Yoav Medan: Ultrasound surgery -- healing without cuts

翻译人员: Chunxiang Qian 校对人员: Zhiyi Chen

Over the last 13 years --

在过去的13年里－

one, three, 13 years --

1,3,13年－

I've been part of an exceptional team at InSightec in Israel

我作为以色列InSightech里一个优秀团队里的一员

and partners around the world

协同世界各地的同道之士

for taking this idea, this concept,

将一个新构想，一个理念

noninvasive surgery,

——非侵入性手术

from the research lab to routine clinical use.

从研究实验室带进日常临床应用

And this is what I'll tell you about.

这将是我要谈论的话题

13 years --

13年－

for some of you, you can empathize with that number.

在座各位当中有些人会对这个数字产生共鸣

For me, today, on this date,

对我来说

it's like a second bar mitzvah experience.

就像第二次成年礼一样

(Laughter)

（笑声）

So this dream

这个梦想的

is really enabled

实现是

by the convergence

两项现存技术

of two known technologies.

结合的结果

One is the focused ultrasound,

一个是聚焦超声

and the other one is the

另一个是

vision-enabled magnetic resonance imaging.

可视化磁共振成像技术

So let's first talk about focused ultrasound.

首先来谈谈聚焦超声

And I hold in my hand

我手里是

a tissue-mimicking phantom.

一个组织模型

It is made out of silicon.

由硅材料制成

It is transparent, made just for you.

透明的，便于大家观察

So you see, it's all intact,

显而易见，它是完整的

completely transparent.

完全透明的

I'll take you now to the acoustic lab.

现在我们来到声学实验室

You see the phantom within the aquarium.

可以看到玻璃缸里的透视图

This is a setup I put in a physics lab.

这是我在物理实验室里的装置

On the right-hand side,

在右边

you see an ultrasonic transducer.

是一台超声传感器

So the ultrasonic transducer

当超声传感器

emits basically an ultrasonic beam

对着模型内部

that focuses inside the phantom.

发射出一束超声波束

Okay, when you hear the click,

你听见咔嗒声

this is when the energy starts to emit

就是能量要发射了

and you see a little lesion form

然后你能看见模型内部

inside the phantom.

出现了小小的损坏

Okay, so everything around it

而周围一切

is whole and intact.

都完好无损

It's just a lesion formed inside.

损伤完全从内部形成

So think about, this is in your brain.

试想一下，如果这是你的大脑

We need to reach a target inside the brain.

我们要击中大脑内部的一处目标

We can do it without harming any tissue.

我们可以在不伤及任何组织的情况下办到

So this is, I think,

我想

the first kosher Hippocratic surgical system.

这是第一个符合犹太戒律的希波克拉底手术系统

(Laughter)

（笑声）

Okay, so let's talk a little bit about ultrasound,

接下来谈谈超声波

the force of ultrasound.

超声波的力量

You know all about imaging, right, ultrasound imaging.

大家都知道超声波成像

And you know also about lithotripsy --

还有体外震波碎石术

breaking kidney stones.

可以震碎肾结石

But ultrasound can be shaped

但超声波可以成为

to be anything in between,

两者间的任何形态

because it's a mechanical force.

因为它是一种机械力

Basically, it's a force acting on a tissue

它横穿组织时对其

that it transverses.

产生作用力

So you can change the intensity, the frequency,

所以可以通过改变超声波的强度、频率

the duration, the pulse shape of the ultrasound

波长和脉冲波形

to create anything

来创造出从喷枪到铁锤的

from an airbrush to a hammer.

任何东西

And I am going to show you

接下来我要展示的是

multiple applications in the medical field

通过聚焦超声波

that can be enabled

只用物理聚焦

just by focusing,

在医疗领域中的

physically focusing.

多种应用

So this idea

使用聚焦超声波

of harnessing focused ultrasound to treat lesions in the brain

来治疗脑损伤

is not new at all.

