摘要
目的:探讨极度曲髋外展位联合马镫形多功能腿架的体位在行经尿道膀胱肿瘤电切术(transure-thral resection of bladder tumor,TURBT)中预防闭孔神经反射的有效性和安全性.方法:选取重庆医科大学附属永川医院2019年12月-2023年6月符合标准的膀胱肿瘤患者112例.对照组取膀胱截石位,试验组采用"极度曲髋外展位"联合马镫形多功能腿架体位.比较术中大腿抽搐的幅度、手术时间、膀胱穿孔、出血量、肌层获取以及术后下肢肌力及感觉情况等.结果:试验组在手术时间、出血量、大腿抽搐幅度、二次TURBT、肌层的获取方面明显优于对照组(P=0.018、P=0.013、P＜0.001、P=0.041、P＜0.001);试验组大腿抽搐幅度极低,分布于大腿抽搐分级1、2级,无3、4级严重反应情况.对照组有4例膀胱穿孔;2组患者均无大血管损伤.术后2组患者下肢肌力均正常,无感觉异常,差异无统计学意义.结论:极度曲髋外展位联合马镫形多功能腿架的体位方式行TURBT能有效预防闭孔神经反射,降低并发症,提高手术疗效.该方式对于没有激光设备的广大基层医疗单位具有重要应用价值.
Abstract
Objective:To explore the effectiveness and safety of the extreme flexion and abduction hip com-bined with a stirrup-shaped multifunctional leg frame position in preventing obturator nerve reflex during transure-thral resection of bladder tumor(TURBT).Methods:A total of 112 patients with bladder tumors treated between December 2019 and June 2023 were included in the study.The control group was placed in a lithotomy position,while the experimental group was placed in an extreme flexion and abduction hip combined with a stirrup-shaped multifunctional leg frame position.The grade of leg jerking during surgery,operation time,bladder perforation,bleeding volume,and postoperative lower limb muscle strength and sensation were compared between groups.Re-sults:The operation time,bleeding volume,the grade of leg jerking,second TURBT,and acquisition of detrusor muscle were significantly better in the experimental group compared to the control group(P=0.018,P=0.013,P＜0.001,P=0.041,and P＜0.001,respectively).The grade of leg jerking in the experimental group was ex-tremely low(distributed in grade 1 and 2),and there were no severe reactions in grade 3 or 4.There were 4 cases of bladder perforations in the control group,while no major vascular injuries were observed.After surgery,both groups had normal lower limb muscle strength without sensory abnormalities,and there were no significant differ-ences between the two groups.Conclusion:TURBT with the extreme flexion and abduction hip combined with a stirrup-shaped multifunctional leg frame position can effectively prevent obturator nerve reflex,reduce complica-tions,and improve surgical efficacy.This method has important application value for basic medical units without laser equipment.
基金项目
重庆市卫生健康委医学科研项目(2024WSJK112)
重庆市永川区自然科学基金(Ycstc)
重庆市永川区自然科学基金(2020nb0231)
重庆医科大学附属永川医院院内科研课题(YJLC202125)
NETL
NSTL
万方数据