Objective:The aims of this study were to compare the efficacy between salvage liver transplantation (sLT) and rehepatectomy (RR) basing on the propensity score matching (PSM), and to explore the prognositc factors of patients with recurrent hepatocellular carcinoma (HCC).Methods:124 patients with intrahepatic recurrence after hepatectomy in our center from January 2012 to August 2018 were divided into sLT group( n=46) and RR group( n=78). 34 patients were selected for data analysis base on 1∶1 propensity score matching (PSM). The advantages and disadvantages of the two surgical methods and the prognostic factors of the patients were discussed by comparing the basic clinical data, OS and DFS of the two groups before and after matching. Results:Before matching, the pre-operative serum total bilirubin, the occurrence of multiple tumors, the proportion of preoperative TACE and the proportion of patients within Milan criteria of the sLT group were higher than those of the RR group, and the maximum tumor diameter of the sLT group was shorter than that of the RR group ( P<0.05); the time of operation, the amount of intra-operative blood loss, the positive of MVI and the proportion of postoperative Clavien grade Ⅲ and above of RR group were higher than those of RR group ( P<0.05). After matching, the operation time, intra-operative blood loss and the proportion of postoperative complications of sLT group were higher than those of RR group; there was nosignificant difference between 1-, 3- and 5- years OS of sLT group and RR group( P>0.05), the 1-, 3- and 5-years DFS of sLT group were better than those of RR group( P<0.05); AFP≥100 μg/L was the independent risk factor of OS, and the type of operation and AFP≥100 μg/L were independent risk factors of DFS. Conclusions:The pre-operative condition of sLT group was more severe, and the operation time, intra-operative blood loss and post-operative severe complication rate of sLT group were higher than those of RR group, and the DFS time of sLT group was longer than that of RR group, but there was no significant difference in OS between the two groups.

Based on the analysis of definition and the causes of excessive medical treatment, this paper discus-ses the harm of excessive medical treatment concretely, including increased health care costs, the waste of medical resources, worsening doctor-patient conflicts that influence the development of holistic medicine. And in the per-spective of ethics, professional spirit and the humanistic quality, it puts forward the prevention and countermeasures to solve the problem of excessive medical treatment.

Objective:To analyze prognostic factors of hepatocellular carcinoma (HCC) combined with portal vein tumor thrombus (PVTT) after surgical resection.Methods:The data of 98 patients with HCC combined with PVTT who underwent surgical resection in Ningbo University Affiliated Li Huili Hospital from January 2008 to June 2019 were analyzed retrospectively, including 83 males and 15 females with an average age of 53 years. The survival rate was calculated by Kaplan-Meier method and compared using log-rank test. Cox regression model was used for the multivariate analysis of the prognosis of patients.Results:The 1, 2, and 3-year overall survival rates were 75.9%, 51.5%, and 35.4%, respectively, with a median survival time of 25 months; the 1, 2, and 3-year disease-free survival rates were 35.0%, 16.1%, and 8.6%, respectively, with a median disease-free survival time of 8 months. Multivariate analysis showed that the overall survival of patients with preoperative alpha-fetoprotein (AFP) ≥400 μg/L ( HR=1.760, 95% CI: 1.079-2.873) and hepatic vein tumor thrombus (HVTT, HR=3.809, 95% CI: 1.655-8.765) was poorer after surgical resection (all P<0.05), while the survival of patients with postoperative adjuvant trans-arterial chemoembolization (TACE) ( HR=0.397, 95% CI: 0.220-0.716, P=0.002) was better. Preoperative AFP≥400 μg/L ( HR=2.339, 95% CI: 1.488-3.676) , undergoing HCC resection combined with PVTT dissection ( HR=2.038, 95% CI: 1.090-3.811), and with HVTT ( HR=2.374, 95% CI: 1.160-4.857) (all P<0.05) are independent risk factors for recurrence in patients with HCC combined with PVTT, postoperative adjuvant TACE ( HR=0.535, 95% CI: 0.307-0.933, P=0.027) is a protective factor. Conclusion:Preoperative AFP≥400 μg/L and HVTT are independent risk factors for the prognosis of patients with HCC combined with PVTT. Reasonable selection of surgical methods and postoperative adjuvant TACE may improve the prognosis of patients.