探讨腹腔镜优先Glisson鞘外阻断肝右前叶切除术治疗肝细胞癌（肝癌）的可行性及安全性。

回顾性分析2016年11月至2018年8月佛山市第一人民医院行腹腔镜优先Glisson鞘外阻断肝右前叶切除术的4例肝癌患者临床资料。患者均为男性；年龄40～72岁，中位年龄65岁。肝癌位于肝Ⅴ、Ⅷ段；最大直径为3.3～4.2 cm，中位直径3.5 cm。患者均签署知情同意书，符合医学伦理学规定。术中优先行右前叶肝蒂Glisson鞘外阻断，按照缺血带准确标记右前叶边界，肝内循肝中静脉、肝右静脉主干离断肝实质。

患者均顺利完成全腹腔镜肝切除术，无中转开腹，无围手术期死亡病例。4例患者平均手术时间为（502±55）min，术中出血量（512±301）ml，术后住院时间（10.7±2.9）d。1例术后3 d出血，开腹手术止血。1例术后7 d复查发现肝断面积液，予行穿刺引流。1例术后2周复查发现右侧胸腔积液，予行胸腔穿刺抽液。术后随访时间为12～36个月，中位随访时间为24个月；随访期间1例复发。

腹腔镜优先Glisson鞘外阻断肝右前叶切除术治疗肝癌安全可行，符合精准肝切除的理念。

To evaluate the feasibility and safety of laparoscopic right anterior lobectomy with prior Glisson extrathecal occlusion in patients with hepatocellular carcinoma (HCC).

Clinical data of 4 HCC patients who underwent laparoscopic right anterior lobectomy with Glisson extrathecal occlusion in the First People's Hospital of Foshan from November 2016 to August 2018 were retrospectively analyzed. All patients were male, aged from 40 to 72 years with a median age of 65 years. The tumors were located in segments Ⅴ and Ⅷ. The maximum diameter was 3.3-4.2 cm, and the median diameter was 3.5 cm. The informed consents of all patients were obtained and the local ethical committee approval was received. Glisson extrathecal occlusion of the right anterior lobe was performed priorly in the operation. The margin of the right anterior lobe was accurately marked according to the ischemic zone. The liver parenchyma was dissected following the middle and right hepatic veins.

All the patients underwent total laparoscopic hepatectomy successfully. No case was converted to open surgery. No perioperative death was reported. The mean operation time, intraoperative blood loss and length of postoperative hospital stay were (502±55) min, (512±301) ml and (10.7±2.9) d, respectively. One patient suffered from bleeding at 3 d after operation and healed after open surgery. One case suffered from liver sectional effusion at postoperative 7 d and treated with catheter drainage. One patient developed pleural effusion on the right side at 2 weeks after operation and received thoracentesis. The postoperative follow-up time was 12-36 months, and the median follow-up time was 24 months. One case recurred during the follow-up.

Laparoscopic right anterior lobectomy with prior Glisson extrathecal occlusion for HCC is safe and feasible, which conforms to the concept of precise hepatectomy.