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, 張澍. 脾臟的基礎研究進展與展望. 西安交通大學學報:醫學版, 2008, 29(1):1-6.
5.	陳希煒, 韓殿冰, 陳維佩.脾臟與遠隔臟器關系.中華肝膽外科雜志, 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.	汪謙, 夏穗生, 姜漢英, 等. 脾臟及促吞噬肽在體外肝細胞培養過程的免疫調控作用. 中華實驗外科雜志, 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, 劉緒舜. 脾臟及脾切除對肝硬化影響的研究進展. 肝膽胰外科雜志, 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. 肝硬化門脈高壓癥脾切除術. 世界華人消化雜志, 2010, 18(33):3533-3538.
19.	李展翼, 劉瑩, 劉宇, 等. 脾切除加賁門周圍血管離斷術對肝硬化合并脾功能亢進患者肝功能的影響. 中華肝臟外科手術學電子雜志, 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, 劉偉新, 肖慧杰, 等. 門脈高壓癥切脾保脾對肝臟細胞凋亡的影響及其意義的研究. 中國實驗診斷學, 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. 部分脾切除術應用進展. 肝膽外科雜志, 2009, 17(6):403-405.
24.	霍景山. 肝硬化門靜脈高壓癥脾保留術的研究進展. 中華肝膽外科雜志, 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.	韓曉梅, 金善愛. 脾動脈插管治療脾功能亢進療效觀察. 吉林醫學, 2010, 3l(032):5790-5791.
30.	李利, 李霞. 部分脾動脈栓塞治療脾功能亢進的療效. 中國老年雜志, 2013, 33(6):1444-1445.
31.	王鵬. 脾切除術與脾動脈栓塞術治療肝硬化合并脾亢的療效對比.中國實用醫藥, 2012, 7(25):92-93.
32.	覃祖云. 部分脾動脈栓塞術與脾切除術治療肝硬化上消化道出血的療效比較. 廣西醫學, 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.	劉全達, 馬寬生, 何振平, 等. 射頻消融治療繼發性脾腫大、脾功能亢進可行性和安全性的實驗研究.中華外科雜志, 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, 師宏山, 喬自勇.脾動脈結扎治療重癥肝硬化門脈高壓脾功能亢進4例. 現代中西醫結合雜志, 201l, 20(7):845-846.
40.	喬自勇, 閆軍波, 孔文杰, 等. 脾動脈結扎加胃冠狀靜脈主干結扎治療重癥肝硬化門脈高壓脾功能亢進療效觀察. 現代中西醫結合雜志, 2014, 23(13):1444-1446.
41.	張啟瑜, 廖毅, 屠金夫, 等. 脾動脈縮窄式遠端脾腎分流術七例. 中華肝膽外科雜志, 2003, 9(4):207-209.
42.	王東, 栗光明, 朱繼業, 等.保脾斷流術治療門靜脈高壓癥上消化道出血的療效分析.中國普外基礎與臨床雜志, 2013, 20(1):29-32.
43.	朱繼業,倪彥彬. 保脾斷流術治療門靜脈高壓癥.中華消化外科雜志, 2013, 12(11):820-822.
44.	張啟瑜.門靜脈高壓癥的外科治療(附135例選擇性脾胃區減斷分流術報告). 2012年浙江省外科學學術年會論文集, 2012:9-14.
45.	徐鋒, 戴朝六, 卜獻民, 等.脾動脈結扎聯合賁門周圍血管離斷術治療門靜脈高壓癥脾功能亢進. 腹部外科, 2014, 27(2):101-105.
46.	姜洪池, 代文杰, 胡震.門靜脈高壓癥外科治療的保脾問題. 外科理論與實踐, 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.	紀旭, 董家鴻. 門靜脈高壓癥的外科治療進展. 中國醫師雜志, 2014, (z1):228-230.
49.	姜洪池, 劉昶.門靜脈高壓癥保脾的有關問題.中華肝膽外科雜志, 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, 張澍. 脾臟的基礎研究進展與展望. 西安交通大學學報:醫學版, 2008, 29(1):1-6.
