超声引导下闭孔神经阻滞在经尿道膀胱肿瘤电切术中的应用

Application of ultrasound-guided obturator nerve block in transurethral resection of bladder tumors

目的探讨超声引导下闭孔神经阻滞(ONB)对降低经尿道膀胱肿瘤电切术(TURBt)中闭孔神经反射相关并发症发生率及术后肿瘤复发率的作用。方法回顾性选取我院2015年7月~2017年4月期间首次诊断为非浸润性膀胱肿癌(NMIBC)并初次行TURBt的单发膀胱侧壁患者96例,根据术前麻醉方式不同分为A,B,C 3组,其中A组实验组(n=32)为腰硬联合麻醉后在超声引导下ONB患者,B组对照组(n=32)为只行全身麻醉的患者,C组对照组(n=32)为只行腰硬联合麻醉的患者,术后均规律膀胱灌注吡柔比星治疗。比较3组患者行TURBt的手术时间、闭孔神经反射发生率、膀胱穿孔发生率、术中改为全身麻醉发生率,术后留置导尿管、膀胱冲洗和住院的时间,术后2年内膀胱肿瘤复发率。结果与C组相比,A组手术时间短、闭孔神经反射发生率低、膀胱穿孔发生率低、无术中改为全麻患者,术后留置导尿管时间短、术后持续膀胱冲洗时间短、术后住院时间短,术后2年半内膀胱肿瘤复发率明显降低(P<0.05)。A组与B组均有闭孔神经反射发生且都较轻微,未导致严重并发症发生。A组与B组在闭孔神经反射发生率、手术时间、膀胱穿孔发生率、术中改为全麻发生率、术后留置导尿管时间、术后持续膀胱冲洗时间、术后住院时间、术后2年内膀胱肿瘤复发率等方面差异均无显著性(P>0.05)。结论超声引导下ONB可有效降低TURBt术中闭孔神经反射的发生,缩短手术时间,明显减少手术相关并发症发生率及术后肿瘤的复发率,具有良好的临床效果。

Objective To investigate the role of ultrasound-guided obturator nerve block(ONB) in reducing the incidence of obturator nerve reflex-related complications and tumor recurrence rate in transurethral bladder tumor resection(TURBt).Methods Ninty-six patients who were diagnosed as lateral wall bladder tumor underwent TURBt between July 2015 and April 2017 were randomly accepted spinal anesthesia combined with obturator nerve block anesthesia(group A,n=32),general anesthesia(group B,n=32) or spinal anesthesia(group C,n=32).Regular intravesical infusion of pirarubicin was performed in all patients after operation.The surgical time,incidence of obturator nerve reflex,incidence of bladder perforation,incidence of intraoperative change to general anesthesia,the retention time of catheter,bladder irrigation time,length of stay and the recurrence rate of bladder tumor within 2 years after operation were all compared among these 3 groups.Results Compared with group C,transurethral time in group A operation was shortened,the operation was carried out smoothly.The incidence of obturator nerve reflex and bladder perforation were significantly lower(P<0.05).Compared with group C,patients in group A had shorter retention time of the catheter,shorter continuous bladder irrigation time,shorter length of stay in hospital,and lower recurrence rate of bladder tumor within 2 years after operation(P<0.05).And there was no significant difference in the above indicators between Group A and B(P>0.05).Conclusion Ultrasound-guided ONB can effectively reduce the occurrence of obturator nerve reflexes during TURBt surgery,shorten the operation time,significantly reduce the incidence of surgical-related complications and the recurrence rate of postoperative tumors,which has excellent clinical application effect.