基于快速手术病房的腹腔镜胆囊切除术教学培训模式探讨  

Day-surgery unit-based training of laparoscopic cholecystectomy:experience and technical data

作　　者：许寅喆 潘颖威 张平 陈志达[3] 李美淑 吕文平[1] 童俊翔[1] 孟翔飞[1] 刘博[1] 卢实春[1] Xu Yinzhe;Pan Yingwei;Zhang Ping;Chen Zhida;Li Meishu;Lyu Wenping;Tong Junxiang;Meng Xiangfei;Liu Bo;Lu Shichun(Faculty of Hepato-Pancreato-Biliary Surgery,the First Medical Center,Chinese PLA General Hospital,Institute of Hepatobiliary Surgery of Chinese PLA,Key Laboratory of Digital Hepatobiliary Surgery of Chinese PLA,Beijing 100853,China;Department of Hepatobiliary Surgery,Shandong Heze Municipal Hospital,Heze 274900,China;Department of General Surgery,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Training Center of Laparoscopic Surgeons,Chinese Medical Doctor Association(PLAGH Center),Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心肝胆胰外科医学部,全军肝胆外科研究所,全军数字肝胆外科重点实验室,北京100853 [2]山东菏泽市立医院肝胆外科,菏泽274900 [3]解放军总医院第一医学中心普通外科医学部,北京100853 [4]中国医师协会腹腔镜外科培训基地(解放军总医院基地),北京100853

出　　处：《中华肝胆外科杂志》2021年第9期667-671,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金(81800552);解放军总医院创新人才工程“3+1”新秀人才项目;军队医学科技青年培育计划-孵化项目(21QNPY108)。

摘　　要：目的分析快速手术病房的腹腔镜胆囊切除术教学培训效果。方法回顾分析2019年1月至2021年4月由解放军总医院胆囊快速手术病房受训医师完成的438例腹腔镜胆囊切除患者资料,其中男性187例,女性251例,年龄范围17~91岁,中位年龄54岁。所有患者依据医师培训模式不同分为传统组(n=260)和规培组(n=178)。规培组医师接受阶梯式规范化培训,包括开放组轮转、模拟器训练和进阶式带教。传统组医师延续传统师徒带教。比较两组手术时间、放置腹腔引流管、上级医师术中会诊率、上级医师接替手术率等。结果传统组19.6%(51/260)放置腹腔引流管,上级医师术中会诊率16.9%(44/260),上级医师接替手术率11.2%(29/260),手术时间(61±33)min;规培组患者10.7%(19/178)放置腹腔引流管,上级医师术中会诊率7.9%(14/178),上级医师接替手术率3.4%(6/178),手术时间(55±30)min。两组上述指标比较差异均有统计学意义(均P<0.05)。规培组同类技术数据均优于传统组。结论基于胆囊快速手术病房的高强度标准化手术作业,阶梯式规范化培训的医师手术时间显著缩短,上级医师术中会诊和接替手术率显著下降,阶梯式规范化教学培训有助于提升受训医师腹腔镜技术熟练度和手术胜任力。Objective To evaluate the day-surgery unit-based training of laparoscopic cholecystectomy(LC).Methods Perioperative data of 438 patients(187 males and 251 females)with a median age of 54(aged 17 to 91)years undergoing LC during January 2019 to April 2021 in the day-surgery unit of Chinese PLA General Hospital were retrospectively collected and subdivided according to the training methods of surgeons[Group A(n=260):conventional training vs.Group B(n=178):protocoled stepwise training].The protocoled stepwise training consists of the rotation in open biliary surgery unit,the stimulator-based laparoscopic training,and the stepwise procedural tutoring.The conventional training features the traditional surgical practice following senior surgeons.The technical data involving operation time,blood loss,the percentages of intraoperative decision-making by senior surgeons and the handing-over of procedure to senior surgeons,etc.were statistically analyzed.Results The operation time was shortened in Group B[(55±30)min vs.(61±33)min],with significantly decreased percentages of intraoperative decision-making by senior surgeons[7.9%(14/178)vs.16.9%(44/260),P<0.05]and the handing-over of procedure to senior surgeons[3.4%(6/178)vs.11.2%(29/260),P<0.05].Conclusion Based on the protocoled stepwise training and the consecutive,high-volumed and standardized procedures,the laparoscopic technical proficiency and competency of the trainee surgeons have been improved.

关 键 词：胆囊切除术 腹腔镜 技能培训 快速康复外科 

分 类 号：R-4[医药卫生] C975[经济管理—劳动经济]