目的 探讨基于Laennec膜的肝静脉鞘内解剖法在腹腔镜解剖性肝切除术中应用的有效性及安全性。方法 回顾性分析2023年9月至2026年2月皖南医科大学第一附属医院（弋矶山医院）肝胆外科二病区连续收治的104例行腹腔镜解剖性肝切除术病人的临床资料。其中，48例病人采用肝静脉鞘内解剖法行腹腔镜解剖性肝切除术（肝静脉鞘内解剖组），56例病人行常规腹腔镜解剖性肝切除术（常规组）。记录并比较两组病人的基线资料、手术相关指标及术后指标。结果 两组病人均顺利完成手术，其中肝静脉鞘内解剖组中转开放手术率为6.3%，常规组为7.1%。肝静脉鞘内解剖组行独立肝段切除15例（4段4例、7段5例、8段6例），联合肝段切除33例（左半肝8例、右前叶6例、右后叶7例、右半肝6例、右后叶+右前叶背侧段4例及肝中叶切除2例）；常规组行独立肝段切除16例（4段4例、7段9例、8段3例），联合肝段切除40例（左半肝11例、右前叶4例、右后叶11例、右半肝8例及肝中叶6例），组间比较差异无统计学意义（P>0.05）；肝静脉鞘内解剖组在手术时间、Pringle法阻断次数、阻断时间、术中出血量均低于常规组，组间比较具有统计学差异（P<0.05）；另外，肝静脉鞘内解剖组术中发生气栓2例，常规组发生1例。两组病人术后第1天肝功能比较差异无统计学意义（P>0.05）；在术后并发症方面，肝静脉鞘内解剖组术后出现Ⅲ级以下并发症6例，Ⅲ/Ⅳ级并发症5例；常规组术后出现Ⅲ级以下并发症7例，Ⅲ/Ⅴ级并发症共7例，组间比较差异无统计学意义（P>0.05）。肝静脉鞘内解剖组病人术后住院时间为（9.3±4.0）d，常规组术后住院时间为（10.1±4.4）d。所有病人病理切缘均为阴性。结论 采用肝静脉鞘内解剖法进行腹腔镜解剖性肝切除术是安全、有效的，能够缩短手术时间并减少术中出血量，但需有效控制中心静脉压。

Objective To preliminarily explore the efficacy and safety of the Laennec membrane-based intrasheath dissection of the hepatic veins in laparoscopic anatomic hepatectomy. Methods This retrospective analysis examined the clinical data of 104 patients who underwent laparoscopic anatomic hepatectomy and were consecutively admitted to Ward 2 of the Department of Hepatobiliary Surgery at the First Affiliated Hospital of Wannan Medical University (Yijishan Hospital) between September 2023 and February 2026. Among these, 48 patients underwent laparoscopic anatomic hepatectomy using the intra-hepatic vein sheath dissection technique (intrasheath dissection of the hepatic veins group), while 56 patients underwent conventional laparoscopic anatomic hepatectomy (conventional group). Baseline data, surgery-related parameters, and postoperative outcomes were recorded and compared between the two groups. Results Both groups of patients successfully underwent surgery; the conversion rate to open surgery was 6.3% in the intra-sheath group and 7.1% in the conventional group. In the intrasheath dissection of the hepatic veins group, 15 cases of isolated hepatic segment resection were performed (4 cases of segment 4, 5 cases of segment 7, and 6 cases of segment 8), and 33 cases of combined hepatic segment resection were performed (8 cases of left hepatic hemispherectomy, 6 cases of right anterior lobe resection, 7 cases of right posterior lobe resection, 6 cases of right hepatic hemispherectomy, 4 cases of right posterior lobe plus dorsal segment of the right anterior lobe resection, and 2 cases of middle hepatic lobe resection); in the conventional group, 16 cases underwent isolated segmental resection (4 cases of segment 4, 9 cases of segment 7, and 3 cases of segment 8), and 40 cases underwent combined segmental resection (11 cases of left hepatic hemispherectomy, 4 cases of right anterior lobe resection, 11 cases of right posterior lobe resection, 8 cases of right hepatic hemispherectomy, and 6 cases of middle hepatic lobe resection); with no statistically significant differences between the groups (P>0.05). The intrasheath dissection of the hepatic veins group had shorter operative times, fewer Pringle maneuvers, shorter occlusion times, and lower intraoperative blood loss compared to the conventional group, and these differences were statistically significant (P<0.05); additionally, 2 cases of air embolism occurred in the intrasheath dissection of the hepatic veins group, compared to 1 case in the conventional group. There was no statistically significant difference in liver function between the two groups on the first postoperative day; regarding postoperative complications, 6 patients in the intrasheath dissection of the hepatic veins group experienced Clavien-Dindo Grade III or lower complications, 5 cases of Grade Ⅲ and Ⅳ complications; in the conventional group, 7 patients experienced Clavien-Dindo Grade Ⅲ or lower complications, and a total of 7 cases of Grade Ⅲ and Ⅴ complications; there was no statistically significant difference between the groups. The postoperative length of hospital stay was (9.3±4.0) days in the intrasheath dissection of the hepatic veins group and (10.1±4.4) days in the conventional group. All patients had negative pathological margins. Conclusion The use of intrasheath dissection of the hepatic veins for laparoscopic anatomic hepatectomy is safe and effective, and can shorten operative time and reduce intraoperative blood loss. However, effective control of central venous pressure is required.