【3.5】手术为何难以普及？
Why is difficult to popularize Xiao procedure?
记者发现，全国仅武汉协和医院、神源医院等少数几家医院正在开展或开展过人工反射弧手术，而中国有几百万截瘫、脊柱裂患者，既然这种手术有85%的成功率，为什么在各大医院没有推广普及呢？
We found that, nationwide, only very few hospitals including Union Hospital in Wuhan and ShenYuan Hospital in Zhengzhou are or have been performing the Xiao procedure, i.e. the artificial reflex arc procedure, while China has millions of people suffering from spinal cord injury (SCI) and spina bifida. If Xiao procedure has 85% success rate, why can’t it be popularized in all the major hospitals?
对此，叶鑫生也很费解，“这么好的手术，为什么就推广不开呢？”
Ye Xinsheng was also confused by the situation, “Why such a good procedure can’t be put into more extensive clinical practice?”
就这个问题，记者采访了多位泌尿外科专家。“我们也有这个疑问呀！”北京大学泌尿外科研究所名誉所长、中国泌尿外科学唯一的中国工程院院士郭应禄对记者说：“肖传国的这个手术在道理上也能讲得通，但不是所有的病人(的神经)都能接得上的”，他以截瘫病人为例解释说，“截瘫也分不同的部位，但能接上膀胱神经的只能是下面(位置的截瘫)，而且你得能找得到神经才能接”，郭应禄说，“所以，就算他说得对，能起作用也是有限制的。”郭表示，他并不了解这种手术治疗脊柱裂的情况，对肖传国接触也不多。
To find the answer, we interviewed several experts in Urosurgery. “We also have this concern!”, said Guo Yinglu, the honorary director of the Institute of Urosurgery at Peking University and the only Academian on Urosurgery in Chinese Academy of Engineering. Guo said, “It makes some sense in the theory of the Xiao procedure. But not for all the patients can it achieve nerve reconnection”. He then took the case of SCI patients as an example. “The injury of spinal cord happens at different levels. Only for those at lower levels, their bladder nerve may be reconnected, and you can only do this when you are able to find the nerve”. Guo continued to say, “So, it means that even if he (Xiao) is correct, the effectiveness (of the procedure) is limited”. Guo said that he was not aware of the situation of applying Xiao procedure to spina bifida, and he did not have much contact with Xiao in person.
其他接受采访的泌尿外科专家也大多不愿多谈肖传国的神经反射弧手术，他们普遍表示，这一技术需要时间的检验。“如果效果好，肯定会得到普及，因为这方面患者的需求很强烈”。
Most of the urosurgical experts interviewed were not willing to talk much about Xiao neurological reflex arc procedure. They all said that this technique needs to face the evaluation along the time. “If it is highly effective, it must gain extensive clinical application, because the specific needs from the affected population are overwhelming.”
也有医生对人工反射弧手术提出质疑。武警总医院病理科主任纪小龙说，神经愈合至今仍是医学上的一个难题，“很难长在一起。打个比方，每根神经就像电话线，里面有好多分支，只有每一根分支都对上了，它才能长好。而现有的任何显微手术都做不到这点，只能靠两根神经自己去找，存在偶然因素。”
But there are doctors expressed doubt to Xiao procedure. Dr. Ji Xiaolong, director of Pathology at the General Hospital of Chinese Armed Police Forces, said that the healing of nerves remains a big challenge in medical field. “It’s hard (for nerve) to grow into one piece. Imagine that each nerve is like a telephone cable with many contacts in it. Only when every contact is connected, can we say it is healed. But current technique in any microscopic surgery can’t achieve this point but leaving the two nerve stumps searching for each other (for reconnecting), it involves uncertainty”.
对于推广难，肖传国自己认为，主要是因为手术过于复杂，“这个手术需要打开脊髓腔，从一大把神经纤维中挑出一根做手术。泌尿外科医生没有任何人会做，除了我培养的博士，因为他们根本不知道怎么进到骨头中去挑神经。而神经外科医生又不懂泌尿，不知道到底哪根神经是管膀胱的，也不知道病人术前膀胱的情况怎么样。”
Regarding Xiao’s own opinion on the difficulties on promoting more clinical application of his procedure, he thought that the primary hinder is the complexity of the operation. “This operation requires opening of the spinal canal, and needs to sort out the one nerve root from a bunch of them to do the re-routing. No urosurgeon knows how to do it, because they don’t know how to pick up the nerve from inside the bones, except those doctors I trained, (they know how to do it). While neurosurgeons don’t know urology, they have no idea which nerve root is for the bladder, neither do they know the preoperational condition of the bladder of the patient”.
“我们办过培训班，也邀请国内的医生参加，但来的都是泌尿外科医生，没有神经外科医生，不能形成一个团队，来了也做不了。现在，我们就打算多培养些博士生，毕业后分到各地，多建立几个中心，统一做。”
“We hosted some training courses, and invited doctors from all over the country to participate. But those came to the training were all urosurgeons, not neurosurgeons. They couldn’t team up, so even if they came for the training, they can’t perform the surgery (later back home). Now, we plan to train more MD students. When they graduate, they can go more places to establish more centers to perform the procedure”.
对于手术难度大造成不易推广的说法，郭应禄认为，如果不是技术本身有问题、不是对技术保密得太厉害，那就应该通过多培养人来达到推广技术的目的。
Regarding the claim that the difficulty of the procedure hinders its application, Guo Yinglu thinks that, if there is no intrinsic problem in the technique itself, or there is no intention to keep the technical secret, it should be brought to extensive clinical application by training more surgeons to perform the procedure.
据肖传国介绍，神源医院的建立就和他的一个博士生有关。不过，他没有从神源医院拿过一分钱。“医院是股份制的，他们要我占股份，我没要。最后大概给了我30%的股份，我说如果有分红，你们也不要给我，把这个钱拿去滚动发展。我现在去那边开刀，火车票都是我自己出的。”
According to Xiao, the establishment of the ShenYuan hospital has something to do with one of his MD students, but Xiao himself did not receive any income from this hospital. “That hospital is a joint-investment. They offered me some shares but I didn’t take it. Finally they gave me about 30% of the hospital. I told them that if there is any profit, I don’t want my part but re-invest to the hospital for further development. Anytime now I am there for performing the surgery, I buy my own train ticket.”