CAJ | 학술논문

目的：探讨对不同时程显微血管吻合训练方案的效果。方法选取分别参加超短时程（4 h，9人）、中时程（12 h，12人）和长时程（300 h，10人）不同培训方案的显微血管吻合训练的神经外科医师31人，其中来自三等甲级医院者22人，其他级别医院者9人；训练前在神经外科工作的平均时间中位数为6（0～19）年。受训者训练后分别在外科显微镜下进行大鼠颈总动脉端-端吻合等考核，比较其完成时间、吻合质量评分、吻合后血管通畅比例。正态分布的计量资料采用单因素方差检验，偏态分布的计量资料采用秩和检验。计数资料比较采用Fisher 精确检验。结果参加超短时程训练者，完成颈动脉端-端吻合的时间为（78±37）min，吻合质量评分为（8.1±2.8）分，通畅血管为2支；参加中时程训练者，吻合时间为（69±20）min，吻合质量评分为（15.8±6.8）分，通畅血管为10支；参加长时程训练者，吻合时间为（34±7）min，吻合水平得分为（23.5±1.3）分，通畅血管为10支。3组学员完成吻合时间比较差异有统计学意义（F ＝9.50， P ＝0.001），长时程组的完成时间短于中时程、超短时程，差异有统计学意义（P ＜0．05）。3组吻合质量评分比较差异有统计学意义（ F ＝26.87，P ＝0.000）。而对于血管通畅支数，中时程和长时程组与超短时程组比较，差异有统计学意义（P ＜0.01）。结论若使受训者显微血管吻合技术达到相对熟练及稳定，需选择长时程训练。
목적：탐토대불동시정현미혈관문합훈련방안적효과。방법선취분별삼가초단시정（4 h，9인）、중시정（12 h，12인）화장시정（300 h，10인）불동배훈방안적현미혈관문합훈련적신경외과의사31인，기중래자삼등갑급의원자22인，기타급별의원자9인；훈련전재신경외과공작적평균시간중위수위6（0～19）년。수훈자훈련후분별재외과현미경하진행대서경총동맥단-단문합등고핵，비교기완성시간、문합질량평분、문합후혈관통창비례。정태분포적계량자료채용단인소방차검험，편태분포적계량자료채용질화검험。계수자료비교채용Fisher 정학검험。결과삼가초단시정훈련자，완성경동맥단-단문합적시간위（78±37）min，문합질량평분위（8.1±2.8）분，통창혈관위2지；삼가중시정훈련자，문합시간위（69±20）min，문합질량평분위（15.8±6.8）분，통창혈관위10지；삼가장시정훈련자，문합시간위（34±7）min，문합수평득분위（23.5±1.3）분，통창혈관위10지。3조학원완성문합시간비교차이유통계학의의（F ＝9.50， P ＝0.001），장시정조적완성시간단우중시정、초단시정，차이유통계학의의（P ＜0．05）。3조문합질량평분비교차이유통계학의의（ F ＝26.87，P ＝0.000）。이대우혈관통창지수，중시정화장시정조여초단시정조비교，차이유통계학의의（P ＜0.01）。결론약사수훈자현미혈관문합기술체도상대숙련급은정，수선택장시정훈련。
Objective To investigate the effect of the training scheme of microvascular anastomosis in different time courses. Methods A total of 31 neurosurgeons were trained with different training schemes of microvascular anastomosis with ultrashort time course (n = 9;4 h),medium time course (n =12;12 h),and long time course (n = 10,300 h)were selected respectively,including 22 neurosurgeons from the top three hospitals and 9 from other levels of hospitals. Before training,the average median time of working in a department of neurosurgery was 6 (range,0 to 19)years. After training,the trainees accepted the assessments,such as performing the rat common carotid artery end to end anastomosis under a surgical microscope. Their completion time,anastomosis quality score,and proportion of vascular patency after anastomosis were compared. The measurement data of normal distribution used the single factor analysis of variance. The skewed distribution used rank sum test. The comparison of count data used Fisher exact test. Results The trainees who participated in the ultrashort time course training,the time of completion of carotid end - end anastomosis was 78 ± 37 min,the anastomosis quality score was 8. 1 ± 2. 8,and 2 vessels were patent;the trainees who participated in the medium time course training,the anastomosis time was 69 ± 20 min,the anastomosis quality score was 15. 8 ± 6. 8,and 10 vessels were patent;the trainees who participated in the long time course training,the anastomosis time was 34 ± 7 min,the anastomosis quality score was 23. 5 ± 1. 3,and 10 vessels were patent. There were significant differences in the completion of anastomosis time among the 3 groups of trainees (F = 9. 50,P = 0. 001). The completion time of the long time course group was shorter than that of the medium time course group and the ultrashort time course group. There were significant differences. There were significant differences in the anastomosis quality score among the 3 groups (F = 26. 870,P = 0. 000). As for the number of the patent vessels,there were significant differences between the medium and long time course groups and the ultrashort time course group (P < 0. 01 ). Conclusion If the vascular anastomosis skills of the trainees achieve relative proficiency and stability,they need to choose the long time course training.