摘要目的： 介绍我中心阶梯式手术培训模式在后腹腔镜肾根治性切除术教学中的初步探索经验。方法： 根据随机数字表的方式,将2017年1月至2021年12月,在中国人民解放军总医院第三医学中心泌尿外科进修或者攻读研究生学位并接受腹腔镜培训的泌尿外科医师30名,随机分为阶梯式培训组和传统教学组。比较两组学员的基线资料,包括年龄、学历、职称以及既往腹腔镜手术经验。达到研究终点后,比较两组的首例手术资料、手术培训时间和例数、学员评分。结果： 两组学员在年龄、学历、职称和腹腔镜手术经验方面均无明显差异（P>0.05）。通过系统培训,两组共30名成员均 可在导师指导下独立完成后腹腔镜肾根治性切除术。首例患者年龄、性别、肿瘤侧别、肿瘤最大径均无明显差异（P>0.05）。与传统教学组相比,阶梯培训组手术培训时间更短（5.7月vs. 6.8月,P=0.007）,培训例数更少（5.3例vs. 6.5例,P=0.002）,首例手术时间更短（88.1 min vs. 101.3min,P=0.010）,学员评分更高（8.2 vs. 7.0,P=0.014）。两组在首例出血量和并发症方面没有明显差异（P>0.05）。结论： 阶梯式手术培训模式安全可行,教学效果优于传统教学模式,适合在其他培训中心推广应用。
Abstract：Objective： To introduce the preliminary exploration experience in the teaching of retroperitoneal laparoscopic radical nephrectomy in the stepped surgical training mode of our center. Methods： According to the method of random number table, 30 urologists who received laparoscopic training in our department from January 2017 to December 2021 were randomly divided into step training group and traditional teaching group. Baseline data, including age, education, job title, and previous laparoscopic experience, were compared between the two groups. After reaching the end point of the study, the data of the first operation, the time and number of cases of surgical training, and the scores of trainees were compared between the two groups. Results： There were no significant differences between the two groups in age, educational background, professional title and laparoscopic surgery experience （P>0.05）. Through systematic training, a total of 30 members of the two groups were able to independently complete retroperitoneal laparoscopic radical nephrectomy under the guidance of their mentors. There were no significant differences in age, gender, tumor side and tumor maximum diameter in the first case （P>0.05）. Compared with the traditional teaching group, the step training group had shorter operation training time （5.7 months vs.6.8 months, P=0.007）, fewer training cases （5.3 cases vs.6.5 cases, P=0.002）, and shorter first operation time （88.1 min vs.101.3 min, P=0.010）. Students scored higher （8.2 vs.7.0, P=0.014）. There was no significant difference between the two groups in the first case of blood loss and complications （P>0.05）. Conclusion： Step operation training mode is safe and feasible, the teaching effect was better than the traditional teaching mode, and it is suitable for popularization and application in other training centers.
顾良友, 王保军, 马鑫, 李宏召, 张旭. 阶梯式手术培训模式在后腹腔镜肾根治性切除术教学中的应用[J]. 微创泌尿外科杂志, 2022, 11(1): 57-61.
Gu Liangyou, Wang Baojun, Ma Xin, Li Hongzhao, Zhang Xu. Application of stepped-operation training model in the teaching of retroperitoneal laparoscopic radical nephrectomy. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2022, 11(1): 57-61.
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