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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 investigate the feasibility of allogeneic penile transplantation for the treatment of penile defects. Methods A 44-year-old man with traumatic penile defect was screened. A brain-dead donor of 23-year-old man was identified after tissue matching. Donor penis in situ after the whole piece of the cut, preserved with 4 ℃ kidney preservation fluid preservation. Transplantation includes anastomosis urethra, penis, dorsal superficial penile vein, dorsal penile vein, dorsal penile artery, penile dorsal nerve, white membrane, Buck fascia and skin. Routine use of anti-infective, anticoagulant, antispasmodic drugs, combined anti-rejection drugs (Zenapir, Xiao Zixin, cyclosporine, methylprednisolone). Postoperative close observation of vital signs, transplants penile blood circulation and drug blood concentration. Results Postoperative penile blood circulation was good, the color was red, the skin temperature was normal, no rejection and infection occurred. The early penile skin was swollen and partial skin incision and decompression were performed. The concentration of cyclosporine in the blood was Co160 .5ng / ml, 10d balloon catheter removed, the patient can stand urination and urination patency. Day 14 patients due to serious psychological problems, will be transplanted penile. Pathology confirmed non-rejection of transplanted penis. Conclusion Good combination of immunosuppressive agents can prevent hyperacute and acute rejection of allogeneic penile transplantation. Allogeneic penile transplantation is an alternative method for the treatment of penile defects.