雙語財經新聞 第79期:心臟醫學領域先驅 阿爾伯特斯塔爾
Cardiac medicine has made tremendous strides since the 1950s, when surgeons placed the first experimental artificial valves in the human heart.
One of the pioneers in that field is Dr. Albert Starr, who co-invented the heart value — which has extended the lives of millions of people. Starr was just 16 when he enrolled at Columbia University in New York during World War II. At that time, school offered accelerated1 programs for young men heading off to war. He finished in two years, and by the time he was 22, had completed medical school. By then, World War II had ended, but the United States was involved in the Korean War so Starr decided to become a military doctor.
阿爾伯特斯塔爾是這個領域的先驅者之一，救治了數百萬人的生命。斯塔爾 進人紐約哥倫比亞大學就讀時才16歲。當時正值第二次世界大戰期間,學校爲將要 奔赴戰場的男青年開設了速成班。他在兩年後唸完了速成班,22歲從醫學院畢業。 那時二戰已經結束,美國卷人了朝鮮戰爭,斯塔爾決定當一名軍醫。“At first, I was a battalion surgeon on the front line, getting shot at. And then I was transferred to a mobile army surgical hospital, a MASH 8076, and I spent a year there,” says Starr. “During that year, I did more than 1000 major operations, just as a young kid. I mean, I was 23 years old.”
斯塔爾說：“起初,我是前線部隊的外科醫生，生活在槍林彈雨當中。後來我被 調到陸軍流動外科醫院，MASH 8076，並且在那兒待了一年。那一年裏，我做了 1000 多個大手術。我那時還是個23歲的毛頭小夥子呢。”
It was a perfect training ground for the future heart surgeon. After leaving the military, Starr moved into the new field of open-heart surgery.
對這位未來的心臟外科醫生來說,這是個最理想的鍛鍊機會。離開軍隊之後， 斯塔爾進入了體外循環心內直視手術領域。“But it was very limited in scope because you couldn’t take too long to do these operations. It would injure various vital organs, especially the brain,” he says. “So we had to develop a mechanical device to imitate3 the lungs and the pumping action of the heart, the heart-lung machine, and it was that development that allowed the growth of open-heart surgery,”
他說可是我們能使用的時間非常有限，因爲你不能花太多時間來做這些手 術，它會損傷不同的重要器官，特別是大腦。所以,我們必須研發一種機械裝置，模 仿肺臟和心臟跳動——心肺機。心肺機的面世使開心手術得以發展。”Researchers in Philadelphia developed that machine in the 1950s. It pumped oxygenated blood through the body, giving surgeons enough time to try to correct faulty heart valves, including the mitral valve inside the heart.
費城的研究者們195#代研發了這種機器。它把含有氧氣的血液輸送到全身， 給外科醫生足夠的時間修補有缺陷的心臟辦膜，包括心臟裏面的冠狀辦膜。“We could put a patient on the heart-lung machine. We could open the left atrium. We could look at the mitral valve. Sometimes we could repair it. If we couldn’t repair it, we had no alternative,，，says Starr. “There was nothing to fall back on, so yalyular4 surgery without an artificial valve — at least as a backup — was a very dangerous game to play.
斯塔爾說：“我們能夠把一名患者和心肺機連接,打開左心房,看到冠狀瓣膜。 有時候我們能夠修復它，如果不能修復它，就沒有替代方法，無路可退。所以沒有人造瓣膜的瓣膜手術是一個非常危險的遊戲。”At the University of Oregon Medical School，Starr got a visit one day from an eccentric engineer named Lowell Edwards. An inventor with many patents to his name, Edwards offered hope for a solution.
在俄勒岡大學醫學院，有一天斯塔爾接待了一位性格古怪的工程師，他叫洛厄爾愛德華茲。擁有許多專利的發明家愛德華茲爲解決問題帶來了希望。“He was a strange character, but I found out he was a great inventor, with a tremendous reputation. He had retired and had a lot of time on his hands and he wanted to develop an artificial heart”
斯塔爾說:“他是個怪人,但他是個了不起的發明家，名聲遠揚。他退休後有大把的時間，他想發明一心臟。”Starr convinced Edwards to narrow his focus and help develop a mechanical replacement for the heart’s mitral valve, which controls blood flow within the heart.
