手术对肿瘤转移的影响以及麻醉对策  

Effect of surgery on cancer recurrence and anaesthetic strategy

作　　者：周获[1] 缪长虹[2] 

机构地区：[1]复旦大学附属中山医院麻醉科,上海200032 [2]复旦大学附属肿煽医院麻醉科

出　　处：《国际麻醉学与复苏杂志》2013年第9期808-811,815,共5页International Journal of Anesthesiology and Resuscitation

摘　　要：背景手术会增加肿瘤的转移，影响肿瘤患者的长期预后。目的通过探讨手术影响肿瘤转移的机制来指导麻醉方法和药物的选择，从而减少肿瘤术后转移的机会。内容介绍了肿瘤转移的过程，以自然杀伤细胞（naturalkillercell，NK）和T辅助（Thelper，Th）细胞为例阐述了肿瘤与免疫的关系，分析了手术增加肿瘤转移的原因，着重讨论了围术期免疫功能抑制的影响因素，包括神经内分泌，炎症，垂体-下丘脑一。肾上腺轴，低体温和输血等5个主要方面。麻醉可以通过β受体阻滞药，环氧酶（cyclo—oxygemase，COX）抑制剂，良好的镇痛，区域麻醉，谨慎选择吸入和静脉麻醉药以及保温和节约用血来减少手术对肿瘤转移的影响。趋向麻醉方法与药物的选择能减少肿瘤术后的转移复发，但仍需大量的前瞻性研究证实。Background Surgery increases cancer recurrence, which has a negative effect on long-term prognosis. Objective The paper discussed the mechanism of surgery on cancer recurrence to guide the choice of anesthesia method and drugs in order to decrease postoperative cancer recurrence. Content Introduce the process of cancer recurrence, take natural killer cell （NK） and T helper（Th） cells for example to recite the relationship of cancer and immunity. Analyze the reason that surgery increases cancer recurrence, especially the effects on perioperative immune inhibition, including neuroendocrine, inflammation, HPA axis, hypothennia and blood transfusion. β-receptor blocker, cyclo-oxyge-nase （COX） inhibitor, good analgesia, regional anesthesia, careful selection of inhalation as well as intravenous anesthetics, avoidable hypothermia and unnecessary blood transfusion can reduce the surgery effect on cancer recurrence. Trend Good choice of anesthesia method and drugs may decrease postoperative recurrence of cancer. But plenty of prospective studies are required.

关 键 词：NK细胞 T辅助细胞 肿瘤术后转移复发 麻醉 

分 类 号：R73-37[医药卫生—肿瘤]