Surgical Treatment for Portal Hypertension with Hypersplenism_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 CHENZhi-yu ,  DAIChao-liu

Department of Hepatobiliary & Splenic Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, China;

Corresponding author：

DAIChao-liu, Email: daicl@sj-hospital.org

Keywords：

Portal hypertension; Hypersplenism; Pericardial devascularization; Subtotal splenectomy; Splenic artery ligation

DOI：

10.7507/1007-9424.20150231

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To summarize the recent development of surgical treatment for portal hypertension with hypersplenism. Methods The related literatures on various operation treatment of hypertension with hypersplenism at home and abroad in recent years were collected and reviewed. Results There are many operation treatment methods of hypertension with hypersplenism, includes the pericardial devascularization, subtotal splenectomy, partial splenic embolization, spleen radiofrequency ablation, splenic artery ligation, distal splenorenal shunt, and so on. The different operation methods each has its advantages and disadvantages, but there are a certain percentage of the incidence of complications. At the same time, due to the limited understanding of the function of the spleen in portal hypertension, the treatment of "resecting" or "reserving" spleen has always been the hot spot of the academic dispute. Conclusion For what kind of operation method is the most suitable for the treatment of hypertension with hypersplenism is no fixed conclusion.

Citation： CHENZhi-yu, DAIChao-liu. Surgical Treatment for Portal Hypertension with Hypersplenism. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(7): 884-888. doi: 10.7507/1007-9424.20150231 Copy

