目的 评价断流联合肝切除或射频消融（RFA）治疗门静脉高压症（PHT）合并原发性肝癌 （HCC）手术安全性和远期疗效。方法 回顾分析 490 例患者临床资料，其中 280 例行断流联合肝切除（肝 切除组），210 例行断流联合 RFA（RFA 组）。观察手术并发症、术后总体与无复发生存率及影响因素。 结果 术后无肝性脑病、肝功能衰竭和手术死亡病例。术后 1、3、5 年总体生存率肝切除组为 94.1%、 81.5%、74.2%，RFA 组为 86.3%、72.0%、37.8%（P < 0.001）。年龄、手术方式、肝癌分期与 Child⁃Pugh 分级为 影响术后总体生存的独立危险因素。术后 1、3、5 年无复发生存率肝切除组为 69.2%、54.4%、40.6%，RFA 组为 58.7%、28.5%、18.5%（P < 0.001）。年龄、肝癌大小，Child⁃Pugh 分级与 AFP 为影响术后无复发生存的 独立危险因素。结论 同期联合手术是 PHT 合并 HCC 安全有效的治疗方式。手术切除远期效果好，在条 件允许的情况下应尽可能采用断流联合肝切除。

Objective To evaluate the safety and long⁃term efficacy of devascularization and hepatectomy or radiofrequency ablation （RFA）to treat portal hypertension （PHT）with hepatocellular carcinoma （HCC）. Method Retrospective analysis of clinical data of 490 patients，including 280 cases of devascularization and hepatectomy（hepatectomy group）and 210 cases of devascularization and RFA（RFA group）. The postoperative complications，overall survival rate andrecurrence free survival rate were observed.To analyze the risk factors of postoperative survival and recurrence of HCC. Results There were no cases of encephalopathy，liver failure and surgical deaths. The overall survival rates at 1，3，5 years after surgery were 94.1%，81.5%，74.2% in the hepatectomy group，and 86.3%，72.0%，37.8% in the RFA group（P < 0.001）. Age，surgical method，tumor staging，and Child⁃ Pugh grading are independent risk factors for overall survival. The 1st，3rd，5th year recurrence free survival rates were 69.2%，54.4%，and 40.6% respectivelyin the hepatectomy group，and 58.7%，28.5%，and 18.5% respectively in the RFA group（P < 0.001）. Age，tumor size，Child⁃Pugh grade，and AFP are independent risk factors for recur⁃ rence free survival. Conclusion Simultaneous surgery is a safe and effective treatment for PHT with HCC. The long⁃ term effect of liver resection is better. Devascularization and liver resection should be preferred in practice.