一种新型腹腔镜多自由度手术器械在外科基本技能培训中的应用效果  

The application effect of a new type of laparoscopic multi-freedom surgical instrument in the training of basic surgical skills

作　　者：陈志达[1] 殷健瀚 刘怡[1] 卢婷婷 张淦 董晓宇 杜晓辉[1] 郗洪庆[1] Chen Zhida;Yin Jianhan;Liu Yi;Lu Tingting;Zhang Gan;Dong Xiaoyu;Du Xiaohui;Xi Hongqing(Department of General Surgery,First Medical Center,Chinese People's Liberation Army General Hospital,Beijing 100853,China;Chinese People's Liberation Army Medical School,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心普通外科医学部,北京100853 [2]解放军医学院研究生院,北京100853

出　　处：《中华外科杂志》2024年第11期1045-1053,共9页Chinese Journal of Surgery

基　　金：军队高层次科技创新人才工程自主科研项目(22QNYC004);解放军总医院青年自主创新科学基金项目(22QNCZ014)。

摘　　要：目的:探讨一种新型腹腔镜多自由度手术器械在外科基本技能培训中的应用效果并分析其学习曲线。方法:收集2023年1—10月在解放军总医院腹腔镜外科医师培训基地接受培训的50名学员的教学记录信息。在培训前按照随机数字表法将50名学员随机分为常规器械组和新型器械组,每组25名。根据研究设计进行“精准夹豆-梅花桩夹豆-套圈定位-双手穿线-缝合打结”5个模块的培训,训练完成后进行考核,记录每个模块的完成时间。两组学员培训前后完成操作时间的变化比较采用倍差(DID)法进行统计分析,学习曲线的拟合分析采用累积求和法。结果:培训前,两组学员完成5个模块所需时间的差异均无统计学意义(P值均>0.05);培训后,两组学员完成5个模块的时间均较培训前缩短[精准夹豆:(63.7±9.3)s比(85.4±18.2)s,t=2.38,P=0.035;梅花桩夹豆(45.2±6.8)s比(103.1±57.2)s,t=8.77,P=0.047;套圈定位:(78.5±19.1)s比(126.2±26.3)s,t=6.96,P=0.019;双手穿线:(63.3±21.2)s比(105.8±27.9)s,t=3.43,P=0.015;缝合打结:(160.2±79.5)s比(228.9±96.6)s,t=4.58,P=0.008];新型器械组学员完成5个模块所用次均操作时间均短于常规器械组(精准夹豆DID值为37.66,t=2.43,P=0.007;梅花桩夹豆DID值为58.42,t=3.03,P=0.013;套圈定位DID值为28.33,t=2.83,P=0.031;双手穿线DID值为48.89,t=2.10,P=0.042;缝合打结DID值为54.78,t=3.57,P=0.012);在梅花桩夹豆、套圈定位和缝合打结模块学习曲线中,新型器械组达到熟练所需的课时均少于常规器械组(梅花桩夹豆:第3学时比第4学时;套圈定位:第4学时比第5学时;缝合打结:第3学时比第5学时);在精准夹豆和双手穿线模块,常规器械组和新型器械组均在第5学时跨越学习曲线,但是两组的曲线斜率的差异有统计学意义(精准夹豆:t=-2.85,P=0.004;双手穿线:t=-2.66,P=0.008)。结论:新型腹腔镜多自由度手术器械在腹腔镜培训教学可以提升学习效果、缩短学�Objective To evaluate the application effect of a new type of laparoscopic multi-degree-of-freedom surgical instrument in the training of basic surgical skills and analyze the learning curve.Methods The teaching records of the trainees who received training in the training base of laparoscopic surgeons in Chinese People′s Liberation Army General Hospital from January to October,2023 were collected.The 50 trainees were randomly divided into conventional instrumentation group and new instrumentation group with 25 trainees in each group according to the random number table method before the training.According to the research design,five modules such as"accurate bean clamping,plum blossom pile bean clamping,ferrule positioning,threading with both hands,sewing and knotting"were trained.After the training,they were assessed and the completion time of each module was recorded.The comparison of the changes of the completion time of the two groups of students before and after training was statistically analyzed by differences-in-differences(DID)method,and the fitting analysis of learning curve was analyzed by cumulative summation method.Results Before the training,there was no statistically significant difference in the time required to complete five modules between the two groups of trainees(all P>0.05).After the training,the time to complete the five modules in both groups was reduced compared to before the training(accurate bean clamping:(63.7±9.3)seconds vs.(85.4±18.2)seconds,t=2.38,P=0.035;plum blossom pile bean clamping:(45.2±6.8)seconds vs.(103.1±57.2)seconds,t=8.77,P=0.047;ring positioning:(78.5±19.1)seconds vs.(126.2±26.3)seconds,t=6.96,P=0.019;threading with both hands:(63.3±21.2)seconds vs.(105.8±27.9)seconds,t=3.43,P=0.015;sewing and knotting:(160.2±79.5)seconds vs.(228.9±96.6)seconds,t=4.58,P=0.008).The average time required to complete the five modules was shorter in the new instrument group compared to the conventional instrument group(DID for accurate bean clamping=37.66,t=2.43,P=0.007;DID for

关 键 词：腹腔镜 规范化培训 多自由度手术器械 基础教学 

分 类 号：R-4[医药卫生] C975[经济管理—劳动经济]