中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2009年
5期
293-296
,共4页
王保军%吴准%张国玺%居正华%王超%史涛坪%马鑫%李宏召%周辉霞%闫永吉%李俊%张旭
王保軍%吳準%張國璽%居正華%王超%史濤坪%馬鑫%李宏召%週輝霞%閆永吉%李俊%張旭
왕보군%오준%장국새%거정화%왕초%사도평%마흠%리굉소%주휘하%염영길%리준%장욱
腹腔镜检查%肾上腺切除术%培训
腹腔鏡檢查%腎上腺切除術%培訓
복강경검사%신상선절제술%배훈
Laparoscopy%Adrenalectomy%Training
目的 建立解剖性后腹腔镜下肾上腺切除术(ARA)的培训方法,评估其安全性和有效性. 方法 5名无开放性肾上腺手术经验的青年医师接受3个阶段腹腔镜培训:①模拟箱训练定向转移、切割及缝合,共300 h;②动物模型训练辨认和游离组织、切割止血及精细缝合打结,共120 h;③临床实践:初期仅为导师扶持腹腔镜,再独立完成简单的腹腔镜手术如肾囊肿去顶术,最后在导师指导下独立完成30例ARA.学员作ARA病例的选择由导师负责,与导师最初的选择一致(除外肾上腺嗜铬细胞瘤).记录患者术前资料包括性别、年龄、体质量指数、肿瘤位置、肿瘤大小、肿瘤病理类型,记录5名学员共完成150例ARA(学员组)总的中转开放率、手术时间、估计出血量、平均住院时间、手术并发症,并与导师最初完成30例ARA(导师组)的相应参数进行比较.采用SPSS 12.0软件进行数据处理,计数、计量资料分别采用x2和t检验(除手术时间为偏态分布,采用非参数检验).结果学员完成ARA患者的术前资料均与导师组患者资料相匹配(P值均>0.05).每名学员都成功实施了30例ARA,无中转开放手术者.学员组150例平均手术时间为82(59～133)min,短于导师组30例的手术时间132(73～230)min(P<0.01).学员组150例ARA的估计出血量为(62.2±22.0)ml,平均住院时间(4.8±1.3)d,与导师组30例ARA的估计出血量(63.9±21.1)ml和平均住院时间(4.5±1.4)d比较,差异无统计学意义(P>0.05).学员组与导师组围手术期并发症发生率比较差异无统计学意义(8.0%和13.3%,P>0.05),但学员组术中轻微并发症发生率(1.3%)低于导师组(10.0%,P<0.05). 结论 阶段性培训方法能安全、有效地使青年泌尿外科医师掌握ARA.
目的 建立解剖性後腹腔鏡下腎上腺切除術(ARA)的培訓方法,評估其安全性和有效性. 方法 5名無開放性腎上腺手術經驗的青年醫師接受3箇階段腹腔鏡培訓:①模擬箱訓練定嚮轉移、切割及縫閤,共300 h;②動物模型訓練辨認和遊離組織、切割止血及精細縫閤打結,共120 h;③臨床實踐:初期僅為導師扶持腹腔鏡,再獨立完成簡單的腹腔鏡手術如腎囊腫去頂術,最後在導師指導下獨立完成30例ARA.學員作ARA病例的選擇由導師負責,與導師最初的選擇一緻(除外腎上腺嗜鉻細胞瘤).記錄患者術前資料包括性彆、年齡、體質量指數、腫瘤位置、腫瘤大小、腫瘤病理類型,記錄5名學員共完成150例ARA(學員組)總的中轉開放率、手術時間、估計齣血量、平均住院時間、手術併髮癥,併與導師最初完成30例ARA(導師組)的相應參數進行比較.採用SPSS 12.0軟件進行數據處理,計數、計量資料分彆採用x2和t檢驗(除手術時間為偏態分佈,採用非參數檢驗).結果學員完成ARA患者的術前資料均與導師組患者資料相匹配(P值均>0.05).每名學員都成功實施瞭30例ARA,無中轉開放手術者.學員組150例平均手術時間為82(59～133)min,短于導師組30例的手術時間132(73～230)min(P<0.01).學員組150例ARA的估計齣血量為(62.2±22.0)ml,平均住院時間(4.8±1.3)d,與導師組30例ARA的估計齣血量(63.9±21.1)ml和平均住院時間(4.5±1.4)d比較,差異無統計學意義(P>0.05).學員組與導師組圍手術期併髮癥髮生率比較差異無統計學意義(8.0%和13.3%,P>0.05),但學員組術中輕微併髮癥髮生率(1.3%)低于導師組(10.0%,P<0.05). 結論 階段性培訓方法能安全、有效地使青年泌尿外科醫師掌握ARA.
