美國(guó)首例生殖器移植手術(shù) 患者有望重獲性功能

A man whose penis was removed because of cancerhas received the first penis transplant in the UnitedStates, at Massachusetts General Hospital in Boston.

一名因?yàn)轭净及┌Y而被切除陰莖的男子在波士頓的麻省總醫(yī)院(Massachusetts General Hospital)接受了美國(guó)首例陰莖移植手術(shù)。

Thomas Manning, 64, a bank courier from Halifax,Mass., underwent the 15-hour transplant operationon May 8 and 9. The organ came from a deceaseddonor.

托馬斯·曼寧(Thomas Manning)現(xiàn)年64歲，是馬薩諸塞州哈利法克斯的一名銀行快遞員。今年5月8日到9日，他接受了一場(chǎng)長(zhǎng)達(dá)15個(gè)小時(shí)的手術(shù)。移植的器官來(lái)自一名已逝捐贈(zèng)者。

“I want to go back to being who I was,” Mr. Manning said on Friday in an interview in hishospital room. Sitting up in a chair, happy to be out of bed for the first time since theoperation, he said he felt well and had experienced hardly any pain.

“我想重新做回原來(lái)的自己，”曼寧周五在病房接受采訪時(shí)說(shuō)。他坐在一把椅子上，因?yàn)槭中g(shù)后第一次下了床而心情不錯(cuò)。他說(shuō)自己感覺(jué)挺好，幾乎感覺(jué)不到什么痛。

“We’re cautiously optimistic,” said Dr. Curtis L. Cetrulo, a plastic and reconstructive surgeonand a leader of the surgical team. “It’s uncharted waters for us.”

“我們保持謹(jǐn)慎的樂(lè)觀，”整形重建外科醫(yī)生、帶領(lǐng)該手術(shù)團(tuán)隊(duì)的柯蒂斯·L·塞特魯洛博士(Curtis L. Cetrulo)說(shuō)。“對(duì)我們來(lái)說(shuō)，這是一片未知的水域。”

The surgery is experimental, part of a research program with the ultimate goal of helpingcombat veterans with severe pelvic injuries, as well as cancer patients and accident victims.

這次手術(shù)是實(shí)驗(yàn)性的，屬于一個(gè)研究項(xiàng)目的一部分。該項(xiàng)目的終極目標(biāo)是給骨盆區(qū)有嚴(yán)重傷殘的退伍軍人、癌癥病人和在事故中受傷的人提供幫助。

If all goes as planned, normal urination should be possible for Mr. Manning within a few weeks,and sexual function in weeks to months, Dr. Cetrulo said.

塞特魯洛表示，如果一切順利，曼寧在幾星期內(nèi)應(yīng)該就可以正常排尿，幾周至幾個(gè)月后，則可以有性功能。

Mr. Manning welcomed questions and said he wanted to speak out publicly to help dispel theshame and stigma associated with genital cancers and injuries, and to let other men knowthere was hope of having normal anatomy restored.

曼寧歡迎外界向他提問(wèn)，并表示他希望自己可以公開(kāi)談?wù)撨@件事，以幫助消除與生殖器癌癥和創(chuàng)傷有關(guān)的恥辱感，也讓其他男士知道他們有希望恢復(fù)正常的生理構(gòu)造。

“Don’t hide behind a rock,” he said.

“不要藏在石頭后面，”他說(shuō)。

He said he was not quite ready to take a close look at his transplant.

他說(shuō)他還沒(méi)有完全做好準(zhǔn)備來(lái)仔細(xì)觀察自己移植的器官。

He will have to take several anti-rejection drugs for the rest of his life. One of them,tacrolimus, seems to speed nerve regeneration and may help restore function to thetransplant, Dr. Cetrulo said.

在余生里，曼寧將必須一直服用幾種抗排異藥物。塞特魯洛表示，其中一種是他克莫司，這種藥似乎會(huì)加速神經(jīng)再生，或許有助于恢復(fù)移植器官發(fā)揮功能。

Another patient, his penis destroyed by burns in a car accident, will receive a transplant as soonas a matching donor becomes available, Dr. Cetrulo said.

塞特魯洛還表示，還有一名在車(chē)禍中燒毀陰莖的病人正在等待合適的捐贈(zèng)器官，一旦配對(duì)成功就會(huì)接受移植手術(shù)。

Surgeons at the Johns Hopkins University School of Medicine are also planning to performpenis transplants, and have had a combat veteran, injured in Afghanistan, on the waiting listfor several months.

約翰·霍普金斯大學(xué)醫(yī)學(xué)院(Johns Hopkins University School of Medicine)的外科醫(yī)生也在計(jì)劃進(jìn)行陰莖移植手術(shù)。一名在阿富汗受傷的退伍軍人已經(jīng)在名單上等待了好幾個(gè)月。

Dr. Cetrulo estimated the cost at $50,000 to $75,000. Both hospitals are paying for theprocedures, and the doctors are donating their time.

