The Influence Of Different Anaesthetic Techniques On Perioprative Immunosuppression Of Patients With Esophageal Cancer

Objective The aim of this study was to investingate the changes in countsof T-lymphocyte subset and natural killer cell(NK cell) as well as B-lymphocyte cell in patients undergoing radical esophogas cancer operation,trying to find an ideal anaesthetic technique causing least immunodepression for this type of surgery.Methods Sixty ASA I ~ II patients undergoing elective radical operation foresophogas cancer,without complications or remidies affecting immune function,were randomly assigned into two groups: General anaesthesia with 30 patients (group G ):general anaesthesia was induced with fentaly, midazolam, succcinylcholine, maintained with intermittent invenous bolus of atracrium and inhalation of N2O and enflurance,and PC A analgesia post-operation. Combined anaesthesia group with 30 patients(group C):General anaestheia and postoperative analgesia were used as those in group Qcompanied by intermittent epidural block with 0.25%bupivacaine before and during operation.Blood samples were drawn from peripheral vein before induction of anaesthesia(TO),at the end of operation(Tl) and on the first (T2) \the third(T3)\the fifth(T4) and the seventh (T5) day after operation,to measure T-lymphocyte subsets (CD3+,CD4+,CD8+,CD4+/CD8+),and CD 19+ B-lymphocyte cells as well as natural kill cell counts by flow cytometry (FACScalibur E4242 USA).Results There were no significant differences in age,body weight,ASA class,andsurgical duration between the two groups. CD3+, CD4+, CD8+ and CD4+/CD8+ decreased significantly at the end of operation and on the first and third postoperative day in two groups(P<0.05).In group C CD3+,CD4+,CD8+ and CD4+/CD8+ almost returned to baseline values on the fifth postoperative day. In group G CD3+,CD4+,CD8+,andCD4+/CD8+ were close to baseline values on the seventh postoperative day.On the fifth postoperative day CD3+,CD4+,CD8+ and CD4+/CD8+ were significantly higher in group C than those in group G ( P<0.05).The B lymphocyte cells increased slightly from the end of operation to the third postoperative day in bothgroups (P>0.05),and there was no remarkable differences between two groups.The NK cell counts began to decrease strikingly from the end of operation to the fifth postoperative day in group G,whereas the decrease began from the first day to the third day after operation in group C .The NK cells recovered on the fifth postoperative day in group C but on the seventh day after operation in group G .On the fifth postoperative day NK cell counts were notable higher in group C than that in group G (P<0.05).Conclusion Epidural block combined with general anaesthesia can improve theimmunosuppression of the perioperative esophageal cancer patient,which could promote the recovery of patient' s immune function.