ABOUT THE SPEAKER
Quyen Nguyen - Surgeon
Quyen Nguyen uses molecular probes that make tumors -- and just the tumors -- glow, as an extraordinary aid to surgeons.

Why you should listen

Dr. Quyen Nguyen’s research (working with Roger Tsien, Nobel Laureate in Chemistry) is focused on the development of fluorescently labeled probes for molecular navigation during surgery. Their first collaborative effort yielded a “smart” probe that makes tumors margins fluoresce, or “glow” and thus easier for surgeons to see and remove accurately during surgery. Their most recent joint effort resulted in another type of probe that can make nerves “glow” during surgery, thus helping surgeons repair injured nerves and avoid inadvertent injury.

She is a professor of surgery and director of the Facial Nerve Clinic at the University of California, San Diego.

More profile about the speaker
Quyen Nguyen | Speaker | TED.com
TEDMED 2011

Quyen Nguyen: Color-coded surgery

Quyen Nguyen:顏色導引手術

Filmed:
1,224,438 views

醫學教科書把人體組織畫上顏色,以便外科醫生學習,但實體組織看起來並非如此。直到現在,Quyen Nguyen在TEDMED展示了如何用運用標記分子,使腫瘤呈現綠色螢光,讓醫生知道正確的切割位置。
- Surgeon
Quyen Nguyen uses molecular probes that make tumors -- and just the tumors -- glow, as an extraordinary aid to surgeons. Full bio

Double-click the English transcript below to play the video.

