肿瘤基底部麻醉在膀胱肿瘤电切术中的应用(1滨州医学院\山东省东营市人民医院泌尿外科山东烟台264003)(2山东省东营市人民医院泌尿外科山东东营257091)【摘要】目的：研究肿瘤基底部麻醉联合硬膜外阻滞麻醉，在预防经尿道膀胱肿瘤电切术(TURBt)中闭孔神经反射中发生的作用。方法：对我院2007年至2012年收治的104例行TURBt术的患者进行回顾性分析，按照不同的麻醉方式将患者分成3组：A组应用硬膜外阻滞麻醉(42例)，B组应用肿瘤基底部局部麻醉联合硬膜外阻滞麻醉(34例)，C组为应用闭孔神经阻滞联合硬膜外阻滞麻醉(29例)。对闭孔神经反射发生率、手术时间、术中出血量、留置导尿管时间、术后膀胱冲洗时间、住院时间、并发症发生率等进行统计学分析。结果:A组术中发生闭孔神经反射19例，其中1例出现轻微膀胱穿孔；B、C组术中发生闭孔神经反射各2例。A、B组间及A、C组间差异均有统计学意义(P≤0.05),B、C组间差异无统计学意义(P≥0.05);A、B、C各组在术后膀胱冲洗时间、留置导尿管时间、住院天数、术后半年肿瘤复发率等方面差异均无统计学意义(P≥0.05)o结论：TURBt术中联合肿瘤基底部浸润麻醉能够有效地抑制闭孔祌经反射的发生，同时未增加其它风险的发生率，相较于闭孔祌经阻滞麻醉，是一种更加安全的手术方式，值得临床上进行推广。【关键词】膀胱肿瘤；经尿道电切术；闭孔神经反射；局部浸润麻醉【中图分类号】R730.5【文献标识码】A【文章编号】2095-1752(2015)36-0090-02ThestudyofroleoflocalinfiltrationanesthesiaintransurethralresectionofbladdertumorWentaoDengl,JiruLu2,ZhiYuan2,WeiJiang2,ShaotingWang2,RuqiangZhengl*.(lBinzhoumedicaluniversity,Yantai,ShandongProvince,264003)(2People’sHospitalofDongying,UrologyDepartment,Dongying,ShandongProvince,257091)【Abstract】ObjectiveToexploretheeffectoflocalinfiltrationanesthesiainthebasesofthetumorsduringtransurethralresectionofbladdertumor(TURBt)inpreventingobturatornervereflex.MethodsTheclinicaldatawerecollectedin104patientsduringTURBtfrom2007to2012.Thepatientsweredividedintothreegroups:Agroupusedepiduralanesthesiain42cases,Bgroupusedlocalinfiltrationanesthesiainthebasesofthetumorsandepiduralanesthesiain34cases,Cgroupusedobturatorneverblockandepiduralanesthesiain34cases.Thenstatisticalanalysiswasoperatedtoevaluatetheincidencerateofobturatornervereflex,operationtime,timeofurineretention,timeofbladderirrigation,lengthofstay,andtheincidencesofcomplications.ResultTheincidenceofobturatornervereflexofAgroupwas19,including1slightperforation;theincidenceofobturatornervereflexofBandCgroupwasboth1.ThedifferencebetweenAandBgroup,AandCgroupwerebothstatisticallysignificant,meanwhiletherewasnostatisticallysignificancebetweenBandCgroup.Thedifferenceoftimeofurineretention,timeofbladderirrigation,andthelengthofstaybetweenA,BandCgroupwerenotstatisticallysignificant.ConclusionLocalinfiltrationanesthesiacouldeffectivelysuppresstheoccurrenceoftheobturatornervereflexinTURBt,andmeanwhiledidnotincreasetheincidenceofotherrisks.Comparedtoobturatorneverblock,localinfiltrationanesthesiaisasafersurgicalapproach,anditisworthtobepromotedinclinicalpractice.【Keywords]Bladdertumor;TURBt;Obturatornervereflex;Localinfiltrationanesthesia膀胱肿瘤是泌尿外科最常见的恶性肿瘤。经尿道膀胱肿瘤电切术(transurethralresectionofbladdertumor,TURBt)是治疗非肌层浸润性膀胱癌的首选方案。在电切侧壁膀胱肿瘤的手术过程中，因膀胱侧壁靠近闭孔祌经走行区,电流易刺激闭孔神经，引起闭孔神经反射，出现大腿内收肌群的强烈收缩，使髋关节突发强烈的屈曲内收，导致膀胱穿孔，甚至血管损伤、结肠穿孔等一系列严重并发症，不但增加了患者的痛苦，也严重影响了治疗效果。因此，术中如何冇效地预防闭孔神经反射的发...