Application value of extreme flexion and abduction hip combined with stirrup-shaped multifunctional leg frame in blocking obturator nerve reflex during transurethral resection of bladder tumor
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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(transurethral 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 combined with a stirrup-shaped multifunctional leg frame position in preventing obturator nerve reflex during transurethral 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. Results 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 extremely 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 differences 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 complications, and improve surgical efficacy. This method has important application value for basic medical units without laser equipment.
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表 1 2组患者一般资料比较
例(%)，X±S 特征 对照组(56例) 试验组(56例) P值 年龄/岁 62.60±8.50 65.70±7.80 0.37 性别 0.45 男 45(80.4) 48(85.7) 女 11(19.6) 8(14.3) 侧别 0.34 右侧 27(48.2) 32(57.1) 左侧 29(51.8) 24(42.9) 肿瘤数量 0.33 单发 35(62.5) 30(53.6) 多发 21(37.5) 26(46.4) BMI/(kg/m2) 22.96±4.63 24.21±4.08 0.19 大小/cm 3.17±2.20 2.83±1.90 0.38 基底宽度/cm 2.00±1.50 1.80±1.40 0.26 
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表 2 2组患者术后治疗效果及并发症比较
例(%)，X±S 指标 对照组(56例) 试验组(56例) P值 手术时间/min 33.1±16.7 20.4±10.8 0.018 膀胱穿孔 4(7.1) 0(0) 0.127 出血量/mL 21.3±9.2 10.2±6.0 0.013 大血管损伤 0(0) 0(0) 大腿抽搐幅度 ＜0.001 Ⅰ 9(16.1) 25(44.6) Ⅱ 13(23.2) 31(55.4) Ⅲ 15(26.8) 0(0) Ⅳ 19(33.9) 0(0) 术后下肢感觉异常 0(0) 0(0) 术后下肢肌力异常 0(0) 0(0)
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表 3 2组患者术后病理结果比较
例(%) 项目 对照组(56例) 试验组(56例) P值 标本是否含肌层 ＜0.001 是 17(30.4) 43(76.8) 否 39(69.6) 13(23.2) 肿瘤分级 0.257 低级别 30(53.6) 24(42.9) 高级别 26(46.4) 32(57.1) 肿瘤分期 0.330 Ta 34(60.7) 30(53.6) T1 18(32.1) 17(30.4) T2及以上 4(7.2) 9(16.0) 二次TURBT 48(85.7) 39(69.6) 0.041 二次TURBT发现肿瘤 16(28.6) 8(14.3) 0.183 二次TURBT仅因为缺少肌层 19(33.9) 4(7.1) 0.005
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