超声引导下闭孔神经阻滞在经尿道膀胱肿瘤等离子电切术中的应用  

Ultrasound-guided obturator nerve block in transurethral plasmakinetic resection of bladder tumor

作　　者：吴训[1,2] 来勇[3] 陈建帆[1] 秦晓平[1] 赖彩永[1] 潘斌[1] 黄保元[1] 詹雄宇 苏泽轩[1,2] 卓育敏[1] WU Xun LAI Yong CHEN Jianfan QING Xiaoping LAI Caiyong PAN Bin HUANG Baoyuan ZHAN Xiongyu SU Zexuan ZHUO Yumin(Department of Urology, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China Institute of Clinical Anatomy, Southern Medical University Department of Anesthe-siology, First Affiliated Hospital of Jinan University)

机构地区：[1]暨南大学附属第一医院泌尿外科,广州510630 [2]南方医科大学临床解剖学研究所 [3]暨南大学附属第一医院麻醉科

出　　处：《临床泌尿外科杂志》2016年第12期1105-1107,共3页Journal of Clinical Urology

基　　金：广东省自然科学基金项目(编号S2013010016503);暨南大学第一临床医学院科研培育专项基金项目(编号20136000Z150360)

摘　　要：目的：比较腰硬联合麻醉和腰硬联合麻醉加超声引导下闭孔神经阻滞在膀胱侧壁及三角区附近肿瘤经尿道膀胱肿瘤等离子电切术（TUPKR-Bt）中的临床效果。方法：回顾性研究2012年1月1日-2015年10月31日在我院泌尿外科行经尿道膀胱肿瘤电切术的98例膀胱侧壁肿瘤患者。其中48例患者单独行腰硬联合麻醉（CSEA组）,50例患者行腰硬联合麻醉加超声引导下闭孔神经阻滞（CSEA＋O组）。结果：CSEA＋O组的肿瘤切除时间（15.38±7.09）min显著短于CSEA组的（19.45±5.70）min,闭孔神经反射发生率及膀胱穿孔率显著少于CSEA组（2%vs.39.6%;0vs.10.4%）,血红蛋白下降水平（0.5±0.37）g/dL显著小于CSEA组（0.8±0.43）g/dL,膀胱刺激征发生率显著少于CSEA组（24%vs.64.6%）,留置尿管时间和住院时间显著短于CSEA组,随访期间肿瘤复发率低于CSEA组（8%vs.22.9%）;输血率和术后1年肿瘤复发率两组差异无统计学意义。结论：超声引导下闭孔神经阻滞应用于TUPKR-Bt患者中,可以有效减少闭孔神经反射的发生,使切除更彻底和安全,减少术中出血,缩短住院时间,减少肿瘤复发。Objective：To compare clinical effects between ultrasound-guided obturator nerve block（ONB）spinal-epidural anesthesia（CSEA）and only CSEA on patients with bladder tumors on the lateral wall and trigone undergoing transurethral plasmakinetic resection of bladder tumor（TUPKR-Bt）.Method：Forty-eight patients underwent TUPKR-Bt under only CSEA（Group CSEA）and other 50 patients under CSEA plus ultrasound-guided ONB（Group CSEA＋O）from January 1st,2012 to October 31 st,2015in the study center were reviewed retrospectively.Result：There were significantly shorter resection time,lower obturator nerve reflex rate and bladder perforation rate,smaller drop in hemoglobin level,less irritation symptoms of bladder,shorter catheterization time and length of stay,lower recurrence rate during follow-up in the CSEA＋O group.However,no significant difference was found in blood transfusion rate and recurrence rate during the first postoperative year between two groups.Conclusion：Ultrasound-guided ONB employed in TUPKR-Bt can prevent obturator nerve reflex,ensure a more complete and secure surgery,reduce intraoperative bleeding,shorten the length of stay,and reduce recurrence.

关 键 词：闭孔神经阻滞 超声引导 膀胱肿瘤 等离子电切 

分 类 号：R737.14[医药卫生—肿瘤] R699.5[医药卫生—临床医学]