这里的“肖”指的是肖传国，“方叉叉”指的是方舟子。这个事情太专业了，我还真是一点不懂，只是转贴在这里，希望专业人士给我们介绍介绍。

王小东

一年总结的基本翻译


背景：通过从腰椎到骶骨运动神经建立一个微连接手术，建立一个皮肤-中枢神经-膀胱的人工反射弧，以恢复脊柱裂病人的膀胱排尿功能，这个概念是肖氏介绍并提出。我们在这里报告这一全新治疗手段1年间的结果和经验。

方法：9个病人，3男6女，中位年龄8岁，跨度从6岁到37岁。手术前，对他们进行广泛评估。神经重建手术一直在神经生理指标监控下进行。术后评估包括：1个月后的神经系统的检查，随访问卷调查和排尿动力学试验，后者包括在术后3，6，9和12个月对肖氏反射弧的刺激。病人的随访要持续3年。


结果：9个病人中，5个在出生后24小时内出现脊柱闭合缺陷，3个发生在未出生时，1个从没做过手术. 平均手术时间是183分钟，平均失血量为57毫升。手术中没有出现任何不良症状。病人在医院平均时间是3.4天。后手术相关的症状包括1个病人脚下垂，3个病人伤口液体和1个病人长时间不能站立。1个月后，神经学检查显示有2个病人的走路得到很大改变，8个病人出现多多少少不同程度的下肢肌肉松弛。随着理疗和时间的推移，他们都能恢复到基础功能水平。有趣的是，术后几个月，有几个病人突然感觉排尿能力变弱，或大便断断续续或便意曾强，接着，情况好转，能够开始排空。12个月后的排尿试验发现，7个儿童能够断断续续地自主排尿平均达133毫升。刺激皮肤，有7个儿童非常明显感觉到排尿肌的压力。总的来说，1年后，9个病人全部表现出膀胱反射弧的收缩能力和膀胱的排空能力。1年后，6个病人的肠道功能也得到恢复。有78%的病人说他们愿意再次进行这样的手术。

结论：早在神经线路再造手术6个月后，就有病人表现开始排尿的能力。早期病人下端肌肉明显松弛的症状能随着理疗和时间的推移，得到改善。 
 

送交者: JFY2 于 2009-11-27 23:45:24

ONE YEAR CLINICAL OUTCOMES WITH LUMBAR TO SACRAL NERVE
REROUTING IN SPINA BIFIDA

First World Congress on Spina Bifida Research and Care
Urology Abstracts

Presenting Author: Kenneth Peters, Ministrelli Program for Urology Research and Education
(MPURE), Department of Urology, Beaumont Hospital
Additional Authors:
• Benjamin Girdler, Ministrelli Program for Urology Research and Education (MPURE),
Department of Urology
• Cindy Turzewski, Ministrelli Program for Urology Research and Education (MPURE),
Department of Urology
• Kevin Feber, Ministrelli Program for Urology Research and Education (MPURE),
Department of Urology
• William Nantau, Department of Clinical Neurophysiology
• Jose Gonzalez, Ministrelli Program for Urology Research and Education (MPURE),
Department of Urology
• Evan Kass, Ministrelli Program for Urology Research and Education (MPURE),
Department of Urology
• Ananias Diokno, Ministrelli Program for Urology Research and Education (MPURE),
Department of Urology
• Gary Trock, Department of Neurology, William Beaumont Hospital
• Juan de Benito, Ministrelli Program for Urology Research and Education (MPURE),
Department of Urology
• Brian Bush, Department of Clinical Neurophysiology

Background: The concept of restoring bladder function in spina bifida by the creation of a skin-
CNS-bladder reflex arc by an intradural lumbar to sacral motor root microanastomosis was
introduced by Xiao. We report our 1 year experience with this novel therapy

Method: Nine patients (3 males, 6 females) with median age of 8 (range 6 to 37) years qualified
for the procedure following extensive preoperative evaluation. Nerve rerouting was then
performed with intraoperative neurophysiological monitoring. Postoperative evaluation included
neurological examination at 1 month, follow-up questionnaires and urodynamic testing including
attempted stimulation of the reflex arc at 3, 6, 9 and 12 months. Ongoing patient follow-up will
continue for three years.

Results: Of the 9 patients, 5 patients had prior defect closure within 24 hours of birth, 3
underwent intrauterine closure and 1 had no prior surgery. Mean operative time was 183 (range
127-278) minutes. Mean EBL was 57 (range 10-100) mL. No intraoperative complications
occurred. Length of stay averaged 3.4 (range 2-7) days. Perioperative complications included
foot-drop in 1 patient, wound drainage in 3 patients, and prolonged inability to bear weight in 1
patient. At 1 month, neurological examination revealed major changes in gait in 2/9. 8/9
displayed variable weakness of one or more lower extremity muscle groups. 8 of 9 patients
returned to or near baseline at 12 months with physical therapy and time. Interestingly, several
months postop, several patients reported sudden worsening of urinary and/or fecal incontinence
and/or increased sensation, then improved continence and the ability to initiate voiding. By 12
month UDTs, 7 children were able to voluntarily void a mean of 133 + 75 cc with an intermittent
flow pattern and mean PVR = 119 + 125 cc. Stimulation of the appropriate dermatome caused a
significant rise in detrusor pressure in 7 of 9 patients. Overall, 9/9 of patients demonstrated a
reflex bladder contraction and/or the ability to initiate voiding by one year. Improvement in
bowel function was reported on twelve month global assessment scores in 6 of 9 patients. 78% of
patients reported that they would undergo the procedure again.

Conclusion: The ability to initiate voiding can be seen as early as 6 months after nerve rerouting.
Early outcomes are associated with significant lower extremity complications that largely