手术直播演示结合分级腹腔镜模拟器训练法在普外科腹腔镜培训中的研究

目的手术直播演示结合分级腹腔镜模拟器训练法在普外科腹腔镜培训中的应用效果。 方法首都医科大学附属北京中医医院参加住院医师规范化培训基地第1阶段普外科、泌尿外科及妇科专业住院医师和本院纳入第1阶段住院医师规范化培训的普外科、泌尿外科及妇科专业研究生组成,共120名。腹腔镜基本技能培训为期1个月,内容包括3部分：手术直播演示每周2台;理论授课每周2次,每次1 h;模拟训练4周,操作每天4 h,包括（初级模块——基本技能训练;中级模块——简单及高级缝合训练;进阶模块——腹腔镜必要技巧训练;高级模块——模拟手术培训）。随机分为3组,其中试验组采用手术演示＋理论授课＋腹腔镜模拟训练;对照组采用理论授课＋手术演示;空白组采用仅进行理论授课,不参与其他培训,安排下一期参加培训。 结果培训后腹腔镜理论考核成绩试验组为（82.00±6.72）分,对照组为（83.40±6.51）分,空白组（83.20±5.72）分,均较培训前提高,但差异均无统计学意义（P＞0.05）,且3组间培训前后理论成绩差异不显著,差异无统计学意义（P＞0.05）。腹腔镜操作技能考核成绩试验组培训后初级模块——基本技能训练、中级模块——简单及高级缝合训练、进阶模块——腹腔镜必要技巧训练、高级模块——模拟手术培训各项操作技能成绩分别为（86.00±5.98）、（86.00±5.98）、（85.00±5.13）和（82.50±6.38）分,较试验组培训前的（37.00±10.81）、（18.00±7.68）、（16.00±8.21）和（10.50±10.50）分显著提高,差异有统计学意义（P＜0.05）;明显高于对照组（46.00±9.95）、（44.00±9.40）、（39.00±7.18）和（35.00±7.18）分,差异均有统计学意义（P＜0.05）;明显高于空白组（36.00±8.21）、（18.50±6.71）、（16.50±9.44）和（11.00±9.68）分,差异均有统计学意义（P＜0.05）。 结论腹腔镜技能模拟训练能有效提高临床医学生的腹腔镜操作技能。

Study on the combination of live operation demonstration and graded laparoscopic simulator training in general surgery laparoscopic training

ObjectiveTo evaluate the application of live operation demonstration combined with graded laparoscopic simulator training in general surgery. MethodsThe Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University was composed of 120 general surgery, urology and gynecology major residents who participated in the first phase of standardized training base for residents, and 120 general surgery, urology and gynecology major graduate students who were included in the first phase of standardized training for residents. Laparoscopic basic skills training lasts for one month, including three parts: 2 live surgical demonstrations per week; Theoretical teaching is conducted twice a week for 1h each time; Simulated training lasts for 4 weeks, and the operation lasts for 4 hours every day, including (primary module basic skills training; intermediate module simple and advanced suture training; advanced module necessary laparoscopic skills training; advanced module simulated surgery training). They were randomly divided into three groups, in which the experimental group received surgical demonstration+theoretical teaching+laparoscopic simulation training; The control group was given theoretical teaching+surgical demonstration; The blank group only conducts theoretical teaching, does not participate in other trainings, and arranges to participate in the next training. ResultsThe theoretical examination scores of laparoscope after training were (82.00 6.72) points in the test group, (83.40 6.51) points in the control group, and (83.20 5.72) points in the blank group, all of which were higher than those before training, but the differences were not statistically significant (P＞0.05), and there was no significant difference between the three groups before and after training, and the differences were not statistically significant (P＞0.05). Laparoscopic operation skill assessment results After the training of the test group, the scores of each operation skill of the primary module - basic skill training, intermediate module-simple and advanced suture training, advanced module - laparoscopic necessary skill training, advanced module - simulated surgery training were (86.00 5.98), (86.00 5.98), (85.00 5.13) and (82.50 6.38) respectively, which were higher than those of the test group before the training (37.00 10.81), (18.00 7.68) The scores of (16.00 8.21) and (10.50 10.50) were significantly improved, and the difference was statistically significant (P＜0.05); The scores in the control group were significantly higher than those in the control group (46.00 9.95), (44.00 9.40), (39.00 7.18) and (35.00 7.18) (P＜0.05); It was significantly higher than the blank group (36.00 8.21), (18.50 6.71), (16.50 9.44) and (11.00 9.68), and the difference was statistically significant (P＜0.05). ConclusionLaparoscopic skill simulation training can effectively improve the laparoscopic operation skills of clinical medical students.