, Ann Arbor.
Transplantation
RALPH J. DAMIANO, M.D.
Chief Assistant Resident in Surgery, Duke University
Medical Center, Durham, North Carolina.
Cardiac Neoplasms
VIII Penulis Naskah
R. DUANE DAVIS, Jr., M.D.
Research Fellow in Surgery, Duke University Medi-
cal Center, Durham, North Carolina
Primary Mediastinal Cysts and Neoplasms
ANDRE DURANCEAU, M.D.
Professor of Surgery, Universit6 de Mont16al, School
of Medicine, Montr6al, Canada. Chief, Thoracic Sur-
gery Service, H6tel-Dieu de Montral Hospital.
The Esophagus
LENNART FAGRAEUS, M.D., Ph.D.
Professor and Chairman, Department of Anesthe-
siology, College of Medicine, University of Okla-
homa, Oklahoma City.
Anesthesia
JOSEPH C. FARMER, Jr., M.D.
Associate Professor, Division of Otolaryngology, De-
partment of Surgery, Duke University School of
Medicine, Durham, North Carolina. Staff. Otolar-
yngology, Duke University Medical Center, and Dur-
ham Veterans Administration Regional Medical Cen-
ter. Consultant, Durham County General Hospital.
Otolarvngologv
JOHN R. FARNDON, B.S., M.8.,
F.R.C.S.
Senior Lecturer in Surgery, University of Newcastle
upon Tyne, United Kingdom. Consultant Surgeon,
Royal Victoria Infirmary, Newcastle upon Tyne,
United Kingdom.
The Thyroid
T. BRUCE FERGUSON, Jr., M.D.
Teaching Scholar in Surgery, Department of Surgery,
Duke University Medical Center, Durham, North
Carolina.
Management of the Surgical Patient with Cardiac
Disease
ROBERT D. FITCH, M.D.
Assistant Professor, Orthopaedic Surgery, Duke Uni-
versity, Durham, North Carolina. Staff Orthopedic
Surgeon, Duke University Hospital. Consultant Or-
thopedist, Lennox Baker Children's Hospital, Dur-
ham.
Fractures of the Upper Extremity; Introduction to
Pediatric Orthopedics
DONALD S. GANN, M.D,
J. Murray Beardsley Professor of Surgery and Chair-
man, Department of Surgery, Brown University,
Division of Biology and Medicine, Providence,
Rhode Island. Surgeon-in-Chief, Rhode Island Hos-
pital, Providence.
Fluid and Electrolyte Management
 Veterans Administration Hospital, San Antonio.
Surgical Disorders of the Small Intestine
W. MARSTON LINEHAN, M.D.
Assistant Professor of Urologic Surgery, Uniformed
Services University of the Health Sciences, Bethesda,
Maryland. Head, Urologic Oncology Section, Sur-
gery Branch, National Cancer Institute, Bethesda.
The Urogenital System
GARY K. LOFLAND, M.D.
Assistant Professor of Surgery, State University of
New York at Buffalo. Chief, Pediatric Cardiac Sur-
gery, Buffalo .Children's Hospital, Buffalo, New
York.
Atrial Septal Defect, Ostium Primum Defect, and
Atriov entricular Canal ; Venticular Septal Defects
JAMES E. LOWE, M.D.
Associate Professor of Surgery and Assistant Profes-
sor of Pathology. Duke Universiry. Durham. North
Carolina. Director, Surgical Electrophysiology Serv-
ice, Duke University Medical Center, Durham.
Surgical Treatment of Cardiac Arrhythmias; Cardiac
Pacemakers
H. KIM LYERLY, M.D.
Senior Resident in Surgery, Department of Surgery,
Duke University Medical Center, Durham, North
Carolina.
Surgical Aspects of Viral Hepatilis and the Acquired
Immune Deficiency Syndrome (AIDS); Pulmonary
Embolism; Arteriovenous Fistulas
BARRY D. MANN, M,D.
