三维可视化技术在肝胆外科临床解剖教学中的应用研究

目的：探讨三维可视化技术在肝胆外科临床解剖教学中的应用价值。方法：选取30名就读于复旦大学附属中山医院外科学专业研究生，分别完成传统教学方法和三维可视化教学方法。传统教学方法基于外科学教材、肝脏解剖图谱、肝脏增强CT图像和手术录像，三维可视化教学基于增强CT的肝脏三维可视化模型和手术录像。每种教学方法结束后，受培训学生分别完成对应的评估量表，包括受培训者主观评价、肝脏脉管解剖、肝段解剖和模拟手术规划4个方面评估内容。结果：三维可视化教学方法下的受培训学生主观评价得分显著高于传统二维影像教学方法得分[（33.3±5.4）分vs（22.0±9.2）分，P<0.001]。三维可视化教学下的学生在掌握肝脏基本脉管解剖得分[（30.5±6.3）分vs（19.8±9.2）分，P<0.001]、肝脏空间脉管解剖得分[（15.9±2.5）分vs（10.0±4.6）分，P<0.001]和模拟手术规划得分[（16.1±2.7）分vs（11.4±4.5）分，P<0.001]的得分能力上均优于传统教学方法；而2种教学方法下受培训学生对于掌握肝段解剖得分能力方面则差异无统计学意义[（16.7±9.3）分vs（15.7±9.9）分]。结论：基于三维可视化技术的临床教学在临床医学生中有较高的接受度，其教学效果总体上优于传统教学方法，可有效提高教学质量和效率，值得推广应用。

The study of application value of three-dimensional visualization technique in clinical anatomy teaching of hepatobiliary surgery

Objective: To explore the application value of three-dimensional visualization technique in clinical anatomical teaching of hepatobiliary surgery.Methods: A total of 30 senior postgraduate students majoring in surgery from Zhongshan Hospital, Fudan University were selected and accepted traditional teaching (n=30) or three-dimensional visualization teaching (n=30), respectively. Traditional teaching was mainly based on surgery textbook, liver anatomical atlas, enhanced liver CT images and corresponding videos of surgical procedures while three-dimensional visualization teaching was mainly based on three-dimensional visualization evaluation images based on enhanced CT data and videos of surgical procedures. Trained students successively accomplished evaluation scales which include trainee subjective assessment, liver vasculature anatomy, liver segmentation and virtual liver surgery planning after each teaching method training.Results: Grades of trainees in subjective assessment (33.3±5.4 vs 22.0±9.2, P<0.001), mastery in liver basic vasculature anatomy (30.5±6.3 vs 19.8±9.2, P<0.001), liver spatial vasculature anatomy (15.9±2.5 vs 10.0±4.6, P<0.001) and virtual liver surgery planning (16.1±2.7 vs 11.4±4.5, P<0.001) under three-dimensional visualization training were significantly higher than those under conventional training, while grades on mastery of liver segmentation anatomy were similar between two methods without significant difference (16.7±9.3 vs 15.7±9.9, P=0.64).Conclusion: Clinical teaching based on three-dimensional visualization technique could be well accepted by clinical medical students, its overall teaching efficacy was superior to conventional teaching method with higher teaching quality and efficiency and thus it is recommended for further application.