并不是新理念

When I was born, this idea was already conceived

这个构想早在我出生之前

by pioneers such as the Fry brothers

就已经形成了，比如弗莱兄弟

and Lars Leksell,

和拉尔斯･莱克塞尔

who is know actually

后者因

as the inventor of the gammaknife.

发明伽玛刀而闻名

But you may not know

但大家可能不知道

that he tried to perform lobotomies in the brain,

早在五十年代他

noninvasively,

尝试利用聚焦超声波

with focused ultrasound in the '50s.

进行非侵入式前脑白质切断术

He failed,

没有成功

so he then invented the gammaknife.

于是他发明了伽玛刀

And it makes you ponder

于是你会思索

why those pioneers failed.

为什么这些先辈都没有成功

And there was something fundamental

因为一些关键的东西

that they were missing.

未被发现和使用

They were missing the vision.

他们缺少成像技术

It wasn't until the invention of the MR

直到磁共振成像的发明

and really the integration of MR

直到磁共振成像

with focused ultrasound

与聚焦超声波的合二为一

that we could get the feedback --

我们才能在解剖学

both the anatomical and the physiological

和生理学上得到肯定答案

in order to have a completely noninvasive, closed-loop

才可以执行完全无侵入、完全体内

surgical procedure.

进行的手术

So this is how it looks, you know,

这就是今天看到的未来

the operating room of the future today.

手术室的样子

This is an MR suite with a focused ultrasound system.

这是配有聚焦超声波系统的磁成像成套设备

And I will give you several examples.

我会给大家看一些例子

So the first one is in the brain.

第一个位于大脑内部

One of the neurological conditions

可以通过聚焦超声波治疗的

that can be treated with focused ultrasound

一个神经性病症是

are movement disorders,

运动障碍

like Parkinson's or essential tremor.

比如帕金森氏症或者原发性颤抖症

What is typical to those conditions,

这类疾病的典型症状就是

to essential tremor for example,

比如原发性颤抖症

is inability

就是吃麦片

to drink or eat cereal or soup

或喝汤的时候

without spilling everything all over you,

会把汤洒得到处都是

or write legibly so people can understand it,

或者写的字没人能识别

and be really independent in your life

必须依赖别人的帮助

without the help of others.

才能生活

So I'd like you to meet John.

让我介绍一下 约翰

John is a retired professor of history

约翰是一位退休的历史教授

from Virginia.

来自维吉尼亚

So he suffered from essential tremor for many years.

患原发性颤抖症多年

And medication didn't help him anymore.

药物治疗再无成效

And many of those patients refused to undergo surgery

许多类似的病人拒绝手术

to have people cut into their brain.

因为需要开颅

And about four or five months ago,

大概四五个月前

he underwent an experimental procedure.

他接受了一个实验性治疗

It is approved under an FDAIDE

这个治疗在夏洛特斯维尔的弗吉尼亚大学获得了

at the University of Virginia

美国食品药物管理监督局的

in Charlottesville

临床实验医疗器材许可

using focused ultrasound

使用聚焦超声

to ablate a point in his thalamus.

切除他视丘里的一个点

And this is his handwriting.

这是他的字迹

"On June 20th," if you can read it,

如果大家看得请的话， “6月20日”

"2011."

“2011年”

This is his handwriting

这是他的字迹

on the morning of the treatment

接受磁共振治疗前的

before going into the MR

之前写下的

So now I'll take you through

接下来我要带各位了解一下

[what] a typical procedure like that looks like,

典型的手术流程

[what] noninvasive surgery looks like.

非侵入性手术的过程

So we put the patient on the MR table.

我们将病人平置于磁共振的手术台上

We attach a transducer, in this case, to the brain,

装上传感器，这里是针对大脑的

but if it will be a different organ,

如果是其他的器官

it will be a different transducer attached to the patient.

就会用其他不一样的传感器

And the physician

医生会

will then take a regular MR scan.

先进行常规磁共振扫描

And the objective of that?

扫描对象呢？

I don't have a pointer here,

我手头没有指示棒

but you see the green, sort of rectangle or trapezoid?

不过你看到这些绿色的类似矩形或梯形的部分吗？

This is the sort of general area of the treatment.

