脾脏在肝癌合并肝硬化中的临床价值

Role of the spleen in patients with liver cancer and cirrhosis

脾脏作为人体最大的淋巴器官,可通过门静脉系统影响肝脏的免疫微环境。肝癌病人往往因为肝硬化和门静脉高压而出现脾功能亢进(脾亢)和脾肿大。脾脏功能失调不仅诱发肝脏纤维化,还改变肝脏的免疫调节,加速肝硬化和抑制肝脏再生能力,且使肝内微环境和免疫系统趋向“促肿瘤生成”与“肿瘤耐受”的状态。脾脏切除术已被证实在术后短期内可改善肝癌病人的一般状态、肝功能,甚至免疫力。因此,脾脏切除术可能提高肝癌病人术后抗癌治疗的耐受性。但对于合并门静脉高压和脾亢的肝癌病人选择进行肝脾联合切除是否存在远期效益或提高生存率仍有争议。

The spleen is the largest lymphoid organ that can affect the immunological microenvironment in the liver via the portal system.Patients with liver cancer,often develop hypersplenism and splenomegaly from underlying cirrhosis and portal hypertension.The malfunction of the spleen not only induces hepatic fibrogenesis,but also changes the immune responses in the liver,so that liver cirrhosis accelerates while liver regeneration subdues.As a result,the hepatic microenvi⁃ronment and the rest of the immune system reach a“tumor progressing”or“tumor tolerant”state.Splenectomy has been shown to improve immune responses,liver function and general condition in patients with liver cancer.Hence,splenectomy may possibly improve the tolerance in live cancer patients for other anticancer treatments.However,the long⁃term benefits and effects on the overall survival of concomitant hepatectomy and splenectomy for liver cancer patients with portal hyper⁃tension and hypersplenism still remain controversial.