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ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 39 Issue 8
Aug.  2023
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Article Navigation >  Journal of Clinical Hepatology  > 2023  >  39(8): 1958-1965

Influence of splenectomy on the course of liver cirrhosis and related mechanism

DOI: 10.3969/j.issn.1001-5256.2023.08.029
  • 1.

    Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China

  • 2.

    Department of Digestive Medicine, Jianyang Hospital of Traditional Chinese Medicine, Chengdu 610075, China

  • 3.

    Department of General Medicine, Jianyang People's Hospital, Chengdu 610075, China

Research funding:

Key Technology Research and Development Program of Sichuan Province (2020YFS0301)

More Information
  • Corresponding author: FENG Quansheng, fengqs118@163.com (ORCID: 0000-0003-3437-8987)
  • Received Date: 2022-11-22
  • Accepted Date: 2023-01-20
  • Published Date: 2023-08-20
    Abstract
  • Splenomegaly is a common pathological change of portal hypertension in liver cirrhosis and can progress to hypersplenism, leading to the reduction in blood cells and increasing the risk of clinical bleeding and infection. Splenectomy is an important method for the treatment of splenectomy with hypersplenism, but it faces the risks of infection, surgical bleeding, postoperative thrombosis, and postoperative pancreatic fistula. However, with the gradual deepening of modern research, it has been found that patients with liver cirrhosis have a certain degree of improvement after splenectomy, such as the reduced risk of gastrointestinal bleeding, a reduction in portal venous pressure, the improvement in the hemodynamics of internal organs, the promotion of liver tissue regeneration, the improvement in liver fibrosis, the regulation of immune function, the improvement in nutritional status, and the reduced risk of liver cancer. With reference to available clinical and experimental studies, this article reviews the influence of splenectomy on the course of liver cirrhosis and actively explores related mechanism, in order to provide reliable reference and basis for the selection and implementation of splenectomy in clinical practice.

     

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  • [1]
    BOLOGNESI M, MERKEL C, SACERDOTI D, et al. Role of spleen enlargement in cirrhosis with portal hypertension[J]. Dig Liver Dis, 2002, 34(2): 144-150. DOI: 10.1016/s1590-8658(02)80246-8.
    [2]
    MCCORMICK PA, MURPHY KM. Splenomegaly, hypersplenism and coagulation abnormalities in liver disease[J]. Baillieres Best Pract Res Clin Gastroenterol, 2000, 14(6): 1009-1031. DOI: 10.1053/bega.2000.0144.
    [3]
    ISHIGAMI M, ISHIZU Y, ONISHI Y, et al. Long-term dynamics of hematological data and spleen volume in cirrhotic patients after liver transplantation-various dynamics depending on etiology[J]. Springerplus, 2013, 2: 374. DOI: 10.1186/2193-1801-2-374.
    [4]
    ORLANDO R, LIRUSSI F, BASSO SM, et al. Splenomegaly as risk factor of liver cirrhosis. A retrospective cohort study of 2, 525 patients who underwent laparoscopy[J]. In Vivo, 2011, 25(6): 1009-1012.
    [5]
    XU JH, FAN YN, JI TT, et al. Clinical characteristics of 500 hospitalized patients with liver cirrhosis: a retrospective analysis from a tertiary hospital in Beijing[J]. Chin J Hepatol, 2022, 30(5): 541-545. DOI: 10.3760/cma.j.cn501113-20201126-00631.

    徐京杭, 樊亚楠, 纪童童, 等. 500例肝硬化住院患者临床特征: 一项来自北京某三甲医院的回顾性分析[J]. 中华肝脏病杂志, 2022, 30(5) : 541-545. DOI: 10.3760/cma.j.cn501113-20201126-00631.
    [6]
    HUANG X, YAO L, DENG ZR, et al. Analysis of clinical characteristics of 481 HBV-related liver cirrhotic patients with low viral load[J]. Chin J Hepatol, 2021, 29(3): 227-233. DOI: 10.3760/cma.j.cn501113-20200302-00081.

