CAJ | 학술논문

目的：为初学者建立标准的肾癌根治术学习及带教策略，并评估该学习方法的安全性和有效性。方法选择上海交通大学附属第一人民医院泌尿外科未掌握肾癌根治术的年轻主治医师6名，随机分成3组，分别为腹腔镜－开放组（即先进行腹腔镜肾癌根治术的学习和临床训练8例，再进行开放性肾癌根治术的学习和临床训练8例，最后考核）；开放－腹腔镜组（即先进行开放性肾癌根治术的学习和临床训练8例，再进行腹腔镜肾癌根治术的学习和临床训练8例，最后考核）；混合组（即同时进行腹腔镜／开放性肾癌根治术的学习和临床训练，间隔使用两种术式行肾癌根治术各8例，最后考核）；考核办法为在指导教师指导下完成腹腔镜肾癌根治术5例，开放性肾癌根治术3例，并收集和比较其临床数据（如手术时间、出血量，术后拔除引流管时间、术后下床活动时间，住院时间等），并评估其手术效果。结果所有肾癌根治术均获成功，无一例腹腔镜肾癌根治术中转开放，最后考核中混合组的训练者学习曲线最短，多项临床评价指标明显优于其他两组。术中并发症比例三组无明显差异。结论初学者在导师指导下可以安全有效的掌握肾癌根治术的手术方法，并且在训练期间腹腔镜及开放手术的有机结合学习和训练有助于更快掌握解剖知识和手术技巧，缩短学习曲线。另外，腹腔镜肾癌根治术的学习和训练对初学者掌握解剖知识，熟悉手术步骤，更快掌握手术方法及减少手术并发症更有帮助，而开放性肾癌根治术也对更快掌握腹腔镜肾癌根治术的要点有助益。
목적：위초학자건립표준적신암근치술학습급대교책략，병평고해학습방법적안전성화유효성。방법선택상해교통대학부속제일인민의원비뇨외과미장악신암근치술적년경주치의사6명，수궤분성3조，분별위복강경－개방조（즉선진행복강경신암근치술적학습화림상훈련8례，재진행개방성신암근치술적학습화림상훈련8례，최후고핵）；개방－복강경조（즉선진행개방성신암근치술적학습화림상훈련8례，재진행복강경신암근치술적학습화림상훈련8례，최후고핵）；혼합조（즉동시진행복강경／개방성신암근치술적학습화림상훈련，간격사용량충술식행신암근치술각8례，최후고핵）；고핵판법위재지도교사지도하완성복강경신암근치술5례，개방성신암근치술3례，병수집화비교기림상수거（여수술시간、출혈량，술후발제인류관시간、술후하상활동시간，주원시간등），병평고기수술효과。결과소유신암근치술균획성공，무일례복강경신암근치술중전개방，최후고핵중혼합조적훈련자학습곡선최단，다항림상평개지표명현우우기타량조。술중병발증비례삼조무명현차이。결론초학자재도사지도하가이안전유효적장악신암근치술적수술방법，병차재훈련기간복강경급개방수술적유궤결합학습화훈련유조우경쾌장악해부지식화수술기교，축단학습곡선。령외，복강경신암근치술적학습화훈련대초학자장악해부지식，숙실수술보취，경쾌장악수술방법급감소수술병발증경유방조，이개방성신암근치술야대경쾌장악복강경신암근치술적요점유조익。
Objective To establish standard learning and teaching strategies of radical nephrectomy for be-ginners,and to evaluate the safety and efficacy of the learning method. Methods 6 young attending doctors as trainee,come from Department of Urology,Shanghai General Hospital,Shanghai Jiao Tong University,who did not grasp the radical nephrectomy,were randomly divided into 3 groups,respectively. Group1 (Mixed group):studying and practicing laparoscopic/open radical nephrectomy at the same time in 8 cases respectively,then e-valuate;Group2 (Laparoscopic-open group ):studying and practicing laparoscopic radical nephrectomy in 8 cases,followed 8 cases of open radical nephrectomy,then evaluate;Group3 (Open -laparoscopic group ):studying and practicing open radical nephrectomy in 8 cases,followed 8 cases of laparoscopic radical nephrecto-my,then evaluate. Finally,every trainee operated 5 cases of laparoscopic radical nephrectomy and 3 cases of open radical nephrectomy under the guidance of teachers and compared of the clinical data such as operation time,bleeding volume,postoperative removal of drainage tube time,postoperative ambulation time,hospitaliza-tion time as assessment. Results all radical nephrectomy were successful,and no cases of laparoscopic radical nephrectomy converted to open. The learning curve of the mixed group was obviously shorter and the clinical in-dexes were better than the other two groups in the final evaluation. The complication ratio had no difference be-tween the three groups. Conclusions beginners can learn radical nephrectomy under the guidance of a mentor safely and effectively. The learning and teaching strategies of the combination of laparoscopic and open radical nephrectomy help trainee quickly grasp the anatomical knowledge and surgical techniques,and meanwhile short-en the learning curve. Meanwhile,learning and training retroperitoneoscopic radical nephrectomy can help be-ginners to master the anatomy knowledge,familiar with the operation steps,quicker to grasp operation and re-duce surgical complications a lot,and the open radical nephrectomy can also help trainee quickly grasp the lapa-roscopic radical nephrectomy operation points.