这可以说是治疗的大致区域

It's a safety boundary

这是目标周围的

around the target.

安全区域

It's a target in the thalamus.

这是视丘中的手术对象

So once those pictures are acquired

只要获取这些图片

and the physician has drawn

并且医生也划出了

all the necessary safety limits and so on,

所有必要的安全限制范围等等，

he selects basically a point --

他就会选取一个点－

you see the round point in the middle where the cursor is --

就是正中间，箭头所指的那个圆点－

and he presses this blue button called "sonicate."

然后他按下这个叫“声处理”的按钮

We call this instance of injecting the energy,

我们把注射能量这一步

we call it sonication.

叫做声波降解法

The only handwork the physician does here

医生唯一的体力活就是

is moving a mouse.

移动鼠标

This is the only device he needs in this treatment.

鼠标是他在治疗过程中唯一需要的设备

So he presses "sonicate," and this is what happens.

他按下“声处理”，接下来

You see the transducer, the light blue.

请看传感器，就是淡蓝的部分

There's water in between the skull and the transducer.

头颅和传感器之间是水

And it does this burst of energy.

传感器释放出能量

It elevates the temperature.

提高温度

We first need to verify

我们首先得确认

that we are on target.

是否命中目标

So the first sonication

因此第一次超声波降解

is at lower energy.

发射能量较低

It doesn't do any damage,

不会产生任何伤害

but it elevates the temperature

只会把温度提高

by a few degrees.

几度而已

And one of the unique capabilities

磁共振的一个

that we leverage with the MR

独特功能就是

is the ability to measure temperature noninvasively.

非侵入性温度测量

This is really a unique capability of the MR.

这是磁共振的特有功能

It is not being used

一般不会用于

in regular diagnostic imaging.

常规的造影诊断

But here we can get

但我们可以使用它

both the anatomical imaging and the temperature maps in real time.

取得实时的解剖影像和温度走势图

And you can see the points there on the graph.

可以看到图像上的这些点

The temperature was raised

温度被暂时提升

to 43 degrees C temporarily.

至43摄氏度

This doesn't cause any damage.

这不会造成任何伤害

But the point is we are right on target.

但重点是我们命中目标了

So once the physician verifies

一旦医生确定

that the focus spot is on the target he has chosen,

聚焦点击中选定目标

then we move to perform

下一步便是

a full-energy ablation

高能切除

like you see here.

如图所示

And you see the temperature rises

温度上升到

to like 55 to 60 degrees C.

55到66摄氏度

If you do it for more than a second,

如果这种状态持续超过一秒

it's enough to basically destroy

基本上就足够摧毁

the proteins of the cells.

细胞中的蛋白质了

This is the outcome from a patient perspective --

这是病人眼中的术后结果－

same day after the treatment.

治疗结束的当天

This is an immediate relief.

症状立刻消失了

(Applause)

（掌声）

Thank you.

谢谢

John is one of [about] a dozen

约翰是众多

very heroic, courageous people

有胆量和勇气参加这项研究的

who volunteered for the study.

志愿者之一

And you have to understand

需要知道的是

what is in people's mind

当他们决定冒这个险时

when they are willing to take the risk.

他们心里想的是什么

And this is a quote from John after he wrote it.

约翰写下这些之后

He said, "Miraculous."

他说：“太神奇了！”

And his wife said, "This is the happiest moment of my life."

他的妻子说：“这是我一生中最开心的时刻。“

And you wonder why.

也许你不理解

I mean, one of the messages I like to carry over

我想说的是

is, what about defending quality of life?

为什么我们要维护生活的质量？

I mean, those people lose their independence.

这些人失去独立生活的能力

They are dependent on others.

他们要依赖于别人

And John today is fully independent.

而约翰现在完全不用依靠别人了

He returned to a normal life routine.

他恢复了正常人的生活

And he also plays golf,

他会去打高尔夫球

like you do in Virginia

就像很多人在

when you are retired.

维吉尼亚的退休生活

Okay, so you can see here the spot.

