复杂肝血管瘤常因瘤体巨大、毗邻或包绕肝门区重要血管及胆道结构，手术风险高、技术难度较大，是肝脏外科具有挑战性的手术。如何在有效控制术中出血的前提下实现安全切除，并最大限度保留肝功能，是临床实践中的核心问题。对于复杂肝血管瘤，须严格把握手术适应证，坚持“无症状不治疗；不长大宜观察”的原则。治疗决策需基于明确的临床症状，并排除周围器官疾病的影响。同时，强调多学科综合治疗协作组（MDT）的精细化评估，尤其是术前利用三维计算机断层扫描（3D-CT）重建和磁共振胰胆管成像（MRCP）技术，明确肿瘤与肝门结构、静脉系统的空间关系，并计算残余肝体积，从而制定个体化的手术方案。肝血流阻断技术（如Pringle法）能有效减少术中出血并使瘤体萎瘪，从而增加操作空间。肝门板相关技术在分离和下降肝门板时，有助于保护胆管结构。此外，遵循Laennec膜理念进行解剖分离，以及在必要时使用肝脏悬吊提拉技术，均能简化操作并降低静脉损伤的风险。在术式选择上，应遵循“首选剥除，必要时切除”的个体化原则，根据肿瘤解剖学特征灵活应用。围手术期管理方面，低中心静脉压技术和自体输血技术的应用对于减少创面出血和异体输血风险至关重要。术后则需密切监测循环稳定、肝功能及凝血功能，积极预防和干预出血、胆漏、感染等并发症。精细的术前评估、清晰的手术策略结合对肝脏解剖和相关膜结构技术的深刻理解，是实现复杂肝血管瘤安全切除并降低并发症的关键。

Complex hepatic hemangioma is a challenging procedure in hepatic surgery, often associated with high surgical risks and great technical difficulties due to its massive size and its adjacency to or encasement of important vascular and biliary structures in the hepatic hilar region. How to achieve safe resection under the premise of effectively controlling intraoperative bleeding and maximally preserving liver function is a core issue in clinical practice. For complex hepatic hemangiomas, surgical indications must be strictly grasped, adhering to the principle of “no treatment for asymptomatic cases; observation for non-enlarging tumors”. Treatment decisions should be based on clear clinical symptoms and exclude the influence of adjacent organ diseases. Meanwhile, refined evaluation by a multidisciplinary team (MDT) is emphasized. In particular, preoperative three-dimensional computed tomography (3D-CT) reconstruction and magnetic resonance cholangiopancreatography (MRCP) should be utilized to clarify the spatial relationship between the tumor and the hilar structures as well as the venous system, and to calculate the residual liver volume, thereby formulating individualized surgical plans. Hepatic inflow occlusion techniques (such as the Pringle maneuver) can effectively reduce intraoperative bleeding and shrink the tumor, thereby increasing the operating space. Hilar plate-related techniques are helpful in protecting biliary structures during the detachment and lowering of the hilar plate. In addition, anatomical dissection following the concept of Laennec’s capsule and the application of liver hanging maneuver when necessary, can simplify the operation and reduce the risk of venous injury. Regarding the selection of surgical procedures, the individualized principle of “enucleation as the first choice, resection when necessary” should be followed, and flexibly applied according to the anatomical characteristics of the tumor. In terms of perioperative management, the application of low central venous pressure (LCVP) technique and autologous blood transfusion is crucial for reducing wound bleeding and the risk of allogeneic blood transfusion. Postoperatively, close monitoring of hemodynamic stability, liver function, and coagulation function is required, along with active prevention and intervention of complications such as bleeding, biliary leakage, and infection. Refined preoperative evaluation, clear surgical strategies, combined with a profound understanding of liver anatomy and related membranous structure techniques, are the keys to achieving safe resection of complex hepatic hemangiomas and reducing complications.