耻骨上经膀胱闭孔神经阻滞法在经尿道膀胱肿瘤电切术中的应用

Suprapubic approach for transvesical obturator nerve block in transurethral resection of bladder tumor

目的:探讨经尿道膀胱肿瘤电切术(TURBT)中耻骨上经膀胱闭孔神经阻滞的安全性与有效性。方法:从2011年7月始,我院收治的有TURBT指征的膀胱侧壁肿瘤患者21例,术中在硬膜外麻醉下行耻骨上经膀胱闭孔神经阻滞预防闭孔神经反射,与往期在硬膜外麻醉下行经会阴闭孔神经阻滞的21例患者,进行闭孔反射发生率、膀胱穿孔发生率、手术时间、出血量方面的比较,术后随访观察肿瘤复发情况。结果:两组手术时间、出血量及术后1年复发率的差异均无统计学意义(P>0.05),但硬膜外麻醉联合耻骨上经膀胱闭孔神经阻滞组的闭孔反射发生率及膀胱穿孔率明显降低(P<0.05)。结论:耻骨上经膀胱闭孔神经阻滞能有效预防闭孔神经反射,可降低TURBT膀胱穿孔率。

Objective：To evaluate the safety and efficacy of transvesical obturator nerve block（ONB）via suprapubic approach during transurethral resection of bladder tumor（TURBT）.Method：Since July 2011,21 patients suffered from lateral bladder wall tumor were treated with TURBT under ONB via suprapubic approach after epidural anesthesia（EA）.Another 21 patients used transvesical ONB through transperineal approach in the past were also included in the study.The incidence of obturator nerve reflex,bladder perforation,blood loss,operation time and recurrence rate were compared between these two methods of ONB.Result：Comparing these two groups,there were no significant differences in operation time,blood loss and one-year recurrence rate（P 〉0.05）,but transvesical ONB via suprapubic approach decreased obturator nerve reflex and bladder perforation during TURBT（P 〈0.05）.Conclusion：Transvesical ONB via suprapubic approach is a safe,effective method to avoid obturator nerve reflex and bladder perforation.