Macrosegregation and shrinkage porosity in large steel ingots are key factors restricting the homogenization of large cast and forged parts. Due to the complex mechanisms of their formation, they have always been challenging issues in the research on solidification control of large steel ingots. The purpose of this review is to systematically revisit the research progress on the mechanisms of macrosegregation and shrinkage porosity formation in large steel ingots, focusing on the mechanisms of formation of 'A' type segregation, positive segregation at the top, and negative segregation at the bottom, and their impact on the quality of steel ingots. At the same time, the conditions and influencing factors for the formation of shrinkage porosity are analyzed in detail, and the interaction between macrosegregation and shrinkage porosity during the solidification process of steel ingots is discussed. Based on existing research results and challenges, prospects for future research directions are proposed, emphasizing the development of high-precision numerical simulation techniques and experimental research methods to deeply understand the internal mechanisms of segregation and porosity formation, providing a scientific basis for formulating effective control strategies.