门静脉高压断流术中脾脏保留与否的研究进展

Research Progress of Spleen Preservation in Portal Hypertension Disconnection

摘要: 门静脉高压症是肝硬化患者最常见的并发症之一，门静脉高压症患者的主要症状包括了脾大、脾功能亢进、腹水、食管胃底静脉出血，其治疗包括内科治疗和外科手术治疗。目前欧美国家主要倾向于内科药物治疗、经颈静脉肝内静脉门体分流术(transjugular intrahepatic portosystemicshunt, TIPS)、内镜治疗，但在我国临床实际中，外科手术治疗还是占据了不可或缺的位置，对于患者的近远期预后影响很大。既往外科治疗门静脉高压症中往往选择切除脾脏来解决脾功能亢进、门静脉高压力的问题，随着对于脾脏功能的进一步认识，各种外科手术时保留脾脏来治疗门静脉高压症的观点开始提出，同时许多全脾切除与部分脾保留对比的相关前瞻性及随机对照实验也纷纷开展。目前，保脾者与切脾者就脾脏保留与否对于门静脉高压患者的肝脏血流和门静脉系统压力、肝功能和外周血三系、门脉系统血栓的发生、机体免疫及对肝硬化的进展等方面意见不一。故笔者结合现有临床与试验研究，就门静脉高压症患者是否需要保留脾脏这一问题进行综述，希望能提高临床认识和给予临床医师提供决策。

Abstract: Portal hypertension is one of the most common complications in patients with liver cirrhosis. The main symptoms of portal hypertension include splenomegaly, hypersplenism, ascites, esoph-agogastric venous bleeding, and its treatment includes medical treatment and surgical treatment. At present, European and American countries mainly prefer medical drug treatment, transjugular intrahepatic portosystemic shunt (TIPS) and endoscopic treatment, but in the clinical practice of our country, surgical treatment still occupies an indispensable position. It has a great impact on the short-term and long-term prognosis of patients. In the previous surgical treatment of portal hyper-tension, splenectomy was often chosen to solve the problems of hypersplenism and high portal vein pressure. With the further understanding of spleen function, the viewpoint of preserving spleen to treat portal hypertension in various surgical operations began to be put forward. At the same time, many prospective and randomized controlled trials were carried out between total splenectomy and partial spleen preservation. At present, spleen conservers and splenectomies have different opinions on liver blood flow and portal system pressure, liver function and peripheral blood pres-sure, occurrence of portal vein thrombosis, immunity and progression of liver cirrhosis in patients with portal hypertension. Therefore, combined with the existing clinical and experimental studies, the author reviews whether patients with portal hypertension need to preserve the spleen, hoping to improve clinical understanding and provide clinicians with decision-making.