经尿道膀胱肿瘤电切术中闭孔神经反射预防方法的讨论  

Preventive methods of obturator never reflex during transurethral resection of bladder tumor

作　　者：王春光[1] 张海峰[2] 杨立新[3] 

机构地区：[1]吉林省榆树市医院泌尿外科,130400 [2]吉林大学第一医院泌尿外科,长春130021 [3]江苏省南京市第二医院,210003

出　　处：《中国医疗前沿》2011年第13期45-46,29,共3页China Healthcare Innovation

摘　　要：目的探讨我院经尿道膀胱肿瘤电切术中,应用闭孔神经反射预防方法的经验体会。方法回顾性总结分析我院自2004年以来的3年中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,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122例,第二组应用全身麻醉42例,第三组应用硬膜外麻醉和闭孔神经阻滞麻醉22例。结果第一组有10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1例严重的膀胱穿孔、大出血,需要行膀胱修补术。第二组和第三组出现2例轻微的闭孔神经反射。结论硬膜外麻醉是不可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,实际上这种方法对小的膀胱肿瘤,手术时间短是非常有效的。但对大的膀胱肿瘤,手术时间长是不合适的。对大的膀胱肿瘤或多发的膀胱肿瘤,应用全身麻醉是非常合适的。上述两种方法应用中掌握肌松药的应用量和维持时间是非常重要的,电切中出现膀胱穿孔多是由于肌松药的应用量或维持时间不够造成闭孔神经反射所致。闭孔神经阻滞麻醉的联合应用是最经济的方法。Objective To explore the experience in prevent obturator never reflex during transurethral resection of bldder tumor.Methods The clinical data to prevent obturator never reflex were collected in 186 cases bladder tumor patients during transurethral resection of bladder tumor from 2004 to 2007.The patients were divided into three groups：first group used epidural anesthesia and muscle relax during with oxygen by facepiece in 122 cases.second group used general anesthesia in 42 cases.third group used epidural anesthesia never blockage method in 22 cases.Results 10 cases patients in first group occurred slight obturator never reflex and not bladder perforation,severe obturator never reflex occurred in 5 cases patients,slight perforation in 4 cases severe perforation and severe bleeding in 1 case,the bladder repair operation were done.Obturator never reflex in 2 cases occur in second and third group patient.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 TUR-BT operation actually.The general anesthesia is suitable for large bladder tumor,multiple bladder tumor or long time TUR-BT operation.The manage of used dose and maintained time of muscle relax drug is very important during first or second group,the lower used dose or short maintain time can develop obturator never reflex and bladder perforation during TUR-BT operation.The obturator never block and epidural anesthesia is economical method.

关 键 词：膀胱肿瘤 经尿道膀胱肿瘤电切术 麻醉方法 闭孔神经反射 

分 类 号：R737.14[医药卫生—肿瘤]