摘要
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300h；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120h；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SPSS12．0软件进行数据处理，计数、计量资料分别采用χ^2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〉O．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。
Objective To develop a staged laparoscopic training program for performing the anatomic retroperitoneoscopic adrenalectomy（ARA）, and to determine its safety and feasibility. Methods Five young urological doctors without previous experience in open adrenalectomy were selected to receive three staged laparoscopic training, including ① training soybean transferring, cutting and suturing in box-trainer, total 300 h; ② training real anatomic dissection, hemostasis, endoscopic suturing and knotting in animal （pig）-model, total 120 h; ③the mentor-initiated clinical training. During 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 supervision. 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. Preoperative 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 χ^2 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 considered 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 successfully. 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 E132 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 difference between the trainees and their tutor （8.0% versus 13.30/00, P〉0.05）, intraoperative minor complication rates of the trainees （1.3 % ） was less than that of the tutor （10.0 %, P〈0.05）. Conelusion The staged laparoscopic training is safe and feasible for young urological doctor to study in performing ARA.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2009年第5期293-296,共4页
Chinese Journal of Urology
基金
基金项目：国家杰出青年科学基金资助项目（30725040）
