Chen Wan-Kun, Ren Li, Wei Ye, Zhu De-Xiang, Miao Chang-Hong, Xu Jian-Min
Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
Int J Colorectal Dis. 2015 Apr;30(4):475-81. doi: 10.1007/s00384-014-2098-1. Epub 2015 Jan 13.
The purpose of this study is to investigate the influence of anesthetic methods on markers of anti-tumor immunity and intestinal functions in fast-track surgery in colon cancer (CC) patients during the perioperative period.
A total of 53 patients with American Society of Anesthesiologists (ASA) I-II status randomly received general anesthesia (G group, n = 27) or general anesthesia combined with epidural anesthesia (E group, n = 26) for surgical tumor resection. The recovery times of intestinal function were evaluated in both groups postoperatively. The frequencies of different subsets of CD4+ T cells and myeloid-derived suppressor cells and C-reactive protein (CRP) were measured by flow cytometry and enzyme-linked immunosorbent assay, respectively, before anesthesia (t0), 1 h after the beginning of surgery (t1), 1 h after the end of surgery (t2), and on day 2 (t3) and day 5 (t4) post-surgery.
There was no significant difference in demographic characteristics between the two groups, but the E group of patients received significantly lower amounts of morphine and sevoflurane. In comparison with those in the G group, significantly greater numbers of lymphocytes and elevated frequencies of Th1 cells were detected at t3 and t4 post-surgery in the E group (p < 0.01). Significantly lower percentages of Th2 cells and regulatory T cells were detected in the E group at t2-4 post-surgery. Whereas the levels of plasma CRP increased post-surgery in both groups, the levels of CRP were significantly lower in the E group than those in the G group at t3-4 post-surgery (p < 0.05). The times to the first flatus and to tolerate a full diet were significantly shorter in the E group than those in the G group (p < 0.01).
General anesthesia combined with epidural anesthesia plays an important role in fast-track surgery, mitigating the surgical stress-related impairment of anti-tumor immune responses and hastening the recovery of intestinal function. This combination might also help to improve long-term outcomes for CC patients.
本研究旨在探讨麻醉方法对结肠癌（CC）患者围手术期快速康复手术中抗肿瘤免疫标志物和肠道功能的影响。
53例美国麻醉医师协会（ASA）I-II级患者随机接受全身麻醉（G组，n = 27）或全身麻醉联合硬膜外麻醉（E组，n = 26）进行肿瘤切除手术。术后评估两组患者的肠道功能恢复时间。分别在麻醉前（t0）、手术开始后1小时（t1）、手术结束后1小时（t2）、术后第2天（t3）和术后第5天（t4），通过流式细胞术和酶联免疫吸附测定法分别测量CD4 + T细胞和髓源性抑制细胞的不同亚群频率以及C反应蛋白（CRP）水平。
两组患者的人口统计学特征无显著差异，但E组患者的吗啡和七氟醚用量明显较低。与G组相比，E组术后t3和t4时检测到的淋巴细胞数量明显更多，Th1细胞频率升高（p < 0.01）。E组术后t2 - 4时检测到的Th2细胞和调节性T细胞百分比明显更低。虽然两组术后血浆CRP水平均升高，但E组术后t3 - 4时的CRP水平明显低于G组（p < 0.05）。E组首次排气和耐受全量饮食的时间明显短于G组（p < 0.01）。
全身麻醉联合硬膜外麻醉在快速康复手术中起重要作用，可减轻手术应激相关的抗肿瘤免疫反应损伤，加速肠道功能恢复。这种联合麻醉方式可能也有助于改善CC患者的长期预后。
