最新美国临床试验结果支持肖氏反射弧手术的有效和可行性

最新美国临床试验结果支持肖氏反射弧手术的有效和可行性 (3541 bytes)
Posted by: 桂铭
Date: October 14, 2010 12:28AM

美国泌尿学会2010年会---脊柱裂患者施行腰椎至骶神经再接术两年后的结果

2010年6月10日
美国加州旧金山

一项引人入胜的针对神经性大小便功能失常的治疗工作正在进行。该治疗是对借助腰椎-骶神经再通手术(LSNR，即肖氏反射弧手术)所建立起来的皮-脊髓- 膀胱神经反射弧进行操控来进行的。该治疗首创于中国，曾经报告过高达87%的成功率。Ken Peters医生及其同事报告了该手术在北美首次临床试验后两年的随访结果。

9名脊髓裂患者接受了经椎板切除术施行的硬膜内LSNR（肖氏反射弧手术）手术。观察了经皮刺激下的尿动力学、仔细的神经学检查、密切的排便和膀胱功能监 测，以及不良副作用。在24个月时间里，9位患者中有7位建立了经（大腿）皮刺激作用下的神经反射弧。8位患者在经皮刺激下能够排尿，其中5位患者能排出 超过50%的膀胱容积（尿量）。8位患者能安全地停止使用抗胆碱能药物。50%的患者解决了逼尿肌失控的问题。还有，50%的患有膀胱顺应性受损（小于 10毫升/厘米水压）的患者，他们的膀胱顺应性得到了显著的改善。

患者的肾脏功能保持稳定。6位患者（66%）的生存质量（QOL）得到了改善。有一位患者的生存质量变坏，是因为出现脚下垂的现象。只有一名患者在基线水平自主排便，5/9的患者在24个月内实现自主排便。

研究者们总结说，7/9的患者通过神经反射弧手术获得了成功的结果。这项治疗技术是一种值得继续研究下去的可行性选项。

英文原文：

AUA 2010 - Two-year outcomes with lumbar to sacral nerve re-routing in spina bifida - Session Highlights

Thursday, 10 June 2010

SAN FRANCISCO, CA USA (UroToday.com) - Interesting work has been ongoing in the treatment of bowel and bladder dysfunction via manipulation of the skin-spinal cord-bladder reflex arc through lumbosacral nerve re-routing (LSNR). Reported success rates have been as high as 87% in China, where the technique was pioneered. Dr. Ken Peters and colleagues reported on the first North American trial on LSNR with minimum 2-year follow- up.

Nine spina bifida patients underwent intradural LSNR via laminectomy. Follow-up included urodynamics with cutaneous dermatome stimulation, careful neurological examination, and close monitoring of bowel and bladder function and adverse events. By 24 months, the authors reported that 7/9 patients had LS nerve reflex with stimulation of the appropriate dermatome, 8/9 patients were voiding, and 5/9 were emptying >50% of their bladder volume. 8/9 were safely off of anticholinergic medications, and 50% of patients had resolution of involuntary detrusor contractions. Additionally, 50% of patients who had compromised bladder compliance as defined by 10mL/cm H20 showed marked improvement.

Renal function remained stable. Quality of life (QOL) was improved in 6/9 (66%). The one patient who described a worsening QOL was the one patient who experienced foot drop. While only one patient was continent of stool at baseline, 5/9 were continent by 24 months.

The investigators concluded that with 7/9 patients in their cohort experienced a successful outcome following LSNR, this technique remains a viable option for consideration and investigation in the future.

Presented by Kevin Feber, Damon Dyche, Benjamin Girdler, Cindy Turzewski, Gary Trock, William Natau, Evan Kass, and Kenneth Peters at the American Urological Association (AUA) Annual Meeting - May 29 - June 3, 2010 - Moscone Center, San Francisco, CA USA

Reported for UroToday by Kathleen C. Kobashi, MD, Head, Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA, USA

原文出处：http: //www.urotoday.com/3401/browse_categories/urinary_incontinence_ui/aua_2010__twoyear_outcomes_with_lumbar_to_sacral_nerve_rerouting_in_spina_bifida__session_highlights06102010. html

最新美国临床试验结果支持肖氏反射弧手术的有效和可行性 (3541 bytes) - 桂铭 2010-10-14, 12:28AM (69413) (1796 reads)
晕，怎么现在忽然成了login后才能看 (256 bytes) - jimi 2010-10-14, 01:45PM (69500) (133 reads)
为什么老肖做的手术比老外做的效果要来的好？ (1652 bytes) - 桂铭 2010-10-14, 12:36AM (69415) (273 reads)
高晓群：“我觉得不能因为肖传国触犯了法律，就全盘否定他的科研成果。”ZT (2851 bytes) - 桂铭 2010-10-14, 12:45AM (69416) (318 reads)
這有幾個關鍵問題 (544 bytes) - mendel 2010-10-14, 01:39AM (69417) (250 reads)
这场官司把反射弧由法律鉴定下是好事.如果属实, 那一切都结束了. (0 bytes) - cruiser2009 2010-10-14, 05:49AM (69440) (160 reads)
晕，官司怎么可能鉴定肖氏反射弧的成功率？ (134 bytes) - jimi 2010-10-14, 06:17AM (69441) (171 reads)
彭律师方记者不是正在组织病人起诉嘛. 这次事件俺感觉会给肖方二人都盖棺定论.其中一个会彻底消失.::sun:: (14 bytes) - cruiser2009 2010-10-14, 06:23AM (69443) (173 reads)
被告根本不是肖传国呀，你压肖传国有什么用？ (86 bytes) - jimi 2010-10-14, 08:51AM (69476) (165 reads)
法律上是无关肖传国, 但是会对手术从技术上做个认定, 即使不是正式学术认定也有一定的说服力. (0 bytes) - cruiser2009 2010-10-14, 08:55AM (69477) (181 reads)
不会的，法院没这样的能力也没这样的义务，何况本案也不涉及 (0 bytes) - jimi 2010-10-14, 09:07AM (69480) (153 reads)
我说的是彭律师发动患者起诉那个案子, 那应该是方博士最后一搏, 如果输了, 他的名字从此消失. (0 bytes) - cruiser2009 2010-10-14, 09:11AM (69481) (144 reads)
那只是医患矛盾呀，是作为个体的患者和神源医院的矛盾 (347 bytes) - jimi 2010-10-14, 09:22AM (69484) (173 reads)