三针法闭孔神经阻滞麻醉在膀胱肿瘤电切术中预防闭孔神经反射的应用

Three-point method of obturator nerve block anesthesia in prevention of obturator nerve reflex in transurethral resection of bladder tumor

目的探讨经膀胱穿刺三点针刺阻滞麻醉法在膀胱肿瘤电切术中预防闭孔神经反射的疗效。方法 2011年2月至2019年3月共收治膀胱侧壁肿瘤患者115例,采用腰硬联合麻醉,均行经尿道膀胱肿瘤电切术,采用点切法,发生闭孔神经反射84例(73.0%),将其随机分成A、B两组。A组(42例)在肿瘤外上方一针法行闭孔神经阻滞,B组(42例)在肿瘤外上方三针法行闭孔神经阻滞。结果 A组有15例发生闭孔神经反射,占35.7%;B组有4例发生闭孔神经反射,占9.5%,差异有统计学意义( P <0.05)。两组均无膀胱穿孔及大出血。结论电切位于膀胱侧壁的肿瘤时易发生闭孔神经反射,点切法能有效防止膀胱穿孔,三针法经膀胱闭孔神经阻滞明显优于单针法。

Objective To investigate the efficacy of transvesical three-point acupuncture block anesthesia for the prevention of obturator nerve reflex in bladder tumor resection. Methods From February 2011 to March 2019, 115 patients with lateral wall bladder tumors were treated with combined spinal-epidural anesthesia. Transurethral resection of bladder tumor was performed by point- cutting. Eighty-four cases (73.0%) of obturator nerve reflexes were randomly divided into groups A and B. Group A (42 cases) underwent obturator nerve block on the upper one point of the tumor, and group B (42 cases) underwent obturator nerve block on the upper three points of the tumor. Results In group A, there were 15 cases of obturator nerve reflex, accounting for 35.7%. In group B, there were 4 cases of obturator nerve reflex, accounting for 9.5%. The difference was statistically significant ( P <0.05). There were no bladder perforation or major bleeding in either group. Conclusions Obturator nerve reflex is prone to occur when resecting tumors located on the lateral wall of the bladder. The point-cutting method can effectively prevent the perforation of the bladder. The three-point method is superior to the single-point method.