消化内镜技术模拟培训的研究现状

近年来,消化内镜技术模拟培训的价值已经被广泛认可,目前已有的内镜模拟培训模型可分为机械模拟模型、活体动物模拟模型、复合动物模拟模型、虚拟现实模拟模型等。为了展现目前各种内镜模拟培训模型的不同及优缺点,本文对已有的消化内镜技术模拟培训研究及应用现状作一综述。     

新时代消化内镜技术培训和内镜医师培养

我国消化内镜技术近年来发展迅速,但内镜医师培训发展相对缓慢,未形成与人民诊疗需求相适应的内镜医师培训体系。美国、日本和英国等发达国家均形成了相对完善的内镜医师培训体系,对我国内镜医师培训工作具有重要借鉴意义。学习国际先进理念,结合我国实际国情,实现内镜医师培训统一报名准入、管理部署、课程学习、考核认证、监督质控,系统性地培养一大批合格、优秀的消化内镜医师,是提升我国新时代消化内镜诊疗水平的必由之路。本文就内镜医师成长轨迹,合格、优秀内镜医师应具备的能力素质和国内外消化内镜医师培训进展作一述评。     

国内外对消化内镜消毒的现状

国内外对消化内镜消毒的现状于中麟随着消化内镜检查的普及，检查病例越来越多，而内镜的消毒问题，能否传播疾病？近年有报告胃镜检查后发生急性胃粘膜病变，已成为国际重视的问题。不论用何种消毒剂消毒都需要一定时间，一个单位又不可能有数台内镜同时使用，因此是国内...     

消化内镜进入新时代

中国的消化内镜发展走过了70余年的历程。我国消化内镜事业逐步在国际消化病学领域占据重要席位,《中华消化杂志》聚焦我国消化内镜发展,关注热点,促进交流,是我国消化内镜飞速发展进入新时代的见证者。随着多学科关键技术的突破和进步,学科之间交叉融合的不断加深,我国消化内镜在智能化、舒适化和微创化领域都取得诸多成绩,学术成就跻身...     

超声内镜对食管癌治疗方式的术前评估价值

目的探讨超声内镜在食管癌的临床诊断上的应用价值以及对各种治疗方式的术前评估作用。方法内镜检查57例食管癌,了解癌肿的影像特征、浸润深度及癌旁淋巴结转移情况,并与术后情况进行比较。结果超声内镜显示肿瘤影像特征为不规则的低回声肿块伴部分或全部管壁结构的破坏,对肿瘤浸润深度诊断总符合率为84．2％（48／57）,对T分期的诊断总符合率为87．7％（50／57）;对N分期的诊断总符合率为84．2％（48／57）。结论超声内镜对食管癌不同治疗方法的选择、手术方式的确定和预后的评估具有重要的参考价值。     

消化内镜机器人的研究进展

机器人在临床医学领域的应用正逐步改变传统的诊疗模式,在消化内镜领域,机器人操作的出现有望在普及内镜检查、完善质控、减轻医师负担等方面发挥重要作用。本文就不同设计类型的消化内镜机器人的研发现状进行介绍。     

消化性溃疡并发症的内镜治疗

消化性溃疡并发症有出血、穿孔、胃输出端梗阻,过去这些并发症常常进行手术治疗,随着治疗内镜的发展,许多并发症病人不需手术即可治愈。1 出血当溃疡基底部动脉受到侵蚀就会发生出血,溃疡出血是最常见的上消化道出血原因,直到不久前仍认为确切的止血措施为外科手术。自从纤维内镜的发展,人们对内镜下止血越来越感兴趣,建立了许多有效的内镜下溃疡止血方法,并对一些方法进行了随机临床对照研究。     

内镜超声对消化道黏膜下肿瘤内镜术前评估的价值和局限性

目的探讨内镜超声检查术（EUS）对消化道黏膜下肿瘤（SMT）层次来源与性质的诊断能力及局限性。方法2016年1月至2018年12月，收治于上海交通大学医学院附属瑞金医院消化科，术前EUS诊断为消化道SMT，接受内镜下切除术治疗，术后病理资料完整的211例病例纳入回顾性研究，以手术病理为参照，分析术前EUS诊断SMT的准确率以及EUS对SMT的诊断局限性。结果病灶位于食管66例、胃108例、十二指肠2例、直肠35例。EUS对病变层次来源的诊断准确率达99.5%（210/211）。就病变性质而言，160例EUS诊断准确（75.8%，160/211）。就不同部位的病变而言，EUS对食管黏膜-黏膜下层来源、食管固有肌层来源、胃黏膜-黏膜下层来源、胃固有肌层来源、十二指肠黏膜下层来源、直肠黏膜-黏膜下层来源病变的诊断准确率分别为90.0%（54/60）、83.3%（5/6）、31.0%（13/42）、89.4%（59/66）、50.0%（1/2）、82.9%（29/35）。对于EUS显示为低回声为主的病变，平滑肌瘤、平滑肌瘤/胃肠间质瘤、神经内分泌肿瘤分别是食管黏膜来源、消化道固有肌层来源和直肠黏膜-黏膜下层来源病变的较常见肿瘤类型。结论尽管EUS对消化道SMT的诊断具有不可替代的重要作用，但其对胃黏膜-黏膜下层来源的各类病变缺乏特异的鉴别手段。由于其中部分病变可能存在恶性潜能，因此在作出诊断时需要更加谨慎。     

