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第七例手术表明:面容移植取得进展

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Five years ago, it was the stuff of science fiction:<}0{>用死者面容代替某个人的面容,这在五年前是科幻小说中的情节。<0} {0>But on Thursday, Boston doctorsperformed the world's seventh such transplant — less than a week after one inFrance — and plans are in the works for more.<}0{>但是,星期二,在法国进行此类手术不到一星期之后,波士顿的医生们实施了世界上第七例面容移植手术,并正在筹划实施更多的手术。


<0}

{0>"Society is allowing us to do this.<}0{>“社会允许我们进行这样的手术。<0} {0>I think you're going to see more and more,"especially in soldiers disfigured in recent wars, said Dr. Frank Papay, asurgeon who helped perform the nation's first face transplant, in December atthe Cleveland Clinic.<}0{>我认为你会见到更多”,特别是在近年来战争中被毁容的士兵中间。十二月在克利夫兰诊所(Cleveland Clinic)帮助实施美国第一例面容移植手术的外科医生,FrankPapay博士这样说。


<0}

{0>Some of the successes have been dazzling.<}0{>某些成就令人注目。<0} {0>People who couldn't eat, speak normally, or go outin public now can walk the streets without being recognized as someone who gota new face.<}0{>原来不能正常吃饭、讲话或在公众场合露面的人,如今能够行走在大街上而不被认出进行过易容手术。


<0}

{0>Even so, face transplants are likely to remain uncommon, used ononly the most severely disfigured, because of the big risks and lifelong needto take medicines to prevent rejection.<}0{>尽管如此,面容移植由于其巨大的风险和需要终生服药以防排异而可能极为罕见,这种手术仅用于严重毁容者。


<0}

{0>"It's not going to be like somepeople imagine — routine, like people getting a facelift, or cosmeticsurgery," said Stuart Finder, director of the Center for Healthcare Ethicsat Cedars-Sinai Medical Center in Los Angeles.<}0{>位于洛杉矶的希达西奈(Cedars-Sinai)医学中心下属的健康照护伦理中心,其主任Stuart Finder说:“这项手术不会象人们想象的那样只是进行一般的整容或美容手术。”


<0}

{0>"We have what appears to be success," he noted, butthere is always the chance that some patients may experience serious rejectionproblems or refuse to stay on the required lifetime of drugs.<}0{>他说明道:“我们貌似取得了成功,”但总有这样的可能性:某些患者可能经历严重的排异作用,或拒绝终生服药。


<0}

{0>Boston doctors stressed the care and psychological screening theyrequired before performing the nation's second face transplant on Thursday.<}0{>波士顿医生们强调了,在星期二进行的美国第二例面容移植手术前,对患者所做必要的护理和心理甄选。<0} {0>The operation, at Harvard-affiliated Brigham andWomen's Hospital, was on a man who suffered traumatic facial injuries from afreak accident.<}0{>这例手术是在哈佛附属布莱汉姆(Brigham)女子医院进行的。患者是一位在意外事故中面部遭受创伤性伤害的男子。


<0}

{0>Face transplants go far beyond the transfer of skin and facialfeatures, using things like bone and cartilage for reconstruction.<}0{>面容移植远远不只是皮肤和面部特征的转移,还要使用象骨骼及软骨之类的材料进行面部重建。<0} {0>The team led by plastic surgeon Dr. Bohdan Pomahacreplaced the man's nose, palate, upper lip, and some skin, muscles and nerveswith those of a dead donor.<}0{>由整形外科医生Bohdan Pomahac博士领导的小组,用一位已死亡的捐献者的面部器官代替了这位男子的鼻子、上腭、上唇以及某些皮肤、肌肉和神经。


<0}

{0>The hospital would not identify the recipient or donor, but thedonor's family members released a statement saying they hope the procedureconvinces others to donate.<}0{>医院不愿对接受者和捐赠者身份做具体说明,但捐赠者家属发表了一份声明说,他们希望该手术能说服其他人进行捐赠。


<0}

{0>"The fact that we are able to give this gift was atremendous comfort in our time of grief," the statement said.<}0{>声明说:“在我们悲痛之时,献出这份礼物,对我们是莫大的安慰。”


