动物模型在内镜下肠道黏膜剥离术操作培训中的探讨

目的 探讨临床见习联合离体猪肠和活体猪肠道作为进行肠道内镜下黏膜剥离术(ESD)培训的可行性.方法 方案为期6个月的培训学习,共操作30例肠道ESD,平均每周1.25例.分为三个阶段,第一阶段为临床见习阶段,第二阶段为体外操作学习,2人共完成15例;第三阶段为猪体内直肠ESD手术.此培训均在解放军第175医院消化内镜中心完成.此次共有2个医师进行学习操作,用靛胭脂联合生理盐水注射制造黏膜隆起灶,再按照标准ESD手术流程进行操作,术后将标本平整展开在泡沫板上,用大头针固定边缘,计量创面大小同时对实验要求、ESD创面大小、操作时间和速度进行记录.同时利用微格教学法,对培训学员的每次操作进行视频录像.数据分析采用SPSS16.0统计软件.结果 为期6个月的培训学习,共操作30例肠道ESD,前后15例操作速度明显提高.结论 临床见习联合离体猪肠和活体猪肠道模型对进行肠道ESD培训具有较高参考价值.

Discussion on the training of the intestinal ESD operation in the animal models

Objective To discuss the feasibility of using pigs as animal models in the training of intestinal ESD, and evaluate the safety, efficiency and feasibility of the animal model of ESD operation in the intestine of pigs. Methods For about 6 months in training and learning, a total of 30 intestinal ESDs were operated, with an average of 1. 5 cases per week. After the intestinal ESDs, specimens were made flat on a foam board, with pins fixed in the edge of the specimens, measuring the size of the ulcers. There were 2 doctors learning operations, our programs were divided into three periods, the first period for the study was theory learning and the sec-ond period for the study was in ex vitro operation;the second stage of the operation were 15 ESD operation cases learning in pigs;the third stage there were 5 ESD operation cases in pigs. These operations were completed in the 175th hospital of PLA, digestive endosco-py center of Nanjing military area command. At the same time, the experimental requirements, the size of ESD ulcers, operation time, and speed were recorded. Results With 6 months of training and learning, a total of 30 cases of intestinal ESD were completed, the speed of last 15 operations significantly improved than the pervious 15 cases. Conclusion Clinical probation combined with pig in-testinal model in vitro and in vivo was of high reference value to the intestinal ESD training.