    皇旭, 姚磊, 邓泽润, 等. 481例低病毒载量HBV相关肝硬化患者临床特征分析[J]. 中华肝脏病杂志, 2021, 29(3): 227-233. DOI: 10.3760/cma.j.cn501113-20200302-00081.
    [7]
    YAMADA S, MORINE Y, IMURA S, et al. Liver regeneration after splenectomy in patients with liver cirrhosis[J]. Hepatol Res, 2016, 46(5): 443-449. DOI: 10.1111/hepr.12573.
    [8]
    WANG Y. The mechanism of splenectomy for improving liver function in patients with liver cirrhosis[D]. Wuhan: Wuhan University, 2019.

    王银. 肝硬化患者脾脏切除术改善肝脏功能的机制研究[D]. 武汉: 武汉大学, 2019.
    [9]
    SHEN DF, GU XH, QI DJ, et al. Effect of splenic artery ligation on liver regeneration in rats following partial hepatectomy by measuring hepatocyte growth factor and transforming growth factor-β1[J]. J Exp Surg, 2019, 36(3): 455-457. DOI: 10.3760/cma.j.issn.1001-9030.2019.03.018.

    申东方, 顾小晖, 漆道金, 等. 大鼠肝部分切除术后肝细胞生长因子、转化生长因子-β1水平变化及脾动脉结扎对大鼠肝再生的影响[J]. 中华实验外科杂志, 2019, 36(3): 455-457. DOI: 10.3760/cma.j.issn.1001-9030.2019.03.018.
    [10]
    MATSUO R, OHKOHCHI N, MURATA S, et al. Platelets strongly induce hepatocyte proliferation with IGF-1 and HGF in vitro[J]. J Surg Res, 2008, 145(2): 279-286. DOI: 10.1016/j.jss.2007.02.035.
    [11]
    ELCHANINOV AV, FATKHUDINOV TK, VISHNYAKOVA PA, et al. Molecular mechanisms of splenectomy-induced hepatocyte proliferation[J]. PLoS One, 2020, 15(6): e0233767. DOI: 10.1371/journal.pone.0233767.
    [12]
    KAWANAKA H, AKAHOSHI T, KINJO N, et al. Effect of laparoscopic splenectomy on portal haemodynamics in patients with liver cirrhosis and portal hypertension[J]. Br J Surg, 2014, 101(12): 1585-1593. DOI: 10.1002/bjs.9622.
    [13]
    KONG DG, LU SC, WU JS, et al. A clinical study of the combined effects of splenectomy on the cirrhotic liver[J]. J Hepatobiliary Surg, 2022, 28(7): 499-503. DOI: 10.3760/cma.j.cn113884-20210402-00123.

    孔德刚, 卢实春, 武聚山, 等. 脾切除对肝硬化肝脏的综合作用的临床研究[J]. 中华肝胆外科杂志, 2022, 28(7): 499-503. DOI: 10.3760/cma.j.cn113884-20210402-00123.
    [14]
    LIU GW, WU X, TANG D, et al. Re-observation of splenectomy and esophagogastric devascularization in patients with hepatitis B cirrhosis and portal hypertension[J]. J Hepatol, 2021, 24(5): 649-652. DOI: 10.3969/j.issn.1672-5069.2021.05.011.

    刘公伟, 吴雪, 唐聃, 等. 脾切除联合门奇静脉断流术治疗乙型肝炎肝硬化门脉高压症患者疗效研究[J]. 实用肝脏病杂志, 2021, 24(5): 649-652. DOI: 10.3969/j.issn.1672-5069.2021.05.011.
    [15]
    ZENG DB, DI L, GUO QL, et al. Splenectomy with portoazygous disconnection for correction of systemic hemodynamic disorders in hepatic cirrhosis patients with portal hypertension: a prospective single-center cohort study[J]. Can J Gastroenterol Hepatol, 2020, 2020: 8893119. DOI: 10.1155/2020/8893119.
    [16]
    IWAKIRI Y. Endothelial dysfunction in the regulation of cirrhosis and portal hypertension[J]. Liver Int, 2012, 32(2): 199-213. DOI: 10.1111/j.1478-3231.2011.02579.x.
    [17]
    ANGUS PW. Role of endothelin in systemic and portal resistance in cirrhosis[J]. Gut, 2006, 55(9): 1230-1232. DOI: 10.1136/gut.2005.088633.
    [18]
    EIPEL C, ABSHAGEN K, VOLLMAR B. Regulation of hepatic blood flow: the hepatic arterial buffer response revisited[J]. World J Gastroenterol, 2010, 16(48): 6046-6057. DOI: 10.3748/wjg.v16.i48.6046.
    [19]
    LI YD, ZHANG HX, ZHAO YB, et al. Changes in cardiac hemodynamic parameters after splenectomy for peripancreatic vessel dissection in patients with cirrhotic portal hypertension[J]. Chin J Hepat, 2019, 24(6): 669-671. DOI: 10.14000/j.cnki.issn.1008-1704.2019.06.028.