斯塔爾說服愛德華茲縮小他的研究範圍，集中精力研發一個代替心臟冠狀瓣膜的機械裝置。冠狀辦膜控制心臟裏的血液流動。The pair employed the latest space-age materials — Dacron, which was already used in heart grafts, as well as Teflon and a flexible silicone5 called Silastic. Their device consisted of a ball inside a cage that moved back and forth, in turn allowing the blood to flow inside or blocking it. The physician experimented with dogs and solved successive problems, from suture leaks to blood clots.
他們兩人採用了最先進的太空時代材利達克隆。達克隆當時已經在心臟移植手術中使用。他們還採用了特氟隆和一種有彈性的硅膠，叫作硅橡膠。他們的 裝置含有一個在前後活動的籠子裏的球體,交替讓血液流人或者堵住血液流人。醫 生用狗來試驗，解決了縫合、血栓等一系列問題。Starr says he and Lowell also encountered non-surgical challenges as they moved through uncharted territory. “We had to design everything, including the ethical elements, financial, clinical. We attacked one at a time, so the first thing we had to decide was, when we do our first human implant?”
斯塔爾說，他和洛厄爾在這片處女地探索的過程中也遇到一些非外科手術方面的挑戰。“我們得設計一切事情,包括倫理因素、財務、臨牀。我們一次攻一個問 Mo我們必須解決的第一件事就是’我們什麼時候麟一從類植入手術。”As the laboratory test dogs survived longer and longer, Starr found himself doing human surgeries sooner than he expected.
隨着實驗室裏接受手術的狗存活得時間越來越長，斯塔爾發現他在人體進行手術的時間比預期來得早。“The chief of cardiology visits the animal laboratory and sees all these healthy dogs with mitral valve replacements. And actually one of them sticks his head through the cage and licks his hand. Meanwhile, he’s got a hospital full of patients in oxygen tents that need mitral valve replacement, and he said, 4You can’t wait on this. We’ve got patients that need this device.”
斯塔爾說:“心臟學主任參觀了動物實驗室，看到那些換上冠狀瓣膜的狗都健康。甚至還有一條狗從籠子裏伸出頭來舔他的手。在這同時呢，醫院吸氧室裏擠滿 了患者，他們需要替換冠狀瓣膜。於是他說,‘你們不能再等了。我們有患者需要這 個裝置。’”Because Starr was operating on patients with terminal6 heart disease, there were many failures along the way. The first patient to receive a mitral valve implant, a woman in her 30s, died when an air bubble formed inside her heart. By the early 1960s, however, many of Starr’s artificial mitral valve patients were successfully resuming their lives.
因爲斯塔爾是爲晚期心臟病人做手術，所以一路走來有許多失敗的病例。第一 個接受冠狀瓣膜移植的是一名30多歲的婦女。她心臟裏形成的一個氣泡要了她的 命。然而在60￥代早期，斯塔爾醫生的人造冠狀嫌膜替換術挽救了許多患者的生Today, hundreds of thousands of patients have had this type of implant, either the Starr-Edwards valve design or refinements on that model. Thousands of Starr’s former patients send him updates through the social networking Internet site Facebook.
今天，數以十萬計的患者做了這種手術，要麼用斯塔爾愛德華茲設計的瓣膜， 要麼用這種模式的改進型。斯塔爾從前的數千名患者通過Facebook向他報告最新 情況。Starr no longer does surgery, but is active as a medical consultant, researcher and teacher. He looks back on the great strides in cardiac surgery over his six decades of practice ——refinements in artificial heart valves, dramatic transplant operations and the widely used procedure of heart bypass surgery — proud to have played a part in developing techniques that have extended so many lives.
現在，阿爾伯特斯塔爾不再做外科手術了。不過他仍然活躍在醫療諮詢、研究和教學領域。回首60年,心臟外科手術取得了巨大進步，人造心臟瓣膜不斷改進提 高，重大的器官移植手術成爲可能，心臟搭橋手術廣泛使用。他爲自己在研發他所 說的延續了千百萬人生命的技術當中發揮了作用而感到驕傲。