00:15
I want to talk to you
0
0
2000
我想跟各位談談
00:17
about one of the biggest最大 myths神話 in medicine醫學,
1
2000
2000
醫學界最大的迷思之一
00:19
and that is the idea理念
2
4000
2000
這個迷思就是
00:21
that all we need are more medical breakthroughs突破
3
6000
3000
只要我們在醫學界有更多的突破
00:24
and then all of our problems問題 will be solved解決了.
4
9000
3000
一切問題就能迎刃而解
00:27
Our society社會 loves to romanticize浪漫
5
12000
3000
世人喜歡把這種事想得浪漫
00:30
the idea理念 of the single, solo獨奏 inventor發明者
6
15000
2000
某位發明家隻身奮鬥
00:32
who, working加工 late晚了 in the lab實驗室 one night,
7
17000
3000
某晚在實驗室工作到很晚
00:35
makes品牌 an earthshaking翻天 discovery發現,
8
20000
3000
有了驚為天人的發現
00:38
and voila, overnight過夜 everything's一切的 changed.
9
23000
4000
突然,一夕之間全都變得不一樣了
00:42
That's a very appealing吸引人的 picture圖片,
10
27000
2000
這樣的畫面非常吸引人
00:44
however然而, it's just not true真正.
11
29000
3000
然而,實情並非如此
00:47
In fact事實, medicine醫學 today今天 is a team球隊 sport運動.
12
32000
3000
實際上,現今的醫學是種團隊運動
00:50
And in many許多 ways方法,
13
35000
2000
很多方面來說
00:52
it always has been.
14
37000
2000
一直都是如此
00:54
I'd like to share分享 with you a story故事
15
39000
2000
我想和大家分享一則故事
00:56
about how I've experienced有經驗的 this very dramatically顯著
16
41000
3000
這故事是我在工作上
00:59
in my own擁有 work.
17
44000
2000
親身經歷的戲劇化改變
01:01
I'm a surgeon外科醫生,
18
46000
2000
我是名外科醫生
01:03
and we surgeons外科醫生 have always had
19
48000
2000
身為外科醫生
01:05
this special特別 relationship關係 with light.
20
50000
3000
我們和光線有種奇妙的關係
01:08
When I make an incision切口 inside a patient's耐心 body身體, it's dark黑暗.
21
53000
4000
當我動刀切入病患的身體時,裡頭是暗的
01:12
We need to shine閃耀 light to see what we're doing.
22
57000
3000
我們要打光才能知道我們正在進行什麼動作
01:15
And this is why, traditionally傳統,
23
60000
3000
這就是為什麼傳統上
01:18
surgeries手術 have always started開始 so early in the morning早上 --
24
63000
2000
手術都在一大早的時候進行
01:20
to take advantage優點 of daylight陽光 hours小時.
25
65000
2000
以便利用白天的光線
01:22
And if you look at historical歷史的 pictures圖片
26
67000
2000
假如你看看歷史照片
01:24
of the early operating操作 rooms客房,
27
69000
2000
早期的手術室
01:26
they have been on top最佳 of buildings房屋.
28
71000
3000
都位在建築物的頂樓
01:29
For example, this is the oldest最老的 operating操作 room房間 in the Western西 world世界,
29
74000
2000
例如:這張是西方世界最早的手術室
01:31
in London倫敦,
30
76000
2000
位在倫敦
01:33
where the operating操作 room房間
31
78000
2000
這間手術室
01:35
is actually其實 on top最佳 of a church教會
32
80000
2000
位在教堂的頂樓
01:37
with a skylight天空之光 coming未來 in.
33
82000
2000
上頭有日光照進來
01:39
And then this is a picture圖片
34
84000
2000
再來這張照片是
01:41
of one of the most famous著名 hospitals醫院 in America美國.
35
86000
3000
美國最有名的醫院之一
01:44
This is Mass General一般 in Boston波士頓.
36
89000
2000
這是波士頓的麻省總醫院
01:46
And do you know where the operating操作 room房間 is?
37
91000
2000
你知道手術室在哪嗎?
01:48
Here it is
38
93000
2000
在這裡
01:50
on the top最佳 of the building建造
39
95000
2000
醫院的頂樓
01:52
with plenty豐富 of windows視窗 to let light in.
40
97000
3000
上面開了很多窗戶引進光線
01:55
So nowadays如今 in the operating操作 room房間,
41
100000
2000
現今的手術室
01:57
we no longer need to use sunlight陽光.
42
102000
3000
不再需要利用陽光
02:00
And because we no longer need to use sunlight陽光,
43
105000
3000
因為我們不需要利用陽光
02:03
we have very specialized專門 lights燈火
44
108000
2000
我們有特製的燈光
02:05
that are made製作 for the operating操作 room房間.
45
110000
2000
專為手術室打造的燈
02:07
We have an opportunity機會
46
112000
2000
我們有機會
02:09
to bring帶來 in other kinds of lights燈火 --
47
114000
2000
引進其他種類的光線
02:11
lights燈火 that can allow允許 us to see
48
116000
2000
這種光線可以讓我們看見
02:13
what we currently目前 don't see.
49
118000
3000
目前我們看不到的地方
02:16
And this is what I think
50
121000
2000
這種光線就是
02:18
is the magic魔法 of fluorescence熒光.
51
123000
2000
神奇的螢光
02:20
So let me back up a little bit.
52
125000
2000
我先把話題拉回以前
02:22
When we are in medical school學校,
53
127000
3000
當我們在醫學院的時候
02:25
we learn學習 our anatomy解剖學 from illustrations插圖 such這樣 as this
54
130000
3000
我們透過插圖學習解剖學,就像這張
02:28
where everything's一切的 color-coded顏色編碼.
55
133000
3000
各部位都用色彩區分
02:31
Nerves神經 are yellow黃色, arteries動脈 are red,
56
136000
2000
神經是黃的,動脈是紅的
02:33
veins are blue藍色.
57
138000
2000
靜脈是藍的
02:35
That's so easy簡單 anybody任何人 could become成為 a surgeon外科醫生, right?
