肖氏手术的风险# WaterWorld - 未名水世界
y*v
1 楼
这个Beaumont医院回答的信比较清楚，你们看看
我写个摘要：
手术有风险，风险是手术一侧神经的变弱或萎缩。原文:The risks of this surgery
are weakness to the lower extremity (the operative side).
若是非同侧，或者两侧都出现问题，则应该是疾病本身造成的而不是手术造成的。
问题：那些被报道的，到底是两侧都有问题，还是就手术侧有问题。还有，就用这个做
个retrospective study 去验证一下安全性，很简单吧。
另，有医生表示：
“肖氏术取用的是单侧一段运动神经，这段神经功能丧失后出现的是废用性萎缩而不是
溃疡。病人本来存在的脊髓受压如果严重会导致双下肢周围神经病变，与糖尿病足的致
病因素有相似之处，出现迁延不愈的溃疡最后截肢。这种病变是渐进性的，也可以解释
为什么这个小孩在术后两年才截肢。”
还有人表示：
“栓系综合症。由于脊柱裂，脊髓被栓到骶骨部位，没有回位，没有伸缩空间，所以，
小孩每长高一点，脊髓就绷得更紧，神经损伤平面就更高：丛最早的膀胱直肠神经（骶
5、4、3、2）到管腿的神经（骶1-腰5、4、3、2）
你们看方舟子利诱告状的那个病人，以前已做过五次手术，就是试图减轻脊髓张力（栓
系松解术），可惜的是，很多病人松解不了，还是要逐渐影响双下肢。”
link都在这儿：
http://www.starlakeporch.net/bbs/read.php?1,57275,57298#msg-572
好几个贴，你们看看。
Letter from Beaumont Hospital on Xiao procedure.
Posted: August 31st, 2009 by jeepgirlnj
Thank you for your interest in our nerve rerouting research study here at
William Beaumont Hospital for people with spina bifida, 6 years and older
and SCI-paraplegic (as a result of trauma) adults, 18 and older, who have
neurogenic bladder.
Dr. Xiao, in China, developed this spinal nerve rerouting procedure and has
been studying it since the late 1980’s. Dr. Xiao has done over 500 of these
surgeries in China with excellent results-more than 80% do not need a
catheter to empty their bladder after the nerve regeneration occurs. In Dr.
Xiao’s patients, those that regained bladder function also regained bowel
function. With Dr. Xiao’s help, we started doing this research study here
at Beaumont in December 2006.
In the surgery, the spinal nerves are rerouted and if successful, the nerves
regenerate (over a period of 6-24 months). If the nerve regeneration is
successful, a new nerve pathway to empty the bladder is created. We can use
a variety of spinal nerves for this pathway. If
it is successful, the person will be able to empty their bladder without the
use of a catheter after this nerve regeneration.
In China, this procedure is now standard of care. Dr. Xiao has taught this
procedure to surgeon’s at all the major hospitals in China.
We have been following Dr. Xiao’s progress for many years. During the
winter of 2006, 3 of our Urologists-Dr Ananias Diokno, Dr Kenneth Peters and
Dr Jose Gonzalez, all went to China to study under Dr Xiao and decided they
wanted to bring this surgery to the US. In the US,
however, in order for a procedure to become standard of care and for
insurances to cover it, it must be proven to work within the US. That means
you must do research. This is why we are doing this research study here at
Beaumont.
We did the first spina bifida child in the US in Dec.2006 and other SCI
patients with Dr. Xiao. Everything went well. We completed 8 more spina
bifida surgeries the first week of April 2007 with Dr. Xiao. We are
beginning to see some encouraging results.
There are risks/side effects that need to be considered. This is a major
surgery done under general anesthetic and should not be taken lightly. The
risks of this surgery are weakness to the lower extremity (the operative
side).【手术的非风险只影响到手术一侧的腿，不会是双腿的。如果双腿出现问题，是
患者疾病本身导致的可能性非常大。】 Everyone will have lower extremity
weakness for at least a period of time after this surgery. Participants may
need a walker or even a wheel chair for a period of time. This is expected;
this would not be considered a complication. We take a lumbar spinal nerve (
a part of the nerve or all of the nerve if it is too small) and attach this
nerve to the bladder nerve. The lumbar spinal nerves are responsible for
walking. It can take time for other nerves to take over the function of the
nerve (or the part of it) taken away. Physical therapy and time helps get
back to their functioning prior to surgery. But there is no guarantee that
their full function will return. Other risks include the risk of anesthesia
– blood clot in the lungs, heart attack, stroke, pneumonia, death. These
are rare, but you need to be aware of them. Anytime you make an incision,
you risk infection. These are the risks.
We are the only site in the US performing this research surgery. The surgery
, with the pre-op testing and 3 year follow-up procedures costs between $30,
000 – 40,000 for each patient. We pay for all of these costs. The costs are
not covered by insurance because it is research. Because there is 3 years
of follow-up with this study, there are a lot of visits to Beaumont required
. We do not provide hotel or transportation costs for out-of-state
participants.
We had a private donor donate the money for all of our previous surgeries.
We have applied for several grants that would allow us to continue this
research by doing additional surgeries. Until we obtain another funding
source, we are adding the names of interested candidates to our list.
Again, thank you for your interest. As I indicated above, children must be 6
years old to participate in this study. Your daughter is young. You have
the advantage to watch the progress made in this area. This will allow you
to make the best health care decisions for her. Let me know if you have
additional questions.
