去离子水注射在预防侧壁膀胱肿瘤电切闭孔反射中的应用  

Application of Deionized Water Injection for Prevention of Obturator Nerve Reflex in Transurethral Resection of Bladder Tumor Located in Lateral Wall

作　　者：龚小新[1] 杨勇[1] 陈从波[1] 黄力[1] 李昊[1] 王黎[1] 姚启盛[1] 

机构地区：[1]湖北医药学院附属太和医院泌尿外科男科,十堰442000

出　　处：《中国现代手术学杂志》2016年第1期66-68,共3页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨去离子水注射在预防膀胱侧壁肿瘤电切手术中发生闭孔神经反射的效果。方法 2012年12月～2014年12月间49例膀胱侧壁肿瘤患者行经尿道膀胱肿瘤电切术,术中采用粘膜下及更深部位的去离子水于肿瘤基底部注射,观察术中闭孔反射发生情况。结果本组49例患者均顺利完成手术,术中平均出血量52（30～100）ml,平均手术时间50（30～80）min。所有患者术中均未发生闭孔反射。随访46例,平均随访时间30（12～42）个月。术后病理结果：34例为非肌层浸润性膀胱尿路上皮癌（T1期）,术后2年内复发9例,再次行TUR-Bt术;15例为肌层浸润性尿路上皮癌（T2期）,其中5例于4周后行二次电切,8例行膀胱癌根治术,2例死于冠心病。结论术中采用去离子水行粘膜下及更深部位注射可有效避免侧壁肿瘤电切术中的闭孔反射,方法简单,值得推广。Objective To explore the effect of deionized water injection for prevention of obturator nerve reflex in transurethral resection of lateral wall of bladder tumor. Methods 49 bladder tumor cases located in lateral wall were treated by transurethral resection of bladder tumor（ TUR-Bt） from December 2012 to December2014. During the surgery,deionized water was injected in the basilar part of tumor. Results All 49 cases were completed the TUR-Bt without obturator nerve reflex. The intra-operative blood loss was 30 to 100 ml with an average of 52 ml,and the operative duration was 30 to 80 minutes with an average of 50 minutes. 46 cases were followed up for 12 to 42 months（ mean,30 months）. In 34 cases with non-muscularis invasive bladder uroepithelium cancer,9 cases were relapsed and performed reoperation of TUR-Bt. In 15 cases with muscularis invasive bladder uroepithelium cancer,5 cases were carried out reoperation of TUR-Bt,8 cases were performed radical cystectomy,and 2 cases died of coronary artery disease. Conclusion The submucous or deeper parts injection of deionized water is an effective and simple method to prevent obturator nerve reflex in TUR-Bt,and it is worthy to be popularized.

关 键 词：膀胱肿瘤 去离子水 闭孔反射 

分 类 号：R737.14[医药卫生—肿瘤]