送交者: Amalgamator 于 2010-10-27 04:34:46

[译文] 现代医学奇迹

2008年12月1日

彼利•克拉塞永远也不会忘记他的第9个生日。在4月3日，他去位于罗伊尔欧克的比尔蒙特医院做了改变他生活的手术----术后他将有希望能自己上厕所。

当彼利还是14大天的胚胎的时候，他的脊髓生出一个洞引发了脊柱裂，这是常见的新生儿缺陷。“脊柱裂是我怀彼利第一个月时由信息错误引起的”，彼利的妈妈杰尼丝•克拉塞说，“细胞生长的时候没有完成使命。彼利这样的孩子的代表性的主要问题是大小便。”

在9年的时间里，彼利一天需要最多达5次插入导尿管以排清膀胱。杰尼丝是在滨州的斯克兰屯工作的胸外科护士，她解释说：“每次给他导尿时，都会有新的细菌进入他的体内，使他承受更高的肾感染和尿路感染的风险。”使用导尿管意味着家里每隔几个小时就要处于一个干净的环境中。因此，导尿帮助了彼利，同时也把他拴在家中。

在2月，当杰尼丝在网上与一个脊柱裂支援小组交流时，一位朋友告诉她比尔蒙特医院的一项研究可能使彼利更好地控制大小便。比尔蒙特医院的这项研究是关于脊柱手术的，它首创于中国，将神经从大腿重新导向膀胱以更好地控制排小便。比尔蒙特是美国唯一进行这项研究的医院，患者有为此远自尤塔州赶来的。中国医生肖传国创立了这一手术，他报告了术后12-24月时有近90%的成功率。

比尔蒙特医院的泌尿科主任坎尼斯•彼得斯医学博士和肖医生移开了彼利脊椎上控制部分大腿肌肉的一小块。杰尼丝说：“风险相对于肾脏疾病来说并不紧要，做决定的时候彼利也参加了。他吓得不轻，不想再做一次手术，但是最后他看到了里面的好处。”

彼利是4个孩子中最小的一个，他回忆说：“我们去了医院，他们在4月3号，我的生日，做了手术。当手术结束的时候，我的妈妈送给我一个绿色的填充龙的礼物，很好玩儿。”

杰尼丝说：“这一手术最让人惊奇的地方是之后我们能看到膀胱收缩。那些医生们竟能从常规环境中取出一些东西，然后让它们在另外的地方工作。”

彼利的新神经回路大约每天生长一毫米。他现在需要的时候只要挠或揪一下大腿，就可以刺激神经使膀胱排尿。彼利正在重新训练膀胱肌肉，现在还不能完全排空，但他正在取得进步。他说：“很高兴我做了手术，因为我终于做到了我以前根本做不了的事情：尿到马桶里。做事情也变得容易了，不必担心尿裤子。”

还要过几年彼利才会知道手术是否成功。杰尼丝看得更远：“即使彼利的结果不好，试验而失败的结果将会帮助其他人，那也比根本不做强。但是，（如果重新选择）我们将毫不犹豫地再做一次。”

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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."