探讨精准肝切除在巨大肝细胞癌（肝癌）中的临床应用价值。

本前瞻性研究对象为2009年5月至2013年5月在中山大学附属第一医院行精准肝切除的110例巨大肝癌患者。其中男92例，女18例；年龄26～75岁，中位年龄48岁；肿瘤直径为10～21 cm。所有患者均签署知情同意书，符合医学伦理学规定。患者术前行薄层CT扫描，利用薄层CT扫描的原始数据，采用Myrian XP Liver三维手术模拟软件对患者肝脏、肿瘤及血管进行三维重建，计算标准残肝体积（SRLV），并进行模拟手术切除。手术采用常规游离肝脏后肝切除或前入路法下腔静脉前预置吊带肝切除术。观察患者术前模拟方案与术中实际实施方案的吻合率。比较患者术前预计SRLV与术中实际SRLV的差异。观察患者手术时间、术中出血量、术中输血量、住院时间及并发症发生情况。术前预计SRLV与术中实际SRLV比较采用t检验。

患者术前拟实施方案与术中实际实施方案的吻合率为92.7%(102/110)。患者术前预计SRLV为(392±96) ml/m²，术中实际SRLV为（406±71）ml/m²，差异无统计学意义（t=-1.230，P>0.05）。患者手术时间中位数为200（150～375）min，术中出血量为500（150～2 000）ml,术中输血量为300（0～1 500）ml，术后住院时间为11（8～67）d。全组患者无围手术期死亡。患者术后并发症发生率为20.0%（22/110）。其中肝功能不全18例，予以护肝等对症治疗后治愈；胆漏3例，予以置管持续性引流后好转；腹腔出血1例，予再次手术止血。

精准肝切除能更好地切除巨大肝癌，保留更多残肝体积，降低术后肝功能不全发生率，是治疗巨大肝癌有效、安全的方法。

To investigate the application value of precise hepatectomy in huge hepatocellular carcinoma (HCC).

The objects of this prospective study were 110 patients with huge HCC undergoing precise hepatectomy in the First Affiliated Hospital of Sun Yat-sen University from May 2009 to May 2013. There were 92 males and 18 females with the age ranging from 26 to 75 years old and a median age of 48 years old. The range of tumor diameter was 10-21 cm. The informed consents of all patients were obtained and local ethical committee approval had been received. All patients underwent thin-slice computer tomography (CT) scan. The livers, tumors and vessels were three-dimensionally reconstructed using Myrian XP Liver surgery simulation software with the original data of thin-slice CT scan. The standard remnant liver volume (SRLV) was calculated, and the simulated operation was performed. Hepatectomy after conventional dissecting of the liver or hepatectomy with presetting hanging band in front of inferior vena cava through anterior approach were performed. The accordance rate of preoperative simulated operation plan and the actual performed intraoperative operation plan was observed. The difference between the predicted SRLV before operation and the actual measured SRLV was compared. The operative time, intraoperative blood loss, blood transfusion, length of hospital stay and complications were observed. The comparison of predicted SRLV and the actual measured SRLV was conducted using t test.

The accordance rate of preoperative simulated operation plan and the actual intraoperative operation plan was 92.7% (102/110). The predicted SRLV before operation was (392±96) ml/m², and the intraoperative actual measured SRLV was (406±71) ml/m², where no significant difference was observed (t=-1.230, P>0.05). The median of operative time was 200 (150-375) min. The intraoperative blood loss was 500 (150-2 000) ml. The intraoperative blood transfusion was 300 (0-1 500) ml. The length of postoperative hospital stay was 11 (8-67) d. No perioperative death was observed. The incidence of postoperative complications was 20.0% (22/110). Eighteen cases suffered hepatic dysfunction and were cured by symptomatic treatments such as liver protection. Three cases suffered biliary leakage and were relieved by persistent catheter drainage. One case suffered abdominal bleeding and underwent the second surgery to stop bleeding.

Precise hepatectomy can help to better resect huge HCC, retain more residual liver volume, and reduce the incidence of postoperative hepatic dysfunction. It is an effective and safe method of treating huge HCC.