58
140000
4000
很簡單,每個人都可以當外科醫生,對吧?
02:39
However然而, when we have a real真實 patient患者 on the table,
59
144000
3000
然而,當我們在看手術台上的實體病人時
02:42
this is the same相同 neck頸部 dissection解剖 --
60
147000
3000
這是相同的頸部解剖面
02:45
not so easy簡單 to tell the difference區別
61
150000
2000
不太易區分
02:47
between之間 different不同 structures結構.
62
152000
2000
不同組織的差異
02:49
We heard聽說 over the last couple一對 days
63
154000
3000
過去幾天我們聽說
02:52
what an urgent緊急 problem問題
64
157000
2000
癌症至今仍是
02:54
cancer癌症 still is in our society社會,
65
159000
2000
我們所面臨的迫切問題
02:56
what a pressing緊迫 need it is
66
161000
2000
我們有急迫的需求
02:58
for us to not have
67
163000
2000
不希望隨時會有人
03:00
one person die every一切 minute分鐘.
68
165000
4000
因為癌症而死
03:04
Well if cancer癌症 can be caught抓住 early,
69
169000
2000
假如能夠早期發現癌症
03:06
enough足夠 such這樣 that someone有人 can have their cancer癌症 taken採取 out,
70
171000
5000
在最初時就透過手術
03:11
excised切除 with surgery手術,
71
176000
2000
把腫瘤移除
03:13
I don't care關心 if it has this gene基因 or that gene基因,
72
178000
2000
我不管是有這個基因或那個基因
03:15
or if it has this protein蛋白 or that protein蛋白,
73
180000
2000
或者有這種蛋白質或那種蛋白質
03:17
it's in the jar.
74
182000
2000
反正都丟到罐子了
03:19
It's doneDONE, it's out, you're cured治愈 of cancer癌症.
75
184000
3000
手術完成,切除了,癌症治好了
03:22
This is how we excise摘除 cancers癌症.
76
187000
2000
這是我們移除腫瘤手術的照片
03:24
We do our best最好, based基於 upon our training訓練
77
189000
3000
我們盡最大能力,依據過去的訓練
03:27
and the way the cancer癌症 looks容貌 and the way it feels感覺
78
192000
3000
還有腫瘤的樣貌和感覺
03:30
and its relationship關係 to other structures結構 and all of our experience經驗,
79
195000
3000
以及腫瘤與其他組織的關聯,還有過去的經驗
03:33
we say, you know what, the cancer's癌症的 gone走了.
80
198000
3000
我們說,你知道嗎,腫瘤清除了
03:36
We've我們已經 made製作 a good job工作. We've我們已經 taken採取 it out.
81
201000
3000
很好,我們把腫瘤移除了
03:39
That's what the surgeon外科醫生 is saying in the operating操作 room房間
82
204000
2000
外科醫生在手術室都會這樣說
03:41
when the patient's耐心 on the table.
83
206000
2000
當患者還在手術台上時
03:43
But then we actually其實 don't know that it's all out.
84
208000
3000
可是我們其實不確定腫瘤是否都移除了
03:46
We actually其實 have to take samples樣本 from the surgical外科 bed,
85
211000
3000
我們必須從腫瘤床採取樣本
03:49
what's left behind背後 in the patient患者,
86
214000
2000
以了解患者體內是否殘存腫瘤
03:51
and then send發送 those bits to the pathology病理 lab實驗室.
87
216000
4000
然後把樣本送到病理實驗室
03:55
In the meanwhile與此同時, the patient's耐心 on the operating操作 room房間 table.
88
220000
2000
這時,患者仍然躺在手術台上
03:57
The nurses護士, anesthesiologist麻醉師, the surgeon外科醫生,
89
222000
2000
護士、麻醉師、外科醫生
03:59
all the assistants助理 are waiting等候 around.
90
224000
2000
所有的助理都在等候
04:01
And we wait.
91
226000
2000
我們就這樣等著
04:03
The pathologist病理學家 takes that sample樣品,
92
228000
2000
病理師把樣本拿去
04:05
freezes凍結 it, cuts削減 it, looks容貌 in the microscope顯微鏡 one by one
93
230000
3000
冷凍、切開,一片片放在顯微鏡下觀察
04:08
and then calls電話 back into the room房間.
94
233000
2000
然後回覆手術室
04:10
And that may可能 be 20 minutes分鐘 later後來 per piece.
95
235000
2000
每件樣本大概要花20分鐘
04:12
So if you've sent發送 three specimens標本,
96
237000
2000
所以假如你送三件樣本
04:14
it's an hour小時 later後來.
97
239000
2000
要等上一小時
04:16
And very often經常 they say,
98
241000
2000
通常他們會說
04:18
"You know what, points A and B are okay,
99
243000
3000
「你知道嗎,A點和B點都沒問題,
04:21
but point C, you still have some residual剩餘的 cancer癌症 there.
100
246000
2000
但是C點仍然殘留些許的腫瘤,
04:23
Please go cut that piece out."
101
248000
3000
請把殘留的腫瘤切除。」
04:26
So we go back and we do that again, and again.
102
251000
3000
所以我們就回去一次又一次再做手術
04:29
And this whole整個 process處理:
103
254000
2000
這就是整個過程
04:31
"Okay you're doneDONE.
104
256000
2000
「好了,完成了,
04:33
We think the entire整個 tumor is out."
105
258000
2000
我們認為腫瘤已經切除了。」
04:35
But very often經常 several一些 days later後來,
106
260000
3000
但通常幾天以後
04:38
the patient's耐心 gone走了 home,
107
263000
2000
病患回家了
04:40
we get a phone電話 call:
108
265000
2000
我們接到電話說:
04:42
"I'm sorry,
109
267000
2000
「抱歉,
04:44
once一旦 we looked看著 at the final最後 pathology病理,
110
269000
2000
我們看了最後的病理報告
04:46
once一旦 we looked看著 at the final最後 specimen標本,
111
271000
2000
我們看了最後的樣本
04:48
we actually其實 found發現 that there's a couple一對 other spots斑點
112
273000