1.	Hayashi H, Takamura H, Yamguchi Y, et al. Recent rolle of Hassab's operation for cirrhotic patients:combination with endoscopic procedure for varices. Asian J Surg, 2012, 35(2):57-61.
2.	Lucas CE. Splenic trauma. Choice of management.Ann Surg, 1991, 213(2):98-112.
3.	Tarantino G, Savastano S, Capone D, et al. Spleen:a new role for an old player? World J Gastroenterol, 2011, 17(33):3776-3784.
4.	李宗芳, 张澍. 脾脏的基础研究进展与展望. 西安交通大学学报:医学版, 2008, 29(1):1-6.
5.	陈希炜, 韩殿冰, 陈维佩.脾脏与远隔脏器关系.中华肝胆外科杂志, 2005, 11(5):359-360.
6.	Morgan TL,Tomich EB.Overwhelming post-splenectomy infection (OPSI):a case report and review of the literature. J Emerg Med, 2012, 43(4):758-763.
7.	Chu HB, Zhang TG, Zhao JH, et al. Assessment of immune cells and function of the residual spleen after subtotal splenectomy due to splenomegaly in cirrhotic patients. BMC Immunol, 2014, 15(1):42.
8.	汪谦, 夏穗生, 姜汉英, 等. 脾脏及促吞噬肽在体外肝细胞培养过程的免疫调控作用. 中华实验外科杂志, 1995, 12(5):314-315.
9.	Deitch EA. Infection in the comprosed host. Surg Clin North Am, 1988, 68(1):181-197.
10.	Weiss L, Gedulding U, Weidanz W. Mechanisms of splenic control of murine malaria:reticular cell activation and the development of a blood-spleen barrier. Am J Anat, 1986, 176(3):251-285.
11.	Weiss L. Barrier cells in the spleen. Immunol Today, 1991, 12(1):24-29.
12.	Li ZF, Zhang S, Huang Y, et al. Morphological changes of blood spleen barrierin portal hypertensive spleen. Chin Med J (Engl), 2008, 121(6):561-565.
13.	Mebius RE, Nolte MA, Kraal G. Development and function of the splenic marginal zone. Crit Rev Immunol, 2004, 24(6):449-464.
14.	汪家富, 刘绪舜. 脾脏及脾切除对肝硬化影响的研究进展. 肝胆胰外科杂志, 2012, 24(5):438-441.
15.	Nomura Y, Kage M, Ogata T, et al. Influence of splenectomy in patients with liver cirrhosis and hypersplenism. Hepatol Res, 2014, 44(10):100-109.
16.	Oishi T, Terai S, Iwamoto T, et al. Splenectomy reduces fibrosis and preneoplastic lesions with increased triglycerides and essential fatty acids in rat liver cirrhosis induced by a choline-deficient L-amino acid-defined diet. Hepatol Res, 2011, 41(5):463-474.
17.	Morinaga A, Ogata T, Kage M, et al. Comparison of liver regeneration after a splenectomy and splenic artery ligation in a dimethylnitrosamine-induced cirrhotic rat model. HPB (Oxford), 2010, 12(1):22-30.
18.	金山, 戴朝六. 肝硬化门脉高压症脾切除术. 世界华人消化杂志, 2010, 18(33):3533-3538.
19.	李展翼, 刘莹, 刘宇, 等. 脾切除加贲门周围血管离断术对肝硬化合并脾功能亢进患者肝功能的影响. 中华肝脏外科手术学电子杂志, 2014, 3(4):235-237.
20.	Walusimbi MS, Dominguez KM, Sands JM, et al. Circulating cellular and humoral elements of immune function following splenic arterial embolisation or splenectomy in trauma patients. Injury, 2012, 43(2):180-183.
21.	侯杰, 刘伟新, 肖慧杰, 等. 门脉高压症切脾保脾对肝脏细胞凋亡的影响及其意义的研究. 中国实验诊断学, 2013,17(7):1191-1193.