    李亚东, 张红霞, 赵颜斌, 等. 肝硬化门静脉高压患者脾切除贲门周围血管离断术后心脏血流动力参数变化情况[J]. 肝脏, 2019, 24(6): 669-671. DOI: 10.14000/j.cnki.issn.1008-1704.2019.06.028.
    [20]
    YANG YJ, ZHENG HY, CHEN YC, et al. Advances in the treatment of portal hypertension and upper gastrointestinal bleeding in patients with liver cirrhosis[J]. Chin Gen Pract, 2020, 23(S2): 271-274. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX2020S2098.htm

    杨悦军, 郑华银, 陈耀成, 等. 肝硬化门脉高压并上消化道出血治疗研究进展[J]. 中国全科医学, 2020, 23(S2): 271-274. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX2020S2098.htm
    [21]
    MA JL, HE LL, LI P, et al. Prognosis of endotherapy versus splenectomy and devascularization for variceal bleeding in patients with hepatitis B-related cirrhosis[J]. Surg Endosc, 2021, 35(6): 2620-2628. DOI: 10.1007/s00464-020-07682-6.
    [22]
    QI RZ, ZHAO X, WANG SZ, et al. Analysis of postoperative complications and survival in 1, 118 cases of open splenectomy with flow dissection for portal hypertension[J]. Chin J Surg, 2018, 56(6): 436-441. DOI: 10.3760/cma.j.issn.0529-5815.2018.06.010.

    齐瑞兆, 赵新, 王胜智, 等. 1118例开腹脾切除断流术治疗门静脉高压症术后并发症及生存分析[J]. 中华外科杂志, 2018, 56(6): 436-441. DOI: 10.3760/cma.j.issn.0529-5815.2018.06.010.
    [23]
    DUAH A, NKRUMAH KN, TACHI K. Non-invasive markers as predictors of oesophageal varices in cirrhotic patient in a teaching hospital in Ghana[J]. Ghana Med J, 2019, 53(2): 142-149. DOI: 10.4314/gmj.v53i2.9.
    [24]
    LI ZW, QI ZR, ZHAO X, et al. Development of incision minimally invasion of splenectomy for portal hypertension[J/CD]. Chin J Hepat Surg: Electronic Edition, 2022, 11(1): 17-20. DOI: 10.3877/cma.j.issn.2095-3232.2022.01.005

