目的 探究肝脏占位行腹腔镜下肝切除术后患者实现肝脏手术教科书结局（TOLS）的影响因素。 方法 通过回顾性队列研究的方法，收集2021年1月至2024年1月就诊于医院且行腹腔镜下肝部分切除术的患者数据，并进行统计分析。 结果 211例肝脏占位患者中，170例（80.6%）术后发生TOLS。腹腔镜下肝切除术患者是否发生肝脏手术教科书式结局与乙肝占比、体质量指数、血清总胆红素、谷草转氨酶、血小板、ASA评分、术中出血量、术中是否输血、手术时间、占位最大径、占位性质和肝切除范围有关（P < 0.05）；其中血清总胆红素、占位最大径、术中出血量和肝切除范围是TOLS的独立危险因素（P < 0.05）。四者联合指标的AUC值为0.974（P < 0.05），预测价值明显高于独立指标。 结论 血清总胆红素、占位最大径、术中出血量和肝切除范围是实现TOLS的独立危险因素，本研究为腹腔镜下肝切除术的短期预后评估提供了新的视角。

Objective To investigate the factors affecting the achievement of the textbook outcome for liver surgery （TOLS） in patients undergoing laparoscopic liver resection for hepatic lesions. Methods A retrospective cohort study was conducted to collect data from patients who underwent laparoscopic partial liver resection at the hospital between January 2021 and January 2024， followed by comprehensive statistical analysis. Results Among 211 patients with liver lesions， 170 （80.6%） successfully achieved TOLS postoperatively. The achievement of TOLS in patients undergoing laparoscopic liver resection was significantly associated with the proportion of hepatitis B carriers， body mass index （BMI）， total bilirubin levels， aspartate aminotransferase （AST）， platelet count， intraoperative blood loss， whether blood transfusion was administered during surgery， operation duration， lesion characteristics， and extent of liver resection （P < 0.05）. Notably， total bilirubin levels， American Society of Anesthesiologists （ASA） score， intraoperative blood transfusion， intraoperative blood loss， and extent of liver resection were identified as independent factors influencing the attainment of TOLS （P < 0.05）. Conclusions Serum total bilirubin levels， intraoperative blood transfusion requirements， intraoperative blood loss volume， and the extent of liver resection independently influence the achievement of TOLS. This study introduces a novel method for evaluating the short-term prognosis following laparoscopic liver resection.