离体器官腹腔镜模拟培训在肾部分切除教学手术中的应用  

Application of laparoscopic simulation training with isolated organs in partial nephrectomy teaching surgery

作　　者：东洁[1] 薛晓强 张玉石[1] 刘广华[1] 谢燚[1] 徐维锋[1] 吴兴成[1] 纪志刚[1] Dong Jie;Xue Xiaoqiang;Zhang Yushi;Liu Guanghua;Xie Yi;Xu Weifeng;Wu Xingcheng;Ji Zhigang(Department of Urology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院泌尿外科,北京100730

出　　处：《中华泌尿外科杂志》2024年第3期212-216,共5页Chinese Journal of Urology

摘　　要：目的探讨离体器官腹腔镜模拟培训教学模式在腹腔镜肾部分切除术培训中的应用效果。方法本研究分析2022年4—6月北京协和医院泌尿外科12名医生接受离体器官腹腔镜肾部分切除术模拟训练的培训结果。12名医生既往参与过腹腔镜基础手法培训、但尚未独立完成腹腔镜肾部分切除术,对其进行每周2次、每次1.5h的离体器官腹腔镜模拟训练,为期3个月,总培训时长为每人39h。利用超声刀分离训练、超声刀切割训练、血管裸化训练、钝性分离训练和肾部分切除及创面缝合训练5个模块对腹腔镜肾部分切除术的分解步骤进行针对性训练,根据评分细则,对各个训练项目进行考核打分。同时,使用问卷调查的方式,了解12名医生对完成手术和手术中每个步骤的自信心。对培训前、后的操作技能和心理素质变化情况进行评估,采用配对t检验或Wilcoxon配对秩和检验比较培训前后数据的差异。结果经过培训后,12名医生在5个训练模块的成绩均有明显提升,超声刀分离训练、超声刀切割训练、血管裸化训练、钝性分离训练和肾部分切除及创面缝合训练评分分别从培训前的(8.5±0.3)、(6.9±0.3)、(4.2±0.4)、(6.6±0.4)、(5.6±0.7)分,提高至(9.8±0.2)、(9.6±0.3)、(9.3±0.2)、(9.4±0.3)分、(9.8±0.2)分,培训前后差异均有统计学意义(P<0.05)。肾部分切除及创面缝合训练的操作时间,由培训前的(47.5±5.8)min,提高至培训后的(21.6±5.1)min,差异有统计学意义(t=18.72,P<0.001)。同时,对完成手术的自信心也从培训前的2(1,3)分,提高至培训后的4(4,4)分,差异有统计学意义(Z=-3.00,P=0.003)。结论离体器官腹腔镜模拟培训,可以使既往无肾部分切除术经验的医生熟练掌握该术式各步骤,在30min内完成肾肿瘤的切除和创面缝合,从而提高对肾部分切除术各步骤的操作信心。Objective To explore the effect of the isolated organ laparoscopic simulation training teaching mode in laparoscopic partial nephrectomy training.Methods A 39-hour in vitro organ laparoscopic simulation training for 12 urologists who had previously participated in laparoscopic basic technique training but had not independently completed laparoscopic partial nephrectomy in Peking Union Medical College Hospital.The training was conducted twice a week for 3 months from April to June 2022.Five modules,namely ultrasonic knife separation training,ultrasonic knife cutting training,vascularization training,blunt separation training,and partial nephrectomy and wound closure training,were used to provide targeted training for the decomposition of laparoscopic partial nephrectomy,and each training item was assessed and scored according to the scoring rules.At the same time,a questionnaire was used to find out the level of confidence of the 12 physicians in completing the operation and each step in the procedure,so as to assess the changes in the operational skills and psychological quality of the physicians before and after training using paired t-tests or Wilcoxon paired rank sum tests.Results After the training,the assessment scores of operations in all surgeons were significantly improved.The training scores of ultrasonic knife separation training,ultrasonic knife cutting training,blood vessel nudity training,blunt separation training,and partial nephrectomy and traumatic suture improved from(8.5±0.3),(6.9±0.3),(4.2±0.4),(6.6±0.4),and(5.6±0.7)to(9.8±0.2),(9.6±0.3),(9.3±0.2),(9.4±0.3),and(9.8±0.2),respectively(P<0.05).The average operation time for the partial renal excision and traumatic suture training improved from(47.5±5.8)minutes to(21.6±5.1)minutes(t=18.72,P<0.001).At the same time,self-confidence in completing the operation was also significantly improved from 2(1,3)before the training to 4(4,4)after the training(Z=-3.002,P=0.003).Conclusions After laparoscopic simulation training with isolated organs,p

关 键 词：腹腔镜 肾部分切除术 腹腔镜模拟培训 离体器官 手术技术 自信心 

分 类 号：R699.2[医药卫生—泌尿科学]