3D腹腔镜胃癌根治术治疗进展期胃癌患者的疗效及对血清外泌体Dicer和PTEN的影响

摘要 目的：探讨3D腹腔镜胃癌根治术治疗进展期胃癌患者的疗效及对血清外泌体Dicer和人第10号染色体缺失的磷酸酶与张力蛋白同源物基因（PTEN）的影响。方法：选择2017年7月到2021年5月选择在本院诊治的进展期胃癌患者60例作为研究对象，根据1:1随机信封抽签法把患者分为3D组与开腹组各30例。开腹组给予开腹手术治疗，3D组给予3D腹腔镜胃癌根治术治疗，对比分析两组的手术指征、并发症、疼痛视觉模拟评分法（VAS）评分以及Dicer和PTEN的表达。结果：两组的手术时间、淋巴结清扫个数对比无差异（P>0.05），3D组的术后排气时间等围手术指标较开腹组低（P<0.05）。3D组术后14 d的并发症发生率较开腹组低（P<0.05）。3D组术后1 d、7 d与14 d的VAS评分低于开腹组（P<0.05）。两组术后14 d的血清外泌体Dicer和PTEN相对表达水平高于术前1 d，3D组高于开腹组（P<0.05）。所有患者随访到2021年11月1日，平均随访时间为（17.92±0.22）个月，3D组的复发率为3.33 %，低于开腹组的20.00 %（P<0.05）。结论：3D腹腔镜胃癌根治术治疗进展期胃癌患者可促进血清外泌体Dicer和PTEN的分泌，不增加手术复杂度，还可促进患者康复，减少并发症，促进缓解患者疼痛，降低随访复发率。

The Effect of 3D Laparoscopic Radical Gastrectomy for Advanced Gastric Cancer and Its Effect on Serum Exosomes Dicer and PTEN

ABSTRACT Objective: To investigate the efficacy of 3D laparoscopic radical gastrectomy for advanced gastric cancer and its effect on serum exosome Dicer and Phosphatase and tensin homolog deleted on chromosome ten (PTEN). Methods: A total of 60 patients with advanced gastric cancer treated in our hospital from July 2018 to May 2021 were selected as the research subjects. According to 1:1 random envelope lottery, the patients were divided into 3D group and laparotomy group, with 30 patients in each group. The open group was treated with open surgery, and the 3D group was treated with 3D laparoscopic radical gastrectomy. The surgical indications, complications, visual analog scales(VAS) score and Dicer and PTEN expressions of the two groups were compared and analyzed. Results: There were no difference in the operation time and the number of lymph node dissections compared between the two groups(P>0.05). The postoperative exhaust time, postoperative gastric tube removal time, surgical incision length, the amount of bleeding, postoperative hospital stay, and surgery in the 3D group were less than that of the open group(P<0.05). The incidence of complications such as anastomotic bleeding, anastomotic leakage, gastroparesis, incision infection, and venous thrombosis in the 3D group at 14 days after operation were lower than the open group(P<0.05). The VAS scores of the 3D group at 1 d, 7 d and 14 d after operation were lower than those of the open group(P<0.05). The relative expression levels of serum exosomes Dicer and PTEN at 14 d after operation in the two groups were higher than that at 1d before operation (P<0.05), the 3D group were higher than the open group (P<0.05). All patients were followed up until November 1, 2021. The average follow-up time were(17.92±0.22) months. The recurrence rate of the 3D group were 3.33 %, which were lower than the 20.00 % of the open group(P<0.05). Conclusion: 3D laparoscopic radical gastrectomy for patients with advanced gastric cancer can promote the secretion of serum exosome Dicer and PTEN without increasing the complexity of surgery, and can also promote the recovery of patients, reduce complications, relieve patients'' pain, and reduce the recurrence rate during follow-up.