3000
我們發現有些其他的點
04:51
where the margins利潤率 are positive.
113
276000
3000
邊緣呈現陽性反應
04:54
There's still cancer癌症 in your patient患者."
114
279000
3000
患者的體內仍有腫瘤。」
04:57
So now you're faced面對 with telling告訴 your patient患者, first of all,
115
282000
3000
所以首先要面對的是告訴患者
05:00
that they may可能 need another另一個 surgery手術,
116
285000
2000
可能要再進行一次手術
05:02
or that they need additional額外 therapy治療
117
287000
2000
或者額外的治療
05:04
such這樣 as radiation輻射 or chemotherapy化療.
118
289000
4000
像是放射線治療或化療
05:08
So wouldn't不會 it be better
119
293000
2000
如果我們能夠知道
05:10
if we could really tell,
120
295000
2000
如果可以在手術時就知道
05:12
if the surgeon外科醫生 could really tell,
121
297000
3000
腫瘤是否仍然存在
05:15
whether是否 or not there's still cancer癌症 on the surgical外科 field領域?
122
300000
3000
這樣是不是更好?
05:18
I mean, in many許多 ways方法, the way that we're doing it,
123
303000
3000
我的意思是,現階段我們進行手術時
05:21
we're still operating操作 in the dark黑暗.
124
306000
4000
很多時候等於在黑暗中動刀
05:25
So in 2004, during my surgical外科 residency住院醫師,
125
310000
3000
2004年,當我在住院醫師期間
05:28
I had the great fortune幸運
126
313000
2000
我很榮幸
05:30
to meet遇到 Dr博士. Roger羅傑 Tsien錢學森,
127
315000
3000
遇見 Roger Chen 醫師
05:33
who went on to win贏得 the Nobel諾貝爾 Prize for chemistry化學
128
318000
3000
後來他在2008年時
05:36
in 2008.
129
321000
2000
獲得諾貝爾化學獎
05:38
Roger羅傑 and his team球隊
130
323000
2000
Roger和他的團隊
05:40
were working加工 on a way to detect檢測 cancer癌症,
131
325000
3000
當時正在研究偵測腫瘤的方法
05:43
and they had a very clever聰明 molecule分子
132
328000
2000
他們後來研發出
05:45
that they had come up with.
133
330000
2000
一種非常神奇的分子
05:47
The molecule分子 they had developed發達
134
332000
2000
他們研發出的分子
05:49
had three parts部分.
135
334000
2000
由三個部分構成
05:51
The main主要 part部分 of it is the blue藍色 part部分, polycation聚陽離子,
136
336000
3000
第一部分是藍色的聚陽離子
05:54
and it's basically基本上 very sticky
137
339000
2000
這東西很容易附著在
05:56
to every一切 tissue組織 in your body身體.
138
341000
2000
身體組織上
05:58
So imagine想像 that you make a solution
139
343000
2000
想像一下你製做了一種溶液
06:00
full充分 of this sticky material材料
140
345000
2000
裡頭都是這種高依附性物質
06:02
and inject注入 it into the veins of someone有人 who has cancer癌症,
141
347000
2000
然後注射到癌症患者的靜脈
06:04
everything's一切的 going to get lit發光的 up.
142
349000
2000
接著全身各部位開始發亮
06:06
Nothing will be specific具體.
143
351000
2000
沒有什麼地方不會發亮
06:08
There's no specificity特異性 there.
144
353000
2000
看不出任何不同的地方
06:10
So they added添加 two additional額外 components組件.
145
355000
2000
所以他們添加了兩種成分
06:12
The first one is a polyanionic聚陰離子 segment分割,
146
357000
3000
第一種是聚陰離子
06:15
which哪一個 basically基本上 acts行為 as a non-stick不粘 backing後盾
147
360000
2000
具有反依附作用
06:17
like the back of a sticker貼紙.
148
362000
2000
就像貼紙下面那張不黏的底紙
06:19
So when those two are together一起, the molecule分子 is neutral中性
149
364000
3000
當這兩種物質結合在一起時,分子變成中性
06:22
and nothing gets得到 stuck卡住 down.
150
367000
2000
不會附著在組織上
06:24
And the two pieces are then linked關聯
151
369000
3000
當這兩種物質結合在一起時
06:27
by something that can only be cut
152
372000
3000
必須使用特定的分子剪刀
06:30
if you have the right molecular分子 scissors剪刀 --
153
375000
2000
才能將兩者分開
06:32
for example, the kind of protease蛋白酶 enzymes
154
377000
2000
像是腫瘤產生的
06:34
that tumors腫瘤 make.
155
379000
2000
蛋白酵素
06:36
So here in this situation情況,
156
381000
2000
在這種溶液裡
06:38
if you make a solution full充分 of this three-part三部分 molecule分子
157
383000
4000
假如溶液裡含有這三種成分
06:42
along沿 with the dye染料, which哪一個 is shown顯示 in green綠色,
158
387000
2000
同時含有綠色染劑
06:44
and you inject注入 it into the vein靜脈
159
389000
3000
把這溶液注射到
06:47
of someone有人 who has cancer癌症,
160
392000
2000
癌症患者的靜脈裡
06:49
normal正常 tissue組織 can't cut it.
161
394000
2000
正常組織無法切斷分子鍵
06:51
The molecule分子 passes通行證 through通過 and gets得到 excreted排出.
162
396000
3000
溶液的分子流經組織,然後代謝掉
06:54
However然而, in the presence存在 of the tumor,
163
399000
2000
然而,當有腫瘤的時後
06:56
now there are molecular分子 scissors剪刀
164
401000
2000
裡面就有分子剪刀
06:58
that can break打破 this molecule分子 apart距離
165
403000
2000
可以把分子分開
07:00
right there at the cleavable裂解 site現場.
166
405000
2000
從可以切開的地方切斷
07:02
And now, boom繁榮,
167
407000
2000
接著,蹦
07:04
the tumor labels標籤 itself本身
168
409000
2000
腫瘤發亮了
