区域麻醉对乳腺癌手术术后复发、转移及免疫应答的影响；系统评价
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Impact of Regional Anesthesia on Recurrence, Metastasis, and Immune Response in Breast Cancer Surgery
背景与目的
围手术期是影响乳腺癌患者长期预后的重要时期。区域阻滞麻醉的使用，如椎旁阻滞（PVB），可能改善乳腺癌手术患者的长期预后。其机制主要是调节手术创伤造成的炎症反应和免疫反应，减少阿片类药物和全麻药物的使用量，通过局麻药的作用直接促进癌细胞死亡。
方 法
系统检索行PVB的乳腺癌手术患者的研究。使用Jadad评分和Ottawa-Newcastle量表评估每项随机对照试验和观察性的回顾性研究的质量。只有高质量的研究被纳入荟萃分析。纳入的研究被分为3组来确定PVB的作用（a）复发和生存，（b）体液免疫反应，（c）细胞免疫反应。
结 果
我们确定了467项相关研究，其中121篇阅读了标题和摘要，107篇被排除在外，15篇研究被纳入进行全文阅读和质量评估。由于存在低质量的研究，并且主要指标缺乏一致性，本文没有进行meta分析。因此，对现有的证据进行了系统评价。
结 论
相关生存。然而，使用PVB可以降低炎症反应和免疫反应，从而全麻药物和阿片类药物的用量。 我们的研究表明，没有证据证明PVB是否可以降低癌症复发或改善癌症
原始文献摘要
Oscar Pérez-González, Luis F. Cuéllar-Guzmán,et al, Impact of Regional Anesthesia on Recurrence, Metastasis, and Immune Response in Breast Cancer Surgery,Reg Anesth Pain Med 2017，42: 00–00
Abstract：
Background and Objectives: The perioperative period is critical in the long-term prognosis of breast cancer patients. The use of regional anes- thesia, such as paravertebral block (PVB), could be associated with improvements in long-term survival after breast cancer surgery by modulating the inflammatory and immune response associated with the surgical trauma, reducing opioid and general anesthetic consumption, and promoting cancer cells death by a direct effect of local anesthetics.
Methods: A systematic literature search was conducted for studies of patients who received PVB for breast cancer surgery. The Jadad score and Ottawa-Newcastle scale were used to assess the methodological quality of randomized controlled trial and observational retrospective studies, re- spectively. Only high-quality studies were considered for meta-analysis. The selected studies were divided into 3 groups to determine the impact of PVB on (a) recurrence and survival, (b) humoral response, and (c) cellular immune response.
Results: We identified 467 relevant studies; 121 of them underwent title and abstract review, 107 were excluded, and 15 studies were selected for full text reading and quality assessment. A meta-analysis was not conducted because of low-quality studies and lack of uniform definition among primary outcomes. Thus, a systematic review of the current evidence was performed.
Conclusions: Our study indicates that there are no data to support or refute the use of PVB for reduction of cancer recurrence or improvement in cancer-related survival. However, PVB use is associated with lower levels of inflammation and a better immune response in comparison with general anesthesia and opioid-based analgesia.
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