电解酸性水对消化内镜消毒的效果

目的探讨电解酸性水消毒法对消化内镜消毒中的消毒效果和应用价值.方法行内镜检查的患者130例,拔镜后立即在距内镜先端10 cm处,1.0 cm范围内用无菌棉签擦试镜身一圈,同时在活检孔道注入生理盐水2 mL,在内镜头端应用无菌试管接收活检孔道流出的液体,混合后即刻放培养基中分别进行培养.52例作常规细菌培养,68例作幽门螺杆菌培养,观察细菌生长情况.然后将内镜置入电解酸性水洗消机Clean TOP WM-1消毒槽消毒7min.再同法取样进行细菌培养.对体外已培养的各种细菌进行了定量灭菌实验.10例内镜检查前发现HBsAg阳性的受检者,消毒前后取样,分别行PCR方法进行HBV-DNA的检测结果 52例消毒前36例有细菌生长,消毒后36阳性者细菌培养全部阴性68例中消毒前39例幽门螺杆菌的尿素酶试验和幽门螺杆菌培养均阳性,消毒后39例细菌培养全部变为阴性.对体外培养的各种细菌灭菌后再培养全部阴性10例HBsAg(+)受检者,消毒前6例HBV DNA阳性,经电解酸性水消毒7min后,6例阳性者皆为阴性.结论电解酸性水对各种细菌和肝炎病毒具有很强的杀灭效果,是一种高效的内镜消毒新方法.     

迎接新世纪消化内镜学科的发展

自７０年代我国引进光纤内镜以来 ,在消化领域中已成为最活跃和发展极快的一门学科。我国１９８４年创刊了《内镜》综合性刊物 ,随着学科不断发展和要求 ,１９９１年２月成立了中华消化内镜学会 ,１９９６年８月《内镜》杂志更名为《中华消化内镜杂志》 ,她已成为从事消化内镜专业医师的良师益友 ,相信今后必将成为推动我国消化内镜学术水平不断发展的重要刊物。展望新世纪 ,发展我国的消化内镜事业是十分必要的。⒈光纤内镜会进一步被电子内镜所取代。电子内镜优越性在于操作医生省力 ,可防止颈椎病的发生 ,图像真实而清晰 ,放大率高 ,有利…     

Interactive virtual assembling in augmented reality

In this paper, a computer-aided methodology based on augmented reality to manipulate and interactively assemble virtual objects is presented. The developed system, based on both hardware and software implementation, allows the user to be immersed in an augmented scene (real world and virtual objects) by means of an head-mounted display and interact with the virtual components using a glove with sensors. The author presents the implementation of the system facing the problems concerning the interpretation of user’s intent to grasp and move the objects and the computer-aided assembly based on a novel approach concerning active features dynamic recognition. An example of implementation is herein reported and discussed.     

Role of virtual reality simulation in endoscopy training

Recent advancements in virtual reality graphics and models have allowed virtual reality simulators to be incorporated into a variety of endoscopic training programmes. Use of virtual reality simulators in training programmes is thought to improve skill acquisition amongst trainees which is reflected in improved patient comfort and safety. Several studies have already been carried out to ascertain the impact that usage of virtual reality simulators may have upon trainee learning curves and how this may translate to patient comfort. This article reviews the available literature in this area of medical education which is particularly relevant to all parties involved in endoscopy training and curriculum development. Assessment of the available evidence for an optimal exposure time with virtual reality simula-tors and the long-term benefits of their use are also discussed.     

表象训练在虚拟现实内镜模拟器培训胃镜初学者中的应用

目的:探讨表象训练在胃镜技能获得中的作用.方法:分层抽样法抽取我校08级临床医学专业男学员30人,随机分为3组.A组(n=10)在常规模拟器练习过程中加入表象训练,B组(n=10)进行常规模拟器练习,C组(n=10)不做任何练习.完成培训结束时所有学员操作病例1,模拟器给出的评分,比较3组间的考核评分.所有学员接受培训前、后心理测评,评价心理状态是否稳定.结果:比较3组考核成绩显示,3组间总分差异有统计学意义,3组组间两两比较显示差异有统计学意义,其中A组优于B组,A组优于C组,B组优于C组.进一步分析差异原因,结果表明,安全性评分和准确性评分、残气量评分、患者痛苦指数评分、操作时间评分A、B、C3组间差异均有统计学意义;而A、B组两组之间比较,只有残气量评分、操作时间评分差异有统计学意义.结论:表象训练可提高使用虚拟现实内镜模拟器培训胃镜技能的效果,教学方法容易实施,学员容易掌握,是一种可行性较高的教学辅助方法.     

