论文部分内容阅读
目的探讨PKRBt术中避免闭孔神经反射的理想办法。方法对78例T2b期以内的膀胱侧壁肿瘤患者行PKRBt治疗,并分两组,第一组40例,采用电刺激方法经腹股沟穿刺诱导闭孔神经反射后注射1%的利多卡因15～20ml阻断闭孔神经;第二组38例,首先切除蒂部以外瘤体,将肿瘤蒂部完全暴露,再将1%的利多卡因10～15ml,利用自制的膀胱穿刺注射针注射于蒂部及其周围。并对两组病例PKRBt术中闭孔神经反射发生率进行比较。结果第一组有7例发生不同程度的闭孔神经反射,发生率为17.5%,其中一例膀胱穿孔,改开放手术,其余6例有不同程度的膀胱壁损伤,更换杆状电极完成手术;第二组仅1例发生轻微闭孔神经反射,发生率为2.6%,膀胱壁无损伤,采用增加封闭深度再次封闭后顺利完成手术。结论等离子双极电切为第三代电切技术,采用自身回路电极,切割温度较低(40℃～90℃),因此较第一、二代电切术中闭孔神经反射发生率低;在PKRBt术中,采用自制的膀胱穿刺注射针(利用F5输尿管插管与7#针头紧密连接,针头外露5mm),直视下将1%的利多卡因10～15ml注射于肿瘤基底部及其周围,封闭深度0.5cm,是避免PKRBt术中闭孔神经反射发生的理想办法。
Objective To explore the ideal method of avoiding obturator nerve reflex in PKRBt. Methods PKRBt was used in 78 patients with bladder wall tumors of T2b stage and divided into two groups. The first group consisted of 40 patients. The animals were injected with 1% lidocaine 15 ~ 20ml blocking the obturator nerve; the second group of 38 patients, first remove the pedicle outside the tumor, the tumor pedicle completely exposed, and then 1% lidocaine 10 ~ 15ml, using homemade bladder puncture injection needle Department and its surroundings. The incidence of obturator nerve reflex in PKRBt was compared between the two groups. Results In the first group, there were 7 cases of obturator nerve reflex in varying degrees, the incidence rate was 17.5%. One case of bladder perforation changed to open surgery and the other 6 cases had different degree of bladder wall injury. In the two groups, only 1 case had a slight obturator nerve reflex, the incidence rate was 2.6%, and the bladder wall was not damaged. The operation was completed successfully by increasing the occlusion depth and closing again. Conclusions Plasma bipolar electrosurgical excision is the third generation of electrosurgical technique. It adopts self-loop electrode with lower cutting temperature (40 ℃ ~ 90 ℃), so it has a lower incidence of obturator nerve reflex than the first and second generation electrotomy. In PKRBt, a homemade bladder puncture needle (close to the 7 # needle using a F5 ureter intubation needle with 5 mm needle exposure) was used to inject 1 to 10 ml lidocaine 1% into the tumor base under direct vision and its Surrounding, the depth of occlusion 0.5cm, PKRBt surgery is to avoid the occurrence of obturator nerve the ideal way.