When the world’s first face transplant was performed in France in 2005, it pushed medical boundaries and made news. Yet the procedure’s future was very much in doubt.
全球首例臉部移植手術2005年在法國進行，衝撞醫學極限，也成為頭條新聞。然而當時這種手術前途頗不看好。
The surgeons, operating on a 38-year-old Frenchwoman whose face had been mauled by her pet Labrador, had to surmount the opposition of prestigious medical societies, which declared the procedure unethical and immoral. Critics, including surgeons who had lost out in competing to do the first face transplant, said the pioneering team did not follow ethical and legal guidelines.
病人是臉部被自家拉布拉多犬嚴重咬傷的38歲法國婦女。手術團隊先得說服認為手術有違醫學倫理與道德的知名醫學團體。反對者指這個先驅團隊未遵守道德與法律規範，其中不乏未能在執行這種手術的競爭中拔得頭籌的外科醫師。
But the first comprehensive review of every face transplant reported since then — 28 in seven countries, counting the French case but not two done in Turkey since the review was completed — has removed many of those early doubts.
然而此後歷次通報臉部移植手術的首次全面檢討（計7國、28例，含法國的這一例，但不包括檢討結束後才在土耳其進行的2次），已化解許多早期的疑慮。
The report, published online by The Lancet in April, says the procedure is generally safe and feasible, and should be offered to more patients.
檢討報告四月發表在「刺胳針」醫學期刊網路版，指出這種手術大體而言安全且可行，應讓更多病人受惠。
The endorsement is cautious: The researchers note that the operation is still experimental, risky and expensive (at least $300,000), and that patients must be carefully selected. After the transplant, recipients may have risks of infection and reactions to toxic anti-rejection drugs.
背書很謹慎。研究人員說，這種手術仍處於實驗階段、有風險、所費不貲（至少30萬美元），而且必須慎選病人。病人術後可能受到感染，並對有毒性的抗排斥藥物產生反應。
But the paper adds that for many people — victims of genetic disorders, gunshots, animal bites, burns and other accidents — transplants can ease or erase the grotesque deformities that leave them subject to taunts, discrimination, isolation and serious depression.
不過報告說，對許多人（遺傳疾病患者、槍傷、動物撕咬、燒傷與其他意外的受害者）來說，移植可以紓解或消除引來嘲笑、歧視、孤獨與嚴重沮喪的嚴重變形。
Conventional reconstruction techniques are often inadequate, and can produce terrible scars and deformities at the sites in the patient’s body from which tissue is removed and transferred to the facial area.
傳統重建手術往往有所不足，還會在病人移除組織移往臉部的身體部位造成駭人的疤痕或畸形。
By contrast, face transplants have transformed the lives of nearly all the surviving recipients. They have regained their ability to eat, drink, speak more intelligibly, smell, smile and blink; many have emerged from ostracism and depression. Four recipients are back to work or school. (Three patients died.)
相形之下，接受臉部移植而仍然健在者，生命幾乎全因手術而翻轉。他們已恢復吃、喝、更清楚說話、嗅、微笑與眨眼的能力；許多人不再自我孤立、憂鬱。其中4人重返職場或學校（3人已死亡）。
The idea of one individual wearing another’s face initially frightened some critics. But the new face “is a pretty unique blend of the recipient and the donor, and it is not as if you would recognize the donor walking down the street,” the review’s senior author, Dr. Eduardo D. Rodriguez of NYU Langone Medical Center in New York, said in an interview. He holds degrees in medicine and dentistry, and led the team that performed a full facial transplant in 2012 when he was at the University of Maryland.
換上別人的臉這光景曾使部分批評者坐立不安。報告主要撰寫人紐約大學藍根醫學中心的羅德里蓋茲醫師說，新臉巧妙結合受贈者與捐贈者，「你不會覺得是看到捐贈者在路上走」。他擁有醫學與牙科雙學位，2012年在馬里蘭大學工作時帶隊執行一次全臉移植手術。
New faces initially feel numb, as if the recipient had come from a dentist’s office. But the numbness lasts for months.
