内镜模拟训练在上消化道内镜培训中的作用研究

Upper gastrointestinal endoscopy training with a computer-based simulator： a randomized controlled trial

目的探讨内镜模拟训练在上消化道内镜教学中的作用。方法2005年1月-2007年3月41名无内镜操作经验的进修医师、研究生、住院医师，随机分为两组。非内镜模拟训练组于内镜中心观摩学习1个月后开始操作内镜，内镜模拟训练组于观摩学习的同时接受10h的内镜模拟训练。由专人对所有受训者最初20例内镜操作进行评价、记录，包括插入食管是否成功、胃内观察是否成功、通过幽门是否成功、进入降段是否成功、总的操作时间。结果插入食管成功率、进入降段成功率两组间差异无统计学意义；胃内观察成功率（P〈0．001）、通过幽门成功率（P〈0．001）、总操作时间（P=0．032），内镜模拟训练组均优于非内镜模拟训练组，两组间差异有统计学意义。结论内镜模拟训练在上消化道内镜教学中有重要作用，有助于受训者迅速掌握内镜操作方法，缩短教学时间，减少患者痛苦。

Objective To explore the role of computer-based simulators in upper gastrointestinal endoscopy training. Methods Forty-one graduate students, residents and GI fellows for further education with no experience in endoscopy were randomly assigned to two groups and underwent one-month training with or without a 10-hour computer-based simulator. Each trainee performed upper endoscopy in 20 patients. Comparison was made between the two groups in terms of these performance parameters： esophageal intubation, retroflexion, pyloric intubation, intubation of the descending part of the duodenum and procedure time. Resuits There was no significant difference in esophageal intubation （P = 0. 699） and intubation of the second part of the duodenum（P =0. 141 ） between two groups. While the differences were significant in retroflexion （ P 〈 0. 001 ）, pyloric intubation（P 〈 0. 001 ） and procedure time （ P = 0. 032 ）, i. e. , the simulator group was much better in performance than the other group. Conclusion The computer-based simulator is effective in providing trainees with the skills needed for upper gastrointestinal endoscopy, shortening the teaching hours and lessening patients＇pain.