经脐入路腹腔镜手术不同打结方法的对比研究  

Using a mechanical evaluation platform to assess three knot-tying techniques in transumbilical endoscopic surgery

作　　者：徐安安[1] 苏远涛[1] 朱江帆[1] 谢晓峰[1] 王永坤[1] 杨欲晓[1] 

机构地区：[1]同济大学附属东方医院,上海200120

出　　处：《腹腔镜外科杂志》2013年第4期277-280,共4页Journal of Laparoscopic Surgery

基　　金：浦东新区卫生系统重点学科建设(编号:PWZxk2010-07)

摘　　要：目的:通过经脐入路腹腔镜手术(transumbilical endoscopic surgery,TUES)操作力学评估平台评估三种打结方法,以客观评价其在TUES操作中的作用。方法:用腹腔镜操作模拟训练箱、SILS port、传感器等建立TUES操作力学评估平台。三种打结方法在同一操作板分别完成8组打结操作,测定各种方法完成打结所需时间与平均载荷。结果:三种方法完成打结的所需时间与平均载荷差异具有明显统计学意义(P<0.01)。腔内单手"O"形打结所需时间最短、平均载荷最小,腔外推结器打结法其次,腔内侧绕打结法耗时最长、消耗平均载荷最多。结论:目前TUES手术常用的三种打结方法中,腔内单手"O"形打结所需时间最短,消耗载荷最小,表明此方法省时、省力。不同打结方法产生结的质量尚待于进一步评估。Objective：Knot tying is difficult but important for transumbilical endoscopic surgery （TUES）. There are several techniques for TUES knot-tying. However,objective assessment of these skills has not yet been established. The aim of this study was to assess three different knot-tying techniques in TUES using a mechanical evaluation platform. Methods：The subject tied 8 knots with each of the three techniques in an inanimate box laparoscopie trainer while the movements of their instruments were evaluated using a TUES mechanical evaluation platform. The operations were assessed on the basis of the time and average load of the dominant hand. Results ：There were significant differences of operation time and average load in all groups compared with each other （P 〈 0.01 ）. The longest time and largest average load were seen with the intracorporeal ＂side winding＂ technique [ （90.48 ± 17.21 ） s, （4.23±0.66） N ]. The extracorporeal knot-tying technique was more time and average load consuming in comparison to the intracorporeal one-hand knot-tying technique during the performance of knot-tying （P 〈0.01 ）. Conclusions：The intraeorporeal one-hand knot-tying technique shows better results than the intracorporeal ＂side winding＂ technique and the extracorporeal knot-tying technique in terms of the time and average load taken. Evaluation of knots quality should be integrated into the objective assessment.

关 键 词：腹腔镜检查 经脐入路 打结操作 

分 类 号：R656[医药卫生—外科学]