Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy.
Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
In Vivo. 2019 Nov-Dec;33(6):1879-1884. doi: 10.21873/invivo.11681.
Surgical stress and anesthesia affect the patient's immune system. Analysis of the lymphocyte response after breast-conserving surgery was conducted to investigate the differences between effects after general and local anesthesia.
Fifty-six patients with breast cancer were enrolled for BCS through local or general anesthesia. Total leukocytes, total lymphocytes, lymphocyte-subsets including CD3, CD19, CD4, CD8, CD16CD56 and CD4/CD8 ratio was examined at baseline and on postoperative days 1, 2 and 3.
Baseline data showed no statistical difference between the two groups. Within-group ANOVA test showed significant differences for total leukocyte count (p<0.001), total lymphocyte count (p=0.009) and proportion of natural-killer cells (p=0.01) in the control group. Between-group analysis showed lower median values of total lymphocytes in the awake surgery group on postoperative days 1, 2 and 3 (p=0.001, p=0.02 and p=0.01, respectively) when compared to the control group. Patients who underwent surgery under general anesthesia had higher total lymphocyte counts on postoperative day 2 (p=0.04).
In this randomized study, breast-conserving surgery plus local anesthesia had a lower impact on postoperative lymphocyte response when compared to the same procedure performed under general anesthesia.
手术应激和麻醉会影响患者的免疫系统。本研究分析了保乳手术后淋巴细胞的反应，以探讨全身麻醉与局部麻醉对其影响的差异。
56 例乳腺癌患者接受局部或全身麻醉行保乳术。分别于术前、术后第 1、2、3 天检测总白细胞数、总淋巴细胞数、淋巴细胞亚群（包括 CD3、CD19、CD4、CD8、CD16+CD56 和 CD4/CD8 比值）。
两组患者的基线数据无统计学差异。组内 ANOVA 检验显示，对照组的总白细胞数（p<0.001）、总淋巴细胞数（p=0.009）和自然杀伤细胞比例（p=0.01）差异有统计学意义。组间分析显示，与对照组相比，全麻组患者术后第 1、2、3 天的总淋巴细胞中位数均较低（p=0.001、p=0.02 和 p=0.01）。全麻组患者术后第 2 天的总淋巴细胞计数较高（p=0.04）。
在本随机研究中，与全身麻醉下进行的相同手术相比，保乳术联合局部麻醉对术后淋巴细胞反应的影响较小。
