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NikolaiBegg_2013X-_让手术关键时刻更安全的工具_
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| The first time I stood in the operating room and watched a real surgery , |
出自雅各贝乌斯医师: 观摩实际手术时, |
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surgery:n.外科;外科手术;手术室;诊疗室;
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| I had no idea what to expect. |
没预料会看到什么。 |
| I was a college student in engineering . |
我当时是工科大学生。 |
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engineering:n.工程;工程学;v.密谋策划;设计制造;改变…的基因;(engineer的现在分词)
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| I thought it was going to be like on TV. |
我以为会像电视上演的一样, |
| Ominous music playing in the background, beads of sweat pouring down the surgeon 's face. |
播着紧张的背景音乐, 豆大的汗珠由外科医生脸上滑落。 |
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Ominous:adj.预兆的;不吉利的; beads:n.(有孔的)珠子;(玫瑰)念珠;(液体的)小滴;(bead的复数) pouring:v.倾倒;倾泻;连续流出;倒出;喷发;(pour的现在分词) surgeon:n.外科医生;
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| But it wasn't like that at all. |
但根本不是那样。 |
| There was music playing on this day, |
当天的确有播音乐, |
| I think it was Madonna's greatest hits. (Laughter) |
我想是玛丹娜的金曲选辑。（笑声） |
| And there was plenty of conversation, not just about the patient 's heart rate, but about sports and weekend plans. |
当时还有许多交谈, 话题除了病人心率外, 还有运动跟周末计划。 |
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patient:adj.有耐心的,能容忍的;n.病人;患者;
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| And since then, the more surgeries I watched, the more I realized this is how it is. |
我手术看得越多, 就越懂那是怎么回事。 |
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surgeries:n.外科手术(surgery复数);
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| In some weird way, it's just another day at the office. |
从某个古怪角度来看,这跟在办公室没两样。 |
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weird:adj.奇怪的;奇异的;离奇的;n.命运;宿命;命运女神;
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| But every so often the music gets turned down, everyone stops talking, and stares at exactly the same thing. |
但有时, 音乐声会被转小, 所有人停止说话, 眼睛盯着同样的东西。 |
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every so often:adv.偶尔;常常;时常; stares:vi.凝视,盯着看;显眼;vt.凝视,盯着看;n.凝视;注视;
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| And that's when you know that something absolutely critical and dangerous is happening. |
那时你就知道,有很重要、 很危险的事情正在进行。 |
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absolutely:adv.绝对地;完全地; critical:adj.鉴定的;[核]临界的;批评的,爱挑剔的;危险的;决定性的;评论的;
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| The first time I saw that |
首次遇到那状况时, |
| I was watching a type of surgery called laparoscopic surgery |
我正在观摩腹腔镜手术。 |
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laparoscopic:adj.腹腔镜检查的;
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| And for those of you who are unfamiliar , laparoscopic surgery, instead of the large open incision you might be used to with surgery, a laparoscopic surgery is where the surgeon creates these three or more small incisions in the patient. |
为不熟悉的人说明一下, 腹腔镜手术不像 传统大切口的手术, 腹腔镜手术中,外科医生 在病人身上开三个以上的切口。 |
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unfamiliar:adj.不熟悉的;不常见的;没有经验的; incisions:n.切口;雕刻,切割;切开;
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| And then inserts these long, thin instruments and a camera, and actually does the procedure inside the patient. |
接着插入这些细长、 并透过它在病患体内进行手术。 |
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instruments:n.器械;仪器;器具;手段(instrument的复数) procedure:n.步骤;手术;(商业、法律或政治上的)程序;
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| This is great because there's much less risk of infection , much less pain, shorter recovery time. |
这很不错,因为感染风险低、 较少疼痛,恢复时间也更短。 |
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infection:n.感染;传染;(身体某部位的)感染;传染病; recovery:n.恢复,复原;痊愈;重获;
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| But there is a trade-off , because these incisions are created with a long, pointed device called a trocar . |
但这其中有着取舍, 因为开这些切口 用的是个尖长的器械, 叫做穿刺套针。 |
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trade-off:n.交换,交易;权衡;协定; device:n.装置;策略;图案; trocar:n.套管针;
