美国首例阴茎移植术：患者有望重获性功能

Man Receives First Penis Transplant in the United States
美国首例阴茎移植术：患者有望重获性功能

A man whose penis was removed because of cancer has received the first penis transplant in the United States, at Massachusetts General Hospital in Boston.

一名因为罹患癌症而被切除阴茎的男子在波士顿的麻省总医院(Massachusetts General Hospital)接受了美国首例阴茎移植手术。

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

托马斯·曼宁(Thomas Manning)现年64岁，是马萨诸塞州哈利法克斯的一名银行快递员。今年5月8日到9日，他接受了一场长达15个小时的手术。移植的器官来自一名已逝捐赠者。

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

“我想重新做回原来的自己，”曼宁周五在病房接受采访时说。他坐在一把椅子上，因为手术后第一次下了床而心情不错。他说自己感觉挺好，几乎感觉不到什么痛。

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

“我们保持谨慎的乐观，”整形重建外科医生、带领该手术团队的柯蒂斯·L·塞特鲁洛博士(Curtis L. Cetrulo)说。“对我们来说，这是一片未知的水域。”

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

这次手术是实验性的，属于一个研究项目的一部分。该项目的终极目标是给骨盆区有严重伤残的退伍军人、癌症病人和在事故中受伤的人提供帮助。

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.

塞特鲁洛表示，如果一切顺利，曼宁在几星期内应该就可以正常排尿，几周至几个月后，则可以有性功能。

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

曼宁欢迎外界向他提问，并表示他希望自己可以公开谈论这件事，以帮助消除与生殖器癌症和创伤有关的耻辱感，也让其他男士知道他们有希望恢复正常的生理构造。

“Don’t hide behind a rock,” he said.

“不要藏在石头后面，”他说。

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

他说他还没有完全做好准备来仔细观察自己移植的器官。

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 the transplant, Dr. Cetrulo said.

在余生里，曼宁将必须一直服用几种抗排异药物。塞特鲁洛表示，其中一种是他克莫司，这种药似乎会加速神经再生，或许有助于恢复移植器官发挥功能。

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

塞特鲁洛还表示，还有一名在车祸中烧毁阴茎的病人正在等待合适的捐赠器官，一旦配对成功就会接受移植手术。

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

约翰·霍普金斯大学医学院(Johns Hopkins University School of Medicine)的外科医生也在计划进行阴茎移植手术。一名在阿富汗受伤的退伍军人已经在名单上等待了好几个月。

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

据塞特鲁洛估计，这项手术的费用在5万至7.5万美元之间。目前这两家医院都在为病人支付手术费用，参与的医生也是在无偿贡献自己的时间。

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

在全球范围内，只出现过另外两例有关阴茎移植的报道：2006年在中国进行的一次以失败告终，2014年在南非进行的一次获得了成功，而且接受移植的患者后来还有了小孩。

Veterans are a major focus of transplant programs in the United States because suicide rates are 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 or a sexual life,” he said. “They can’t even go to the bathroom standing up.”

塞特鲁洛称，在美国，退伍军人是移植手术项目主要关注的对象，因为生殖器官和泌尿系统严重损伤的军人自杀率格外高。“有些是18到20岁的小伙子，他们觉得自己不再有希望获得亲密关系或性生活，”他说。“他们甚至都做不到直立小便。”

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

他说，考虑到如此严重的心理创伤，阴茎移植手术或许可以挽救他们的人生。

Dr. Cetrulo said the team would most likely perfect its techniques on civilian patients and then move 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 warriors undergo unproven techniques — i.e., they do not want them to be ‘guinea pigs,’ as they have already sacrificed so much.”

塞特鲁洛称，手术团队极有可能会先通过平民病患来完善技术，然后再将其运用到受伤老兵身上。该团队还将训练军队医生进行移植手术。他在电子邮件中表示，美国国防部“不想让受伤的勇士接受未经验证的技术，也就是说不愿让他们做‘小白鼠’，因为他们已经做出了很大牺牲”。

His team is working on ways to minimize or even eliminate the need for anti-rejection medicines, which transplant patients typically have to take. That research is especially important 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.

他带领的团队正在想办法把对抗排斥药物的需求降到最低，甚至消除。接受移植手术的病人往往都需要服用这类药物。他表示，这类研究对老兵尤其重要，因为很多老兵都是年轻人，如果不得不几十年坚持服用这类药物，他们会面临严重的副作用风险，如癌症和肾脏受损。

From 2001 to 2013, 1,367 men in the military suffered so-called genitourinary injuries in Iraq or Afghanistan, according to the Department of Defense Trauma Registry. Nearly all were under 35 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.

美国国防部创伤登记(Department of Defense Trauma Registry)的数据显示，从2001年到2013年，有1367名美国军人在伊拉克或阿富汗受到所谓的泌尿生殖系统损伤。这些人几乎都在35岁以下，且基本上都是被统称为简易爆炸装置(IED)的自制炸弹所伤。一些人失去了部分或全部阴茎。

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

麻省总医院的团队为阴茎移植准备了三年时间。为了绘制结构图，该团队在一个尸体实验室里小心翼翼地进行解剖，还在五六个已去世的捐献者身上做手术，练习切除移植手术所需的组织。参与曼宁的手术的，有大约12名医生和另外30名医护人员。

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

团队带头人、医院地区泌尿科主任迪肯·高(Dicken Ko)表示，该团队并未拟定固定的移植手术数量。他说，医院会一次性评估所有候选人，并决定是否同意进行手术。目前，他表示，移植手术仅限于癌症和外伤患者，不面向跨性别者。

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

在2012年，工作期间发生的一场事故导致曼宁被送了医院，并最终出现在了移植手术团队的面前。重型设备倒在他身上，导致他身受重伤。治疗他的医生发现他的阴茎上有一处异常生长物，他此前并未注意到。

Tests revealed an aggressive and potentially fatal cancer. Penile cancer is rare, with about 2,030 new cases and 340 deaths expected in the United States this year.

检查发现，他患上了一种恶性的、可能会致命的癌症。阴茎癌不常见，美国今年预计会出现大约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.”

曼宁称，如果不是那场意外，“我两年前就不在了。”

Doctors said that to save his life, they would have to remove most of his penis, in an operation called 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.

医生称，为了挽救他的生命，他们必须切除他的大部分阴茎。这种手术叫阴茎部分切除术。曼宁的泌尿肿瘤医生亚当·S·费尔德曼(Adam S. Feldman)估计，每年会有几百人因为癌症而需要接受阴茎全部或部分切除术。

Mr. Manning was left with a stump about an inch long. He had to sit to urinate. Intimacy was out 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,” he said.

手术过后，曼宁的阴茎只有大约一英寸（约合2.5厘米）长。他必须得坐着小便。性生活则完全不可能。发现癌症时，他是单身，也没有恋人。切除手术过后，发展新恋情已经不可想象。“我不会靠近任何人，”他说。

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

“我没法和任何人发展恋爱关系。总不能对女方说，‘我做过阴茎切除手术，’”他接着说。

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

手术过后，还没出院，他就开始向费尔德曼打听移植的事情。当时，医院里还没人考虑这个问题，费尔德曼也承认自己当时觉得这个主意有点奇怪。

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

但曼宁从未放弃希望。“我一直保持着乐观心态，”他说。

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

曼宁无怨无悔。他期待重回工作岗位，并希望最终能再次享受爱情生活。

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

“如果运气好的话，我能恢复到以前的75%，”他说。“手术前是10%。但他们没有保证。这是协议的一部分。”