目的：应用 R.E.N.A.L. 肾功能评分系统进行配对分析，比较腹膜后腹腔镜肾部分切除术（Laparoscopic  Partial Nephrectomy，LPN）与机器人肾部分切除术（Robot-assisted Partial Nephrectomy，RPN）的围手术期疗效。 方法：对 2016 年 1 月—2020 年 3 月 543 例于浙江大学医学院附属第一医院泌尿外科行腹腔镜及机器人辅助肾部分切 除术患者的相关临床资料进行分析。根据 R.E.N.A.L. 肾功能评分、性别和年龄进行 1∶1 配对（112 对配对），通过 统计分析对围手术期结果进行比较。结果：LPN 组和 RPN 组在年龄、性别、体重指数（Body Mass Index，BMI）、 肿瘤大小、美国麻醉学家协会（American Society of Anesthesiologists，ASA）评分和术前估算肾小球滤过率（Estimated  Glomerular Filtration Rate，eGFR） 方 面 均 无 显 著 差 异。 接 受 LPN 的 患 者 左 侧 肿 瘤 所 占 比 例 略 高（51.7% Vs  42.9%，P=0.032）。两组在手术时间、术中出血量、术后住院时间（Length of Stay，LOS）、术后 eGFR、输血量和 / 或术后并发症等方面均无显著差异。RPN 组热缺血时间（Warm Ischemia Time，WIT）明显比 LPN 组短（18.9 min Vs  22.6 min，P=0.032）。以复杂性为特点的亚集分析显示，复杂肿瘤 RPN 的 WIT 显著短于 LPN（21.1 min Vs 26.3 min， P=0.012），而单纯性肿瘤 RPN 与 LPN 的 WIT 差异无统计学意义（16.4 min Vs 18.3 min，P=0.085）。结论：经腹膜 后 RPN 手术时间较经腹膜后 LPN 短，但二者围手术期效果基本相同。在有限的腹膜后工作空间内进行复杂的肿瘤 切除和修补，机器人辅助手术可能比传统的腹腔镜术更具优势。

Objective: To compare the perioperative outcomes of patients undergoing retroperitoneal laparoscopic  partial nephrectomy(LPN) and retroperitoneal robot-assisted partial nephrectomy (RPN) by matched analysis using R.E.N.A.L.  nephrometry scoring system. Methods: Relevant clinical data of 543 case of laparoscopic and robot-assisted partial nephrectomy  performed by a single surgeon via the RP approach from January 2016 to March 2020 from our database were screened and  analyzed. Two groups were matched 1:1 (112 matched pairs) by R.E.N.A.L. nephrometry score, gender, and age. Statistical  analysis was done to compare perioperative outcomes. Results: There was no significant difference between the LPN group and  RPN group in terms of age, gender, body mass index (BMI), tumor size, American Society of Anesthesiologists (ASA) score or  preoperative estimated glomerular filtration rate (eGFR). Patients undergoing LPN had a slightly higher proportion of the left side  tumor (51.7% Vs 42.9%, P=0.032). No significant differences regarding to operative time, estimated blood loss, postoperative  LOS, postoperative eGFR, transfusion or postoperative complications were found between the two groups. However, Warm  ischemia times (WIT) in the RPN group were significantly shorter than that in the LPN group (18.9 min Vs 22.6 min, P=0.032).  Subset analysis based on complexity indicated that WIT of complex tumors in the RPN group was significantly shorter than that  in the LPN group (21.1 min Vs 26.3 min, P=0.012), but no difference of WIT was found on simple tumors between the RPN  group and LPN group (16.4 min Vs 18.3 min, P=0.085). Conclusion: Retroperitoneal RPN showed shorter WIT and generally  equivalent perioperative results to retroperitoneal LPN. Robotic surgery may have advantages over the traditional laparoscopic  surgery on complex tumor excision and renorrhaphy in the limited retroperitoneal space.

收稿日期：2021-04-18  录用日期：2022-05-21 

Received Date: 2021-04-18  Accepted Date: 2022-05-21 

基金项目：国家自然科学基金（81772270） 

Foundation Item: National Natural Science Foundation (81772270) 

通讯作者：王平，Email：wpyyy@zju.edu.cn；汪朔，Email：shuowang11@hotmail.com 

Corresponding Author: WANG Ping, Email: wpyyy@zju.edu.cn; WANG Shuo, Email: shuowang11@hotmail.com 

引用格式：徐一帆，夏丹，孟宏舟，等 . 机器人与腹腔镜后腹膜入路肾肿瘤部分切除术：一项单一外科医生围手术期疗效的配对 比较 [J]. 机器人外科学杂志（中英文），2023，4（4）：333-342. 

Citation: XU Y F, XIA D, MENG H Z, et al. Retroperitoneal robotic versus laparoscopic partial nephrectomy for renal tumors: a matched comparison of perioperative outcomes of a single surgeon [J]. Chinese Journal of Robotic Surgery, 2023, 4(4): 333- 342.

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