ABSTRACT
Objective:To evaluate the effect of epidural block combined with general anesthesia on T helper (Th) cell balance and outcome after hepatectomy.Method:Seventy patients aged 18-64 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing hepatectomy in our hospital, were randomly assigned into combined epidural-general anesthesia group (E+ G group, n=35) and general anesthesia group (G group, n=35). The consumption of anesthetics during operation and analgesics after operation was recorded.Blood samples were obtained on the morning of the operation day (T 0) and morning of 2nd and 3rd days after operation (T 1, 2). The concentrations of interferon (IFN)-γ, interleukin-4 (IL-4), IL-17, IL-10 and transforming growth factor (TGF)-β 1 were determined by enzyme-linked immunosorbent assay.The ratio of IFN-γ/IL-4 was calculated.The patients were followed up for 3 yr after operation, and the survival and tumor-free survival were recorded.Multivariate COX proportional hazards model was used for multivariate analysis of the factors associated with survival and tumor-free survival. Results:Sixty-one patients were finally included in this study, including 31 patients in E+ G group and 30 patients in G group.Compared with G group, the consumption of fentanyl, sevoflurane and postoperative morphine was significantly decreased, the plasma concentrations of IFN-γ and IL-4 at T 1 and IL-17 and TGF-β 1 at T 2 were decreased, the ratio of IFN-γ/ IL-4 was increased, and the overall survival rate and tumor-free survival rate were increased in E+ G group ( P<0.05). The results of multivariate COX proportional hazards model analysis showed that vascular invasion was a risk factor for tumor-free survival and overall survival ( P<0.05), and anesthesia method was not a risk factor for tumor-free survival ( P>0.05). Conclusion:Compared with general anesthesia alone, epidural block combined with general anesthesia is more helpful in maintaining the balance of Th cells and in improving the outcome of hepatectomy.