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.