目的

对比沿肝静脉主干入路与传统入路下腹腔镜解剖性肝脏切除术治疗肝细胞癌的临床应用效果。

方法

回顾性分析2021年1月至2023年12月确诊并接受腹腔镜解剖性肝脏切除术的112例肝细胞癌患者资料，根据手术入路不同分为肝静脉组（n=56例，经肝静脉主干入路）和传统组（n=56例，经传统入路）。应用统计学软件SPSS 25.0处理数据，围手术期指标、肝功能指标等计量资料以（±s）描述，组内行配对样本t检验，组间行独立样本t检验；术后并发症等计数资料以频数和百分比描述，行χ²检验。P＜0.05表示差异有统计学意义。

结果

肝静脉组患者手术时间短于传统组，术中出血量少于传统组（P＜0.05）；术后7d，两组患者丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）较术前升高，但肝静脉组低于传统组（P＜0.05）；传统组与肝静脉组患者术后并发症总发生率（12.5% vs. 7.1%）比较，差异无统计学意义（P＞0.05）。

结论

肝细胞癌患者采取沿肝静脉主干入路下腹腔镜解剖性肝脏切除术治疗，较传统入路手术时间短、术中出血量少，且能减少手术操作对肝功能的损伤，安全性好。

Objective

Compare the clinical application effects of laparoscopic anatomical hepatectomy for hepatocellular carcinoma via the approach along the main trunk of the hepatic vein and the traditional approach.

Methods

Retrospectively analyze the data of 112 patients with hepatocellular carcinoma who were diagnosed and underwent laparoscopic anatomical hepatectomy from January 2021 to December 2023.According to the different surgical approaches，they were divided into the hepatic vein group（n=56 cases，via the approach along the main trunk of the hepatic vein） and the traditional group （n=56 cases，via the traditional approach）.The statistical software SPSS 25.0 was used to process the data.Measurement data such as perioperative indexes and liver function indexes were described as （±s）.The paired sample t test was performed within the group，and the independent sample t test was performed between the groups.Count data such as the postoperative complications were described by frequency and percentage，and the χ² test was performed.A P value less than 0.05 indicated that the difference was statistically significant.

Results

The operation time of patients in the hepatic vein group was shorter than that in the traditional group，and the intraoperative blood loss was less than that in the traditional group （P＜0.05）.Seven days after the operation，the levels of alanine aminotransferase （ALT） and aspartate aminotransferase （AST） in both groups increased compared with those before the operation，but the levels in the hepatic vein group were lower than those in the traditional group （P＜0.05）.There was no statistically significant difference in the incidence of major postoperative complications between the traditional group and the hepatic vein group （12.5% vs. 7.1%）（P＞0.05）.

Conclusion

For patients with hepatocellular carcinoma，laparoscopic anatomical hepatectomy via the approach along the main trunk of the hepatic vein has a shorter operation time and less intraoperative blood loss compared with the traditional approach.Moreover，it can reduce the damage to liver function caused by surgical procedures and has good safety.