探讨精准肝切除术的临床应用价值。

回顾性分析2014年1月至2017年12月在云南省临沧市人民医院行肝切除术的317例患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男202例，女115例；年龄28~78岁，中位年龄47岁。原发病：原发性肝癌207例，肝门部胆管癌6例，胆囊癌8例，肝血管瘤13例，肝内胆管结石73例，肝寄生虫病10例。根据手术方法不同将患者分为精准肝切除组（精准组，171例）和非解剖性肝切除组（对照组，146例）。两组术中出血量、术后住院时间等比较采用t检验，率的比较采用χ²检验或Fisher确切概率法。

精准组术中出血量、术后住院时间分别为（528±69）ml、（18.3±2.4）d，明显低于对照组的（827±66）ml、（24.5±3.6）d（t=-3.51，-2.87；P<0.05）。精准组术后出血、胆漏、肝周包裹性积液分别为0、1、2例，对照组相应为1、4、7例，差异有统计学意义（χ²=-，5.16，4.68；P<0.05）。精准组术后1、2年无瘤生存率和结石复发率分别为73%（82/112）、51%（57/112）、5%（2/39），明显优于对照组的56%（55/99）、40%（40/99）、21%（7/34） （χ²=4.44，3.82，4.31；P<0.05）。

精准肝切除术是一种安全、有效的术式，具有术中出血少、术后并发症发生率低、住院时间短、术后无瘤生存率高和结石复发率低优势。

To investigate the application value of precise hepatectomy in clinical practice.

Clinical data of 317 patients who underwent hepatectomy in the People's Hospital of Lincang from January 2014 to December 2017 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 202 patients were male and 115 female, aged 28-78 years with a median age of 47 years. Primary diseases: 207 patients were diagnosed with primary liver cancer, 6 cases of hilar cholangiocarcinoma, 8 cases of gallbladder carcinoma, 13 cases of hepatic hemangioma, 73 cases of intrahepatic bile duct stones and 10 cases of hepatic parasitic diseases. All patients were divided into the precise hepatectomy group (precise group, n=171), and non-anatomical hepatectomy groups (control group, n=146) according to different surgical methods. Intraoperative blood loss and postoperative length of hospital stay were compared between two groups by t test. The rate comparison was performed by Chi-square test or Fisher's exact test.

In precise group, the intraoperative blood loss and postoperative length of hospital stay were (528±69) ml and (18.3±2.4) d respectively, significantly less than (827±66) ml and (24.5±3.6) d in control group (t=-3.51, -2.87; P<0.05). In precise group, no postoperative bleeding, 1 case of bile leakage and 2 cases of perihepatic encapsulated effusion was observed, whereas it was correspondingly 1, 4, 7 cases in control group (χ²=-, 5.16, 4.68; P<0.05). In precise group, the 1-, 2-year tumor-free survival rates and stone recurrence rate were 73%(82/112), 51%(57/112) and 5%(2/39), significantly better than 56%(55/99), 40%(40/99) and 21%(7/34) in the control group (χ²=4.44, 3.82, 4.31; P<0.05), respectively.

Precise hepatectomy is a safe and efficacious surgery, which possesses advantages of slight intraoperative bleeding, low incidence of postoperative complications, short length of hospital stay, high postoperative tumor-free survival rate and low stone recurrence rate.