切换至 "中华医学电子期刊资源库"

中华肝脏外科手术学电子杂志 ›› 2026, Vol. 15 ›› Issue (04) : 642 -647. doi: 10.3877/cma.j.issn.2095-3232.2026.04.020

综述

肝硬化门静脉高压症脾切除术后并发症研究进展
方荣焕, 孟子凡, 李馥彤, 鹿云皓, 杨永生()   
  1. 130022 长春,吉林大学第二医院肝胆胰外科
  • 收稿日期:2025-07-12 出版日期:2026-08-10
  • 通信作者: 杨永生
  • 基金资助:
    吉林省卫健委卫生健康科技能力提升项目(2023JC013); 吉林省财政厅医疗卫生人才专项基金(2024WSZX-A02)

Research progress in complications after splenectomy in cirrhotic patients with portal hypertension

Ronghuan Fang, Zifan Meng, Futong Li, Yunhao Lu, Yongsheng Yang()   

  1. Department of Hepatobiliary and Pancreatic Surgery, the Second Hospital of Jilin University, Changchun 130022, China
  • Received:2025-07-12 Published:2026-08-10
  • Corresponding author: Yongsheng Yang
引用本文:

方荣焕, 孟子凡, 李馥彤, 鹿云皓, 杨永生. 肝硬化门静脉高压症脾切除术后并发症研究进展[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(04): 642-647.

Ronghuan Fang, Zifan Meng, Futong Li, Yunhao Lu, Yongsheng Yang. Research progress in complications after splenectomy in cirrhotic patients with portal hypertension[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2026, 15(04): 642-647.

肝硬化会引发诸多严重并发症,其中包括因门静脉高压症导致的脾功能亢进,以及食管-胃底静脉曲张出血。近年来,随着多种治疗手段如药物治疗、脾动脉栓塞术、经颈静脉肝内门静脉分流术等被广泛应用,手术治疗在应对门静脉高压症时的作用逐步降低。然而,结合我国临床实际情况来看,脾切除术作为治疗门静脉高压症的主要手术方式依旧有着重要意义,是其他治疗方式难以完全取代的。脾切除术联合选择性贲门周围血管离断术是治疗门静脉高压症引起的脾功能亢进和食管-胃底静脉曲张出血的最常用手术方法,在中国各级医院广泛实施,挽救了无数生命。然而,脾切除术后的并发症限制了其进一步改善门静脉高压症患者的生活质量,本文旨在系统性地综述脾切除术后的并发症,为门静脉高压症患者的精细化管理提供理论依据。

Liver cirrhosis can cause multiple severe complications, including portal hypertension-induced hypersplenism and oesophageal variceal bleeding. In recent years, with widespread application of different treatments such as drug therapy, splenic artery embolization and transjugular intrahepatic portosystemic shunt, the role of surgical resection in the management of portal hypertension has been gradually weakened. However, combined with the actual clinical situation in China, splenectomy, as the main surgical treatment for portal hypertension, is still of significance, which can not be completely replaced by alternative options.Splenectomy combined with selective pericardial devascularization is the most common procedure to treat hypersplenism and oesophageal variceal bleeding caused by portal hypertension, which has been widely applied in Chinese hospitals at all levels and saved the lives of patients. However, complications post-splenectomy limit further improvement in the quality of life of patients with portal hypertension. In this review, the complications after splenectomy were systematically analyzed, aiming to provide theoretical basis for refined management of patients with portal hypertension.

