目的:比较机器人与腹腔镜中低位直肠癌根治术病人的围术期相关指标及术后泌尿功能评分,评价机器人手术安全性及术后泌尿功能恢复情况。方法:回顾性分析2015年9月至2018年10月间在我科接受中低位直肠癌根治术313例病人的临床病理资料。运用倾向性评分匹配法（1∶1,卡钳值=0.01）,基于性别、年龄、体质量指数、ASA评分和肿瘤分期,将机器人手术组与腹腔镜组配对。分析两种手术方式中低位直肠癌根治术的安全性以及对泌尿功能的影响。通过国际前列腺症状评分（IPSS）评估术前及术后1、3和6个月的泌尿功能。结果:倾向性评分配比后,两组各101例纳入配对研究。在手术根治度方面两组差异无统计学意义。两组在手术时间、术中出血量、术后首次排气时间、术后住院时间之间差异都有统计学意义（P<0.001）。机器人组IPSS在术后1个月低于腹腔镜组（P<0.001）。亚组分析显示,>60岁的低位直肠癌病人中,机器人组IPSS在术后1个月低于腹腔镜组（P=0.027）。术后3、6个月两组IPSS差异无统计学意义。结论:机器人手术的根治度与腹腔镜手术相仿。机器人直肠癌根治术后近期泌尿功能恢复以及康复都早于腹腔镜组,尤其在60岁以上的低位直肠癌病人中更为突出。

Objective To compare perioperative index and postoperative urinary function following radical resection for middle and low rectal cancer between robotic and laparoscopic surgery. Methods Clinicopathological data of 313 patients with radical surgery for middle and low rectal cancer at our department from September 2015 to October 2018 were analyzed retrospectively. Propensity score matching analysis (1∶1, caliper value=0.01) between robotic surgery group and laparoscopic surgery group was performed based on gender, age, body mass index, American Society of Anesthesiology score, and tumor staging. Two surgical approaches were studied for safety in radical treatment of middle and low rectal cancer and the effect on urinary function, which was assessed using the International Prostate Symptom Score (IPSS) preope-ratively and 1, 3, and 6 months after surgery. Results The matched sample of 101 cases in two groups using propensity score was included. There was no statistical difference in the outcome of radical resection between two groups. However, significant differences were found in operative time, intraoperative blood loss, time to first flatus and postoperative hospital stay (P<0.001). IPSS of robotic surgery group was significantly lower than that of laparoscopic group 1 month after surgery(P<0.001). IPSS of patients older than 60 with low rectal cancer in robotic surgery group was lower than that in laparoscopic surgery group 1 month postoperatively(P=0.027), and no significant difference in IPSS 3 and 6 months after surgery was present between two groups. Conclusions The efficacy of robotic radical surgery was same as laparoscopic surgery for middle and low rectal cancer. The radical surgery of patients with rectal cancer in robotic approach had urinary function less impaired and short-term rehabilitation better compared to that in laparoscopic approach, especially for patients older than 60 with low rectal cancer.