07:06
and it gets得到 fluorescent.
169
411000
2000
並且發出螢光
07:08
So here's這裡的 an example of a nerve神經
170
413000
3000
這邊以神經為例
07:11
that has tumor surrounding周圍 it.
171
416000
2000
神經的周遭有腫瘤
07:13
Can you tell where the tumor is?
172
418000
2000
你看得出來腫瘤在哪嗎?
07:15
I couldn't不能 when I was working加工 on this.
173
420000
3000
我在那時候根本看不出來
07:18
But here it is. It's fluorescent.
174
423000
2000
不過現在有了,螢光的地方就是了
07:20
Now it's green綠色.
175
425000
2000
看起來是綠色的
07:22
See, so every一切 single one in the audience聽眾
176
427000
3000
在座的每位聽眾
07:25
now can tell where the cancer癌症 is.
177
430000
3000
都看得出來腫瘤在哪
07:28
We can tell in the operating操作 room房間, in the field領域,
178
433000
3000
我們在手術室能夠以分子般的細微程度
07:31
at a molecular分子 level水平,
179
436000
2000
判斷腫瘤位置
07:33
where is the cancer癌症 and what the surgeon外科醫生 needs需求 to do
180
438000
2000
知道哪邊需要進行手術
07:35
and how much more work they need to do
181
440000
2000
以及需要做到什麼程度
07:37
to cut that out.
182
442000
3000
才能將腫瘤切除
07:40
And the cool thing about fluorescence熒光
183
445000
2000
螢光最炫的地方在於
07:42
is that it's not only bright,
184
447000
3000
螢光不只會發亮
07:45
it actually其實 can shine閃耀 through通過 tissue組織.
185
450000
3000
還能穿透組織發亮
07:48
The light that the fluorescence熒光 emits發射
186
453000
3000
螢光所發出光線
07:51
can go through通過 tissue組織.
187
456000
2000
能夠穿透組織
07:53
So even if the tumor is not right on the surface表面,
188
458000
3000
就算腫瘤不在組織的表面
07:56
you'll你會 still be able能夠 to see it.
189
461000
3000
一樣可以看得到
07:59
In this movie電影, you can see
190
464000
2000
這段影片可以看見
08:01
that the tumor is green綠色.
191
466000
3000
腫瘤呈現綠色
08:04
There's actually其實 normal正常 muscle肌肉 on top最佳 of it. See that?
192
469000
3000
正常肌肉組織在上面,看到沒?
08:07
And I'm peeling去皮 that muscle肌肉 away.
193
472000
2000
我把肌肉剝開
08:09
But even before I peel that muscle肌肉 away,
194
474000
2000
不過就算還沒把肌肉剝開
08:11
you saw that there was a tumor underneath.
195
476000
3000
仍然看得到底下有腫瘤
08:14
So that's the beauty美女 of having a tumor
196
479000
3000
散發出螢光的腫瘤
08:17
that's labeled標記 with fluorescent molecules分子.
197
482000
3000
看起來就是這麼漂亮
08:20
That you can, not only see the margins利潤率
198
485000
2000
你不只能夠以分子般細微的尺度
08:22
right there on a molecular分子 level水平,
199
487000
2000
看出腫瘤的範圍
08:24
but you can see it even if it's not right on the top最佳 --
200
489000
3000
即使腫瘤的位置不在最上層一樣看得見
08:27
even if it's beyond your field領域 of view視圖.
201
492000
3000
即使有東西阻隔同樣看得到
08:30
And this works作品 for metastatic轉移性 lymph淋巴 nodes節點 also.
202
495000
3000
這項技術也可用在轉移性淋巴結
08:33
Sentinel哨兵 lymph淋巴 node節點 dissection解剖
203
498000
2000
前哨性淋巴腺摘除術
08:35
has really changed the way that we manage管理 breast乳房 cancer癌症, melanoma黑色素瘤.
204
500000
4000
改變了我們治療乳癌、黑色素瘤的方式
08:39
Women婦女 used to get
205
504000
2000
過去女性為了
08:41
really debilitating衰弱 surgeries手術
206
506000
2000
徹底切除腋下淋巴結
08:43
to excise摘除 all of the axillary lymph淋巴 nodes節點.
207
508000
3000
必須接受非常折人的手術
08:46
But when sentinel哨兵 lymph淋巴 node節點
208
511000
3000
不過按照我們治療
08:49
came來了 into our treatment治療 protocol協議,
209
514000
3000
前哨性淋巴結的方法
08:52
the surgeon外科醫生 basically基本上 looks容貌 for the single node節點
210
517000
3000
外科醫生會先尋找
08:55
that is the first draining排水 lymph淋巴 node節點 of the cancer癌症.
211
520000
3000
最早形成腫瘤的淋巴結
08:58
And then if that node節點 has cancer癌症,
212
523000
3000
假如這個淋巴結帶有腫瘤
09:01
the woman女人 would go on to get
213
526000
2000
該名女性病患
09:03
the axillary lymph淋巴 node節點 dissection解剖.
214
528000
2000
必須接受腋下淋巴結切除術
09:05
So what that means手段
215
530000
2000
也就是說
09:07
is if the lymph淋巴 node節點 did not have cancer癌症,
216
532000
3000
假如這個淋巴結沒有腫瘤
09:10
the woman女人 would be saved保存
217
535000
2000
患者就不必接受
09:12
from having unnecessary不必要 surgery手術.
218
537000
2000
不必要的手術
09:14
But sentinel哨兵 lymph淋巴 node節點, the way that we do it today今天,
219
539000
3000
現今我們執行的前哨性淋巴腺摘除術
09:17
is kind of like having a road map地圖
220
542000
2000
有點像拿著地圖
09:19
just to know where to go.
221
544000
2000
才知道要往哪邊走
09:21
So if you're driving主動 on the freeway高速公路
222
546000
2000
就像你在高速公路上開車
09:23
and you want to know where's哪裡 the next下一個 gas加油站 station,
223
548000
2000
想要知道下個加油站在哪
09:25
