麻醉选择在皮肤黑色素瘤手术中的影响
Matthew G K Benesch1, Joseph J Skitzki
1Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA.
Melanoma research
|November 4, 2023
概括
总麻醉可以通过抑制免疫力增加黑色素瘤复发风险. 避免全身麻醉,选择局部或区域麻醉可以改善患者的黑色素瘤特定存活率.
科学领域:
- 在瘤学瘤学.
- 麻醉学 麻醉学
- 免疫学 免疫学 免疫学
背景情况:
- 侵袭性皮肤黑色素瘤是一种致命的皮肤癌,通常用手术治疗.
- 黑色素瘤是免疫原性的,外科手术期间的全身麻醉 (挥发性麻醉剂,阿片类药物) 可能会抑制免疫功能.
- 这种免疫抑制可以促进残留黑色素瘤细胞或微转移的生存和传播,可能导致疾病复发.
研究的目的:
- 评估外科手术期间麻醉剂对黑色素瘤患者结局的影响.
- 探索区域或局部麻醉在皮肤黑色素瘤手术中的潜在益处,而不是全身麻醉.
主要方法:
- 审查观察性临床研究,检查麻醉类型和黑色素瘤结果.
- 对麻醉剂对免疫系统和癌症生物学影响的临床前数据的分析.
- 考虑不断发展的黑色素瘤外科治疗策略,包括哨兵淋巴结活检和新辅助免疫治疗反应.
主要成果:
- 临床前研究表明,挥发性麻醉剂和阿片类药物抑制免疫力,与局部药物不同.
- 观察性临床研究显示出混合的结果,但一些研究表明,与区域性或脊髓麻醉相比,全身麻醉减少了黑色素瘤特异性生存率.
- 由于更新的淋巴结管理协议,随着局部/区域麻醉的最终手术的指示增加.
结论:
- 由全身麻醉诱导的外科手术期间免疫抑制可能会对黑色素瘤特异性存活率产生负面影响.
- 皮肤黑色素瘤患者可能受益于避免全身麻醉,并在可行的情况下选择区域或局部麻醉.
- 需要进一步的研究来证实麻醉选择在黑色素瘤治疗和生存中的好处.
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