Assistant Clinical Professor, University of California,
School of Medicine at Los Angeles.
Principles of Surgical Oncology
WILLIAM H. MARKS, M.D., Ph.D.
Assistant Professor of Surgery and Biochemistry,
Stritch School of Medicine, Loyola University of
Chicago, Chicago, Illinois. Staff, Loyola University
Medical Center, Section of General Surgery, May-
wood, Illinois.
Transplantation
TERUO MATSUMOTO, M.D., Ph.D.
Professor and Chairman, Department of Surgery,
Hahnemann University, Philadelphia, Pennsylvania.
Chief of Surgery, Hahnemann University Hospital.
Attending Surgeon, St. Agnes Medical Center, Phil-
adelphia.
The Spleen
RICHARD L. McCANN, M.D.
Assistant Professor of Surgery, Duke University
Medical School, Durhani, North Carolina. Attending
Staff, Duke University Medical Center. Consultant,
Durham Veterans Administration Medical Center,
X Penulis Naskah
Durham.
The Lymphatic System
DONALD C. McILRATH, M.D.
of Surgery, Mayo Medical School; Chair_
Professor
man, Department of Surgery, Mayo Clinic, Roches_
ter, Minnesota.
Syrqt:q! Disorders of the Vermiform Appendix and
Meckel's Diverticulum
JOSEPH S. McLAUGHLIN, M.D.
Professor of Surgery. Head. Division of Thoracic and
Cardiovascular Surgery, University of Maryland
School of Medicine, College park, Maryland. Staff,
University Hospital, College park.
Surgical Disorders of the Pericardium
N. TAIT McpHEDRAN, M.D.,
F.R.C.S.C.
Professor, Depgrtment of Surgery, Faculty of Medi-
cine. University of Calgary. Albe;ta, Canada. Senior
Surgeon. Foothills Hospital, Calgary.
Wound Healing and Management
JON F. MORAN, M.D.
Associate Professor and Chairman, Department of
Thoracic and Cardiovascular Surgery, University of
Kansas Medical Center, Kansas City.
The Surgical Treatment of pulmonary Tuberculosis
JOHN A. MORRIS, JR., M.D.
Assistant Professor of Surgery, Vanderbilt University
School of Medicine, Nashville, Tennessee. Directoi.
Division of Trauma, Vanderbilt University Hospital,
Nashville.
The Acute Abdomen
RONALD LEE NICHOLS, M.D.
Henderson Professor and Vice-Chairman, Depart-
ment of. Sutgery; Professor of Microbiology and
Immunology, Tulane University School of MJdicine,
New Orleans, Louisiana. Attending Surgeon, Tulane
Medical Center Hospital and Charity Hospital of
Louisiana at New Orleans.
Surgical Infections and Choice of Antibiotics
P. MICHAEL OLMSTEAD, M.D.
Assistant Professor, The Pennsylvania State Univer-
sity School of Medicine, Hershey, pennsylvania. As-
sistant Professor, Hershey Medical Center.
Surgical Disorders of the Skin
CRAIG O. OLSEN, M.D.
Instructor, Harvard Medical School, Boston, Mas-
sachusetts. Attending Physician, Department of Sur_
gery, New England Deaconess Hospital, Boston.
Cardiopulmonary Bypass for Cardiac Surgery
W. CHRISTOPHER PEDERSON, M.D.
Assistant Professor of Surgery, Division of Plastic
and Reconstructive Surgery, Duke University Medi-
cal Center, Durham, North Carolina.
Burns
ALICE R. PEREZ, M.D.
tellow, Gastrointestinal Research, Department of
.iurgery, Temple University School of Medicine, Phil-
adelphia, Pennsylvania.
Stomach and Duodenum: Surgical Anatomy,
Physiology, and Pathology
MORTON H. PERLMAN, M.D.
Professor and Director, Division of Surgical Educa-
tion, Department of Surgery,. Hahnemann Univer-
sity. Philadelphia. Pennsylvania.
