{"id":16,"date":"2025-03-26T18:15:43","date_gmt":"2025-03-26T18:15:43","guid":{"rendered":"https:\/\/spinabifida.kaza.cz\/?p=16"},"modified":"2025-05-13T21:06:07","modified_gmt":"2025-05-13T21:06:07","slug":"nitrodelozni-operace","status":"publish","type":"post","link":"https:\/\/spina-bifida.cz\/index.php\/2025\/03\/26\/nitrodelozni-operace\/","title":{"rendered":"Nitrod\u011blo\u017en\u00ed operace"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\">Obecn\u00e9 informace<\/h2>\n\n\n\n<p>Spina bifida je vrozen\u00e1 vada p\u0159i n\u00ed\u017e se p\u00e1te\u0159 b\u011bhem v\u00fdvoje plodu spr\u00e1vn\u011b neuzav\u0159e. Jedn\u00e1 se o typ defektu neur\u00e1ln\u00ed trubice, kter\u00fd postihuje mozek, m\u00edchu nebo p\u00e1te\u0159 vyv\u00edjej\u00edc\u00edho se plodu.<\/p>\n\n\n\n<p>Nejz\u00e1va\u017en\u011bj\u0161\u00ed a nejb\u011b\u017en\u011bj\u0161\u00ed formou spina bifida je myelomeningok\u00e9la. P\u0159i tomto \u201eotev\u0159en\u00e9m\u201c defektu neur\u00e1ln\u00ed trubice jsou m\u00edcha a okoln\u00ed nervy nebo jin\u00e9 nervov\u00e9 prvky obna\u017eeny otvorem v z\u00e1dech plodu. To m\u00e1 za n\u00e1sledek \u010d\u00e1ste\u010dn\u00e9 nebo \u00fapln\u00e9 ochrnut\u00ed \u010d\u00e1st\u00ed t\u011bla d\u00edt\u011bte pod otvorem. Defekt neur\u00e1ln\u00ed trubice se m\u016f\u017ee objevit kdekoli po d\u00e9lce p\u00e1te\u0159e, ale b\u011b\u017en\u011b se nach\u00e1z\u00ed pod\u00e9l doln\u00ed \u010d\u00e1sti zad.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"480\" height=\"428\" src=\"https:\/\/spina-bifida.cz\/wp-content\/uploads\/2025\/03\/texas-mmc.jpeg\" alt=\"\" class=\"wp-image-156\" srcset=\"https:\/\/spina-bifida.cz\/wp-content\/uploads\/2025\/03\/texas-mmc.jpeg 480w, https:\/\/spina-bifida.cz\/wp-content\/uploads\/2025\/03\/texas-mmc-300x268.jpeg 300w\" sizes=\"auto, (max-width: 480px) 100vw, 480px\" \/><figcaption class=\"wp-element-caption\">Zdroj: <a href=\"https:\/\/www.texaschildrens.org\/content\/conditions\/spina-bifida-myelomeningocele\" target=\"_blank\" rel=\"noreferrer noopener\">www.texaschildrens.org<\/a><\/figcaption><\/figure>\n\n\n\n<p>V USA se myelomeningok\u00e9la se vyskytuje zhruba u 3 z ka\u017ed\u00fdch 10 000 \u017eiv\u011b narozen\u00fdch d\u011bt\u00ed. Je to nej\u010dast\u011bj\u0161\u00ed vrozen\u00e1 vada centr\u00e1ln\u00edho nervov\u00e9ho syst\u00e9mu a nejb\u011b\u017en\u011bj\u0161\u00ed trvale invalidizuj\u00edc\u00ed vrozen\u00e1 vada, pro kterou neexistuje \u017e\u00e1dn\u00fd zn\u00e1m\u00fd l\u00e9k.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Mo\u017enosti l\u00e9\u010dby<\/h2>\n\n\n\n<p>Historicky byla l\u00e9\u010dba u d\u011bt\u00ed s roz\u0161t\u011bpem p\u00e1te\u0159e chirurgick\u00fdm z\u00e1krokem v prvn\u00edch dnech po narozen\u00ed k uzav\u0159en\u00ed defektu. U mnoha miminek se v\u0161ak vyvine hydrocefalus neboli p\u0159ebyte\u010dn\u00e1 mozkom\u00ed\u0161n\u00ed tekutina v mozku, kterou je t\u0159eba odv\u00e1d\u011bt p\u0159es shunt (dutou trubici) chirurgicky implantovanou do mozku d\u00edt\u011bte po cel\u00fd \u017eivot.<\/p>\n\n\n\n<p><em>I dnes je v \u010cesk\u00e9 republice je\u0161t\u011b st\u00e1le b\u011b\u017enou prax\u00ed tuto vadu operovat a\u017e po narozen\u00ed d\u00edt\u011bte do 48 hodin, kdy se roz\u0161t\u011bp chirurgicky uzav\u0159e. Operace m\u016f\u017ee defekt opravit, av\u0161ak zm\u011bny, kter\u00e9 roz\u0161t\u011bp p\u00e1te\u0159e do doby operace zp\u016fsobil, mohou b\u00fdt z l\u00e9ka\u0159sk\u00e9ho hlediska \u010dasto nevratn\u00e9.<\/em> <strong>M\u00edcha a nervy vy\u010dn\u00edvaj\u00edc\u00ed p\u0159es z\u00e1da plodu jsou vystaveny plodov\u00e9 vod\u011b v d\u011bloze, co\u017e m\u016f\u017ee zp\u016fsobit progresivn\u00ed po\u0161kozen\u00ed a dal\u0161\u00ed degradaci hybnosti, \u010d\u00edm d\u00e9le bude vada nel\u00e9\u010dena.