超声引导下闭孔神经阻滞在经尿道膀胱肿瘤电切术中预防闭孔神经反射的效果研究  

Clinical application of obturator nerve block guided by ultrasound in transurethral resection of bladder tumor for prevention of obturator nerve reflex

作　　者：何露 吴顺理 吕艳 陈展 伍庄 HE Lu;WU Shunli;LV Yan;CHEN Zhan;WU Zhuang(Department of Urology,The Hua Run and Wu Gang General Hospital,Wuhan 430080,China)

机构地区：[1]华润武钢总医院泌尿外科,武汉430080

出　　处：《现代泌尿生殖肿瘤杂志》2023年第1期25-29,共5页Journal of Contemporary Urologic and Reproductive Oncology

摘　　要：目的比较超声联合神经刺激仪引导下经腹股沟远端入路闭孔神经阻滞(ONB)和传统体表标志定位联合神经刺激仪引导下ONB在经尿道膀胱肿瘤电切术(TURBT)中预防闭孔神经反射的效果差异。方法收集2019年3月至2021年12月在华润武钢总医院行TURBT的患者共32例,术前影像学或内镜检查评估膀胱肿瘤均位于膀胱侧壁单侧或双侧闭孔神经支配区域,将其随机分为超声引导组(U组)18例和体表标志定位组(S组)14例。对比两组患者每侧ONB的穿刺次数、操作时间、ONB成功率、术中ONB的效果及并发症发生情况等。结果U组患者均为1次穿刺成功;S组患者有8侧为1次穿刺成功,10侧为2次及以上穿刺成功,其中1例失败,两组穿刺成功率比较差异无统计学意义(P>0.05)。U组ONB操作时间显著低于S组(P<0.05)。U组有1例术中出现轻度闭孔神经反射;S组有8例术中出现轻度闭孔神经反射,两组比较差异有统计学意义(P<0.05)。所有患者均未出现局麻药中毒、术后闭孔神经支配区域痛性感觉异常及闭孔神经损伤等情况。结论与传统体表标志定位联合神经刺激仪引导下ONB比较,超声联合神经刺激仪引导下经腹股沟远端入路ONB定位更准确、穿刺次数少、操作时间短且阻滞效果好,值得临床推广使用。Objective To compare the efficacy between obturator nerve block(ONB)via distal inguinal approach guided by ultrasound combined with nerve stimulator and ONB guided by traditional body surface marker localization combined with nerve stimulator in preventing obturator nerve reflex in tranurethral resection of bladder tumor.Methods Thirty-two patients treated with transurethral resection of bladder tumor were divided into two groups:ultrasound-guided U group(n=18)and body surface marker locating S group(n=14).Preoperative imaging or endoscopic examination assessed that the bladder tumors were located in the unilateral or bilateral obturator nerve innervation area of the lateral bladder wall.The number of puncture,operation time of each ONB,the success rate of two ONB methods,the effect of intraoperative ONB and the occurrence of complications were recorded.Results All patients in group U had one attempt,8 sides in group S had one attempt,10 sides in group S had more than two attempts,and 1 patient failed.The difference between the two groups was no statistically significant(P>0.05).The operation time of ONB in U group was significantly shorter than that in S group(P<0.05).During operation,one case was found obturator nerve reflex in group U,while 8 cases in group S.No local anesthetic poisoning occurred in both groups.Postoperative painful paresthesia or obturator nerve injury in the area innervated by the obturator nerve was found in both groups.Conclusions Compared with the group guided by traditional body surface localization combined with nerve stimulator,the ONB via distal inguinal approach guided by ultrasound combined with nerve stimulator is more worth promoting for its more accurate location,less fitting times,shorter operation time and better blocking effect.

关 键 词：超声 神经刺激仪 闭孔神经阻滞 经尿道膀胱肿瘤电切术 

分 类 号：R737.14[医药卫生—肿瘤]