The Department of Surgery, the University of Tokushima, Tokushima, Japan.
Hepatol Res. 2008 Dec;38(12):1159-71. doi: 10.1111/j.1872-034X.2008.00384.x. Epub 2008 Aug 5.
For years splenectomy in hepatic disorders has been indicated only for the treatment of gastro-esophageal varices. However, with recent advances in medical and surgical treatments for chronic hepatic disorders, the use of splenectomy has been greatly expanded, such that splenectomy is used for reversing hypersplenism, for applying interferon treatment for hepatitis C, for treating hyperdynamic portal circulation associated with intractable ascites, and for controlling portal pressure during small grafts in living donor liver transplantation. Such experiences have shown the importance of portal hemodynamics, even in cirrhotic livers. Recent advances in surgical techniques have enabled surgeons to perform splenectomy more safely and less invasively, but the procedure still has considerable clinical outcomes. Splenectomy in hepatic disorders may become a more common procedure with expanded indications. However, it should also be noted that the long-term effects of splenectomy, in terms of improved hematological or hepatic function, is still not guaranteed. Moreover, the impact of splenectomy on immunologic status remains unclear and needs to be elucidated in both experimental and clinical settings.
多年来，脾切除术仅在治疗胃食管静脉曲张时才适用于肝脏疾病。然而，随着慢性肝脏疾病的医学和外科治疗的最新进展，脾切除术的应用已经大大扩展，例如脾切除术可用于逆转脾功能亢进、应用干扰素治疗丙型肝炎、治疗与难治性腹水相关的高动力门静脉循环以及在活体供肝移植中小移植物时控制门静脉压力。这些经验表明门静脉血液动力学的重要性，即使在肝硬化肝脏中也是如此。外科技术的最新进展使外科医生能够更安全、更微创地进行脾切除术，但该手术仍然具有相当大的临床效果。脾切除术在肝脏疾病中的应用可能会随着适应证的扩大而变得更加普遍。然而，也应该注意到，脾切除术在改善血液或肝脏功能方面的长期效果仍然不能保证。此外，脾切除术对免疫状态的影响尚不清楚，需要在实验和临床环境中阐明。
