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目的:探讨经尿道膀胱肿瘤电切术(TURBT)中耻骨上经膀胱闭孔神经阻滞的安全性与有效性。方法:从2011年7月始,我院收治的有TURBT指征的膀胱侧壁肿瘤患者21例,术中在硬膜外麻醉下行耻骨上经膀胱闭孔神经阻滞预防闭孔神经反射,与往期在硬膜外麻醉下行经会阴闭孔神经阻滞的21例患者,进行闭孔反射发生率、膀胱穿孔发生率、手术时间、出血量方面的比较,术后随访观察肿瘤复发情况。结果:两组手术时间、出血量及术后1年复发率的差异均无统计学意义(P>0.05),但硬膜外麻醉联合耻骨上经膀胱闭孔神经阻滞组的闭孔反射发生率及膀胱穿孔率明显降低(P<0.05)。结论:耻骨上经膀胱闭孔神经阻滞能有效预防闭孔神经反射,可降低TURBT膀胱穿孔率。
Objective: To investigate the safety and efficacy of suprapubic transobdominal obturator nerve block in transurethral resection of bladder tumor (TURBT). Methods: From July 2011, 21 patients with TURBT indications of bladder tumor in our hospital were treated by epidural anesthesia for the prevention of obturator nerve reflex by supra-suprapubic obstruction. In the past, 21 patients underwent perineal obturator nerve block under epidural anesthesia were compared the incidence of obturator reflex, incidence of bladder perforation, operation time and blood loss, and the recurrence was observed after operation. Results: There was no significant difference in the operation time, the amount of bleeding and the recurrence rate at 1 year after operation between the two groups (P> 0.05). However, closed-cell reflex occurred in the epidural anesthesia combined with supra-suprapubic closed-vessel block Rate and bladder perforation rate was significantly lower (P <0.05). Conclusion: The suprapubic bladder obstruction can effectively prevent obturator nerve reflex and reduce the bladder perforation rate of TURBT.