椎旁阻滞对肝癌切除患者外周血循环肿瘤细胞和T淋巴细胞亚群的影响

Effect of paravertebral block anesthesia on circulating tumor cells and T lymphocyte subsets in patients with primary liver cancer undergoing hepatectomy

目的研究椎旁阻滞对肝癌切除患者外周血循环肿瘤细胞和T淋巴细胞亚群的影响。方法 2014年3月~2017年3月我科治疗的110例肝癌患者被随机分为椎旁阻滞麻醉55例和硬膜外阻滞麻醉55例。所有患者均接受根治性肝叶切除术治疗,监测阻滞前(T0)、阻滞后20 min(T1)、阻滞后60 min(T2)、术毕(T3)循环参数,检测外周血T淋巴细胞亚群和外周血循环肿瘤细胞。结果椎旁阻滞组T1、T2和T3时相心率和平均动脉压显著快于或高于硬膜外阻滞组(P<0.05);椎旁阻滞组术后48 h外周血CD4^+细胞百分比和CD4^+/CD8^+比值分别为(39.57±7.12)%和(1.24±0.22),显著高于硬膜外阻滞组的【(36.83±6.63)%和(1.09±0.19),P<0.05】,CD8^+细胞百分比和循环肿瘤细胞数分别为(32.29±5.81)%和(18.61±3.35)×10^(-5),显著低于硬膜外阻滞组的【(34.61±6.23)%和(20.59±3.70)×10^(-5),P<0.05】;椎旁阻滞术中瑞芬太尼用量、苏醒时间、术后48 h镇痛泵按压次数显著少于或短于硬膜外阻滞组(P<0.05)。结论椎旁阻滞可以保证肝癌切除患者血流动力学的稳定,促进术后免疫功能的恢复,减少外周血循环肿瘤细胞数,可能降低了肿瘤侵袭或转移的风险。

Objective To investigate the effect of paravertebral block anesthesia on circulating tumor cells and T lymphocyte subsets in patients with primary liver cancer(PLC)undergoing hepatectomy.Methods 110 patients with PLC undergoing resection of liver cancer were recruited in our hospital between March 2014 and March 2017,and they were divided into the paravertebral block and the epidural block group,with 55 cases in each group when anesthesia.All patients underwent radical hepatectomy in our hospital.Cardiovascular parameters were monitored before block(T0),at 20min after block(T1),at 60min after block(T2)and at the end of operation(T3).The T lymphocyte subsets and circulating tumor cells in peripheral blood were detected.Postoperative pain was evaluated by VAS.Results The heart rates and mean arterial pressure in the paravertebral block group at T1,T2 and T3 were significantly quicker or higher than those in the epidural block group(P<0.05);the percentage of CD4+cells andratio of CD4+/CD8+cells in the paravertebral block group 48h after operation were(39.57±7.12)%and(1.24±0.22),much higher than[(36.83±6.63)%and(1.09±0.19),P<0.05],while CD8+cells and circulating tumor cells were(32.29±5.81)%and(18.61±3.35)×10-5,significantly lower than[(34.61±6.23)%and(20.59±3.70)×10-5,P<0.05]in the epidural block group;the dosage of remifentanil,recovery time and the times of pressing analgesia pump in the paravertebral block group were significantly less or shorter than those in the epidural block group(P<0.05).Conclusion Paravertebral block can ensure hemodynamic stability,promote the recovery of postoperative immune functions,reduce peripheral circulating tumor cells and might reduce the risk of tumor invasion and metastasis in patients undergoing resection of liver cancer.