活体猪模型在超级微创内镜隧道法黏膜下剥离手术培训中的应用

目的对活体猪模型在超级微创内镜隧道法黏膜下剥离手术(ESTD)培训进行初步的探讨。 方法对消化内镜培训者进行为期3个月的隧道法黏膜下剥离术的动物培训，共操作活猪8头，分别建立超级微创内镜黏膜下剥离术(ESD)和ESTD动物训练模型。训练者进行手术理论学习，在高年资医师的指导下进行ESTD术和ESD术，记录ESD和ESTD的总体操作时间，隧道长度，创面面积大小，操作速度(创面面积/时间)。使用调查问卷检测学员培训前后的能力变化。数据使用SPSS.23统计软件进行分析。 结果ESD和ESTD手术解剖模型在手术训练中，未出现不可处理的术中大出血和术后延迟性出血。ESTD模型出现食管小穿孔2例，均使用软组织夹进行封闭处理，2种手术模型均无延迟穿孔。分别有1例ESTD和3例的ESD未完成而需要高级医师接手，未出现动物死亡的情况。 结论活体猪模型用于内镜隧道法黏膜下剥离手术培训安全且可行，相对于传统ESD手术在黏膜下剥离的培训过程更有优势。

Establishment of an in-vivo porcine model in surgical training of super minimally invasive endoscopic tunneling submucosal dissection

ObjectiveThis study aim to established an in-vivo porcine model for the training of super minimally invasive endoscopic dissection (ESTD). MethodsThe trainees were trained for 3 months, and a total of 8 live pigs were operated. Super minimally invasive endoscopic submucosal dissection (ESD) and ESTD animal training models were established. The trainees studied the surgical theory, performed ESTD and ESD under the guidance of senior doctors. We recorded the overall operation time, tunnel length, wound area size, and operation speed (wound area/ time). A questionnaire was used to detect changes in competence before and after training. Data were analyzed using the SPSS.23 statistical software. ResultsThe ESD and ESTD surgical anatomy models showed no ununtreated intraoperative major bleeding and delayed postoperative bleeding during surgical training. Two cases of small esophageal perforation appeared in ESTD models, all were closed with soft tissue clips. None of the surgical models had delayed perforation. There ESD cases and one ESTD case were unfinished and senior doctors needed to take over, and no animal died. ConclusionThe in-vivo porcine model is effective and feasible for endoscopic tunneling and submucosal dissection surgery training, which is beneficial to improve the endoscopic learning curve of trainees.