<\/strong><\/p>\n\n\n\n<p>Pro zlep\u0161en\u00ed v\u00fdsledk\u016f p\u0159i narozen\u00ed byla provedena p\u0159elomov\u00e1 studie o fet\u00e1ln\u00ed oprav\u011b myelomeningok\u00e9ly. Tato klinick\u00e1 studie, zn\u00e1m\u00e1 jako <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/29246577\/\">Management of Myelomeningocele Study (MOMS Trial)<\/a>, uk\u00e1zala, \u017ee operace proveden\u00e1 na plodu za \u00fa\u010delem opravy defektu vede ke sn\u00ed\u017een\u00ed v\u00fdskytu hydrocefalu, sn\u00ed\u017een\u00ed nebo zabr\u00e1n\u011bn\u00ed nutnosti shuntu a zlep\u0161en\u00ed funkce nohou ve srovn\u00e1n\u00ed se standardn\u00ed poporodn\u00ed operac\u00ed. Studie MOMS pou\u017e\u00edvala chirurgick\u00fd p\u0159\u00edstup \u201eotev\u0159en\u00e9 hysterotomie\u201c, kdy byla zp\u0159\u00edstupn\u011bna a opravena p\u00e1te\u0159 plodu p\u0159es 7\u20138 cm \u0159ez v d\u011bloze.<\/p>\n\n\n\n<p>V sou\u010dasn\u00e9 dob\u011b b\u00fdv\u00e1 tedy nitrod\u011blo\u017en\u00ed operace (tak\u00e9 zn\u00e1ma pod n\u00e1zvem intrauterinn\u00ed operace) opravy spiny bifidy prov\u00e1d\u011bna p\u0159ibli\u017en\u011b mezi 19. a\u017e 26. t\u00fddnem t\u011bhotenstv\u00ed.<\/p>\n\n\n\n<p><em>Zdroj:<\/em> <a href=\"https:\/\/www.texaschildrens.org\/content\/conditions\/spina-bifida-myelomeningocele\" target=\"_blank\" rel=\"noreferrer noopener\">www.texaschildrens.org\/&#8230;<\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"block-b4394f1e-1ec9-40c5-82ad-5bfad4d51446\">V\u00fdhody a rizika intrauterinn\u00ed fet\u00e1ln\u00ed operace opravy defektu spiny bifidy<\/h2>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-1 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<h3 class=\"wp-block-heading\">V\u00fdhody<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Zastaven\u00ed nebo zpomalen\u00ed progresivn\u00edho po\u0161kozen\u00ed m\u00edchy, postupu hydrocefalu a degradaci hybnosti <\/li>\n\n\n\n<li>Lep\u0161\u00ed pohybov\u00e9 v\u00fdsledky ve srovn\u00e1n\u00ed s d\u011btmi operovan\u00fdmi postnat\u00e1ln\u011b<\/li>\n\n\n\n<li>Statistick\u00e9 sn\u00ed\u017een\u00ed \u0161ance nutnosti pro zaveden\u00ed ventrikul\u00e1rn\u00ed shunt<\/li>\n<\/ul>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<h3 class=\"wp-block-heading\">Rizika<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Zv\u00fd\u0161en\u00fd v\u00fdskyt p\u0159ed\u010dasn\u00e9ho porodu<\/li>\n\n\n\n<li>\u010cast\u011bj\u0161\u00ed p\u0159edpoklad porodu c\u00edsa\u0159sk\u00fdm \u0159ezem (sekc\u00ed)<\/li>\n\n\n\n<li>Riziko ruptury d\u011blohy p\u0159i otev\u0159en\u00e9 operaci<\/li>\n<\/ul>\n\n\n\n<p>Pacientky b\u00fdvaj\u00ed po prenat\u00e1ln\u00ed operaci d\u011blohy bedliv\u011b sledov\u00e1ny a doch\u00e1z\u00ed na pravideln\u00e9 kontroly. V p\u0159\u00edpad\u011b otev\u0159en\u00e9 fet\u00e1ln\u00ed operace mohou b\u00fdt hospitalizov\u00e1ny a\u017e do porodu.<\/p>\n<\/div>\n<\/div>\n\n\n\n<h2 class=\"wp-block-heading\">Otev\u0159en\u00e1, fetoskopick\u00e1 a laparoskopick\u00e1 fet\u00e1ln\u00ed chirurgie<\/h2>\n\n\n\n<p>V sou\u010dasn\u00e9 dob\u011b existuje v\u00edce metod intrauterinn\u00ed operace uzav\u0159en\u00ed roz\u0161t\u011bpu p\u00e1te\u0159e. R\u016fzn\u00e1 pracovi\u0161t\u011b preferuj\u00ed odli\u0161n\u00e9 p\u0159\u00edstupy a v\u0161echny metody maj\u00ed v\u011bdecky podlo\u017een\u00e9 p\u0159\u00ednosy.<\/p>\n\n\n\n<p><strong>Otev\u0159en\u00e1 fet\u00e1ln\u00ed operace <\/strong>vyu\u017e\u00edv\u00e1 obdoby c\u00edsa\u0159sk\u00e9ho \u0159ezu. V celkov\u00e9 anestezii matky i d\u00edt\u011bte je d\u011bloha otev\u0159ena podobn\u011b jako u porodu c\u00edsa\u0159sk\u00fdm \u0159ezem, p\u0159ebyte\u010dn\u00fd vak odstran\u011bn a p\u00e1te\u0159 za\u0161ita. Jednotliv\u00e9 vrsty d\u011blohy, sval\u016f a k\u016f\u017ee se pak postupn\u011b za\u0161ij\u00ed. V\u00fdhodou se ud\u00e1v\u00e1 snaz\u0161\u00ed p\u0159\u00edstup a v\u00fdhled chirurga k samotn\u00e9 operaci. Nev\u00fdhodou t\u00e9to metody pak v\u011bt\u0161\u00ed stres a do\u010dasn\u00e1 bolestivost poci\u0165ovan\u00e1 pacientkami po operaci. D\u00edky tomu, \u017ee otev\u0159en\u00e1 operace se prov\u00e1d\u00ed d\u00e9le, je k dispozici v\u00edce dat ohledn\u011b jej\u00edho u\u017eitku.