肝细胞癌行腹腔镜解剖性肝右后区联合右前区背侧段切除术对比右半肝切除术疗效评价

摘要/Abstract

摘要： 目的：探究肝细胞癌腹腔镜解剖性肝右后区联合右前区背侧段切除术对比右半肝切除术临床疗效。
方法：采用回顾性描述性研究方法收集2020年1月至2025年1月中国医学科学院北京协和医学院肿瘤医院收治的34例肝细胞癌患者的临床资料。根据手术方式将其分为肝右后区联合右前区背侧段切除组（联合切除组,17例）与标准右半肝切除组（右半肝切除组,17例）。对比分析两组患者的术中情况、术后恢复指标及远期随访预后。
结果：术中显示34例患者均顺利完成腹腔镜解剖性肝切除术,无中转开腹。与右半肝切除组相比,联合切除组的手术时间较长,第一肝门阻断时间较长,但在术中出血量及输血量上两组表现相当;基于三维重建预测的剩余肝体积,联合切除组显著优于右半肝切除组。术后显示34例患者无住院期间死亡及30 d内再住院;术后组织病理学检查结果显示均为肝细胞癌,标本切缘均为阴性;联合切除组术后胆瘘、腹水等并发症发生率低于右半肝切除组,均经冲洗引流、腹腔穿刺引流后好转;联合切除组术后出现肝功能衰竭风险略低于右半肝切除组,但差异无统计学意义（P=0.403）。34例患者均随访至2026年3月1日,联合切除组的总生存、无复发生存情况均整体优于右半肝切除组,但差异均无统计学意义（P=0.34、0.60）。
结论：腹腔镜解剖性肝右后区联合右前区背侧段切除术治疗肝细胞癌安全可行。相较于标准右半肝切除术,能显著保留更多剩余肝体积并具有潜在降低术后肝衰竭风险的可能,具有更优的围手术期获益且远期疗效并未降低。

关键词: 肝细胞癌, 近红外荧光腹腔镜探查, 解剖性肝切除术, 门静脉流域, 吲哚菁绿, 术中超声, 外科手术

Abstract: Objective:To investigate the clinical efficacy of laparoscopic anatomical resection of the right posterior section combined with the dorsal segment of the right anterior section versus standard right hepatectomy for hepatocellular carcinoma (HCC).
Methods:A retrospective descriptive study was conducted. The clinical data of 34 patients with HCC admitted to the Cancer Hospital, Chinese Academy of Medical Sciences from January 2020 to January 2025 were collected. Based on the surgical procedures, the patients were divided into the combined resection group (anatomical resection of the right posterior section combined with the dorsal segment of the right anterior section, n=17) and the standard right hepatectomy group (right hepatectomy group, n=17). Intraoperative conditions, postoperative recovery indicators, and long-term follow-up prognosis were compared and analyzed between the two groups.
Results:Intraoperative findings demonstrated that all 34 patients successfully underwent laparoscopic anatomical hepatectomy without conversion to open surgery. Compared with the right hemihepatectomy group, the combined resection group exhibited longer operative duration and prolonged hepatic hilum occlusion time; however, both groups showed comparable intraoperative blood loss and transfusion volumes. The residual liver volume predicted by three-dimensional reconstruction was significantly larger in the combined resection group than in the right hemihepatectomy group. Postoperative evaluations revealed no in-hospital deaths or readmissions within 30 days among all 34 patients. Histopathological examinations confirmed hepatocellular carcinoma in all cases, with negative surgical margins. The combined resection group exhibited lower incidence of postoperative complications such as bile fistula and ascites, which resolved after irrigation drainage and peritoneal puncture drainage. The risk of postoperative liver failure was slightly lower in the combined resection group compared to the right hemihepatectomy group, though the difference was not statistically significant (P=0.403). Follow-up until March 1, 2026, showed that the combined resection group achieved superior overall survival and recurrence-free survival rates compared to the right hemihepatectomy group, although these differences were not statistically significant (P=0.34 and P=0.60).
Conclusions:Laparoscopic anatomical resection of the right posterior section combined with the dorsal segment of the right anterior section is safe and feasible for the treatment of HCC. Compared with standard right hepatectomy, this procedure can significantly preserve more future liver remnant and reduce the risk of postoperative liver failure, offering better perioperative benefits without compromising long-term oncological outcomes.

Key words: Hepatocellular carcinoma, Near-infrared fluorescence laparoscopy, Anatomical hepatectomy, Portal vein basin, Indocyanine green, Intraoperative ultrasound, Surgical resection

罗漫, 胡耀炜, 王之浩, 王宏光. 肝细胞癌行腹腔镜解剖性肝右后区联合右前区背侧段切除术对比右半肝切除术疗效评价[J]. 肝癌电子杂志, 2026, 13(2): 1-8.

Luo Man, Hu Yaowei, Wang Zhihao, Wang Hongguang. Efficacy evaluation of laparoscopic anatomical resection of the right posterior and dorsal segments of the hepatic lobe combined with right anterior region resection versus right hemihepatectomy in hepatocellular carcinoma[J]. Electronic Journal of Liver Tumor, 2026, 13(2): 1-8.

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