住院医师腹腔镜手术技能培训的课程摸索——以腹腔镜阑尾炎手术为例  

Exploration of laparoscopy skill training course in residents:taking laparoscopic appendectomy as an example

作　　者：黄利军[1] 唐紫兰 李瑭[2] 邓美海[3] 徐见亮[3] 魏波[1] Huang Lijun;Tang Zilan;Li Tang;Deng Meihai;Xu Jianliang;Wei Bo(Department of Gastrointestinal Surgery,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,Guangdong,China;Department of Medical Simulation Center,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,Guangdong,China;Department of Hepatobiliary Surgery,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,Guangdong,China)

机构地区：[1]中山大学附属第三医院胃肠外科,广东广州510630 [2]中山大学附属第三医院临床技能中心,广东广州510630 [3]中山大学附属第三医院肝胆外科,广东广州510630

出　　处：《中国毕业后医学教育》2023年第1期44-49,共6页Chinese Journal of Graduate Medical Education

基　　金：中山大学校级本科教学改革与质量工程项目(82000-12220011)。

摘　　要：目的探索以胜任力为目标实施住院医师腹腔镜阑尾切除术手术技术培训。方法以胜任腹腔镜下阑尾切除术为目标,对进入住院医师规范化培训的1年级外科专业住院医师行三阶段培训。培训完成后,指导医师全程指导住院医师真实完成腹腔镜下阑尾切除术,检验胜任力情况,并发放回收调查问卷。结果9位住院医师均完成三阶段培训。经过培训后,住院医师在双手套圈、仿肉缝合打结、动物离体器官模拟手术3项上操作时间显著缩短,差异均有统计学意义(均P<0.05);其他项目训练前后差异不明显;操作质量均有提升,但是仅在双手套圈、仿肉缝合打结、钝锐性分离肠系膜、动物离体器官模拟手术方面差异有统计学意义(P<0.05)。训练后住院医师在仿肉缝合打结、锐性分离肠系膜项目的操作时间长于指导医师,操作质量在夹豆项目、双极使用及肠管缝合方面弱于指导医师,差异有统计学意义(P<0.05)。所有住院医师均完成真实患者腹腔镜下阑尾切除术,完成率100%,操作质量与指导医师相当,但是操作时间显著延长[(57.8±24.0)min比(26.3±8.9)min,P<0.05]。线性相关结果提示腹腔镜模拟阑尾切除手术时间和真实病人手术时间均与仿肉缝合打结时间相关。调查问卷提示88.9%(8/9)的住院医师对培训方式满意,大部分的住院医师认为缝合打结相关操作有难度。结论三阶段培训模式可以让住院医师胜任腹腔镜下阑尾切除术,腹腔镜缝合打结可能是该术式培训的核心内容。Objective To explore the mode of competency-aimed laparoscopic appendectomy skill training in residents.Methods Residents of standardized residency training program Grade 1 were taught by the mode of three-step training program to be competent for laparoscopic appendectomy.Questionnaires were done after the training.Results All 9 residents finished the three-step training.They made improvement in time cost and quality after training.While compared with the teachers,their time cost was longer in suture knot and separation of mesentery,but similar in other training programs,Lower quality results were found in bean clipping,bipolar device usage and intestine suture.All residents finished real patient's laparoscopic appendectomy with equal quality but longer time[(57.8±24.0)min vs(26.3±8.9)min,P<0.05].According to the Pearson's test,only suture knot was correlated to both simulated surgery and real surgery.The satisfaction rate was 88.9%,and most of them considered suture knot difficult.Conclusion The three-step training mode can help residents to be competent for laparoscopic appendectomy,while suture knot might be the core training content for this procedure.

关 键 词：腹腔镜 阑尾切除术 培训模式 胜任力 住院医师 

分 类 号：G423[文化科学—课程与教学论] R574.61[文化科学—教育学]