兔在泌尿外科腹腔镜手术基本技能培训中的应用

摘要

目的：探讨兔在泌尿外科腹腔镜手术基本技能培训中的应用价值。方法建立兔腹腔镜肾切除、输尿管吻合及肾盂输尿管成形术的动物模型；在自制模拟训练箱内，对8名无实际腹腔镜手术操作经验的临床医师分别进行10次此3种术式的模拟训练，记录每人每次手术操作完成时间，观察学习曲线和训练效果。结果8名医师均顺利完成培训，腹腔镜下肾切除手术时间从首次（45．75±6．88）min降至第6次、末次的（30．75±4．53） min、（25．86±3．31）min；腹腔镜下输尿管吻合手术时间从首次（56．75±7．13）min降至第8次、末次的（43．00±4．34） min、（35．50±4．04）min；腹腔镜下肾盂输尿管成形手术时间从首次（77．38±5．34）min降至末次的（59．13±7．26） min ，差异均有统计学意义（P＜0．05）。并且训练后期，总体上参与者缝合时出现重缝、撕裂组织的概率明显下降，控制的针距和边距也更精确，完成的质量和外观上都有明显的改善。结论兔可以便利地用来建立腹腔镜肾切除、输尿管吻合及肾盂输尿管成形手术训练的动物模型；适合于临床医师进行泌尿外科腹腔镜手术基本技能操作培训。%Objective To evaluate the application value of the rabbit for training the basic skills of urologic laparoscopic surgery . Methods The rabbit models of laparoscopic nephrectomy ,ureteral anastomosis and pyeloureteroplasty were established ;in the self-made simulation training box ,8 clinical doctors without the actual operating experience of laparoscopic surgery participated in 10 rounds of simulation training by taking the 3 operation models .The operation completion time for each time was recorded .The learning curves and the training effects were observed .Results 8 doctors were successfully completed training .The operative time of laparoscopic nephrectomy was declined from (45 .75 ± 6 .88)min at the first time to (30 .75 ± 4 .53)min at the sixth time and (25 .86 ± 3 .31)min at the final time ;the operative time of laparoscopic ureteral anastomosis from (56 .75 ± 7 .13)min at the first time to(43 .00 ± 4 .34)min at the eighth time and(35 .50 ± 4 .04)min at the final time ;the operative time of laparoscopic pyeloureteroplas-tyfrom(77.38±5.34)minatthefirsttimeto(59.13±7.26)minatthefinaltime;thedifferenceswerestatisticallysignificant(P<0 .05) .Furthermore ,the probability of repeated sewing and tearing tissue were significantly decreased on the whole .The controlled stitch length and edge length also were more accurate .The quality and appearance of the complete operation were significantly im-proved .Conclusion Rabbit can be conveniently used to set up the animal models for training laparoscopic nephrectomy ,ureteral an-astomosis and pyeloureteroplasty ,which is suitable for clinical urologic doctors to train the basic operating skills of laparoscopic sur-gery .