目的：探讨二氧化碳气膀胱情况下实施经尿道膀胱肿瘤整块切除的可行性及疗效。方法：对2018年8月收治1例膀胱肿瘤患者实施气膀胱下经尿道膀胱肿瘤整块切除术。患者全麻下取截石位,二氧化碳气膀胱压力设定为1.463 kPa(11 mmHg)。充气情况下直视插入电切镜,首先行膀胱镜检查。按照精准经尿道膀胱肿瘤切除的方法,以单极针状电极距离肿瘤基底边缘0.5 cm的正常膀胱黏膜进行电灼,再将针尖插入膀胱壁内,将组织向远离膀胱壁的方向牵拉,电切切断组织。沿肿瘤基底进行锐性结合钝性分离,直至完整切除整个肿瘤。通过取瘤器完整取出肿瘤。留置尿管后以生理盐水持续膀胱冲洗。术后24 h内给予盐酸吡柔比星膀胱灌注。结果：患者肿瘤位于输尿管开口外上方膀胱左侧壁,在CO₂充盈膀胱情况下,以针状电极完整切除肿瘤。术中动脉血气分析CO₂分压正常,无闭孔神经反射,无明确出血。手术历时15 min,整块切除肿瘤后完整取出,肿瘤直径1.5 cm。病理报告为膀胱低级别尿路上皮癌,未侵犯肌层,切缘阴性。术后2 d拔除尿管,术后3个月行膀胱镜检查见膀胱内创面愈合良好,术后随访1年未见肿瘤复发。结论：CO₂气膀胱下应用针状电极可以实施膀胱肿瘤整块切除。该术式具有不需灌洗液、无尿外渗、无闭孔神经反射、无出血、无肿瘤播散、可整块切除肿瘤等优点,处理复杂膀胱肿瘤时具有优势。

Objective： To investigate the feasibility and efficacy of transurethral en bloc resection of bladder tumor in the condition of carbon dioxide pneumocystoscopy.Methods： The patient was placed in the lithotomy position under general anesthesia, and the bladder pressure of carbon dioxide was set as 11 mmHg. Cystoscopy was first performed. Accurate transurethral resection of bladder tumor was performed by using a monopolar needle electrode. The normal bladder mucosa was electrocauterized circularly 0.5 cm away from the edge of the tumor. Then the needle was inserted into the bladder wall to pull the tissue towards the midline, followed by cutting with an electrical cutting current. Sharp and blunt separations were performed along the base of the tumor until the entire tumor was completely removed. A tumor trapper was used to extract the tumor en bloc through the sheath of the resectoscope. The patient received continuous bladder irrigation with saline solution after catheter indwelling. Immediate intravesical chemotherapy was carried out by instillation of pirobicin hydrochloride within 24 h after surgery.Results： The tumor nested in the left side wall of the bladder near the ureteral orifice. En bloc resection of the tumor was achieved by the monopolar needle electrode with CO₂ insufflation. Intraoperative arterial blood gas analysis showed normal pressure of CO₂. No obturator nerve reflex or bleeding occurred. The operation time was 15 min and the tumor was extracted en bloc. The tumor was 1.5 cm in diameter and pathologic report showed low grade urothelial carcinoma of the bladder, with a negative margin. No invasion of the muscular layer was observed. The catheter was removed 2 days post-operation. Cystoscopy 3 months after operation showed a well healing of the tumor bed in the bladder, and no tumor recurrence was found during one-year follow-up period after the operation.Conclusions： En bloc tumor resection can be achieved with a needle electrode under CO₂pneumocystoscope. This novel technique has advantages including en bloc tumor resection and extraction, less flushing fluid used, and without consideration of urine extravasation, obturator nerve reflexion, bleeding, or tumor spreading during operation.