you have a map地圖 to tell you that that gas加油站 station is down the road.
224
550000
3000
地圖上顯示往前走就到了
09:28
It doesn't tell you whether是否 or not
225
553000
2000
地圖上不會告訴你
09:30
the gas加油站 station has gas加油站.
226
555000
2000
加油站有沒有油
09:32
You have to cut it out, bring帶來 it back home,
227
557000
3000
你得把油箱帶回家
09:35
cut it up, look inside
228
560000
2000
打開來看
09:37
and say, "Oh yes, it does have gas加油站."
229
562000
2000
然後才知道:「真的耶,裡面有油。」
09:39
So that takes more time.
230
564000
2000
所以這樣太費時了
09:41
Patients耐心 are still on the operating操作 room房間 table.
231
566000
2000
患者仍然躺在手術台
09:43
Anesthesiologists麻醉醫師, surgeons外科醫生 are waiting等候 around.
232
568000
2000
麻醉師、外科醫生在一旁等候
09:45
That takes time.
233
570000
2000
要等上一會的時間
09:47
So with our technology技術, we can tell right away.
234
572000
3000
有了這項技術,我們馬上就可以知道結果
09:50
You see a lot of little, roundish圓形 bumps顛簸 there.
235
575000
3000
這裡有一些小小的、圓圓的腫塊
09:53
Some of these are swollen lymph淋巴 nodes節點
236
578000
3000
其中有些是腫大的淋巴結
09:56
that look a little larger than others其他.
237
581000
2000
看起來比其他的要大
09:58
Who amongst其中包括 us hasn't有沒有 had swollen lymph淋巴 nodes節點 with a cold?
238
583000
3000
在座的各位有誰感冒時不會造成淋巴結腫大?
10:01
That doesn't mean that there's cancer癌症 inside.
239
586000
2000
腫大的淋巴結未必代表裡面有腫瘤
10:03
Well with our technology技術,
240
588000
2000
運用我們的技術
10:05
the surgeon外科醫生 is able能夠 to tell immediately立即
241
590000
3000
外科醫生可以馬上知道
10:08
which哪一個 nodes節點 have cancer癌症.
242
593000
2000
哪個淋巴結有腫瘤
10:10
I won't慣於 go into this very much,
243
595000
2000
細節部分不再多講
10:12
but our technology技術, besides除了 being存在 able能夠
244
597000
2000
不過這項技術
10:14
to tag標籤 tumor and metastatic轉移性 lymph淋巴 nodes節點 with fluorescence熒光,
245
599000
4000
除了可以用螢光標記轉移性淋巴結外
10:18
we can also use the same相同 smart聰明 three-part三部分 molecule分子
246
603000
4000
我們也可以用相同的三合一分子
10:22
to tag標籤 gadolinium onto the system系統
247
607000
3000
在系統裡標記出釓
10:25
so you can do this noninvasively無創.
248
610000
2000
如此可以用非入侵方式達到目的
10:27
The patient患者 has cancer癌症,
249
612000
2000
患者患有癌症
10:29
you want to know if the lymph淋巴 nodes節點 have cancer癌症
250
614000
2000
我們想在手術前
10:31
even before you go in.
251
616000
2000
知道他的淋巴結是否有腫瘤
10:33
Well you can see this on an MRIMRI.
252
618000
3000
可以用核磁共振影像得知
10:36
So in surgery手術,
253
621000
2000
在手術時
10:38
it's important重要 to know what to cut out.
254
623000
3000
了解切除掉的是什麼東西很重要
10:41
But equally一樣 important重要
255
626000
2000
不過同樣重要的是
10:43
is to preserve保留 things
256
628000
3000
把具有重要功能的組織
10:46
that are important重要 for function功能.
257
631000
3000
保留下來
10:49
So it's very important重要 to avoid避免 inadvertent非故意的 injury.
258
634000
3000
所以避免疏忽造成傷害很重要
10:52
And what I'm talking about
259
637000
2000
我這裡所說的是
10:54
are nerves神經.
260
639000
2000
神經
10:56
Nerves神經, if they are injured受傷,
261
641000
2000
假如神經受損
10:58
can cause原因 paralysis麻痺,
262
643000
2000
可能會造成癱瘓
11:00
can cause原因 pain疼痛.
263
645000
3000
造成疼痛
11:03
In the setting設置 of prostate前列腺 cancer癌症,
264
648000
2000
以前列腺癌來說
11:05
up to 60 percent百分 of men男人
265
650000
2000
有60%的患者
11:07
after prostate前列腺 cancer癌症 surgery手術
266
652000
2000
在前列腺癌手術後
11:09
may可能 have urinary尿 incontinence失禁
267
654000
2000
會出現尿失禁
11:11
and erectile勃起 disfunction功能不全.
268
656000
2000
以及勃起障礙
11:13
That's a lot of people to have a lot of problems問題 --
269
658000
3000
很多的問題發生在很多人的身上
11:16
and this is even in
270
661000
2000
即使是在
11:18
so-called所謂 nerve-sparing神經保留 surgery手術,
271
663000
2000
所謂的神經保護手術也一樣
11:20
which哪一個 means手段 that the surgeon外科醫生 is aware知道的 of the problem問題,
272
665000
4000
也就是說外科醫生知道這個問題
11:24
and they are trying to avoid避免 the nerves神經.
273
669000
2000
並且想辦法避開神經
11:26
But you know what, these little nerves神經 are so small,
274
671000
3000
不過各位知道嗎,和前列腺癌相比
11:29
in the context上下文 of prostate前列腺 cancer癌症,
275
674000
3000
神經非常的纖細
11:32
that they are actually其實 never seen看到.
276
677000
2000
醫生根本看不見
11:34
They are traced追踪
277
679000
2000
只能透過
11:36
just by their known已知 anatomical解剖 path路徑
278
681000
2000
已知的解剖路徑
11:38
along沿 vasculature血管.
279
683000
2000
沿著血管尋找
11:40
And they're known已知 because somebody has decided決定 to study研究 them,
280
685000
4000
因為有人對此研究,我們才得以知道
