探讨腹腔镜右半肝切除术（LRH）治疗肝细胞癌（肝癌）的安全性和疗效。

回顾性分析2014年1月至2020年7月佛山市第一人民医院收治的85例肝癌患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男75例，女10例；年龄29~74岁，中位年龄52岁。肝功能均为Child-Pugh分级A级，肿瘤直径<8 cm。根据手术方式不同分为LRH组与开腹右半肝切除术（ORH）组，两组均采用标准化、流程化前入路右半肝切除术。两组手术时间、术后住院时间等比较采用t检验或秩和检验，术后并发症等率的比较采用χ²检验或Fisher确切概率法，生存分析采用Kaplan-Meier法和Log-rank检验。

LRH组平均手术时间为（332±52）min，明显长于ORH组的（287±59）min（t=3.316，P<0.05）。LRH组术后肛门排气时间为（1.5±0.9）d，明显短于ORH组的（2.8±0.8）d（t=-3.119，P<0.05）。LRH组术后住院时间中位数为9（2）d，明显短于ORH组的12（4）d（Z=-3.210，P<0.05）。LRH组无围手术期死亡，ORH组围手术期死亡2例，差异无统计学意义（P=0.508）。LRH组术后并发症发生率为16%（4/25），ORH组为33%（20/60），差异无统计学意义（χ²=2.617，P>0.05）。LRH组无肝切缘旁复发，腹腔种植性转移1例；ORH组肝切缘旁复发1例，腹腔种植性转移2例，切缘旁复发差异无统计学意义（P=1.000），腹腔种植性转移差异亦无统计学意义（χ²=0.243，P>0.05）。LRH组术后1、3年无瘤生存率分别为72.0%、62.6%，ORH组相应为65.6%、41.0%，差异无统计学意义（χ²=2.835，P>0.05）。LRH组术后1、3年总体生存率分为96.0%、75.4%，ORH组相应为88.3%、76.5%，差异亦无统计学意义（χ²=0.016，P>0.05）。

标准化、流程化前入路LRH治疗肝癌安全、可行，具有微创、术后恢复快等优势，在无瘤生存及总体生存等方面与ORH相当。

To evaluate the safety and efficacy of laparoscopic right hemihepatectomy (LRH) in the treatment of hepatocellular carcinoma (HCC).

Clinical data of 85 HCC patients admitted to the First People's Hospital of Foshan from January 2014 to July 2020 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 75 patients were male and 10 female, aged 29-74 years with a median age of52 years. All patients were classified as Child-Pugh A, and the tumor diameter was <8 cm. According to different surgical procedures, all patients were divided into the LRH group and open right hemihepatectomy (ORH) group. Standardized and processed right hemihepatectomy via the anterior approach was adopted in two groups. The operation time and the length of postoperative hospital stay between two groups were compared by t test or rank-sum test. The rate comparison, such as the incidence rate of postoperative complications, between two groups was compared by Chi-square test or Fisher's exact probability test. Survival analysis was conducted by Kaplan-Meier curve and Log-rank test.

The average operation time in the LRH group was (332±52) min, significantly longer than (287±59) min in the ORH group (t=3.316, P<0.05). The time to first flatus in the LRH group was (1.5±0.9) d, significantly shorter than (2.8±0.8) d in the ORH group (t=-3.119, P<0.05). The median length of postoperative hospital stay in the LRH group was 9(2) d, significantly shorter than 12(4) d in the ORH group (Z=-3.210, P<0.05). No perioperative death was reported in the LRH group, 2 cases in the ORH group, and no significant difference was observed between two groups (P=0.508). In the LRH group, the incidence of postoperative complications was 16%(4/25) and 33%(20/60) in the ORH group, and no significant difference was observed between two groups (χ²=2.617, P>0.05). In the LRH group, no hepatic marginal recurrence occurred, and 1 case had abdominal implantation metastasis. In the ORH group, 1 case developed hepatic marginal recurrence and 2 cases of abdominal implantation metastasis. No significant differences were observed in hepatic marginal recurrence (P=1.000) and abdominal implantation metastasis (χ²=0.243, P>0.05) between two groups. In the LRH group, the postoperative 1-, 3-year tumor-free survival rates were 72.0%, 62.6%, and 65.6%, 41.0% in the ORH group, respectively. No significant difference was observed between two groups (χ²=2.835, P>0.05). In the LRH group, the postoperative 1-, 3-year overall survival rates were 96.0%, 75.4%, and 88.3%, 76.5% in the ORH group, respectively. No significant difference was observed between two groups (χ²=0.016, P>0.05).

It is safe and feasible to apply standardized and processed LRH via the anterior approach for the treatment of HCC, which has multiple advantages of minimal invasiveness and rapid postoperative recovery. Moreover, LRH yields equivalent tumor-free survival and overall survival to ORH.