主题：【原创】有一种骗局叫做方舟子--揭穿方舟子的伪装 -- 思想的行者

美国泌尿学权威、密执根州Beaumont Hospitals （这是美国有名的一家医院）泌尿科主任 Dr. Kenneth M. Peters 等在First World Congress on Spina Bifida Research and Care Urology会议上的的摘要，报告了对九个病人在他们医院里实施“肖氏手术”一年后的总结报告。（收录在 JOURNAL OF UROLOGY Volume: 181 Issue: 4 Pages: 310-311， 原文在网上也可以查到：http://medicalconference.spinabi ... e6fa5%7D/UROL27.PDF，顺便说一句，这个结果获得了会议的第三名奖）。网上也有中文翻译：

背景：通过一个显微手术连接腰骶运动神经，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小时内实行胎儿脊髓膨出闭合手术，3个则在未出生时行子宫内脊髓膨出闭合手术，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。手术后相关的症状包括1个病人脚下垂，3个病人伤口渗液， 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乏力，但随着理疗和时间的推移，他们恢复到或接近于术前水平。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增强，接着，情况好转，能够开始自我控制排尿和主动排尿。12个月后的尿流动力学复查发现，7个儿童能够间续性自主排尿平均达133+75毫升，余尿119+125毫升，刺激反射弧相应皮肤，有7个儿童非常明显出现排尿肌的压力上升。总的来说，1年后，9个病人全部表现出通过人工反射弧引起的膀胱收缩能力和/或膀胱的主动排尿能力。术后1年，6个病人报告大便功能也得到恢复。有78%的病人说他们愿意再次进行这样的手术。

结论：自主排尿功能可以早在神经线路再造手术6个月后即出现。术后病人下肢肌肉乏力的症状能随着理疗和时间的推移得到显著改善。

虽然不是这个专业的，读了这个报告我还是能理解一点肖式手术的意义、副作用和局限性（即使这是个成功的手术）。脊柱裂病会导致膀胱排尿功能障碍，进一步引起肾病乃至肾衰竭死亡。肖式手术就是为了解决膀胱排尿功能障碍将其他神经连接到膀胱上解决排尿功能障碍，避免肾病肾衰竭。肖式手术并不能完全解决脊柱裂病（说的不对请老肖等纠正），但能解决脊柱裂病引起的排尿问题。这是它的局限性，大概也是有些患者不理解的地方。可能的副作用是脚下垂、伤口渗液、长时间不能站立、下肢肌肉乏力等。这也好理解。动了神经必然会引起这样的不良反应。问题是能不能完全或部分恢复。对患者来说，如果不能完全或部分恢复，用牺牲一条腿的部分甚至全部功能换取排尿功能恢复以避免肾病肾衰竭是否值得？这都是需要回答的问题。Dr. Peters 至少给出了初步可信的结果：1年后，9个病人全部表现出通过人工反射弧引起的膀胱收缩能力和/或膀胱的排空能力。这个结果是用科学的测量（尿流动力学）检测出来的。而且，副作用有，但可以完全或部分恢复。

From March 15 to 18, the First World Congress on Spina Bifida Research and Care convened in Orlando, Fla., under the direction of the Spina Bifida Association of America (SBA). This multidisciplinary meeting involved representatives from more than 30 countries around the world and represented a broad range of fields including neurosurgery, orthopedics, urology, developmental pediatrics, nursing and epidemiology/public health. Approximately 20 pediatric neurosurgeons from a wide range of academic and private practices attended and discussed a variety of important topics including the management of hydrocephalus and tethered spinal cord, transitional care and the controversial new procedure, lower urinary tract refunctionalization by somatic/autonomic nerve root transposition in children, commonly known as the Xiao procedure.

Chuan-Guo Xiao, MD, presented the urology keynote lecture and reviewed outcome data for the “Xiao procedure,” lower urinary tract refunctionalization by somatic/autonomic nerve root transposition in children with spinal cord abnormalities. He reported that 1,320 patients have undergone this procedure in China. Follow-up data were available for 400 patients: 87 percent demonstrated effectiveness of the procedure as measured by freedom from catheterization and freedom from recurrent urinary tract infections. Dr. Xiao then stayed for an additional day at the end of the meeting to present a one-day symposium on the procedure. This represented the first time these techniques had been taught in North America.

The procedure, commonly called the Xiao procedure, involves the surgical transposition of functional lumbar ventral roots to sacral roots. Typically the L5 ventral root is partially or completely divided and rerouted/anastamosed to the S3 root or complex of sacral roots containing S3 and S4. The rationale for the procedure centers on the spinal reflex-arc and on the capability of somatic motor axons to regenerate into and replace preganglionic axons. Clinically vigorous stimulation within the dermatome of the transposed lumbar root initiates a spinal reflex that results in bladder contraction. Experimental work done by Xiao and colleagues in the late 1980s and early 1990s in rat, cat and dog models demonstrated histological evidence of bladder reinnervation. Between 1995 and 2002, 86 patients with spinal cord injuries were treated, and the reported success rate was 80 percent. The National Institutes of Health sponsored a trial for 40 spinal-cord-injured patients at New York University in 2003. An 80 percent response rate was reported. Between 2000 and 2003, 40 patients with spina bifida were treated and an 85 percent effectiveness rate was observed. Between 2003 and the time of the meeting presentation, approximately 1,300 children had undergone the Xiao procedure in China. Only 400 patients were available for follow-up due to cultural and geographic issues, but Dr. Xiao and his team observed an 87 percent rate of effectiveness.

As a result of these reported outcomes there has been great excitement among spina bifida patients and their families about the procedure. Other urologists and neurosurgeons throughout the world have become sufficiently interested in learning the procedure, and Dr. Xiao has lectured and operated extensively. The Orlando meeting was the first time that he taught the surgical technique in a postgraduate course in North America. More than 75 attendees were present and were evenly divided between urologists and neurosurgeons.

The Xiao procedure has been performed in the United States by a group from William Beaumont Hospital in Royal Oak, Mich., led by urologist Ken Peters. Dr. Peters traveled to China to learn the procedure and invited Dr. Xiao to be present at the initial surgeries in Michigan. Financing was achieved through philanthropic benefactors, and follow-up has been comprehensive and essentially uniform. Dr. Peters also presented at the Orlando postgraduate course. A total of nine patients were operated upon and their outcomes were reviewed with up to a three-year follow-up. Dr. Peters reported that two patients are no longer requiring catheterization and that seven of nine patients have some measureable return of reflex. Bowel function improved more quickly and more extensively than bladder function. Eight-to-nine patients had bilateral leg weakness initially, yet their weakness improved back to baseline such that only one patient has residual weakness. One patient has foot drop.