浅表膀胱肿瘤汽化切除术中膀胱穿孔分析

Analysis on Bladder Perforation by Transurethral Electrovaporization for Superficial Bladder Tumor

目的探讨经尿道膀胱肿瘤汽化切除术(TVB t)中膀胱穿孔的原因及预防措施。方法总结分析158例经尿道膀胱肿瘤汽化切除术中11例膀胱穿孔病历。结果11例中,7例因闭孔神经反射发生腹膜外穿孔,其中6例未行闭孔神经阻滞;4例腹膜内穿孔,其中3例在处理膀胱顶部及前壁肿瘤时,汽化过深而出现,1例切除膀胱前壁肿瘤时,气泡爆炸引起。结论穿孔是TVB t手术的严重并发症,患侧闭孔神经阻滞,术中保持低压冲洗或保持回流水通畅,均能有效地避免或减少穿孔的发生;术中应及时排出汽化中产生的气体,或改变体位避开气泡,预防气泡爆炸的发生。

Objective The reason and precautionary measures to bladder perforation by transurethral electrovaporization of superficial bladder tumor （TVBt） were explored roundly in this study. Methods Conclusion and analysis 11 cases with bladder perforation from 158 patients performed in with transurethral electrovaporization of superficial bladder carcinoma. Result For the 11 cases with bladder perforation, 7 cases got extraperitoneal foraminose because of obturator nerve reflex included 6 cases without obturator nerve block. For the other 4 cases of intraperitoneal perforation, 3 patients were given too deep vaporization to tumor on apex and antetheca of bladder while another case got intraperitoneal foraminose for air bubble burst when removing tumor on antetheca of bladder. Conclusion Perforation is a severe syndrome to TVBt. Obturator nerve block on diseased side, keeping low-pressure irrigation or smooth refluence can all effectively avoid or reduce perforation. When performing electrovaporization, ways of instant exhaust of vapors or different body positions to elude bubbles shall be taken to prevent from the burst of air bubbles.