| Background and purpose: Bladder tumor is the most commonly in the urinary system. Most of them are the superficial bladder tumors with a low invasion and high cell differentiation. The first selecting way of treatmenting superficial bladder tumours is transurethral resection. In surgical procedures,however,the stimulation to obturator nevre caused by the electrical current will make the surgery more difficult. Worse still, it can endanger the patients'life. From a literature survey, many methods have been used to prevent the obturator nerve reflex of which the obturator nerve block is used usually. But the effectiveness of nerve block is not fine, because the obturator nerve supply usually is effected by the filling of bladder or the fat tissue surrounding of it, et al. In this paper, we intented to study the relationship between the nervous reflex and the style and circuit of electric current and look for a simple method, " electric coagulation ", which can be used in a common resecto- scope and reduce the incidence of obturator nerve reflex.It can make that there is another way to be used by the doctors,reduce the operative complication and degrade the operation risk.Methods:1.Animal experiment:1.1 120 frogs were divided into four groups(A,B,C,D) in random. The negative plate was lay under the leg but the nerve of contralat leg was stimulated by electricity in group A and B.Contrastly, the negative plate was lay under the homolat leg in group C and D.The sciatic nerves of frog were stimulated by the way of electric cutting in group A and C and electric coagulation in group B and D respectivly. The maximum contraction tension of muscle was compared between the group of electric cutting and electric coagulation.1.2 Four dogs were choosed and then the electric coagulation of hypercator be used to stimulate the wall of urinary bladder .Through biopsing the wall of urinary bladder,we try to understand the degeneration depth of the wall of urinary bladder caused by different intensity(60W,70W,80W,90W) and action time(1S,3S,7S).2. Clinical operative application:From 2000 to 2006, the patients with bladder lateral wall tumour had been underwent transurethral resection of bladder tumor in the department of urology of the first people's hospital of Chenzhou. They were divided into two groups(G,H) in random.The bladder lateral tumors were resected by the way of electric cutting in group G. The lateral bladder tumor were resected by the way of electric coagulation directly in group H. Whether the obturator nerve reflex would happen or not was observed during the operation.Results:1. Animal experiment(never reflex):The t-test was carried out to compare the maximum contraction tension of muscles caused by the way of electric cutting between group A and C. The t value was 2.06, P=0.04.There was significant difference in two groups(P<0.05).The t-test was carried out to compare the maximum contraction tension of muscles caused by the way of electric coagulation between group B and D. The t value was 3.75, P=0.00.There was significant difference of two groups(P<0.05).The t-test was carried out to analyze the maximum contraction tension of muscles between the way of electric cutting and the electric coagulation when the negative plate was lay under the contralat legs. The t value was 6.00, P=0.00.There was significant difference of them(P<0.05).The t-test was carried out to analyze the maximum contraction tension of muscle between the electric cutting and the electric coagulation when the negative plate was under the homolat legs. The t value was 4.35, P=0.00.There was significant difference of them(P<0.05).2. Animal experiment(cauterization depth): The F test was carried out to analyze the data.The result showed that electric stimulation with different power and action time caused different cauterization depth of the wall of urinary bladder. The F value respec- tively was 82.016 and 9.199, P<0.05.To analyze difference of the cauterization depth between different power and action time by S-N-K test. In addition to the group of 3th second and 7th second, there was statistics significance of each group.3. Clinical operation applicationThe Chi-square test was applied to compare the obturator nerve reflex incidence between group G and H. The x2 value was 5.599, P=0.018.There was statistics significant difference of two groups(P<0.05).Conclusions:1. The way of electric coagulation can reduce or avoid the incidence of obturator nerve reflex during the transurethral resection of bladder tumour.2. Electric stimulation can cause nerve reflex when the negative plate is lay under the homolat leg more than the negative plate the is under the contralat leg.3. Electric cutting can cause the nerve reflex more easily than electric coagulation do. |
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