<0}

{0>At a news conference on Friday, Pomahac said:<}0{>在星期五的新闻发布会上,Pomahac说:“<0}{0>"There is no risk of recognizing the donor onthe new patient.<}0{>没有将患者当成捐赠者的可能。<0} {0>There's a 60 percent chance the patient will lookhow he used to look."<}0{>患者相貌如前的可能性为60%。”


<0}

{0>In a phone interview earlier Friday, Pomahac (pronounced POE-ma-hawk)said the man's injury occurred some years ago, and it left him with "noteeth, no palate, no nose, no lip."<}0{>星期五早上的电话采访中, Pomahac(音POE-ma-hawk)说,该男子是数年前受的伤,伤后他没有牙齿,没有上腭,没有鼻子,没有嘴唇。”#p#分页标题#e#


<0}

{0>"It was difficult for him to speak, to eat, to drink.<}0{>“他难以说话,难以吃饭,难以饮水。”<0} {0>It certainly caused a lot of social problems,"Pomahac said.<}0{>Pomahac说:“这的确引起了一系列的社会问题。”


<0}

{0>The man had been Pomahac's patient for a long time, and doctorsdecided to pursue a face transplant because previous attempts to treat him lefthim still badly deformed.<}0{>该男子长期以来一直是Pomaha的病人,由于以前的治疗仍使其丑陋不堪,所以医生们决定实施面部移植手术。<0} {0>It took three months to find a suitable donor, whoalso provided some organs for transplant in other patients, Pomahac said.<}0{>Pomahac 说,寻找合适的捐赠者用了三个月时间,捐赠者还为其他患者的移植手术提供了器官。


<0}

{0>The 17-hour operation began at 1:15 a.m.Thursday, with therecipient and the donor in operating rooms across the hall from each other.<}0{>这项17个小时的手术开始于星期二1:15 a.m.,接受者和捐赠者分别处在中间隔着大厅的两个手术室内。<0} {0>The patient was still recovering from anesthesia onFriday.<}0{>星期五,患者仍在从麻醉中苏醒。


<0}

{0>"He's still not fully awake so he has not seen himself.<}0{>“他还没有完全苏醒,所以看不到自己。<0} {0>We have not really had a meaningful conversation sofar," Pomahac said.<}0{>到目前为止,我们真的没有与他进行过有意义的谈话。”Pomahac说。


<0}

{0>"He was incredibly motivated to go forward with it,"and was extensively evaluated psychologically by doctors in and outside ofBrigham, Pomahac said.<}0{>Pomahac说,“他令人难以置信地积极面对手术”,布莱汉姆医院及院外的医生对其进行了广泛的评估。<0} {0>"We really made sure that nothing was left to chance."<}0{>“我们确保没有其他选择。”


<0}

{0>The seven primary surgeons and other assistants all donated theirtime and services, Pomahac said.<}0{>Pomahac说,七名主要医生和其他助手全都无偿地拿出了时间,义务工作。


<0}

{0>"We are essentially making a lifelong commitment to helphim," the surgeon said.<}0{>该医生说:“我们实质上承诺帮他一生。”


<0}

{0>Pomahac was born in Ostrava in the Czech Republic, and graduatedfrom Palacky University School of Medicine in Olomouc, Czech Republic.<}0{>Pomahac出生于捷克共和国,毕业于捷克共和国奥洛莫茨(Olomouc)市帕拉茨基大学(Palacky University)医学院。<0} {0>He came to Brigham for a surgical researchinternship in 1996 and now, at 38, is associate director of its burn center,where he treats trauma and plastic surgery cases.<}0{>1996年,他以外科研究实习生的身份来布莱汉姆医院,今年38岁,是烧伤中心副主任,从事创伤及整形外科病例的治疗。<0}

{0>The Boston hospital's board approved Pomahac's plans to offerface transplants a year ago.<}0{>波士顿医院董事会一年前就批准了Pomahac提供的面部移植的方案。


<0}

{0>The world's first transplant in 2005 was led by Dr. Jean-MichelDubernard in Amiens, France, who treated Isabelle Dinoire, a woman who had beenmauled by a dog and grotesquely disfigured.<}0{>2005年世界首例手术是由Jean-Michel Dubernard医生主刀的,在法国亚眠市进行。治疗的是一位名叫IsabelleDinoire的妇女,她遭受一只狗的袭击并被毁容。<0} {0>Dinoire's appearance today isvirtually normal.<}0{>如今,Dinoire的外貌基本正常。


