关键词: 中央型肾肿瘤；经腹腔入路腹腔镜肾部分切除术；经后腹腔入路腹腔镜肾部分切除术；达芬奇机器人；肾功能；肠道功能

Abstract: Objective To explore the influence of Da Vinci robot-assisted different approaches of laparoscopic partial nephrectomy (LPN) on the renal function and intestinal function recovery in the treatment of central renal tumors.Methods Totally 100 patients with central renal tumors who received Da Vinci robot-assisted LPN in the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture were selected from November 2022 to March 2024.According to the consent of the patients,they were divided into transperitoneal group and retroperitoneal group by envelope drawing method,with 50 cases in each group.The transperitoneal group adopted transperitoneal approach,while the retroperitoneal group received retroperitoneal approach.The surgical status and postoperative recovery status,renal function [serum creatinine (Scr),glomerular filtration rate (GFR) and blood urea nitrogen (BUN)],intestinal function recovery status [restore exhaust time,plasma diamine oxidase (DAO),D-lactic acid and urinary lactulose/mannose (L/M)] and complications were compared between groups.Results The surgical time,intraoperative blood loss,renal warm ischemia time,restore exhaust time,urinary catheter indwelling time and hospitalization time with (126.76±23.89) h,(115.86±6.93) ml,(25.41±6.57) min,(2.29±0.56) d,(4.89±0.93) d and (11.08±1.92) d in transperitoneal group were longer or more than the retroperitoneal group [(111.58±21.86) h,(86.27±6.71) ml,(17.08±5.16) min,(1.73±0.43) d,(3.16±0.62) d and (9.29±2.07) d,all P<0.05].1 month after surgery,the SCr level in transperitoneal group with (83.04±10.13) μmol/L was lower than (88.55±9.16) μmol/L in retroperitoneal group while the GFR value with (58.27±6.19) ml/min was higher than (54.36±6.05) ml/min in retroperitoneal group (P<0.05).The levels of DAO,D-lactic acid and the value of urine L/M with (3.39±0.57) mg/L，(2.09±0.31) mg/L and (0.08±0.02) in transperitoneal group at 24 hours after surgery,which were higher than the retroperitoneal group[(3.07±0.46) mg/L，(1.72±0.25) mg/L and (0.05±0.02),P<0.05].The total incidence rates of postoperative complications in transperitoneal group and retroperitoneal group were 12.00% and 8.00% (P>0.05).Conclusion The two approaches of LPN assisted by Da Vinci robot have their own advantages in the treatment of central renal tumors.Transperitoneal approach is more conducive to improving renal function,but retroperitoneal approach is more conducive to shortening the postoperative recovery time and promoting the intestinal function recovery and has lower incidence rates of complications.

Key words: central renal tumors;laparoscopic partial nephrectomy via transperitoneal approach;laparoscopic partial nephrectomy via retroperitoneal approach;da Vinci robot;renal function;intestinal function