目的 探讨腹腔镜左半肝切除术中不同肝血流阻断方式对原发性肝癌患者血清高迁移率族蛋白B1（HMGB1）、胸苷激酶1（TK1）、H2A组蛋白家族成员X（H2AFX）水平及免疫功能的影响。 方法 选择2022年1月至2023年5月期间康复大学青岛中心医院收治的141例原发性肝癌患者（腹腔镜左半肝切除），依据其术中实际采用的肝血流阻断方式分为A组（Pringle法，n = 57）、B组（鞘内解剖法，n = 45）与C组（联合静脉阻断法，n = 39）。3组术后均进行随访，随访截至2025年5月31日或患者死亡。比较3组围手术期相关指标，比较术前和术后3 d 3组肝功能［丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、总胆红素（TBIL）、前白蛋白（PA）、碱性磷酸酶（ALP）］、免疫功能（CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺）、血清HMGB1、TK1、H2AFX水平情况，比较3组随访期间术后并发症发生情况及总生存期（OS）、无进展生存期（PFS）。 结果 3组间的术中出血量及术后恢复时间（包括排气、下床、进食流质及住院时间）C组< B组< A组（P < 0.05）。较术前，3组术后3 d ALT、AST、TBIL、ALP、CD8⁺升高，且A组> B组> C组；PA、CD3⁺、CD4⁺、CD4⁺/CD8⁺下降，A组< B组< C组，差异有统计学意义（P < 0.05）。相较术前，3组术后3 d血清HMGB1、TK1、H2AFX水平升高，且C组< B组< A组（P < 0.05）。随访期间，C组并发症发生率低于A、B组，差异有统计学意义（P < 0.05），B组与A组并发症比较差异无统计学意义（P > 0.05）。3组总OS比较差异有统计学意义（χ² = 7.189，P = 0.028），其中C组OS优于A组（HR = 0.517，95%CI：0.325 ~ 0.824）和B组（HR = 0.621，95%CI：0.387 ~ 0.996）；3组PFS比较差异有统计学意义（χ² = 7.493，P = 0.024），其中C组PFS优于A组（HR = 0.509，95%CI：0.319 ~ 0.814）和B组（HR = 0.644，95%CI：0.400 ~ 1.038）。 结论 联合静脉阻断法相较于单纯Pringle法或单纯鞘内解剖法，能更有效地抑制腹腔镜左半肝切除术引起的血清HMGB1、TK1、H2AFX水平升高，减轻肝功能损伤和免疫功能紊乱，减少术后并发症，并获得更优的近期疗效与远期生存。

Objective To investigate the effects of different hepatic blood flow occlusion methods on the serum levels of high mobility group protein B1 （HMGB1）， thymidine kinase 1 （TK1）， H2A histone family member X （H2AFX）， and the immune function in patients with primary liver cancer during laparoscopic left hemihepatectomy. Methods A total of 141 patients diagnosed with primary hepatocellular carcinoma who underwent laparoscopic left hemihepatectomy at the Rehabilitation University Qingdao Central Hospital from January 2022 to May 2023 were selected. According to the actual hepatic blood-flow occlusion technique employed during the surgery， they were divided into three groups： Group A （Pringle maneuver， n = 57）， Group B （intrahepatic sheath dissection method， n = 45）， and Group C （combined venous occlusion method， n = 39）. All three groups were followed up post-operatively until May 31， 2025， or until the patient's death. Perioperative indicators were compared among the groups. Liver function ［alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， total bilirubin （TBIL）， prealbumin （PA）， alkaline phosphatase （ALP）］， immune function （CD3⁺， CD4⁺， CD8⁺， CD4⁺/CD8⁺ ratio）， and serum levels of HMGB1， TK1， and H2AFX were evaluated preoperatively and on the third postoperative day. Moreover， the incidence of postoperative complications during the follow-up period， overall survival （OS）， and progression-free survival （PFS） were compared among the three groups. Results Significant differences were detected among the three groups in terms of intraoperative blood loss and postoperative recovery times （including time to first flatus， ambulation， initiation of liquid diet， and hospital stay）. Group C exhibited the most favorable outcomes， followed by Group B， and then Group A （C < B < A， P < 0.05）. When compared to preoperative levels， on the third postoperative day， the levels of ALT， AST， TBIL， ALP， and CD8⁺ increased in all groups. Group A had the highest levels， followed by Group B， and Group C had the lowest （A > B > C， P < 0.05）. Conversely， the levels of PA， CD3⁺， CD4⁺， and the CD4⁺/CD8⁺ ratio decreased. Group A had the lowest values， followed by Group B， and Group C had the highest （A < B < C， P < 0.05）. Compared with preoperative levels， the serum levels of HMGB1， TK1， and H2AFX increased on the third postoperative day in all groups. The smallest increase was observed in Group C， followed by Group B， and the greatest increase was in Group A （C < B < A， P < 0.05）. During the follow-up period， the complication rate in Group C was significantly lower than those in Groups A and B （P < 0.05）， while there was no significant difference between Groups A and B （P > 0.05）. A statistically significant difference in overall OS was identified among the three groups （χ² = 7.189， P = 0.028）. Specifically， Group C had a superior OS compared to Group A （HR = 0.517， 95%CI： 0.325 - 0.824） and Group B （HR = 0.621， 95%CI： 0.387 - 0.996）. Similarly， a statistically significant difference in PFS was found （χ² = 7.493， P = 0.024）， with Group C showing better PFS than Group A （HR = 0.509， 95%CI： 0.319 - 0.814） and Group B （HR = 0.644， 95%CI： 0.400 - 1.038）. Conclusions Compared with the conventional Pringle maneuver or the intrahepatic sheath dissection method used alone， the combined venous occlusion method can more effectively suppress the postoperative elevation of serum HMGB1， TK1， and H2AFX levels induced by laparoscopic left hemihepatectomy. It can mitigate liver function impairment and immunological dysfunction， reduce postoperative complications， and achieve superior short-term efficacy and long-term survival outcomes.