11:44
which哪一個 means手段 that we're still learning學習
281
689000
2000
也就是說我們仍在研究
11:46
about where they are.
282
691000
2000
神經的位置在哪
11:48
Crazy to think that we're having surgery手術,
283
693000
3000
很難想像如果我們要動手術切除腫瘤
11:51
we're trying to excise摘除 cancer癌症, we don't know where the cancer癌症 is.
284
696000
3000
但卻不知道腫瘤在哪
11:54
We're trying to preserve保留 nerves神經; we can't see where they are.
285
699000
3000
想要保留神經,但卻看不見在哪
11:57
So I said, wouldn't不會 it be great
286
702000
2000
所以我說,如果可以找到方法
11:59
if we could find a way
287
704000
2000
看見發出螢光的神經
12:01
to see nerves神經 with fluorescence熒光?
288
706000
3000
那不是很好嗎?
12:04
And at first this didn't get a lot of support支持.
289
709000
4000
起先這項研究沒有受到什麼支持
12:08
People said, "We've我們已經 been doing it this way for all these years年份.
290
713000
2000
大家都說:「這些年來我們都這樣開刀,
12:10
What's the problem問題?
291
715000
2000
有什麼問題嗎?
12:12
We haven't沒有 had that many許多 complications並發症."
292
717000
3000
我們很少遇到併發症。」
12:15
But I went ahead anyway無論如何.
293
720000
2000
不過我執意進行
12:17
And Roger羅傑 helped幫助 me.
294
722000
2000
Roger 協助我
12:19
And he brought his whole整個 team球隊 with him.
295
724000
3000
而且他帶著他的團隊
12:22
So there's that teamwork團隊合作 thing again.
296
727000
4000
所以這又是團隊研究
12:26
And we eventually終於 discovered發現 molecules分子
297
731000
3000
最後我們發現
12:29
that were specifically特別 labeling標籤 nerves神經.
298
734000
2000
可以標記神經的分子
12:31
And when we made製作 a solution of this,
299
736000
2000
當我們做好溶液
12:33
tagged標記 with the fluorescence熒光
300
738000
2000
用螢光作為標記
12:35
and injected注射 in the body身體 of a mouse老鼠,
301
740000
3000
把溶液注入老鼠體內
12:38
their nerves神經 literally按照字面 glowed閃著.
302
743000
2000
神經真的發亮了
12:40
You can see where they are.
303
745000
2000
各位可以看見神經在哪
12:42
Here you're looking at a sciatic坐骨神經 nerve神經 of a mouse老鼠,
304
747000
4000
現在看到的是老鼠的坐骨神經
12:46
and you can see that that big, fat脂肪 portion一部分 you can see very easily容易.
305
751000
3000
各位可以很容易的看見大大、肥肥的部分
12:49
But in fact事實, at the tip小費 of that where I'm dissecting解剖 now,
306
754000
3000
實際上,在我正在解剖的位置上
12:52
there's actually其實 very fine arborizationsarborizations
307
757000
3000
分佈著細微的神經分支
12:55
that can't really be seen看到.
308
760000
2000
肉眼看不見
12:57
You see what looks容貌 like little Medusa美杜莎 heads coming未來 out.
309
762000
4000
看起來就像小小的梅杜莎蛇頭伸出來
13:01
We have been able能夠 to see nerves神經
310
766000
2000
我們可以看見
13:03
for facial面部 expression表達, for facial面部 movement運動, for breathing呼吸 --
311
768000
3000
控制表情、顏面動作和呼吸的神經
13:06
every一切 single nerve神經 --
312
771000
2000
每一條都看得見
13:08
nerves神經 for urinary尿 function功能 around the prostate前列腺.
313
773000
3000
前列腺周圍泌尿功能的神經
13:11
We've我們已經 been able能夠 to see every一切 single nerve神經.
314
776000
3000
我們可以看見每條神經
13:14
When we put these two probes探頭 together一起 ...
315
779000
4000
當我們把這兩根探針放一起
13:18
So here's這裡的 a tumor.
316
783000
2000
看到腫瘤了
13:20
Do you guys know where the margins利潤率 of this tumor is?
317
785000
3000
各位知道腫瘤的範圍有多大嗎?
13:23
Now you do.
318
788000
3000
這麼大
13:26
What about the nerve神經 that's going into this tumor?
319
791000
3000
那麼腫瘤裡的神經又在哪呢?
13:29
That white白色 portion一部分 there is easy簡單 to see.
320
794000
2000
白色的部分很容易看見
13:31
But what about the part部分 that goes into the tumor?
321
796000
2000
但是穿進腫瘤的神經在哪呢?
13:33
Do you know where it's going?
322
798000
2000
各位知道神經分布在哪嗎?
13:35
Now you do.
323
800000
2000
這樣子
13:37
Basically基本上, we've我們已經 come up with a way
324
802000
2000
基本上,我們已經找到
13:39
to stain弄髒 tissue組織
325
804000
2000
把組織染色的方法
13:41
and color-code色標 the surgical外科 field領域.
326
806000
2000
並且在特定區域用顏色作標記
13:43
This was a bit of a breakthrough突破.
327
808000
3000
這是一項突破
13:46
I think that it'll它會 change更改 the way that we do surgery手術.
328
811000
4000
我想這會改變目前執行手術的方式
13:50
We published發表 our results結果
329
815000
2000
我們把結果發布於
13:52
in the proceedings訴訟 of the National國民 Academy學院 of Sciences科學
330
817000
2000
美國國家科學院院刊
13:54
and in Nature性質 Biotechnology生物技術.
331
819000
2000
以及自然生物科技期刊上
13:56
We received收到 commentary評論 in Discover發現 magazine雜誌,
332
821000
3000
發現雜誌和經濟學人雜誌
13:59
in The Economist經濟學家.
333
824000
2000
對我們的研究作了評論
14:01
And we showed顯示 it to a lot of my surgical外科 colleagues同事.
