【罂粟摘要】硬膜外和静脉镇痛对结直肠癌术后无病生存率的影响比较：一项多中心随机对照试验

【罂粟摘要】硬膜外和静脉镇痛对结直肠癌术后无病生存率的影响比较：一项多中心随机对照试验广西医科大学 作者：米勒之声 硬膜外和静脉镇痛对结直肠癌术后无病生存率的影响比较：一项多中心随机对照试验 贵州医科大学 高鸿教授课题组 翻译：牛振瑛编辑：佟睿 审校：曹莹 背景 与全身阿片类镇痛相比

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作者：米勒之声

硬膜外和静脉镇痛对结直肠癌术后无病生存率的影响比较：一项多中心随机对照试验

贵州医科大学 高鸿教授课题组

翻译：牛振瑛编辑：佟睿 审校：曹莹

背景

与全身阿片类镇痛相比，胸段硬膜外镇痛(TEA)被认为可以提高结直肠癌根治性手术后的存活率。然而，完全基于回顾性研究的证据存在相互矛盾的结论。

方法

本研究为前瞻性的多中心研究，选取2011年6月至2017年5月期间计划行择期结直肠癌手术的患者，随机分为患者自控TEA组或吗啡静脉镇痛(PCA)组。主要观察指标是术后5年无病生存情况。次要观察指标是术后疼痛、术后30天的并发症(心血管、呼吸系统、感染性、手术相关和泌尿系统并发症)、住院时间(LOS)和首次返回肿瘤治疗(RIOT)时间。

结果

研究共纳入了221例(110例TEA和111例PCA)患者，其中有180例(89例TEA和91例PCA)纳入了最终数据分析。5年无病生存率TEA组为76%，PCA组为69%;未调整风险比(HR): 1.31(95%[CI]: 0.74-2.32)， P=0.35;调整后的HR: 1.19(95%[CI]:0.61-2.31)， P = 0.61。在开放和微创手术中，TEA组的患者在术后前24小时有更好的疼痛缓解效果，但之后没有差异。两组之间术后并发症、LOS和RIOT无差异。

结论

在大肠癌手术患者的5年无病生存率方面，TEA和PCA组之间没有显著差异。除了在术后最初24小时内减少术后疼痛外，TEA与静脉注射吗啡的PCA相比没有其他差异。

原始文献来源

Falk W, Magnuson A, Eintrei C,et,al.Comparison between epidural and intravenous analgesia effects ondisease-free survival after colorectal cancer surgery: arandomisedmulticentre controlled trial[J].Br J Anaesth. 2021 Jul;127(1):65-74. doi: 10.1016/j.bja.2021.04.002.

Comparison between epidural and intravenous analgesia effects on disease-free survival after colorectal cancer surgery: a randomised multicentre controlled trial

Abstract

Background: Thoracic epidural analgesia (TEA) has been suggested to improve survival after curative surgery for colorectal cancer compared with systemic opioid analgesia. The evidence, exclusively based on retrospective studies, is contradictory.

Methods: In this prospective, multicentre study, patients scheduled for elective colorectal cancer surgery between June 2011 and May 2017 were randomised to TEA or patient-controlled i.v. analgesia (PCA) with morphine. The primary endpoint was disease-free survival at 5 yr after surgery. Secondary outcomes were postoperative pain, complications,

length of stay (LOS) at the hospital, and first return to intended oncologic therapy (RIOT).

Results: We enrolled 221 (110 TEA and 111 PCA) patients in the study, and 180 (89 TEA and 91 PCA) were included in the primary outcome. Disease-free survival at 5 yr was 76% in the TEA group and 69% in the PCA group; unadjusted hazard ratio (HR): 1.31 (95% confidence interval [CI]: 0.74-2.32), P=0.35; adjusted HR: 1.19 (95% CI: 0.61-2.31), P=0.61. Patients in the TEA group had significantly better pain relief during the first 24 h, but not thereafter, in open and minimally invasive

procedures. There were no differences in postoperative complications, LOS, or RIOT between the groups.

Conclusions: There was no significant difference between the TEA and PCA groups in disease-free survival at 5 yr in patients undergoing surgery for colorectal cancer. Other than a reduction in postoperative pain during the first 24h after surgery, no other differences were found between TEA compared with i.v. PCA with morphine.

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编辑：牟雪

校对：Michel.米萱

米勒之声编辑部

米勒之声，用心相伴

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