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很多研究認(rèn)為麻醉可能影響免疫系統(tǒng)、可能與腫瘤復(fù)發(fā)相關(guān)，現(xiàn)分享一篇發(fā)表在Anesthesiology雜志上的最新文獻(xiàn)，供參考！

摘要譯文（供參考） 硬膜外鎮(zhèn)痛與結(jié)直腸癌術(shù)后復(fù)發(fā)：一項(xiàng)基于丹麥回顧性登記的隊(duì)列研究 

背景： 手術(shù)是結(jié)直腸癌的主要治療手段。然而，手術(shù)誘發(fā)的免疫和體液反應(yīng)可能促進(jìn)腫瘤微轉(zhuǎn)移。有人認(rèn)為硬膜外鎮(zhèn)痛可以保護(hù)免疫能力，防止腫瘤轉(zhuǎn)移。因此，作者驗(yàn)證了硬膜外鎮(zhèn)痛可以減少結(jié)直腸癌手術(shù)后癌癥復(fù)發(fā)的假設(shè)。

方法： 利用丹麥結(jié)直腸癌組數(shù)據(jù)庫和丹麥麻醉數(shù)據(jù)庫，選擇2004年至2018年間因結(jié)直腸癌手術(shù)而術(shù)后無殘留腫瘤組織的患者。暴露組的定義是術(shù)前置入硬膜外導(dǎo)管進(jìn)行鎮(zhèn)痛。主要結(jié)果是結(jié)直腸癌復(fù)發(fā)，次要結(jié)果是死亡率。根據(jù)丹麥衛(wèi)生注冊(cè)中心的數(shù)據(jù)，使用經(jīng)驗(yàn)證的算法確定復(fù)發(fā)。隨訪至死亡或2018年9月7日。作者使用傾向評(píng)分匹配來調(diào)整潛在的術(shù)前混雜因素。 

結(jié)果： 在11618人的研究人群中，3496人（30.1%）在手術(shù)前置入硬膜外導(dǎo)管。硬膜外鎮(zhèn)痛組在全憑靜脈麻醉、剖腹手術(shù)和直腸腫瘤中的比例較高，2009年至2012年間硬膜外鎮(zhèn)痛的使用頻率最高。傾向評(píng)分匹配的研究隊(duì)列由每組2980人組成，具有平衡的基線協(xié)變量。中位隨訪時(shí)間為58個(gè)月（四分位數(shù)范圍為29至86）。硬膜外鎮(zhèn)痛組有567人（19.0%）復(fù)發(fā)，無硬膜外鎮(zhèn)痛組有610人（20.5%）復(fù)發(fā)。作者發(fā)現(xiàn)硬膜外鎮(zhèn)痛與復(fù)發(fā)（危險(xiǎn)比，0.91；95%可信區(qū)間，0.82至1.02）或死亡率（危險(xiǎn)比，1.01；95%可信區(qū)間，0.92至1.10）之間沒有關(guān)聯(lián)。 

結(jié)論： 在結(jié)直腸癌手術(shù)中，硬膜外鎮(zhèn)痛與癌癥復(fù)發(fā)率無統(tǒng)計(jì)學(xué)顯著相關(guān)性。

原文摘要 Epidural Analgesia and Recurrence after Colorectal Cancer Surgery: A Danish Retrospective Registry-based Cohort Study Background: Surgery is the main curative treatment for colorectal cancer. Yet the immunologic and humoral response to surgery may facilitate progression of micro-metastases. It has been suggested that epidural analgesia preserves immune competency and prevents metastasis formation. Hence, the authors tested the hypothesis that epidural analgesia would result in less cancer recurrence after colorectal cancer surgery. Methods: The Danish Colorectal Cancer Group Database and the Danish Anesthesia Database were used to identify patients operated for colorectal cancer between 2004 and 2018 with no residual tumor tissue left after surgery. The exposure group was defined by preoperative insertion of an epidural catheter for analgesia. The primary outcome was colorectal cancer recurrence, and the secondary outcome was mortality. Recurrences were identified using a validated algorithm based on data from Danish health registries. Follow-up was until death or September 7, 2018. The authors used propensity score matching to adjust for potential preoperative confounders. Results: In the study population of 11,618 individuals, 3,496 (30.1%) had an epidural catheter inserted before surgery. The epidural analgesia group had higher proportions of total IV anesthesia, laparotomies, and rectal tumors, and epidural analgesia was most frequently used between 2009 and 2012. The propensity score-matched study cohort consisted of 2,980 individuals in each group with balanced baseline covariates. Median follow-up was 58 months (interquartile range, 29 to 86). Recurrence occurred in 567 (19.0%) individuals in the epidural analgesia group and 610 (20.5%) in the group without epidural analgesia. The authors found no association between epidural analgesia and recurrence (hazard ratio, 0.91; 95% CI, 0.82 to 1.02) or mortality (hazard ratio, 1.01; 95% CI, 0.92 to 1.10). Conclusions: In colorectal cancer surgery, epidural analgesia was not statistically significantly associated with less cancer recurrence.

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編輯：Michel.米萱

校對(duì)：Mijohn.米江

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