Attenuation of the tumor-promoting effect of surgery by spinal blockade in rats
Attenuation of the tumor-promoting effect of surgery by spinal blockade in rats
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DOI：
10.1097/00000542-200106000-00022
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发表时间：
2001-06-01
期刊：
影响因子：
8.8
通讯作者：
Ben-Eliyahu, S
中科院分区：
文献类型：
--
作者：
Bar-Yosef, S;Melamed, R;Ben-Eliyahu, S
背景：围手术期的特点是免疫抑制状态，动物研究表明这是手术促进肿瘤转移的基础。由于这种免疫抑制部分归因于神经内分泌应激反应，作者假设脊髓阻滞（已知可减弱这种反应）可能会降低手术的促肿瘤作用。 方法：Fischer-344 大鼠在单独氟烷全身麻醉或联合全身吗啡（10 毫克/千克）或使用布比卡因（50 微克）和吗啡（10马克杯）。对照组要么被麻醉，要么不受干扰。手术后5小时抽血以评估自然杀伤细胞的数量和活性，或者给大鼠静脉注射MADB106腺癌细胞，该细胞仅转移至肺部。通过量化接种后 24 小时内肿瘤细胞的肺滞留或通过计数 3 周后的肺转移来评估转移发展。结果：仅在全身麻醉期间进行的剖腹手术使肺肿瘤滞留增加了 17 倍。添加脊柱阻滞使这种效应降低了 70%。转移数量从对照组的 16.7 +/- 10.5（平均值 +/- SD）增加到手术后的 37.2 +/- 24.4，并在脊柱阻滞期间减少到 10,5 +/- 4.7。全身吗啡也降低了手术的效果，但程度较轻。手术和单独麻醉对自然杀伤细胞活性的抑制程度相似。结论：在氟烷全身麻醉中添加脊髓阻滞剂可显着减弱手术对转移的促进作用。
Background: The perioperative period is characterized by a state of immunosuppression, which was shown in animal studies to underlie the promotion of tumor metastasis by surgery. As this immunosuppression is partly ascribed to the neuroendocrine stress response, the authors hypothesized that spinal blockade, known to attenuate this response, may reduce the tumor-promoting effect of surgery.Methods: Fischer-344 rats were subjected to a laparotomy during general halothane anesthesia alone or combined with either systemic morphine (10 mg/kg) or spinal block using bupivacaine (50 mug) with morphine (10 mug). Control groups were either anesthetized or undisturbed. Blood was drawn 5 h after surgery to assess number and activity of natural killer cells, or rats were inoculated intravenously with MADB106 adenocarcinoma cells, which metastasize only to the lungs. Metastatic development was assessed by quantifying lung retention of tumor cells 24 h after inoculation or by counting pulmonary metastases 3 weeks later.Results: Laparotomy conducted during general anesthesia alone increased lung tumor retention up to 17-fold. The addition of spinal block reduced this effect by 70%, The number of metastases increased from 16.7 +/- 10.5 (mean +/- SD) in the control group to 37.2 +/- 24.4 after surgery and was reduced to 10,5 +/- 4.7 during spinal block. Systemic morphine also reduced the effects of surgery, but to a lesser degree. Natural killer cell activity was suppressed to a similar extent by surgery and by anesthesia alone.Conclusions: The addition of spinal blockade to general halothane anesthesia markedly attenuates the promotion of metastasis by surgery.