对比前入路腹腔镜解剖性左半肝切除术与隧道法腹腔镜解剖性左半肝切除术治疗肝细胞癌（HCC）的临床效果。

回顾性选取2019年12月至2024年12月接受腹腔镜解剖性左半肝切除术的肝细胞癌患者114例作为研究对象，根据手术操作入路方式分为前入路组（n=57，采用前入路腹腔镜解剖性左半肝切除术）和隧道法组（n=57，采用隧道法腹腔镜解剖性左半肝切除术）。采用t检验或χ²检验比较围手术期指标、肝功能指标、炎症因子等指标；以Kaplan-Meier法绘制患者术后12个月无病生存曲线，行Log-Rank检验。

隧道法组术中出血量低于前入路组，隧道法组肝门阻断时间、胃肠功能恢复时间、引流管拔除时间、住院时间均短于前入路组（P<0.05）。与术前比较，两组术后3 d、7 d丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）指标均升高；与术后3 d比较，术后7 d ALT、AST指标均降低，且隧道法组低于前入路组（P<0.05）。与术前比较，两组术后3 d白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、C-反应蛋白（CRP）指标均升高，术后7 d指标降低，且隧道法组低于前入路组（P<0.05）。两组患者术后并发症总发生率及术后12个月的无病生存期比较，差异均无统计学意义（P>0.05）。

与前入路腹腔镜解剖性左半肝切除术相比，隧道法腹腔镜解剖性左半肝切除术可减少肝细胞癌患者术中出血量、缩短肝门阻断时间，加快术后胃肠功能恢复、引流管拔除及住院进程，能减少手术操作对肝功能的损伤和炎症反应，安全性良好，并促进术后短期恢复。

To compare the clinical efficacy of laparoscopic anatomical left hepatectomy via anterior approach versus tunnel approach for hepatocellular carcinoma (HCC).

A total of 114 patients with HCC who underwent laparoscopic anatomical left hepatectomy from December 2019 to December 2024 were retrospectively enrolled. The patients were divided into the anterior approach group (n=57) and the tunnel approach group (n=57) according to surgical access. Perioperative parameters, liver function indices and inflammatory factors were compared using the t test or χ² test. The 12-month postoperative disease-free survival curves were plotted by the Kaplan-Meier method, and the Log-Rank test was performed for intergroup comparison.

The tunnel approach group had less intraoperative blood loss, as well as shorter hepatic portal occlusion time, gastrointestinal function recovery time, drainage tube removal time and hospital stay than the anterior approach group (P<0.05). Compared with preoperative levels, alanine transaminase (ALT) and aspartate transaminase (AST) were elevated on postoperative day 3 and day 7 in both groups; these two indicators decreased on postoperative day 7 relative to day 3, and were significantly lower in the tunnel approach group (P<0.05). Interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP) increased on postoperative day 3 and decreased on postoperative day 7 in both groups, with lower levels observed in the tunnel approach group (P<0.05). There were no significant differences in the overall incidence of postoperative complications and 12-month disease-free survival between the two groups (P>0.05).

Compared with laparoscopic anatomical left hepatectomy via the anterior approach, the tunnel approach can reduce intraoperative blood loss and hepatic portal occlusion time, accelerate the recovery of gastrointestinal function, drainage tube removal and hospital discharge. It also alleviates surgical damage to liver function and postoperative inflammatory response with favorable safety, and facilitates short-term postoperative recovery of HCC patients.