<\/p>\n\n\n\n<p><strong>Laparoskopick\u00e1 fet\u00e1ln\u00ed operace<\/strong> oproti tomu vstupuje do d\u011blohy skrz 2 nebo 3 men\u0161\u00ed \u0159ezy. Vyu\u017e\u00edv\u00e1 poznatk\u016f modern\u00edch endoskopick\u00fdch operac\u00ed. Proveden\u00ed uzav\u0159en\u00e9 operace se li\u0161\u00ed na jednotliv\u00fdch pracovi\u0161t\u00edch. N\u011bkter\u00e9 kliniky vyu\u017e\u00edvaj\u00ed tzv. <em>minim\u00e1ln\u011b invazivn\u00ed metodu<\/em>, p\u0159i n\u00ed\u017e vstupuj\u00ed do b\u0159i\u0161n\u00ed dutiny p\u0159es n\u011bkolik mal\u00fdch \u0159ez\u016f p\u0159\u00edmo p\u0159es k\u016f\u017ei. Samotn\u00fd roz\u0161t\u011bp p\u00e1te\u0159e pak m\u016f\u017ee b\u00fdt uzav\u0159en bu\u010fto za\u0161it\u00edm nebo p\u0159ilo\u017een\u00edm kolagenov\u00e9 n\u00e1plasti. N\u00e1plasti vyu\u017e\u00edvaj\u00ed pro zamezen\u00ed fixace m\u00edchy p\u0159i dal\u0161\u00edm r\u016fstu d\u00edt\u011bte. P\u0159\u00edkladem pracovi\u0161t\u011b, kde tuto operaci prov\u00e1d\u011bj\u00ed je n\u011bmeck\u00e1 klinika v Mannheimu.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\" id=\"mannheim\"><img loading=\"lazy\" decoding=\"async\" width=\"576\" height=\"1024\" src=\"https:\/\/spina-bifida.cz\/wp-content\/uploads\/2025\/03\/image-1-576x1024.png\" alt=\"\" class=\"wp-image-91\" srcset=\"https:\/\/spina-bifida.cz\/wp-content\/uploads\/2025\/03\/image-1-576x1024.png 576w, https:\/\/spina-bifida.cz\/wp-content\/uploads\/2025\/03\/image-1-169x300.png 169w, https:\/\/spina-bifida.cz\/wp-content\/uploads\/2025\/03\/image-1-768x1365.png 768w, https:\/\/spina-bifida.cz\/wp-content\/uploads\/2025\/03\/image-1-864x1536.png 864w, https:\/\/spina-bifida.cz\/wp-content\/uploads\/2025\/03\/image-1.png 1152w\" sizes=\"auto, (max-width: 576px) 100vw, 576px\" \/><figcaption class=\"wp-element-caption\">Uk\u00e1zka <em>Minim\u00e1ln\u011b invazivn\u00ed metody p. profesora Kohla z n\u011bmeck\u00e9 kliniky v Mannheimu<\/em><br>Naho\u0159e: fotografie myelomeningok\u00e9ly, uprost\u0159ed: pr\u016fb\u011bh operace minim\u00e1ln\u011b invazivn\u00ed metodou, dole: \u010derstv\u011b na\u0161it\u00fd kolagenov\u00fd patch a drobn\u00e9 jizvy po operaci matky<br><em>Zdroj<\/em>: \u201eLebensforum Spezial: Der Fetus als Patient: neue Optionen\u201c (Magazin \u201eLebensforum\u201c, 2018) V\u00edce informac\u00ed o t\u00e9to metod\u011b na: <a href=\"https:\/\/dzft.de\/wp-content\/uploads\/2024\/04\/Authors-Offprint_TKohl_SBA.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">dzft.de\/&#8230;<\/a><\/figcaption><\/figure>\n\n\n\n<p><strong>Fetoskopick\u00e1 operace <\/strong>je jak\u00fdmsi mezistupn\u011bm mezi otev\u0159enou a uzav\u0159enou fet\u00e1ln\u00ed operac\u00ed, nebo\u0165 kombinuje oba p\u0159\u00edstupy: zat\u00edmco p\u0159es k\u016f\u017ei se u\u010din\u00ed c\u00edsa\u0159sk\u00fd \u0159ez, do samotn\u00e9 d\u011blohy se pak vch\u00e1z\u00ed endoskopicky n\u011bkolika mal\u00fdmi \u0159ezy a n\u00e1stroji, jimi\u017e se defekt odstran\u00ed a za\u0161ije. To umo\u017e\u0148uje dobrou kontrolu nad ob\u011bma pacienty v pr\u016fb\u011bhu operace a z\u00e1rove\u0148 to sni\u017euje z\u00e1t\u011b\u017e na d\u011blohu v dal\u0161\u00edm t\u011bhotenstv\u00ed, zvy\u0161uje pr\u016fm\u011brnou dobu t\u011bhotenstv\u00ed a narozd\u00edl od otev\u0159en\u00e9 operace, nevylu\u010duje p\u0159irozen\u00fd porod. Tento zp\u016fsob operace nab\u00edz\u00ed v belgick\u00e9 nemocnici v Leuven, v texask\u00e9 d\u011btsk\u00e9 nemocnici a v dal\u0161\u00edch americk\u00fdch klinik\u00e1ch.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\" id=\"leuven\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"690\" src=\"https:\/\/spina-bifida.cz\/wp-content\/uploads\/2025\/03\/fetoscopic-spina-bifida-repair.png\" alt=\"\" class=\"wp-image-202\" srcset=\"https:\/\/spina-bifida.cz\/wp-content\/uploads\/2025\/03\/fetoscopic-spina-bifida-repair.png 1024w, https:\/\/spina-bifida.cz\/wp-content\/uploads\/2025\/03\/fetoscopic-spina-bifida-repair-300x202.png 300w, https:\/\/spina-bifida.cz\/wp-content\/uploads\/2025\/03\/fetoscopic-spina-bifida-repair-768x518.png 768w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><figcaption class=\"wp-element-caption\">Fetoskopick\u00e1 operace dle ilustrace na webu Texas Children&#8217;s Hospital <a href=\"https:\/\/www.texaschildrens.org\/content\/conditions\/spina-bifida-myelomeningocele\" target=\"_blank\" rel=\"noreferrer noopener\">Zdroj: www.texaschildrens.org\/&#8230;<\/a><\/figcaption><\/figure>\n\n\n\n<blockquote class=\"wp-block-quote has-medium-font-size is-layout-flow wp-block-quote-is-layout-flow\">\n<h3 class=\"wp-block-heading