PBS高端访谈:阿富汗战争受伤士兵接受历史性阴茎移植（在线收听）

AMNA NAWAZ: Now, a historic transplant for a soldier who was injured in Afghanistan and one that could potentially transform his life in important ways. Jeffrey Brown speaks with a key member of the team behind the surgery about its potential impact. A note for some viewers: Our conversation is focused on sensitive issues involving the male anatomy.

JEFFREY BROWN: They are horrific physical injuries that affect self-esteem and identity and are rarely even discussed. Between 2001 and 2013, more than 1,300 men fighting in Iraq and Afghanistan suffered devastating injuries to the genitals from bomb blasts. Now surgeons at the Johns Hopkins School of Medicine in Baltimore have announced the most complex transplant to date of a penis, scrotum and part of the abdominal wall from a deceased donor to a wounded soldier who has chosen to remain anonymous. The surgery was performed in March and involved 11 surgeons. One of them, Dr. Richard Redett, joins us now. And welcome to you. Doctor, first, why did you and your team feel this was important to do?

DR.RICHARD REDETT, Johns Hopkins School of Medicine: Well, you know, we met our patient for the first time about five years ago. When we evaluated him and examined him, we realized that the losses of tissue was very significant. It involved part of his abdominal wall, his entire penis and his scrotum. And he had other neighboring injuries which really made conventional reconstruction almost impossible for him. At the about same time, we had started doing a penis transplant. He's a great candidate, and a great person, and it all just made sense.

JEFFREY BROWN: These kinds of transplants have been tried and done before, but what has been done and what made this one unique?

DR.RICHARD REDETT: There have been three prior penis transplants that we know about, two in South Africa, one in Boston. And those were partial or complete penis transplants. But what makes this so unique is that it involves the entire penis, the scrotum and part of his abdominal wall. And when these soldiers sustain these type of IED injuries, they get a big blast to the pelvis and they lose a lot of tissue. And we were able to replace exactly what he had lost with the donated tissue.

JEFFREY BROWN: And I was reading connecting artery, veins, nerves. He's expected, I understand, to be released from the hospital later this week. Is the hope of a return to urinary and sexual functions?

DR.RICHARD REDETT: We are confident that he will be able to urinate like he normally would and resume normal sexual function eventually.

JEFFREY BROWN: And what -- so, what is his status now?

DR.RICHARD REDETT: He's in the hospital. He's doing well. He's up walking. We're monitoring him for signs of infection or rejection, none of which he has. We're sorting out his medications that he will take for his immunosuppression. He's in good spirits. He's doing really well.

JEFFREY BROWN: You mentioned the immunosuppression, because that's one of the big issues, isn't it, whether the body will reject the transplant?

DR.RICHARD REDETT: Correct.

JEFFREY BROWN: But explain that, because I think that means he is going to have to go through therapy for a long time, which also, I think, went to some of the ethical issues that were raised here.

DR.RICHARD REDETT: Right. When we started looking at this about five years ago, one of the common questions we would get is, how can you consider doing a penis transplant and placing a young man on immunosuppression? But until you meet one of these guys, and you realize what they have given to their country, what they have lost, it doesn't make sense, but when you meet him and you sit down with him and you talk with him, it all makes sense. You know it's the right thing to do. So, one of the things we have done here is, when we procure the graft from the donor, we also take the vertebral column, the bones that make up the spine. We grind that up. We extract the bone marrow cells and the stem cells, and we infuse that into our patient about two weeks after surgery. And that allows us to reduce pretty significantly the amount of immunosuppression that he will be on for the rest of his life. So, it's our plan to send him home not on three medications, but only on one medication.

JEFFREY BROWN: I gather there are other questions, ethical questions that came up about the cost, about the necessity of something like this. The hospital covered the cost in this case. How far ahead are you and your colleagues thinking about this kind of procedure, how routine it might become one day?

DR.RICHARD REDETT: Well, you know, I think the thing that holds us back right now is the immunosuppression. And I think, as we do more of these -- and we're seeing this with hand transplants and face transplants -- it will become more acceptable, considered less experimental and a little more mainstream.

JEFFREY BROWN: And the donor, we should say, wasn't identified, nor was his cause of death. But the family issued a statement in praise and saying in his honor of what happened. Explain what you know of that.

DR.RICHARD REDETT: Well, you know, I think the family has some military connections. And when they heard that we were doing this on a soldier that gave so much for his country, I think it was a little easier for them to do it. Because there haven't been many penis transplants done in the United States, it's a difficult ask when you approach the donor family.

JEFFREY BROWN: And just finally, I mentioned the more than 1,300 men in various cases like this. Can you see a wider -- wider procedures?

DR.RICHARD REDETT: I can. I can see doing more of these in wounded warriors, servicemen that have been injured overseas. But I think, eventually, we will expand our indications to include people with other conditions as well. The Boston group did it on a patient that had removal of his penis for cancer. There are a lot of men that have significant birth defects that may benefit from this. So, I think, as we get more experience, we will expand the indications.

JEFFREY BROWN: Dr. Richard Redett of the Johns Hopkins School -- University School of Medicine, thank you very much.

DR.RICHARD REDETT: Thank you.