據(jù)塞特魯洛估計(jì)，這項(xiàng)手術(shù)的費(fèi)用在5萬(wàn)至7.5萬(wàn)美元之間。目前這兩家醫(yī)院都在為病人支付手術(shù)費(fèi)用，參與的醫(yī)生也是在無(wú)償貢獻(xiàn)自己的時(shí)間。

Worldwide, only two other penis transplants have been reported: a failed one in China in 2006and a successful one in South Africa in 2014, in which the recipient later fathered a child.

在全球范圍內(nèi)，只出現(xiàn)過(guò)另外兩例有關(guān)陰莖移植的報(bào)道：2006年在中國(guó)進(jìn)行的一次以失敗告終，2014年在南非進(jìn)行的一次獲得了成功，而且接受移植的患者后來(lái)還有了小孩。

Veterans are a major focus of transplant programs in the United States because suicide ratesare exceptionally high in soldiers with severe damage to the genitals and urinary tract, Dr.Cetrulo said. “They’re 18- to 20-year-old guys, and they feel they have no hope of intimacy ora sexual life,” he said. “They can’t even go to the bathroom standing up.”

塞特魯洛稱，在美國(guó)，退伍軍人是移植手術(shù)項(xiàng)目主要關(guān)注的對(duì)象，因?yàn)樯称鞴俸兔谀蛳到y(tǒng)嚴(yán)重?fù)p傷的軍人自殺率格外高。“有些是18到20歲的小伙子，他們覺(jué)得自己不再有希望獲得親密關(guān)系或性生活，”他說(shuō)。“他們甚至都做不到直立小便。”

Given the psychological toll, he said, a penis transplant can be lifesaving.

他說(shuō)，考慮到如此嚴(yán)重的心理創(chuàng)傷，陰莖移植手術(shù)或許可以挽救他們的人生。

Dr. Cetrulo said the team would most likely perfect its techniques on civilian patients and thenmove on to injured veterans. It will also train military surgeons to perform the transplants.The Department of Defense, he said in an email, “does not like to have wounded warriorsundergo unproven techniques — i.e., they do not want them to be ‘guinea pigs,’ as they havealready sacrificed so much.”

塞特魯洛稱，手術(shù)團(tuán)隊(duì)極有可能會(huì)先通過(guò)平民病患來(lái)完善技術(shù)，然后再將其運(yùn)用到受傷老兵身上。該團(tuán)隊(duì)還將訓(xùn)練軍隊(duì)醫(yī)生進(jìn)行移植手術(shù)。他在電子郵件中表示，美國(guó)國(guó)防部“不想讓受傷的勇士接受未經(jīng)驗(yàn)證的技術(shù)，也就是說(shuō)不愿讓他們做‘小白鼠’，因?yàn)樗麄円呀?jīng)做出了很大犧牲”。

His team is working on ways to minimize or even eliminate the need for anti-rejectionmedicines, which transplant patients typically have to take. That research is especiallyimportant for veterans, he said, because many are young and will risk serious adverse effects,like cancer and kidney damage, if they have to take the drugs for decades.

他帶領(lǐng)的團(tuán)隊(duì)正在想辦法把對(duì)抗排斥藥物的需求降到最低，甚至消除。接受移植手術(shù)的病人往往都需要服用這類藥物。他表示，這類研究對(duì)老兵尤其重要，因?yàn)楹芏嗬媳际悄贻p人，如果不得不幾十年堅(jiān)持服用這類藥物，他們會(huì)面臨嚴(yán)重的副作用風(fēng)險(xiǎn)，如癌癥和腎臟受損。

From 2001 to 2013, 1,367 men in the military suffered so-called genitourinary injuries in Iraqor Afghanistan, according to the Department of Defense Trauma Registry. Nearly all were under35 and had been hurt by homemade bombs, commonly called improvised explosive devices,or I.E.D.s. Some lost part or all of their penises.

美國(guó)國(guó)防部創(chuàng)傷登記(Department of Defense Trauma Registry)的數(shù)據(jù)顯示，從2001年到2013年，有1367名美國(guó)軍人在伊拉克或阿富汗受到所謂的泌尿生殖系統(tǒng)損傷。這些人幾乎都在35歲以下，且基本上都是被統(tǒng)稱為簡(jiǎn)易爆炸裝置(IED)的自制炸彈所傷。一些人失去了部分或全部陰莖。

The Massachusetts General team spent three years preparing for the penis transplants. Theteam did meticulous dissections in a cadaver lab to map out anatomy, and operated on five orsix dead donors to practice removing the tissue needed for the transplants. Mr. Manning’soperation involved about a dozen surgeons and 30 other health care workers.

麻省總醫(yī)院的團(tuán)隊(duì)為陰莖移植準(zhǔn)備了三年時(shí)間。為了繪制結(jié)構(gòu)圖，該團(tuán)隊(duì)在一個(gè)尸體實(shí)驗(yàn)室里小心翼翼地進(jìn)行解剖，還在五六個(gè)已去世的捐獻(xiàn)者身上做手術(shù)，練習(xí)切除移植手術(shù)所需的組織。參與曼寧的手術(shù)的，有大約12名醫(yī)生和另外30名醫(yī)護(hù)人員。

Dr. Dicken Ko, a team leader and the director of the hospital’s regional urology program, saidthe team had not planned a set number of transplants. Instead, he said, the hospital willevaluate candidates one at a time and decide whether to allow surgery. For now, he said, thetransplants will be limited to cancer and trauma patients, and will not be offered totransgender people.