has-medium-font-size\"><strong>Kter\u00e1 metoda je tedy nejlep\u0161\u00ed? <\/strong><\/h3>\n\n\n\n<p>Zeptejte se kliniky, kter\u00e1 d\u011bl\u00e1 p\u0159edev\u0161\u00edm otev\u0159en\u00e9 operace a vysv\u011btl\u00ed v\u00e1m, \u017ee nejlep\u0161\u00ed variantou pro d\u00edt\u011b je otev\u0159en\u00e1 operace, nebo\u0165 chirurg m\u00e1 lep\u0161\u00ed rozhled a manipula\u010dn\u00ed prostor b\u011bhem operace. Klinika zab\u00fdvaj\u00edc\u00ed se p\u0159ev\u00e1\u017en\u011b uzav\u0159en\u00fdmi fet\u00e1ln\u00edmi operacemi v\u00e1m ov\u0161em \u0159ekne, \u017ee uzav\u0159en\u00e1 operace se zd\u00e1 b\u00fdt v\u00fdhodn\u011bj\u0161\u00ed pro matku bez zhor\u0161en\u00ed v\u00fdsledk\u016f d\u00edt\u011bte. Statisticky lze srovn\u00e1vat jednotliv\u00e9 metody jen obt\u00ed\u017en\u011b u\u017e jen proto, \u017ee ka\u017ed\u00e9mu chirurgovi vyhovuje v\u00edce jin\u00fd zp\u016fsob operace.<\/p>\n\n\n\n<p>V kone\u010dn\u00e9m d\u016fsledku se tedy d\u00e1 usuzovat, \u017ee v\u00fdsledek <em>samotn\u00e9 operace <\/em>se odv\u00edj\u00ed sp\u00ed\u0161e od konkr\u00e9tn\u00edho p\u0159\u00edpadu, v\u00fdchoz\u00edch podm\u00ednek a schopnost\u00ed, zku\u0161enost\u00ed a preferenc\u00ed operat\u00e9ra, ne\u017eli od samotn\u00e9ho zp\u016fsobu operace. <\/p>\n<\/blockquote>\n\n\n\n<h2 class=\"wp-block-heading\">Mo\u017enosti v Evrop\u011b<\/h2>\n\n\n\n<p>B\u011bhem pr\u016fzkumu mo\u017enost\u00ed nitrod\u011blo\u017en\u00edch fet\u00e1ln\u00edch operac\u00ed v lednu 2025 jsme v Evrop\u011b objevili t\u0159i kliniky, kter\u00e9 se opravou spiny bifidy in utero zab\u00fdvaj\u00ed: v N\u011bmecku, \u0160v\u00fdcarsku a v Belgii. Ve v\u0161ech byli nad m\u00edru vst\u0159\u00edcn\u00ed.<\/p>\n\n\n\n<p>N\u00e1sleduj\u00edc\u00ed informace platily pro n\u00e1\u0161 p\u0159\u00edpad v lednu 2025 a slou\u017e\u00ed pouze pro \u00favodn\u00ed orientaci. Tyto \u00fadaje mohou b\u00fdt \u010dasov\u011b omezen\u00e9 a mohou se m\u011bnit v z\u00e1vislosti na aktu\u00e1ln\u00edch podm\u00ednk\u00e1ch. Pro konkr\u00e9tn\u00ed a aktu\u00e1ln\u00ed informace je vhodn\u00e9 kontaktovat p\u0159\u00edslu\u0161n\u00e9 kliniky.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Klinika ve m\u011bst\u011b Mannheim v N\u011bmecku<\/h3>\n\n\n\n<p>N\u011bmeck\u00e1 klinika v Mannheimu nab\u00edz\u00ed vlastn\u00ed pln\u011b laparoskopickou <em>Minim\u00e1ln\u011b invazivn\u00ed metodu<\/em> operace p\u0159es <a href=\"#mannheim\">3 mal\u00e9 \u0159ezy veden\u00e9 p\u0159\u00edmo p\u0159es b\u0159icho<\/a>. Z\u00e1da d\u011b\u0165\u00e1tka uzav\u00edraj\u00ed kolagenovou n\u00e1plast\u00ed. Po n\u011bkolikadenn\u00ed poopera\u010dn\u00ed hospitalizaci jsou ochotni propustit pacientku dom\u016f, pokud se za ni zaru\u010d\u00ed m\u00edstn\u00ed klinika pou\u010den\u00e1 o pot\u0159ebn\u00e9 p\u00e9\u010di pro matku i d\u00edt\u011b.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"575\" src=\"https:\/\/spina-bifida.cz\/wp-content\/uploads\/2025\/03\/csm_Spina_bifida_minimal-invasive_Operation_ee04953483-1024x575.jpg\" alt=\"\" class=\"wp-image-248\" srcset=\"https:\/\/spina-bifida.cz\/wp-content\/uploads\/2025\/03\/csm_Spina_bifida_minimal-invasive_Operation_ee04953483-1024x575.jpg 1024w, https:\/\/spina-bifida.cz\/wp-content\/uploads\/2025\/03\/csm_Spina_bifida_minimal-invasive_Operation_ee04953483-300x168.jpg 300w, https:\/\/spina-bifida.cz\/wp-content\/uploads\/2025\/03\/csm_Spina_bifida_minimal-invasive_Operation_ee04953483-768x431.jpg 768w, https:\/\/spina-bifida.cz\/wp-content\/uploads\/2025\/03\/csm_Spina_bifida_minimal-invasive_Operation_ee04953483.jpg 1400w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-full wp-duotone-unset-1\"><img loading=\"lazy\" decoding=\"async\" width=\"800\" height=\"532\" src=\"https:\/\/spina-bifida.cz\/wp-content\/uploads\/2025\/03\/Spina_bifida_Verschluss_Ruecken.jpg\" alt=\"\" class=\"wp-image-249\" srcset=\"https:\/\/spina-bifida.cz\/wp-content\/uploads\/2025\/03\/Spina_bifida_Verschluss_Ruecken.jpg 800w, https:\/\/spina-bifida.cz\/wp-content\/uploads\/2025\/03\/Spina_bifida_Verschluss_Ruecken-300x200.jpg 300w, https:\/\/spina-bifida.cz\/wp-content\/uploads\/2025\/03\/Spina_bifida_Verschluss_Ruecken-768x511.jpg 768w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Zdroj