The Spleen
ROBERT B. PEYTON, M.D.
Assistant Professor of Surgery, New York Hospital,
Cornell Medical Center, New York City, New York.
Ventricular Aneurysm
KENNETH P. RAMMING, M.D.
Professor of Surgery, Division of Oncology and Car-
diothoracic Surgery. University of California School
of Medicine, Los Angeles.
Diseases of the Colon and Rectum
J. SCOTT RANKIN, M.D.
Associate Professor, Department of Surgery, Duke
University Medical Center. Durham, North Carolina.
Cardiopulmonary Resuscitation; The Coronary
Circulation: Physiologic Determinants of Coronarl,
Blood Flow, Cardiac Metabolism, and
Intraoperatit,e Myocardial Protection
DOUGLAS S. REINTGEN, M.D.
Chief Resident in Surgery, Duke University Medical
Center, Durham, North Carolina.
The Liy,er
WALLACE R. RITCHIE, Jr., M.D.,
Ph.D.
Professor and Chairman, Department of Surgery,
Temple University School of Medicine. lhilaOetphii,
Pennsylvania. Chairman, Department of Surgery,
Temple University Medical Center, philadelphia.
Stomach and Duodenttm: Surgical Anatomy,
Physiology. and Parhology
BENJAMIN F. RUSH, Jr., M.D.
Professor and Chairman, Department of Surgery,
University of Medicine and Dentistry of New Jer-
sey/New Jersey Medical School, Newark. Surgeon-
in-Chief, Universitv Hospital, Newark.
Principles of Operative Surgery: Antisepsis, Asepsis,
Technique, Sutures, and Drains
DAVID C. SABISTON, Jr., M.D.
James B. Duke Professor and Chairman, Department
of Surgery. Duke University School of Medicine.
Durham, North Carolina.
Milestones in Surgery; Preoperative Preparations of
the Surgical Patient; Surgical Management of
Morbid Obesity; The Liver; Hernias; Pulmonary
Embolism; The Lungs and Chest Wall: Physiologic
Aspects of Respiratory Function and Management of
Respiratory Insufficiency in Surgical Patienrs:
Bronchoscopy; Lung Abscess and Fungal Infections;
Disorders of the Pleura and Empyema;
Bronchiectasis; Cartinoma of the Lung; Thoracic
Outlet Syndrome; Disorders of the Chest Wall; The
Mediastinum: Primary Mediastinal Cysts and
Neoplasms; The Heart: Patent Ductus Arteriosus,
Coarctation of the Aorta, Aortopulmonary Window,
and Anomalies of the Aortic Arch; Atrial Septal
Defect, Ostium Primum Defect, and Atrioventricular
Canal; Disorders of Pulmonary Venous Return:
Total Anomalous Pulmonary Venous Connection;
Ventricular Septal Defects; The Tetralogy of Fallot;
Double Outlet Right Ventricle; Tricuspid Atresia;
Truncus Arteriosus; Transposition of the Great
Arteries; Congenital Aortic Stenosis; The Coronary
C irculatio n : Phy siolo gical Determinants of Coronary
Blood Flow, Cardiac Metabolism, and
Intraoperative Myocardial Protection; Ventricular
Aneurysm; Cardiac Transplantation: The Total
Artifcial Heart; Congenital Lesions of the Coronary
Arteries; Acquired Diseases of the Aortic Valve;
Acquired Mitral and Tricuspid Disease; Ebstein's
Anomaly; Cardiac Neoplasms; Management of the
Surgical Patient wilh Cardiac Disease;
Cardiopulmonary Bypass for Cardiac Surgery
MICHAEL G. SARR, M.D.
Assistant Professor'of Surgery, Mayo Medical
School, Rochester, Minnesota.
The Biliarv System
JOHN L. SAWYERS, M.D,
John Clinton Foshee Distinguished professor and
Chairman of Surgery, Vandeibilt University; Nash-
ville, Tennessee. Surgeon-in-Chief, Vanderbilt Uni_
versity Hospiral. Nashville.
