目的:评估小肝癌热消融治疗术后残留危险因素。方法:回顾性分析2009年12月至2015年8月中国医学科学院肿瘤医院收治的107例单发最大径≤3 cm首诊肝细胞癌患者，其中男性81例，女性26例；<70岁83例，70岁及以上24例。以射频消融或微波消融为治疗手段，4~6周后复查肝脏CT或磁共振成像（MRI）。根据有无强化判断肿瘤是否已失活，并通过术前术后的CT或MRI对照判断是否完全消融，以此评估消融疗效。观测指标主要包括患者一般资料、肿瘤位置及毗邻、消融方式、肝炎病史等。采用单因素、多因素logistic回归分析其消融残留危险因素。结果:完全消融101例，残留6例，残留率5.6%。单因素分析显示肿瘤临近血管结构、分化差、甲胎蛋白（AFP）≥200 μg/L为消融残留的危险因素（n P值均<0.05）；多因素logistic回归分析显示肿瘤分化差为唯一独立危险因素（n HR=2.26，95%n CI 0.25~20.50，n P=0.030）。n 结论:肿瘤低分化是热消融治疗小肝癌术后残留的独立危险因素。针对这部分患者应术后行严密随访，并多学科讨论制定综合治疗方案。“,”Objective:To evaluate the risk factors of residual tumor after thermal ablation in patients with small hepatocellular carcinoma.Methods:This was a retrospective study recruiting 107 patients diagnosed as single hepatocellular carcinoma with maximum diameter ≤3 cm from December 2009 to August 2015 in National Cancer Center. The cohort enrolled 81 males and 26 females, including 83 patients younger than 70 years old. All patients were treated with radiofrequency ablation or microwave ablation, and evaluated by CT or MRI after 4-6 weeks compared with baseline data. Potentially related factors were analyzed such as patients′ characteristics, tumor location and adjacent, ablation pattern, hepatitis B/C infection. A multivariate logistic regression analysis was conducted for the independence of risk factors.Results:Six patients (5.6%) with residual tumor was detected in the whole population of 101 cases. Univariate analysis suggested that tumor adjacent to vascular structure, poor differentiation, AFP≥200 μg/L were the risk factors of residue disease (all n P<0.05). Multivariate logistic regression suggested that pathological type of poorly differentiated tumor was the only independent risk factor (n HR=2.26,95%n CI 0.25-20.50, n P=0.030).n Conclusions:Poorly differentiated pathology is an independent predictive factor for residual disease in small hepatocellular carcinoma after thermal ablation. Such patients should be routinely followed up after operation.