基于离体猪肾灌注技术的腹腔镜肾部分切除的短期培训课程建立及有效性评价

发布时间：2018-03-23 10:14

本文选题：肾部分切除　切入点：腹腔镜手术　出处：《南方医科大学》2017年硕士论文

【摘要】：目的1、构建灌注技术的离体猪肾腹腔镜培训模型。2、通过不同级别医师离体猪肾腹腔镜手术对培训模型的效度验证及评价,评估能否用于腹腔镜肾部分切除(laparoscopic partial nephrectomy,LPN)培训。3、初步探索实验组腹腔镜学习规律并绘制学习曲线,明确规范化培训能否对临床医生的腔镜培养提供帮助。方法1、构建模型:取带肾蒂的新鲜猪肾,去除肾脏纤维囊外肾周脂肪并动脉插管(备连接悬挂于距离地面高度136cm输液架1L容量杯灌注液灌注),在猪肾下极表面画两个同心圆圈,小的直径28mm,大的直径32mm,为手术切除区域,将肾脏固定于人体塑料模型中手术操作。2、验证模型:邀请6名高级职称医师、6名中级职称医师、8名初级职称医师分别组成高级组、中级组和初级组。其中高级组人员为LPN专家并问卷调查。实验每人行2个肾脏下极部分切除手术。统计切除时间、切除损伤外内圈个数、缝合时间、针口撕裂个数、撕裂总长度、撕裂最长、缝合创面间隙、出血控制率。学习曲线探索筛选成绩相当的12名住院医师学员进行培训,随机分为实验组(6名)和对照组(6名),行离体猪肾表面的两个“8”字的浅层缝合及肾部分切除手术等培训,统计浅层“8”字缝合时间、定点缝合偏差、23评分及验证模型指标。结果1、Likert评分中,模型解剖条件为5.00±0.00;模拟灌注出血情况为4.33±0.52;操作质感为4.33±0.52;外观及颜色为4.33±0.52;模型总体逼真情况为4.67±0.52;LPN专家对模型总体的逼真情况表示认可,认为模型是适合培训。2、初、中、高级组人员在2次腹腔镜下离体猪肾部分切除术的肾脏部分切除时间、缝合时间、内外圈损伤数、缝合针口撕裂个数、撕裂最长、撕裂总长度、缝合后切缘间隙及出血控制率等指标进行统计,均有统计学意义,验证了模型的有效构造效度。3、学习曲线:内圈损伤数、创面缝合时间在第3次之后达到平台期。外圈损伤数,撕裂总长、撕裂最长在第6次之后达到平台期。撕裂个数、浅层“8”字缝合时间、23评分、定点缝合偏差、出血控制率第7次培训之后达到平台期。肾部分切除时间、缝合后间隙在第8次之后达到平台期,提示初级职称人员在此模型下经过8次培训后手术技能达到稳定值。实验组培训效果明显优于对照组。结论本研究成功构建灌注技术的腹腔镜肾部分切除术的培训模型。通过Likert评分表问卷调查高级职称人员一致认为此模型适合培训。初、中、高三组在术后统计结果验证了模型的有效构造效度。学习曲线提示培训8次达到平台期。此培训模型可用于培训腹腔镜下肾部分切除术。
[Abstract]:Objective 1. To establish an in vitro pig kidney laparoscopic training model with perfusion technique, and to evaluate the validity of the model by using different levels of physicians in isolated porcine kidney laparoscopic surgery. To evaluate the feasibility of using LPN training in laparoscopic partial nephrectomy (LPN), and to explore the learning pattern and curve of LPN in the experimental group. It is clear whether standardized training can help clinicians in endoscopic culture. Methods 1. Model: fresh pig kidney with kidney pedicle, Removal of perirenal fat from renal fiber capsule and arterial catheterization (attached to a 1L volume cup perfusion perfusion tank suspended at a height above the ground, two concentric circles with a small diameter of 28 mm and a large diameter of 32 mm are drawn on the surface of the inferior pole of the pig kidney. The kidney was fixed in the plastic model of human body. 2. To verify the model, 6 doctors with senior title and 6 doctors with middle title and 8 doctors with primary title were invited to form a senior group. Middle group and primary group. The senior group were LPN experts and questionnaire. Each of the two patients underwent partial nephrectomy. The excision time, the number of outer rings, the suture time, the number of laceration of the needle and mouth were calculated. Total tear length, longest tear, wound space suture, bleeding control rate. The rats were randomly divided into experimental group (n = 6) and control group (n = 6). Two "8" characters were sutured by superficial suture and partial nephrectomy were performed. The suture time of superficial "8" character was counted. Fixed-point suture deviation score 23 and verification model index. Results 1 in the Likert score, The anatomic condition of the model is 5.00 卤0.00; the simulated perfusion bleeding is 4.33 卤0.52; the operating texture is 4.33 卤0.52; the appearance and color is 4.33 卤0.52. the overall lifelike condition of the model is 4.67 卤0.52LPN experts approve the overall lifelike condition of the model, and think that the model is suitable for training. In the senior group, the partial nephrectomy time, suture time, injury number of the inner and outer ring, the number of laceration of the stitches, the longest tear, the total length of the laceration were the longest in two laparoscopic partial nephrectomy. Statistical significance was found in the margin space and bleeding control rate after suture, which verified the validity of the model. The learning curve was as follows: the number of inner ring injuries, the wound suture time reached the plateau stage after the third time, the number of outer ring injuries, the number of outer ring injuries, the number of outer ring injuries, the number of outer ring injuries, and the number of outer ring injuries. The total tear length, the longest tear reached the platform stage after the sixth time, the number of tears, the suture time of the superficial "8" word was 23 scores, the fixed point suture deviation, the bleeding control rate reached the platform stage after the 7th training, and the partial nephrectomy time, The space after suture reached the plateau stage after the eighth time. The results suggest that the training effect of the experimental group is better than that of the control group. Conclusion the successful construction of laparoscopic partial nephrectomy with perfusion technique in the experimental group is better than that in the control group. The training model. Through the Likert score form questionnaire survey senior title personnel agreed that this model is suitable for training. The statistical results of the third group showed the validity of the model. The learning curve indicated that the training reached platform stage 8 times. This training model can be used to train laparoscopic partial nephrectomy.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R-4;C975

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