334
826000
3000
我們把成果拿給很多外科醫生同事看
14:04
They said, "Wow!
335
829000
2000
他們都說:「哇!
14:06
I have patients耐心
336
831000
2000
我的病人
14:08
who would benefit效益 from this.
337
833000
2000
可以因此受惠
14:10
I think that this will result結果 in my surgeries手術
338
835000
2000
我想這可以為我未來執行的手術
14:12
with a better outcome結果
339
837000
2000
帶來較好的成效
14:14
and fewer complications並發症."
340
839000
3000
並且減少併發症
14:17
What needs需求 to happen發生 now
341
842000
2000
現在要做的是
14:19
is further進一步 development發展 of our technology技術
342
844000
3000
進一步研究這項技術
14:22
along沿 with development發展
343
847000
2000
同時研發
14:24
of the instrumentation儀器儀表
344
849000
2000
相關的醫療儀器
14:26
that allows允許 us to see
345
851000
2000
好讓我們可以
14:28
this sort分類 of fluorescence熒光 in the operating操作 room房間.
346
853000
3000
在手術室看見螢光
14:31
The eventual最終 goal目標
347
856000
2000
最終的目標是
14:33
is that we'll get this into patients耐心.
348
858000
3000
把這項技術用在病患身上
14:36
However然而, we've我們已經 discovered發現
349
861000
3000
然而,我們發現
14:39
that there's actually其實 no straightforward直截了當 mechanism機制
350
864000
2000
現在沒有直接可用的裝置
14:41
to develop發展 a molecule分子
351
866000
2000
可以製作
14:43
for one-time一次 use.
352
868000
2000
供單次使用的分子
14:45
Understandably可以理解, the majority多數 of the medical industry行業
353
870000
3000
我們可以了解,大部分的醫療產業
14:48
is focused重點 on multiple-use多種用途 drugs毒品,
354
873000
4000
把主力集中在多用途的藥物
14:52
such這樣 as long-term長期 daily日常 medications藥物治療.
355
877000
3000
例如長效性的日服藥物
14:55
We are focused重點 on making製造 this technology技術 better.
356
880000
3000
我們把焦點放在改進技術
14:58
We're focused重點 on adding加入 drugs毒品,
357
883000
3000
添加藥物
15:01
adding加入 growth發展 factors因素,
358
886000
2000
添加生長因子
15:03
killing謀殺 nerves神經 that are causing造成 problems問題
359
888000
2000
殺除有問題的神經
15:05
and not the surrounding周圍 tissue組織.
360
890000
3000
而且不傷害周圍的組織
15:08
We know that this can be doneDONE and we're committed提交 to doing it.
361
893000
4000
我們知道這是可行的,所以我們堅決研究
15:12
I'd like to leave離開 you with this final最後 thought.
362
897000
4000
我想把我的感想跟大家分享
15:16
Successful成功 innovation革新
363
901000
2000
成功的創新
15:18
is not a single breakthrough突破.
364
903000
3000
並不是單一的突破
15:21
It is not a sprint短跑.
365
906000
3000
不像百米衝刺
15:24
It is not an event事件 for the solo獨奏 runner跑步者.
366
909000
4000
不是單一跑者的比賽
15:28
Successful成功 innovation革新
367
913000
2000
成功的創新
15:30
is a team球隊 sport運動, it's a relay中繼 race種族.
368
915000
3000
是團隊運動,是接力賽跑
15:33
It requires要求 one team球隊 for the breakthrough突破
369
918000
4000
需要某個團隊先行突破
15:37
and another另一個 team球隊
370
922000
2000
另一個團隊
15:39
to get the breakthrough突破 accepted公認 and adopted採用.
371
924000
2000
把這項突破拿來應用
15:41
And this takes the long-term長期 steady穩定 courage勇氣
372
926000
3000
這需要長久堅忍不拔的勇氣
15:44
of the day-in日式 day-out一天出 struggle鬥爭
373
929000
2000
日復一日的奮鬥
15:46
to educate教育, to persuade說服
374
931000
3000
去教育、說服其他人
15:49
and to win贏得 acceptance驗收.
375
934000
3000
以獲得接受
15:52
And that is the light that I want to shine閃耀
376
937000
2000
這就是我在健康和醫療
15:54
on health健康 and medicine醫學 today今天.
377
939000
2000
所點亮的一盞燈
15:56
Thank you very much.
378
941000
2000
謝謝各位
15:58
(Applause掌聲)
379
943000
4000
(鼓掌)
Translated by 俊偉 盧
Reviewed by Joyce Chou

▲Back to top

ABOUT THE SPEAKER
Quyen Nguyen - Surgeon
Quyen Nguyen uses molecular probes that make tumors -- and just the tumors -- glow, as an extraordinary aid to surgeons.

Why you should listen

Dr. Quyen Nguyen’s research (working with Roger Tsien, Nobel Laureate in Chemistry) is focused on the development of fluorescently labeled probes for molecular navigation during surgery. Their first collaborative effort yielded a “smart” probe that makes tumors margins fluoresce, or “glow” and thus easier for surgeons to see and remove accurately during surgery. Their most recent joint effort resulted in another type of probe that can make nerves “glow” during surgery, thus helping surgeons repair injured nerves and avoid inadvertent injury.

She is a professor of surgery and director of the Facial Nerve Clinic at the University of California, San Diego.

More profile about the speaker
Quyen Nguyen | Speaker | TED.com