摘要
目的探讨经尿道个性化等离子切除膀胱侧壁浅表肿瘤的有效性、安全性及对闭孔神经的影响。方法选择2012年11月~2015年5月本院收治的130例侧壁浅表膀胱肿瘤患者,应用双极等离子电切系统进行电极个性化、切除个体化,切、凝、推、拨相结合,综合利用离子能与机械能对肿瘤进行解剖性切除。设定电切功率100~120 W,电凝60~80 W,杆状电极设定电切功率60~80 W,电凝40~60 W。灌注液为生理盐水,电切深度达浅肌层,切除范围达肿瘤基底周围1~2 cm膀胱黏膜,术后表柔比星、丝裂霉素交替灌注膀胱腔化疗。结果手术时间10~40 min,平均（25±15）min;术中出血量5~30 m L,平均（15±5）m L;24 h内继发出血2例,1例为高血压（190/110 mm Hg）,术前控制不充分,1例为膀胱痉挛诱发,重返手术室止血,镜下见动脉活动性出血,均顺利止血;无输血病例;无TUR综合征;无反射性穿孔发生,因切除过深,冲洗组织块时膀胱穿孔1例;无闭孔神经反射发生;术后失访13例,117例随访6~36个月均未见原手术部位肿瘤复发,1年后异位复发12例（10.3%）,2年异位复发16例（13.7%）,3年异位复发18例（15.4%）。结论经尿道等离子电极个性化、切除个体化;综合利用离子能与电能;切、凝、推、拨相结合解剖性切除膀胱侧壁浅表膀胱肿瘤,安全、有效、复发率低、能有效避免闭孔神经反射、避免穿孔等严重并发症、操作简单易于值得推广。
Objective To investigate the efficacy, safety and the incidence of obturator nerve reflex of personalized PKRBT for bladder tumor in sidewall. Methods From November 2012 to May 2015,a total of 130 patients of our hospital with superficial bladder tumor in sidewall were included in this study. Bipolar plasmakinetic resection system of was used to resect the tumor. For different patient personalized electrode was used for indi vidualized excision. Combined cutting, coagulation, push, pull and apply ion energy and mechanical energy to anatomical resection. The generator was programmed in 100~120 W in cutting and 60~80 W for coagulation. For rod electrodes,68~80 W in cutting and 40-60 W for coagulation. As fluid of irrigation, saline was used. Resection to superficial muscle,around the basement 1-2 cm of the bladder tumor. All patients underwent an early instillation within the 24 h after the TUR use MMC or Epirubicin. Results Operative time was 10-40 min, average time was（25±15） min; blood loss was 5~30 m L, an average of（15±5） m L; secondary bleeding within 24 hours happened in two cases, one patient with hypertension（190/110 mm Hg）, preoperative treatment is not sufficient; another was induced by bladder spasm. All of were successfully stopped bleeding by electrocoagulation; no one need blood transfusion; no TUR syndrome; no reflective perforation,only one case for cut too deep,when flushing the organization caused bladder perforation; no obturator nerve reflex occurs.Excepted for 13 cases,117 cases were followed up for 6 to 36 months, recurrence happened in 12 patients（10.3%） after 1 year,16 patients（13.7%） after 2 years,18 patients（15.4%） after 3 years, but none was in situ recurrence. Conclusion Personalized PKRBT is safe, effective and has low complications and recurrence rate, can effectively avoid the obturator nerve reflex. It is worth the clinical promotion.
出处
《中国现代医生》
2016年第5期50-53,共4页
China Modern Doctor
关键词
膀胱肿瘤
经尿道电切
等离子
闭孔神经反射
Bladder tumor
Transurethral resection
Plasmakinetic
Obturator nerve reflex
