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目的:比较腰硬联合麻醉和腰硬联合麻醉加超声引导下闭孔神经阻滞在膀胱侧壁及三角区附近肿瘤经尿道膀胱肿瘤等离子电切术(TUPKR-Bt)中的临床效果。方法:回顾性研究2012年1月1日~2015年10月31日在我院泌尿外科行经尿道膀胱肿瘤电切术的98例膀胱侧壁肿瘤患者。其中48例患者单独行腰硬联合麻醉(CSEA组),50例患者行腰硬联合麻醉加超声引导下闭孔神经阻滞(CSEA+O组)。结果:CSEA+O组的肿瘤切除时间(15.38±7.09)min显著短于CSEA组的(19.45±5.70)min,闭孔神经反射发生率及膀胱穿孔率显著少于CSEA组(2%vs.39.6%;0vs.10.4%),血红蛋白下降水平(0.5±0.37)g/dL显著小于CSEA组(0.8±0.43)g/dL,膀胱刺激征发生率显著少于CSEA组(24%vs.64.6%),留置尿管时间和住院时间显著短于CSEA组,随访期间肿瘤复发率低于CSEA组(8%vs.22.9%);输血率和术后1年肿瘤复发率两组差异无统计学意义。结论:超声引导下闭孔神经阻滞应用于TUPKR-Bt患者中,可以有效减少闭孔神经反射的发生,使切除更彻底和安全,减少术中出血,缩短住院时间,减少肿瘤复发。
OBJECTIVE: To compare the clinical effects of obstructed orbital nerve block (TUPKR-Bt) guided by combined spinal-epidural anesthesia and spinal-epidural anesthesia with ultrasound in the treatment of tumors in the bladder and near the trigone. Methods: A retrospective study of 98 cases of bladder tumor with transurethral cystadenocarcinoma in Urology from January 1, 2012 to October 31, 2015 in our hospital was retrospectively studied. Forty-eight patients underwent CSEA and CSEA alone. Fifty patients underwent combined spinal-epidural anesthesia plus ultrasound-guided obturator nerve block (CSEA + O) group. Results: The tumor resection time (15.38 ± 7.09) min in CSEA + O group was significantly shorter than that in CSEA group (19.45 ± 5.70) min, and the incidence of obturator nerve reflex and bladder perforation rate was significantly lower than that in CSEA group (2% vs.39.6 (0.5% ± 0.37) g / dL was significantly lower than that of CSEA group (0.8 ± 0.43) g / dL, and the incidence of bladder irritation was significantly lower than that of CSEA group (24% vs.64.6%) , Catheterization time and hospital stay were significantly shorter than CSEA group. The recurrence rate of tumor during follow-up was lower than that of CSEA group (8% vs.22.9%). There was no significant difference between the two groups in blood transfusion rate and 1-year postoperative tumor recurrence rate. CONCLUSIONS: Ultrasound-guided obturator nerve block is effective in reducing the incidence of obturator nerve reflex in patients with TUPKR-Bt, making the resection more complete and safe, reducing the intraoperative bleeding, shortening the hospital stay and reducing the recurrence of tumors.