对比绕肝悬吊前入路与传统入路右半肝切除术治疗原发性肝细胞癌的效果及安全性。

回顾性分析2021年2月至2024年2月93例行右半肝切除术的原发性肝细胞癌患者临床资料，经倾向评分匹配后，最终纳入84例患者。根据入路方式分为传统入路组（采用传统入路）和前入路组（采用绕肝悬吊前入路），每组各42例。应用SPSS 26.0统计学软件进行统计分析，符合正态分布的计量资料以（±s）表示，组间比较采用独立样本t检验；计数资料用[例（%）]表示，组间率比较采用χ²检验；绘制Kaplan-Meier生存曲线，采用Log-Rank检验生存结局。P<0.05为差异有统计学意义。

与传统入路组相比，前入路组患者手术时间和住院时间更短、术中出血量更少、术中输血率更低（P<0.05）；术后7d，两组血清丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）和总胆红素（TBIL）水平均高于术前，但前入路组低于传统入路组（P<0.05）；术后7d，两组患者血清肿瘤坏死因子-α（TNF-α）、白细胞介素-6和C反应蛋白（CRP）水平均高于术前，但前入路组低于传统入路组（P<0.05）；两组患者术后并发症总发生率比较，差异无统计学意义（P>0.05）；术后1年，传统入路组患者累计无病生存率低于前入路组（P<0.05）；传统入路组与前入路组总生存率比较，差异无统计学意义（P>0.05）。

相较于传统入路，绕肝悬吊前入路右半肝切除术可显著缩短原发性肝细胞癌患者的手术和住院时间，减少术中出血量及输血需求，同时有助于减轻术后炎症反应和肝功能损伤。

To compare the efficacy and safety of the anterior approach with hepatic suspension versus the traditional approach in right hepatectomy for primary hepatocellular carcinoma.

A retrospective analysis was performed on the clinical data of 93 patients with primary hepatocellular carcinoma who underwent right hepatectomy from February 2021 to February 2024. After propensity score matching, 84 patients were finally included. They were divided into the traditional approach group (treated with the traditional approach) and the anterior approach group (treated with the anterior approach with hepatic suspension) according to the surgical approach, with 42 patients in each group. Statistical analysis was performed using SPSS 26.0 software. Measurement data conforming to normal distribution were expressed as (±s), and independent sample t test was used for comparison between groups. Count data were expressed as rates (%), and the χ² test was used for comparison of rates between groups. Kaplan-Meier survival curves were plotted, and the Log-Rank test was used to analyze survival outcomes. A P value < 0.05 was considered statistically significant.

Compared with the traditional approach group, the anterior approach group had shorter operation time and hospital stay, less intraoperative blood loss, and a lower intraoperative transfusion rate (P<0.05). At 7 days after surgery, the serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBIL) in both groups were higher than those before surgery, but the levels in the anterior approach group were lower than those in the traditional approach group (P<0.05). At 7 days after surgery, the serum levels of tumor necrosis factor-α (TNF-α), interleukin-6, and C-reactive protein (CRP) in both groups were higher than those before surgery, but the levels in the anterior approach group were lower than those in the traditional approach group (P<0.05). There was no statistically significant difference in the total incidence of postoperative complications between the two groups (P>0.05). At 1 year after surgery, the cumulative disease-free survival rate in the traditional approach group was lower than that in the anterior approach group (P<0.05). There was no statistically significant difference in the overall survival rate between the traditional approach group and the anterior approach group (P>0.05).

Compared with the traditional approach, right hepatectomy via the anterior approach with hepatic suspension can significantly shorten the operation time and hospital stay, reduce intraoperative blood loss and transfusion requirements in patients with primary hepatocellular carcinoma, and also help alleviate postoperative inflammatory responses and liver function damage.