Імунна відповідь при використанні раннього парентерального харчування та епідуральної анестезії/ аналгезії в структурі періопераційної інтенсивної терапії у хворих на рак сечового міхура в запущеній стадії

The tendency to an increase in the incidence of cancer, which is observed in Ukraine as well as in the world and, accordingly, an increase in the complexity and duration of surgical interventions encourage the search for new and improved tactics of perioperative care in oncosurgery. The purpose of our study was to study the relationship between the choice of anesthesia, nutritional status of patients with locally advanced metastatic bladder cancer and changes in some immunological parameters in the early postoperative period. Materials, methods and results. Prospective study. Forty-six patients undergoing general sevoflurane inhalation anesthesia combined with intravenous fentanyl were divided into two groups. Patients of the first group also were administered epidural analgesia and parenteral nutrition in the early postoperative period (from the first day) was prescribed. Population and subpopulation composition of peripheral blood lymphocytes was determined on the basis of phenotypic characteristics of lymphocytes determination: CD3+, CD20+, CD3+4+, CD3+8+, CD3– 16+56+, HLA-DR+. The results of the study showed that in patients with bladder cancer the use of epidural anesthesia and analgesia and early parenteral nutrition helps maintain the number of main effectors of the cell-mediated immune response, namely, NK-lymphocytes and CTL. Taking into account the fact that it is the cellular link of the immune system that plays the main role in the implementation of the antitumor immune response, providing the overall antitumor resistance of the organism, it seems promising to use the epidural block and early parenteral nutrition in patients operated on advanced bladder cancer. Conclusions. The use of the epidural block in combination with general anesthesia for radical cystectomy and early onset of parenteral nutrition contribute to a lesser load on the patient’s immune state, a reduction in complications in the postoperative period, an early preservation of nutritional status, and a reduction in the duration of treatment of patients with advanced bladder cancer.