经尿道等离子手术中膀胱内爆炸分析

Analysis of Intravesical Explosion in Transurethral Plasma Surgery

目的分析经尿道等离子手术术中并发症膀胱内爆炸的原因,探讨治疗方法及预防措施。方法集我院行经尿道等离子切除术的患者病例资料,就发生术中膀胱内爆炸的病例进行回顾性分析。结果 988例患者因前列腺增生,膀胱肿瘤,膀胱内异物等行1002次经尿道前列腺等离子切除手术,其中8例发生膀胱内爆炸,4例无明显损伤,2例出现明显膀胱局部损伤,2例出现膀胱不规则破裂,1例为良性前列腺增生患者,腹膜完整,1例为膀胱肿瘤患者,腹膜破裂,均行开放手术修补膀胱,术后均恢复良好,痊愈出院。结论经尿道等离子切除术中膀胱内爆炸发生率低,发生突然,严重的可致膀胱破裂,需要及时发现并行膀胱破裂修补。主要原因是术中切除组织时产生的可燃性气体与外界进人膀胱空气混合,当膀胱中气体至一定比例,电火花可触发膀胱爆炸。减少外界气体进入膀胱、及时排出膀胱内气体、缩短手术时间,可预防膀胱内爆炸。

Objective To analyze the causes of intravesical explosion during transurethral plasma surgery,and to explore the treatment and preventive measures. Methods The data of patients undergoing transurethral plasma resection in our hospital were collected and the cases of intravesical explosion during operation were analyzed retrospectively. Results 1002 times of transurethral plasma resection of prostate were performed in 988 patients for benign prostatic hyperplasia,bladder tumor and intravesical foreign body.Among them,8 cases had intravesical explosion,4 cases had no obvious injury,2 cases had obvious local bladder injury,2 cases had irregular rupture of bladder,one case was benign prostatic hyperplasia,the peritoneum was intact,and the other case was bladder tumor,accompanied by peritoneal rupture.All patients underwent open operation to repair bladder,and all of them recovered well after operation,cured and discharged from hospital. Conclusion The incidence of intravesical explosion in transurethral plasma resection is low and sudden,and severe one can lead to bladder rupture.Therefore,it is necessary to find and repair bladder rupture in time.The main reason is that the combustible gas produced during the removal of tissue is mixed with the outside air in the bladder.When the gas in the bladder reaches a certain proportion,the electric spark can trigger the bladder explosion.And the explosion in the bladder can be prevented by reducing the external gas into the bladder,removing the gas in the bladder in time and shortening the operation time.