fotografi\u00ed: <a href=\"https:\/\/www.umm.de\/fetale-therapie\/krankheitsbilder\/spina-bifida-offener-ruecken\/\" target=\"_blank\" rel=\"noreferrer noopener\">www.umm.de\/fetale-therapie\/&#8230;<\/a><\/figcaption><\/figure>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\">\n<p><strong>Kontakt<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li class=\"has-medium-font-size\"><a href=\"https:\/\/www.umm.de\/fetale-therapie\/krankheitsbilder\/spina-bifida-offener-ruecken\/\" target=\"_blank\" rel=\"noreferrer noopener\">webov\u00e9 str\u00e1nky fet\u00e1ln\u00ed terapie v Mannheimu<\/a><\/li>\n\n\n\n<li class=\"has-medium-font-size\"><a href=\"mailto:thomas.kohl@umm.de\">thomas.kohl@umm.de<\/a><\/li>\n\n\n\n<li class=\"has-medium-font-size\"><a href=\"https:\/\/dzft.de\/wp-content\/uploads\/2024\/04\/Authors-Offprint_TKohl_SBA.pdf\">v\u00edce informac\u00ed o minim\u00e1ln\u011b invazivn\u00ed metod\u011b a pr\u00e1ci prof. Kohla<\/a><\/li>\n<\/ul>\n<\/blockquote>\n\n\n\n<h3 class=\"wp-block-heading\">Klinika v Curychu ve \u0160v\u00fdcarsku<\/h3>\n\n\n\n<p>\u0160v\u00fdcarsk\u00e1 klinika v Curychu nab\u00edz\u00ed otev\u0159enou fet\u00e1ln\u00ed operaci vych\u00e1zej\u00edc\u00ed z poznatk\u016f v\u00fdzkumu Children&#8217;s Hospital of Philadephia (CHOP). Tato metoda p\u0159istupuje do d\u011blohy pomoc\u00ed c\u00edsa\u0159sk\u00e9ho \u0159ezu. Vzhledem ke zv\u00fd\u0161en\u00e9mu riziku p\u0159ed\u010dasn\u00e9ho porodu po t\u00e9to operaci, z\u016fst\u00e1vaj\u00ed pacientky v nemocnici a\u017e do porodu.<\/p>\n\n\n\n<p>Do t\u00e9to nemocnice vys\u00edl\u00e1 k operaci t\u011bhotn\u00e9 pacientky s d\u011btmi se spinou bifidou bratislavsk\u00e1 klinika ObGyn. K lednu 2025 vyslal ObGyn k \u00fasp\u011b\u0161n\u00e9 operaci ji\u017e 16 pacientek slovensk\u00e9ho p\u016fvodu.<\/p>\n\n\n\n<p>Cena samotn\u00e9 operace je srovnateln\u00e1 s cenou operace v N\u011bmecku, nicm\u00e9n\u011b vzhledem ke kone\u010dn\u00e9 nutnosti porodu v zahrani\u010d\u00ed se celkov\u00e9 vy\u017eadovan\u00e9 finance podstatn\u011b zv\u00fd\u0161\u00ed.<\/p>\n\n\n\n<figure class=\"wp-block-video\"><video controls src=\"https:\/\/www.swissfetus.ch\/uploads\/attachments\/cm790rto800ssntladlkmu68w-rueckendeckung-englisch-compressed.mp4\"><\/video><figcaption class=\"wp-element-caption\">Zdroj videa: <a href=\"https:\/\/www.swissfetus.ch\/en\/diagnostic-and-therapeutic-care\/open-fetal-surgery\/spina-bifida\" target=\"_blank\" rel=\"noreferrer noopener\">www.swissfetus.ch<\/a><\/figcaption><\/figure>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\">\n<p><strong>Kontakt<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li class=\"has-medium-font-size\"><a href=\"https:\/\/www.usz.ch\/en\/department\/neonatology\/service\/spina-bifida\/\" target=\"_blank\" rel=\"noreferrer noopener\">Webov\u00e9 str\u00e1nky neonatologick\u00e9ho odd\u011blen\u00ed nemocnice v Curychu<\/a><\/li>\n\n\n\n<li class=\"has-medium-font-size\"><a href=\"mailto:fetalsurgery@kispi.uzh.ch\" target=\"_blank\" rel=\"noreferrer noopener\">fetalsurgery@kispi.uzh.ch<\/a><\/li>\n\n\n\n<li class=\"has-medium-font-size\"><a href=\"https:\/\/www.swissfetus.ch\/en\/diagnostic-and-therapeutic-care\/open-fetal-surgery\/spina-bifida\">v\u00edce informac\u00ed a fotografie otev\u0159en\u00e9 operace<\/a><\/li>\n<\/ul>\n<\/blockquote>\n\n\n\n<h3 class=\"wp-block-heading\">Nemocnice v Lovani v Belgii<\/h3>\n\n\n\n<p>Belgick\u00e1 nemocnice v Lovani nab\u00edz\u00ed jak otev\u0159enou, tak i fetoskopickou fet\u00e1ln\u00ed operaci uzav\u0159en\u00ed spiny bifidy. <a href=\"#leuven\">Fetoskopick\u00e1 varianta<\/a> prob\u00edh\u00e1 c\u00edsa\u0159sk\u00fdm \u0159ezem skrz k\u016f\u017ei, do d\u011blohy se v\u0161ak n\u00e1sledn\u011b vstupuje laparoskopicky. K za\u010d\u00e1tku roku 2025 u\u017e posb\u00edrali zku\u0161enosti s v\u00edce ne\u017e 500 operacemi tohoto typu. Cena operace ve srovn\u00e1n\u00ed s ostatn\u00edmi evropsk\u00fdmi pracovi\u0161t\u011bmi byla v t\u00e9to nemocnici nejni\u017e\u0161\u00ed.