摘要
目的探讨椎管内麻醉下闭孔神经阻滞(ONB)在经尿道膀胱肿瘤切除术(TURBT)中的临床疗效。方法由2名独立的研究员按照事先制定的检索策略从PubMed、the Cochrane Library、Embase、Web of Science、万方、知网和维普数据库检索国内外相关数据,检索时间从建库之初至2020年5月,同时按照纳入标准筛选与ONB辅助椎管内麻醉相关的随机对照试验,观察指标包括闭孔反射率、膀胱穿孔、手术时间和住院时间,并采用Stata 14.2完成数据的汇总分析。结果本研究最终纳入11篇文献进行Meta分析。与采用ONB辅助的患者相比,无ONB辅助的患者TURBT中更容易出现闭孔反射(RR:0.17,95%CI:0.11~0.26),并且研究间无明显异质性(P=0.975,I 2=0.0%)。与采用ONB辅助的患者相比,无ONB辅助的患者TURBT中更容易出现膀胱穿孔(RR:0.22,95%CI:0.11~0.42),并且研究间无明显异质性(P=0.980,I 2=0.0%)。与无ONB辅助的患者相比,采用ONB辅助的患者手术时间更短(WMD:-9.83,95%CI:-15.00^-4.66),但是研究间存在高度异质性(P<0.1,I 2=85.4%)。此外,采用ONB辅助和无ONB辅助的患者住院时间比较,差异无统计学意义(WMD:-0.12,95%CI:-0.38~0.15)。结论ONB辅助椎管内麻醉可以降低TURBT中闭孔反射率和膀胱穿孔的风险,缩短手术时间。若麻醉医生和手术医生经验不足,对膀胱侧壁肿瘤患者应常规使用ONB辅助椎管内麻醉行TURBT治疗。
Objective To explore the clinical efficacy of obturator nerve block(ONB)assisted intraspinal anesthesia during transurethral resection of bladder tumors(TURBT).Methods Relevant domestic and foreign data in databases of PubMed,the Cochrane Library,Embase,Web of Science,Wanfang,CNKI and VIP were searched by two independent research operators according to the pre-designed search strategy from the databases construction to May 2020,randomized controlled trials related to ONB assisted intraspinal anesthesia were collected according to the inclusion criteria.The observation indicators included obturator jerk,bladder perforation,operation time and hospital stay were summarized and analyzed by Stata 14.2.Results Totally 11 studies were included in the meta-analysis.Compared with ONB-assisted patients,the obturator jerk was more likely to occur during TURBT in patients without ONB-assisted(RR:0.17,95%CI:0.11~0.26),and there was no obvious heterogeneity among the studies(P=0.975,I 2=0.0%);the bladder perforation was more likely to occur during TURBT(RR:0.22,95%CI:0.11~0.42),and there was no obvious heterogeneity among the studies(P=0.980,I 2=0.0%);the operation time was longer in patients without ONB-assisted(WMD:-9.83,95%CI:-15.00^-4.66),but there was a high heterogeneity among studies(P<0.1,I 2=85.4%);however,there was no significant difference in the hospital stay between two kinds of patients(WMD:-0.12,95%CI:-0.38~0.15).Conclusion ONB assisted intraspinal anesthesia during TURBT has a lower risk of obturator jerk and bladder perforation,which can shortern the operation time.When anesthesiologists and surgeon are lack of rich experiences,ONB should be considered routinely in patients with lateral bladder wall tumors during TURBT.
作者
赵犁天
冯德超
刘圣琢
杨玉帛
白云金
韩平
魏武然
ZHAO Li-tian;FENG De-chao;LIU Sheng-zhuo;YANG Yu-bo;BAI Yun-jin;HAN Ping;WEI Wu-ran(Third Department of General Surgery,Gongxian People s Hospital in Yibin City,Yibin Sichuan 644500,China;Department of Urological Surgery/Institute of Urinary Surgery,West China Hospital of Sichuan University,Chengdu Sichuan 610041,China)
出处
《局解手术学杂志》
2020年第11期908-913,共6页
Journal of Regional Anatomy and Operative Surgery
基金
四川省科技厅重点研发项目(2020YFH0099)
四川大学华西医院学科卓越发展1·3·5工程项目(ZY2016104)。
关键词
闭孔神经阻滞
经尿道膀胱肿瘤切除术
椎管内麻醉
META分析
obturator nerve block
transurethral resection of bladder tumors
intraspinal anesthesia
Meta-analysis
