国际学员三站式强化内镜黏膜下剥离术动物模拟培训的实践  

Practice of three-station intensive animal simulation training of endoscopic submucosal dissection for international trainees

作　　者：高竹清 姜维 郭俊峰 黄鑫源 孙秀静 孟凡冬 王拥军 李鹏 Gao Zhuqing;Jiang Wei;Guo Junfeng;Huang Xinyuan;Sun Xiujing;Meng Fandong;Wang Yongjun;Li Peng(Department of Gastroenterology,Beijing Friendship Hospital,Capital Medical University,National Clinical Research Center for Digestive Diseases,Beijing Digestive Disease Center,Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院消化内科/国家消化系统疾病临床医学研究中心/北京市消化疾病中心/首都医科大学消化病学系/消化疾病癌前病变北京市重点实验室,100050

出　　处：《中华医学教育探索杂志》2020年第9期1083-1087,共5页Chinese Journal of Medical Education Research

基　　金：国家科技部国家重点研发计划(2017YFC0U3600);国家自然科学基金面上项目(81570507);北京市科学技术委员会京津冀协同创新推动项目(Z171100004517009);首都临床特色应用研究(Z141107002514018);首都卫生发展科研专项项目(2016-1-2022);北京市卫计委一带一路消化内镜国际合作项目。

摘　　要：目的探索家猪离体胃模型在对国际学员进行内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)培训中的应用价值。方法对15名国际学员进行为期20 d的ESD培训,第一阶段为理论知识学习,完成消化内镜基础及动物模拟培训调查问卷。第二阶段将其随机分为离体动物模型组(A组,8人)和临床观察学习组(B组,7人)。A组在临床观察学习期间,同时按照规范操作步骤进行离体动物模型培训课程。培训结束时考核两组学员ESD操作情况,并再次完成问卷。应用SPSS 20.0进行«检验和卡方检验。结果A组与B组ESD总操作时间差异有统计学意义(P<0.05),注射时间、标记时间差异没有统计学意义(P>0.05),切开时间及黏膜剥离时间差异有统计学意义。A组与B组的ESD操作速度差异无统计学意义。两组切除标本大小差异无统计学意义。两组均有1例为分块切除病灶,其余为整块切除。在操作过程中各发生1例穿孔。同时,对比离体动物模型组学员培训前后操作情况,发现培训后ESD总操作时间、切开时间明显提高。结论以理论知识为基础结合家猪离体胃动物模型培训的内镜培训具有较高的教学参考价值,能够使各国学员熟悉并初步掌握ESD的基础理论知识及操作方法,帮助各国学员日后在临床开展ESD操作。Objective To explore the value of ex-vivo porcine stomach model for endoscopic submucosal dissection(ESD)training for international trainees.Methods Fifteen international students received ESD training and learning for twenty days.Firstly,students learned basic theory of ESD and completed a questionnaire.Then they were randomized to receive endoscopic training either on the vitro animal(group A)or on training experience(group B)of the clinical observation.At last,one case was assessed by an experienced endoscopist.The total and step-by-step operating time,complete resection,size of specimen and complications were recorded.All students completed the questionnaire once again.SPSS 20.0 was used for t test and chi-square test.Results There was significant difference in total ESD operation time between group A and group B(P<0.05).There were significant differences between the two groups on cutting time and dissection time,but there was no difference on marking time,injection time and operating speed.There was only one case of block resection and perforation in each group.For group A,their mastery and clinic confidence of ESD had been obviously increased after the animal training course.Compared with the operation before the training in group A,it was found that the total time and cutting time of the ESD after the training were also significantly improved.Conclusion Theory combined with endoscopic training on vitro animal model can make the trainees familiar with the basic theory and master the operational skills,which is helpful and valuable for them to perform ESD in further clinic practice.

关 键 词：内镜黏膜下剥离术 动物模拟培训 家猪离体胃模型 

分 类 号：R5[医药卫生—内科学]