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目的采用录像分析法自身对照展示后腹腔镜肾癌根治术的手术技巧及难点,以利于缩短初学者腹腔镜手术的学习曲线。方法以我院泌尿外科某医生2002年1月1日至2006年12月31日开展的147例(肿瘤分期均为T1N0M0)腹腔镜肾癌根治术手术录像为分析材料,将其前30例与后30例手术录像进行自身对比研究,观察不同操作水平下的手术情况,比较两组患者手术时间、出血量、中转开腹频次等指标,总结初学者手术难点及应对技巧。结果两组手术患者基线资料无统计学差异。前组手术患者平均手术时间、出血量、中转开放频次、增加Trocar的例数明显多于后组患者,差异具有统计学意义(P均<0.01)。录像分析结果表明,初学者在行后腹腔镜肾癌根治术时存在解剖识别能力不足、显露及分离组织不够彻底、腹腔镜操作基本技巧不够熟练等缺点,应及时予以锻炼提高。结论采用录像分析法自身对照比较某医生后腹腔镜肾癌根治术初学阶段及熟练阶段的手术经过,可以很好展示该手术的难点、要点,加深初学者对手术方法及操作技巧的理解,缩短学习时间,值得推广采用。
Objective To analyze the surgical techniques and difficulties of postoperative laparoscopic radical nephrectomy by video analysis, in order to shorten the learning curve of laparoscopic surgery for beginners. Methods A total of 147 cases (T1N0M0) of laparoscopic radical nephrectomy performed by a doctor from Urology Department of our hospital from January 1, 2002 to December 31, 2006 were selected as the analysis materials. The first 30 cases After 30 cases of surgery video comparison of their own to observe the operation under different operating conditions, the two groups were compared operation time, blood loss, frequency of transit laparotomy and other indicators, summarize the difficulty and skills of beginners surgery. Results The baseline data of two groups of patients had no statistical difference. The mean operative time, bleeding volume, frequency of transfer to open surgery in the former group of patients were significantly higher than those in the latter group (P all <0.01). Video analysis showed that beginners lagoscopic radical nephrectomy there is inadequate anatomical identification, revealing and separation of tissue is not enough, laparoscopic basic skills are not enough skilled shortcomings, should be timely exercise to improve. Conclusion Compared with the self-control of video-assisted analysis in a laparoscopic radical nephrectomy of laparoscopic radical nephrectomy, we can show the difficulty and key points of this operation well, and improve the comprehension and shortening of beginner’s operation method and skill. Learning time, it is worth promoting promotion.