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| And the way the surgeon uses this device is that he takes it and he presses it into the abdomen until it punctures through. |
而外科医生用这器械的方法 是他抓着这东西, 然后压在你的腹部, 直到它穿进去。 |
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abdomen:n.腹部;下腹;腹腔; punctures:n.小孔;刺痕;穿刺术(puncture的复数);v.穿刺(puncture的三单形式);减低;
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| And now the reason why everyone in the operating room was staring at that device on that day was because he had to be absolutely careful not to plunge it through and puncture it into the organs and blood vessels below. |
这就是为何在手术室的所有人 在当时都盯着那东西看, 因为他必须非常小心 不要穿太过, 以免刺穿下面的脏器和血管。 |
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staring:adj.凝视的,目不转睛的;显眼的;v.凝视;盯着看;显眼;(stare的现在分词) plunge:v.暴跌;使突然前冲(或下落);骤降;突降;n.跳水;突然跌落;突然分离;骤减; organs:n.[生物]器官;机构;风琴(organ的复数); vessels:n.血管(vessel的复数);船舶;容器;
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| But this problem should seem pretty familiar to all of you because I'm pretty sure you've seen it somewhere else. |
但这问题大家都很熟, 因为你们八成在其他地方看过了。 |
| (Laughter) |
（笑声） |
| Remember this? |
记得这个吧？ |
| (Applause) |
（掌声） |
| You knew that at any second that straw was going to plunge through, and you didn't know if it was going to go out the other side and straight into your hand, or if you were going to get juice everywhere, but you were terrified. Right? |
你很清楚在某个时间点, 吸管会刺穿, 而你不知是否会穿透, 戳到你的手, 或把果汁噴得到处是。 你怕死了。对吧？ |
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straw:n.稻草; adj.稻草的;
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| Every single time you did this, you experienced the same fundamental physics that I was watching in the operating room that day. |
每次你做这件事, 所体验到的物理原理, 都和我那天在手术室经历的一样。 |
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fundamental:n.基础; adj.十分重大的;
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| And it turns out it really is a problem. |
这显然是个大问题。 |
| In 2003, the FDA actually came out and said that trocar incisions might be the most dangerous step in minimally invasive surgery. |
2003 年,FDA 甚至出面表示: 套针穿刺或许是在微创手术中 最危险的步骤。 |
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minimally:adv.最低限度地;最低程度地; invasive:adj.侵略性的;攻击性的;
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| Again in 2009, we see a paper that says that trocars account for over half of all major complications in laparoscopic surgery. |
2009 年,我们又看到一篇论文说: 腹腔镜手术的主要併发症 有半数以上和穿刺套针有关。 |
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account for:对…负有责任;对…做出解释;说明…的原因;导致;(比例)占;
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| And, oh by the way , this hasn't changed for 25 years. |
噢！除此之外, 这件事已经 25 年没变了。 |
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by the way:顺便说一下;
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| So when I got to graduate school , this is what I wanted to work on. |
所以我上研究所时, 就想做这东西。 |
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graduate school:研究所,研究院;
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| I was trying to explain to a friend of mine what exactly I was spending my time doing, and I said, |
我试着跟朋友解释 我到底在忙什么, 我说: |
| It's like when you're drilling through a wall to hang something in your apartment. |
「这就像你为了挂东西 钻墙壁那样。 |
| There's that moment when the drill first punctures through the wall and there's this plunge. Right? |
钻子在钻穿墙壁那个瞬间 会爆冲一下。对吧？」 |
| And he looked at me and he said, |
然后他看着我说: |
| You mean like when they drill into people's brains? |
「你是说,像他们钻人脑袋那样？」 |
| And I said, Excuse me? (Laughter) |
然后我说:「啥？！」（笑声） |
| And then I looked it up and they do drill into people's brains. |
我后来查了一下,发现他们真会这么做。 |
| A lot of neurosurgical procedures actually start with a drill incision through the skull . |
很多的神经外科手术 第一步就是在你颅骨上钻个洞。 |
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neurosurgical:神经外科的; procedures:n.程序;规程(procedure的复数); skull:n.头盖骨,脑壳;
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| And if the surgeon isn't careful, he can plunge directly into the brain. |
如果外科医生不谨慎, 他有可能会直接戳到脑部。 |
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directly:adv.直接地;立即;马上;正好地;坦率地;conj.一…就;
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| So this is the moment when I started thinking, okay, cranial drilling, laparoscopic surgery, why not other areas of medicine? |
