目的　通过临床肝脏能量代谢研究,探索一套评价肝储备功能,减少手术侵袭及合理进行术后保肝支持治疗的围手术期处理方案。方法　回顾性分析我院 1990 年 1 月至 2004 年 1 月共 14 年间收治的 2 143 例肝癌病例的术前资料、手术治疗情况、术后处理和临床过程以及随访资料。将病例分为前期组(前 7 年)和后期组(后7年)进行比较,同时对术前磷酸化耐受指数(RTI)测定、术中半肝血流阻断及术后连续定时的动脉血酮体比率(AKBR)测定进行分析,并比较其价值。结果　①两组比较显示,后期组小肝癌比例增加,手术切除率增加,术后并发症及死亡率下降,长期生存率提高; ②采用术前RTI测定来指导手术方式选择,使术后并发症发生率由 21.1%降至11.0%,手术死亡率由1.6%降至0.3%; ③术中采用全入肝血流阻断(n=476)与半肝血流阻断技术(n=523)相比较,术后并发症率及手术死亡率分别由 25.8%及 2.3%降至 11.9%及 0.6%,住院时间平均缩短 3.5 d; ④术后采用连续AKBR监测以指导术后保肝、支持治疗,对及时处理和预防肝衰有重要价值。结论　肝切除术围手术期采用肝能量代谢指标(RTI、AKBR)测定,可以准确、有效地评价肝储备功能,指导手术切除范围并合理进行术后保肝、支持治疗; 术中采用半肝血流阻断技术可有效降低手术侵袭,保护残肝功 Objective To explore a set of perioperative management protocols for assessing liver reserve function, reducing surgical invasion and rational postoperative hepatoprotective support through clinical liver energy metabolism. Methods The preoperative data, surgical treatment, postoperative management, clinical course and follow-up data of 2 143 cases of HCC treated in our hospital from January 1990 to January 2004 for 14 years were retrospectively analyzed. The cases were divided into the early group (7 years) and the later group (7 years later), and compared with preoperative phosphorylation tolerance index (RTI), intraoperative hepatic blood flow occlusion and continuous postoperative timing Arterial blood ketone body ratio (AKBR) determination was analyzed and its value was compared. Results ① Comparison of two groups showed that the proportion of small hepatocellular carcinoma in the late stage increased, the rate of surgical resection increased, the postoperative morbidity and mortality decreased, and the long-term survival rate increased. ② The preoperative RTI measurement was used to guide the choice of surgical procedure and make the postoperative complications (N = 476) and hemihepatic blood flow occlusion (n = 523) during the operation, and the mortality rate decreased from 21.1% to 11.0% and from 1.6% to 0.3% Comparing the postoperative complications rate and operative mortality rate from 25.8% and 2.3% to 11.9% and 0.6% respectively, and hospitalization time shortened 3.5 days on average; ④After continuous AKBR monitoring to guide postoperative hepatoprotective and supportive care , Have important value in dealing with and preventing liver failure in time. Conclusions Perioperative hepatic energy metabolism index (RTI, AKBR) can be used to evaluate the hepatic reserve function accurately and effectively, guide the scope of surgical resection and reasonably carry out postoperative hepatoprotective and supportive therapy. During operation, Flow blocking technology can effectively reduce surgical invasion, protect residual liver function