<\/p>\n\n\n\n<p>Lova\u0148sk\u00e1 nemocnice, podobn\u011b jako mannheimsk\u00e1, je ochotna propustit po poopera\u010dn\u00ed hospitalizaci pacientku dom\u016f pod podm\u00ednkou n\u00e1sledn\u00e9 intenzivn\u00ed ambulantn\u00ed p\u00e9\u010de \u0161kolen\u00e9ho pracovi\u0161t\u011b, v \u010cesk\u00e9 republice konkr\u00e9tn\u011b \u00fastavu v Podol\u00ed. Centrum fet\u00e1ln\u00ed medic\u00edny v Podol\u00ed s lova\u0148skou nemocnic\u00ed dlouhodob\u011b spolupracuje, pacientky vys\u00edl\u00e1 pr\u00e1v\u011b do t\u00e9to nemocnice a zaji\u0161\u0165uje jim podporu p\u0159edopera\u010dn\u00edch vy\u0161et\u0159en\u00ed i poopera\u010dn\u00ed p\u00e9\u010de.<\/p>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\">\n<p><strong>Kontakt<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li class=\"has-medium-font-size\"><a href=\"https:\/\/www.uzleuven.be\/en\/departments\/fetal-medicine\">Webov\u00e9 str\u00e1nky fet\u00e1ln\u00ed medic\u00edny UZ Leuven<\/a><\/li>\n\n\n\n<li class=\"has-medium-font-size\"><a href=\"mailto:fetal.medicineleuven@uzleuven.be\" target=\"_blank\" rel=\"noreferrer noopener\">fetal.medicineleuven@uzleuven.be<\/a><\/li>\n<\/ul>\n<\/blockquote>\n\n\n\n<h2 class=\"wp-block-heading\">Podpora v \u010cesk\u00e9 republice<\/h2>\n\n\n\n<p>Pokud v\u00e1s zaujala mo\u017enost nitrod\u011blo\u017en\u00ed operace v \u010cesk\u00e9 republice a r\u00e1di byste se o n\u00ed dozv\u011bd\u011bli v\u00edc, sjednejte si sch\u016fzku s <a href=\"https:\/\/spina-bifida.cz\/#podoli\" target=\"_blank\" rel=\"noreferrer noopener\">\u00daPMD Podol\u00ed<\/a>. \u00dastav pro d\u00edt\u011b a matku maminky cel\u00fdm procesem laskav\u011b prov\u00e1d\u00ed a poskytuj\u00ed pot\u0159ebnou podporu a informace i v t\u011b\u017ek\u00fdch chv\u00edl\u00edch.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Poji\u0161t\u011bn\u00ed<\/h2>\n\n\n\n<p>Jednou z hlavn\u00edch ot\u00e1zek, kter\u00e9 si pacientky uva\u017euj\u00edc\u00ed o nitrod\u011blo\u017en\u00ed fet\u00e1ln\u00ed operaci v Evrop\u011b kladou, je, zda poji\u0161\u0165ovna bude ochotn\u00e1 n\u00e1klady na operaci uhradit. Na\u0161t\u011bst\u00ed jim v t\u00e9to z\u00e1le\u017eitosti pom\u00e1h\u00e1 usnesen\u00ed Evropsk\u00e9 unie.<\/p>\n\n\n\n<p>Pokud je v r\u00e1mci Evropsk\u00e9 unie nebo \u0160v\u00fdcarska dostupn\u00fd zdravotn\u00ed z\u00e1krok, kter\u00fd pacient pot\u0159ebuje, a nen\u00ed mo\u017en\u00e9 ho podstoupit v jeho domovsk\u00e9 zemi, m\u011bla by jak\u00e1koliv evropsk\u00e1 zdravotn\u00ed poji\u0161\u0165ovna z\u00e1krok proplatit na z\u00e1klad\u011b schv\u00e1len\u00e9ho formul\u00e1\u0159e S2.<\/p>\n\n\n\n<p class=\"has-medium-font-size\">O tento formul\u00e1\u0159 je nutn\u00e9 za\u017e\u00e1dat ve va\u0161\u00ed poji\u0161\u0165ovn\u011b spolu s l\u00e9ka\u0159sk\u00fdm vyj\u00e1d\u0159en\u00edm o nezbytnosti operace a p\u0159edpokl\u00e1dan\u00e9 cen\u011b z\u00e1kroku, kterou z\u00edsk\u00e1te od finan\u010dn\u00edho odd\u011blen\u00ed vybran\u00e9 zahrani\u010dn\u00ed kliniky. V\u00fdhodou v p\u0159\u00edpad\u011b operace spiny bifidy je i <a href=\"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full\/10.1002\/uog.11176\">existuj\u00edc\u00ed studie<\/a>, \u017ee prenat\u00e1ln\u00ed operace oproti postnat\u00e1ln\u00ed v\u00fdrazn\u011b sn\u00ed\u017e\u00ed p\u0159edpokl\u00e1dan\u00e9 finance n\u00e1sledn\u00e9 p\u00e9\u010de. <em>(Viz: Werner, E.F., Han, C.S., Burd, I., Lipkind, H.S., Copel, J.A., Bahtiyar, M.O. and Thung, S.F. (2012), Evaluating the cost-effectiveness of prenatal surgery for myelomeningocele: a decision analysis. Ultrasound Obstet Gynecol, 40: 158-164.&nbsp;<a href=\"https:\/\/doi.org\/10.1002\/uog.11176\">https:\/\/doi.org\/10.1002\/uog.11176<\/a>)<\/em><\/p>\n\n\n\n<p>Vzhledem k tomu, \u017ee <strong>mo\u017enost operovat spinu bifidu prenat\u00e1ln\u011b je \u010dasov\u011b omezen\u00e1 <\/strong>(operace by m\u011bla b\u00fdt provedena do 27. t\u00fddne t\u011bhotenstv\u00ed), je u\u017eite\u010dn\u00e9 si zajistit kontakt na revizn\u00edho l\u00e9ka\u0159e poji\u0161\u0165ovny, se kter\u00fdm budete o ud\u011blen\u00ed souhlasu jednat, a o nal\u00e9havosti p\u0159\u00edpadu jej informovat. <em>V na\u0161em p\u0159\u00edpad\u011b z\u00edsk\u00e1n\u00ed souhlasu trvalo 2 t\u00fddny (respektive 1 t\u00fdden od pod\u00e1n\u00ed spr\u00e1vn\u011b vypln\u011bn\u00e9ho formul\u00e1\u0159e a kontaktov\u00e1n\u00ed revizn\u00edho l\u00e9ka\u0159e).