经尿道膀胱肿瘤电切术中闭孔神经反射的临床研究

目的探讨利用针形电极诱发神经反射、弧形切割并结合肿瘤基底部闭孔神经阻滞在经尿道膀胱肿瘤电切术（TURBT）中预防闭孔神经反射的效果。方法 2008年4月至2010年10月,82例膀胱肿瘤患者在椎管麻醉下行TURBT,对针形电极弧形切割诱发的闭孔神经反射采用肿瘤基底部闭孔神经阻滞。结果术中针形电极诱发闭孔神经反射27例,通过肿瘤基底部深肌层水平方向浸润注射利多卡因后闭孔神经反射消失。27例均顺利完成手术,未发现膀胱壁破裂、严重出血等并发症。结论针形电极弧形切割结合肿瘤基底部闭孔神经阻滞可有效预防TURBT术中闭孔神经反射,降低膀胱穿孔及严重出血的发生率。该方法简便易行,具有一定临床应用价值。

Transvesical blockade of the obturator nerve to prevent obturator nerve reflex in transurethral resection of bladder tumors

Objective To investigate the efficacy of bracket-shaped cutting using needle electrode combination with transvesical block to avoid obturator nerve reflex during transurethral resection of bladder tumors（TURBT）.Methods Between April 2008 and October 2010,82 cases of bladder tumor were underwent TURBT under spinal anesthesia.Among these cases,the muscle spasms were induced in 27 cases by needle electrode during bracket-shaped cutting,then these cases were managed with transvesical obturator nerve block with 0.5% lidocaine.Results In 27 cases with obturator nerve reflex,muscle spasms vanished after transvesical obturator nerve block.We did not experience any serious complication in all these cases.Conclusions Bracket-shaped cutting with needle electrode combination with transvesical obturator nerve block is an effective technique to reduce complications such as bladder perforation and severe bleeding caused by obturator nerve reflex during TURBT.