从那时候我开始思考, 好,颅骨钻孔、腹腔镜手术, 那其他医学领域呢？ |
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cranial:adj.头盖的;
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| Because think about it, when was the last time you went to the doctor and you didn't get stuck with something? Right? |
你想想,哪次你去看医生 没被塞点什么,是吧？ |
| So the truth is in medicine puncture is everywhere. |
事实就是, 在医学上,穿刺无所不在。 |
| And here are just a couple of the procedures that I've found that involve some tissue puncture step. |
而这只是我查到的几种手术, 其中有组织穿刺的步骤。 |
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involve:v.包含;需要;牵涉;牵连;影响;(使)参加; tissue:n.纸巾,手巾纸;(人、动植物细胞的)组织;
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| And if we take just three of them — laparoscopic surgery, epidurals , and cranial drilling — these procedures account for over 30,000 complications every year in this country alone. |
如果我们只看其中三种── 腹腔镜手术、硬膜外麻醉、颅骨钻孔── 而这些手术引发了超过三万起的併发症, 而这只是这个国家一年的数字。 |
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epidurals:adj.硬脑膜外的;硬膜上的;
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| I call that a problem worth solving. |
我认为这是个值得解决的问题。 |
| So let's take a look at some of the devices that are used in these types of procedures. |
让我们来看一些 用在这类手术的器械。 |
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take a look at:看一看;检查; devices:n.[机][计]设备;[机]装置;[电子]器件(device的复数);
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| I mentioned epidurals. This is an epidural needle . |
我提过硬膜外麻醉。这是硬膜外套针。 |
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needle:n.针;针头;指针;缝针;v.穿过;刺激;拿针缝;拿针穿;
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| It's used to puncture through the ligaments in the spine and deliver anesthesia during childbirth . |
他用来穿刺脊椎韧带, 在分娩时注射麻醉药。 |
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ligaments:n.[解剖]韧带(ligament的复数); spine:n.脊柱,脊椎;刺;书脊; anesthesia:n.麻醉;麻木(等于anaesthesia); childbirth:n.分娩;
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| Here's a set of bone marrow biopsy tools. |
这是组骨髓切片取样工具, |
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bone marrow:n.骨髓; biopsy:n.活组织检查;切片检查法;v.活组织检查;切片检查法;
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| These are actually used to burrow into the bone and collect bone marrow or sample bone lesions . |
用来做骨骼穿孔, 并收集骨髓,或做骨骼病变的取样。 |
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burrow:n.地洞,洞穴v.挖掘;穴居;潜伏; lesions:[生物]损伤;
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| Here's a bayonette from the Civil War. |
这是南北战争的刺刀。 |
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Civil:adj.公民的;民间的;文职的;有礼貌的;根据民法的;
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| (Laughter) |
（笑声） |
| If I had told you it was a medical puncture device you probably would have believed me. |
若我告诉你这是医学穿刺器材, 你说不定真会相信我。 |
| Because what's the difference? |
因为这没什么不同嘛！ |
| So, the more I did this research the more I thought there has to be a better way to do this. |
我越深入研究, 越是觉得 |
| And for me the key to this problem is that all these different puncture devices share a common set of fundamental physics. |
对我来说,问题的关键在于 所有的这些穿刺器材 都遵循同一套物理原理。 |
| So what are those physics? |
什么原理呢？ |
| Let's go back to drilling through a wall. |
让我们回到钻墙壁。 |
| So you're applying a force on a drill towards the wall. |
你透过钻子对墙施加压力, |
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applying:v.申请,请求;使用;应用;(apply的现在分词)
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| And Newton says the wall is going to apply force back, equal and opposite. |
牛顿告诉我们,墙壁会给我们反作用力, 等量且反向。 |
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Newton:n.牛顿(英国科学家);牛顿(力的单位);
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| So, as you drill through the wall, those forces balance. |
当你正在钻的时候, 两力平衡。 |
| But then there's that moment when the drill first punctures through the other side of the wall, and right at that moment the wall can't push back anymore. |
但在某个瞬间, 墙壁会被钻穿, 墙壁将无法再提供反作用力。 |
| But your brain hasn't reacted to that change in force. |
但你的大脑还来不及对变化作出反应, |
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reacted:v.起反应; (react的过去分词和过去式)
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| So for that millisecond , or however long it takes you to react, you're still pushing, and that unbalanced force causes an acceleration , and that is the plunge. |
