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目的应用猪肾构建简便的培训模型,使受训者能够在模拟肾脏具有持续血供的环境下行腹腔镜下肾部分切除术(LPN),掌握手术过程中的技术要点。方法将新鲜的保留肾门的离体猪肾放置在打开的金属盒上,用红色的液体行肾动脉灌注以模拟肾脏的血供。特殊设计的金属盒放置猪肾的同时还能储存经肾动脉人工灌注后流出的灌注液。受训者被要求在猪肾上切除直径约2 cm的球形肾脏组织,并缝合肾盂、肾实质。参与培训的受训者对腹腔镜手术的操作能力基本相当,且均已完成腹腔镜“干实验室”培训计划。在20 d的培训期内,记录受训者完成LPN所用的时间,并由培训指导员全程监督手术过程和手术质量。结果培训结束后,平均手术总时间由(46.1±1.6)min降低至(27.9±1.8)min(P<0.001),第4次培训后手术总时间开始有明显的缩短;肾脏部分切除后肾盂、肾实质缝合时间从(30.4±1.8)min下降至(19.4±1.2)min(P<0.001)。受试者手术质量评分从开始的(2.02±0.19)分上升至结束时的(4.41±0.14)分(P<0.001),其中前5次培训的质量评分上升趋势较明显。所有受训者在10次培训结束后对完成高质量的LPN充满信心。结论应用易于获得的离体猪肾构建简便、经济的培训模型,通过培训,可使受训者获得完成LPN所需的手术技巧。
Objective To construct a simple training model with porcine kidney so that trainees can perform laparoscopic partial nephrectomy (LPN) in a simulated environment with continuous blood supply of the kidneys and master the technical points during the operation. Methods Fresh kidney piglets were placed in open metal kidney on the open metal box, with a red liquid renal artery perfusion to simulate the blood supply to the kidneys. Specially designed metal box placed pig kidney can also be stored after artificial renal perfusion fluid perfusion. The trainee was asked to remove a spherical kidney tissue approximately 2 cm in diameter from the kidney and suture the renal pelvis and renal parenchyma. Trainees who participated in the training had basically the same operating ability for laparoscopic surgery and had completed the laparoscopic “dry laboratory” training program. During the 20-day training period, the time taken for the trainee to complete the LPN was recorded and the trainer inspected the entire surgical procedure and the quality of the operation. Results After the end of training, the average operation time decreased from (46.1 ± 1.6) min to (27.9 ± 1.8) min (P <0.001), and the total time of the first training after the fourth training was significantly shortened. The renal pelvis, Renal parenchymal suture time decreased from (30.4 ± 1.8) min to (19.4 ± 1.2) min (P <0.001). The score of the operation quality of the subjects increased from the beginning of (2.02 ± 0.19) to the end of (4.41 ± 0.14) points (P <0.001), of which the quality scores of the first five trainings increased more obviously. All trainees have confidence in completing high quality LPN after 10 training sessions. Conclusion The use of readily available ex vivo porcine kidney constructs a simple and cost-effective training model that enables trainees to acquire the surgical skills needed to perform LPN.