<0}

{0>The first U.S. face transplant, and the most extensive operationso far, was done in December by doctors at Cleveland Clinic.<}0{>目前美国首例也是面容移植最广泛的手术是十二月份由克利夫兰诊所(Cleveland Clinic)的医生们实施的。<0} {0>They replaced 80 percent of awoman's face with that of a female cadaver.<}0{>他们用死尸的面容代替了一位妇女面容的80%。<0} {0>The woman's identity has not beenrevealed, nor the circumstances that led to the transplant.<}0{>该妇女的身份及移植的详细情况没有披露。


<0}

{0>The woman left the hospital in February, and is doing"phenomenally well," Papay said.<}0{>Papay说,该妇女于二月份出院,如今看起来良好。<0} {0>"Her speech is improved so everyone canunderstand her now, and she has a great outlook on life.<}0{>“她讲话有了改善,现在,每个人都能理解她说的话。她生活前景良好。<0} {0>She's very comfortable with the way she looks nowand she's very happy."<}0{>如今,她对自己的外貌感到欣慰,她很快乐。”


<0}

{0>The early successes are encouraging, but should not lead toover-exuberance, and extending the operation too fast, said Finder, the LosAngeles ethicist.<}0{>洛杉矶伦理学家 Finder说,被步成功令人鼓舞,但不应当引起实施过多,也不宜推广过快。


<0}

{0>"This is still very new and hence requires a hyper-vigilanceabout helping patients understand what they're getting into," he said.#p#分页标题#e#<}0{>他说,这仍然是一项新手术,因此在帮助患者理解他们将来的境况时,需要高度的警惕。”


<0}

{0>People who have received other transplants — organs, hands — havesometimes discovered they traded one set of problems for another, and get sickof taking the medicines needed to maintain the transplant.<}0{>接受其它器官移植(器官、手)的人,有时发现,解决了彼问题却出现了此问题,并厌倦服用维持移植所必须的药物。<0} {0>At least one hand transplant recipient later had thehand amputated for this reason.<}0{>由于这一原因,至少有一名接受移植者后来又让医生将移植的手切除。


<0}

{0>Pomahac originally was considering only people who had alreadyreceived a kidney or other organ transplant, because they already would be onimmune-suppressing medicines and would therefore have a low risk of rejecting anew face.<}0{>Pomahac最初仅考虑已接受过肾脏或其它器官移植的人,因为他们正在服用免疫抑制药物,因而对新面容排异的风险较低。


<0}

{0>"I still think that's the best group of patients but we haveenlarged the protocol" to include others with severe facial deformities,he said.<}0{>他说,“我仍认为那是最佳的患者群,但我们将协议扩大了”,将其他面部畸形的人也包括进来。


<0}

{0>"It's really in its infancy in terms of knowing what willhappen," he added.<}0{>他补充说:“在了解将来会发生什么事情方面,的确处于初期。”<0} {0>"Each of the cases is its own uniquestory."<}0{>“每一个病例都有自己独特的情况。”


<0}

{0>Eventually, surgeons hope to form waiting lists of face transplantcandidates "just like for any other organ," Pomahac said.<}0{>Pomahac说,外科医生们最终希望列出面容移植候选者名单,“就象其它任何器官移植一样”。<0}


译文:7th surgery shows face transplants gaining ground

Five years ago, it was the stuff of science fiction: Replacesomeone's face with one from a dead donor. But on Thursday, Bostondoctors performed the world's seventh such transplant — less than aweek after one in France — and plans are in the works for more.

"Societyis allowing us to do this. I think you're going to see more and more,"especially in soldiers disfigured in recent wars, said Dr. Frank Papay,a surgeon who helped perform the nation's first face transplant, in December at the Cleveland Clinic.

Someof the successes have been dazzling. People who couldn't eat, speaknormally, or go out in public now can walk the streets without beingrecognized as someone who got a new face.

Even so, face transplantsare likely to remain uncommon, used on only the most severelydisfigured, because of the big risks and lifelong need to takemedicines to prevent rejection.