阿曼娜·纳瓦泽：现在一位在阿富汗战争中受伤的士兵接受了一次历史性移植手术，而这次手术可能给他今后的生活带来重大转变。杰弗里·布朗采访了该手术团队中的一位重要成员，讨论了该手术的潜在影响。观看这篇报道的朋友请注意：我们的话题涉及男性解剖等敏感问题。

杰弗里·布朗：这些骇人的身体损伤，影响自尊自信，但很少有人讨论。2001至2013年间，在伊拉克和阿富汗，1300多名男子遭受炸弹爆炸伤害，生殖器受到严重损伤。现在，巴尔的摩约翰霍普金斯医学院的外科医生宣布为所选受伤士兵实施，迄今为止最复杂的阴茎、阴囊和部分腹壁移植手术，这些组织的捐献者均来自已故人士，被移植者则匿名受献。该手术于三月进行，11名外科医生协作完成。他们中的一位，理查德·雷德特医生今天做客节目。欢迎你。医生，首先，你和你的团队为什么认为这很重要？

约翰霍普金斯医学院理查德·雷德特医生：你知道，大约五年前，我们与我们的病人首次相遇。当我们为他进行身体评估，为他检查时，我们意识到他的组织损失非常严重。他的部分腹壁，整个阴茎以及阴囊全部严重受损。此外，他还存在周边伤势，这使得常规组织重建几乎无望。大约在同一时间，我们开始做阴茎移植手术。他是个非常合适的人选，而且是一个伟大的人，这一切都顺理成章。

杰弗里·布朗：这种移植手术之前已经有过尝试，但是，我们之前也做过这类手术，那么为什么这次与众不同，我们都做了什么？

理查德·雷德特医生：我们知道，在此之前已有三例阴茎移植手术，其中两例在南非，一例在波士顿。那些手术是部分或完整的阴茎移植。而我们这例手术的独特，在于它涉及的范围：整个阴茎、阴囊以及部分腹壁。当这些士兵承受这类IED损伤时，他们的骨盆会承受很大的冲击，造成很多组织损伤。我们能够用捐赠的组织，将他们受损的组织完全替代。

杰弗里·布朗：我正在阅读关于动脉、静脉、神经连接的书籍。据我了解，他预计本周晚些时候出院。有恢复泌尿系统功能和性功能的希望吗？

理查德·雷德特医生：我们确信他能像平常一样小便，并最终恢复正常的性功能。

杰弗里·布朗：那么，他现在的状态如何？

理查德·雷德特医生：他在医院。状态很好。也能起身走路。我们正在对他的感染及排异迹象进行监测，他完全没问题。我们给了他一些免疫抑制药物。他精神很好。状态极佳。

杰弗里·布朗：你提到了免疫抑制，因为这是一个大问题，是吧，身体是否会对移植产生排异？

理查德·雷德特医生：没错。

杰弗里·布朗：但请解释一下，因为我认为这意味着他将不得不长时间接受治疗，而且我认为这也带来了一些伦理层面的问题。

理查德·雷德特医生：是的。当我们在五年前开始研究这个问题时，我们会遇到一个常见问题，如何能够考虑让一个年轻人接受阴茎移植和排异治疗？但除非你真的见到这些人，你意识到他们给了国家做了什么贡献，他们失去了什么，这没有道理，但是当你遇到他时，你坐下来和他谈话，一切顺理成章。你知道这是正道。所以，我们在这里完成的一件事情是，当我们从捐献者体内获取器官时，我们也会摘除他的脊柱，构成脊柱的骨骼。我们对此进行了研究。我们提取骨髓细胞和干细胞，并在手术后约两周将其注入患者体内。这使我们能够大大降低，他将来一生中，所需的排异抑制量。因此，我们计划他回家后，不用服用三种药物，只需一种。

杰弗里·布朗：我还收集到了其他一些问题，伦理问题，费用问题以及必要性问题。在这种情况下，医院承担费用。你的这一做法到底有多超前，关于这类手术同事是怎么想的？有一天这种流程是否能够常规化？

理查德·雷德特医生：你知道，我认为现在牵绊我们的是排异反应问题。我认为，随着更多此类手术的展开 - 我们看到手部移植和面部移植 - 它会变得更可接受，更少的实验性和更加的主流化。

杰弗里·布朗：我们应该说，我们并不了解捐赠者的身份，他们的死因也未可知。这家人发表了一份充满溢美之词的声明，描述了所发生的一切，以此来纪念他。在此方面你有何了解？

理查德·雷德特医生：嗯，你知道，我认为这个家族有一些军事背景。当他们听说这一切是为了一名为国做出巨大贡献的士兵时，我认为他们接受起来可能更容易一点。因为在美国，阴茎移植手术并没有太多先例，所以当你与捐赠家庭接触时，有些困难。

杰弗里·布朗：最后，我提到了，受伤男子多达1300多名。您觉得我们能普及这类手术吗？

理查德·雷德特医生：可以，我们可以为更多在海外受伤的士兵提供这种手术。但我认为，最终，我们可以将手术范围扩大到其它情况的病人身上。波士顿小组为一名因癌症切除阴茎的患者实施了这项手术。有很多携带明显出生缺陷的男性，可能会从中受益。所以，我认为，随着我们经验的积累，我们将扩大我们的涵盖范围。

杰弗里·布朗：约翰霍普金斯大学医学院理查德·雷德特博士，非常感谢你。

理查德·雷德特医生：谢谢你。