【摘要】 肝炎后肝硬化通常合并门静脉高压症,后者常致脾功能亢进(脾亢)。对于同时伴有脾亢的患者,是否联合行脾脏切除,目前尚存在争议。持保脾观点的一方认为,脾切除后会降低免疫功能,增加感染机会和肝肿瘤的发生,同时会增加门静脉系统并发血栓的风险。而主张切脾的一方认为,联合脾切除作为外科治疗门脉高压症的主要方法之一,除了能降低门静脉压、减少消化道出血的发生及纠正血细胞减少外,且认为病变的脾脏,会导致免疫抑制,脾切除后可以改善患者的免疫功能,还能促进肝细胞再生、改善肝功能、抑制肝纤维化进展。目前双方主要就切脾与保脾对患者的肝血流和门静脉压、肝功和血系、血栓的发生、机体免疫及对肝纤维化的进展等方面意见不一。故笔者结合现有临床及实验研究,综述肝硬化门静脉高压症所致脾亢患者是否需行脾脏切除术的现状和研究进展,以期提高临床的认识和为临床决策提供参考。更多还原

【Abstract】 Posthepatitic cirrhosis is usually complicated with portal hypertension, and the latter often causes hypersplenism. Yet, there is controversy about whether splenectomy is necessary for those patients with combined hypersplenism. Those who hold the view of spleen preservation believe that splenectomy will impair immune function, increase the chance of infection and the occurrence of liver tumors, and meanwhile increase the risk of portal vein thrombosis. Those who advocate for splenectomy believe not only that as one of the main surgical treatment methods for portal hypertension, synchronous splenectomy can decrease the portal vein pressure, reduce the occurrence of gastrointestinal bleeding and correct cytopenia, but that the diseased spleen will lead to immune suppression, and splenectomy can improve the immune function of patients, and simultaneously, it can also promote the regeneration of liver cells, improve liver function and inhibit the progression of liver fibrosis. At present, the two sides have different opinions on some issues comparing patients with splenectomy and spleen preservation,such as liver blood flow and portal vein pressure, liver function and blood system, occurrence of thrombosis, immune system and progress of liver fibrosis. Therefore, based on the existing clinical and experimental studies, the authors address the current status and research progress regarding whether splenectomy should be performed in patients with hypersplenism caused by cirrhotic portal hypertension, so as to improve clinical understanding and provide relevant information for clinical decision making.更多还原