麻醉与手术对乳腺癌患者围手术期免疫功能的影响

目的]探讨喉罩通气全凭静脉麻醉下乳腺癌改良根治术对患者围手术期T淋巴细胞亚群及自然杀伤细胞（NK细胞）的影响。方法]随机选择Ⅱ～Ⅲ期术前化疗或非化疗乳腺癌患者各25例．A组为术前未化疗组，B组为术前化疗组：分别于麻醉前、手术结束时、术后第1d及术后第3d用流式细胞仪检测T淋巴细胞亚群、NK细胞值。结果]与麻醉前相比，两组患者术后第1d、第3d的CD8^＋和NK细胞下降明显（P〈0．05）．而CD4^＋／CD8^＋显著性升高（P〈0．05）；但两组间术后第1d、第3dCD3^＋、CD8^＋、NK细胞以及CD4^＋／CD8^＋比较差异无显著性（P〉0．05）。结论]喉罩通气全凭静脉麻醉下乳腺癌改良根治术对术前化疗或非化疗患者的免疫系缔部有一定的抑制作用．而这种抑制作用与患者术前是否讲行辅助化疗无关．

Impact of Anesthesia and Surgery on Immunity in Patients with Breast Cancer Perioperation

Purpose ] To investigate the effects of total intravenous anesthesia（TIVA） on T lymphocyte subsets and NK cells in patients with breast cancer undergoing modified radical mastectomv. Methods] T lymphocyte subsets and NK cells in 25 cases with breast cancer stage Ⅱ-Ⅲ undergoing preoperative chemotherapy and 25 cases with breast cancer stage Ⅱ-Ⅲ without preoperative chemotherapy were detected by flow cytometry at pre-anesthesia, end of operation, 1 day and 3 day postoperation. Results]
Compared with pre-anesthesia, CD8^＋,NK cells at 1 day and 3 day postoperation decreased significantly（P〈0.05）; while CD4^＋/CD8^＋ increased significantly（P〈0.05）. CD3^＋,CD8^＋, NK cells and CD4^＋/CD8^＋ at 1 day and 3 day postoperation were not significantly difference between two groups. Conclusion] Under TIVA, modified radical mastectomy inhibits immunologic system, and the inhibition is not related to preoperative adjuvant chemotherapy.