美國首例生殖器移植手術 患者有望重獲性功能

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.

一名因爲罹患癌症而被切除陰莖的男子在波士頓的麻省總醫院(Massachusetts General Hospital)接受了美國首例陰莖移植手術。

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.

托馬斯·曼寧(Thomas Manning)現年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，他接受了一場長達15個小時的手術。移植的器官來自一名已逝捐贈者。

“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.

“我想重新做回原來的自己，”曼寧週五在病房接受採訪時說。他坐在一把椅子上，因爲手術後第一次下了牀而心情不錯。他說自己感覺挺好，幾乎感覺不到什麼痛。

“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.”

“我們保持謹慎的樂觀，”整形重建外科醫生、帶領該手術團隊的柯蒂斯·L·塞特魯洛博士(Curtis L. Cetrulo)說。“對我們來說，這是一片未知的水域。”

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.

這次手術是實驗性的，屬於一個研究項目的一部分。該項目的終極目標是給骨盆區有嚴重傷殘的退伍軍人、癌症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，曼寧在幾星期內應該就可以正常排尿，幾周至幾個月後，則可以有性功能。

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.

曼寧歡迎外界向他提問，並表示他希望自己可以公開談論這件事，以幫助消除與生殖器癌症和創傷有關的恥辱感，也讓其他男士知道他們有希望恢復正常的生理構造。

“Don’t hide behind a rock,” he said.

“不要藏在石頭後面，”他說。

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

他說他還沒有完全做好準備來仔細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 the transplant, Dr. Cetrulo said.

在餘生裏，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，這種藥似乎會加速神經再生，或許有助於恢復移植器官發揮功能。

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.

塞特魯洛還表示，還有一名在車禍中燒燬陰莖的病人正在等待合適的捐贈器官，一旦配對成功就會接受移植手術。

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.

約翰·霍普金斯大學醫學院(Johns Hopkins University School of Medicine)的外科醫生也在計劃進行陰莖移植手術。一名在阿富汗受傷的退伍軍人已經在名單上等待了好幾個月。

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.

據塞特魯洛估計，這項手術的費用在5萬至7.5萬美元之間。目前這兩家醫院都在爲病人支付手術費用，參與的醫生也是在無償貢獻自己的時間。

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.

在全球範圍內，只出現過另外兩例有關陰莖移植的報道：2006年在中國進行的一次以失敗告終，2014年在南非進行的一次獲得了成功，而且接受移植的患者後來還有了小孩。

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.”

塞特魯洛稱，在美國，退伍軍人是移植手術項目主要關注的對象，因爲生殖器官和泌尿系統嚴重損傷的軍人自殺率格外高。“有些是18到20歲的小夥子，他們覺得自己不再有希望獲得親密關係或性生活，”他說。“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，考慮到如此嚴重的心理創傷，陰莖移植手術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 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.”

塞特魯洛稱，手術團隊極有可能會先通過平民病患來完善技術，然後再將其運用到受傷老兵身上。該團隊還將訓練軍隊醫生進行移植手術。他在電子郵件中表示，美國國防部“不想讓受傷的勇士接受未經驗證的技術，也就是說不願讓他們做‘小白鼠’，因爲他們已經做出了很大犧牲”。

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.

他帶領的團隊正在想辦法把對抗排斥藥物的需求降到最低，甚至消除。接受移植手術的病人往往都需要服用這類藥物。他表示，這類研究對老兵尤其重要，因爲很多老兵都是年輕人，如果不得不幾十年堅持服用這類藥物，他們會面臨嚴重的副作用風險，如癌症和腎臟受損。

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.

美國國防部創傷登記(Department of Defense Trauma Registry)的數據顯示，從2001年到2013年，有1367名美國軍人在伊拉克或阿富汗受到所謂的泌尿生殖系統損傷。這些人幾乎都在35歲以下，且基本上都是被統稱爲簡易爆炸裝置(IED)的自製炸彈所傷。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. 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.

麻省總醫院的團隊爲陰莖移植準備了三年時間。爲了繪製結構圖，該團隊在一個屍體實驗室裏小心翼翼地進行解剖，還在五六個已去世的捐獻者身上做手術，練習切除移植手術所需的組織。參與曼寧的手術的，有大約12名醫生和另外30名醫護人員。

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.

團隊帶頭人、醫院地區泌尿科主任迪肯·高(Dicken Ko)表示，該團隊並未擬定固定的移植手術數量。他說，醫院會一次性評估所有候選人，並決定是否同意進行手術。目前，他表示，移植手術僅限於癌症和外傷患者，不面向跨性別者。

An accident at work in 2012 brought Mr. Manning to the hospital, and ultimately to 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，工作期間發生的一場事故導致曼寧被送了醫院，並最終出現在了移植手術團隊的面前。重型設備倒在他身上，導致他身受重傷。治療他的醫生髮現他的陰莖上有一處異常生長物，他此前並未注意到。

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.

檢查發現，他患上了一種惡性的、可能會致命的癌症。陰莖癌不常見，美國今年預計會出現大約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 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.

醫生稱，爲了挽救他的生命，他們必須切除他的大部分陰莖。這種手術叫陰莖部分切除術。曼寧的泌尿腫瘤醫生亞當·S·費爾德曼(Adam S. Feldman)估計，每年會有幾百人因爲癌症而需要接受陰莖全部或部分切除術。

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.

手術過後，曼寧的陰莖只有大約一英寸（約合2.5釐米）長。他必須得坐着小便。性生活則完全不可能。發現癌症時，他是單身，也沒有戀人。切除手術過後，發展新戀情已經不可想象。“我不會靠近任何人，”他說。

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

“我沒法和任何人發展戀愛關係。總不能對女方說，‘我做過陰莖切除手術，’”他接着說。

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.

手術過後，還沒出院，他就開始向費爾德曼打聽移植的事情。當時，醫院裏還沒人考慮這個問題，費爾德曼也承認自己當時覺得這個主意有點奇怪。

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。“我一直保持着樂觀心態，”他說。

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

曼寧無怨無悔。他期待重回工作崗位，並希望最終能再次享受愛情生活。

“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.”

“如果運氣好的話，我能恢復到以前的75%，”他說。“手術前是10%。但他們沒有保證。這是協議的一部分。”