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現代醫學奇迹
虹橋科教論壇
送交者: Amalgamator 於 2010-10-27 06:30:39
[譯文] 現代醫學奇迹
2008年12月1日
彼利•克拉塞永遠也不會忘記他的第9個生日。在4月3日，他去位於羅伊爾歐克的比爾蒙特醫院做了改變他生活的手術----術后他將有希望能自己上廁所。
當彼利還是14大天的胚胎的時候，他的脊髓生出一個洞引發了脊柱裂，這是常見的新生兒缺陷。「脊柱裂是我懷彼利第一個月時發生的畸形」，彼利的媽媽傑尼絲•克拉塞說，「細胞生長的時候沒有完成使命。彼利這樣的孩子的代表性的主要問題是大小便。」
在9年的時間裡，彼利一天需要最多達5次插入導尿管以排清膀胱。傑尼絲是在濱州的斯克蘭屯工作的胸外科護士，她解釋說：「每次給他導尿時，都會有新的細菌進入他的體內，使他承受更高的腎感染和尿路感染的風險。」使用導尿管意味著家裡每隔幾個小時就要處於一個乾淨的環境中。因此，導尿幫助了彼利，同時也把他拴在家中。
在2月，當傑尼絲在網上與一個脊柱裂支援小組交流時，一位朋友告訴她比爾蒙特醫院的一項研究可能使彼利更好地控制大小便。比爾蒙特醫院的這項研究是關於脊柱手術的，它首創於中國，將神經從大腿重新導向膀胱以更好地控制排小便。比爾蒙特是美國唯一進行這項研究的醫院，患者有為此遠自尤塔州趕來的。中國醫生肖傳國創立了這一手術，他報告了術后12-24月時有近90%的成功率。
比爾蒙特醫院的泌尿科主任坎尼斯•彼得斯醫學博士和肖醫生移開了彼利脊椎上控制部分大腿肌肉的一小塊。傑尼絲說：「風險相對於腎臟疾病來說並不緊要，做決定的時候彼利也參加了。他嚇得不輕，不想再做一次手術，但是最後他看到了裡面的好處。」
彼利是4個孩子中最小的一個，他回憶說：「我們去了醫院，他們在4月3號，我的生日，做了手術。當手術結束的時候，我的媽媽送給我一個綠色的填充龍的禮物，很好玩兒。」
傑尼絲說：「這一手術最讓人驚奇的地方是之後我們能看到膀胱收縮。那些醫生們竟能從常規環境中取出一些東西，然後讓它們在另外的地方工作。」
彼利的新神經迴路大約每天生長一毫米。他現在需要的時候只要撓或揪一下大腿，就可以刺激神經使膀胱排尿。彼利正在重新訓練膀胱肌肉，現在還不能完全排空，但他正在取得進步。他說：「很高興我做了手術，因為我終於做到了我以前根本做不了的事情：尿到馬桶里。做事情也變得容易了，不必擔心尿褲子。」
還要過幾年彼利才會知道手術是否成功。傑尼絲看得更遠：「即使彼利的結果不好，試驗而失敗的結果將會幫助其他人，那也比根本不做強。但是，（如果重新選擇）我們將毫不猶豫地再做一次。」
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原文：http://housecall.beaumonthospitals.com/innovations-nerve-rewiring
Modern Medical Marvels
December 1, 2008
Billy Kraser will never forget his ninth birthday. On April 3, he went to Beaumont Hospital in Royal Oak and had a life-changing surgery that will hopefully allow him to use the bathroom on his own.
When Billy was a 14-day-old embryo, his spinal cord developed a hole in it that caused spina bifida, a common birth defect. "Spina bifida is a malformation that happened during the first month of mypregnancy with Billy," says his mom, Janice Kraser. "The cells didn't complete their mission when developing. The major problem for kids like Billy is typically bowel and bladder issues."
For nine years, Billy had a catheter inserted up to five times a day to empty his bladder. "Any time you cath him, you're introducing new bacteria into his body, putting him at a higher risk for kidney and urinary tract infections," explains Janice, an open-heart surgery nurse in Scranton, Penn. Using the catheter required the family to be in a clean environment every couple of hours. So, while the catheter was helping Billy, it was also tethering him to his home.
But in February, Janice was online with a spina bifida support group when a friend told her about a research study at Beaumont that could give Billy more control over his bladder and bowels. The research at Beaumont uses a spinal surgery pioneered in China to redirect nerves from the leg to the bladder to gain better control of urination. Beaumont is the only U.S. hospital performing this surgery, and patients have traveled from as far as Utah for it. The Chinese doctor who developed the surgery, Chuan-Guo Xiao, M.D., reports an almost 90-percent success rate and an average time for results of 12 to 24 months after surgery.
Kenneth Peters, M.D., chairman of Urology at Beaumont, Royal Oak and Dr. Xiao removed a piece of Billy's vertebrae that controls part of the thigh muscle. "The risks were inconsequential compared to the risk for kidney disease," says Janice. "Billy was part of the decision. He was scared and didn't want to have another surgery, but in the end, he saw the good in it."
"We got to the hospital and they did surgery on April 3, my birthday," remembers Billy, the youngest of four children. "When the surgery was over, my mom gave me a green dragon stuffed animal as a present. It's pretty cool."
Janice says, "The most amazing part of the procedure was afterward, when we could see the bladder contractions. The doctors were able to take something out of its normal environment and make it work somewhere else."
Billy's newly re-wired nerve grows about one millimeter a day. He's able to urinate on demand, just by scratching or pinching his thigh, which stimulates the nerve and signals the bladder to empty. Billy's working on retraining his bladder muscles and is not able to empty completely yet, but he's making progress. "I'm glad I had the surgery because I can finally do what I could never do before: pee in the toilet," he says. "I can also do stuff easier now without having a problem worrying about having an accident."
Billy has a few more years before he'll know if the surgery was a success. Janice looks at the bigger picture: "If it doesn't end up working for Billy, it's better to try and fail and help someone else in the future than to not have done it at all. But, we would do it again, without hesitation."
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