    李志伟, 齐瑞兆, 赵新, 等. 门静脉高压症脾切除切口微创化发展[J/CD]. 中华肝脏外科手术学电子杂志, 2022, 11(1): 17-20. DOI: 10.3877/cma.j.issn.2095-3232.2022.01.005
    [25]
    ZENG DB, DI L, ZHANG RC, et al. The effect of splenectomy on the reversal of cirrhosis: a prospective study[J]. Gastroenterol Res Pract, 2019, 2019: 5459427. DOI: 10.1155/2019/5459427.
    [26]
    LIANG QS, XIE JG, YU C, et al. Splenectomy improves liver fibrosis via tumor necrosis factor superfamily 14 (LIGHT) through the JNK/TGF-β1 signaling pathway[J]. Exp Mol Med, 2021, 53(3): 393-406. DOI: 10.1038/s12276-021-00574-2.
    [27]
    LI N, WANG Z, LIN J. Up-regulated expression of PTEN after splenetomy may prevent the progression of liver fibrosis in rats[J]. J Hepatobiliary Pancreat Sci, 2016, 23(1): 50-56. DOI: 10.1002/jhbp.300.
    [28]
    WATANABE M, MURATA S, HASHIMOTO I, et al. Platelets contribute to the reduction of liver fibrosis in mice[J]. J Gastroenterol Hepatol, 2009, 24(1): 78-89. DOI: 10.1111/j.1440-1746.2008.05497.x.
    [29]
    HAYASHI H, BEPPU T, SHIRABE K, et al. Management of thrombocytopenia due to liver cirrhosis: a review[J]. World J Gastroenterol, 2014, 20(10): 2595-2605. DOI: 10.3748/wjg.v20.i10.2595.
    [30]
    LV YF, LI XQ, GONG XG, et al. Effect of surgery treatment on hypersplenism caused by cirrhotic portal hypertension[J]. Minerva Chir, 2013, 68(4): 409-413. DOI: 10.1016/j.jpedsurg.2012.09.048.
    [31]
    LIU W. Long-term efficacy of major splenectomy in the treatment of patients with cirrhotic portal hypertension[J]. Med Diet Health, 2019(12): 27-28. https://www.cnki.com.cn/Article/CJFDTOTAL-YXSL201912018.htm

    刘伟. 肝硬化门静脉高压症患者行脾大部切除术治疗的远期疗效观察[J]. 医学食疗与健康, 2019(12): 27-28. https://www.cnki.com.cn/Article/CJFDTOTAL-YXSL201912018.htm
    [32]
    JANDL JH, Aster RH. Increased splenic pooling and the pathogenesis of hypersplenism[J]. Am J Med Sci, 1967, 253(4): 383-398. DOI: 10.1097/00000441-196704000-00001.
    [33]
    WANG YX, LI GW, LI ZF. The role of splenomegaly and splenic macrophage in the occurrence of hypersplenism of portal hypertension[J]. J Xi'an Med Univ, 2001(2): 129-131. DOI: 10.3969/j.issn.1671-8259.2001.02.011.

    王永向, 李国威, 李宗芳. 脾大脾脏巨噬细胞在门脉高压症脾亢发生中的作用[J]. 西安医科大学学报, 2001(2): 129-131. DOI: 10.3969/j.issn.1671-8259.2001.02.011.
    [34]
    HU ZP, DING ZQ, TAO LJ, et al. Observation of platelet antibodies in the serum of patients with post-hepatitis cirrhosis[J]. J Blood Transfusion, 1990(4): 208. DOI: 10.13303/j.cjbt.issn.1004-549x.1990.04.029.

    胡兆平, 丁子清, 陶良军, 等. 肝炎后肝硬化患者血清中血小板抗体的观察[J]. 中国输血杂志, 1990(4): 208. DOI: 10.13303/j.cjbt.issn.1004-549x.1990.04.029.
    [35]
    YOSHIDA D, NAGAO Y, TOMIKAWA M, et al. Predictive factors for platelet count after laparoscopic splenectomy in cirrhotic patients[J]. Hepatol Int, 2012, 6(3): 657-661. DOI: 10.1007/s12072-011-9315-6.
    [36]
    WANG P, LI Z, REN S, et al. Spleen regulates hematopoietic stem/progenitor cell functions through regulation of egf in cirrhotic hypersplenism[J]. Dig Dis Sci, 2018, 63(7): 1860-1867. DOI: 10.1007/s10620-018-5091-7.
    [37]
    LV Y, WU H, LAU WY, et al. Impact of total splenectomy on peripheral lymphocytes and their subsets in patients with hypersplenism associated with cirrhotic portal hypertension[J]. Sci Rep, 2021, 11(1): 21246. DOI: 10.1038/s41598-021-00692-x.
    [38]
    HUANG N, JI FP, ZHANG S, et al. Spleen-associated effects on immunity in hepatitis B virus-related cirrhosis with portal hypertension[J]. J Interferon Cytokine Res, 2019, 39(2): 95-105. DOI: 10.1089/jir.2018.0121.
    [39]
    HIRAKAWA Y, OGATA T, SASADA T, et al. Immunological consequences following splenectomy in patients with liver cirrhosis[J]. Exp Ther Med, 2019, 18(1): 848-856. DOI: 10.3892/etm.2019.7640.
    [40]
    LV X, YANG F, GUO X, et al. Hypersplenism is correlated with increased risk of hepatocellular carcinoma in patients with post-hepatitis cirrhosis[J]. Tumour Biol, 2016, 37(7): 8889-8900. DOI: 10.1007/s13277-015-4764-5.
    [41]
    ZHANG XF, LIU Y, LI JH, et al. [Effect of splenectomy on the risk of hepatocellular carcinoma development among patients with liver cirrhosis and portal hypertension: a multi-institutional cohort study][J]. Chin J Surg, 2021, 59(10): 821-828. DOI: 10.3760/cma.j.cn112139-20210713-00308.

