利多卡因阻滞预防膀胱侧壁肿瘤电切术中闭孔神经反射的临床疗效

Clinical efficacy of lidocaine in prevention of the obturator nerve reflex during transurethral resection of sidewall bladder cancer

目的探讨18G经皮肾穿刺针膀胱肿瘤基底部肌层或膀胱肌层外穿刺,1%利多卡因30 ml阻滞预防电切术中闭孔神经反射的效果。方法 2008年2月至2014年2月对收治的膀胱侧壁肿瘤患者,在电切术前用电极电灼刺激肿瘤基底部进行测试,证实存在66例。随机分为三组,用1%利多卡因行肿瘤基底部肌层或膀胱肌层外注射,其中A组22例行肿瘤基底部肌层注射,B组24例行膀胱肌层外注射,C组20例不做穿刺注射,为对照组。结果 A组有11例(50%)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6例(25%),两组比较差异有统计学意义(P<0.05)。对仍出现闭孔神经反射的6例,用电切环完全可以切除瘤体和肿瘤基底部及其周围组织,未发生闭孔反射引起膀胱穿孔。C组有16例(80%)患者在电切时发生不同程度的闭孔神经反射。结论术前应用1%利多卡因浸润注射肿瘤基底部肌层或膀胱肌层外,能有效降低闭孔神经反射的发生率,膀胱肌层外注射效果明显优于肿瘤基底部肌层注射。

Objective To investigate the effect of 18 G percutaneous needle-based bladder cancer or bladder muscle layer at the bottom of the outer muscle layer puncture with 30 ml 1% lidocaine on prevention of the obturator nerve reflex during transurethral resection of sidewall bladder cancer.Methods From February 2008 to February 2014,on the sidewall of bladder cancer patients treated before transurethral resection of the tumor with the bottom of the base electrode electrocautery stimulation test confirmed the presence of 66 cases.They were randomly divided into three groups,and treated with 1% lidocaine line the base of the muscle due to cancer or bladder muscular injection,22 patients in group A had the tumor base muscular injection,24 cases in group B had the bladder muscular injection,20 patients in group C had no puncture injection as the control group.Results Eleven cases（50%） in group A had obturator nerve reflex in varying degrees,and 6 cases（25%） had slight reflection in group B,the difference was statistically significant.Six cases had obturator nerve reflex,but electric cutting ring can completely resect the tumor and tumor basal and surrounding tissue,without the occurrence of obturator nerve reflexcause bladder perforation.Sixteen patients（80%） in the control group had varying degrees of obturator nerve reflex during transurethral resection.Conclusion 1% lidocaine infiltration tumor basal muscle layer or bladder muscle layer before operation can effectively reduce the incidence rate of obturator nerve reflex,and bladder muscle layer effect is better than that of tumor injection basal muscle injection.