经尿道电切镜下电凝+含切法切除侧壁膀胱肿瘤的疗效分析

摘要

Objective To investigate the clinical effect of applying electrocoagulation plus tumor resection in the endoscopic sheath to avoid obturator nerve reflex during transurethral resection of bladder tumor (TURBT).Methods The clinical data were collected in 114 patients during TURBT from 2010 to 2016.The patients were divided into two groups: In group A, 56 patients were received conventional TURBT and other 58 patients were received special TURBT which was applied electrocoagulation plus tumor resection in the endoscopic sheath method in group B.The incidence rate of obturator nerve reflex, operation time period, catheter indwelling time, postoperative bladder irrigation time, length of stay hospitalization, the incidences of complications, and recurrence rate, incidence of bladder perforation.Results The incidence of obturator nerve reflex of Group A was 48 (including 34 severe obturator nerve reflex, 13 severe perforation, 14 cases changing general anesthesia, 5 cases of open operation).The incidence of obturator nerve reflex of Group B was 42 (including 11 severe obturator nerve reflex, 2 severe perforation, 1 case changing general anesthesia, 1 case of open operation).The difference of severe perforation rate between Group A and Group B was statistically significant (P<0.05).The difference of catheter indwelling time, time of bladder irrigation, and the length of stay between Group A and Group B was not statistically significant (P>0.05).Conclusions Applying electrocoagulation plus tumor resection in the endoscopic sheath during TURBT could effectively suppress the occurrence of incidence of bladder rupture perforation in the obturator nerve reflex.%目的 探讨经尿道电切镜下电凝+含切法切除侧壁膀胱肿瘤在应对闭孔神经反射的作用. 方法 对我院2010年3月至2016年6月收治的114例侧壁膀胱肿瘤行经尿道膀胱肿瘤电切术(transurethral resection of bladder tumor, TURBT)患者的资料进行回顾性分析,按照不同的手术方式将患者分成两组:A组应用常规的TURBT方法切除膀胱肿瘤(56例),B组采用电凝+含切的方法切除肿瘤(58例).对闭孔神经反射发生率、手术时间、留置导尿管时间、术后膀胱冲洗时间、住院时间、膀胱破裂穿孔发生率及术后半年复发等进行统计学分析. 结果 A组术中发生闭孔神经反射48例(严重闭孔神经反射发生34例),其中13例出现膀胱穿孔,中转全麻14例,中转开放手术5例;B组术中发生闭孔神经反射42例(严重闭孔神经反射发生11例),其中2例出现膀胱穿孔,中转全麻1例,中转开放手术1例.A、B组间在严重闭孔神经反射发生例数、膀胱穿孔例数、中转全麻例数、中转开放手术例数方面比较,差异均有统计学意义(P<0.05);A、B组在术后膀胱冲洗时间、留置导尿管时间、住院时间、术后半年肿瘤复发等方面差异均无统计学意义(P>0.05). 结论 经尿道电切镜下电凝+含切法切除侧壁膀胱肿瘤可以有效减少严重闭孔神经反射导致的膀胱破裂发生率.