團(tuán)隊(duì)帶頭人、醫(yī)院地區(qū)泌尿科主任迪肯·高(Dicken Ko)表示，該團(tuán)隊(duì)并未擬定固定的移植手術(shù)數(shù)量。他說(shuō)，醫(yī)院會(huì)一次性評(píng)估所有候選人，并決定是否同意進(jìn)行手術(shù)。目前，他表示，移植手術(shù)僅限于癌癥和外傷患者，不面向跨性別者。

An accident at work in 2012 brought Mr. Manning to the hospital, and ultimately to thetransplant team. Heavy equipment had fallen on him, causing severe injuries. The doctorstreating him saw an abnormal growth on his penis that he had not noticed.

在2012年，工作期間發(fā)生的一場(chǎng)事故導(dǎo)致曼寧被送了醫(yī)院，并最終出現(xiàn)在了移植手術(shù)團(tuán)隊(duì)的面前。重型設(shè)備倒在他身上，導(dǎo)致他身受重傷。治療他的醫(yī)生發(fā)現(xiàn)他的陰莖上有一處異常生長(zhǎng)物，他此前并未注意到。

Tests revealed an aggressive and potentially fatal cancer. Penile cancer is rare, with about2,030 new cases and 340 deaths expected in the United States this year.

檢查發(fā)現(xiàn)，他患上了一種惡性的、可能會(huì)致命的癌癥。陰莖癌不常見(jiàn)，美國(guó)今年預(yù)計(jì)會(huì)出現(xiàn)大約2030例新增病例和340例死亡病例。

If not for the accident, Mr. Manning said, “I would’ve been in the ground two years ago.”

曼寧稱，如果不是那場(chǎng)意外，“我兩年前就不在了。”

Doctors said that to save his life, they would have to remove most of his penis, in an operationcalled a partial penectomy. Mr. Manning’s urologic oncologist, Dr. Adam S. Feldman,estimated that a few hundred men a year needed full or partial penectomies because of cancer.

醫(yī)生稱，為了挽救他的生命，他們必須切除他的大部分陰莖。這種手術(shù)叫陰莖部分切除術(shù)。曼寧的泌尿腫瘤醫(yī)生亞當(dāng)·S·費(fèi)爾德曼(Adam S. Feldman)估計(jì)，每年會(huì)有幾百人因?yàn)榘┌Y而需要接受陰莖全部或部分切除術(shù)。

Mr. Manning was left with a stump about an inch long. He had to sit to urinate. Intimacy wasout of the picture. He was single and was not involved with anyone when the cancer was found.After the amputation, new relationships were unthinkable. “I wouldn’t go near anybody,” hesaid.

手術(shù)過(guò)后，曼寧的陰莖只有大約一英寸(約合2.5厘米)長(zhǎng)。他必須得坐著小便。性生活則完全不可能。發(fā)現(xiàn)癌癥時(shí)，他是單身，也沒(méi)有戀人。切除手術(shù)過(guò)后，發(fā)展新戀情已經(jīng)不可想象。“我不會(huì)靠近任何人，”他說(shuō)。

He continued: “I couldn’t have a relationship with anybody. You can’t tell a woman, ‘I had apenis amputation.’”

“我沒(méi)法和任何人發(fā)展戀愛(ài)關(guān)系。總不能對(duì)女方說(shuō)，‘我做過(guò)陰莖切除手術(shù)，’”他接著說(shuō)。

Before he had even left the hospital after the amputation, he began asking Dr. Feldman about atransplant. No one at the hospital was considering the idea yet, and Dr. Feldman admits that hethought it was a bit outlandish.

手術(shù)過(guò)后，還沒(méi)出院，他就開(kāi)始向費(fèi)爾德曼打聽(tīng)移植的事情。當(dāng)時(shí)，醫(yī)院里還沒(méi)人考慮這個(gè)問(wèn)題，費(fèi)爾德曼也承認(rèn)自己當(dāng)時(shí)覺(jué)得這個(gè)主意有點(diǎn)奇怪。

But Mr. Manning never gave up hope. “I kept my eye on the prize,” he said.

但曼寧從未放棄希望。“我一直保持著樂(lè)觀心態(tài)，”他說(shuō)。

Manning has no regrets. He looks forward to going back to work and hopes to eventually havea love life again.

曼寧無(wú)怨無(wú)悔。他期待重回工作崗位，并希望最終能再次享受愛(ài)情生活。

“If I’m lucky, I get 75 percent of what I used to be,” he said. “Before the surgery I was 10percent. But they made no promises. That was part of the deal.”

“如果運(yùn)氣好的話，我能恢復(fù)到以前的75%，”他說(shuō)。“手術(shù)前是10%。但他們沒(méi)有保證。這是協(xié)議的一部分。”