送交者: niupi 于 2005-9-22, 21:51:52:
成果鉴定的时候（２００４）是６２例， 发表文章的时候（２００５，２００４年投稿）只有２０例了，还有４２例这么丢了？？？
发布日期：2004-08-31
武汉协和医院首创的“人工反射弧”概念可应用于外科手术，使因先天性脊柱裂而导致大小便失控的患儿可自主控制排便。这一成果２８日已通过７位中国科学院、工程院院士及多位著名外科专家的鉴定，标志着先天性脊髓脊膜膨出患儿膀胱功能重建取得突破。
国家“９７３计划”项目“神经损伤修复与功能重建的应用基础研究”首席科学家、武汉协和医院泌尿外科主任肖传国教授早在上世纪８０年代，即提出了“人工体神经－内脏神经发射弧”（简称人工反射弧）的神经学新概念，其基本原理是：利用截瘫后废用的体神经，通过手术将其与支配膀胱的内脏自主神经吻合杂交，形成一种新的可经皮肤控制的神经反射排尿通路，即形成人工的“皮肤－脊髓中枢－膀胱”排尿反射弧，这一全新设计也被学术界称为“肖氏反射弧”。自１９９５年起，协和医院利用这一原理和技术治疗脊髓损伤截瘫患者取得了成功。
著名神经科学家、中国科学院韩济生院士等专家一致认为，这项世界首创的外科学技术处于国际先进水平，并再次印证了“肖氏人工反射弧”这一新概念在神经科学中的独特地位，为解决人体器官神经功能障碍性疾病提供了全新和有效的方法，为神经科学和临床医学作出了重大贡献。
脊柱裂是最常见的出生缺陷之一。资料显示，我国每１万例活产儿中有８．５例发生脊柱裂，其中８０％－８５％的脊柱裂患者发生腰骶部脊柱脊膜膨出，损伤了控制膀胱的相关神经，导致下肢功能障碍和大小便失控。排尿功能障碍不仅影响生活质量，而且继发的泌尿系感染和肾功能衰竭是患儿的主要致死因素，对这一疾病目前尚无理想的治疗方法。
据肖传国介绍，２０００年至今，武汉协和医院治疗脊髓脊膜膨出患者６２例，５５例术后一年左右恢复可控协同排尿，所有获得排尿功能者大便功能也转为正常，并同时获得了膀胱、直肠感觉功能。
（新华社提供，未经许可，严禁转载）
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Urol. 2005 Jun;173(6):2112-6.
An artificial somatic-autonomic reflex pathway procedure for bladder control in children with spina bifida.
Xiao CG, Du MX, Li B, Liu Z, Chen M, Chen ZH, Cheng P, Xue XN, Shapiro E, Lepor H.
Departments of Urology, Tongji Medical College, Xiehe Hospital, Huazhong University of Science and Technology, Wuhan, China. xiaocg@mails.tjmu.edu.cn
PURPOSE: Neurogenic bladder is a major problem for children with spina bifida. Despite rigorous pharmacological and surgical treatment, incontinence, urinary tract infections and upper tract deterioration remain problematic. We have previously demonstrated the ability to establish surgically a skin-central nervous system-bladder reflex pathway in patients with spinal cord injury with restoration of bladder storage and emptying. We report our experience with this procedure in 20 children with spina bifida. MATERIALS AND METHODS: All children with spina bifida and neurogenic bladder underwent limited laminectomy and a lumbar ventral root (VR) to S3 VR microanastomosis. The L5 dorsal root was left intact as the afferent branch of the somatic-autonomic reflex pathway after axonal regeneration. All patients underwent urodynamic evaluation before and after surgery. RESULTS: Preoperative urodynamic studies revealed 2 types of bladder dysfunction- areflexic bladder (14 patients) and hyperreflexic bladder with detrusor external sphincter dyssynergia (6). All children were incontinent. Of the 20 patients 17 gained satisfactory bladder control and continence within 8 to 12 months after VR microanastomosis. Of the 14 patients with areflexic bladder 12 (86%) showed improvement. In these cases bladder capacity increased from 117.28 to 208.71 ml, and mean maximum detrusor pressure increased from 18.35 to 32.57 cm H2O. Five of the 6 patients with hyperreflexic bladder demonstrated improvement, with resolution of incontinence. Urodynamic studies in these cases revealed a change from detrusor hyperreflexia with detrusor external sphincter dyssynergia and high detrusor pressure to nearly normal storage and synergic voiding. In these cases mean bladder capacity increased from 94.33 to 177.83 ml, and post-void residual urine decreased from 70.17 to 23.67 ml. Overall, 3 patients failed to exhibit any improvement. CONCLUSIONS: The artificial somatic-autonomic reflex arc procedure is an effective and safe treatment to restore bladder continence and reverse bladder dysfunction for patients with spina bifida.