<\/em> Pokud se souhlas poji\u0161\u0165ovny nestihne vy\u0159\u00eddit v\u010das, lze \u017e\u00e1dat o zp\u011btnou refundaci n\u00e1klad\u016f.<\/p>\n\n\n\n<p>Po ud\u011blen\u00ed souhlasu s formul\u00e1\u0159em S2 v\u00e1m bude zahrani\u010dn\u00ed l\u00e9ka\u0159sk\u00e1 p\u00e9\u010de poskytnuta za stejn\u00fdch podm\u00ednek jako osob\u00e1m, kter\u00e9 jsou v tomto st\u00e1t\u011b poji\u0161t\u011bny. Je tedy mo\u017en\u00e9, \u017ee budete muset doplatit m\u00edrnou nevysokou spolu\u00fa\u010dast. O jej\u00ed v\u00fd\u0161i se informujte u vybran\u00e9 kliniky.<\/p>\n\n\n\n<p><strong>Na co je d\u016fle\u017eit\u00e9 pamatovat p\u0159i vypl\u0148ov\u00e1n\u00ed \u017e\u00e1dosti o zahrani\u010dn\u00ed z\u00e1krok<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>ve formul\u00e1\u0159i uv\u00e9st, \u017ee operace se v \u010cesk\u00e9 republice neprov\u00e1d\u00ed<\/li>\n\n\n\n<li>zajistit si co nejd\u0159\u00edve p\u0159edpokl\u00e1dan\u00e9 n\u00e1klady operace na finan\u010dn\u00edm odd\u011blen\u00ed zvolen\u00e9 kliniky<\/li>\n\n\n\n<li>informovat revizn\u00edho l\u00e9ka\u0159e Va\u0161\u00ed poji\u0161\u0165ovny o urgentnosti \u017e\u00e1dosti a \u010dasov\u00e9m omezen\u00ed, do kdy lze operaci prov\u00e9st (ide\u00e1ln\u011b telefonicky)<\/li>\n<\/ul>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\">\n<p>Informace zdravotn\u00ed poji\u0161\u0165ovny VZP ohledn\u011b zahrani\u010dn\u00ed zdravotn\u00ed p\u00e9\u010de z b\u0159ezna 2025<\/p>\n\n\n\n<p class=\"has-small-font-size\">&#8220;<strong>Pokud poji\u0161t\u011bnec obdr\u017e\u00ed p\u0159edem souhlas sv\u00e9 zdravotn\u00ed poji\u0161\u0165ovny s \u00fahradou zdravotn\u00ed p\u00e9\u010de&nbsp;<\/strong>v r\u00e1mci&nbsp;<strong>zem\u00ed EU\/EHP\/\u0160v\u00fdcarska&nbsp;<\/strong>(je mu vystaven formul\u00e1\u0159 E112\/S2), m\u00e1 zde n\u00e1rok na poskytnut\u00ed a \u00fahradu pl\u00e1novan\u00e9 p\u00e9\u010de za podm\u00ednek dan\u00fdch p\u0159edpisy st\u00e1tu o\u0161et\u0159en\u00ed. \u017d\u00e1dost zdravotn\u00ed poji\u0161\u0165ovn\u011b pod\u00e1v\u00e1 s\u00e1m, prost\u0159ednictv\u00edm sv\u00e9ho z\u00e1konn\u00e9ho z\u00e1stupce nebo odborn\u00e9ho o\u0161et\u0159uj\u00edc\u00edho l\u00e9ka\u0159e. Vypln\u00ed formul\u00e1\u0159&nbsp;<a href=\"https:\/\/media.vzpstatic.cz\/media\/Default\/formulare\/zadost-o-souhlas-planovane-zdravotni-sluzby-v-zahranici.pdf\"><strong>\u017d\u00e1dost poji\u0161t\u011bnce o ud\u011blen\u00ed souhlasu s \u00fahradou n\u00e1klad\u016f na pl\u00e1novan\u00e9 zdravotn\u00ed slu\u017eby v zahrani\u010d\u00ed<\/strong><\/a>&nbsp;(obdr\u017e\u00ed ho na kter\u00e9koli pobo\u010dce VZP), dolo\u017e\u00ed zdravotn\u00ed dokumentac\u00ed a vyj\u00e1d\u0159en\u00edm doporu\u010duj\u00edc\u00edho odborn\u00e9ho o\u0161et\u0159uj\u00edc\u00edho l\u00e9ka\u0159e ze specializovan\u00e9ho pracovi\u0161t\u011b v \u010cR. Zdravotn\u00ed p\u00e9\u010de mu m\u016f\u017ee b\u00fdt poskytnuta pouze&nbsp;<strong>ve zdravotnick\u00fdch za\u0159\u00edzen\u00edch napojen\u00fdch na ve\u0159ejn\u00fd syst\u00e9m zdravotn\u00edho poji\u0161t\u011bn\u00ed&nbsp;<\/strong>a&nbsp;p\u0159e\u00fa\u010dtov\u00e1v\u00e1 se p\u0159es v\u00fdpomocnou zahrani\u010dn\u00ed zdravotn\u00ed poji\u0161\u0165ovnu a sty\u010dn\u00e1 m\u00edsta (v \u010cR Kancel\u00e1\u0159 zdravotn\u00edho poji\u0161t\u011bn\u00ed) do jeho zdravotn\u00ed poji\u0161\u0165ovny. Poji\u0161t\u011bnec hrad\u00ed pouze spolu\u00fa\u010dast, poplatky a doplatky stejn\u011b jako tamn\u00ed poji\u0161t\u011bnci.<\/p>\n\n\n\n<p class=\"has-small-font-size\">Mo\u017enost \u00fahrady pl\u00e1novan\u00e9 zdravotn\u00ed p\u00e9\u010de \u010desk\u00fdmi zdravotn\u00edmi poji\u0161\u0165ovnami v zem\u00edch EU, EHP a \u0160v\u00fdcarska je zakotvena v Na\u0159\u00edzen\u00ed Rady (EEC) 883\/2004, konkr\u00e9tn\u011b v \u010dl\u00e1nku 20, odst. 1 a 2, a v Na\u0159\u00edzen\u00ed Rady (EEC) 987\/2009, \u010dl\u00e1nek 26. Problematika schvalovac\u00edho procesu se op\u00edr\u00e1 tak\u00e9 o rozsudky Evropsk\u00e9ho soudn\u00edho dvora.