5. 陳希煒, 韓殿冰, 陳維佩.脾臟與遠隔臟器關系.中華肝膽外科雜志, 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. 汪謙, 夏穗生, 姜漢英, 等. 脾臟及促吞噬肽在體外肝細胞培養過程的免疫調控作用. 中華實驗外科雜志, 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, 劉緒舜. 脾臟及脾切除對肝硬化影響的研究進展. 肝膽胰外科雜志, 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. 肝硬化門脈高壓癥脾切除術. 世界華人消化雜志, 2010, 18(33):3533-3538.
19. 李展翼, 劉瑩, 劉宇, 等. 脾切除加賁門周圍血管離斷術對肝硬化合并脾功能亢進患者肝功能的影響. 中華肝臟外科手術學電子雜志, 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, 劉偉新, 肖慧杰, 等. 門脈高壓癥切脾保脾對肝臟細胞凋亡的影響及其意義的研究. 中國實驗診斷學, 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. 部分脾切除術應用進展. 肝膽外科雜志, 2009, 17(6):403-405.
24. 霍景山. 肝硬化門靜脈高壓癥脾保留術的研究進展. 中華肝膽外科雜志, 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. 韓曉梅, 金善愛. 脾動脈插管治療脾功能亢進療效觀察. 吉林醫學, 2010, 3l(032):5790-5791.
30. 李利, 李霞. 部分脾動脈栓塞治療脾功能亢進的療效. 中國老年雜志, 2013, 33(6):1444-1445.
31. 王鵬. 脾切除術與脾動脈栓塞術治療肝硬化合并脾亢的療效對比.中國實用醫藥, 2012, 7(25):92-93.
32. 覃祖云. 部分脾動脈栓塞術與脾切除術治療肝硬化上消化道出血的療效比較. 廣西醫學, 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. 劉全達, 馬寬生, 何振平, 等. 射頻消融治療繼發性脾腫大、脾功能亢進可行性和安全性的實驗研究.中華外科雜志, 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, 師宏山, 喬自勇.脾動脈結扎治療重癥肝硬化門脈高壓脾功能亢進4例. 現代中西醫結合雜志, 201l, 20(7):845-846.
40. 喬自勇, 閆軍波, 孔文杰, 等. 脾動脈結扎加胃冠狀靜脈主干結扎治療重癥肝硬化門脈高壓脾功能亢進療效觀察. 現代中西醫結合雜志, 2014, 23(13):1444-1446.
41. 張啟瑜, 廖毅, 屠金夫, 等. 脾動脈縮窄式遠端脾腎分流術七例. 中華肝膽外科雜志, 2003, 9(4):207-209.
42. 王東, 栗光明, 朱繼業, 等.保脾斷流術治療門靜脈高壓癥上消化道出血的療效分析.中國普外基礎與臨床雜志, 2013, 20(1):29-32.
43. 朱繼業,倪彥彬. 保脾斷流術治療門靜脈高壓癥.中華消化外科雜志, 2013, 12(11):820-822.
44. 張啟瑜.門靜脈高壓癥的外科治療(附135例選擇性脾胃區減斷分流術報告). 2012年浙江省外科學學術年會論文集, 2012:9-14.
45. 徐鋒, 戴朝六, 卜獻民, 等.脾動脈結扎聯合賁門周圍血管離斷術治療門靜脈高壓癥脾功能亢進. 腹部外科, 2014, 27(2):101-105.
46. 姜洪池, 代文杰, 胡震.門靜脈高壓癥外科治療的保脾問題. 外科理論與實踐, 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. 紀旭, 董家鴻. 門靜脈高壓癥的外科治療進展. 中國醫師雜志, 2014, (z1):228-230.
49. 姜洪池, 劉昶.門靜脈高壓癥保脾的有關問題.中華肝膽外科雜志, 2003, 9(10):577-580.

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Surgical Treatment for Portal Hypertension with Hypersplenism

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