目的:探讨严格以肝中静脉为引导的精准性半肝切除治疗区域性肝胆管结石的临床疗效与经验。方法:回顾性分析香港大学深圳医院肝胆胰外科2015年7月至2019年7月采用半肝切除术治疗区域性肝胆管结石47例患者资料，其中男性15例，女性32例，年龄(42±15)岁。全程显露并保留肝中静脉纳入精准手术组(n n＝26)，未能全程显露肝中静脉或者损伤肝中静脉纳入对照组(n n＝21)。对比两组患者的手术时间、术中出血量等手术资料以及术后并发症等情况。n 结果:所有患者均顺利完成手术，术后无肝衰竭患者，术后90 d无死亡患者。精准手术组的手术时间(5.2±1.8)h、术中出血量(620.5±450.8)ml，与对照组手术时间(4.9±2.3)h、术中出血量(760.5±540.2)ml比较差异无统计学意义(n P>0.05)。共有19例(40.4%)患者(精准手术组7例，对照组12例)出现各类并发症36次，术后并发症发生率对照组多于精准手术组[47.6%(10/21)比19.2%(5/26)]，差异具有统计学意义(n P<0.05)。47例患者均获得随访，随访时间6～30个月。术后远期并发症对照组5例患者分别出现残留结石、胆道感染、肝脓肿及胆肠吻合吻合口狭窄伴结石复发，精准手术组仅2例分别发现残留结石及胆肠吻合吻合口狭窄伴结石复发，远期并发症发生率对照组多于精准手术组[23.8%(5/21)比7.7%(2/26)]，差异具有统计学意义(n P0.05). A total of 19 patients (40.4%) (7 in the precision surgery group and 12 in the control group) developed 36 post operative complications of various types. The postoperative complication rate in the control group was higher than that in the precision surgery group [47.6%(10/21) vs 19.2% (5/26)], the difference was significant (n P<0.05). All 47 patients were followed-up for 6 to 30 months. For postoperative long-term complications: 5 patients in the control group had residual stones, biliary tract infection, liver abscess, and biliary-enteric anastomosis stenosis with recurrence of stones, and only 2 patients in the precision surgery group were found to have residual stones and biliary-enteric anastomotic stenosis. Stone recurrence, (the incidence of long-term complication) in the control group was significantly higher than that in the precision surgery group [23.8% (5/21) vs 7.7% (2/26)], (n P<0.05).n Conclusions:Precise anatomical hemi-hepatectomy strictly guided by MHV for regional hepatolithiasis could more fully remove stones and lesions, and reduced the rate of stone recurrence. It was safe and feasible with favorable efficacy.