Application Of Maximal Preservation Of Prostatic Peripheral Structure In Laparoscopic Radical Prostatectomy

Objective To evaluate the clinical efficacy of the maximal preservation of prostatic peripheral structure in laparoscopic radical prostatectomy.Methods Clinical data of 120 patients with radical prostatectomy performed by laparoscopy in**hospital from September 2019 to March 2021 were collected.61 patients who met the inclusion criteria and did not meet the exclusion criteria were selected and divided into two groups according to different surgical methods.Among them,31 patients in the experimental group underwent radical prostatectomy with maximum preservation of the surrounding prostate structure under laparoscopy,and 30 patients in the control group underwent standard radical prostatectomy with laparoscopy.The experimental group did not open the bilateral pelvic fascia,did not suture the dorsal venous complex,did not cut the prostatic pubic ligament.When separating the bladder neck mouth,seminal vesicle,dieldrin fascia and lateral pedicle,try to use cold knife and HEM-O-lock,if there is much bleeding when separating the neurovascular bundle,suture the bleeding point.The concept of veil was used in the dissociation of the anterior prostate tissue,and the prostate was completely "pulled out" from the detrusor muscle group and fascia structure on the pelvic floor after the urethra was severed.After anastomosing the bladder and urethra,the "nest" composed of the detrusor skirt and neurovascular bundle was sutured with the tissue around the bladder neck.Collected the data of age,preoperative Gleason score,preoperative PSA,intraoperative blood loss,postoperative hospital stay,postoperative complications,positive surgical margin rate,urinary continence recovery within one month after surgery,at three months after surgery,average time of urinary continence recovery after surgery,and the time of postoperative sexual function recovery of all patients.SPSS25.0 software was used to compare the statistical differences between the two groups.Results There were no significant differences in the age,preoperative PSA and Gleason score between the experimental group and the control group,and the results were not statistically significant.There was no significant difference between the experimental group and the control group in postoperative hospital stay,postoperative complications,positive surgical margin rate,and the results were not statistically significant.The median amount of intraoperative blood loss in the experimental group was 100.00ml.This in control group was 80.00 mL.The amount of intraoperative blood loss in the experimental group was higher than that in the control group,and the results were statistically significant.In the experimental group,15 patients recovered from urinary continence within 1 month after surgery,accounting for 48.4%of the total number of patients,and in the control group,2 cases recovered from urinary continence within 1 month after surgery,accounting for 6.7%of the total number of patients.The experimental group had a significant advantage in the recovery rate of urinary control 1 month after operation,and the results were statistically significant.In the experimental group,24 cases recovered from urinary continence within 3 month after surgery,accounting for 77.4%of the total number of patients,while in the control group,15 cases recovered from urinary continence within 3 month after surgery,accounting for 50%of the total number of patients.The experimental group had a significant advantage in the recovery rate of urinary control 1 month after operation,and the results were statistically significant.The median recovery time of postoperative urinary control in the experimental group was was 1.5 months.This data in control group was 3.25 months.The experimental group had obvious advantages in the mean recovery time and median recovery time of postoperative urinary control.The results were statistically significant.In the experimental group,15 patients recovered from erectile function within 6 months after operation,accounting for 71.4%of the total number of patients.There were 6 cases in the control group,accounting for 35.3%of the total.Patients in the experimental group had a significant advantage in erectile function recovery within 6 months after surgery,and the results were statistically significant.Conclusion Compared with standard radical prostatectomy,laparoscopic radical prostatectomy with maximum preservation of the surrounding prostate structure resulted in slightly more intraoperative blood loss,but no one needed blood transfusion,and it has obvious advantages in postoperative urinary control recovery time and erectile function recovery rate.For patients with clinical stage cT1a-cT2c,Gleason score ≤7,PSA≤20ng/mL,and preoperative sexual function,laparoscopic radical prostatectomy with maximum preservation of the surrounding prostate structure is preferred.