《泌尿时报》在去年12月1日刊出介绍肖氏术在美国的2年和3年结果，很正面

有趣，《泌尿时报》在去年12月1日刊出介绍肖氏术在美国的2年和3年结果，很正面 (4306 bytes)
Posted by: 桂铭
Date: June 23, 2011 11:28PM

也是同一个记者Cheryl Guttman Krader写的报道，与那个德国肖氏术结果的报道在同一期刊出。新语丝只报忧，不报喜，呵呵。

Sacral nerve re-routing possible in spina bifida patients

Publish date: Dec 1, 2010
By: Cheryl Guttman Krader

Based on their 2-year outcomes, seven of the nine patients said they would undergo the procedure again.


Damon Dyche, MD
Royal Oak, MI—A pilot study evaluating spinal nerve re-routing to restore bladder and bowel function in children with spina bifida has generated some promising results that are a basis for undertaking a larger and more rigorous multicenter trial, reported urologists from William Beaumont Hospital, Royal Oak, MI.

The pilot study included nine children who underwent lumbar to sacral nerve (S2 or S3) re-routing through a laminectomy. At 24 months of follow-up, bladder contraction could be initiated by stimulation of the appropriate dermatome in seven patients, proving the re-routing was successful. Eight patients were able to void some, five were emptying their bladder by more than half, and eight no longer needed antimuscarinic medications, although only two were able to discontinue intermittent catheterization. Urodynamic studies showed bladder capacity increased and compliance improved.

9个孩子接受了肖氏术，两年后7个病人可以通过挠相应的皮肤区实现自主小便，证明肖氏术的反射弧成功建立了。5个病人可以排空超过一半的膀胱里的尿。

Overall, the children seemed to obtain an even greater benefit for improved bowel function. There were no cases of bowel function worsening, and six children achieved significant improvements, including four who no longer required enemas or experienced any fecal incontinence.

患者在排大便功能方面得到更大的改善。

Based on their 2-year outcomes, seven of the nine patients said they would undergo the procedure again. Results of serial renal ultrasound imaging and serum metabolic panels showed stable renal function. However, stress urinary incontinence continued to be a problem for the majority of children, and quality of life was worsened in one child who had persistent foot drop after surgery, reported co-author Damon Dyche, MD.

"We are now planning an NIH-sponsored multicenter trial to further investigate the safety and effectiveness of the re-routing procedure," said Dr. Dyche, chief urology resident at William Beaumont Hospital, working with Kenneth M. Peters, MD, and colleagues. "We want to stress that because of the potential risks, we feel strongly that it should be performed only in a clinical research protocol."

Data from 36 months of follow-up are being reviewed, and while the final analysis is not yet completed, it appears that the benefit of the surgery has not reached a plateau at 24 months. Dr. Dyche reported that at 3 years, four of the nine children are off catheterization and voiding. An additional four children have undergone the re-routing procedure, and at 9 months postoperatively, two were voiding and off catheterization.

The multicenter study will be conducted at William Beaumont Hospital and Emory University, Atlanta. In addition to enrolling more patients, its methods will include additional assessments to provide more robust data on anal and bladder sphincter function. However, there will be no changes in the surgery itself, which aims to reproduce the procedure performed by its innovator, Chuan-Guo Xiao, MD.

"If we change the procedure and the surgery is not successful, we'd be criticized for modifying the technique," said Dr. Peters, chairman of urology at William Beaumont Hospital.

"First, we need to prove there is a benefit using the same technique as Dr. Xiao, and then we believe there are many ways to refine the procedure that can make it better."

The multicenter study will exclude children who had undergone intrauterine closure of their myelomeningocele because the two children in the pilot study in whom the re-routing was not successful were among three children with this history.

"Children who had intrauterine surgery had significant scar tissue that made the re-routing surgery much more difficult," Dr. Peters told Urology Times.

