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目的探讨经尿道膀胱肿瘤汽化切除术(TVB t)中膀胱穿孔的原因及预防措施。方法总结分析158例经尿道膀胱肿瘤汽化切除术中11例膀胱穿孔病历。结果11例中,7例因闭孔神经反射发生腹膜外穿孔,其中6例未行闭孔神经阻滞;4例腹膜内穿孔,其中3例在处理膀胱顶部及前壁肿瘤时,汽化过深而出现,1例切除膀胱前壁肿瘤时,气泡爆炸引起。结论穿孔是TVB t手术的严重并发症,患侧闭孔神经阻滞,术中保持低压冲洗或保持回流水通畅,均能有效地避免或减少穿孔的发生;术中应及时排出汽化中产生的气体,或改变体位避开气泡,预防气泡爆炸的发生。
Objective To investigate the causes and preventive measures of bladder perforation in transurethral resection of bladder tumor (TVB t). Methods A total of 158 bladder transurethral resection cases of bladder transurethral bladder cancer were reviewed. Results Of the 11 cases, 7 cases had extraperitoneal perforation due to obturator nerve reflex. Of them, 6 cases did not obstruct obturator nerve block and 4 cases had intraperitoneal perforation. Among them, 3 cases were deeply vaporized during the treatment of bladder top and anterior wall tumors And there, 1 case of anterior resection of the bladder tumor, bubble explosion caused. Conclusion perforation is a serious complication of TVB t surgery, ipsilateral obturator nerve block, intraoperative low pressure flush or maintain the smooth flow of reflux, can effectively prevent or reduce the occurrence of perforation; intraoperative vapors should be promptly discharged Gas, or change position to avoid bubbles, to prevent the occurrence of bubble explosion.