羽矢

1. Duke大学John S. Wiener在2010年6月的脊柱裂协会的讲座中透露神经外科专家们对肖氏手术的反对意见：“神经外科专家们注意到，他（肖传国）的手术是一种脊髓栓系松解。这可解释一些（肖氏手术的）正面结果”。
http://conference.spinabifidaassociation.org/site/c.qkI1KgMTIrF/b.5591661/k.633B/Educational_Sessions.htm
37th SBA National Conference
June 27-30, 2010 Cincinnati, Ohio
Session Presentations
Health Issues Affecting Men with Spina Bifida: The Xiao Procedure
Slide 11
Neurosurgeons noted his procedure was a spinal cord detethering
Could explain some of positive results

2. 资料表明，“肖氏手术”号称治疗脊髓栓系综合征
华中科技大学外科学2005年度“国家精品课程”申报表
http://202.114.128.246/shenbao/shenbaobiao/wk.doc
肖传国教授在国际上首次提出并证实了“人工建立体神经—内脏神经反射弧”这一神经科学新概念，为成功治疗内脏器官神经功能失控提供了理论基础，至今，已治疗截瘫或脊髓栓系综合征导致的神经原性膀胱患者100余例

“何梁何利基金”报奖材料
http://www.hlhl.org.cn/detail.asp?ID=476
该反射弧被命名为“肖氏反射弧”。至今，已治疗截瘫和脊髓栓系综合征所导致的大小便失禁患者90余例

《临床泌尿外科杂志》网站
http://www.cjcu.com.cn/showart.aspx?artid=3187
肖传国教授在国际上首次提出并证实 “人工建立体神经-内脏神经反射弧”这一神经泌尿科学新概念，首创“肖氏反射弧”并用于治疗截瘫或脊髓栓系综合征导致的神经原性膀胱。

吴秀英.体神经-内脏神经反射弧膀胱功能重建术的护理.护理学杂志,2002,17(4):259-261
http://www.cqvip.com/qk/93738x/2002004/6120159.html
协和医院泌尿外科肖传国教授在国际上首次提出并证实“人工建立体神经-内脏神经反射弧”这一神经科学新概念，首创“肖氏反射弧”并用于治疗截瘫或脊髓栓系综合征导致的神经原性膀胱。

高晓群2006年接受“南国都市报”采访
http://www.xys.org/xys/ebooks/others/science/dajia7/xiaochuanguo130.txt
高院长说，以前几乎对此病束手无策， 从上世纪80年代末开始，经过15年的潜心研究，肖传国提出国际公认的“肖氏反射弧”原理—这是外科领域里仅有的几项以中国人姓氏命名的手术原理。至今，已治疗截瘫或脊髓栓系综合征导致的神经原性膀胱患者200余例

《临床泌尿外科杂志》网站
Comprehensive Report Of the Fourth (2008) International Academic Conference of Journal of Clinical Urology
The Fourth (2008) International Academic Conference of Journal of Clinical Urology is held on the beautiful scenic spot– - Huangshan mountains in Anhui Province on September 12nd ~ 15th 2008.
Comprehensive Report Of the Fourth (2008) International Academic Conference of Journal of Clinical Urology
Professor Xiao Chuanguo report on “New progress in xiao’s reflex arc” for the conference. He explain the establishment mechanism of the artificial reflex arc in a simple way, and introduced the surgery at home and abroad in the application of the latest situation. The delegates considered that the artificial reflex arc is put forward for the first time and confirmed that this surgery can use nerve regeneration to regenerate  rectal innervation of bladder and its central control. The surgery for the first time innovated the key technology of the treatment of incontinence caused by congenital spina bifida tethered cord syndrome.