[www.modernmedicine.com]



依稀记得方粉们当初七嘴八舌地讨论过这篇文章 (432 bytes)
Posted by: babyfat
Date: June 24, 2011 06:50PM

比较搞笑的有以下高论：

1. Based on their 2-year outcomes, seven of the nine patients said they would undergo the procedure again.

有方粉一脸天真：“其中6人会再次手术“是什么意思？想把右侧也作了？

2.it appears that the benefit of the surgery has not reached a plateau at 24 months.

另一方粉很愤怒：NND，什么破手术，24个月还没有效！

现在为了配合医闹官司，教主一声令下，教徒们旧事重提，于是继续展现他们的无知和无耻而已。


还有的方粉喜欢扮专家，把记者的英文话往自己喜欢的方向去编译 (406 bytes)
Posted by: 桂铭
Date: June 25, 2011 01:13AM

记者把“最大膀胱容量从术前的346毫升降到293毫升”作为正面点来报道，有自学成才的方粉泌尿专家就敢加私货注来否定记者的话，呵呵。

人家说最大膀胱容量，他扯膀胱容量。人家报道了肖氏术的正面成果，他却装作没看到那篇报道一样。谎话说上一千遍，就觉得成了真理了。在媒体和各种百科资料里拼命诋毁肖氏术，就自我感觉到肖氏术真的是骗术，而且世界多国的泌尿外科医生都被老肖骗了，呵呵。

掩耳盗铃的故事是怎么来者？自欺欺人。


关键 (230 bytes)
Posted by: causality
Date: June 25, 2011 10:50AM

是国内的媒体太无知，有的有正义感但无正义能力，以及国内的相关专业机构太不专业。多年编译科普文章的方成了代表“发达国家”的科学圣人，加上善于攻击他人，比如对科学松鼠会等科普同行表现出极端的妒忌，常常小题大做予以贬低，在国内成了一霸。



德国的结果首先否定了所谓肖氏术残害患者的谣言 (1617 bytes)
Posted by: 桂铭
Date: June 21, 2011 11:13PM

肯定肖氏术是安全的手术。

其次，单纯从记者的报道来看(Cheryl Guttman Krader不是医生，是一个记者；这是一篇媒体报道，而不是科学论文），德国的结果中，术前术后比较来看，至少有一位患者在电刺激下获得排尿，说明反射尽管很微弱，还是存在的，这应该是手术的结果，如果术前没有这种现象的话。

Although the surgery failed to achieve its primary goal for any of the eight SCI patients, there were some positive effects noted in urodynamic studies, for which there was a mean follow-up of 27 months. Mean maximum bladder capacity decreased from 346 mL preoperatively to 293 mL after the surgery, and the maximum detrusor pressure decreased from 61 cm H2O to 40 cm H2O. A few patients benefited with fewer bladder infections and improvement in bowel movements.

尽管没有达到预期的目的，但是通过尿动力学分析，在平均27月的观察期间，最大膀胱容量从术前的346毫升降到293毫升（[最大膀胱容量]： 当膀胱充盈至产生急迫排尿欲望时的容量为最大膀胱容量。就是说患者膀胱尿量以前要达到346毫升才想尿尿，术后因为神经传导有了改善，膀胱尿量达到293毫升，就想要尿尿了），最大逼尿肌压力也从61厘米水柱降到40厘米水柱，一些患者的膀胱感染减少了，大便功能改善了，这些都是施行肖氏术之后得到的正面意义的结果。

至于说患者术后没有达到预期的结果，原因是很多的。老肖提到过患者的选择问题和术后护理训练康复问题。医学治疗，都有个适应症问题，同样一个治疗，在不同状态下的病人身上，取得的疗效很难一致，这是医学的特征，也是常见现象。至于说患者要完全达到正常人那样的大小便功能，基本上是属于过高愿望要求。患者能够实现自主性排大小便（尽管不是每次都能自主控制），减少尿路膀胱感染，就是肖氏术的成功了。就德国的结果令患者膀胱感染减少，就说明肖氏术的成功和有益之处，不容抹煞。