Analysis Of Risk Factors Associated With Laparoscopic Radical Prostatectomy And Postoperative Recovery In Elderly People

OBJECTIVE:To investigate the risk factors associated with laparoscopic radical prostatectomy(LRP)complications in elderly patients,and to provide reference for the prevention and treatment of laparoscopic radical prostatectomy complications in elderly patients.METHODS:A retrospective analysis of 99 patients with prostate cancer diagnosed by puncture and underwent laparoscopic radical prostatectomy in the First Affiliated Hospital of Soochow University from January 2016 to January 2018.To Find and record the patient's relevant clinical data in detail,including:age,body mass index(BMI),hypertension,diabetes,preoperative PSA,preoperative plasma albumin concentration,Gleason score,pathological stage,prostate volume,membranous urethral length(MUL),preoperative neoadjuvant hormonal therapy,intraoperative blood loss,postoperative wound urinary leakage,postoperative pathology positive margin and postoperative urinary incontinence(3 months,12months).The degree of recovery of postoperative urinary incontinence function was evaluated by the urine pad counting method.The clinical data of the patients were processed by statistical software.The measurement data were analyzed by t-test.The data of the two groups were compared by chi-square test.If statistically significant,multivariate logistic analysis was used to analyze the risk factors of surgical complications.RESULTS:A total of 99 patients were enrolled in this study,Surgical pneumoperitoneum pressure:15kp,surgical position;Trendenburg position.Aged 73.02±4.259 years,ranging from 65 to 84 years,including 32 persons aged 70 years(group A),67 persons aged 70 years(group B).BMI of 23.758±3.411 kg/M2,and the range was 15.52?41.54kg/m2.There were 48 patients with hypertension and 51 patients without hypertension.There were 15 patients with diabetes and 84 patients without diabetes.The prostate volume was 40.34±22.518ml,and the range was 9.01?117.00ml.The preoperative PSA concentration was 30.0765±28.0736ng/ml,and the range was 3.50?141.9ng/ml.The length of the urethra of the membrane before surgery was 12.941±2.728mm,and the range was 6.31?20.98mm.The preoperative albumin concentration was 41.575±3.557g/L,and the range was 34.5-48.9g/L.39 patients(39.39%)received neoadjuvant endocrine therapy before surgery,and 60 patients(60.61%)didn't.The statistical results showed:(1)There was no significant difference in age between the two groups.There was no statistically significant difference between the age and the complications of LRP surgery.(P>0.05)(2)neoadjuvant endocrine therapy and surgical bleeding before surgery was statistically significant.(P<0.05)(3)Prostate volume,pathological stage,Gleason score,and hypertension were associated with postoperative pathological margins.(P<0.05)(4)The pathological stage and membrane urethra length in elderly patients were correlated with the recovery of urinary incontinence in the three months.(P<0.05)(5)Preoperative albumin concentration in elderly patients and recovery of urinary incontinence in the twelve months were statistically significant.(P<0.05)(6)There was no statistically significant difference between the study factors in this case and the occurrence of postoperative wound leakage of urine in elderly patients.(P>0.05)Conclusions:1.Laparoscopic radical prostatectomy can be used as a comprehensive treatment in elderly patients after excluding contraindications.2.Elderly patients undergoing neoadjuvant endocrine therapy before surgery may increase the amount of surgical bleeding.3.The higher the pathological stage and Gleason score,the higher the incidence of postoperative pathological margin.Small volume prostate and hypertension were positively correlated with postoperative pathological margin.4.The longer the urethral length of the membrane in elderly patients,the lower the pathological staging level,and the better the recovery of urinary incontinence in the three months.5.Elderly patients with normal preoperative albumin concentration is helpful for the recovery of urinary incontinence in the twlve months after surgery.6.This study did not find a correlation with the urinary leakage of laparoscopic prostate cancer after radical surgery in elderly patients.