22.	Guo Y, Wu CZ, Liao Y, et al. The expression and significance of CD4⁺ CD25⁺ CD127 ^low/-regulatory T cells and Foxp3 in patients with portal hypertension and hypersplenism. Hepatogastroenterology, 2013, 60(123):581-584.
23.	李正天, 姜洪池. 部分脾切除术应用进展. 肝胆外科杂志, 2009, 17(6):403-405.
24.	霍景山. 肝硬化门静脉高压症脾保留术的研究进展. 中华肝胆外科杂志, 2006, 12(6):428-429.
25.	Chu HB, Liu XF, Zhao JH, et al. Subtotal splenectomy for splenomegaly in cirrhotic patients. Int J Clin Exp Pathol, 2014, 7(8):4981-4990.
26.	Maddison FE. Embolic therapy of hypersplenism.Invest Radiol, 1973, 8:280-281.
27.	Spigos DG, Jonasson O, Mozes M, et al. Partial splenic embolization in the treatment of hypersplenism. AJR Am J Roentgenol, 1979, 132(5):777-782.
28.	He XH, Gu JJ, Li WT, et al. Comparison of total splenic artery embolization and partial splenic embolization for hypersplenism. World J Gastroenterol, 2012, 18(24):3138-3144.
29.	韩晓梅, 金善爱. 脾动脉插管治疗脾功能亢进疗效观察. 吉林医学, 2010, 3l(032):5790-5791.
30.	李利, 李霞. 部分脾动脉栓塞治疗脾功能亢进的疗效. 中国老年杂志, 2013, 33(6):1444-1445.
31.	王鹏. 脾切除术与脾动脉栓塞术治疗肝硬化合并脾亢的疗效对比.中国实用医药, 2012, 7(25):92-93.
32.	覃祖云. 部分脾动脉栓塞术与脾切除术治疗肝硬化上消化道出血的疗效比较. 广西医学, 2009, 31(4):508-509.
33.	Smith M, Ray CE. Splenic artery embolization as an adjunctive procedure for portal hypertension. Semin Intervent Radiol, 2012, 29(2):135-139.
34.	Hadduck TA, McWilliams JP. Partial splenic artery embolization in cirrhotic patients. World J Radiol, 2014, 6(5):160-168.
35.	刘全达, 马宽生, 何振平, 等. 射频消融治疗继发性脾肿大、脾功能亢进可行性和安全性的实验研究.中华外科杂志, 2003, 41(4):299-302.
36.	Feng K, Ma K, Liu Q, et al. Randomized clinical trial of splenic radiofrequency ablation versus splenectomy for severe hypersplenism. Br J Surg, 2011, 98(3):354-361.
37.	Liu Q, Ma K, He Z, et al. Radiofrequency ablation for hypersplenism in patients with liver cirrhosis:a pilot study. J Gastrointest Surg, 2005, 9(5):648-657.
38.	Liu Q, Ma K, Song Y, et al. Two-year follow-up of radiofrequency ablation for patients with cirrhotic hypersplenism:Does increased hepatic arterial flow induce liver regeneration? Surgery, 2008, 143(4):509-518.
39.	孔文杰, 师宏山, 乔自勇.脾动脉结扎治疗重症肝硬化门脉高压脾功能亢进4例. 现代中西医结合杂志, 201l, 20(7):845-846.
40.	乔自勇, 闫军波, 孔文杰, 等. 脾动脉结扎加胃冠状静脉主干结扎治疗重症肝硬化门脉高压脾功能亢进疗效观察. 现代中西医结合杂志, 2014, 23(13):1444-1446.
41.	张启瑜, 廖毅, 屠金夫, 等. 脾动脉缩窄式远端脾肾分流术七例. 中华肝胆外科杂志, 2003, 9(4):207-209.
42.	王东, 栗光明, 朱继业, 等.保脾断流术治疗门静脉高压症上消化道出血的疗效分析.中国普外基础与临床杂志, 2013, 20(1):29-32.
43.	朱继业,倪彦彬. 保脾断流术治疗门静脉高压症.中华消化外科杂志, 2013, 12(11):820-822.
44.	张启瑜.门静脉高压症的外科治疗(附135例选择性脾胃区减断分流术报告). 2012年浙江省外科学学术年会论文集, 2012:9-14.
45.	徐锋, 戴朝六, 卜献民, 等.脾动脉结扎联合贲门周围血管离断术治疗门静脉高压症脾功能亢进. 腹部外科, 2014, 27(2):101-105.
46.	姜洪池, 代文杰, 胡震.门静脉高压症外科治疗的保脾问题. 外科理论与实践, 2006, 11(3):193-195.
47.	Yin L, Liu H, Zhang Y, et al. The surgical treatment for portal hypertension:a systematic review and meta-analysis. ISRN Gastroenterol, 2013, 2013:464053.
48.	纪旭, 董家鸿. 门静脉高压症的外科治疗进展. 中国医师杂志, 2014, (z1):228-230.
49.	姜洪池, 刘昶.门静脉高压症保脾的有关问题.中华肝胆外科杂志, 2003, 9(10):577-580.

