硬膜外麻醉联合膀胱穿刺局部麻醉在膀胱侧壁肿瘤电切术中的应用  

The application of epidural anesthesia combined with bladder injection in transurethral resection of bladder tumor

作　　者：王伟录[1] 李巧星[1] 王勇[1] 梁东彦[1] 李云龙[1] 

机构地区：[1]江苏大学附属昆山第一人民医院泌尿外科,昆山215300

出　　处：《现代泌尿外科杂志》2017年第2期116-118,共3页Journal of Modern Urology

摘　　要：目的探讨硬膜外麻醉联合膀胱穿刺局部麻醉在膀胱侧壁肿瘤电切术中预防闭孔神经反射的可行性。方法收集74例硬膜外麻醉联合膀胱穿刺局部麻醉行膀胱侧壁肿瘤经尿道电切术的患者资料,常规经尿道膀胱肿瘤电切术(TURBT)44例,经膀胱穿刺局部麻醉注射利多卡因后进行膀胱肿瘤电切术30例,分析其闭孔神经反射、膀胱穿孔的发生情况。结果常规经尿道膀胱肿瘤电切术患者44例中20例发生闭孔神经反射,其中6例发生非控制性膀胱穿孔;30例膀胱穿刺局部麻醉注射利多卡因后进行TURBT的患者,仅2例出现轻微闭孔神经反射,无膀胱穿孔。两组间比较有统计学差异(P<0.05)。结论硬膜外麻醉联合膀胱穿刺局部麻醉注射利多卡因后行TURBT术,能有效降低闭孔神经反射的发生率,增加手术安全性。Objective To investigate the feasibility of epidural anesthesia combined with bladder injection in the electroresection of lateral wall bladder tumor to prevent obturator nerve reflex.Methods Clinical data of 74 patients with lateral wall bladder tumor who received transurethral resection of bladder tumor（TURBT）were retrospectively analyzed.Of all patients,44 underwent conventional TURBT,30 underwent TURBT after lidocaine injection.Results Of the 44 patients in the conventional TURBT group,20 developed obturator nerve reflex,and6 developed non-controlled bladder perforation.Among the 30 cases undergoing TURBT after lidocaine injection,only 2 had mild obturator nerve reflex,and no case had bladder perforation.Conclusion By combining epidural anesthesia with bladder injection in TURBT,the incidence of obturator nerve reflex can be reduced significantly,and the surgical safety can be enhanced.

关 键 词：硬膜外麻醉 膀胱侧壁肿瘤 利多卡因 闭孔神经反射 

分 类 号：R737.14[医药卫生—肿瘤]