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
光明网：http://topics.gmw.cn/2010-10/15/content_1313583.htm
桂铭 刊发时间：2010-10-15
今日，一位网友指出不久前的一次美国医学界的会议认可了肖氏反射弧手术的效果。该网友原文如下：
美国泌尿学会2010年会---关于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
另一位网友mendel在同一个帖子中予以补充说：
这里面有几个关键问题：
1）肖氏反射弧存在嗎？
是存在的，看Peters的嚴格試驗，9個病人，7個成功建立反射弧，也就是說刺激大腿皮膚，確實導致膀胱壓力增加。另外兩個，沒有檢查到，并不表示沒有建立起反射弧，正如 Peters所言，可能是在檢測時沒有找到準確的刺激位置。
2）肖氏反射弧的建立，可以用來排尿嗎？
目前情況看，要復雜點。需要更大規模的，嚴格的臨床檢驗才可以得出結論。很明顯，在一部分病人中是很有效的，手術后成功建立的反射弧，確實可以用來通過刺激皮膚排尿。但是，有的病人還沒有，原因不清。
3）手術后，病人的需要嚴格的學習和訓練，使反射弧用來控制排尿嗎？
是的。
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