ABSTRACT
Objective:This paper intends to explore the clinical efficacy and safety of the refined extroperitoneal intrafascial laparoscopic radical prostatectomy in patients with localized prostate cancer.Methods:The data of 107 patients with localized prostate cancer who were underwent laparoscopic radical prostatectomy in our hospital from July 2013 to January 2020 were analyzed retrospectively. According to the operation methods, the patients were divided into two groups: the refined intra fascial resection group (59 cases) and the conventional interfascial neurovascular bundle reservation group(48 cases). There was no significant different comparing the age [(61.8±8.9) years vs. (62.2±8.1) years, P=0.71], body mass index (BMI) [(24.8±1.3) kg/m 2 vs.(24.3±1.4) kg/m 2, P=0.89], preoperative total prostate specific antigen (PSA) [(6.8±0.9) ng/ml vs. (7.2±1.1) ng/ml, P=0.44], prostate volume [(47.9±18.4) ml vs. (48.3±17.9) ml, P=0.67] between the modified group and the conventional group. The clinical stage of the two groups was both in cT 1-T 2aN 0M 0, and the preoperative Gleason score was less than or equal to 7 ( P=0.76). In the improved group, the bilateral pelvic floor fascia was not dissected, the dorsal deep vein complex was not sutured, the denonvillier fascia was kept intact, the prostate was dissected by intrafascial technique, and the bilateral vascular and nerve bundles were completely preserved. After anastomosing the urethra and bladder neck, the bilateral prostate fascia, the pubic bladder-prostate ligament, DVC and the anterior wall of bladder neck were continuously sutured with 3-0 barbed wire in order to anatomically reconstructe the anterior suspension system. The preoperative data, intraoperative condition, postoperative pathological stage, positive margin rate and postoperative 6-month's follow-up, especially incontinence and erectile function were compared between the two groups. Results:There was no significant difference between the two groups in the basic clinical data, intraoperative bleeding volume[(90.6±26.4)ml vs.(105.3±34.1)ml, P>0.05], prostate-specific antigen 6 weeks after operation[(0.08±0.06)ng/ml vs.(0.09±0.07) ng/ml, P>0.05], postoperative pathological stage and positive margin rate(12.5% vs. 11.9%, P>0.05). In the early postoperative stage, patients performed a significantly better continence. Continence rate in 1 week: 16.7%(8/48) vs. 52.5%(31/59)( P<0.05), in 1 month: 29.2%(14/48)vs. 64.4%(38/59)( P<0.05), and in 3 month 52.1%(25/48) vs. 77.9%(46/59)( P<0.05). And also a better erectile function recovery rate in 1 month: 8.3%(4/48) vs. 23.7%(14/59)( P<0.05), in 3 month: 27.1%(13/48) vs. 49.2%(29/59)( P<0.05), in refined intrafascial group, but that was not significant different between the two groups 6 months after operation. Conclusion:The refined intrafascial laparoscopic radical prostatectomy can completely reconstruct the anatomic structure adjacent to urethra, and preserve utmostly the pelvic floor muscle, prostate fascia and neurovascular bundle, which are supposed to facilitate the revovery of urinary incontinence and erectile dysfunction in the early postoperative period.
ABSTRACT
Objective To evaluate the lithotripsy efficiency of a newly calculi anchoring forceps in vitro.Methods Compared the efficiency with or without calculi anchoring forceps in the circumstances imitate percutaneous nephrolithotomy.There are 24 calculus for each group in random selection.The lithotripsy was completed by one people.the time,energy and retained calculus were compared by T-test.Results When the energy expenditure reaches 2 kJ,the operating time was (4.7 ± 0.9) min in group 1 and (4.2 ± 0.9) min in group 2 (P ＞ 0.05).The removal calculus showed no differences between the two groups (P ＞ 0.05).After the energy used over 2 k J,the operating time of the remained calculus were (4.5 ± 1.2) min in group 1 and (9.2 ± 2.6) min in group 2 respectively (P ＜ 0.05),and the energy consumed (1.7 ± 0.5) kJ and (2.6 ± 0.4) kJ respectively (P ＜ 0.05).Total energy consumed in group 1 and group2 was (3.7±0.5) kJ and (4.6±0.5) kJ (P＜0.05).And the cumulate time used was (9.2±1.7) min and (13.4 ±2.7) min in group 1 and group 2 respectively (P ＜0.05).Conclusions The calculi anchoring forceps can improve the efficiency of lithotripsy in vitro.The improvement was significant for the calculus whose diameter was smaller than lcm.