探讨精准肝蒂离断技术在肝细胞肝癌（肝癌）解剖性肝段切除患者中应用的安全性及临床疗效。

本前瞻性研究采用非随机对照方法，选择2008年1月至2010年4月在南京大学医学院附属鼓楼医院肝胆外科行肝段切除术治疗的60例肝癌患者为研究对象。所有患者均签署知情同意书，符合医学伦理学规定。按肝切除方法将患者分为精准肝蒂离断组（精准组）和传统手术组（传统组），每组各30例。精准组患者男25例，女5例；年龄（51±14）岁；传统组患者男23例，女7例；年龄（52±12）岁。精准组术前行多层螺旋计算机体层摄影术（MSCT）三维血管重建，精确评估拟切除肝段的肝蒂分支和肝静脉段间分支的解剖位置。术中采取精细钳夹法切开肝实质，解剖、离断拟切除肝段的肝蒂，然后以超声定位肝静脉段间分支作为肝实质离断面，完成单一或联合肝段切除。传统组行常规术前检查及评估，术中按照超声定位肿瘤，以肝脏表面解剖标志确定肝段范围。以超声吸引刀切开肝实质，最后处理肝蒂，完成单一或联合肝段切除。两组患者术前、术中及术后临床资料中的计量资料比较采用t检验，分类资料比较采用χ²检验或Fisher确切概率法。

精准组与传统组患者的术前资料、术中出血量、术中输血量、手术时间、手术方式、术后肝功能指标、术后住院时间的比较，差异均无统计学意义（P>0.05）。精准组与传统组术后病理肿瘤切缘分别为（2.3±0.7）、（1.5±0.6）cm，差异有统计学意义（t=4.950，P<0.05）。精准组与传统组术后均未出现严重并发症，并发症发生率分别为23%（7/30）、50%（15/30），差异有统计学意义（χ²=4.593，P<0.05）。精准组与传统组术后1年肿瘤复发率分别为10%（3/30）、17%（5/30），精准组的肿瘤复发率有所降低，但差异无统计学意义（χ²=0.577，P>0.05）。

精准肝蒂离断技术在肝癌解剖性肝段切除中的应用有着与传统手术方法同样的安全性，且可减少术后并发症的发生，保证手术切缘阴性，有望降低术后复发率，提高肝癌的治愈率。

To investigate the safety and effect of precise pedicle transection in anatomical hepatic segmentectomy of hepatocellular carcinoma(HCC).

Sixty HCC patients, who underwent hepatic segmentectomy in Department of Hepatobiliary Surgery, the Affiliated Drum Tower Hospital of Medical School of Nanjing University from January 2008 to April 2010, were enrolled in this prospective non-randomized controlled study. The informed consents of all patients were obtained and the ethical committee approval was received. The patients were divided into 2 groups according to the procedure of hepatectomy: the precise pedicle transection group(precise group) and the traditional surgery group(traditional group) with 30 cases in each group. There were 25 males and 5 females in the precise group with the mean age of (51±14) years old and 23 males, 7 females in the traditional group with the mean age of (52±12) years old. Three-dimensional reconstruction was performed in patients of precise group by multi-slice spiral computed tomography (MSCT). The anatomic constructions of hepatic pedicle branches and intersegmental branch of hepatic vein of liver segment to be resected were evaluated precisely. The liver parenchyma was split using precise clamping and the pedicle of liver segment was transected. The intersegmental branch of hepatic vein was positioned by ultrasonic as the section of liver parenchyma and single or combined segmental resection was performed. Patients in the traditional group received conventional preoperative examination and evaluation. The tumor was positioned by ultrasonic during the operation and the liver segment to be resected was confirmed according to the anatomical mark of liver. The liver parenchyma was split using cavitron ultrasonic surgical aspirator(CUSA) and the pedicle was transected finally, single or combined segmental resection was completed. The comparison of measurement data of preoperative, intraoperative and postoperative between two groups was conducted using t test. The comparison of classification data was conducted using Chi-square test or Fisher definite probability test.

There was no significant difference in the patients' preoperative data, amount of intraoperative bleeding, blood transfusion, duration of surgery, surgical procedures, postoperative liver function indexes as well as postoperative length of hospital stay(P>0.05). The length of tumor incisal edge in the precise group and traditional group were(2.3±0.7)cm, (1.5±0.6)cm respectively, and significant difference was observed between two groups (t=4.950, P<0.05) . No severe postoperative complication was observed in the precise group and traditional group. The incidences of postoperative complications of the precise group and traditional group were 23% (7/30) , 50% (15/30) respectively, and significant difference was observed between two groups (χ²=4.593, P<0.05) . The 1-year HCC recurrence rate in precise group was lower than that in traditional group, but there was no significant difference between two groups [10% (3/30) vs. 17% (5/30) ; χ²=0.577, P>0.05].

The precise pedicle transection has the same safety as the conventional surgery in anatomic hepatic segmentectomy of HCC. It can reduce the incidence of postoperative complications, ensure negative tumor incisal edge, reduce the postoperative recurrence rate and improve the curative rate for HCC.