应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

Videomimicography in displaying skills of retroperitoneal laparoscopic radical nephrectomy in a self control manner

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 use videomimicography to display the skills of retroperitoneal laparoscopic radical nephrectomy in a self control manner,so as to help the beginners to learn the skills quickly.Methods The videos of 147 cases of retroperitoneal laparoscopic radical nephrectomy for renal-cell carcinomas （T1 N0 M0）,which were performed by a surgeon in our department from Jan.1,2002 to Dec.31,2006,were retrospectively analyzed.The first 30 cases were compared with the last 30 cases in terms of operative manipulation,outcomes,problems in operation,and complications after operation.The difficulties in learning retroperitoneal laparoscopic radical nephrectomy from videos were discussed.Results There were no differences between the two patient groups in age,gender,the location or size of the tumors.The bleeding volumes,operation time,frequencies of transferring to open surgery,and addition of Trocar in the first 30 patients were significantly more than those in the last 30 patients （all P 0.01）.Results of videomimicography demonstrated that the beginners had a poor anatomic knowledge,the exposure and tissue isolation were not enough,and they had a poor basic skill in manipulating laparoscope.Conclusion Videomimicography can better display the difficulties in retroperitoneal laparoscopic radical nephrectomy in a self control manner,which can help the beginner to understand the operating skills;the method is worth popularizing.