"It's not goingto be like some people imagine — routine, like people getting afacelift, or cosmetic surgery," said Stuart Finder, director of theCenter for Healthcare Ethics at Cedars-Sinai Medical Center in Los Angeles.

"Wehave what appears to be success," he noted, but there is always thechance that some patients may experience serious rejection problems orrefuse to stay on the required lifetime of drugs.

Bostondoctors stressed the care and psychological screening they requiredbefore performing the nation's second face transplant on Thursday. Theoperation, at Harvard-affiliated Brigham and Women's Hospital, was on a man who suffered traumatic facial injuries from a freak accident.

Facetransplants go far beyond the transfer of skin and facial features,using things like bone and cartilage for reconstruction. The team ledby plastic surgeon Dr. Bohdan Pomahac replaced the man's nose, palate,upper lip, and some skin, muscles and nerves with those of a dead donor.

Thehospital would not identify the recipient or donor, but the donor'sfamily members released a statement saying they hope the procedureconvinces others to donate.

"The fact that we are able to give this gift was a tremendous comfort in our time of grief," the statement said.

Ata news conference on Friday, Pomahac said: "There is no risk ofrecognizing the donor on the new patient. There's a 60 percent chancethe patient will look how he used to look."

Ina phone interview earlier Friday, Pomahac (pronounced POE-ma-hawk) saidthe man's injury occurred some years ago, and it left him with "noteeth, no palate, no nose, no lip."

"It was difficult for him to speak, to eat, to drink. It certainly caused a lot of social problems," Pomahac said.

Theman had been Pomahac's patient for a long time, and doctors decided topursue a face transplant because previous attempts to treat him lefthim still badly deformed. It took three months to find a suitabledonor, who also provided some organs for transplant in other patients,Pomahac said.

The 17-hour operation began at1:15 a.m. Thursday, with the recipient and the donor in operating roomsacross the hall from each other. The patient was still recovering fromanesthesia on Friday.

"He's still not fully awake so he has not seen himself. We have not really had a meaningful conversation so far," Pomahac said.

"Hewas incredibly motivated to go forward with it," and was extensivelyevaluated psychologically by doctors in and outside of Brigham, Pomahacsaid. "We really made sure that nothing was left to chance."

The seven primary surgeons and other assistants all donated their time and services, Pomahac said.

"We are essentially making a lifelong commitment to help him," the surgeon said.

Pomahac was born in Ostrava in the Czech Republic, and graduated from Palacky University School of Medicinein Olomouc, Czech Republic. He came to Brigham for a surgical researchinternship in 1996 and now, at 38, is associate director of its burncenter, where he treats trauma and plastic surgery cases.

The Boston hospital's board approved Pomahac's plans to offer face transplants a year ago.

The world's first transplant in 2005 was led by Dr. Jean-Michel Dubernard in Amiens, France, who treated Isabelle Dinoire, a woman who had been mauled by a dog and grotesquely disfigured. Dinoire's appearance today is virtually normal.

The first U.S. face transplant, and the most extensive operation so far, was done in December by doctors at Cleveland Clinic.They replaced 80 percent of a woman's face with that of a femalecadaver. The woman's identity has not been revealed, nor thecircumstances that led to the transplant.

The woman left the hospital in February, and is doing"phenomenally well," Papay said. "Her speech is improved so everyonecan understand her now, and she has a great outlook on life. She's verycomfortable with the way she looks now and she's very happy."

The early successes are encouraging, but should not lead toover-exuberance, and extending the operation too fast, said Finder, theLos Angeles ethicist.

"This is still very new and hence requires a hyper-vigilanceabout helping patients understand what they're getting into," he said.

People who have received other transplants — organs, hands —have sometimes discovered they traded one set of problems for another,and get sick of taking the medicines needed to maintain the transplant.At least one hand transplant recipient later had the hand amputated for this reason.

Pomahac originally was considering only people who had already received a kidney or other organ transplant, because they already would be on immune-suppressing medicines and would therefore have a low risk of rejecting a new face.

"I still think that's the best group of patients but we have enlargedthe protocol" to include others with severe facial deformities, hesaid.

"It's really in its infancy in terms of knowing what will happen," he added. "Each of the cases is its own unique story."

Eventually, surgeons hope to form waiting lists of face transplant candidates "just like for any other organ," Pomahac said.

___

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