猪胆石症模型制作及腹腔镜培训  

Swine cholelithiasis modeling and laparoscopic training

作　　者：张卫国[1] 刘国华[1] 狄长安[1] 张世民[1] 金大庆[1] 李卫民[1] 

机构地区：[1]首都医科大学平谷教学医院,北京101200

出　　处：《腹腔镜外科杂志》2014年第1期51-53,共3页Journal of Laparoscopic Surgery

基　　金：北京市委;市政府重点工作区县级应急项目(编号:Z111107056811048);首都卫生发展科研专项项目(编号:2011-7111-01))

摘　　要：目的:探讨猪胆石症模型的制作方法及腹腔镜手术的培训效果。方法:通过开腹或腹腔镜手术植入灭菌的人胆囊结石,完成造模。选择普通外科住院医师20名,体外培训合格后,用造模猪进行胆囊切除培训。结果:30头猪在开腹或腹腔镜下均顺利完成造模,造模猪情况良好,无一例死亡。培训前行B超检查均证实结石存在。与正常猪相比,模型猪胆囊周围粘连明显,尤以胆囊底较重,其中12例模型伴胆囊炎症,胆囊壁水肿增厚,可较真实地模拟人胆石症的临床病理变化。学员均顺利完成培训。4组学员因胆囊炎症造成胆囊撕裂,结石漏出;3组因胆囊周围粘连,分离层次不清造成胆囊床出血;2组胆囊动脉出血。学员通过操作,提高了腹腔镜手术技巧及意外情况的处理能力。结论:猪胆石症模型可真实地模拟人胆石症的临床病理变化,通过培训可增加学员对腹腔镜技术的理解,提高其腹腔镜操作水平。Objective： To investigate the method of swine cholelithiasis modeling and the effectiveness of laparoscopic training. Methods ： In laparotomy or laparoscopy, human aseptic gallstones were embedded to complete the model. 20 residents of the general sur- gery were selected, after their in vitro training was qualified, they received training of cholecystectomy with swine model. Results： Swine cholelithiasis modeling was successfully made in 30 pigs by laparotomy or laparoscopy, animal models were in good condition, no deaths occurred. Cholelithiasis was approved by pre-training B-ultrasound examination. Compared with the normal pig, adhesions around gall- bladder of swine model were obvious, and the adhesion at fundus of gallbladder was heavier. 12 cases were accompanied by cholecysti- tis, thickening and edema of gallbladder wall, clinical and pathological changes of the human cholelithiasis could be truly simulated. All trainees successfully completed their training. Dilaceration of gallbladder and leakage of calculi caused by cholecystitis was found in4 groups of participants, gallbladder bed hemorrhage occurred in 3 groups due to adhesions around the gallbladder and unclear separating layer, cystic artery bleeding was found in 2 groups. Laparoscopic techniques and the ability to handle unexpected situations improved af- ter the training. Conclusions：Swine cholelithiasis model can simulate clinically pathological changes of the human cholelithiasis, after training participants understanding of laparoscopic techniques increases, the level of laparoscopic techniques improves.

关 键 词：胆石 猪 模型 动物 腹腔镜检查 培训 

分 类 号：R-332[医药卫生]