[1]
Wang Y, Wang M, Liu C, et al. Global burden of liver cirrhosis 1990–2019 and 20 years forecast: results from the global burden of disease study 2019[J]. Ann Med, 2024, 56: 2328521. DOI: 10.1080/07853890.2024.2328521.
[2]
张群青, 吴娟, 王妍. 肝硬化门静脉高压症患者肝脏血流动力学指标与门静脉压力梯度的相关性[J/OL]. 中华消化病与影像杂志(电子版), 2025, 15(6): 616-620. DOI: 10.3877/cma.j.issn.2095-2015.2025.06.011.
[3]
Wang G, Dong W, Zhang H, et al. Activation of MEK-ERK-c-MYC signaling pathway promotes splenic M2-like macrophage polarization to inhibit PHcH-liver cirrhosis[J]. Front Immunol, 2024, 15: 1417521. DOI: 10.3389/fimmu.2024.1417521.
[4]
张宏伟, 邢玉雪, 贾哲, 等. 术前输注血小板在肝癌合并肝硬化门静脉高压症肝脾联合切除患者中的疗效[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(4): 576-581. DOI: 10.3877/cma.j.issn.2095-3232.2025.04.012.
[5]
Zakeri S, Gorji N, Akhtari M, et al. Splenectomy may have more complications than currently proven[J]. Med Hypotheses, 2018, 112: 43-46. DOI: 10.1016/j.mehy.2018.01.009.
[6]
Swinson B, Waters PS, Webber L, et al. Portal vein thrombosis following elective laparoscopic splenectomy: incidence and analysis of risk factors[J]. Surg Endosc, 2022, 36(5): 3332-3339. DOI: 10.1007/s00464-021-08649-x.
[7]
Yao W, Feng YA, Liu T, et al. Rivaroxaban versus low-molecular weight heparin plus warfarin prevents portal vein system thrombosis after splenectomy and pericardial devascularization: a randomized clinical trial[J]. EXCLI J, 2021, 20: 537-549. DOI: 10.17179/excli2020-3120.
[8]
Yang M, Liu J. Low-molecular weight heparin prevents portal vein system thrombosis after splenectomy: a systematic review and meta-analysis[J]. ANZ J Surg, 2020, 90(12): 2420-2424. DOI: 10.1111/ans.15865.
[9]
Li T, Wang LL, Li YP, et al. Predictors of portal vein thrombosis after splenectomy in patients with cirrhosis[J]. World J Hepatol, 2024, 16(2): 241-250. DOI: 10.4254/wjh.v16.i2.241.
[10]
Qu D, Dai D, Li G, et al. Development of an explainable prediction model for portal vein system thrombosis post-splenectomy in patients with cirrhosis[J]. BMJ Health Care Inform, 2025, 32(1): e101319. DOI: 10.1136/bmjhci-2024-101319.
[11]
Lin YK, Cai XR, Hong HJ, et al. Risk factors of portal vein system thrombosis after splenectomy: a meta-analysis[J]. ANZ J Surg, 2023, 93(12): 2806-2819. DOI: 10.1111/ans.18633.
[12]
Gao H, Sun B, Li X, et al. Risk factors for portal vein system thrombosis after partial splenic embolisation in cirrhotic patients with hypersplenism[J]. Clin Radiol, 2023, 78(12): 919-927. DOI: 10.1016/j.crad.2023.07.022.
[13]
Baldari L, Boni L, Giuliani B, et al. Porto-spleno-mesenteric venous thrombosis after elective splenectomy: a retrospective cohort study[J]. Front Immunol, 2023, 14: 1216283. DOI: 10.3389/fimmu.2023.1216283.
[14]
Li Y, Fu X, Li Y, et al. Early prevention and risk factors analysis of portal vein system thrombosis after laparoscopic splenectomy and pericardial devascularization[J]. Surg Endosc, 2022, 36(12): 8918-8926. DOI: 10.1007/s00464-022-09340-5.
[15]
Arnold P, Belchos J, Meagher A, et al. Postoperative pancreatic fistula following traumatic splenectomy: a morbid and costly complication[J]. J Surg Res, 2022, 280: 35-43. DOI: 10.1016/j.jss.2022.07.005.
[16]