我写个摘要：
手术有风险，风险是手术一侧神经的变弱或萎缩。原文:The risks of this surgery
are weakness to the lower extremity (the operative side).
若是非同侧，或者两侧都出现问题，则应该是疾病本身造成的而不是手术造成的。
问题：那些被报道的，到底是两侧都有问题，还是就手术侧有问题。还有，就用这个做
个retrospective study 去验证一下安全性，很简单吧。
另，有医生表示：
“肖氏术取用的是单侧一段运动神经，这段神经功能丧失后出现的是废用性萎缩而不是
溃疡。病人本来存在的脊髓受压如果严重会导致双下肢周围神经病变，与糖尿病足的致
病因素有相似之处，出现迁延不愈的溃疡最后截肢。这种病变是渐进性的，也可以解释
为什么这个小孩在术后两年才截肢。”
还有人表示：
“栓系综合症。由于脊柱裂，脊髓被栓到骶骨部位，没有回位，没有伸缩空间，所以，
小孩每长高一点，脊髓就绷得更紧，神经损伤平面就更高：丛最早的膀胱直肠神经（骶
5、4、3、2）到管腿的神经（骶1-腰5、4、3、2）
你们看方舟子利诱告状的那个病人，以前已做过五次手术，就是试图减轻脊髓张力（栓
系松解术），可惜的是，很多病人松解不了，还是要逐渐影响双下肢。”
link都在这儿：
http://www.starlakeporch.net/bbs/read.php?1,57275,57298#msg-572
好几个贴，你们看看。
Letter from Beaumont Hospital on Xiao procedure.
Posted: August 31st, 2009 by jeepgirlnj
Thank you for your interest in our nerve rerouting research study here at
William Beaumont Hospital for people with spina bifida, 6 years and older
and SCI-paraplegic (as a result of trauma) adults, 18 and older, who have
neurogenic bladder.
Dr. Xiao, in China, developed this spinal nerve rerouting procedure and has
been studying it since the late 1980’s. Dr. Xiao has done over 500 of these
surgeries in China with excellent results-more than 80% do not need a
catheter to empty their bladder after the nerve regeneration occurs. In Dr.
Xiao’s patients, those that regained bladder function also regained bowel
function. With Dr. Xiao’s help, we started doing this research study here
at Beaumont in December 2006.
In the surgery, the spinal nerves are rerouted and if successful, the nerves
regenerate (over a period of 6-24 months). If the nerve regeneration is
successful, a new nerve pathway to empty the bladder is created. We can use
a variety of spinal nerves for this pathway. If
it is successful, the person will be able to empty their bladder without the
use of a catheter after this nerve regeneration.
In China, this procedure is now standard of care. Dr. Xiao has taught this
procedure to surgeon’s at all the major hospitals in China.
We have been following Dr. Xiao’s progress for many years. During the
winter of 2006, 3 of our Urologists-Dr Ananias Diokno, Dr Kenneth Peters and
Dr Jose Gonzalez, all went to China to study under Dr Xiao and decided they
wanted to bring this surgery to the US. In the US,
however, in order for a procedure to become standard of care and for
insurances to cover it, it must be proven to work within the US. That means
you must do research. This is why we are doing this research study here at
Beaumont.
We did the first spina bifida child in the US in Dec.2006 and other SCI
patients with Dr. Xiao. Everything went well. We completed 8 more spina
bifida surgeries the first week of April 2007 with Dr. Xiao. We are
beginning to see some encouraging results.
There are risks/side effects that need to be considered. This is a major
surgery done under general anesthetic and should not be taken lightly. The
risks of this surgery are weakness to the lower extremity (the operative
side).【手术的非风险只影响到手术一侧的腿，不会是双腿的。如果双腿出现问题，是
患者疾病本身导致的可能性非常大。】 Everyone will have lower extremity
weakness for at least a period of time after this surgery. Participants may
need a walker or even a wheel chair for a period of time. This is expected;
this would not be considered a complication. We take a lumbar spinal nerve (
a part of the nerve or all of the nerve if it is too small) and attach this
nerve to the bladder nerve. The lumbar spinal nerves are responsible for
walking. It can take time for other nerves to take over the function of the
nerve (or the part of it) taken away. Physical therapy and time helps get
back to their functioning prior to surgery. But there is no guarantee that
their full function will return. Other risks include the risk of anesthesia
– blood clot in the lungs, heart attack, stroke, pneumonia, death. These
are rare, but you need to be aware of them. Anytime you make an incision,
you risk infection. These are the risks.
We are the only site in the US performing this research surgery. The surgery
, with the pre-op testing and 3 year follow-up procedures costs between $30,
000 – 40,000 for each patient. We pay for all of these costs. The costs are
not covered by insurance because it is research. Because there is 3 years
of follow-up with this study, there are a lot of visits to Beaumont required
. We do not provide hotel or transportation costs for out-of-state
participants.
We had a private donor donate the money for all of our previous surgeries.
We have applied for several grants that would allow us to continue this
research by doing additional surgeries. Until we obtain another funding
source, we are adding the names of interested candidates to our list.
Again, thank you for your interest. As I indicated above, children must be 6
years old to participate in this study. Your daughter is young. You have
the advantage to watch the progress made in this area. This will allow you
to make the best health care decisions for her. Let me know if you have
additional questions.
