同种异体阴茎移植1例初步临床研究报告  

A preliminary case report of human penile transplantation

作　　者：胡卫列[1] 吕军[1] 张利朝[1] 吴文[1] 聂海波[1] 朱云松[1] 邓志雄[1] 赵永斌[1] 沈文[1] 曹启友[1] 邱晓拂[1] 杨菁华[1] 白莹[1] 

机构地区：[1]广州军区广州总医院泌尿外科广州军区泌尿外科研究所,中国人民解放军下尿路疾病诊治中心,广州510010

出　　处：《中国男科学杂志》2006年第11期6-9,共4页Chinese Journal of Andrology

摘　　要：目的探讨异体阴茎移植治疗阴茎缺损的可行性。方法筛选1例44岁男性外伤性阴茎缺损病人,经组织配型后确定一名23岁男性的脑死亡供者。供体阴茎原位灌注后整块切取,用4℃肾脏保存液灌注保存。移植手术包括吻合尿道海绵体、阴茎海绵体、阴茎背浅静脉、阴茎背深静脉、阴茎背动脉、阴茎背神经、白膜、Buck筋膜及皮肤。术后常规应用抗感染、抗凝、解痉药物,联合应用抗免疫排斥药物(赛尼哌、骁悉、环孢素、甲泼尼龙)。术后密切观察生命体征、移植阴茎血循环及药物血浓度。结果术后移植阴茎血液循环良好,颜色红润,皮肤温度正常,未见排斥反应和感染发生,早期阴茎皮肤肿胀,予局部皮肤切开减压,术后第5天测血中环孢素浓度为Co160．5ng／ml,10d拔除气囊导尿管,患者能站立排尿且排尿通畅。第14天患者因严重心理问题,将移植阴茎切除。病理证实移植阴茎无排斥反应。结论配型好联合应用免疫抑制剂可以防止异体阴茎移植的超急和急性排斥反应发生,异体阴茎移植是治疗阴茎缺损的可供选择方法。Objective To study the feasibility of penis transplantation in human being. Methods An age forty-four male recepients with traumatic penis amputation for 8 months, were matched with a brain-dead donor of twenty-two years old. After the donors penis was amputated, it was irrigated with organ preservation solution at 4℃. The transplantation involved anastomoses of urethra corpus spongiosum, corpus cavemosum, superficial dorsal vein, deep dorsal vein, dorsal artery, dorsal nerve, cavemosal artery, tunica albuginea, Buck＇s fascia, superficialis, and skin closure. After surgery the patients were received wide-spectrum antibiotics（Sulperazon）, anticoagulants, antispasm agents and immunosuppressants including Daclizumab Injection （Zanapax）, Mycophenolate Mofetil Capsules（CellCept）, Prednisone Acetate Tablets systematically. Clinical observations including vital signs and circulation of the penis, immune state were monitored by assaying cyclosporine in the blood. Results After surgery the patient recovered well, there were no sign of rejection and infection. Penile blood supply and skin temperature were normal. The penis skin was swollen after 24h postoperatively, and was incised for relieving the edema. The patient could urinate smoothly in standing position at day 10 after removal of catheter. The concentration of cyclosporine was 160.5 ng/ml at 5th day. At 14th day postoperatively the penile allograft was cut off due to severe psychological problem between recipient and his wife, it was confirmed no rejection on pathological examination. Conclusion Ideal histocompatability and combined usage of currently available immunosurppressants can prevent hyperacute and acute rejection of human penis transplantation. Penile transplantation should be recommended for the selective treatment of penile defect.

关 键 词：阴茎/移植 阴茎缺失 移植 同种 

分 类 号：R697.15[医药卫生—泌尿科学]