3. 肖传国最早的13例脊髓脊膜膨出患者患者，均具栓系综合征
肖传国等. 人工体神经-内脏神经反射弧治疗脊髓脊膜膨出患者大小便功能障碍. 《临床泌尿外科杂志》 2003年11期
获1年以上随访的13例，……MRI检查示典型的栓系综合征影像。

4. 神源医院肖氏手术与栓系松解术同时做
http://bkb.ynet.com/article.jsp?oid=59384400
北京科技报《调查神源医院》

前河南神源医院院长高晓群向《北京科技报》解释，目前，治疗脊柱裂的常规手术是对脊髓栓系进行松解来完成的，这就好比把神经看作一个松紧带，由于这根 “松紧带”没有达到脊髓的适应长度，因此栓系松解手术就是将过紧的神经解开后重新衔接以此达到延长这根“松紧带”的目的来完成治疗，而“肖氏反射弧”采用的方法则是除了松解以外，医生还会用患儿上肢或者腰部健康的神经连接到受损的膀胱神经上，让膀胱神经与健康神经生在一起恢复成健康神经。根据其理论，术后，如果恢复情况良好，患者就会出现小便的感觉。

神源医院广告：“修补+松解+反射弧重建省时省力省钱”、“脊髓脊膜膨出——做两个手术花一样钱”。

5. 肖传国2005年英文论文否认在肖氏手术的同时做栓系松解术，指出：“除非纤维脂肪瘤太大导致脊髓或神经根受压，否则不予切除；对终丝牵拉症和术后粘连不予治疗”。栓系松解术通常包含上述几项术式。即便如此，肖氏手术要切开硬脊膜囊，应有硬脊膜内松解的效果。
http://www.ncbi.nlm.nih.gov/pubmed/15879861
Xiao CG, Du MX, Li B, Liu Z, Chen M, Chen ZH, Cheng P, Xue XN, Shapiro E, Lepor H. An artificial somatic-automonic reflex pathway procedure for bladder control in children with spina bifida. J Urol 2005; 173: 2112.
The fibrolipoma was avoided unless it was too large and caused spinal cord or root compression. The tight filum terminale or postoperative adhesions were also untreated to avoid inadvertent damage.

6. 栓系松解术治疗栓系综合征文献
http://www.ncbi.nlm.nih.gov/pubmed/16952698
Tarcan et al. Does surgical release of secondary spinal cord tethering improve the prognosis of neurogenic bladder in children with myelomeningocele? J Urol. 2006 Oct;176(4 Pt 1):1601-6

56 children… Urodynamic parameters in terms of cystometric bladder capacity and detrusor leak point pressure substantially improved 6 months after untethering surgery (125 vs 170 ml and 69.1 vs 47.5 cm H2O, respectively, p < 0.05). Assessment of urodynamic findings in 19 children at 1 year failed to demonstrate a significant change in these parameters.
CONCLUSIONS:
Our study shows that secondary untethering surgery may significantly improve urological outcome.
RESULTS
… A further comparison of urodynamic parameters at 6 and 12 months in 19 children in whom the data were available revealed that the urodynamic improvement was persisting at 1 year….

56例继发性栓系综合征，栓系松解术后尿路感染、上尿路扩张、术后膀胱输尿管反流消失或显著改善。术后6个月尿动力学参数极大改善。现有19名患者的12个月尿动力学参数，与术后6个月相比无显著改变，表明尿动力学改善是持久的。结论：继发性解拴术可显著改善泌尿学结果。

http://www.ncbi.nlm.nih.gov/pubmed/17328264
Hsieh MH et al. The effects of detethering on the urodynamics profile in children with a tethered cord. J Neurosurg. 2006 Nov;105(5 Suppl):391-5.
in five (50%) of the 10 children with abnormal preoperative UDS results, the postoperative UDS demonstrated improved or normal urodynamics.
10名术前尿动力学结果异常的患者中的5名，术后尿动力学研究表现出改善或正常的尿动力学数据

http://www.ncbi.nlm.nih.gov/pubmed/12145516
CS. von Kocha et al. Clinical Outcome in Children Undergoing Tethered Cord Release Utilizing Intraoperative Neurophysiological Monitoring. Pediatr Neurosurg. 2002 Aug;37(2):81-6.
Significant bowel and bladder improvement was seen in 4 out of 25 patients

http://www.ncbi.nlm.nih.gov/pubmed/10804050
M. Selçuki et al. Patients with urinary incontinence often benefit from surgical detethering of tight filum terminale. Child’s Nervous System, Volume 16, Number 3, 150-154

http://www.ncbi.nlm.nih.gov/pubmed/16506479
Lee GY et al. Surgical management of tethered cord syndrome in adults: indications, techniques, and long-term outcomes in 60 patients. J Neurosurg Spine. 2006 Feb;4(2):123-31.
Subjective improvement in bladder function was noted in 50% of patients with bladder dysfunction at presentation.

