两种腹腔镜下膀胱尿道吻合训练模型的比较

Comparison of the efficiency of two kinds of laparoscopic urethrovesical anastomosis training models

目的与鸡皮模型对比，验证利用鸡躯干、泄殖腔和猪大肠构建的新型腹腔镜下膀胱尿道吻合训练模型的训练功效。方法采用鸡的后半部躯干模拟人盆腔，3mm泄殖腔残端模拟人尿道残端，15cm猪结肠段模拟人膀胱或新膀胱。材料置入腹腔镜训练箱中，运用腹腔镜器械进行腹腔镜下膀胱尿道间断性吻合的模拟训练。40名无腹腔镜手术经验的学员随机分为2组。A组20名，采用新模型训练8h；B组20名，采用鸡皮模型训练8h。训练前、后采用动物模型测试学员完成腹腔镜下膀胱尿道吻合的时间和质量。结果与鸡皮模型相比，新型训练模型更好地模拟了人盆腔、尿道残端和膀胱、新膀胱的形态、结构和性状。训练后2组在测试中完成速度[实验组：（64±11）min与（123±20）min，P〈0．05；对照组：（77±12）min与（121±17）min，P〈0．05]和吻合质量（实验组：8．8±1．0与3．8±1．2，P〈0．05；对照组：7．7±0．9与3．7±1．1，P〈0．05）均有较大提高，而训练后实验组学员比对照组所需的完成时间更短（P〈0．05），吻合质量更高（P〈0．05）。结论新型腹腔镜下膀胱尿道吻合训练模型能有效帮助泌尿外科医生掌握腹腔镜下膀胱尿道吻合技术，提高腹腔镜下缝合技巧。

Objective To verify the efficiency of a new laparoscopic urethrovesical anastomosis training model by comparing it with the chicken skin model. Methods Chicken posterior trunks and porcine colons were used to construct the training model. The posterior trunk of a chicken was used to simulate a human pelvis, and a 3-mm cloacal stump was used to simulate a human urethral stump. A 15-cm segment of porcine colon with a 1-cm orifice was used to simulate a human bladder or neobladder. An imitation urethrovesical anastomosis was performed with laparoscopic instruments in a laparoscopic training box. Forty trainees with no laparoscopic experience were randomized into 2 groups. The trainees in group A （n=20） practiced using this new model for 8 h, while those in group B （n= 20） practiced using the chicken skin model for 8 h. The trainees＇ skills were assessed using the porcine model before and after training. Results Compared with the chicken skin model, this new training model more accurately resembled the structure and characteristic of human pelvis, urethral stump, and bladder （neobladder）. After the training sessions, both groups improved in anastomosis time [Group A.. （64±11）min vs. （123＋20）min, P〈0.05; Group B： （77±12）min vs. （121±17） min, P〈0.05] and quality （GroupA： 8.8±1.0 vs. 3. 821.2, P〈0.05; Group B： 7.7±0.9 vs. 3. 721.1, P〈0.05）. Compared with trainees in group B, trainees in group A required less time and achieved a higher quality score （P〈0.05）. Conclusions This new training model can help urologic surgeons to reduce learning curve of this technique and improve their suturing skills. It is an effective, convenient training model for laparoscopic urethrovesical anastomosis.