目的：本研究旨在对我国西部地区县级医院肝癌诊断和治疗能力现状进行研究，发现并分析其现存问题和影响县级医院肝癌诊疗能力的因素；在此基础上构建一套针对县级医院肝癌诊疗能力的评价体系，以促进县域肝癌规范化管理，为县级医院提高肝癌诊疗能力提供建议与参考，提升县域肝癌诊疗水平。方法：采用文献研究法，梳理当前我国县级医院肝癌诊疗的现状与问题；采用Joinpoint回归模型对全国肝癌发病率和死亡率年平均变化趋势进行分析；采用问卷调查法和知情人访谈法开展县级医院肝癌诊疗相关的现场调研；通过文献研究构建县级医院肝癌诊疗能力评价体系指标池，采用德尔菲专家咨询法对指标进行讨论和筛选，并利用层次分析法计算出每个指标的权重。结果：（1）我国肝癌持续高发，2012至2018年间，全国肿瘤登记地区肝癌发病与死亡数量呈逐年上升趋势，发病率与死亡率年度变化趋势平稳；（2）2012至2018年间，西部地区肿瘤登记地区肝癌发病率呈小幅下降趋势，死亡率呈小幅上升趋势；（3）西部地区县级医院肝癌诊疗水平存在机构间的不平衡，整体能力有待提升；（4）本研究基于肝癌诊疗技术和县医院功能定位两个维度，构建了县级医院肝癌诊疗能力评价指标体系，包含4个一级指标，13个二级指标和46个三级指标；（5）经层次分析法计算各指标权重，一级指标按权重大小排序依次为县医院职责、规范化管理、治疗能力、诊断能力，三级指标权重排序前五依次为建立患者医共体内下转通道、采用标准版临床诊疗指南、组建县域医共体、具备远程会诊条件、建立患者上转通道。结论：（1）我国肝癌流行情况未明显改善，需加强肝癌防诊治各环节建设；（2）西部地区县级医院肝癌诊疗能力薄弱，规范化管理程度有待提高；（3）建议出台针对基层的肝癌诊疗方案，推进县级肝癌诊疗能力和规范性评价，同时加强县域肝癌诊疗配套设施建设；（4）县级医院接诊肝癌中晚期患者多，应当加强对肝癌的规范化、全病程管理，并提升县域肝癌晚期支持与人文关怀水平。

Objective: The study aims to investigate the current situation of hepatocellular carcinoma(HCC) diagnosis and treatment capacity of county hospitals in Western China, to find and analyse the existing problems and factors affecting the HCC diagnostic and treatment capacity of county hospitals; to construct an evaluation system for the HCC diagnostic and treatment capacity of county hospitals, in order to promote the standardization of the management of HCC in counties, to provide suggestions and references for the improvement for policy-makers and to improve the level of the diagnostic and treatment capacity of HCC in the counties.Methods: This study adopts the literature review method to sort out the current situation and problems of hepatocellular carcinoma diagnosis and treatment in county hospitals in China; analyses the nationwide average annual trend of liver cancer incidence and mortality using the Joinpoint regression model; carries out on-site research related to HCC diagnosis and treatment in county hospitals using the questionnaire survey method and the informant interview method; constructs the indicator pool of the evaluation system of HCC diagnosis and treatment capacity of county hospitals through the literature review; the indicators of the evaluation system of HCC diagnosis and treatment capacity of county hospitals are discussed and filtered using the Delphi expert consultation method and the weights of each indicator are calculated using the AHP method.Results: (1) The incidence of liver cancer in China continues to be at a high level, with the number of liver cancer incidence and mortality in the national cancer registration area showed a rising trend year by year, and the average annual percentage change of incidence and mortality rate was stable between 2012 and 2018. (2) The incidence rate of liver cancer in Western China showed a slight decreasing trend, while the death rate showed a slight increasing trend during this period. (3) The HCC diagnosis and treatment capacity of the county hospitals in Western China has inter-institutional imbalance, and the overall capacity needs to be improved. (4) This study also constructs an evaluation index system of HCC diagnosis and treatment capacity of county hospitals based on two dimensions: HCC diagnosis and treatment methods and county hospitals responsibility, which contains 4 first-level indicators, 13 second-level indicators, and 46 third-level indicators. (5) Under the calculation by AHP method, the dimension of county hospital‘s responsibility has the greatest weight among first-level indicators, followed by standardized management, treatment capacity, and diagnostic capacity. The top five third-level indicators in order of weight are the establishment of a downward referral channel for patients within the county medical community, the adoption of a standardised version of clinical diagnosis and treatment guidelines, the formation of a county medical community, the availability of tele-consultation services, and the establishment of an upward referral channel for patients.Conclusion: (1) The incidence of liver cancer in China has not been significantly improved, so that it is necessary to strengthen the construction of liver cancer prevention, diagnosis and treatment. (2) The capacity of county hospitals in Western China to diagnose and treat liver cancer is weak, with the standardisation of management to be improved. (3) The study suggests that HCC diagnosis and treatment manual should be introduced at primary-level, and to promote the evaluation of HCC diagnosis and treatment capacity. (4) To enhance the management of HCC throughout the course of the disease, and to improve the level of support and palliative care for patients in the terminal stages of HCC in the county area.