有几毫秒时间 ──依你的反应速度而定,你还在施加压力。 而不平衡的力造成加速度, 导致爆冲。 |
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millisecond:n.毫秒; unbalanced:adj.心理不平衡; v.使不平衡; (unbalance的过去分词和过去式) acceleration:n.加速,促进;[物]加速度;
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| But what if right at the moment of puncture you could pull that tip back, actually oppose the forward acceleration? |
但如果在刺穿瞬间, 你能够将针尖 往加速的反方向缩回呢？ |
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what if:如果…怎么办? tip:n.小窍门,小费;v.给…小费;使倾斜; oppose:v.反对(计划、政策等);抵制;阻挠;(在竞赛中)与…对垒;
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| That's what I set out to do. |
那就是我要做的。 |
| So imagine you have a device and it's got some kind of sharp tip to cut through tissue. |
想像你有种器材, 它有用来刺穿组织的针尖。 |
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sharp:锋利的,尖的
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| What's the simplest way you could pull that tip back? |
把针尖缩回的最简单方法是什么？ |
| I chose a spring. |
我选择了弹簧。 |
| So when you extend that spring, you extend that tip out so it's ready to puncture tissue, the spring wants to pull the tip back. |
当弹簧拉伸,针尖便伸出, 就能穿刺组织。 弹簧会想拉回针尖。 |
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extend:vt.延伸; vi.延伸;
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| How do you keep the tip in place until the moment of puncture? |
你如何在穿透前, 固定住针尖呢？ |
| I used this mechanism . |
我采用这机械结构。 |
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mechanism:n.机制;原理,途径;进程;机械装置;技巧;
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| When the tip of the device is pressed against tissue, the mechanism expands outwards and wedges in place against the wall. |
当针尖受到组织的反作用力, 这机构会向外撑向内壁。 |
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expands:v.展开; (expand的第三人称单数) outwards:adv.向外地; wedges:n.楔形; v.楔入;
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| And the friction that's generated locks it in place and prevents the spring from retracting the tip. |
而其产生的摩擦力 会锁定针尖,阻止弹簧将它缩回。 |
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friction:n.摩擦,[力]摩擦力; generated:v.产生;引起;(generate的过去式和过去分词) retracting:n.收起;v.缩回;撤消;食言(retract的ing形式);
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| But right at the moment of puncture, the tissue can't push back on the tip anymore. |
但在穿透瞬间, 组织不再提供反作用力。 |
| So the mechanism unlocks and the spring retracts the tip. |
所以机构解锁,弹簧将针尖缩回。 |
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unlocks:开启;开锁; retracts:v.缩进; n.收缩核;
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| Let me show you that happening in slow motion . |
看一下慢动作。 |
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slow motion:adj.缓慢的;慢动作的;高速度摄影的;
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| This is about 2,000 frames a second, and I'd like you to notice the tip that's right there on the bottom, about to puncture through tissue. |
这大约每秒 2,000 画格。 注意针尖的部分, 在画面下方,即将刺穿组织。 |
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frames:n.[计][电子][通信]帧,[电影]画面;[建][计]框架;眼镜架(frame的复数);
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| And you'll see that right at the moment of puncture, right there, the mechanism unlocks and retracts that tip back. |
你会发现在刺穿的瞬间, |
| I want to show it to you again, a little closer up. |
我们拉近点再看一次。 |
| You're going to see the sharp bladed tip, and right when it punctures that rubber membrane it's going to disappear into this white blunt sheath . |
你会看到那尖锐的针尖, 在它刺穿橡胶膜的瞬间, 会缩进那个钝边白色套管。 |
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bladed:adj.有叶片的;有刀刃的(blade的形容词形式); rubber:n.橡胶;橡皮;v.涂橡胶于…; membrane:n.膜;薄膜;羊皮纸; disappear:v.消失;失踪;不复存在; blunt:adj.钝的,不锋利的;生硬的;直率的;v.使迟钝; sheath:n.鞘;护套;叶鞘;女子紧身服装;
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| Right there. |
在这。 |
| That happens within four 100ths of a second after puncture. |
这一切都在百分之四秒内发生。 |
| And because this device is designed to address the physics of puncture and not the specifics of cranial drilling or laparoscopic surgery, or another procedure, |
而且因为这项设计是遵循穿刺的物理原理 而非针对颅骨钻孔、 腹腔镜手术或其他手术, |
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specifics:n.细节;特性(specific的复数);详情;
