腹腔镜下肝部分切除术培训系统的建立及有效性评价

发布时间：2018-02-25 21:42

本文关键词： 铸型标本三维重建快速成型制造腹腔镜培训训练模型左肝外侧叶切除术模型验证　出处：《南方医科大学》2017年博士论文　论文类型：学位论文

【摘要】：背景伴随着现在肝胆外科的发展,现代手术模式已从传统的有创的开放式手术转变为现代微创精准手术,特别是成熟的腹腔镜外科手术的开展加快了这一进程。现在,使用腹腔镜技术进行特定肝段肿瘤的精准切除术已成为常规手术。但肝脏结构复杂,实施腹腔镜下肝脏部分切除术(LLR)的技术难度高,风险较大,目前基层的医院尚未广泛开展。因此,充分了解肝脏解剖结构及其毗邻关系和丰富的腹腔镜操作经验对于肝胆外科医生开展此类手术非常重要。本研究,我们将利用三维打印技术和离体器官灌注技术设计构建系统化的腹腔镜下左肝外侧叶切除术的高级培训模型并验证其有效性。目的基于三维打印技术和离体器官连续灌注技术构架系统化的腹腔镜下左肝外侧叶切除术的高级培训模型并验证其有效性方法A.基于三维打印技术的肝脏解剖模型的辅助学习效果分析为探索三维打印技术在基础解剖教育中的价值,该课程设计有两个方向的子课题。1.三维可视化模型、三维打印模型在肝脏解剖教学的价值分析招募一名50岁男性志愿者,扫描后获取其肝脏影像数据。通过图像的三维重建获取肝脏结构的三维模型。将肝实质模型分为八个部分构建肝段的三维可视化模型。将肝实质模型上表面去除仅保留底面即为设计的三维打印模型的蓝本。制作完成后,专家组成员采用5分的Likert量表对肝段三维可视化模型、三维打印模型进行评估。然后利用学生组随机对照试验与传统的解剖图谱作比较,评价模型的教学效能。2.不同设计的三维打印模型在肝脏解剖教学中的价值分析选取一具新鲜的肝脏标本灌注后进行CT扫描。三维重建后设计打印三种不同的肝段模型,模型一没有肝实质模型仅有管道模型,模型二有管道模型和透明的肝实质外形,第三种有管道模型和肝段间隔。制作完成后,专家组成员采用5分的Likert量表对三种三维打印模型进行评估。92名大一学生组随机分为四组在四种不同的教具辅助下学习肝段解剖知识。通过比较两次测试的结果来评价不同模型的教学效能B.基于离体器官灌注技术的腹腔镜下左肝外侧叶切除术的培训模型的建立及分析26名腹腔镜经验不同的志愿者分为初级组(7人)、中级组(14人)、高级组(5人)。利用离体羊肝通过灌注血管制作培训模型。三组完成两次次培训以验证培训模型的可行性。中级组在完成第一轮训练后随机分为两组。实验组完成十次培训,对照组完成两次培训。记录训练参数并统计分析评估训练效能。结果1.三维打印肝脏模型均可以显著提高肝脏解剖学习效果;2.利用离体羊肝构建的系统化腹腔镜下左肝外侧叶切除术培训模型在短期技能培训后可显著提高培训者腔镜操作技能。结论系统化的腹腔镜肝脏部分切除术的高级培训模型既可以提高训练者的肝脏解剖的认知又可以在短时间内提高训练者系统化的高级腔镜操作技能。
[Abstract]:With the background of development of modern department of hepatobiliary surgery now, operation mode has changed from the traditional open surgery and minimally invasive surgery into a modern precision, especially in laparoscopic surgery of mature accelerated the process. Now, the specific segments of liver tumor resection precision has become a routine surgical technique. But the use of laparoscopic liver the complex structure, the implementation of laparoscopic liver resection (LLR) of the high technical difficulty, high risk, the grass-roots hospital has not been widely carried out. Therefore, to fully understand the anatomy of liver and adjacent structures and rich experience of laparoscopic operation is very important for hepatobiliary surgeons to carry out such operations. In this study, we will use advanced training model printing technology and the isolated organ perfusion technology design system of laparoscopic hepatic left lateral lobectomy and verify its effectiveness Based on the advanced training model. The purpose of 3D printing technology and in vitro organ laparoscopic continuous perfusion technical framework of the left lateral lobe of liver resection and to verify the effectiveness of the method of A. analysis assisted learning effect of 3D printing technology for the exploration of the liver anatomy model of three-dimensional printing technology based on anatomical education value based on.1. model the 3D visualization of sub topics of the curriculum design in two directions, three-dimensional printing model of anatomy teaching in the liver of the analysis of the value of a 50 year old male volunteers were recruited, after scanning to obtain the liver image data. To obtain 3D model of liver structure through three-dimensional reconstruction. The liver model is divided into eight parts to construct liver segment the 3D visualization model. The model on the surface of the liver parenchyma removal is retained only the bottom surface of the three-dimensional printing model design blueprint. The production is completed, a member of the expert group The 5 point Likert scale on the 3D visual model of hepatic segment, 3D printing model evaluation. Then the students anatomical atlas of randomized controlled trials comparing with the traditional teaching model, 3D printing efficiency of.2. in different design evaluation model in the liver anatomy teaching value analysis and selection of a fresh liver specimen after reperfusion CT scans were performed in three different print design. Liver 3D reconstruction model, a model not only liver model pipeline model, model two pipeline model and transparent liver shape, there are third kinds of pipe model and liver interval. The production is completed, a member of the expert group by Likert 5 table evaluation of.92 freshman group were randomly divided into four groups in the four kinds of teaching aids in different learning hepatic segmental anatomy knowledge. Three kinds of 3D printing model is evaluated by comparing the results of two tests B. teaching effectiveness based on different model establishment of training model of laparoscopic isolated organ perfusion technique under hepatic left lateral lobectomy and analysis of 26 different laparoscopic experience volunteers were divided into primary group (7), intermediate group (14 people), senior group (5 people). The isolated sheep liver by vascular perfusion making training model. Three groups completed two times to verify the feasibility of training training model. In the intermediate group completed the first round of training were randomly divided into two groups. The experimental group completed ten training, the control group completed two training. Training records and statistical parameters analysis and evaluation of training effectiveness. The 1. dimensional printing liver model anatomy of the liver can significantly improve the learning effect; 2. by systematic body construction under the laparoscopic liver resection of left lateral lobe surgery training model in short-term training can significantly enhance the training of endoscopic operation skills. Conclusion systematic The advanced training model of laparoscopic partial hepatectomy can not only improve the cognition of liver anatomy of trainers, but also improve trainers' systematic advanced endoscopic operation skills in a short time.

【学位授予单位】：南方医科大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R657.3

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