全阴茎及阴囊移植手术成功实施，可让移植阴茎恢复完整功能

Many soldiers returning from combat bear visible scars, or even lost limbs, caused by blasts from improvised explosive devices, or IEDs. However, some servicemen also return with debilitating hidden injuries -- the loss of all or part of their genitals. Now, the Johns Hopkins reconstructive surgery team that performed the country’s first bilateral arm transplant in a wounded warrior has successfully performed the first total penis and scrotum transplant in the world.

许多从战斗中归来的士兵在战争中因简易爆炸装置的爆炸造成了明显的伤疤，甚至失去了肢体。但是还有一些军人也会带着较为隐蔽的伤害回来-失去所有或部分的生殖器。现在，曾成功进行过双侧手臂移植手术的约翰·霍普金斯大学整形外科手术团队实现了世界首例全阴茎及阴囊移植手术。

We are hopeful that this transplant will help restore near-normal urinary and sexual functions for this young man, says W.P. Andrew Lee, M.D., professor and director of plastic and reconstructive surgery at the Johns Hopkins University School of Medicine.

“我们希望这次移植手术能帮助这个年轻人恢复基本正常的泌尿功能和性功能。”约翰·霍普金斯大学医学院整形外科主任 Andrew Lee说。

A team of nine plastic surgeons and two urological surgeons was involved in the 14-hour surgery on March 26. They transplanted from a deceased donor the entire penis, scrotum (without testicles) and partial abdominal wall.

3月26日，该手术持续了14个小时，完成这一创举的是一支由9名整形外科医生和2名泌尿外科医生组成的团队。为了进行移植，手术团队从已故捐赠者身上获取了整个阴茎、阴囊（没有睾丸）和部分腹壁，以恢复受体的正常解剖学结构。

It’s a real mind-boggling injury to suffer, it is not an easy one to accept, says the recipient who is a veteran who sustained injuries in Afghanistan and wishes to remain anonymous. "When I first woke up, I felt finally more normal... [with] a level of confidence as well. Confidence... like finally I’m okay now," he says. The recipient is a veteran who sustained injuries in Afghanistan and wishes to remain anonymous. He has recovered from the surgery and is expected to be discharged from the hospital this week.

“这真是令人难以置信的痛苦，而且并不容易接受，”接受手术的士兵说，“当我第一次醒过来时，我终于感到正常多了……也更加有某种程度的自信-我终于没事了。”这位年轻士兵在阿富汗战争中受伤，出于我们都能理解的原因，他希望保持匿名，并要求尊重他的隐私。目前他已从手术中恢复过来，预计这周就将出院。

While it’s possible to reconstruct a penis using tissue from other parts of the body, says Lee, a prosthesis implant would be necessary to achieve an erection, and that comes with a much higher rate of infection. Additionally, due to other injuries, servicemen often don’t have enough viable tissue from other parts of their bodies to work with.

相比于异体移植，对于另一种手术思路-用自身其他部位的组织来重建阴茎，Lee表示这在理论上是可行的，但要想恢复勃起功能就必须植入假体，而后者会增加术后感染的风险。此外，由于身上还有其他创伤，士兵身上通常没有足够的其他部位的组织来进行手术。

This type of transplant, where a body part or tissue is transferred from one individual to another, is called vascularized composite allotransplantation. The surgery involves transplanting skin, muscles and tendons, nerves, bone and blood vessels. As with any transplant surgery, tissue rejection is a concern. The patient is put on a regimen of immunosuppressive drugs to prevent rejection. Lee’s team has developed an immune modulation protocol aimed at minimizing the number of these drugs needed to prevent rejection.

这种将一个人的一部分身体或组织移植给另一个人的手术被称作血管复合异体移植术（vascularized composite allotransplantation）。整个手术需要移植皮肤、肌肉和肌腱、神经、骨骼和血管。与任何移植手术一样，这种手术也会遇到免疫排斥的问题。在本例手术中，解决这一问题的方式是给患者服用免疫抑制剂。Lee的团队找到了一系列免疫调节方法，可以在最小化用药量的同时最大化地防止免疫排斥反应。