【摘要】 背景与目的：肝内异位脾种植（ES）在临床上较为罕见，患者多在体检中偶然发现肝内病灶，极易误诊为肝脏的良性或恶性肿瘤而影响治疗。因此，本研究探讨肝内ES的临床特点及其诊治方法。方法：回顾性分析总结2015年1月—2022年1月上海东方肝胆外科医院收治的肝内ES患者的临床资料，并行相关文献复习。结果：6例肝内ES患者中，男性4例，女性2例；年龄39～78岁，中位年龄51岁。均有外伤致脾破裂出血行脾切除手术史，脾切除术后至初诊肝内ES时间为20～33年，中位时间27年；4例为单纯肝内ES,2例为肝脏合并膈肌多发ES；伴有右上腹不适者1例，其余5例均在体检中发现；术前MRI或CT检查5例拟诊为肝癌，1例拟诊为血管平滑肌脂肪瘤。6例患者均行肝切除手术。术后病理均证实为异位脾组织，肝内ES灶大小为1.5～5.9 cm，中位直径3.2 cm，其中1例肝内2个病灶病理结果分别为肝内ES和肝细胞癌。6例患者术后恢复顺利，随访半年均未发现新发ES病灶。文献复习结果显示，脾外伤或脾切除术后，90%的ES发生于腹腔内，以小肠浆膜、大网膜、壁层腹膜、肠系膜及盆腔多见，而发生于肝脏、膈肌或其他远隔器官较为罕见。结论：既往有脾外伤行脾切除手术史者，发现肝内病灶应考虑ES可能；肝内ES生长缓慢，多无临床症状，明确诊断后对不伴有临床症状者无需特殊处理。更多还原

【Abstract】 Background and Aims: Intrahepatic ectopic splenosis(ES) is relatively rare in clinical practice. In most patients, the intrahepatic lesions are accidentally found during physical examination, often misdiagnosed as benign or malignant liver tumors, and may be given inappropriate treatment. Therefore, this study was conducted to investigate the clinical characteristics of intrahepatic ES and its diagnosis and treatment methods.Methods: The clinical data of 6 patients with intrahepatic ES treated in Shanghai Eastern Hepatobiliary Surgery Hospital from January 2015 to January 2022 were retrospectively analyzed and summarized, and the relevant literature review was performed.Results: Of the 6 patients with intrahepatic ES, 4 cases were males, and 2 cases were females, aged 39-78 years, with a median age of 51 years; all cases had a history of splenectomy for traumatic splenic rupture and hemorrhage, and the time from splenectomy to initial diagnosis of intrahepatic ES was 20-33 years, with a median time of 27 years; 4 cases were pure intrahepatic ES, and 2 cases were multiple ES of the liver and diaphragm; one case was accompanied by discomfort of the right upper abdomen, and all the other 5 cases were found in physical examination; 5 cases were initially diagnosed as liver cancer, and 1 case was as initially diagnosed as angiomyolipoma by preoperative MRI or CT. All 6 patients underwent hepatectomy. Postoperative pathological examination confirmed that all the specimens were ectopic splenic tissue. The size of the intrahepatic splenic implant was 1.5-5.9 cm, with a median diameter of 3.2 cm. In one patient, the two lesions were ES and hepatocellular carcinoma, respectively, as determined by pathological examination. All 6 patients recovered uneventfully after the operation, and no new ES lesions were found during half a year follow-up period. The results of literature review showed that 90% of the ES occur in the abdominal cavity, which is frequently found in the serosa of the small intestine, the greater omentum, the parietal peritoneum, the mesentery, and the pelvic cavity, but rarely detected in the liver, the diaphragm, and other remote organs.Conclusion: In individuals with a previous history of splenectomy for splenic trauma, the possibility of heterotopic ES should be considered after detecting intrahepatic lesions; Intrahepatic ES grows slowly, and most of them have no clinical symptoms. No special treatment is needed for those without clinical symptoms after a definite diagnosis.更多还原