The Acute Abdomen
WORTHINGTON G. SCHENK III,
M.D.
Assistant Professor of Surgery, University of Vir-
ginir. Charlorresville. Auending phyiician. Univcr-
sity o[ Virginia Hospitals. Charlottesville. Consulting
Phvsician. Veterans Administration Hospital, Saleml
Virginia.
Surgicul Disorders ol the Veins
BRUCE D. SCHIRMER. M.D.
Assistant Professor of Surgery, Univcrsity ol Vir_
ginia, Charlottesville. Assistanr profcssor,,i Srrg"ry.
University of Virginia Hospitals. Cjharlottcsville.
Preoperative Preparution ctf the Surgical I'atitnt
Penulis Naskah XI
 JAMES A. SCHULAK, M.D.
Agsociate Professor of Surgery, Case Western Re-
serve University, School of Medicine, Cleveland,
Ohio. Director of Transplantation, University Hos-
pitals of Cleveland.
S urgical Complications
WILLIAM SCHUMER, M.D.
Professor and Chairman, Department of Surgery,
and Professor, Department of Biochemistry, Univer-
sity of Health Sciences/The Chicago Medical School,
North Chicago, Illinois. Attending Physician, Sur-
gical Service, Veterans Administration North Chi-
cago Medical Center. Chief, University Surgical Serv-
ice, Saint Mary of Nazareth Hospital Center,
Chicago. Visiting Faculty, Naval Hospital, Great
Lakes, Illinois.
Homeostasis and Shock
JAMES H. F. SHAW, M.8., Ch.B.
Senior Lecturer in Surgery, Auckland University,
New Zealand. Consultant, Surgeon, Auckland Hos-
pital.
Nutrition and Metabolism in Surgical Patients
JAMES D. SINK, M.D.
Assistant Professor of Surgery, Emory University
School of Medicine, Atlanta, Georgia. Staff, The
Henfietta Egleston Hospital for Chiidren, Emory
University Hospital, Crawford W. Long Hospital,
Atlanta.
Tricuspid Atresia; Truncus Arteriosus; Transposition
of the Great Arteries
PETER K. SMITH, M.D.
Assistant Professor of Surgery, Duke University
Medical Center, Durham, North Carolina.
Physiologic Aspects of Respiratory Function and
Management of Respiratory Insufficiency in Surgical
Patients
JAMES L. TALBERT, M.D.
Professor and Chief of Children's Surgery, University
of Florida College of Medicine, Gainesville. Chief of
Pediatric Surgery, Shands Hospital at the University
of Florida, Gainesville, and University Hospital of
Jacksonville, Florida.
Pediatric Surgery
YIl Penulis Naskah
NORMAN W. THOMPSON, M.D.
of Surgery, University of Michigan, Ann
Professor
Arbor. Chief, Division of Endocrine Surgery, Uni-
versity of Michigan Hospitals, Ann Arbor.
The Parathyroid Glands
JEREMIAH G. TURCOTTE, M.D.
F.A. Coller Professor of Surgery, University of Mich-
igan, Ann Arbor. Chairman of the Department of
Surgery, University of Michigan Medical Center,
Ann Arbor.
Transplantation
ROSS M. UNGERLEIDER, M.D.
of Surgery, Duke University,
Assistant Professor
Durham, North Carolina. Chief, Pediatric Cardiac
Surgery, Duke University Medical Center, Durham.
Bronchoscopy; Double Outlet Right Ventricle;
Congenital Aortic Stenosis
JAMES R. URBANIAK, M.D.
Professor of Orthopaedic Surgery and Chief, Division
of Orthopaedic Surgery, Duke University Medical
Center, Durham, North Carolina.
The Musculoskeletal System; The Hand and Wrist;
Fractures of the Spinal Column
PETER VAN TRIGT, M.D.
