目的:观察射频消融(RFA)治疗肝癌切除术后复发小肝癌的安全性和有效性。方法:回顾性分析2014年1月至2015年5月我院65例原发性肝癌切除术后复发小肝癌的患者的临床资料。其中对照组(30例)行再次手术切除复发的肝癌;观察组(35例)采用超声引导下经皮射频消融和腹腔镜辅助下射频消融对复发的肝癌进行原位消融毁损。结果:(1)观察组治疗对肝功的损害明显小于对照组;(2)对照组肝癌完全切除率为88.37%(38/43)、观察组肝癌的完全消融毁损率为89.58%(43/48);2组术中均无副损伤发生;观察组的术中出血量、术后漏胆发生率、术后住院时间均明显低于对照组(P<0.05);(3)2组的血清甲胎蛋白(AFP)与血管内皮生长因子(VEGF)浓度在术后第2周与术前1 d比较均明显降低(P<0.05),在术后第6个月、第12个月、第18个月行组间比较均无显著性差异(P>0.05);(4)观察组术后1个月复查CT,其所有癌灶的完全凝固性坏死率为85.41%;癌灶越大,完全性凝固性坏死率越低;(5)观察组的肝癌再次复发率在RFA术后第6个月、第12个月、第18个月与对照组比较均无显著性差异(P>0.05)。结论:射频消融治疗肝癌切除术后复发的小肝癌是微创、安全和有效的。 Objective: To observe the safety and efficacy of radiofrequency ablation (RFA) in the treatment of recurrent small hepatocellular carcinoma after hepatectomy. Methods: The clinical data of 65 patients with recurrent small hepatocellular carcinoma after resection of primary liver cancer from January 2014 to May 2015 in our hospital were retrospectively analyzed. The control group (30 cases) underwent surgical resection of recurrent hepatocellular carcinoma; the observation group (35 cases) underwent ultrasound-guided percutaneous radiofrequency ablation and laparoscopic-assisted radiofrequency ablation for recurrent hepatocellular carcinoma undergoing in situ ablation and damage. RESULTS: (1) The damage to liver function in the observation group was significantly less than that in the control group; (2) The complete resection rate of liver cancer in the control group was 88.37% (38/43), and the complete ablation and destruction rate of the liver cancer in the observation group was 89.58% (43/ 48); There was no secondary injury in the 2 groups; intraoperative blood loss, postoperative leak rate, postoperative hospital stay were significantly lower in the observation group than in the control group (P<0.05); Serum alpha-fetoprotein (AFP) and vascular endothelial growth factor (VEGF) levels were significantly lower at the 2nd week after surgery compared with 1d before surgery (P<0.05), and at the 6th and 12th months after surgery. There was no significant difference between the 18th month group (P>0.05); (4) In the observation group, the complete coagulation necrosis rate of all the foci was 85.41% at 1 month after the observation; the larger the foci The rate of complete coagulative necrosis was lower; (5) The recurrence rate of liver cancer in the observation group had no significant difference with the control group at the 6th, 12th, and 18th months after RFA (P> 0.05). Conclusion: Radiofrequency ablation is a minimally invasive, safe and effective treatment for recurrent small hepatocellular carcinoma after hepatectomy.