硬膜外麻醉联合膀胱穿刺局部麻醉在膀胱侧壁肿瘤电切术中的应用
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摘要
目的探讨硬膜外麻醉联合膀胱穿刺局部麻醉在膀胱侧壁肿瘤电切术中预防闭孔神经反射的可行性。方法收集74例硬膜外麻醉联合膀胱穿刺局部麻醉行膀胱侧壁肿瘤经尿道电切术的患者资料,常规经尿道膀胱肿瘤电切术(TURBT)44例,经膀胱穿刺局部麻醉注射利多卡因后进行膀胱肿瘤电切术30例,分析其闭孔神经反射、膀胱穿孔的发生情况。结果常规经尿道膀胱肿瘤电切术患者44例中20例发生闭孔神经反射,其中6例发生非控制性膀胱穿孔;30例膀胱穿刺局部麻醉注射利多卡因后进行TURBT的患者,仅2例出现轻微闭孔神经反射,无膀胱穿孔。两组间比较有统计学差异(P<0.05)。结论硬膜外麻醉联合膀胱穿刺局部麻醉注射利多卡因后行TURBT术,能有效降低闭孔神经反射的发生率,增加手术安全性。
Objective To investigate the feasibility of epidural anesthesia combined with bladder injection in the electroresection of lateral wall bladder tumor to prevent obturator nerve reflex.Methods Clinical data of 74 patients with lateral wall bladder tumor who received transurethral resection of bladder tumor(TURBT)were retrospectively analyzed.Of all patients,44 underwent conventional TURBT,30 underwent TURBT after lidocaine injection.Results Of the 44 patients in the conventional TURBT group,20 developed obturator nerve reflex,and6 developed non-controlled bladder perforation.Among the 30 cases undergoing TURBT after lidocaine injection,only 2 had mild obturator nerve reflex,and no case had bladder perforation.Conclusion By combining epidural anesthesia with bladder injection in TURBT,the incidence of obturator nerve reflex can be reduced significantly,and the surgical safety can be enhanced.
Objective To investigate the feasibility of epidural anesthesia combined with bladder injection in the electroresection of lateral wall bladder tumor to prevent obturator nerve reflex.Methods Clinical data of 74 patients with lateral wall bladder tumor who received transurethral resection of bladder tumor(TURBT)were retrospectively analyzed.Of all patients,44 underwent conventional TURBT,30 underwent TURBT after lidocaine injection.Results Of the 44 patients in the conventional TURBT group,20 developed obturator nerve reflex,and6 developed non-controlled bladder perforation.Among the 30 cases undergoing TURBT after lidocaine injection,only 2 had mild obturator nerve reflex,and no case had bladder perforation.Conclusion By combining epidural anesthesia with bladder injection in TURBT,the incidence of obturator nerve reflex can be reduced significantly,and the surgical safety can be enhanced.
引文
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[9]徐刚,郑奇传,丁方成.PKRBT治疗浅表性膀胱肿瘤术中预防闭孔神经反射的体会[J].中外医疗,2012,10(10):19-20.
[2]CESUR M,ERDEM AF,ALICI HA,et al,The role of succiny lcholine in the prevention of the obturator nerver reflex during transurethral resection of bladder tumors[J].Saudi Med J,2008,29(5):668-671.
[3]左玉良,王朝明.经尿道膀胱肿瘤切除术中闭孔神经反射的防止[J].中华实用诊断与治疗杂志,2011,25(9)923-924.
[4]KHORRAMI M,HADI M,JAVID A,et al.A comparison between blind and nerve stimulation guided obturator never block in transurethral resection of bladder tumor[J].J Endourol,2012,26(10):1319-1322.
[5]XIONG YC,X H,YANG XH,et al.Total intravenous general anesthesia with laryngeal mask airway for transurethral tesection of bladder tumor[J].J Med Colleges of PLA,2007,22(4):234-237.
[6]任春凯,唐喆,余秋健,等.利多卡因阻滞预防膀胱侧壁电切术中闭孔神经反射的临床疗效[J].临床医学,2015,35(1):36-37.
[7]那彦群,李鸣.泌尿外科学高级教程[M].北京:人民军医出版社,2014:140-142.
[8]严春寅,吴进锋,黄玉华,等.TURBT术中避免闭孔神经反射的对策[J].现代泌尿生殖肿瘤杂志,2009,1(2):124-125.
[9]徐刚,郑奇传,丁方成.PKRBT治疗浅表性膀胱肿瘤术中预防闭孔神经反射的体会[J].中外医疗,2012,10(10):19-20.