本文選題：腎部分切除　切入點：腹腔鏡手術(shù)　出處：《南方醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的1、構(gòu)建灌注技術(shù)的離體豬腎腹腔鏡培訓(xùn)模型。2、通過不同級別醫(yī)師離體豬腎腹腔鏡手術(shù)對培訓(xùn)模型的效度驗證及評價,評估能否用于腹腔鏡腎部分切除(laparoscopic partial nephrectomy,LPN)培訓(xùn)。3、初步探索實驗組腹腔鏡學(xué)習(xí)規(guī)律并繪制學(xué)習(xí)曲線,明確規(guī)范化培訓(xùn)能否對臨床醫(yī)生的腔鏡培養(yǎng)提供幫助。方法1、構(gòu)建模型:取帶腎蒂的新鮮豬腎,去除腎臟纖維囊外腎周脂肪并動脈插管(備連接懸掛于距離地面高度136cm輸液架1L容量杯灌注液灌注),在豬腎下極表面畫兩個同心圓圈,小的直徑28mm,大的直徑32mm,為手術(shù)切除區(qū)域,將腎臟固定于人體塑料模型中手術(shù)操作。2、驗證模型:邀請6名高級職稱醫(yī)師、6名中級職稱醫(yī)師、8名初級職稱醫(yī)師分別組成高級組、中級組和初級組。其中高級組人員為LPN專家并問卷調(diào)查。實驗每人行2個腎臟下極部分切除手術(shù)。統(tǒng)計切除時間、切除損傷外內(nèi)圈個數(shù)、縫合時間、針口撕裂個數(shù)、撕裂總長度、撕裂最長、縫合創(chuàng)面間隙、出血控制率。學(xué)習(xí)曲線探索篩選成績相當(dāng)?shù)?2名住院醫(yī)師學(xué)員進(jìn)行培訓(xùn),隨機分為實驗組(6名)和對照組(6名),行離體豬腎表面的兩個“8”字的淺層縫合及腎部分切除手術(shù)等培訓(xùn),統(tǒng)計淺層“8”字縫合時間、定點縫合偏差、23評分及驗證模型指標(biāo)。結(jié)果1、Likert評分中,模型解剖條件為5.00±0.00;模擬灌注出血情況為4.33±0.52;操作質(zhì)感為4.33±0.52;外觀及顏色為4.33±0.52;模型總體逼真情況為4.67±0.52;LPN專家對模型總體的逼真情況表示認(rèn)可,認(rèn)為模型是適合培訓(xùn)。2、初、中、高級組人員在2次腹腔鏡下離體豬腎部分切除術(shù)的腎臟部分切除時間、縫合時間、內(nèi)外圈損傷數(shù)、縫合針口撕裂個數(shù)、撕裂最長、撕裂總長度、縫合后切緣間隙及出血控制率等指標(biāo)進(jìn)行統(tǒng)計,均有統(tǒng)計學(xué)意義,驗證了模型的有效構(gòu)造效度。3、學(xué)習(xí)曲線:內(nèi)圈損傷數(shù)、創(chuàng)面縫合時間在第3次之后達(dá)到平臺期。外圈損傷數(shù),撕裂總長、撕裂最長在第6次之后達(dá)到平臺期。撕裂個數(shù)、淺層“8”字縫合時間、23評分、定點縫合偏差、出血控制率第7次培訓(xùn)之后達(dá)到平臺期。腎部分切除時間、縫合后間隙在第8次之后達(dá)到平臺期,提示初級職稱人員在此模型下經(jīng)過8次培訓(xùn)后手術(shù)技能達(dá)到穩(wěn)定值。實驗組培訓(xùn)效果明顯優(yōu)于對照組。結(jié)論本研究成功構(gòu)建灌注技術(shù)的腹腔鏡腎部分切除術(shù)的培訓(xùn)模型。通過Likert評分表問卷調(diào)查高級職稱人員一致認(rèn)為此模型適合培訓(xùn)。初、中、高三組在術(shù)后統(tǒng)計結(jié)果驗證了模型的有效構(gòu)造效度。學(xué)習(xí)曲線提示培訓(xùn)8次達(dá)到平臺期。此培訓(xùn)模型可用于培訓(xùn)腹腔鏡下腎部分切除術(shù)。
[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 鹵0.00; the simulated perfusion bleeding is 4.33 鹵0.52; the operating texture is 4.33 鹵0.52; the appearance and color is 4.33 鹵0.52. the overall lifelike condition of the model is 4.67 鹵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.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R-4;C975

【參考文獻(xiàn)】

相關(guān)期刊論文 前3條

1 Fabio C M Torricelli;Joao Arthur B A Barbosa;Giovanni S Marchini;;Impact of laparoscopic surgery training laboratory on surgeon's performance[J];World Journal of Gastrointestinal Surgery;2016年11期

2 肖菊姣;孔祥雪;付茂慶;游輔宇;王張林;李鑒軼;;腹腔鏡肝切除術(shù)培訓(xùn)模型的構(gòu)建[J];中國臨床解剖學(xué)雜志;2015年02期

3 李云;楊波;曾欽松;葉華茂;楊慶;許傳亮;王林輝;孫穎浩;;應(yīng)用離體豬腎構(gòu)建腹腔鏡下腎部分切除術(shù)的培訓(xùn)模型[J];第二軍醫(yī)大學(xué)學(xué)報;2012年06期

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本文編號：1653010