脾切除术对肝硬化病程的影响及机制

Influence of splenectomy on the course of liver cirrhosis and related mechanism

脾肿大是肝硬化门静脉高压常见的病理改变,并可进展为脾功能亢进,导致患者血细胞减少,增加临床出血、感染等风险。脾切除术是治疗脾大伴脾功能亢进的重要手段,但面临着感染、手术出血、术后血栓形成、术后胰瘘等风险。然而,随着现代研究的不断深入,脾切除术后肝硬化患者的病情在一定程度上得到了改善,例如降低消化道出血的风险、降低门静脉的压力、改善内脏等的血流动力学、促进肝组织的再生、改善肝纤维化、调节免疫、改善营养状况、降低肝癌发生的风险等。本文结合现有的临床和实验研究,综述了脾切除术对肝硬化病程的影响及其机制,以期为临床脾切除术的选择和开展提供可靠的参照和依据。

Splenomegaly is a common pathological change of portal hypertension in liver cirrhosis and can progress to hypersplenism,leading to the reduction in blood cells and increasing the risk of clinical bleeding and infection.Splenectomy is an important method for the treatment of splenectomy with hypersplenism,but it faces the risks of infection,surgical bleeding,postoperative thrombosis,and postoperative pancreatic fistula.However,with the gradual deepening of modern research,it has been found that patients with liver cirrhosis have a certain degree of improvement after splenectomy,such as the reduced risk of gastrointestinal bleeding,a reduction in portal venous pressure,the improvement in the hemodynamics of internal organs,the promotion of liver tissue regeneration,the improvement in liver fibrosis,the regulation of immune function,the improvement in nutritional status,and the reduced risk of liver cancer.With reference to available clinical and experimental studies,this article reviews the influence of splenectomy on the course of liver cirrhosis and actively explores related mechanism,in order to provide reliable reference and basis for the selection and implementation of splenectomy in clinical practice.