本文關(guān)鍵詞： 鑄型標(biāo)本 三維重建 快速成型制造 腹腔鏡培訓(xùn) 訓(xùn)練模型 左肝外側(cè)葉切除術(shù) 模型驗(yàn)證　出處：《南方醫(yī)科大學(xué)》2017年博士論文　論文類型：學(xué)位論文

【摘要】：背景伴隨著現(xiàn)在肝膽外科的發(fā)展,現(xiàn)代手術(shù)模式已從傳統(tǒng)的有創(chuàng)的開(kāi)放式手術(shù)轉(zhuǎn)變?yōu)楝F(xiàn)代微創(chuàng)精準(zhǔn)手術(shù),特別是成熟的腹腔鏡外科手術(shù)的開(kāi)展加快了這一進(jìn)程。現(xiàn)在,使用腹腔鏡技術(shù)進(jìn)行特定肝段腫瘤的精準(zhǔn)切除術(shù)已成為常規(guī)手術(shù)。但肝臟結(jié)構(gòu)復(fù)雜,實(shí)施腹腔鏡下肝臟部分切除術(shù)(LLR)的技術(shù)難度高,風(fēng)險(xiǎn)較大,目前基層的醫(yī)院尚未廣泛開(kāi)展。因此,充分了解肝臟解剖結(jié)構(gòu)及其毗鄰關(guān)系和豐富的腹腔鏡操作經(jīng)驗(yàn)對(duì)于肝膽外科醫(yī)生開(kāi)展此類手術(shù)非常重要。本研究,我們將利用三維打印技術(shù)和離體器官灌注技術(shù)設(shè)計(jì)構(gòu)建系統(tǒng)化的腹腔鏡下左肝外側(cè)葉切除術(shù)的高級(jí)培訓(xùn)模型并驗(yàn)證其有效性。目的基于三維打印技術(shù)和離體器官連續(xù)灌注技術(shù)構(gòu)架系統(tǒng)化的腹腔鏡下左肝外側(cè)葉切除術(shù)的高級(jí)培訓(xùn)模型并驗(yàn)證其有效性方法A.基于三維打印技術(shù)的肝臟解剖模型的輔助學(xué)習(xí)效果分析為探索三維打印技術(shù)在基礎(chǔ)解剖教育中的價(jià)值,該課程設(shè)計(jì)有兩個(gè)方向的子課題。1.三維可視化模型、三維打印模型在肝臟解剖教學(xué)的價(jià)值分析招募一名50歲男性志愿者,掃描后獲取其肝臟影像數(shù)據(jù)。通過(guò)圖像的三維重建獲取肝臟結(jié)構(gòu)的三維模型。將肝實(shí)質(zhì)模型分為八個(gè)部分構(gòu)建肝段的三維可視化模型。將肝實(shí)質(zhì)模型上表面去除僅保留底面即為設(shè)計(jì)的三維打印模型的藍(lán)本。制作完成后,專家組成員采用5分的Likert量表對(duì)肝段三維可視化模型、三維打印模型進(jìn)行評(píng)估。然后利用學(xué)生組隨機(jī)對(duì)照試驗(yàn)與傳統(tǒng)的解剖圖譜作比較,評(píng)價(jià)模型的教學(xué)效能。2.不同設(shè)計(jì)的三維打印模型在肝臟解剖教學(xué)中的價(jià)值分析選取一具新鮮的肝臟標(biāo)本灌注后進(jìn)行CT掃描。三維重建后設(shè)計(jì)打印三種不同的肝段模型,模型一沒(méi)有肝實(shí)質(zhì)模型僅有管道模型,模型二有管道模型和透明的肝實(shí)質(zhì)外形,第三種有管道模型和肝段間隔。制作完成后,專家組成員采用5分的Likert量表對(duì)三種三維打印模型進(jìn)行評(píng)估。92名大一學(xué)生組隨機(jī)分為四組在四種不同的教具輔助下學(xué)習(xí)肝段解剖知識(shí)。通過(guò)比較兩次測(cè)試的結(jié)果來(lái)評(píng)價(jià)不同模型的教學(xué)效能B.基于離體器官灌注技術(shù)的腹腔鏡下左肝外側(cè)葉切除術(shù)的培訓(xùn)模型的建立及分析26名腹腔鏡經(jīng)驗(yàn)不同的志愿者分為初級(jí)組(7人)、中級(jí)組(14人)、高級(jí)組(5人)。利用離體羊肝通過(guò)灌注血管制作培訓(xùn)模型。三組完成兩次次培訓(xùn)以驗(yàn)證培訓(xùn)模型的可行性。中級(jí)組在完成第一輪訓(xùn)練后隨機(jī)分為兩組。實(shí)驗(yàn)組完成十次培訓(xùn),對(duì)照組完成兩次培訓(xùn)。記錄訓(xùn)練參數(shù)并統(tǒng)計(jì)分析評(píng)估訓(xùn)練效能。結(jié)果1.三維打印肝臟模型均可以顯著提高肝臟解剖學(xué)習(xí)效果;2.利用離體羊肝構(gòu)建的系統(tǒng)化腹腔鏡下左肝外側(cè)葉切除術(shù)培訓(xùn)模型在短期技能培訓(xùn)后可顯著提高培訓(xùn)者腔鏡操作技能。結(jié)論系統(tǒng)化的腹腔鏡肝臟部分切除術(shù)的高級(jí)培訓(xùn)模型既可以提高訓(xùn)練者的肝臟解剖的認(rèn)知又可以在短時(shí)間內(nèi)提高訓(xùn)練者系統(tǒng)化的高級(jí)腔鏡操作技能。
[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.

【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R657.3

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