| Background and Objective:Primary liver cancer(PLC)is one of the most common malignancies in the world?Although the incidence of hepatitis B virus infection in recent years decreased significantly,but the overall incidence of primary liver cancer and mortality still showed a significant growth trend,while the overall survival of primary liver cancer did not significantly improve.So far,Surgical resection still is the preferred method of diagnosis and treatment of liver cancer,but due to the surgical trauma,one of the most important chief complaints of postoperative patient is pain,furthermore,the body's immune function was significantly worse within a few days after hepatectomy.which resulted in a significantly different in early prognosis of patients.Howerer,Postoperative pain on the immune function and early prognosis of the impact is not clear.this paper collected the South Hospital of the last two years of liver cancer cases,to explore the postoperative pain and the relationship between cellular immunity and early prognosis.and to provide the basis for the rapid rehabilitation of primary liver cancer.Method:Clinical and pathological dates of 90 patients with primary liver cancer who underwent radical liver resection in the department of Hepatobiliary surgery,nanfanghospital,southern medical university,from June 2014 to October 2016 were analysis respectively,The patients were scored according to the digital grading method.NRS?3 was divided into effective analgesia group(n = 51)and NRS>3 invalid analgesia group(n = 39)within 0-7 days after operation.We retrospectively analyzed the clinicopathologic features of liver function,blood routine,incision length,tumor site,maximal diameter,postoperative liver function and cellular immune function of the two groups.At he same time,the postoperative complications,organ function recovery and other indicators of changes.Were observed and recorded.The differences,prognosis and clinical significance between the two groups were analyzed.Result:1.this study showed that the most severe pain occurred in the postoperative day 1,until the first 5 days after surgery,the degree of pain in the patient gradually reduced day by day.The results shows that the degree of pain significantly reduced after giving a continuous effective analgesic treatment,it suggested that analgesic effects of the effective analgesia group was significantly better than those of the ineffective analgesia group,which significantly relieved the pain and discomfort of the patients.according to the comparison of the preoperative basic date of patients between two groups,we find that there were no significant differences in preoperative basic date,including age,body mass index and so on,and general liver function parameters and nutrition indexes such as ALT,AST,TBIL,PT and ALB before operation between the effective analgesia group and the ineffective analgesia group(P>0.05).2.we compared the intraoperative and pathological indexes between between the effective analgesia group and the ineffective analgesia group show that there were no significant statistically differences in length,tumor size,number of tumor,presence of capsule and operation time,the location of the tumor,Whether the hepatic portal block or not,Whether liver section suture or not and other surgical treatment;in addition,the amount of intrahepatic blood loss,intraoperative blood transfusion,anesthesia of patients were recorded and compared,the difference was also not statistically significant(P>0.05).Postoperative pathological examination showed that compared with the ineffective analgesia group,there was no statistically significant difference in the pathological type of tumor,whether there was lymph node metastasis or portal vein or vascular tumor thrombus or not,TNM stage and pathological differentiation degree of tumor in the effective analgesia group(P>0.05).3.Through by comparison of liver function and nutrition status before and after operation in two groups,we find that there was no significant difference in ALT,AST,TBIL,PT and ALB between the two groups before operation(P>0.05).And the preoperative and postoperative liver function and nutritional status of the two groups were compared,the levels of ALT,AST,TBIL,PT and ALB between the two groups were significantly different(P<0.05),but also the increase or extension of ALT,AST,TBIL,PT in the effective analgesia group were significantly lower than that in the ineffective group Analgesic group,the difference was statistically significant(P<0.05).Addition,the results showed that the levels of ALB and HB in the two groups were significantly lower than those before operation(P<0.05).The level of ALB in the effective analgesia group was significantly higher than that of the ineffective analgesic group at the 5th day after operation(P<0.05),however,there was no significant difference in the ALB level and postoperative hemoglobin level on the 1st day,the 3rd day and the 7th day after operation(P>0.05).4.The incidence of total postoperative complications including liver function recovery delay,pneumonia or pleural effusion,intestinal obstruction,poor sleep was significantly lower in the effective analgesia group than those in the ineffective analgesia group(P<0.05).Moreover,The time of first anal exhaust,the time of the first out of bed,the time of first feeding,the day of Postoperative hospital stay and the time of abdominal drainage tube retention in peritoneal cavity of patients in the effective analgesia group were significantly lower than those in ineffective analgesia group,the difference was statistically significant(p<0.05).5.Flow cytometry was used to detect immune cell subpopulations in 90 patients with primary liver cancer,the results showed that the expression of CD3 +T cells and CD4+T cells and the ratio of CD4 +/CD8 + in the peripheral blood of the two groups were significantly lower than those of the normal group,while the expression level of CD8+T cells was higher than that of the normal people,the difference was statistically significant(P<0.05),Indicating that immune function in patients with liver cancer is inhibited to varying degrees.However,the level of postoperative CD3+T cells,CD4+T cells,CD8+T cells and CD4+/CD8+in the two groups were significantly lower than those before operation,the difference was statistically significant(P<0.05),indicating that surgical trauma exacerbation of immune function inhibition.By detecting the immune cell subsets on the first day,the third day and the seventh day after operation,we could find that the expression level of CD3+T cell,CD4+T cell,CD8+T cell and the ratio of CD4+/CD8+in the two groups was statistically significant(P<0.05).The effective analgesia group was significantly better than the ineffective analgesic groupIn conclusion1.Effective analgesic therapy can significantly reduce liver function damage in patients with primary liver cancer who underwent radical resection of liver cancer,and promote liver function recovery as quickly as possible.2.the ratio of CD4+T cell/CD8+T cell is a sensitive indicator of the immune function balance of the body,the patients with primary liver cancer Show varying degrees of inhibition of immune function before operation,liver resection further aggravate the immune dysfunction,but effective analgesic therapy has a protective effect on postoperative immune function of patients with liver cancer,The better the analgesic effect,the better the protective effect of immune function,There was positive correlation between them.3.sustained and effective analgesic treatment can accelerate the recovery of organ function,reduce hospital stay and medical costs and improve postoperative treatment efficacy of patients with liver cancer.4.we can relieve the degree of stress response of patients,Reduce the incidence of postoperative complications,accelerate the rapid recovery of patients to improve the clinical prognosis of patients with liver caner who underwent radical liver resection by postoperative effective analgesic treatment. |
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