<\/p>\n\n\n\n<p class=\"has-small-font-size\">Zdravotn\u00ed poji\u0161\u0165ovna mus\u00ed ud\u011blit souhlas s \u00fahradou, jde-li o zdravotn\u00ed slu\u017eby, kter\u00e9<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li class=\"has-small-font-size\"><strong>jsou hrazen\u00e9 z \u010desk\u00e9ho ve\u0159ejn\u00e9ho zdravotn\u00edho poji\u0161t\u011bn\u00ed&nbsp;<\/strong>(nehrad\u00ed se l\u00e9\u010dba, kterou si poji\u0161t\u011bnci v \u010cR mus\u00ed zaplatit, ani nov\u00e1 l\u00e9\u010dba v \u010cR dosud neschv\u00e1len\u00e1) a<\/li>\n\n\n\n<li class=\"has-small-font-size\"><strong>v \u010cR nemohou b\u00fdt poskytnuty v medic\u00ednsky ospravedlniteln\u00e9 dob\u011b<\/strong>&nbsp;(tzn. \u010dekac\u00ed doba v \u010cR by p\u0159esahovala p\u0159ijatelnou dobu vych\u00e1zej\u00edc\u00ed z objektivn\u00edho l\u00e9ka\u0159sk\u00e9ho posouzen\u00ed pot\u0159eb pacienta p\u0159i zhodnocen\u00ed jeho zdravotn\u00edho stavu v dob\u011b pod\u00e1n\u00ed \u017e\u00e1dosti).<\/li>\n<\/ul>\n\n\n\n<p class=\"has-small-font-size\">V p\u0159\u00edpad\u011b, kdy nen\u00ed spln\u011bna by\u0165 jen jedna z t\u011bchto dvou podm\u00ednek,&nbsp;<strong>nem\u00e1 poji\u0161t\u011bnec na souhlas s \u00fahradou zdravotn\u00ed p\u00e9\u010de pr\u00e1vn\u00ed n\u00e1rok<\/strong>.<\/p>\n\n\n\n<p class=\"has-small-font-size\">Se souhlasem zdravotn\u00ed poji\u0161\u0165ovny je mo\u017en\u00e9 i vycestovat za p\u00e9\u010d\u00ed do tzv. smluvn\u00edch st\u00e1t\u016f, p\u0159\u00edpadn\u011b do ostatn\u00edch zem\u00ed.V zem\u00edch, se kter\u00fdmi jsou uzav\u0159eny Smlouvy o soci\u00e1ln\u00edm zabezpe\u010den\u00ed, vych\u00e1z\u00ed mo\u017enost \u00fahrady z t\u011bchto smluv a jejich spr\u00e1vn\u00edch ujedn\u00e1n\u00ed.<\/p>\n\n\n\n<p class=\"has-small-font-size\"><strong>V ostatn\u00edch zem\u00edch je mo\u017eno ve zcela v\u00fdjime\u010dn\u00fdch p\u0159\u00edpadech a na z\u00e1klad\u011b p\u0159edem poskytnut\u00e9ho souhlasu zdravotn\u00ed poji\u0161\u0165ovny hradit p\u00e9\u010di dle \u00a7 16 z\u00e1kona \u010d. 48\/97 Sb., o ve\u0159ejn\u00e9m zdravotn\u00edm poji\u0161t\u011bn\u00ed, je-li jej\u00ed poskytnut\u00ed z hlediska zdravotn\u00edho stavu poji\u0161t\u011bnce jedinou mo\u017enost\u00ed zdravotn\u00ed p\u00e9\u010de.<\/strong>&#8220;<\/p>\n\n\n\n<p class=\"has-small-font-size\">Zdroj: <a href=\"https:\/\/www.vzp.cz\/pojistenci\/cestovani-a-pobyt-v-zahranici\/planovana-pece-poskytnuta-pacientovi-v-zahranici\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.vzp.cz\/&#8230;<\/a> , v b\u0159eznu 2025<\/p>\n<\/blockquote>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Obecn\u00e9 informace Spina bifida je vrozen\u00e1 vada p\u0159i n\u00ed\u017e se p\u00e1te\u0159 b\u011bhem v\u00fdvoje plodu spr\u00e1vn\u011b neuzav\u0159e. Jedn\u00e1 se o typ defektu neur\u00e1ln\u00ed trubice, kter\u00fd postihuje mozek, m\u00edchu nebo p\u00e1te\u0159 vyv\u00edjej\u00edc\u00edho se plodu. Nejz\u00e1va\u017en\u011bj\u0161\u00ed a nejb\u011b\u017en\u011bj\u0161\u00ed formou spina bifida je myelomeningok\u00e9la. P\u0159i tomto \u201eotev\u0159en\u00e9m\u201c defektu neur\u00e1ln\u00ed trubice jsou m\u00edcha a okoln\u00ed nervy nebo jin\u00e9 nervov\u00e9 prvky [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5],"tags":[],"class_list":["post-16","post","type-post","status-publish","format-standard","hentry","category-operace"],"_links":{"self":[{"href":"https:\/\/spina-bifida.cz\/index.php\/wp-json\/wp\/v2\/posts\/16","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/spina-bifida.cz\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/spina-bifida.cz\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/spina-bifida.cz\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/spina-bifida.cz\/index.php\/wp-json\/wp\/v2\/comments?post=16"}],"version-history":[{"count":102,"href":"https:\/\/spina-bifida.cz\/index.php\/wp-json\/wp\/v2\/posts\/16\/revisions"}],"predecessor-version":[{"id":380,"href":"https:\/\/spina-bifida.cz\/index.php\/wp-json\/wp\/v2\/posts\/16\/revisions\/380"}],"wp:attachment":[{"href":"https:\/\/spina-bifida.cz\/index.php\/wp-json\/wp\/v2\/media?parent=16"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/spina-bifida.cz\/index.php\/wp-json\/wp\/v2\/categories?post=16"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/spina-bifida.cz\/index.php\/wp-json\/wp\/v2\/tags?post=16"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}