Huang L, Yu Q, Peng H, et al. Postoperative outcomes following a modified method of surgical division of the splenic pedicle in 719 patients during splenectomy for portal hypertension: a 12-year, retrospective, single-center study[J]. Med Sci Monit, 2022, 28: e937763. DOI: 10.12659/msm.937763.
[17]
Zhu JM, Chen G, Jiao ZY. Non-operative treatment of gastric fistula after splenectomy combined with pericardial devascularisation in portal hypertension[J]. J Coll Physicians Surg Pak, 2021, 31(3): 334-336. DOI: 10.29271/jcpsp.2021.03.334.
[18]
Qu Y, Ren S, Li C, et al. Management of postoperative complications following splenectomy[J]. Int Surg, 2013, 98(1): 55-60. DOI: 10.9738/cc63.1.
[19]
Al Kahf S, Roche A, Baron A, et al. Pulmonary hypertension in sickle cell disease[J]. La Presse Médicale, 2023, 52(4): 104209. DOI: 10.1016/j.lpm.2023.104209.
[20]
Feld JJ, Kato GJ, Koh C, et al. Liver injury is associated with mortality in sickle cell disease[J]. Aliment Pharmacol Ther, 2015, 42(7): 912-921. DOI: 10.1111/apt.13347.
[21]
El-Gohary Y, Fleming A, Zhang H, et al. Acute chest syndrome after splenectomy in children with sickle cell disease[J]. J Surg Res, 2019, 242: 336-341. DOI: 10.1016/j.jss.2019.04.077.
[22]
Koehl JL, Koyfman A, Hayes BD, et al. High risk and low prevalence diseases: acute chest syndrome in sickle cell disease[J]. Am J Emerg Med, 2022, 58: 235-244. DOI: 10.1016/j.ajem.2022.06.018.
[23]
Tahir F, Ahmed J, Malik F. Post-splenectomy sepsis: a review of the literature[J]. Cureus, 2020, 12(2): e6898. DOI: 10.7759/cureus.6898.
[24]
Luu S, Spelman D, Woolley IJ. Post-splenectomy sepsis: preventative strategies, challenges, and solutions[J]. Infect Drug Resist, 2019, 12: 2839-2851. DOI: 10.2147/idr.s179902.
[25]
Sun LM, Chen HJ, Jeng LB, et al. Splenectomy and increased subsequent cancer risk: a nationwide population-based cohort study[J]. Am J Surg, 2015, 210(2): 243-251. DOI: 10.1016/j.amjsurg.2015.01.017.
[26]
Kristinsson SY, Gridley G, Hoover RN, et al. Long-term risks after splenectomy among 8, 149 cancer-free American veterans: a cohort study with up to 27 years follow-up[J]. Haematologica, 2014, 99(2): 392-398. DOI: 10.3324/haematol.2013.092460.
[27]
Linet MS, Nyrén O, Gridley G, et al. Risk of cancer following splenectomy[J]. Int J Cancer, 1996, 66(5): 611-616. DOI: 10.1002/(SICI)1097-0215(19960529)66: 5 <611:: AID-IJC5> 3.0.CO; 2-W.
[28]
Ai XM, Ho LC, Han LL, et al. The role of splenectomy in lipid metabolism and atherosclerosis (AS)[J]. Lipds Health Dis, 2018, 17(1): 186. DOI: 10.1186/s12944-018-0841-2.
[29]
Gunes O, Turgut E, Bag YM, et al. The impact of splenectomy on human lipid metabolism[J]. Ups J Med Sci, 2022, 127. DOI: 10.48101/ujms.v127.8500.
[30]
Tsai MS, Chou SE, Lai HS, et al. Long-term risk of acute coronary syndrome in splenectomized patients due to splenic injury[J]. Medicine, 2015, 94(9): e610. DOI: 10.1097/md.0000000000000610.
[31]
Ejikeme C, Elkattawy S, Kayode-Ajala F, et al. Reactive thrombocytosis after splenectomy in hereditary spherocytosis: case report and literature review[J]. Eur J Case Rep Intern Med, 2021, 8(7): 21. DOI: 10.12890/2021_002673.
[32]
Luu S, Woolley IJ, Andrews RK. Platelet phenotype and function in the absence of splenic sequestration (Review)[J]. Platelets, 2021, 32(1): 47-52. DOI: 10.1080/09537104.2020.1732322.
[33]
