摘要
目的探讨膀胱肿瘤基底部黏膜下阻滞与肌层及黏膜下同时阻滞预防电切术中闭孔神经反射的效果差异。方法 2000年1月至2009年5月对收治的膀胱侧壁肿瘤患者,在电切术前用滚珠状电极电灼刺激肿瘤基底部进行测试,证实存在闭孔神经反射的76例被随机分为A、B两组,用2%利多卡因行肿瘤基底部浸润注射,其中A组38例行肿瘤基底部黏膜下注射,B组38例则行肌层及黏膜下同时注射。结果 A组有28.95%(11例)患者在电切时发生不同程度的闭孔神经反射,B组发生轻微反射5.26%(2例),差异有统计学意义。对仍出现闭孔神经反射的13例,用电切环切除瘤体,而肿瘤基底部及其周围组织改用滚珠状或汽化电极进行汽化,防止了膀胱穿孔的发生。结论术前应用滚珠状电极电灼刺激肿瘤基底部,不仅能帮助识别是否存在闭孔神经反射,而且操作直观安全;用利多卡因浸润注射肿瘤基底部肌层及黏膜下,能有效降低闭孔神经反射发生率,肌层和黏膜下同时注射效果明显优于单纯黏膜下注射。
Objective To investigate the prevention of obturator nerve reflex by lidocaine infiltration in different histologic layer during transurethral resection of bladder tumors.Methods Between January 2000 and May 2009,76 patients with bladder tumors in inducible of obturator nerve reflex by tumor basement stimulation were divided into 2 groups.38 patients（group A） received simple submucous infiltration of 2% lidocaine around the tumor basement before transurethral resection while the other 38 patients（group B） underwent submucous combined with detrusor muscle infiltration.Results Muscle spasms were observed in 11 patients in group A and only 2 patients in group B.The occurrence of obturator nerve reflex was significantly higher in group A（28.95%） than in group B（5.26%） by Fisher’s exact test（P=0.012）.Conclusions Lidocain block is a useful technique for the prevention of obturator spasms during the transurethral resection of lateral bladder tumors.Combine submucous with detrusor muscle infiltration is more effective than simple submucous infiltration.
出处
《中华腔镜泌尿外科杂志（电子版）》
2010年第4期8-10,共3页
Chinese Journal of Endourology(Electronic Edition)
基金
苏州市科技计划项目(WS200812)
关键词
膀胱肿瘤
经尿道电切术
闭孔神经
神经阻滞
Urinary Bladder Neoplasms Obturator Nerve Nerve Block Transurethral Resection of Bladder Tumor
