探讨腹腔镜困难肝段肝癌切除术的安全性和可行性。

回顾性分析2016年1月至2020年1月佛山市第一人民医院行困难肝段切除术的14例肝细胞癌（肝癌）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12例，女2例；平均年龄（49±9）岁。肿瘤位于Ⅰ段2例，Ⅶ段3例，Ⅷ段8例，Ⅷ和Ⅳa段交界处1例；肿瘤直径中位数2.4（2.0～2.5）cm。所有诊断均经术后病理检查证实。观察患者手术情况和术后并发症发生情况。

14例患者均在腹腔镜下完成手术，无中转开腹。手术时间345（330～390）min，术中出血量200（100～200）ml。术后胸腔积液1例，腹腔包裹性积液合并感染1例，肺部感染1例，均经保守治疗后治愈。无围手术期死亡。术后住院时间8（7～10）d。随访时间23（14～42）个月，无失访患者。随访期间6例肿瘤复发，3例再次行手术切除，2例行射频消融，1例放弃治疗。

腹腔镜困难肝段肝癌切除术是安全、可行的。合理选择手术入路，充分暴露手术视野，术中超声精准定位，选择合理的入肝血流控制方法及肝实质离断平面是安全实施腹腔镜困难肝段肝癌切除术的关键。

To evaluate the safety and feasibility of laparoscopic resection of difficult segments for hepatocellular carcinoma (HCC).

Clinical data of 14 patients with HCC who underwent resection of difficult liver segments in the First People's Hospital of Foshan from January 2016 to January 2020 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 12 patients were male and 2 female, aged (49±9) years on average. The tumors were located in segment Ⅰ in 2 cases, segment Ⅶ in 3 cases, segment Ⅷ in 8 cases and junction of segments Ⅷ and Ⅵa in 1 case. The median tumor diameter was 2.4(2.0-2.5) cm. The diagnoses of all patients were confirmed by postoperative pathological examination. Operative conditions and postoperative complications were observed.

All 14 patients completed laparoscopic hepatectomy, and none of them was converted to open surgery. The operation time was 345(330-390) min and intraoperative blood loss was 200(100-200) ml. Postoperative pleural effusion occurred in 1 case, peritoneal encapsulated effusion complicated with infection in 1 case and pulmonary infection in 1 case, which were cured after conservative treatments. No perioperative death was noted. The length of postoperative hospital stay was 8(7-10) d. The follow-up time was 23(14-42) months. No patient was lost to follow-up. 6 patients recurred during postoperative follow-up. Among them, 3 cases underwent surgical resection, 2 cases received radiofrequency ablation, and1 case gave up treatments.

Laparoscopic resection of difficult segments for HCC is a safe and feasible treatment. Reasonable selection of surgical approach, full exposure of surgical field, accurate positioning by intraoperative ultrasound, appropriate control of liver blood inflow and liver resection plane are the key factors for the safe performance of laparoscopic resection of difficult segments for HCC.