Bollova D, Reptova A, Valkovicova T, et al. Risk of chronic thromboembolic pulmonary hypertension after splenectomy[J]. Bratislava Med J, 2024, 125(3): 176-182. DOI: 10.4149/bll_2024_28.
[34]
Huang L, Li W, Yang T, et al. Association between splenectomy and portal hypertension in the development of pulmonary hypertension[J]. Pulm Circ, 2020, 10(1): 1-9. DOI: 10.1177/2045894019895426.
[35]
Hsu CY, Chen HJ, Hsu CY, et al. Splenectomy increases the subsequent risk of systemic lupus erythematosus[J]. Rheumatol Int, 2016, 36(2): 271-276. DOI: 10.1007/s00296-015-3388-9.
[36]
Ambler WG, Kaplan MJ. Vascular damage in systemic lupus erythematosus[J]. Nat Rev Nephrol, 2024, 20(4): 251-265. DOI: 10.1038/s41581-023-00797-8.
[37]
Wu SC, Fu CY, Muo CH, et al. Splenectomy in trauma patients is associated with an increased risk of postoperative type Ⅱ diabetes: a nationwide population-based study[J]. Am J Surg, 2014, 208(5): 811-816. DOI: 10.1016/j.amjsurg.2014.03.003.
[38]
Haile M, Boutajangout A, Chung K, et al. The Cox-2 inhibitor meloxicam ameliorates neuroinflammation and depressive behavior in adult mice after splenectomy[J]. J Neurophysiol Neurol Disord, 2016, 3: 101.
[39]
Xiao W, Yang X, Wang Y, et al. Splenectomy delays fracture healing by affecting the level of tumor necrosis factor alpha, interleukin 6 and bone morphogenetic protein[J]. Adv Clin Exp Med, 2018, 27(2): 165-171. DOI: 10.17219/acem/67755.
[40]
Ni F, Zhang T, Xiao W, et al. IL-18-mediated SLC7A5 overexpression enhances osteogenic differentiation of human bone marrow mesenchymal stem cells via the c-MYC pathway[J]. Front Cell Dev Biol, 2021, 9: 748831. DOI: 10.3389/fcell.2021.748831.
[1] 王茹文, 潘辰, 车颖, 佟梦萦. 甲状腺热消融术后结节破裂三例病例报道及基于文献的系统分析[J/OL]. 中华医学超声杂志(电子版), 2026, 23(04): 316-323.
[2] 张彬, 王敏, 郑鹏, 冯犁, 李鑫, 赵高平. 早期胃癌淋巴结转移的危险因素及预后分析[J/OL]. 中华普外科手术学杂志(电子版), 2026, 20(04): 337-342.
[3] 杨敏, 杜峻峰, 辛林璞. 腹腔镜胃癌根治术后常见并发症防治与管理[J/OL]. 中华普外科手术学杂志(电子版), 2026, 20(04): 352-355.
[4] 谢华林, 刘宾, 孙倩男, 王道荣. 改善术后肠造口功能研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2026, 20(04): 398-401.
[5] 马宁, 周太成, 陈双. 食管裂孔疝手术并发症的预防与处理:以单中心经验为核心的实践策略[J/OL]. 中华疝和腹壁外科杂志(电子版), 2026, 20(03): 253-258.
[6] 彭宇明, 尹强, 袁妙贤, 陈立健, 季春宜, 盛新仪, 谢惟心. 儿童门静脉海绵样变性的侧枝循环特征及Rex术疗效[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(04): 575-582.
[7] 王旋, 李甫, 陈雪雯, 黄金鑫, 高浩, 张晞文, 余金钟. 抗凝血酶Ⅲ在门静脉高压症消化道出血急诊胃镜治疗时机选择中的参考作用[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(04): 600-605.
[8] 谢敖文, 雷金, 王攀, 王文儿, 于毅, 彭欣然, 陶承刚, 黄熙龙. 脾外伤分级及治疗:单中心260例经验总结[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(04): 627-633.
[9] 谢青松, 秦少坤, 刘付宝. 预防性脾栓塞在左侧门静脉高压症脾切除术中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(04): 634-641.
[10] 苏德强, 田晓丰, 李梓康, 杨佳, 丁绪鹏, 曹宏. 血液病脾切除治疗中的热点问题与发展方向[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(04): 515-522.
[11] 王孟龙. 门静脉高压症的治疗选择策略[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(04): 523-528.
[12] 牛海鹏, 王石. 脾脏肿瘤诊疗策略[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(04): 529-536.
[13] 张宇, 郑卫华, 张俊晶. 门静脉高压症的诊治及并发症研究现状与展望[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(04): 537-544.
[14] 李中宇, 杨谨闻, 麻勇. 微创脾部分切除术的发展现状与展望[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(04): 545-550.
[15] 孙楚桓, 穆建成, 杨宁, 郭婉月, 彭柏森, 邓立行, 项俊涵, 李学民, 范玮. 了解飞秒激光辅助白内障手术的应用现状与挑战[J/OL]. 中华眼科医学杂志(电子版), 2026, 16(03): 129-133.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?