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肖氏反射弧手术疗效得到美国医学界独立证明

作者：岳东晓  于 2011-4-30 07:48 发表于 最热闹的华人社交网络--贝壳村 通用分类:热点杂谈|已有7评论

Urodynamics/Incontinence/Female Urology: Neurogenic Voiding Dysfunction 

Moderated Poster 

Source of Funding: Ministrelli Program for Urology Research and Education (MPURE) 

1502: THREE-YEAR CLINICAL OUTCOMES WITH LUMBAR TO SACRAL NERVE REROUTING IN SPINA BIFIDA 

Kenneth Peters，Kevin Feber， Benjamin Girdler， William Nantau， Evan Kass， Jose Gonzalez， Gary Trock ，Ananias Diokno，Royal Oak, MI 

INTRODUCTION AND OBJECTIVES: The concept of restoring bladder and bowel function inspina 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 three-year experience with the novel procedure. 

METHODS: Nine patients (3 males, 6 females) with median age of 8 (range 6 to 37) years enrolled in this institutional review board approved protocol. After extensive preoperative evaluation, lumbar to sacral nerve rerouting was performed using intraoperative neurophysiological monitoring. Postoperative evaluation included follow-up questionnaires,urodynamic testing (UDT), voiding diaries, renal function studies and bowel assessment. 

RESULTS: Of the 9 patients, 5 patients had defect closure within 24 hours of birth, 3 had intrauterine closure and 1 had no prior surgery. Mean operative time was 183 (range 127-278) minutes. No intraoperative complications occurred. One patient developed permanent foot drop and 8 had transient lower extremity weakness. By 12 months, 7 of 9 had a documented cutaneous to bladder reflex. At 3 years, 2 patients did not return for follow-up and were considered non-responders. Seven patients returned for 36-month evaluation. On UDT, maximum cystometric capacity improved from mean 210 cc to 293 cc. At baseline 4/7 had neurogenic detrusor overactivity (NDO); at 36 months 1/7 had NDO. Median compliance improved from 12.2 ml/H20 to 28.4 ml/H2O and 3 with a baseline compliance of less than 10 had normalization (7 to 34.3, 9.4 to 21.2, and 8.3 to 28.4). At baseline, 2/7 were able to void with an average void of 23 cc. At 36 months, 6/7 no longer required catheterization and 6/7 reported mean voided volume of 156cc on voiding diaries. Uroflow demonstrated a mean voided volume of 248 cc with a 93 cc post void residual and a voiding efficiency of 73%. All 6 patients were voiding > 59% of their bladder capacity. 5 of 7 require some valsalva to void. 6/7 subjects had persistent stress incontinence with 1 subject dry, 3 with occasional leak, 3 frequent leaks. At baseline, 3/7 considered their bowels normal and 1/7 were continent of stool. At 36-months 6/7 considered bowels normal and 4/7 continent of stool. Antimuscarinics were stopped in all subjects except the 1 with persistent NDO. Renal ultrasounds and serum creatinines remained stable. No long-term complications were identified and 6/7 would undergo the procedure again. 

CONCLUSIONS: 

Lumbar to sacral nerve rerouting can improve bladder and bowel function in patients withneurogenic bladder associated with spina bifida. 

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回复 wcat 2011-4-30 08:14
什么是独立的？这实验就在那儿进行的，怎么能说独立的？并且只有9个病人，难道不觉得这个sample太小，即使成功也不太可能说明问题吗？没有足够的试验就（在中国）上了临床，你不觉得不道德吗？！
回复 tutu0077 2011-4-30 09:46
找半天就找到个poster，而且才7个病人，就能说“得到美国医学界独立证明”了？你不觉得肖的疗法真的像他吹的那样牛的话，会连一篇正式的publication都没有吗？这种证据也只能忽悠不懂英文也没学过science的普通民众。还说方舟子民科，人家至少比你拿出的证据专业的多。你知道正儿八经搞科研的科学家怎么对待民科的吗？懒得理！你再看看肖什么反应。
回复 goodoctor 2011-4-30 10:14
老兄，隔行如隔山，您歇歇吧!
回复 岳东晓 2011-4-30 11:52
肖氏弧相关信息在肖传国的博客上，有兴趣的可以跟他交流，我不过综合相关信息。至于方舟子这剽窃大王，已经多人鉴定无误。
回复 wcat 2011-4-30 17:26
怎么觉得科学素养是如此欠缺！有像肖这样做科学研究的吗？拿不出像样的结果只靠自吹自擂，别人置疑就上法院告，雇人打。你也是这样做研究的吗？方舟子做的是十分有意义的工作。在中国目前骗子横行的社会，方的工作就显得十分必要和可贵！
回复 hanfeng109 2011-5-2 02:54
wcat: 怎么觉得科学素养是如此欠缺！有像肖这样做科学研究的吗？拿不出像样的结果只靠自吹自擂，别人置疑就上法院告，雇人打。你也是这样做研究的吗？方舟子做的是十分 ...
赞同!
回复 liubaxintian 2011-5-2 10:36
This paper was actually published last year

2010 Journal of Urology 184 (2), pp. 702-707  
Outcomes of Lumbar to Sacral Nerve Rerouting for Spina Bifida  Kenneth M. Peters, Benjamin Girdler, Cindy Turzewski, Gary Trock, Kevin Feber, William Nantau, Brian Bush, Jose Gonzalez, Evan Kass, Juan de Benito, Ananias Diokno

Purpose
Restoring bladder and bowel function in spina bifida by creation of a skin-central nervous system-bladder reflex arc via lumbar to sacral nerve rerouting has a reported success rate of 87% in China. We report 1-year results of the first North American trial on nerve rerouting.

Materials and Methods
Nine subjects were enrolled in the study. Intradural lumbar to sacral nerve rerouting was performed. Subjects underwent urodynamic testing with stimulation of the cutaneous dermatome and careful neurological followup. Adverse events were closely monitored along with changes in bowel and bladder function.

Results
At 1 year 7 patients (78%) had a reproducible increase in bladder pressure with stimulation of the dermatome. Two patients were able to stop catheterization and all safely stopped antimuscarinics. No patient achieved complete urinary continence. The majority of subjects reported improved bowel function. One patient was continent of stool at baseline and 4 were continent at 1 year. Of the patients 89% had variable weakness of lower extremity muscle groups at 1 month. One child had persistent foot drop and the remainder returned to baseline by 12 months.

Conclusions
This is the first known North American trial on lumbar to sacral nerve rerouting to restore bladder and bowel function in patients with spina bifida. Although the majority of subjects experienced lower extremity weakness immediately postoperatively, most returned to baseline within 12 months. The exception was 1 patient with a persistent foot drop. Seven subjects had a reproducible bladder contraction with stimulation of the appropriate dermatome, proving the development of a somatic to visceral reflex. The impact of this surgery on improvement in quality of life still needs to be determined. This procedure should remain on a research protocol, and more patients and longer followup are needed to understand fully the associated risk/benefit ratio.

Acknowledgments
C. G. Xiao provided guidance in developing the trial and expertise in training the surgeons involved.

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