经尿道膀胱肿瘤电切术中膀胱内爆炸2例分析(1)
doi：10.3969/j.issn.1007-614x.2014.15.35
摘 要 目的：探讨经尿道膀胱肿瘤电切术中膀胱爆炸的原因及预防措施。方法：对2例术中发生膀胱爆炸患者资料进行回顾性分析。结果：2例均是在连续电切并使用Ellick冲洗球冲洗膀胱后，再次电切或电凝时发生膀胱内爆炸。1例发生膀胱不规则破裂，急诊行膀胱全切双侧输尿管皮肤造口术；1例黏膜破裂，肌层完好，电切镜下止血。2例患者术后恢复良好，痊愈出院。结论：膀胱爆炸发生突然，多发生在肿瘤较多且位于膀胱前壁及顶壁的患者，主要原因是在冲洗膀胱时进入了一定量的空气，在与膀胱内可燃气体充分混合达一定比例后，因电火花引发爆炸，易导致膀胱破裂。应以预防为主，及时排空膀胱内气体，操作时电切环周围尽量减少气体存留，可预防膀胱爆炸的发生。
关键词 经尿道膀胱肿瘤电切 爆炸 膀胱破裂
Analysis of 2 cases of intravesical explosion in the process of transurethral resection of bladder tumor
Zhao Xiaolei，Du Xinyi，Xu Wenchao，Hou Junqing，Xu Weibo，Chang Junkai
Department of Urology，the Huaihe Hospital of Henan University(Kaifeng City，Henan)，475000
Abstract Objective：To investigate the causes and preventive measures of bladder explosion during transurethral resection of bladder tumor.Methods：Retrospective analysis of 2 patients with bladder explosion happened in the process of operation.Results：2 patients with intravesical explosion were happened in retransurethral resection or electric coagulation after continuous cutting and the use of Ellick bulb syringe irrigation of bladder.1 cases with bladder irregular rupture was given cystectomy bilateral cutaneous ureterostomy in emergency；1 cases with mucosa rupture and muscle layer intact was given hemostasis under electricity cut mirror.2 patients recovered well after operation，and they were discharged from hospital.Conclusion：Bladder exploded happened suddenly，and often occur in the patients with many tumors and it located in the anterior wall or the top wall of the bladder.The main reason was entered amount of air when washing bladder，when it mixed with combustible gas of bladder，then triggered the explosion if meet electric spark，it will leading to rupture of bladder easily.If we can taking preventive measures，emptying bladder gas timely，minimizing the surrounding gas retention when operating the diathermy loop，we will prevent the occurrence of bladder explosion.
Key words Transurethral resection of bladder tumor；Explosion；
Rupture of bladder
经尿道膀胱肿瘤电切术是治疗低级别膀胱尿路上皮癌的金标准。我院从2000年开展膀胱肿瘤电切手术以来，有2例在术中发生气体爆炸，现报告如下。
病例资料
例1：患者，男，65岁。因“全程无痛肉眼血尿2个月”为主诉入院。2个月前患者无明显诱因出现全程无痛肉眼血尿，偶有小血块，无尿频、尿急、尿痛，无腰酸、腰痛等。B超示：膀胱内多发肿物。膀胱镜检查示：膀胱右侧壁有多个菜花状肿物，大小约2cm×3cm，有蒂约0.8cm，膀胱前壁有多个菜花状肿物，最大约2cm×2cm；病理示：低级别尿路上皮癌。入院诊断膀胱肿瘤。在硬膜外麻醉下行经尿道膀胱肿瘤汽化电切术，冲洗液为4%甘露醇，电切功率120W，电凝功率60W，手术先切除膀胱右侧壁多个肿物，Ellick冲洗器反复冲洗出肿瘤组织，后切除膀胱前壁肿物时，听到沉闷爆炸声，患者自觉腹痛，心率变快，由75次/分升至110次/分。膀胱不能充盈，膀胱内视野鲜红，穿刺腹腔有淡红色液体抽出，迅速中转开放手术，见膀胱前壁及右侧壁有多处不规则破口，最长的破口长约4cm。破口边缘不整齐、形态不规则，前壁破口与腹腔相通，腹腔内有约400ml淡红色液体，探查腹腔脏器，未见明显损伤。因术前未做肠道准备，遂急诊行膀胱全切双侧输尿管皮肤造口术，手术顺利，术后痊愈出院，术后复查5年无局部复发。(赵小磊 杜信毅 徐文超 侯俊清 徐卫波 常俊锴)
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