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| it's applicable across these different medical disciplines and across different length scales . |
其适用范围涵盖医学各领域, 以及各种不同规模。 |
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applicable:adj.可适用的;可应用的;合适的; disciplines:n.[管理]纪律(discipline的复数); v.训导; scales:n.规模范围; v.攀登; (scale的第三人称单数和复数)
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| But it didn't always look like this. |
但它不见得长这样。 |
| This was my first prototype . |
这是我作品的原型。 |
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prototype:n.原型;雏形;最初形态;
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| Yes, those are popsicle sticks, and there's a rubber band at the top. |
对,那是冰棒棍, 顶部那是橡皮筋。 |
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popsicle:n.棒冰(商标名); rubber band:n.橡皮筋;胶带;
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| It took about 30 minutes to do this, but it worked. |
做这只花 30 分钟,但成品就有用了。 |
| And it proved to me that my idea worked and it justified the next couple years of work on this project. |
它证明我的想法可行, 并让我接下来几年的付出有所凭据。 |
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justified:adj.正当的; v.证明…正确; (justify的过去式和过去分词)
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| I worked on this because this problem really fascinated me. |
我投入其中, |
| It kept me up at night. |
甚至使我夜不能眠。 |
| But I think it should fascinate you too, because I said puncture is everywhere. |
但我想这也该吸引你, 因为穿刺无所不在。 |
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fascinate:vt.使着迷,使神魂颠倒;vi.入迷;
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| That means at some point it's going to be your problem too. |
意味着在某个时刻,那也将成为你的问题。 |
| That first day in the operating room |
进手术室第一天, |
| I never expected to find myself on the other end of a trocar. |
我没料到有天穿刺套针会用在我身上。 |
| But last year, I got appendicitis when I was visiting Greece. |
但去年,我在希腊时患上阑尾炎。 |
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appendicitis:n.[医]阑尾炎;盲肠炎;
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| So I was in the hospital in Athens, and the surgeon was telling me he was going to perform a laparoscopic surgery. |
我在雅典的医院, 外科医生告知我 他将进行腹腔镜手术。 |
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perform:v.表演;执行;履行;演出;工作,运转(好/不好);
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| He was going to remove my appendix through these tiny incisions, and he was talking about what I could expect for the recovery, and what was going to happen. |
他将透过那些小切口切除阑尾, 接着他告诉我预期的康复状况、 接下来会做什么。 |
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appendix:n.附录;阑尾;附加物;
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| He said, Do you have any questions? And I said, Just one, doc. |
他说:「你有什么问题吗？」我说:「只有一个。 |
| What kind of trocar do you use? |
你们用的是哪种穿刺套针？」 |
| So my favorite quote about laparoscopic surgery comes from a Doctor H. C. Jacobaeus: |
关于腹腔镜手术,我最爱的引语 出自雅各贝乌斯医师: |
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quote:v.引用;报价;举例说明;开价;为(企业的股份)上市;n.引用;
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| It is puncture itself that causes risk. |
「造成风险的,是穿刺本身。」 |
| That's my favorite quote because H.C. Jacobaeus was the first person to ever perform laparoscopic surgery on humans, and he wrote that in 1912. |
这是我最爱的引语,因为雅各贝乌斯 是在人体进行腹腔镜手术的第一人。 而他在 1912 年写下这句话。 |
| This is a problem that's been injuring and even killing people for over 100 years. |
这问题伤害人们,甚至致人于死已超过百年之久。 |
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injuring:v.伤害,使受伤;损害,伤害;(injure的现在分词)
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| So it's easy to think that for every major problem out there there's some team of experts working around the clock to solve it. |
你可以安逸地想说,重要问题 已有一群专家不眠不休致力解决。 |
| The truth is that's not always the case. |
真相是,事情并非总如此。 |
| We have to be better at finding those problems and finding ways to solve them. |
我们得找到这样的问题, 并找方法解决。 |
| So if you come across a problem that grabs you, let it keep you up at night. |
所以若你遇到那种「刺眼」的问题, 让自己夜以继日地投入吧！ |
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come across:偶然遇见;给人以…的印象; grabs:n.链钩(grab的复数);v.抓取;捕获(grab的第三人称单数);
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| Allow yourself to be fascinated, because there are so many lives to save. |
让自己为其着迷, 因为有太多的生命,正待幫助。 |
| (Applause) |
（掌声） |