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使用基于普罗波的静脉全麻醉和基于塞沃弗的吸入麻醉的肝切除术后无复发的生存率:一项随机对照研究

Ji-Hye Kwon¹, Jeayoun Kim¹, Hyean Yeo²

¹Department of Anaesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.

|January 8, 2025

概括

在经过肝切除术的肝细胞癌患者中,选择手术内麻醉,基于普罗波的静脉内全麻醉或基于西沃弗的吸入麻醉,并没有显著影响肝细胞癌患者的无复发或整体存活率. 然而,全静脉麻醉在开放性肝切除术病例中显示出生存益处.

科学领域:

肝胆道手术肝胆道手术
麻醉学麻醉学
手术瘤学手术瘤学

背景情况:

临床前和观察性研究表明,麻醉选择可能会影响瘤行为.
关于手术内麻醉剂对瘤复发和肝癌切除术后转移的影响的临床证据是不确定的.

研究的目的:

为了比较基于propofol的全静脉麻醉 (TIVA) 与基于sevoflurane的吸入麻醉 (IA) 对肝细胞癌 (HCC) 肝切除术后的瘤结局的影响.

主要方法:

一项随机对照试验,比较TIVA和IA在成人患者中进行选择性肝切除术的HCC.
使用卡普兰-梅尔方法和日志等级测试来比较无复发生存期 (RFS),总生存期 (OS),肝内RFS和肝外RFS.
主要结局是为期一年的RFS.

主要成果:

在TIVA (79.1%) 和IA (77.7%) 组 (aHR 1.04) 之间,一年的RFS是相似的.
在两组麻醉组之间,在一年内肝内RFS,肝外RFS或OS中没有发现显著差异.
亚组分析表明,TIVA与开放性肝切除术 (HR 0.49) 中的复发或死亡风险明显较低相关,但在腹腔镜手术 (HR 1.14) 中并非如此.

结论:

术内麻醉技术 (TIVA与IA) 在接受肝切除术的HCC患者中没有显著影响术后复发和整体存活率.
在接受开放性肝切除术的患者中观察到TIVA的潜在生存益处,这需要进一步调查.

关键词:

麻醉 anesthesia 这是一种麻醉.癌症的复发是癌症的复发.肝细胞癌是肝细胞癌.普罗波福尔 (Propofol) 是一种七伏氨酸是什么意思

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