超声引导下闭孔神经阻滞在经尿道膀胱肿瘤等离子电切术中的应用

发布时间：2018-04-25 20:02

本文选题：闭孔神经阻滞 + 超声引导　；参考：《临床泌尿外科杂志》2016年12期

【摘要】：目的:比较腰硬联合麻醉和腰硬联合麻醉加超声引导下闭孔神经阻滞在膀胱侧壁及三角区附近肿瘤经尿道膀胱肿瘤等离子电切术(TUPKR-Bt)中的临床效果。方法:回顾性研究2012年1月1日~2015年10月31日在我院泌尿外科行经尿道膀胱肿瘤电切术的98例膀胱侧壁肿瘤患者。其中48例患者单独行腰硬联合麻醉(CSEA组),50例患者行腰硬联合麻醉加超声引导下闭孔神经阻滞(CSEA+O组)。结果:CSEA+O组的肿瘤切除时间(15.38±7.09)min显著短于CSEA组的(19.45±5.70)min,闭孔神经反射发生率及膀胱穿孔率显著少于CSEA组(2%vs.39.6%;0vs.10.4%),血红蛋白下降水平(0.5±0.37)g/dL显著小于CSEA组(0.8±0.43)g/dL,膀胱刺激征发生率显著少于CSEA组(24%vs.64.6%),留置尿管时间和住院时间显著短于CSEA组,随访期间肿瘤复发率低于CSEA组(8%vs.22.9%);输血率和术后1年肿瘤复发率两组差异无统计学意义。结论:超声引导下闭孔神经阻滞应用于TUPKR-Bt患者中,可以有效减少闭孔神经反射的发生,使切除更彻底和安全,减少术中出血,缩短住院时间,减少肿瘤复发。
[Abstract]:Objective: to compare the clinical effects of combined spinal-epidural anesthesia and combined spinal-epidural anesthesia with ultrasound guided obturator nerve block in the treatment of bladder cancer by transurethral resection of bladder tumor by transurethral plasma resection (TUPKR-Btt). Methods: 98 patients with lateral wall tumor of bladder underwent transurethral resection of bladder tumor from January 1, 2012 to October 31, 2015. Among them, 48 cases were treated with CSEA alone and 50 cases were treated with combined spinal-epidural anesthesia and ultrasound guided obturator nerve block (CSEA O group). Results the resection time was 15.38 卤7.09)min significantly shorter than that in CSEA group (19.45 卤5.70 min). The incidence of obturator nerve reflex and bladder perforation was significantly lower than that in CSEA group (2vs.39.60vs.10.4). The decreased level of hemoglobin was 0.5 卤0.37)g/dL significantly lower than that of CSEA group (0.8 卤0.43g / dL), and the incidence of bladder irritation was significantly lower. In CSEA group, 24vs.64.6, the time of indwelling urinary catheter and the length of stay were significantly shorter than that of CSEA group. The recurrence rate of tumor in CSEA group was lower than that in CSEA group, but there was no significant difference between the two groups in blood transfusion rate and tumor recurrence rate in one year after operation. Conclusion: Ultrasound-guided obturator nerve block in TUPKR-Bt patients can effectively reduce the occurrence of obturator nerve reflex, make resection more complete and safe, reduce intraoperative bleeding, shorten hospital stay, and reduce tumor recurrence.
【作者单位】：暨南大学附属第一医院泌尿外科;南方医科大学临床解剖学研究所;暨南大学附属第一医院麻醉科;
【基金】：广东省自然科学基金项目(编号S2013010016503) 暨南大学第一临床医学院科研培育专项基金项目(编号20136000Z150360)
【分类号】：R737.14

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