经尿道膀胱肿瘤电切术中预防闭孔神经反射致膀胱穿孔的不同方法介绍  

Exploration in preventing methods of bladder perforation owing to obturator never reflex during transurethral resection of bladder tumor

作　　者：姜博[1] 朱强[1] 张海峰[1] 

机构地区：[1]吉林大学第一医院泌尿外科,长春130021

出　　处：《中华腔镜泌尿外科杂志（电子版）》2011年第2期30-32,共3页Chinese Journal of Endourology(Electronic Edition)

摘　　要：目的总结经尿道膀胱肿瘤电切术中,应用各种闭孔神经反射预防方法避免膀胱穿孔的经验。方法回顾性分析总结我院自2007年1月至2009年12月在经尿道膀胱肿瘤电切术中,应用闭孔神经反射预防方法的临床资料。经尿道膀胱肿瘤电切术的患者186例,男性115例,女性71例,年龄27～87岁,平均54岁。膀胱左侧或右侧壁单发肿瘤134例,膀胱多发表浅性肿瘤52例,根据患者采用的麻醉方法被分成三组,其中第一组应用硬膜外麻醉和肌松药及面罩给氧56例,第二组应用全身麻醉104例,第三组应用硬膜外麻醉和闭孔神经阻滞麻醉26例。结果 186例患者中,第一组有6例出现轻微的闭孔神经反射,未造成膀胱穿孔,有5例出现严重的闭孔神经反射,造成轻微的膀胱穿孔4例,不需要膀胱修补,造成2例严重的膀胱穿孔,1例大出血,需要进行膀胱修补术。第二组出现2例轻微的闭孔神经反射,造成轻微的膀胱穿孔,不需要膀胱修补。第三组造成1例严重的膀胱穿孔,需要进行膀胱修补术。结论硬膜外麻醉是不能抑制闭孔神经反射的,肌松药的应用可以抑制膀胱肌肉的收缩,对大的表浅性膀胱肿瘤或多发的表浅性膀胱肿瘤,应用全身麻醉是非常适合的。闭孔神经阻滞麻醉和硬膜外麻醉的联合应用是经济的方法,但闭孔神经阻滞不全,效果不佳是出现闭孔神经反射的原因。Objective To explore the experience in preventing methods of bladder perforation owing to obturator never reflex during transurethral resection of bladder tumor（TURPt）.Methods The clinical data to prevent bladder perforation owing to obturator never reflex were collected in 186 patients during transurethral resection of bladder tumor from 2007 to 2009.The patients were divided into three groups：first group used epidural anesthesia and muscle relax drug with oxygen by facepiece in 56 cases,second group used general anesthesia in 104 cases,third group used epidural anesthesia and obturator never blockage method in 26 cases.Result Slight and severe obturator never reflex occurred separately in 6 cases and in 5 cases in first group,slight perforation in 4 cases,severe perforation in 2 cases and severe bleeding in 1 cases,the bladder repair operation were done.Slight obturator never reflex and slight perforation occurred in 2 cases in second group,the bladder repair operation were not necessary.Severe obturator never reflex and severe perforation occurred in 1 cases patient in third group,the bladder repair operation were done also.Conclusion Epidural anesthesia could not blockage obturator never reflex.The muscle relax drug can block the contraction of bladder muscle,this method is useful for little bladder tumor or short time TURBt operation actually.The general anesthesia is suitable for large superficial bladder tumor,multiple superficial bladder tumor or long time TURBt operation.The obturator never block and epidural anesthesia is an economical method.The incomplete obturator never block is the reason of developing obturator never reflex.

关 键 词：膀胱肿瘤 经尿道膀胱肿瘤电切术 闭孔神经反射 膀胱穿孔 

分 类 号：R737.14[医药卫生—肿瘤]