一种新型的经皮肾镜手术离体动物模型

目的 介绍一种新型的X线和B超定位下经皮肾镜手术(PCNL)培训的离体动物模型.方法 模型由带有输尿管的新鲜成年猪肾、2根肋骨的全层胸壁、2根长钉和1块木板组成.输尿管预置导管后,胸壁对折包裹猪肾,2根肋骨覆盖肾上极,用长钉将模型固定在木板上.可以切开肾盂预置石子以训练碎石操作.X线定位:经输尿管导管注入造影剂,逆行肾盂造影显示肾集合系统,确定目标肾盏后,C-臂探头向术者方向旋转30°,使穿刺针、目标肾盏长轴和C-臂长轴在同一平面上,穿刺针头和针尾呈牛眼征.穿刺针确定方向后,C-臂调整到垂直位,观察穿刺深度并按原方向穿人目标肾盏.B超定位:经输尿管导管注入生理盐水制造人工肾积水,B超引导下确定目标肾盏.穿刺完成后,进行扩张、碎石等训练.训练结束后,解剖猪肾,对穿刺针和扩张效果进行检测.结果 126名泌尿外科医生接受培训,其中104名(82.5 %)成功完成模型的经皮肾镜的穿刺、扩张、碎石等操作,114名(90.5%)医生认为该模型对临床手术有帮助或非常有帮助.结论 该模型可以较好地模拟临床PCNL操作过程,为初学者提供一个轻松的学习环境,可反复检查操作训练,为临床手术积累经验.

Abstract：

Objective To lessen the learning curve of percutaneous renal lithotripsy(PCNL),we introduced a novel ex-vivo learning and training model for PCNL under fluoroscopy and ultrasonography-guided access. Methods The model was set up nailing an adult porcine kidney with＞3 cm ureter (freshly removed from the slaughtering factory),with a full thickness flap of the thoracic wall or abdomen wall with two ribs,to a board.The porcine kidney was placed within the flap with the catheterized ureter outside.The kidney was enclosed by the flap so as to create a roodel for percutaneous renal surgery;with the ribs overlying the upper portion of the kidney.The model was fixed to the board by two nails.Artificial stone material was implanted in the renal pelvis.Fluoroscopy guidance access:Retrograde pyelography via injection of contrast medium into the ureteral catheter images the collecting system. After the long axis of the target calyx is identified,the C-arm is rotated 30 degrees toward the surgeon,placing the C-arm axis in the same posterior plane of the kidney.The needle is advanced in the plane of the fluoroscopic beam,and the appropriate needle placement is determined by obtaining a bull's-eye sign on the fluoroscope screen. Rotating the C-arm to a vertical position monitors the depth of the needle penetration. Ultrasonography guidance access:The renal pelvis can he filled with normal saline through a catheter to simulate hydronephrosis and the target calyx is identified under ultrasonography guidance.The tract dilation and stone disintegration were followed.After training,the kidney can be opened to examine the target calyx and the complication of dilation. Results Altogether,126 urologists attended a urologic endoscopic technique training course.Of the 126 trainees,104 (82.5%) successfully performed the whole percutaneous procedure.At the end of training,114 (90.5 %) of the 126 attendees rated the porcine kidney model for simulation of percutaneous renal surgery as very helpful or helpful.Conclusions This biological training model simulates realistically the clinical procedure of PCNL with respect to trainee experience in a low stress environment that provides an opportunity for repetitive performances in order to learn basic technical skills for the clinical procedure of PCNL in the future.

A novel ex vivo model For percutaneous renal surgery

Objective To lessen the learning curve of percutaneous renal lithotripsy(PCNL),we introduced a novel ex-vivo learning and training model for PCNL under fluoroscopy and ultrasonography-guided access. Methods The model was set up nailing an adult porcine kidney with＞3 cm ureter (freshly removed from the slaughtering factory),with a full thickness flap of the thoracic wall or abdomen wall with two ribs,to a board.The porcine kidney was placed within the flap with the catheterized ureter outside.The kidney was enclosed by the flap so as to create a roodel for percutaneous renal surgery;with the ribs overlying the upper portion of the kidney.The model was fixed to the board by two nails.Artificial stone material was implanted in the renal pelvis.Fluoroscopy guidance access:Retrograde pyelography via injection of contrast medium into the ureteral catheter images the collecting system. After the long axis of the target calyx is identified,the C-arm is rotated 30 degrees toward the surgeon,placing the C-arm axis in the same posterior plane of the kidney.The needle is advanced in the plane of the fluoroscopic beam,and the appropriate needle placement is determined by obtaining a bull's-eye sign on the fluoroscope screen. Rotating the C-arm to a vertical position monitors the depth of the needle penetration. Ultrasonography guidance access:The renal pelvis can he filled with normal saline through a catheter to simulate hydronephrosis and the target calyx is identified under ultrasonography guidance.The tract dilation and stone disintegration were followed.After training,the kidney can be opened to examine the target calyx and the complication of dilation. Results Altogether,126 urologists attended a urologic endoscopic technique training course.Of the 126 trainees,104 (82.5%) successfully performed the whole percutaneous procedure.At the end of training,114 (90.5 %) of the 126 attendees rated the porcine kidney model for simulation of percutaneous renal surgery as very helpful or helpful.Conclusions This biological training model simulates realistically the clinical procedure of PCNL with respect to trainee experience in a low stress environment that provides an opportunity for repetitive performances in order to learn basic technical skills for the clinical procedure of PCNL in the future.