CAJ | 학술논문

目的观察翻转电切环侧切法联合超脉冲等离子柱状电极在膀胱肿瘤电切术中预防闭孔神经反射的可行性和临床疗效. 方法膀胱侧壁肿瘤患者211例,在腰麻或硬膜外麻醉下行经尿道肿瘤电切术,先采用电切环常规切除肿瘤,术中出现闭孔神经反射或进行至闭孔神经映射区时,改用超脉冲等离子柱状电极汽化切割剩余肿瘤组织,后再采用电切环翻转180度,以电切环侧边修平电极切除后的创面. 结果 211例患者采用翻转电切环侧切法切除膀胱侧壁肿瘤时,出现轻微闭孔神经反射192例,仅表现为大腿内收肌群收缩颤动,身体移位不明显,可顺利完成手术；术中未出现强烈闭孔神经反射者. 结论经尿道膀胱肿瘤电切术中,倒扣电切环侧切法和柱状电极切除法联合应用安全、简单、有效,不增加治疗费用,值得广泛推广.
목적 관찰번전전절배측절법연합초맥충등리자주상전겁재방광종류전절술중예방폐공신경반사적가행성화림상료효. 방법 방광측벽종류환자211례,재요마혹경막외마취하행경뇨도종류전절술,선채용전절배상규절제종류,술중출현폐공신경반사혹진행지폐공신경영사구시,개용초맥충등리자주상전겁기화절할잉여종류조직,후재채용전절배번전180도,이전절배측변수평전겁절제후적창면. 결과 211례환자채용번전전절배측절법절제방광측벽종류시,출현경미폐공신경반사192례,부표현위대퇴내수기군수축전동,신체이위불명현,가순리완성수술；술중미출현강렬폐공신경반사자. 결론 경뇨도방광종류전절술중,도구전절배측절법화주상전겁절제법연합응용안전、간단、유효,불증가치료비용,치득엄범추엄.
Objective To observe the results and reality of transurethral resection of bladder tumor(TUR-Bt) with upside down loop and plsamakinetic in the prevention of obturator nerve reflex.Methods A total of 211 patients with lumbar anesthesia received TUR-Bt.Firstly,the tumor tower above bladder wall was cut with the traditional way.When intraoperative findings were obturator nerve reflex,or to the obturator nerve mapping area,operation should be changed to superimpulse plasma column electrode vaporization to cut off residual tumor tissue,then after flipping the loop,the residual tumour was resected with upside-down loop from the tumour side wall.Results In 211 cases,192 cases had a little obturator nerve reflex,but the movement of body was not obvious,which did not influence the operation.The serious complication,such as perforation of bladder and injury of nerve and vessel,did not occur.Conclusions The lateral resection of bladder side wall tumour with upside-down loop can effectively avoid strong obturator nerve reflex,which is safe,uncomplicated,and efficacious and it does not increase the additional outlay and hurt.