不同麻醉方式对腹腔镜前列腺癌根治术患者围术期细胞免疫功能的影响

目的探讨不同麻醉方式对腹腔镜前列腺癌根治术患者围术期细胞免疫功能的影响。方法选择18例腹腔镜前列腺癌根治术患者, 随机分为两组:全凭静脉麻醉组（A组）和静脉全麻复合腰硬联合麻醉组（B组），每组9例。分别于麻醉前1 h（T0）、麻醉后1 h（T1）、术后24 h（T2）及术后7 d（T3）抽取外周静脉血，测定两组各时间段T淋巴细胞亚群（CD3+、CD4+、CD8+、CD4+/CD8+值）及NK细胞（CD16+56+）水平，分析两组麻醉手术后各时间点、各指标与T0时相比的变化。结果两组患者T1时与T0时比较，T淋巴细胞（CD3+、CD4+、CD4+/CD8+）及NK细胞（CD16+56+）水平均有所降低，其中A组降低水平有统计学意义（P < 0.05）；两组患者T2时与T0时比较T淋巴细胞（CD3+、CD4+、CD4+/CD8+）及NK细胞（CD16+56+）水平均明显降低，差异均有统计学意义（A组P < 0.01，B组P < 0.05），组间比较A组下降程度较B组更显著（P < 0.05）；两组患者T3时各指标均接近T0水平（P>0.05）；各时间点两组患者CD8+变化均无统计学意义（P>0.05）。结论全凭静脉麻醉与静脉全麻复合腰硬联合麻醉对腹腔镜前列腺癌根治术患者均有一过性不同程度的细胞免疫功能抑制，而静脉全麻复合腰硬联合麻醉的抑制作用较轻。 

Application of three dimensional visualization technology for laparoscopic Resection of cystic carcinoma in pancreatic body and tail

ObjectiveTo discuss the effects of different anesthesia on the cellular immune function of perioperative period in patients with laparoscopic radical prostatectomy.Methods18 patients with laparoscopic radical prostatectomy were randomly divided into two groups: total intravenous anesthesia group (groupA) and general anesthesia reunite with combined spinal-epidural anesthesia group (groupB), 9 cases in each group.Venous blood were sampled respectively in 1h before anesthesia (T0), 1h (T1), 24 h (T2) and 7 d (T3) after anesthesia, then determined between the two groups at each time period of T lymphocyte subsets (CD3+, CD4+, CD8+, CD4+/CD8+ratio) and NK cell (CD16+56+) levels, and then analysis the changes of the indexs between different time points after operation and T0 in two groups.ResultsTwo groups of patients were decreased in the levels of T cell subsets (CD3 +, CD4 +, CD4 +/CD8 +ratio) and NK cells (CD16 +56 +) at T1 compared with T0, and the levels of group A decreased significantly (P < 0.05). Two groups of the levels of T cell subsets (CD3+, CD4+, CD4+/CD8+ratio) and NK cells (CD16 +56 +) decreased lower at T2 than T0 (groupA:P < 0.01, groupB:P < 0.05), and group A decreased lower than group B (P < 0.05). All the datas of the two groups were closed to the levels of T0 at T3 (P>0.05). The levels of CD8+ changed unsignificantly at all time points in two groups (P>0.05).ConclusionsBoth total intravenous anesthesia and general anesthesia reunite with combined spinal-epidural anesthesia have different degrees of temporary inhibition of cellular immune function for patients with laparoscopic radical prostatectomy, the latter is a lesser inhibitory effect.