好，请看这里的雾状物

It's like three millimeters in the middle of the brain.

在大脑中间大约3毫米处

There's no damage outside.

没有任何外部损伤

He suffers from no neurodeficit.

他没有任何神经损伤

There's no recovery needed, no nothing.

没有康复期 什么都不用

He's back to his normal life.

他直接恢复到正常生活

Let's move now

下面我们要

to a more painful subject.

谈论一个痛苦的话题

Pain is something

疼痛可以让

that can make your life miserable.

生活变得很悲惨

And people are suffering from all kinds of pain

人们承受着各种各样的痛苦

like neuropathic pain, lower-back pain

比如神经痛、腰痛

and cancer pain from bone metastases,

骨转移带来的癌症疼痛

when the metastases get to your bones,

当癌细胞转移进入你的骨髓

sometimes they are very painful.

有时候会非常非常痛

All those I've indicated

我谈到的这些痛症

have already been shown

都已经被证实

to be successfully treated

可以通过聚焦超声技术

by focused ultrasound

非常快速地治愈

relieving the pain, again, very fast.

可以一下子消除疼痛

And I would like to tell you

下面我想介绍一下

about PJ.

PJ

He's a 78 year-old farmer

他是个农民 78岁了

who suffered from -- how should I say it? --

他的疼痛

it's called pain in the butt.

来自臀部

He had metastases in his right buttock,

他的癌细胞转移到了臀部右侧

and he couldn't sit

即使有药物治疗

even with medication.

他也无法坐下

He had to forgo all the farm activities.

他停止了任何劳作

He was treated with radiation therapy,

接受了放射治疗

state-of-the-art radiation therapy,

最先进的放射治疗

but it didn't help.

但毫无帮助

Many patients like that favor radiation therapy.

很多病人倾向于放射治疗

And again, he volunteered

但他决定参与

to a pivotal study

我们这个在世界范围内

that we ran worldwide,

进行的重大研究项目

also in the U.S.

当然也包括美国

And his wife actually took him.

是他的妻子带他来的

They drove like three hours

他们从农场开了

from their farm to the hospital.

大概三个小时的车

He had to sit on a cushion,

他得坐在一个垫子上

stand still, not move,

一动都不能动

because it was very painful.

不然就会很痛

He took the treatment,

他接受了治疗

and on the way back,

回家路上

he drove the truck by himself.

他就能自己开卡车了

So again, this is an immediate relief.

这再次证明 治疗瞬间就消除了疼痛瞬间

And you have to understand

你可以体会

what those people feel

当病痛解除时

and what their family experiences

这些病人和

when it happens.

他们家人的感受

He returned again

他又开始了

to his daily routine on the farm.

每天在农场的劳作

He rides his tractor.

他开着他拖拉机

He rides his horse to their mountain cabin regularly.

骑着马定期去山间小屋

And he has been very happy.

从此一直都很开心

But now, you ask me,

但现在你会问我

but what about war, the war on cancer?

那么对癌症的宣战呢？

Show us some primary cancer.

我们要看看对于那些首要癌症

What can be done there?

这个研究能做些什么呢？

So I have good news and bad news.

我这儿有好消息，也有坏消息

The good news: there's a lot that can be done.

好消息是：我们能做的有很多

And it has been shown actually outside of the U.S.

这点美国以外地区已经得到证实

And doing that in the U.S.

但是在美国的话

is very painful.

非常棘手

I don't see, without this nation

似乎没有全民为之请愿

taking it as some collective will

或视其为国民目标来推进

or something that is a national goal to make that happen,

事情就没法办成

it will not happen.

我不这样认为

And it's not just because of regulation;

这不仅是制度法规的问题

it's because of the amount of money needed

还有现行的实证医学体系下

under the current evidence-based medicine

要投入的巨额资金以及

and the size of trials and so on

临床试验的规模等等

to make it happen.

都成为实现目标的阻碍

So the first two applications

研究的首要两项应用

are breast cancer and prostate cancer.

是乳腺癌和前列腺癌

They were the first to be treated by focused ultrasound.

