椎管内麻醉可减少淋巴液流动：首例人体研究的概念验证

Neuraxial Anesthesia Reduces Lymphatic Flow: Proof-of-Concept in First In-Human Study.

作者信息

Hiller Jonathan G, Ismail Hilmy M, Hofman Michael S, Narayan Kailash, Ramdave Shakher, Riedel Bernhard J

机构信息

From the *Department of Cancer Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Australia; †Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia; ‡PhD candidate, Monash University, Clayton, Melbourne, Australia; §Department of Diagnostic Imaging, Peter MacCallum Cancer Centre, Australia; ‖Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Australia; ¶Department of Obstetrics and Gynaecology, University of Melbourne, Australia; and #Department of Nuclear Imaging and PET, Monash Medical Centre, Australia.

出版信息

Anesth Analg. 2016 Nov;123(5):1325-1327. doi: 10.1213/ANE.0000000000001562.

DOI:10.1213/ANE.0000000000001562

PMID:27636740

Abstract

Dilation of lymphatic vessels may contribute to iatrogenic dissemination of cancer cells during surgery. We sought to determine whether neuraxial anesthesia reduces regional lymphatic flow. Using nuclear lymphoscintigraphy, 5 participants receiving spinal anesthesia for brachytherapy had lower extremity lymph flow at rest compared with flow under conditions of spinal anesthesia. Six limbs were analyzed. Four limbs were excluded because of failure to demonstrate lymph flow (1 patient, 2 limbs), colloid injection error (1 limb), and undiagnosed deep vein thrombosis (1 limb). All analyzed limbs showed reduced lymph flow washout from the pedal injection site (range 62%-100%) due to neuraxial anesthesia. Lymph flow was abolished in 3 limbs. We report proof-of-concept that neuraxial anesthesia reduces lymphatic flow through a likely mechanism of sympathectomy.

摘要

淋巴管扩张可能在手术过程中导致医源性癌细胞播散。我们试图确定神经轴索麻醉是否会减少局部淋巴液流动。使用核素淋巴闪烁造影术，5名接受脊髓麻醉以进行近距离放射治疗的参与者在静息状态下的下肢淋巴液流动与脊髓麻醉状态下的流动相比更低。对6条肢体进行了分析。4条肢体被排除，原因分别为未显示出淋巴液流动（1例患者，2条肢体）、胶体注射错误（1条肢体）以及未确诊为深部静脉血栓形成（1条肢体）。所有分析的肢体均显示，由于神经轴索麻醉，从足部注射部位的淋巴液流动清除减少（范围为62% - 100%）。3条肢体的淋巴液流动消失。我们报告了概念验证，即神经轴索麻醉通过可能的交感神经切除术机制减少淋巴液流动。