猪内镜黏膜下剥离术的模拟培训研究  

Simulation training study of porcine model for endoscopic submucosal dissection

作　　者：崔梅花[1,2] 牟方宏[1,2] 刘海芹[1,2] 张鸿雁[1,2] 王鲁燕[1,2] 刘徐[1,2] 

机构地区：[1]航天中心医院 [2]北京大学航天临床医学院消化科,北京100049

出　　处：《胃肠病学和肝病学杂志》2015年第3期344-347,共4页Chinese Journal of Gastroenterology and Hepatology

基　　金：航天中心医院特色临床医学应用发展项目(TS-201201)

摘　　要：目的对家猪行内镜黏膜下剥离术(endoscopic submucosal dissection,ESD),探讨其作为ESD操作培训动物模型的可行性和应用价值。方法 3只健康家猪麻醉稳定后,按照规范操作步骤对家猪胃窦或食管部位行ESD相关操作,记录切除标本大小、完整切除情况、环形切开时间、黏膜下剥离时间、总操作时间、并发症等,切除标本用甲醛固定后送病理检查。结果 ESD完整切除标本9例(胃窦6例,食管3例),术中无大出血、穿孔等并发症。在食管部位ESD的黏膜下剥离时间、总操作时间明显长于胃窦部(P<0.05)。胃窦部ESD操作的前3例与后3例相比,尽管切除标本大小无明显差异,但ESD总操作时间明显延长[(52.33±4.04)min vs(38.67±3.51)min,P=0.012]。结论以猪为动物模型行ESD操作作为初学者的培训方法之一是可行的,可以帮助内镜医师改善开始做患者ESD操作前的学习曲线。Objective To investigate the feasibility and value of using pigs as a model for practising endoscopic sub- mucosal dissection （ESD） by a novice. Methods Three healthy pigs were used in this experimental study. When the pig was under stable anesthesia, ESI） was carried out in the pig＇ s stomach or esophagus according to the standard oper- ating procedures. The following variables were analyzed： specimen size, complete and en bloc resection rate, time for circumferential incision, time for submucosal dissection, time for total resection duration, and complications. The speci- men was submerged in formalin, then delivered to the pathology department to be analyzed. Results Complete resection was achieved in 9 cases （6 cases of gastric antrum, 3 cases of esophagus） , and without major bleeding and perforation during the procedure. The mean duration for submucosal dissection of ESD in esophagus, and the mean duration for total resection were longer than gastric antrum （P 〈 0.05 ）. The mean total resection time was significantly increased for the gastric cases performed in the first three of the study than in the latter three [ （52.33±4.04） min vs （38.67±3.51 ） min, P = 0. 012 ], although the specimen size did not differ. Conclusion ESD training is feasible in porcine models for novice. Training in animal models could help endoscopists overcome the learning curve before starting ESD in humans.

关 键 词：内镜黏膜下剥离术 猪 动物模型 模拟培训 

分 类 号：R57[医药卫生—消化系统] R459.9[医药卫生—内科学]