Assistant Professor of Surgery, Duke University
Medical Center, Durham, North Carolina.
Acquired Mitral and Tricuspid Valvular Disease
KENT J. WEINHOLD, Ph.D.
Assistant Medical Research Professor, .Department
of Surgery, Duke University Medical Center, Dur-
ham, North Carolina.
Surgical Aspects of Viral Hepatitis and the Acquired
Immune Deficiency Syndrome (AIDS)
J. MARK WILLIAMS, M.D.
Assistant Professor of Surgery, East Carolina Uni-
versity School of Medicine, Greenville, North Caro-
lina. Staff, Pitt County Memorial Hospital, Green-
ville.
Acquired Diseases of the Aortic Valve
 Kata Pengantsr
Edisi Bahas& Indonesia
Buku yang anda pegang ini mempakan suatu perkembangan dari buku ajar bedah yang berjudul Textbook of
Surgery: The Biological Basis for Modern Surgical Practice dengan editor Davis Christopher, dengan penerbit
yang sama yaitu W.B. Saunders. Buku yang berjudul sebelumnya ini sudah tidak diterbitkan lagi.
Buku ajar bedah utama ini merupakan buku penting dan berguna bagi mahasiswa kedokteran di Indonesia. Isi
buku ini mencakup dasar-.dasar ilmu bedah yang amat mendukung kegiatan praktis sehari-hari dokter di tempat
praktik atau di rumah sakit. Bahkan jika pan mahasiswa kedokteran akan bertugas di Puskesmas, maka buku ini
merupakan buku yang dapat diandalkan.
Sementara proses pengerjaan bagian kedua buku ajar ini masih berlangsung, kami mengharapkan para mahasis-
wa sudah dapat mengambil manfaat dari Bagian I ini.
Banyak perkembangan mutakhir diikutsertakan dalam pembahasan dasar-dasar ilmu bedah pada Bagian I ini,
seperti tnnsplantasi organ vital, penularan AIDS/hepatitis virus, perkembangan imunobiologi, dan lainlain.
Kareru tak ada gading yang tak retak, maka kami sangat bersimpati terhadap koreksi, kritik serta saran anda
para peminat buku ini. Semoga anda puas membaca dan memahami isi buku ini.

Penerbit.
 ,.-!J

Daftar Isi

1. KejadianPentingdalamllmu Bedah. ..........1

2. HomeostasisdanSyok .....r ........12
J. PenatalaksanaanCairandanElektrolit...... .........36
4. PersiapanPraoperasi PasienBedah. ..:. .. ....7j
5. Hernostasis: Patofisiologi dan Penatalaksanaan Kelainan Klinik . . . . . .9g
6. Gizi dan Metabolisme pada Pasien Bedah .

1 Anestesi ....,. .134

8. PenyembuhandanPenatalaksanaanluka.. ...145
9. Luka Bakar . .. ..151
10. Prinsip-prinsip Operasi Antisepsis, Tehnik,Jahitan,danDrainase ...... ....164
11. Infeksi BedahdanPemilihanAntibiotika ......176
t2. SegiBedahHepatitisVrusdanSindromaDefisiensiImunAkuisita(AIDS)
13. Penatalaksanaan Orang yang Cedera Akut . .. .226
14. Komplikasi Bedah. .. . . .253
15. Transplantasi..;... ....Zgz
16. Prinsip Onkologi Bedah. .. ....33g
77. Payudara ... .. ..365
18. Glandula Thyroidea ........415
19. GlandulaParathyroidea ..,,...43I
20. Hypophysis danAdrenalis..... ......444
21. Esophagus
22. Abdomen Akuta .
490
23. LambungdanDuodenum.... ........513
L Anatomi Bedah Fisiologi dan Patologi. . . . .513
II. Penatalaksanaan Bedah Obesitas Morbid.
24.KelainanBedahUsusHalus. ....i. ...543
Indeks. ......545

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