1. Hayashi H, Takamura H, Yamguchi Y, et al. Recent rolle of Hassab's operation for cirrhotic patients:combination with endoscopic procedure for varices. Asian J Surg, 2012, 35(2):57-61.
2. Lucas CE. Splenic trauma. Choice of management.Ann Surg, 1991, 213(2):98-112.
3. Tarantino G, Savastano S, Capone D, et al. Spleen:a new role for an old player? World J Gastroenterol, 2011, 17(33):3776-3784.
4. 李宗芳, 张澍. 脾脏的基础研究进展与展望. 西安交通大学学报:医学版, 2008, 29(1):1-6.
5. 陈希炜, 韩殿冰, 陈维佩.脾脏与远隔脏器关系.中华肝胆外科杂志, 2005, 11(5):359-360.
6. Morgan TL,Tomich EB.Overwhelming post-splenectomy infection (OPSI):a case report and review of the literature. J Emerg Med, 2012, 43(4):758-763.
7. Chu HB, Zhang TG, Zhao JH, et al. Assessment of immune cells and function of the residual spleen after subtotal splenectomy due to splenomegaly in cirrhotic patients. BMC Immunol, 2014, 15(1):42.
8. 汪谦, 夏穗生, 姜汉英, 等. 脾脏及促吞噬肽在体外肝细胞培养过程的免疫调控作用. 中华实验外科杂志, 1995, 12(5):314-315.
9. Deitch EA. Infection in the comprosed host. Surg Clin North Am, 1988, 68(1):181-197.
10. Weiss L, Gedulding U, Weidanz W. Mechanisms of splenic control of murine malaria:reticular cell activation and the development of a blood-spleen barrier. Am J Anat, 1986, 176(3):251-285.
11. Weiss L. Barrier cells in the spleen. Immunol Today, 1991, 12(1):24-29.
12. Li ZF, Zhang S, Huang Y, et al. Morphological changes of blood spleen barrierin portal hypertensive spleen. Chin Med J (Engl), 2008, 121(6):561-565.
13. Mebius RE, Nolte MA, Kraal G. Development and function of the splenic marginal zone. Crit Rev Immunol, 2004, 24(6):449-464.
14. 汪家富, 刘绪舜. 脾脏及脾切除对肝硬化影响的研究进展. 肝胆胰外科杂志, 2012, 24(5):438-441.
15. Nomura Y, Kage M, Ogata T, et al. Influence of splenectomy in patients with liver cirrhosis and hypersplenism. Hepatol Res, 2014, 44(10):100-109.
16. Oishi T, Terai S, Iwamoto T, et al. Splenectomy reduces fibrosis and preneoplastic lesions with increased triglycerides and essential fatty acids in rat liver cirrhosis induced by a choline-deficient L-amino acid-defined diet. Hepatol Res, 2011, 41(5):463-474.
17. Morinaga A, Ogata T, Kage M, et al. Comparison of liver regeneration after a splenectomy and splenic artery ligation in a dimethylnitrosamine-induced cirrhotic rat model. HPB (Oxford), 2010, 12(1):22-30.
18. 金山, 戴朝六. 肝硬化门脉高压症脾切除术. 世界华人消化杂志, 2010, 18(33):3533-3538.
19. 李展翼, 刘莹, 刘宇, 等. 脾切除加贲门周围血管离断术对肝硬化合并脾功能亢进患者肝功能的影响. 中华肝脏外科手术学电子杂志, 2014, 3(4):235-237.
20. Walusimbi MS, Dominguez KM, Sands JM, et al. Circulating cellular and humoral elements of immune function following splenic arterial embolisation or splenectomy in trauma patients. Injury, 2012, 43(2):180-183.
21. 侯杰, 刘伟新, 肖慧杰, 等. 门脉高压症切脾保脾对肝脏细胞凋亡的影响及其意义的研究. 中国实验诊断学, 2013,17(7):1191-1193.
22. Guo Y, Wu CZ, Liao Y, et al. The expression and significance of CD4⁺ CD25⁺ CD127 ^low/-regulatory T cells and Foxp3 in patients with portal hypertension and hypersplenism. Hepatogastroenterology, 2013, 60(123):581-584.
