目的

探讨肝细胞癌（肝癌）腹腔镜下解剖性肝中叶切除手术操作流程优化。

方法

回顾性分析2019 年1 月至2023 年1 月广东省中医院及广东省中医院珠海医院收治的16 例肝癌患者临床资料。其中男14 例，女2 例；平均年龄（57±10）。BMI（22±3） kg/m²。合并HBV 感染15 例，其中肝硬化7 例。ICGR15 为0.060±0.024，肿瘤数量（1.8±0.7）个，肿瘤最大直径（6.8±1.9）cm，剩余肝体积占比（59.0±9.1）%。采用以肝脏表面解剖为标记，术中超声定位，肝实质先行的入路，优化手术流程，行完全腹腔镜下解剖性肝中叶切除术。观察患者围手术期情况、并发症和疗效。

结果

16 例手术均获成功，无1 例中转开腹。手术时间（212±61）min，术中出血量（191±125）ml，肝门阻断时间（46±9）min。肝切缘（13±5）mm。术后1 例创面少量胆漏，经保守治疗痊愈，无出现出血、肝衰竭、感染等严重并发症或死亡病例。术后住院时间（10.9±2.2）d。随访时间8.0～34.0 个月，中位随访时间22.6 个月。随访期间2 例复发，无死亡病例。

结论

在熟练掌握腹腔镜肝叶切除术操作要点的前提下，优化流程的腹腔镜肝中叶切除术治疗肝癌更加简便，且安全可行。

Objective

To investigate the process optimization of laparoscopic anatomical mesohepatectomy for hepatocellular carcinoma （HCC）.

Methods

Clinical data of 16 HCC patients admitted to Guangdong Provincial Hospital of Chinese Medicine and Zhuhai Branch of Guangdong Provincial Hospital of Chinese Medicine from January 2019 to January 2023 were retrospectively analyzed.Among them，14 patients were male and 2 females， aged （57±10） years on average， body mass index （BMI） of（22±3） kg/m².15 patients were complicated with HBV infection， including 7 cases of cirrhosis.The ICGR15 was calculated as 0.060±0.024， the number of tumors was （1.8±0.7）， the maximal diameter of tumors was （6.8±1.9） cm， and the residual liver volume accounted for （59.0±9.1）%.Anatomical liver surface markers were made， intraoperative ultrasound was used for localization，the route of liver parenchyma mesohepatectomy was prioritized and surgical process was optimized.Laparoscopic anatomical mesohepatectomy was performed.Perioperative status， complications and efficacy were observed.

Results

16 patients successfully underwent the surgery， and none was converted to open surgery.The operation time was （212±61） min， intraoperative blood loss was （191±125） ml， the time of hepatic portal occlusion was （46±9） min and hepatic surgical margin was （13±5） mm.Mild postoperative bile leakage occurred in 1 case， which was cured by conservative treatment.No severe complications such as bleeding， liver failure and infection or death were reported.The length of postoperative hospital stay was （10.9±2.2） d.Postoperative follow-up time was ranged from 8.0 to 34.0 months， and the median follow-up time was 22.6 months.During postoperative follow-up， 2 cases recurred and no death occurred.

Conclusions

Under the premise of mastering the highlights of laparoscopic hepatectomy， optimized laparoscopic mesohepatectomy is a convenient， safe and feasible treatment for HCC.