探讨局限性解剖性肝段切除（LASR）治疗中央区大肝细胞癌（肝癌）的安全性和疗效。

回顾性分析2011年1月至2016年1月在昆明医科大学第一附属医院行LASR的34例中央区大肝癌患者临床资料。其中男30例，女4例，年龄36～68岁，中位年龄53岁。肝功能Child-Pugh分级均为A级，31例合并肝硬化。患者均签署知情同意书，符合医学伦理学规定。患者均先解剖第一肝门，分别悬吊门静脉及肝动脉的左侧一级和右侧二级分支，根据拟切除范围切断或阻断相应的血管，确定缺血线，采用超声刀联合钳夹法断肝。

全部患者均按计划完成LASR，无发生手术相关死亡。平均手术时间（233±48）min，术中出血量（304±151）ml，术中输血4例。术后总并发症发生率24%（8/34），其中肝衰竭1例，经保守治疗治愈。随访时间12～60个月，24例复发或转移，中位无瘤生存时间29个月，1、5年累积生存率分别为83%、45%。

LASR治疗中央区大肝癌是一种安全、有效的术式，尤其适合合并肝硬化患者，可降低肝衰竭发生率和手术死亡率。

To explore the safety and efficacy of localized anatomical segmental resection (LASR) in the treatment of patients with centrally located large hepatocellular carcinoma (HCC).

Clinical data of 34 patients with centrally located large HCC underwent LASR in the First Affiliated Hospital of Kunming Medical University between January 2011 and January 2016 were analyzed retrospectively. There were 30 males and 4 females, aged from 36-68 and with a median age of 53 years old. All the patients were with graded A liver function by Child-Pugh Classification, and 31 were complicated with cirrhosis. The informed consents of all patients were obtained and the local ethical committee approval was received. The porta hepatis was dissected first in all patients. The portal vein and left primary and right secondary branches of hepatic artery were suspended respectively. Corresponding vessels were cut off or clamped according to the extent of planned resection, the ischemic line was determined and the liver was resected by ultrasonic scalpel with clamping technique.

All patients underwent LASR as scheduled, and no perioperative death occurred. The mean length of operation was (233±48) min. The intraoperative blood loss was (304±151) ml. Four patients received blood transfusion during the operation. The postoperative overall incidence of complications was 24%(8/34), including 1 case of liver failure who was cured with conservative treatments. All patients were followed up for 12-60 months, during which recurrence or metastasis occurred in 24 patients. The median disease-free survival time was 29 months, and the 1, 5-year overall survival was 83% and 45%.

LASR is safe and effective in the treatment of patients with centrally located large HCC, especially for patients with cirrhosis, and it can reduce the incidence of liver failure and operative mortality.