| Objective:To explore the influencing factors of perioperative indicators of laparoscopic radical prostatectomy(LRP)Methods:From December 10,2015 to February 18,2019,urology department of the First Affiliated Hospital of Suzhou University was collected.The data of LRP cases with the same experienced person(>200 cases)as the main knife were analyzed.Age,body mass index(BMI),diabetes mellitus,history of abdominal surgery,preoperative prostate specific antigen(PSA),prostate volume and perforation were analyzed.The number of needles(12 needles for systemic puncture,12 needles for Targeted Fusion puncture on MRI),pathological stage(<T3a,≥T3a),positive margin of incision,Gleason score of pathology after operation were 5 groups(6 points,3+4 points,4+3 points,8 points,9 points and 10 points),pelvic lymphadenectomy(including bilateral obturator,internal iliac and external iliac lymph nodes),new adjuvant therapy,or not.The history of prostate resection,the influence on operation time,intraoperative bleeding volume and hospital stay after operation.The influence of BMI,preoperative PSA,pathological stage(T2,T3,T4),pathological Gleason score and new adjuvant therapy on the positivity of pathological margin after operation was also discussed.Multivariate linear regression analysis was used to analyze the influencing factors of operation time,intraoperative bleeding volume and post-operative hospitalization time.The relationship between BMI,prostate volume and operation time was analyzed by linear correlation.The relationship between the history of prostate resection and operation time was analyzed by Spearman correlation coefficient.There are two steps in the analysis of influencing factors of positive margin of incision.First,the independent variables are screened by single factor chi-square test,and then the independent variables which are statistically significant or close to statistical significance by single factor analysis are analyzed by multi-factor logistic regression.Results:A total of 116 LRP patients were enrolled in this study.Multivariate linear regression analysis showed that BMI,prostate volume,pelvic lymphadenectomy and history of prostate resection were the influencing factors of LRP operation time(P<0.05);linear correlation analysis showed that BMI was positively correlated with operation time(r=0.294,P=0.002);prostate volume was positively correlated with operation time(r=0.247,P=0.002).Spearman correlation coefficient analysis showed that the history of prostate resection was positively correlated with the operation time(r=0.334,P=0.001).Age,BMI,diabetes mellitus,history of abdominal surgery,preoperative PSA,prostate volume,puncture method and needle count,pathological stage,positive margin of incision,postoperative pathological Gleason score,pelvic lymphadenectomy,history of prostate resection,whether using new adjuvant therapy to treat bleeding in LRP and hospital stay were not clear.Significant effect(P>0.05).Multivariate logistic regression analysis showed that pathological stage was an important factor affecting the positive margin of resection(P=0.001,OR=13.637),and whether or not to accept neoadjuvant therapy was also an important factor affecting the positive margin of resection in patients with pathological stage T3(P=0.022,OR=0.150).Conclusion:BMI,prostate volume,pelvic lymphadenectomy,and the history of prostate resection affect the operation time of LRP,and the higher the BMI value and prostate volume,the longer the operation time;the operation time of pelvic lymphadenectomy was prolonged;the longer the operation time of LRP in patients with a history of prostate resection;the perioperative influencing factors of bleeding volume and hospitalization time after operation are not clear;the pathological stage is post-operative resection.The higher the pathological stage,the higher the positive rate of incision margin.Neoadjuvant therapy for patients with pathological stage T3 can effectively reduce the incidence of positive incision margin. |
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