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目的:探讨经尿道针状电极膀胱肿瘤电切术避免闭孔神经反射的可行性。方法:12例膀胱肿瘤患者,肿瘤均位于膀胱侧壁,直径1~4cm。采用硬膜外麻醉,以等离子针状电极距肿瘤基底周边1cm电凝膀胱壁黏膜层后,将针尖插入肌层,向远离膀胱壁方向牵拉、切断,直至显露半透明的膀胱外层纤维结缔组织,在肌层与结缔组织之间剥离膀胱肿瘤,完整切除肿瘤基底所在膀胱壁全层送病理检查。观察手术时间、术中闭孔神经反射发生情况、术中及术后并发症、肿瘤病理分期。结果:共切除12枚肿瘤,单枚肿瘤切除时间3~30min,平均(12.7±10.4)min;所有病例均未加用闭孔神经阻滞,术中均无闭孔神经反射发生,术中出血极少,术后无继发出血。留置尿管3~7d。切除肿瘤均获得完整病理分期:T1期6枚,T2a期4枚,T2b期2枚。随访3~6个月未见肿瘤复发。结论:经尿道针状电极膀胱肿瘤电切术具有切割精准、出血少、可获取完整标本的优点。在切除膀胱侧壁肿瘤时能避免闭孔神经反射,为膀胱侧壁肿瘤的切除提供了一种安全有效的新方法。
Objective: To investigate the feasibility of transurethral resection of bladder tumor to avoid obturator nerve reflex. Methods: Twelve patients with bladder cancer, the tumors were located in the bladder wall, a diameter of 1 ~ 4cm. Using epidural anesthesia, the plasma needle electrodes coagulate the mucosa of the bladder wall 1 cm away from the periphery of the tumor base, insert the tip of the needle into the muscular layer, pull and cut away from the direction of the bladder wall until the translucent bladder outer fibrous connective Tissue, in the muscle and connective tissue between the stripping of bladder tumor, the complete excision of the tumor floor where the bladder wall to send full-thickness pathological examination. Observe the operation time, intraoperative closed obturator nerve reflex occurrence, intraoperative and postoperative complications, tumor pathological stage. Results: A total of 12 tumors were excised. The excision time of single tumor was 3 to 30 minutes (mean, 12.7 ± 10.4) min. No obturatorial nerve block was applied in all cases. No obturator nerve reflex occured during the operation. Intraoperative bleeding Very few, no secondary bleeding after surgery. Indwelling catheter 3 ~ 7d. Tumor resection were obtained complete pathological staging: T1, 6, T2a 4, T2b 2. Follow-up 3 to 6 months no tumor recurrence. Conclusions: Transurethral needle-electrode bladder tumor resection has the advantages of accurate cutting, less bleeding and complete specimen. It can obstruct obturator nerve reflex when excision of bladder tumor, which provides a safe and effective new method for excision of bladder tumor.