虚拟现实技术应用于脑卒中康复治疗的研究现状及进展

虚拟现实技术自20世纪80年代问世至今,已融入经济、教育、娱乐甚至军事等各个领域,为用户提供各种逼真体验。虚拟现实可以为操作者提供身临其境的沉浸感,在反复场景交互中,使操作者强化互动中所带来的感官刺激及场景中功能的学习。在近年各种疾病的临床康复治疗中,虚拟现实凭借以上优势,日益得到重视并已广泛应用于运动、平衡及认知等康复治疗中。脑卒中后肢体运动功能康复一直是康复领域的难点及热点,本文对比传统康复手段,综述了虚拟现实技术对脑卒中患者康复的优势、特点和不足,并展望虚拟现实技术对促进脑卒中患者康复的前景。     

仿真外科训练系统在微创外科的应用

目的 通过比较计算机模拟仿真训练和传统训练模型的训练效果，对模拟仿真训练的有效性和可行性进行评价。方法 17名低年外科医生和24名医学生被随机分成4组，分别受到计算机模拟仿真训练或传统训练模型的训练1h。在接受训练后，他们将在传统训练模型中接受连续缝合测试30min，根据完成缝合的数量和准确性来评价被测试者的能力。结果 无论接受何种训练，低年外科医生的测试结果都优于医学生，尤其在缝合速度方面，无论低年外科医生还是医学生，接受计算机模拟仿真训练的测试结果优于传统训练。结论 计算机模拟仿真训练将可能在腹腔镜外科训练中发挥重要作用。     

Augmented reality (AR) and virtual reality (VR) applied in dentistry

The OSCE is a reliable evaluation method to estimate the preclinical examination of dental students. The most ideal assessment for OSCE is used the augmented reality simulator to evaluate. This literature review investigated a recently developed in virtual reality (VR) and augmented reality (AR) starting of the dental history to the progress of the dental skill. As result of the lacking of technology, it needs to depend on other device increasing the success rate and decreasing the risk of the surgery. The development of tracking unit changed the surgical and educational way. Clinical surgery is based on mature education. VR and AR simultaneously affected the skill of the training lesson and navigation system. Widely, the VR and AR not only applied in the dental training lesson and surgery, but also improved all field in our life.     

Virtual reality simulators for gastrointestinal endoscopy training

The use of simulators as educational tools for medical procedures is spreading rapidly and many efforts have been made for their implementation in gastrointestinal endoscopy training. Endoscopy simulation training has been suggested for ascertaining patient safety while positively influencing the trainees' learning curve. Virtual simulators are the most promising tool among all available types of simulators. These integrated modalities offer a human-like endoscopy experience by combining virtual images of the gastrointestinal tract and haptic realism with using a customized endoscope. From their first steps in the 1980s until today, research involving virtual endoscopic simulators can be divided in two categories: investigation of the impact of virtual simulator training in acquiring endoscopy skills and measuring competence. Emphasis should also be given to the financial impact of their implementation in endoscopy, including the cost of these state-of-theart simulators and the potential economic benefits from their usage. Advances in technology will contribute to the upgrade of existing models and the development of new ones; while further research should be carried out to discover new fields of application.     

VirDe: a new virtual reality design approach

Virtual reality (VR), even if it does not represent any more a novel technology, is one of the most powerful tool to help designers during the development of new projects. This is proved by very numerous research activities related to this field. In this research, we have studied a new way to approach the development of a product. We present the ongoing development of a system, called VirDe, acronym of virtual design, which can allow the designers to perform the whole design process, from the modelling phase to the finite element method (FEM) simulation analysis, in a virtual reality environment. This new method allows remarkable time and money saving in the overall product design process, but the most important contribution of VirDe is that, as far as we concerned, there is no known similar approach which has been studying the simultaneous combination of CAD, FEM and virtual environment (VE).     

Virtual reality simulators for gastrointestinal endoscopy training简

The use of simulators as educational tools for medical procedures is spreading rapidly and many efforts have been made for their implementation in gastrointestinal endoscopy training. Endoscopy simulation training has been suggested for ascertaining patient safety while positively influencing the trainees’ learning curve. Virtual simulators are the most promising tool among all available types of simulators. These integrated modalities offer a human-like endoscopy experience by combining virtual images of the gastrointestinal tract and haptic realism with using a customized endoscope. From their first steps in the 1980s until today, research involving virtual endoscopic simulators can be divided in two categories: investigation of the impact of virtual simulator training in acquiring endoscopy skills and measuring competence. Emphasis should also be given to the financial impact of their implementation in endoscopy, including the cost of these state-of-the-art simulators and the potential economic benefits from their usage. Advances in technology will contribute to the upgrade of existing models and the development of new ones; while further research should be carried out to discover new fields of application.