脾切除术对肝硬化的影响及手术相关问题的探讨

Effect of splenectomy on liver cirrhosis and related surgical issues

肝病患者在肝纤维化和肝硬化阶段,脾脏形态功能产生相应变化。是否对肝硬化患者进行脾切除一直以来存有争议。脾切除术作为外科治疗复发性门静脉高压伴食管胃底静脉曲张破裂出血的方法,除能降低门静脉压、减少消化道出血机会及纠正WBC和PLT减少外,还具有改善肝功能、促进肝细胞再生、抑制肝纤维化进展等保护肝脏的作用。结合现有临床及实验室数据,综述了脾切除术对硬化肝脏的影响,以及手术术式选择、术后并发症防治等相关问题,以期对肝硬化患者推广行脾切除术。

Patients with liver fibrosis and cirrhosis experience certain changes in spleen morphology and function,and there is always a controversy over whether to perform splenectomy in patients with liver cirrhosis. As a surgical treatment of recurrent portal hypertension complicated by esophagogastric variceal bleeding,splenectomy can reduce portal venous pressure,reduce the possibility of gastrointestinal bleeding,and correct the reduced white blood cell count and platelet count. It can also protect the liver by improving liver function,promoting regeneration of hepatocytes,and inhibiting the progression of liver fibrosis. With reference to available clinical and laboratory data,this article reviews the effect of splenectomy on the cirrhotic liver and related issues such as selection of surgical procedures and prevention and treatment of postoperative complications,in order to promote splenectomy in patients with liver cirrhosis.