观察闭孔神经阻滞联合腰麻下单极与双极经尿道电切术治疗膀胱侧壁肿瘤的疗效及安全性  

Efficacy and safety of monopolar and bipolar transurethral resection of bladder lateral wall tumor under obturator nerve block combined with spinal anesthesia

作　　者：邓新喜[1] 李勋钢[1] 万滨[1] 张卓[1] 卢依刚[1] 张文圣[1] DENG Xinxi;LI Xungang;WAN Bin;ZHANG Zhuo;LU Yigang;ZHANG Wensheng(Department of Urology,Jiu Jiang No.1 People's Hospital,Jiujiang,Jiangxi,332000,China)

机构地区：[1]九江市第一人民医院泌尿外科,江西九江332000

出　　处：《临床泌尿外科杂志》2022年第7期507-510,516,共5页Journal of Clinical Urology

基　　金：江西省卫生健康委科技计划项目(No:SKJP220201758)。

摘　　要：目的:比较闭孔神经阻滞(ONB)联合腰麻下单极和双极经尿道膀胱肿瘤电切术(TURBT)治疗膀胱侧壁肿瘤的疗效和安全性。方法:纳入九江市第一人民医院2016年1月—2019年12月在ONB联合腰麻下行TURBT治疗的120例患者。患者被随机分为单极TURBT组和双极TURBT组,术后随访18个月。统计两组患者临床基本资料(性别、年龄、肿瘤大小、数量、肿瘤病理分级等)、围手术期(闭孔神经反射、膀胱穿孔、电切综合征、是否切至膀胱肌层、手术前后血红蛋白、血Na^(+)、手术时间、留置尿管时间和住院天数)及术后随访资料(膀胱肿瘤复发率)。结果:两组患者临床基本数据比较差异无统计学意义,但单极TURBT组与双极TURBT组血红蛋白降低值[(0.81±0.09)g/dL vs.(0.78±0.07)g/dL,P=0.03]、手术时间[(43.67±11.40)min vs.(38.57±8.25)min,P=0.006]及住院天数[(6.00±0.82)d vs.(5.70±0.76)d,P=0.04]比较,双极TURBT组具有显著性优势。而闭孔神经反射、膀胱穿孔、完整切除肿瘤、电切综合征和肿瘤复发率等方面比较,差异无统计学意义。结论:ONB联合腰麻治疗膀胱侧壁肿瘤,单极TURBT和双极TURBT疗效相似,但双极TURBT安全性更高。Objective:To compare the efficacy and safety between monopolar and bipolar transurethral resection of bladder tumor(TURBT)under obturator nerve block(ONB)combined with spinal anesthesia in the treatment of bladder lateral wall tumor.Methods:From January 2016 to December 2019,120 patients who were treated with TURBT under ONB combined with spinal anesthesia in Jiu Jiang No.1 People's Hospital were included.The patients were randomly divided into monopolar TURBT and bipolar TURBT and were followed up for 18 months.The basic clinical data(sex,age,tumor size,tumor number.tumor pathological grade,etc.),perioperative period(obturator nerve reflex,bladder perforation,TUR syndrome.whether to cut to the bladder muscle layer,hemoglobin,Na^(+),operation time,indwelling catheter time and hospital stay)and postoperative follow-up data(bladder tumor recurrence rate)were collected.Results:There was no difference in basic clinical data between the two groups.However,bipolar TURBT had significant advantages in hemoglobin reduction[(0.81±0.09)g/dL vs.(0.78±0.07)g/dL,P=0.03],operation time[(43.67±11.40)min vs.(38.57±8.25)min,P=0.006]and hospital stay[(6.00±0.82)d vs.(5.70±0.76)d,P=0.04].There was no significant difference in obturator nerve reflex,bladder perforation,complete resection of tumor,TUR syndrome or tumor recurrence rate.Conclusion:The efficacy of monopolar TURBT is similar to that of bipolar TURBT in the treatment of bladder lateral wall tumor under ONB combined with spinal anesthesia,but bipolar resection is safer.

关 键 词：闭孔神经阻滞 单极电切 双极电切 膀胱肿瘤 安全性 

分 类 号：R737.15[医药卫生—肿瘤]