无闭孔神经反射的经尿道针状电极膀胱肿瘤电切术  

Transurethral needle electrode resection of bladder tumors without obturator nerve reflex

作　　者：李建昌[1,2] 徐阿祥[1] 孙圣坤[1] 杨国强[1] 许勇[1] 陈光富[1] 符伟军[1] 张旭[1] 

机构地区：[1]中国人民解放军总医院泌尿外科,北京100853 [2]广东医学院附属医院泌尿外科

出　　处：《微创泌尿外科杂志》2014年第6期368-371,共4页Journal of Minimally Invasive Urology

基　　金：国家高技术研究发展计划(2012AA021101)

摘　　要：目的:探讨经尿道针状电极膀胱肿瘤电切术避免闭孔神经反射的可行性。方法:12例膀胱肿瘤患者,肿瘤均位于膀胱侧壁,直径1~4cm。采用硬膜外麻醉,以等离子针状电极距肿瘤基底周边1cm电凝膀胱壁黏膜层后,将针尖插入肌层,向远离膀胱壁方向牵拉、切断,直至显露半透明的膀胱外层纤维结缔组织,在肌层与结缔组织之间剥离膀胱肿瘤,完整切除肿瘤基底所在膀胱壁全层送病理检查。观察手术时间、术中闭孔神经反射发生情况、术中及术后并发症、肿瘤病理分期。结果:共切除12枚肿瘤,单枚肿瘤切除时间3~30min,平均(12.7±10.4)min;所有病例均未加用闭孔神经阻滞,术中均无闭孔神经反射发生,术中出血极少,术后无继发出血。留置尿管3~7d。切除肿瘤均获得完整病理分期:T1期6枚,T2a期4枚,T2b期2枚。随访3~6个月未见肿瘤复发。结论:经尿道针状电极膀胱肿瘤电切术具有切割精准、出血少、可获取完整标本的优点。在切除膀胱侧壁肿瘤时能避免闭孔神经反射,为膀胱侧壁肿瘤的切除提供了一种安全有效的新方法。Objective:To investigate the feasibility of obviating the obturator nerve reflex during transurethral needle electrode resection of bladder tumors(TUNER-BT).Methods:This series included 12 patients with bladder tumors located in the lateral bladder wall with 1-4cm in diameter.The patients received epidural anesthesia.After electrocautery of the bladder mucosa 1cm away from the tumor base by coagulation current,the needle tip was inserted into the muscle layer and the muscle fiber was stretched away from the lateral bladder wall,followed by electroresection current,until the outer semitransparent connective tissue was exposed.Then the tumor as well as its basement was dissected in the plane between the muscular layer and the connective tissue.The specimens containing the tumor and full thickness of the bladder wall were obtained for pathological inspection.The operation time,obturator nerve reflex,peri-operative complications,and pathologic stage of the tumor were observed.Results:Twelve bladder tumors were resected with the operative time of 3-30 min per tumor[range,(12.7±10.4)min].Obturator nerve blockade was not necessary in any case and no obturator nerve reflex occured.Peri-operative blood loss was minimal.The urine drainage retained 3-7days.The pathologic stage of the tumors resected showed 6tumors in T1 stage,4tumors in T2 astage,and 2tumors in T2 bstage.Conclusions:TUNER-BT is accompanied by advantages such as precise resection,minimal blood loss,and en bloc specimen.TUNER-BT provides a novel and reliable technique by obviating the obturator nerve stimulation during treatment of bladder tumors located in the lateral bladder wall.

关 键 词：膀胱肿瘤 尿路上皮癌 等离子针状电极 膀胱部分切除术 经尿道膀胱肿瘤切除术 闭孔神经反射 

分 类 号：R737.14[医药卫生—肿瘤]