翻转电切环联合柱状电极在膀胱侧壁肿瘤电切术中预防闭孔神经反射的疗效  

Clinical effect of transurethral resection of bladder tumor with upside down loop and plsamakinetic in the prevention of obturator nerve reflex

作　　者：吴升[1] 祝黎洁[1] 尤晓明[1] 邵红宝[1] 戴枫[1] 秦锋[1] 彭涛[1] 宋宁宏[2] 

机构地区：[1]无锡市第三人民医院泌尿外科,214041 [2]江苏省人民医院泌尿外科

出　　处：《中华老年医学杂志》2012年第11期952-953,共2页Chinese Journal of Geriatrics

摘　　要：目的观察翻转电切环侧切法联合超脉冲等离子柱状电极在膀胱肿瘤电切术中预防闭孔神经反射的可行性和临床疗效。方法膀胱侧壁肿瘤患者211例，在腰麻或硬膜外麻醉下行经尿道肿瘤电切术，先采用电切环常规切除肿瘤，术中出现闭孔神经反射或进行至闭孔神经映射区时，改用超脉冲等离子柱状电极汽化切割剩余肿瘤组织，后再采用电切环翻转180度，以电切环侧边修平电极切除后的创面。结果211例患者采用翻转电切环侧切法切除膀胱侧壁肿瘤时，出现轻微闭孔神经反射192例，仅表现为大腿内收肌群收缩颤动，身体移位不明显，可顺利完成手术；术中未出现强烈闭孔神经反射者。结论经尿道膀胱肿瘤电切术中，倒扣电切环侧切法和柱状电极切除法联合应用安全、简单、有效，不增加治疗费用，值得广泛推广。Objective To observe the results and reality of transurethral resection of bladder tumor（TUR-Bt）with upside down loop and plsamakinetic in the prevention of obturator nerve reflex. Methods A total of 211 patients with lumbar anesthesia received TUR-Bt. Firstly, the tumor tower above bladder wall was cut with the traditional way. When intraoperative findings were obturator nerve reflex, or to the obturator nerve mapping area, operation should be changed to super- impulse plasma column electrode vaporization to cut off residual tumor tissue, then after flipping the loop, the residual tumour was resected with upside down loop from the tumour side wall. Results In 211 cases, 192 cases had a little obturator nerve reflex, but the movement of body was not obvious, which did not influence the operation. The serious complication, such as perforation of bladder and injury of nerve and vessel, did not occur. Conclusions The lateral resection of bladder side wall tumour with upside-down loop can effectively avoid strong obturator nerve reflex, which is safe, uncomplicated, and efficacious and it does not increase the additional outlay and hurt.

关 键 词：膀胱肿瘤 闭孔神经 

分 类 号：R737.14[医药卫生—肿瘤]