목적 건립해부성후복강경하신상선절제술(ARA)적배훈방법,평고기안전성화유효성. 방법 5명무개방성신상선수술경험적청년의사접수3개계단복강경배훈:①모의상훈련정향전이、절할급봉합,공300 h;②동물모형훈련변인화유리조직、절할지혈급정세봉합타결,공120 h;③림상실천:초기부위도사부지복강경,재독립완성간단적복강경수술여신낭종거정술,최후재도사지도하독립완성30례ARA.학원작ARA병례적선택유도사부책,여도사최초적선택일치(제외신상선기락세포류).기록환자술전자료포괄성별、년령、체질량지수、종류위치、종류대소、종류병리류형,기록5명학원공완성150례ARA(학원조)총적중전개방솔、수술시간、고계출혈량、평균주원시간、수술병발증,병여도사최초완성30례ARA(도사조)적상응삼수진행비교.채용SPSS 12.0연건진행수거처리,계수、계량자료분별채용x2화t검험(제수술시간위편태분포,채용비삼수검험).결과학원완성ARA환자적술전자료균여도사조환자자료상필배(P치균>0.05).매명학원도성공실시료30례ARA,무중전개방수술자.학원조150례평균수술시간위82(59～133)min,단우도사조30례적수술시간132(73～230)min(P<0.01).학원조150례ARA적고계출혈량위(62.2±22.0)ml,평균주원시간(4.8±1.3)d,여도사조30례ARA적고계출혈량(63.9±21.1)ml화평균주원시간(4.5±1.4)d비교,차이무통계학의의(P>0.05).학원조여도사조위수술기병발증발생솔비교차이무통계학의의(8.0%화13.3%,P>0.05),단학원조술중경미병발증발생솔(1.3%)저우도사조(10.0%,P<0.05). 결론 계단성배훈방법능안전、유효지사청년비뇨외과의사장악ARA.
Objective To develop a staged laparoscopic training program for performing the ana-tomic retroperitoneoscopic adrenalectomy(ARA), and to determine its safety and feasibility. Me-thods Five young urological doctors without previous experience in open adrenalectomy were selected third period, trainees acted as camera holder first, then performed simple operations such as laparo-scopic renal cyst unroofing. Finally, they performed 30 ARA independently under the mentor's super-vision. Pheochromocytoma was ruled out for its large tumor size and potential cardiovascular risk. The patient selection criteria were the same as those of the initial 30 cases performed by the tutor. Preope-rative data of the initial 30 ARA performed by each trainee and tutor which included gender, age, body mass index, tumor size, tumor location and pathological diagnosis of tumor were compared between trainees and the tutor. The intraoperative and postoperative data of 150 ARA in the trainees were compared with the initial 30 ARA of the tutor. These included mean operative time, estimated blood loss, length of hospital stay, conversion rate, complication rate. Qualitative and quantitative data were compared between the groups using x2 and t test statistics methods by SPSS 12.0 for Windows, except operative time, which was from a nonnormal distribution. A P value less than 0.05 was consi-dered to be statistically significant. Results Preoperative data of the initial 30 ARA performed by each trainee were marched to those of the mentor (all P>0.05). All ARA were completed successful-ly. No procedure converted to open surgery. The median operative time of the trainees was 82 min (range 59-133 min), which was less than that of the tutor [132 min (range 73-230 min), P< 0.01]. And the trainees' learning curve was flatter than their tutor's. Estimated blood loss and length of hospital stay for the 5 trainees and the tutor were 62.2±22.0 ml, 4.8±1.3 d and 63.9±21.1 ml, 4.5±1.4 d respectively. There was no significant difference between these results (both P>0.05). No major complication was observed. Though the total perioperative complication rates were no diffe-rence between the trainees and their tutor (8.0% versus 13.3%, P>0.05), intraoperative minor complication rates of the trainees (1.3%) was less than that of the tutor (10.0%, P<0.05). Con-clusion The staged laparoscopic training is safe and feasible for young urological doctor to study in performing ARA.