http://www.ncbi.nlm.nih.gov/pubmed/17162083
Abrahamsson et al. Urodynamic findings in children with myelomeningocele after untethering of the spinal cord. J Urol. 2007 Jan;177(1):331-4
After untethering secondary to myelomeningocele 35% of the patients experienced improved bladder function and 5% deteriorated. All of the patients who deteriorated before untethering improved afterward, and 90% of those who were stable preoperatively continued to be stable postoperatively.
20例继发性栓系综合征患者，施行栓系松解术后膀胱功能改善35%，加重5%

Bui CJ, Tubbs RS, Oakes WJ. Tethered cord syndrome in children: a review. Neurosurg Focus. 2007;23(2):E2.
http://thejns.org/doi/pdfplus/10.3171/FOC-07/08/E2
Results of Untethering Surgery
The results of surgical untethering in symptomatic TCS patients are generally favorable, but the extent of im-provement varies depending on the preoperative symp-toms and deficits. In 1975, Anderson 1 reported in his series of 73 pediatric patients with OSD and TCS that the rate of improved pain was 100%, whereas the rates of improved sensorimotor and sphincter function were 42 and 43%, respectively, and those of symptom stabilization were 45 and 48%, respectively. In their patients, Lee et al. 27 reported that pain improved in approximately 80% of patients, neurological improvement or stabilization occurred in 90% (with quicker recovery of motor rather than sensory function), and bladder function improved in 50%. Guerra at al. 11reported similar results, with 48% improvement seen in pediatric patients with abnormal urodynamics. Other studies have yielded higher improvement rates for urological dysfunction, with an average of 87% seen in seven studies having a total of 161 patients.36 It must be noted that urological improvement is not as favorable in older children and in the adult population. 26 Huttman et al. 14 compared the durations of symptoms with outcomes and concluded that pain and spasticity responded favorably to surgery regardless of the duration of symptoms, whereas improvements in sensorimotor and bladder function were inversely related to the duration of symptoms. It must also be noted that even though many
authors have noted significant improvement in bladder function, complete urological recovery is rare.

http://www.ncbi.nlm.nih.gov/pubmed/19569907
Al-Holou et al. (2009) The outcome of tethered cord release in secondary and multiple repeat tethered cord syndrome. J Neurosurg Pediatr. 2009 Jul;4(1):28-36.
84例继发性栓系综合征患者，施行栓系松解术后6个月随访结果：
小便改善11%，加重19%，不变70%；
大便改善10%，加重7%，不变83%。
一年或更长时间随访结果：
小便改善15%，加重20%，不变64%；
大便改善20%，加重31%，不变49%。

http://www.cnki.com.cn/Article/CJFDTOTAL-ZHMN200404008.htm
蒋寿宁等. 脊髓栓系综合征致上尿路积水的手术疗效观察. 中华泌尿外科杂志2004年第25卷第4期
对20例TCS伴有上尿路积水患者进行去栓手术,观察比较手术前后膀胱剩余尿、肾和输尿管积水、肾皮质厚度及肾功能的变化. 结果膀胱剩余尿恢复正常5例,减少10例,总有效率83%.肾积水明显减少6例,轻度减少7例,无改变7例,总有效率65%.输尿管积水明显减少7例,好转4例,无变化7例,总有效率61%.肾皮质厚度明显增加5例,轻度增加2例,无改变13例,总有效率35%.肾功能中度尿毒症转为轻度2例,轻度转为正常4例,14例同术前正常.