| Introduction :Thoracic epidural anesthesia (TEA) can significantly reduce the surgical stress response , provide better analgesia. This study is designed to investigate the effects of TEA conbind general anesthesia during operation and postoperative epidural analgesia on the plasma levels of cortisol(Cor) and IL-6, and differentiation of human helper T cell in the esophageal carcinoma patients undergoing thoracic surgery, and to explore the mechanism.Methods: Sixty esophageal carcinoma patients, ASAI～II, were randomly allocated into four groups with 15 cases each . Patients in group I and II were received total intravenous general anesthesia (TIVA) .However patient in group III and IV were given TEA combind and TIVA during operation. Postoperatively, patients in group I and III were used controlled intravenous analgesia (PCIA); however patients in group II and IV were used controlled epidural analgesia (PCEA) . Peripheral blood samples for measurement of cortisol,IL-6,IFN-γ(as a marker of Th1 cells),IL-4(as a marker of Th2 cells),TGF-β1 and IL-17(as markers of Th17 cells)were taken before the induction of anesthesia(T0),at 2h after incision(T1),at 4h after the end of surgery(T2),24h after the end of surgery(T3) and 48h after the end of surgery(T4). The VAS scores were assessed at 24h,48h and 72h postoperatively both in rest and activity conditions. The levels of cortisol and IL-6 in plasma were measured by radioimmunoassay. The levels of IFN-γ,IL-4,TGF-β1 and IL-17 in plasma were quantified by enzyme-linked immuno sorbent assay(ELISA). The ratio of IFN-γ/IL-4 were calculated as Th1/ Th2 cells.Results: (1)Effect of analgesia The VAS in group II and group IV were significantly lower than that of group I in rest or activity conditions(both,P<0.05). The VAS in group IV were significantly lower than that of group III in rest or activity (both,P<0.05). And the VAS in groupII were significantly lower than that of group III at 72h after operation in rest or activity , but at 48h only in activity (P<0.05).(2)Changes of Cor and IL-6 in plasma Compared with T0, the levels of Cor in group I and I I at T1 rose significantly (P<0.05); however these levels in group III and IV began to rise at T3(P<0.05)..And it is earlier that levels in group II and IV at T4 were returned to these levels at T0 (P>0.05). Compared with group IV , the levels of Cor in group I were higher at T1,T2,T3 and T4(P<0.05).;these in group II were higher at T2 (P<0.05);these in group III were higher at T3 and T4 ( both,P<0.05). Compared with group III, the levels of Cor in group I were higher than at T1 and T2 (both P <0.05). but these levels in group II at T4 were lower (P<0.05).Compared with T0, the levels of IL-6 in group I and II rose significantly at T1 (P<0.05); however these levels in group III began to rise at T3 (P<0.05). Compared with group IV , the levels of IL-6 in group I were higher at T1,T2and T4(P<0.05). The levels of IL-6 in group II were higher than those in group IV at T1 and T2 (P<0.05); these levels were higher than those in group III at T4 (P<0.05).(3) Changes of the ratio of Th1/Th2 Compared with T0,the IFN-γ/IL-4 ratio in group I and II were decreased significantly at T2(P<0.05).;however this ratio in group III and IV began to decrease significantly at T3(P<0.05).The IFN-γ/IL-4 ratios in group III and IV at T2 were higher than those in group I and II (P<0.05). These ratios in group IV at T3 and T4 were higher than those in group I (P<0.05).(4) Changes of Th17 cell The levels of TGF-β1 in all groups were decreased significantly at T3 compared with those at T0 (P<0.05). However there were no differences among four groups (P>0.05) . The levels of IL-17 in group I and II at T2 and T3 were higher than those at T0 (P<0.05). The IL-17 levels in group IV at T2,T3 and T4 were decreased significantly compared with that in group I(P<0.05).Conclusion: These resluts show that the plasma Cor and IL-6 levels in esophageal carcinoma patients undergoing thoracic surgery were increased significantly when operation was begining . At the same time Th0 cells shift to Th2 cells ,and the IL-17 levels have the tendency to increase. No matter general anesthesia combined with TEA or PCEA only can inhibit stress response and provide more effective postoperative pain relief. They also can slowdown Th0 cells shift to Th2 cells and reduce the differentiation or formation of Th17 cells ,which are proinflammatory. There will get more effective results if TEA combine with PCEA,.
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