    张谞丰, 刘阳, 李建辉, 等. 脾切除对病毒性肝炎肝硬化合并门静脉高压症患者肝癌发生影响的多中心队列研究[J]. 中华外科杂志, 2021, 59(10): 821-828. DOI: 10.3760/cma.j.cn112139-20210713-00308.
    [42]
    HUANG N, JI F, ZHANG S, et al. Effect of splenectomy on serum cytokine profiles in hepatitis b virus-related cirrhosis patients with portal hypertension[J]. Viral Immunol, 2018, 31(5): 371-378. DOI: 10.1089/vim.2017.0176.
    [43]
    ZENG DB, ZHANG C, DI L, et al. The impact of splenectomy and esophagogastric devascularization on the nutrition status of patients with cirrhosis and portal hypertension[J]. J Hepatobiliary Surg, 2017, 23(7): 437-440. DOI: 10.3760/cma.j.issn.1007-8118.2017.07.002.

    曾道炳, 张纯, 邸亮, 等. 脾切除联合门奇静脉断流术对肝硬化合并门静脉高压症患者近远期营养状况的影响[J]. 中华肝胆外科杂志, 2017, 23(7): 437-440. DOI: 10.3760/cma.j.issn.1007-8118.2017.07.002.
    [44]
    SINWAR PD. Overwhelming post splenectomy infection syndrome-review study[J]. Int J Surg, 2014, 12(12): 1314-1316. DOI: 10.1016/j.ijsu.2014.11.005.
    [45]
    SHENG CF, LIU BY, ZHANG HM, et al. Overwhelming postsplenectomy infection[J]. Genet Mol Res, 2015, 14(1): 2702-2706. DOI: 10.4238/2015.March.30.30.
    [46]
    WU Y, LI H, ZHANG T, et al. Splanchnic vein thrombosis in liver cirrhosis after splenectomy or splenic artery embolization: a systematic review and meta-analysis[J]. Adv Ther, 2021, 38(4): 1904-1930. DOI: 10.1007/s12325-021-01652-7.
    [47]
    QI X, HAN G, YE C, et al. Splenectomy causes 10-fold increased risk of portal venous system thrombosis in liver cirrhosis patients[J]. Med Sci Monit, 2016, 22: 2528-2550. DOI: 10.12659/msm.898866.
    [48]
    JIANG S, AI Y, NI L, et al. Platelet-derived TGF-β1 is related to portal vein thrombosis in cirrhosis by promoting hypercoagulability and endothelial dysfunction[J]. Front Cardiovasc Med, 2022, 9: 938397. DOI: 10.3389/fcvm.2022.938397.
    [49]
    HUANG ZY, LI J. Splenectomy in patients with liver cirrhosis: the pros and cons[J]. J Hepatol, 2019, 22(04): 459-461. DOI: 10.3969/j.issn.1672-5069.2019.04.002.

    黄志寅, 李静. 肝硬化脾切除术利弊权衡细思量[J]. 实用肝脏病杂志, 2019, 22(4): 459-461. DOI: 10.3969/j.issn.1672-5069.2019.04.002.
    [50]
    WANG H, SHEN XX, CHEN LQ, et al. Association of JAK/STAT signaling pathway with portal vein thrombosis after splenectomy in cirrhotic patients with portal hypertension[J]. J Clin Hepatol, 2022, 38(10): 2260-2264. DOI: 10.3969/j.issn.1001-5256.2022.10.012.

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