麻醉与ERAS:肿瘤手术麻醉与远期预后

Anesthesia and Long-term Outcome of Patients in Cancer Surgery

围手术期多种因素包括手术创伤、肿瘤组织病理分期、低体温、输血、麻醉等,均可以直接或间接影响肿瘤细胞的侵袭、增殖能力,并引起全身炎症反应,干预机体免疫功能,因此可能促进肿瘤的复发和转移,影响预后。不同麻醉方法和药物均可以通过对患者免疫系统和肿瘤细胞的干扰,直接或间接的影响患者的预后。本文仅对麻醉方法影响肿瘤手术患者远期预后进行简述,并且提出以下问题和进行讨论:麻醉方法能改变肿瘤手术患者远期预后?麻醉药与镇痛药如何选择?目前肿瘤手术麻醉管理有何对策?麻醉、外科医生观念如何转变?

Perioperative factors including surgical trauma,tumor histopathological staging,hypothermia,blood transfusion,and anesthesia,can directly or indirectly influence of tumor cell proliferation and invasion,and lead to systemic inflammatory response,intervention in the immune function,thus may promote tumor recurrence and metastasis,affect the outcome.Different anesthetic methods and anesthetics can directly or indirectly affect the outcome of patients through the patients＇ immune systems and the interference of tumor cells.This review only summarizes anesthesia method affect long-term outcome of patients in cancer surgery,and propose and discuss the following problems：whether or not the anesthesia method can change the long-term outcome of patients in cancer surgery？How to choose anesthesia and analgesia？What is the strategics in anesthesia management in cancer surgery？How to change the ideas of anesthesiologist and surgeon？