新臉最初會使人覺得麻木，彷彿受贈者剛看完牙醫。這種感覺會持續幾個月。
Skeptics doubted that recipients would ever regain normal facial sensations — feeling a kiss or a breeze, smelling mowed grass. But some did, as early as three months after the transplant. Some critics said nerve repair would take too long to achieve functional gains, for instance in eating and swallowing, but some patients could bring their new lips together by six months and close their mouths by eight months. By three months, some were able to swallow and speak intelligibly. Smiling began later, after about two years, and continued to improve after eight years.
有人懷疑受贈者會恢復正常的臉部知覺，包括感覺一個吻或微風，聞到刈草的氣味。然而有些人的確會恢復，最快在術後3個月。有批評者說，神經修復需時太長，無法達到功能上的利益，例如吃與吞嚥。然而有些病人術後6個月即可讓兩唇相碰，8個月可以闔嘴。有人3個月就能吞嚥並清楚說話。微笑較晚，約要到2年後，8年後仍持續改善。
Not surprisingly, the overriding reason for success was a rigorous pre-transplant effort to identify candidates who would be motivated to stick to an anti- rejection regimen and who had a strong social support system. Deciding who is and who is not a face transplant candidate can be more grueling than the surgery, which can take longer than a day.
可想而知，成功關鍵在於嚴選願恪遵抗排斥療法，且有堅定群體支持的病人。挑選適合病人可能比時而長逾一天的手術還累人。
Surgeons can spend years training for the procedure and then spend months more seeking a donor with a compatible complexion, bone structure and other important characteristics.
醫師可能得先受多年訓練，再以數月物色外觀、骨骼結構與其他重要特徵合適的捐贈者。
One team removes the face and underlying tissues from a donor, while a second team removes the damaged portions of the recipient’s face. Bone, if needed, is attached first. Then four major arteries and veins, two on each side of the upper neck, are attached as quickly as possible. Once blood flows to nourish the new face, surgeons can take more time to stitch nerves, muscles, other soft tissues and finally the skin.
一個手術團隊取下捐贈者的臉部與皮下組織，另一團隊則移除受贈者臉部的受損部位。如有必要，先繫上骨頭，其次盡速繫好位於上頸部兩側的4條主動脈與靜脈。血液開始為新臉供應養分時，醫師再縫綴神經、肌肉與其他軟組織，最後是皮膚。
As the graft heals and nerves regenerate, rehabilitation to relearn speaking and other tasks begins; monitoring for rejection lasts a lifetime. The early successes of hand and arm transplants, starting in 1998, helped advocates for face transplants. Because both kinds of transplants involve a mixture of bone, blood vessels, muscle, nerve and other soft tissues, skeptics said standard immunosuppressant therapy might not prevent rejection. But a three-drug regimen used for heart, liver and kidney transplants turned out to work.
移植物癒合與神經再生後，開始重學講話與其他功能的復健。排斥現象須終身監控。1998年開始的早期手、臂成功移植使支持者得以提倡臉部移植。由於這兩種手術都涉及骨頭、血管、肌肉、神經與其他軟組織，懷疑者說，標準的免疫抑制療法可能無法預防排斥。然而一種針對心、肝與腎移植手術的3藥合一療法經證明有效。
French surgeons have performed 10 face transplants. Seven transplants have been done in the United States, seven in Turkey, three in Spain, and one each in Belgium, China and Poland.
法國醫師做過10次臉部移植。美國、土耳其各7次，西班牙3次，比利時、中國大陸與波蘭各一次。
Dr. Rodriguez said he undertook the review to help improve outcomes in future cases, and to determine how many face transplants needed to be done to convince health insurers to pay for them. The costs of surgery and anti-rejection therapy require lifelong financial support. Many recipients need post-transplant surgical revision for such problems as bone and dental realignment, which increases the risk of infection and poor wound healing.
羅德里蓋茲說，他檢討歷次手術是要改善未來手術的效果，並決定要有多少案例健保業者才願給付。手術與抗排斥治療需要終身的財務支援。許多人因骨、齒重新整合而須在術後做外科整形，提高感染與傷口癒合不良的機率。
Government agencies have contributed to pressure for expansion. As Dr. Rodriguez said, “With some victims from fire, police and military armed services, it can be argued that we have a moral imperative to restore them to society.”
政府機構增強了多做手術的壓力。他說：「有些病人因火吻或任軍警而受傷。讓他們重返社會是我們的道德責任。」
