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目的：探讨腹腔镜解剖性肝切除治疗肝细胞癌的临床效果及安全性。方法：选择2011 年2 月～2013 年8 月在我院进行诊治的肝细胞癌患者90 例，将其随机分为治疗组与对照组，每组各45 例。治疗组采用腹腔镜解剖性肝切除治疗，对照组采用开腹解剖性肝切除，两组术后都常规化疗3 个月，观察和比较两组术中出血量、术后肛门排气时间和术后住院时间，并发症的发生情况及术前后血清谷氨酸转移酶(ALT)与天冬氨酸转移酶(AST)的水平。结果：与对照组相比，治疗组的术中出血量、术后肛门排气时间和术后住院时间均明显降低或缩短(P<0.05)，术后3 个月的膈下积液、切口感染、肺部感染、胆漏的发生率明显降低(P<0.05)。两组术前血清ALT 与AST 值对比差异无统计学意义(P>0.05)；术后1 周，两组的ALT 与AST 值都明显升上(P<0.05)；术后3个月，治疗组的ALT 与AST 值明显低于对照组(P<0.05)。所有患者随访到2015 年8 月，治疗组的中位生存期为(18.33± 3.11)个月，而对照组为(12.46± 2.19)个月，较治疗组明显缩短(P<0.05)。结论：腹腔镜解剖性肝切除治疗肝细胞癌具有更好的微创性，能减少近期并发症的发生，促进肝功能的恢复，且能够延长患者的生存时间。

英文摘要:

Objective:To investigate the clinical effects and safty of laparoscopic anatomical liver resection for the hepatocellular carcinoma.Methods:90 patients with hepatocellular carcinoma treated from February 2011 to August 2013 in our hospital were equally divided into the treatment group and the control group accorded to the computer software randomization method, 45 patients in each group, the treatment group was given the laparoscopic anatomical liver resection, and the control group was given the open anatomic liver resection, and all the patients were given the postoperative chemotherapy routinely for 3 months. The blood loss, postoperative anal exhaust time, postoperative hospital stay, the occurrence of complications and the level of serum glutamate transferase (ALT) and aspartate aminotransferase (AST) levels were compared before and after surgery between two groups.Results:The blood loss, postoperative anal exhaust time and postoperative hospital stay of treatment group were lower or shorter than those of the control group (P<0.05).,the incidence of subphrenic effusion, wound infection, pulmonary infection, bile leakage and other complications in the treatment group during 3 months after surgery were significantly lower than that of the control group (P<0.05). No significant difference was foun in the preoperative serumALT and AST values between two groups (P>0.05). And the serumALT and AST values at 1st week after surgery of both groups w significantly ascended(P <0.05); but the serum ALT and AST values of treatment group were significantly lower than those of the control group at 3 months after surgery (P<0.05). All patients were followed until August 2015, the median survival time of treatment group was 18.33± 3.11 months, while the control group was 12.46± 2.19 months and significantly shorter than that of the treatment group (P<0.05).Conclusion:Laparoscopic liver resection had better minimally invasive for hepatocellular carcinoma, it could reduce the complications, promote the recovery of liver function, and prolong the survival time of patients.

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