探讨腹腔镜肝切除术（LH）在肝细胞癌（肝癌）中的临床应用价值。

回顾性分析2010年1月至2012年1月在第三军医大学西南医院行LH治疗的159例肝癌患者临床资料。其中男135例，女24例，平均年龄（52±12）岁。肝功能Child-Pugh分级A级147例，B级12例。所有患者均签署知情同意书，符合医学伦理学规定。术中采用充分暴露肝脏、控制性低中心静脉压、第一肝门阻断或区域性入肝血流阻断、超声刀切肝等方法控制出血。观察患者手术中转率、手术时间、术中出血量、输血率、入肝血流阻断、术后并发症等情况。采用Kaplan-Meier生存曲线进行生存分析。

本组患者手术中转开腹率6.3%（10/159），中转开腹原因为肝右静脉损伤1例，肝中静脉损伤4例，肝离断面出血3例，切缘阳性2例。手术时间（228±64）min，术中出血量中位数450（50～1 600）ml，围手术期输血率8.8%（14/159），行第一肝门入肝血流阻断92例，血流阻断时间（37±15）min。患者术后胃肠道功能恢复时间（2.5±0.6）d，住院时间（10±3）d。患者术后并发症发生率为12.6%（20/159），其中1例患者术后1周死于肝衰竭。患者术后1、3年总体生存率分别为94%、80%，无瘤生存率分别为85%、64%。

采用合适的出血控制技术，LH治疗肝癌是安全、可行的，可以取得良好疗效。

To investigate the clinical application value of laparoscopic hepatectomy (LH) in hepatocellular carcinoma (HCC).

Clinical data of 159 patients with HCC undergoing LH in the Southwest Hospital of the Third Military Medical University between January 2010 and January 2012 were retrospectively analyzed. Among the patients, 135 were males and 24 were females with the average age of (52±12) years old. One hundred and forty-seven cases were with liver function of Child-Pugh Class A and 12 with Class B. The informed consents of all patients were obtained and the local ethical committee approval was received. Measures such as fully liver exposure, controlled low central venous pressure, first hepatic portal occlusion or regional hepatic vascular inflow occlusion, and hepatectomy with harmonic scalpel were used for bleeding control during the surgery. The rate of conversion to laparotomy, duration of operation, intraoperative blood loss, blood transfusion rate, hepatic inflow occlusion and postoperative complications of the patients were observed. The survival analysis was conducted using Kaplan-Meier survival curves.

The rate of conversion to laparotomy was 6.3%(10/159) including 1 case of right hepatic vein injury, 4 of middle hepatic vein injury, 3 of bleeding from liver dissection surface and 2 of positive incisal margin. The duration of operation, the median intraoperative blood loss and the perioperative blood transfusion rate were respectively (228±64) min, 450(50-1600) ml and 8.8%(14/159). Hepatic inflow occlusion was applied on 92 cases, and the inflow occlusion time was (37±15) min. The postoperative recovery time of gastrointestinal function was (2.5±0.6) d and the hospital stay was (10±3) d. The postoperative complication incidence was 12.6% (20/159), including 1 case died of liver failure 1 week after surgery. The postoperative 1-, 3-year overall survival rates were respectively 94%, 80%, and the 1-, 3-year disease-free survival rates were respectively 85%, 64%.

With appropriate bleeding control techniques, LH is safe and feasible for HCC, and can achieve good curative efficacy.