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目的:比较达芬奇Xi系统与达芬奇Si系统机器人辅助腹腔镜肾上腺切除术治疗肾上腺肿瘤的临床疗效和费用。方法:回顾性分析2019年6月至2020年12月南昌大学第一附属医院收治的99例肾上腺肿瘤患者的病例资料，患者均接受达芬奇机器人辅助腹腔镜肾上腺切除术。采用Si系统(Si组)57例，男35例，女22例；年龄(45.6±14.0)岁；合并糖尿病6例，高血压病10例，既往有腹部手术史14例；体质指数(BMI)(21.0±1.2)kg/mn 2；美国麻醉医师协会(ASA)评分≥3分9例；肿瘤位于左侧28例，右侧29例；肿瘤直径(3.9±1.2)cm。采用Xi系统(Xi组)42例，男21例，女21例；年龄(44.8±14.5)岁；合并糖尿病2例，高血压病12例，既往有腹部手术史11例；BMI(21.4±1.8)kg/mn 2；ASA评分≥3分7例；肿瘤位于左侧15例，右侧27例；肿瘤直径(3.7±1.1)cm。两组的一般资料比较差异均无统计学意义(n P>0.05)。手术方式：两组手术方式除对接过程不同外，其余手术步骤大致相同。Si组对接方式为医生手持吸引器作为引导，手术室护士在吸引器引导下将机器人系统引入定泊，然后完成对接。Xi组采用机器人系统自带的激光定位系统对接，不需手动定位及引导。与Si系统相比，Xi系统的机械臂术中操作更灵活。比较两组的治疗效果、安全性及费用，根据Clavien-Dindo分级系统评估并发症。n 结果:Si组和Xi组的麻醉时间分别为(140.0±24.3)min和(125.6±26.4)min(n P＝0.006)，对接时间分别为(7.8±1.4)min和(5.0±0.9)min(n P<0.001)，手术时间分别为(109.0±18.8)min和(98.8±20.7)min(n P＝0.013)，术中估计失血量分别为(121.5±70.8)ml和(124.7±68.9)ml(n P＝0.824)，术后引流管留置时间分别为(3.4±1.2)d和(3.4±1.3)d(n P＝0.892)，术后卧床时间分别为(2.3±1.0)d和(2.5±1.2)d(n P＝0.419)，术后住院时间分别为(6.4±1.5)d和(6.2±1.5)d(n P＝0.484)。Si组和Xi组术后发生Clavien≥3级并发症分别为4例和2例(n P＝0.642)。Si组和Xi组住院期间总费用分别为(51 975.2±7 320.8)元和(56 830.9±8 392.5)元(n P＝0.003)，手术及耗材费用分别为(23 785.3±4 063.1)元和(28 021.2±6 066.8)元(n P0.05). Operation method: except for the different docking procedures, the same surgical procedures were roughly performed in the two groups. The docking method of the Si group was the doctor holding the attractor as the guide. The operating room nurse introduced the robot cart under the guidance of the attractor, and then completed the docking.Group Xi docking adoptd the own laser positioning system of the robot system, without manual positioning and guidance; the mechanical arm of the Xi system was also more flexible. Complications were graded according to the Clavien-Dindo grading system. Comparing the treatment effect, safety, and cost of the two groups were compared.n Results:The anesthesia times in the Si and Xi groups were (140.0±24.3) min and (125.6±26.4) min (n P=0.006), respectively. The surgical times in the Si and Xi groups were (109.0±18.8) min and (98.8±20.7) min (P=0.013), respectively. The docking times between the Si and Xi groups were (7.8±1.4) min and (5.0±0.9) min (n P<0.001), respectively. The estimated intraoperative blood loss in the Si and Xi groups was (121.5±70.8) ml and (124.7±68.9) ml (n P=0.824), respectively. The postoperative indwelling times of the drainage tube in the Si and Xi groups were (3.4±1.2) d and (3.4±1.3) d (n P=0.892), respectively. Postoperative bed times in the Si and Xi groups were (2.3±1.0) d and (2.5±1.2) d (n P=0.419), respectively. Postoperative hospitalization times in the Si and Xi groups were (6.4±1.5) d and (6.2±1.5) d (n P=0.484), respectively. Post Clavien ≥ grade 3 complications were four and two in groups Si and Xi, respectively (n P=0.642). The total cost during hospitalization in the Si and Xi groups was (51 975.2±7 320.8) Yuan and (56 830.9±8 392.5) Yuan, respectively (n P=0.003). The surgery and consumables costs for the Si and Xi groups were (23 785.3±4 063.1) Yuan and (28 021.2±6 066.8) Yuan (n P<0.001), respectively.n Conclusions:Compared with the Si system, the Xi system robot-assisted laparoscopic adrenalectomy can provide similar perioperative results and safety, and shorten the time of anesthesia and surgery, but the total cost of hospitalization is increased.