Abstract: Hepatosplenomegaly in children is a common clinical sign in pediatrics，with etiologies involving multisystem diseases. Currently，there are problems such as non-standard medical history collection，omissions in assessment，disordered examinations，delayed initiation of multidisciplinary collaboration（MDT），narrow coverage of existing literature，and poor practicality. Based on clinical needs and practice，this article clarifies the definition and etiologies of hepatosplenomegaly，proposes that the diagnosis should follow the principle of“first evaluating acute/critical conditions，then conducting screening”，and identifies the etiologies through systematic medical history collection，physical examination，and progressive auxiliary examinations，thereby providing a practical reference for standardizing clinical diagnosis. 

Key words: hepatomegaly, splenomegaly, children, diagnosis

摘要： 儿童肝脾肿大是儿科常见体征，病因涉及多系统疾病，当前存在病史采集不规范、评估疏漏、检查无序、多学科协作启动滞后、现有文献覆盖窄、实操性弱等问题。文章从临床需求出发，基于临床实践，明确肝脾肿大的定义与病因，提出诊断应遵循“先评急危重症、后行筛查”的原则，通过系统的病史采集、体格检查及循序渐进的辅助检查以明确病因，为规范临床诊断提供实用参考。

关键词: 肝肿大, 脾肿大, 儿童, 诊断