中文摘要：

目的探讨精准肝切除术治疗大肝癌的临床疗效。方法采用回顾性描述性研究方法。收集2014年6月至2015年6月中山大学附属第一医院收治的49例原发性肝癌患者的临床资料。术前对患者一般情况、肝功能分级进行评估，计算剩余肝脏体积／标准肝脏体积（FLV／SLV）比值。符合行大肝癌切除术标准者行右半肝切除术、扩大右半肝切除术或联合肝脏分隔和门静脉结扎的二步肝切除术（ALPPS）。观察指标：（1）术前评估结果。（2）手术情况：手术方式，肝切除术手术时间，术中出血量及围术期输血情况：ALPPS第1步手术时间、第1步术中出血量、第1步与第2步手术间隔时间、至第2步手术时肝体积增长率、第2步手术时间和术中出血量。（3）术后情况：术后住院时间、术后并发症（肝功能不全、胆汁漏、腹腔感染、切口感染、胸腔积液、腹腔积液、膈下积液等）。（4）随访情况。采用门诊方式进行随访，了解患者术后肿瘤复发率。随访时间截至2016年6月。正态分布的计量资料以x^-±s表示，偏态分布的计量资料用肘（范围）表示。结果（1）术前评估结果：49例患者中，46例术前肝功能Child—Pugh分级A级，3例B级；46例ICGR15〈10％及FLV／SLV〉35％，3例ICGR15〉15％或FLV／SLV〈35％。（2）手术情况：49例患者中，44例行右半肝切除术，2例行扩大右半肝切除术，3例行ALPPS。44例行右半肝切除术及2例行扩大右半肝切除术患者手术时间为230min（170～405min），术中出血量为400mL（100～5000mL），围术期输血19例，输血量为550mL（200～2750mL）。3例行ALPPS患者均成功完成2步手术，第1步手术时间分别为80、190、180min，术中出血量分别为100、300、150mL。第1步与第2步手术间隔时间分别为9、11、13d，至第2步手术时肝体积增长率分别为88．4％、78．0％、94．6％，第2步手术时间分别?

英文摘要：

Objective：To evaluate the clinical effect of precise liver resection for large hepatocellular carcinoma （HCC） under the guidance of precision surgery theory. Methods：The retrospective and descriptive study was conducted. The clinical data of 49 patients with HCC who were admitted to the First Affiliated Hospital of Sun YatSen University between June 2014 and June 2015 were collected. The preoperative assessments of general condition and liver function were conducted, and the ratio of future liver volume/standard liver volume （FLV/SLV） was calculated. Patients underwent right hemihepatectomy, extended right hemihepatectomy or associating liver partition and portal vein ligation for staged hepatectomy （ALPPS） based on preoperative comprehensive assessment.Observation indicators： （1） results of preoperative assessment; （2） operation situations： surgical procedures, time of hepatectomy, volumes of intraoperative blood loss and perioperative blood transfusion; time and volume of intraoperative blood loss in the first surgery, interval time between the first and second surgery, growth rate of liver volume up to the second surgery, time and volume of intraoperative blood loss in the second surgery; （3） postoperative situations： duration of postoperative hospital stay, postoperative complications （hepatic dysfunction, bile leakage, intraabdominal infection, wound infection, pleural effusion, peritoneal effusion and subphrenic effusion）; （4） followup situation. Followup using outpatient examination was performed to detect 1year recurrence rate of patients up to June 2016. Measurement data with normal distribution were represented as x^-±s and measurement data with skewed distribution were represented as M （range）. Results： （1） Results of preoperative assessment： of 49 patients, grade A of Childpugh classification was found in 46 patients and grade B in 3 patients. ICG R15〈10% and FLV/SLV〉35% was detected in 46 patients,and ICG R15〉15% or FLV/SLV〈35% in 3 patie