这两种是癌症中首先使用聚焦超声波治疗的

And we have better-than-surgery results in breasts.

乳腺癌的治疗结果显示比手术效果更好

But I have a message for the men here.

不过有个消息提供给在场男士

We heard here yesterday Quyen

听说吉兰昨天在这里

talking about the adverse event trait

探讨了前列腺癌治疗的

in prostate cancer.

不良症状

There is a unique opportunity now

通过使用磁共振成像和聚焦超声波技术

with focused ultrasound guided by MR,

我们有一个全新的治疗前景

because we can actually think about

因为我们可以考虑

prostate lumpectomy --

前列腺肿瘤切除－

treating just the focal lesion

治疗局部病变

and not removing the whole gland,

而不用切除整个腺体

and by that, avoiding all the issues

这样就避免了

with potency and incontinence.

性功能丧失和尿失禁问题

Well, there are other cancer tumors in the abdomen --

其他的一些出现在腹腔的癌症－

quite lethal, very lethal actually --

相当致命，可以说很致命

pancreas, liver, kidney.

胰脏，肝脏，肾脏里的

The challenge there

治疗的困难是－

with a breathing and awake patient --

病人是完全清醒的

and in all our treatments,

在我们所有的治疗中

the patient is awake and conscious

病人完全清醒

and speaks with the physician --

可以和医生交谈－

is you have to teach the MR some tricks

困难就是我们得让磁共振成像

how to do it in real time.

实现实时成像

And this will take time.

这不容易

This will take two years.

我们花了两年做到

But I have now a message to the ladies.

现在有一个带给女士们的消息

And this is, in 2004,

2004年

the FDA has approved MR-guided focused ultrasounds

美国食品药物管理局已经批准了磁共振成像引导聚焦超声波技术

for the treatment of symptomatic uterine fibroids.

应用于子宫肌瘤的临床治疗

Women suffer from that disease.

女性常受此病痛折磨

All those tumors

肿瘤会导致

have heavy bleeding during periods,

经期大量出血

abdominal pressure, back pain,

腹部张痛 背痛

frequent urination.

尿频

And sometimes, they cannot even conceive and become pregnant

有时甚至会导致

because of the fibroid.

无法受孕

This is Frances.

这位女性住在法国

She was diagnosed with a grapefruit-sized fibroid.

她被诊断出长有一个柚子大小的子宫肌瘤

This is a big fibroid.

这是很大的子宫肌瘤

She was offered a hysterectomy,

医生建议她切除子宫

but this is an inconceivable proposition

但对于期望怀孕的人来说

for someone who wants to keep her pregnancy option.

这是无法接受的选择

So she elected to undergo a focused ultrasound procedure

她在2008年选择了接受

in 2008.

聚焦超声波治疗

And in 2010, she became a first-time mother to a healthy baby.

2010年她成了一个健康宝宝的妈妈

So new life was born.

就这样一个新生命诞生了

(Applause)

（掌声）

So in conclusion,

最后

I'd like to leave you with actually four messages.

我想要给各位留下四个信息

One is, think about the amount

首先试想一下

of suffering that is saved

非侵入式手术

from patients undergoing noninvasive surgery,

可以让多少病人脱离苦海

and also the economical and emotional burden

可以帮助他们的家人、社区

removed from their families and communities

还有社会减轻多少

and the society at large --

经济和情感上的负担－

and I think also from their physicians, by the way.

我想应该也减轻了医生的负担

And the other thing I would like you to think about

另外请想象一下

is the new type of relationship

医患之间形成了

between physician and patients

一种新的关系

when you have a patient on the table

当病人躺着手术台上

[who] is awake and can even monitor the treatment.

他是完全清醒的甚至可以监督治疗

In all our treatments,

在我们的治疗中

the patient holds a stop sonication button.

病人握着一个解除手术的按钮

He can stop the surgery at any moment.

病人可以随时中止手术

And with that note,

带着这些讯息，

I would like to thank you for listening.

最后我想感谢各位的聆听

(Applause)

（掌声）