23. 李正天, 姜洪池. 部分脾切除术应用进展. 肝胆外科杂志, 2009, 17(6):403-405.
24. 霍景山. 肝硬化门静脉高压症脾保留术的研究进展. 中华肝胆外科杂志, 2006, 12(6):428-429.
25. Chu HB, Liu XF, Zhao JH, et al. Subtotal splenectomy for splenomegaly in cirrhotic patients. Int J Clin Exp Pathol, 2014, 7(8):4981-4990.
26. Maddison FE. Embolic therapy of hypersplenism.Invest Radiol, 1973, 8:280-281.
27. Spigos DG, Jonasson O, Mozes M, et al. Partial splenic embolization in the treatment of hypersplenism. AJR Am J Roentgenol, 1979, 132(5):777-782.
28. He XH, Gu JJ, Li WT, et al. Comparison of total splenic artery embolization and partial splenic embolization for hypersplenism. World J Gastroenterol, 2012, 18(24):3138-3144.
29. 韩晓梅, 金善爱. 脾动脉插管治疗脾功能亢进疗效观察. 吉林医学, 2010, 3l(032):5790-5791.
30. 李利, 李霞. 部分脾动脉栓塞治疗脾功能亢进的疗效. 中国老年杂志, 2013, 33(6):1444-1445.
31. 王鹏. 脾切除术与脾动脉栓塞术治疗肝硬化合并脾亢的疗效对比.中国实用医药, 2012, 7(25):92-93.
32. 覃祖云. 部分脾动脉栓塞术与脾切除术治疗肝硬化上消化道出血的疗效比较. 广西医学, 2009, 31(4):508-509.
33. Smith M, Ray CE. Splenic artery embolization as an adjunctive procedure for portal hypertension. Semin Intervent Radiol, 2012, 29(2):135-139.
34. Hadduck TA, McWilliams JP. Partial splenic artery embolization in cirrhotic patients. World J Radiol, 2014, 6(5):160-168.
35. 刘全达, 马宽生, 何振平, 等. 射频消融治疗继发性脾肿大、脾功能亢进可行性和安全性的实验研究.中华外科杂志, 2003, 41(4):299-302.
36. Feng K, Ma K, Liu Q, et al. Randomized clinical trial of splenic radiofrequency ablation versus splenectomy for severe hypersplenism. Br J Surg, 2011, 98(3):354-361.
37. Liu Q, Ma K, He Z, et al. Radiofrequency ablation for hypersplenism in patients with liver cirrhosis:a pilot study. J Gastrointest Surg, 2005, 9(5):648-657.
38. Liu Q, Ma K, Song Y, et al. Two-year follow-up of radiofrequency ablation for patients with cirrhotic hypersplenism:Does increased hepatic arterial flow induce liver regeneration? Surgery, 2008, 143(4):509-518.
39. 孔文杰, 师宏山, 乔自勇.脾动脉结扎治疗重症肝硬化门脉高压脾功能亢进4例. 现代中西医结合杂志, 201l, 20(7):845-846.
40. 乔自勇, 闫军波, 孔文杰, 等. 脾动脉结扎加胃冠状静脉主干结扎治疗重症肝硬化门脉高压脾功能亢进疗效观察. 现代中西医结合杂志, 2014, 23(13):1444-1446.
41. 张启瑜, 廖毅, 屠金夫, 等. 脾动脉缩窄式远端脾肾分流术七例. 中华肝胆外科杂志, 2003, 9(4):207-209.
42. 王东, 栗光明, 朱继业, 等.保脾断流术治疗门静脉高压症上消化道出血的疗效分析.中国普外基础与临床杂志, 2013, 20(1):29-32.
43. 朱继业,倪彦彬. 保脾断流术治疗门静脉高压症.中华消化外科杂志, 2013, 12(11):820-822.
44. 张启瑜.门静脉高压症的外科治疗(附135例选择性脾胃区减断分流术报告). 2012年浙江省外科学学术年会论文集, 2012:9-14.
45. 徐锋, 戴朝六, 卜献民, 等.脾动脉结扎联合贲门周围血管离断术治疗门静脉高压症脾功能亢进. 腹部外科, 2014, 27(2):101-105.
46. 姜洪池, 代文杰, 胡震.门静脉高压症外科治疗的保脾问题. 外科理论与实践, 2006, 11(3):193-195.
47. Yin L, Liu H, Zhang Y, et al. The surgical treatment for portal hypertension:a systematic review and meta-analysis. ISRN Gastroenterol, 2013, 2013:464053.
48. 纪旭, 董家鸿. 门静脉高压症的外科治疗进展. 中国医师杂志, 2014, (z1):228-230.
49. 姜洪池, 刘昶.门静脉高压症保脾的有关问题.中华肝胆外科杂志, 2003, 9(10):577-580.

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Surgical Treatment for Portal Hypertension with Hypersplenism

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