家猪模型中胆胰管循序插管培训在ERCP教学中的应用价值研究

The sequential ERCP training of bile duct and pancreatic duct cannulation in the pig model

目的探讨家猪模型中胆胰管循序插管培训在ERCP教学中的应用价值。方法5名学员先接受胆管插管培训，培训次数在5～10次不等，由ERCP操作专家评估培训结果，评估结果合格后进人胰管插管阶段的培训。所有培训结果，由操作专家采用3分法进行评价，1分为较差，2分为尚可，3分为优秀，评价内容包括成功插镜至十二指肠乳头平面并取直镜身的时间、培训前后单个患者的总操作时间、操作技巧评分，培训结束后收集学员的反馈信息。结果5名学员均成功完成胆胰管循序插管培训。培训前平均插镜时间为（5．2±1．5）min，培训后明显缩短为（2．5±0．7）rain（P〈0．05）；培训前平均操作技巧为（1．3±0．5）分，培训后增加为（2．7±0．5）分，操作技巧较培训前有了显著提高（P〈O．05）。培训结束后学员对教学的印象深刻，认为教学的实践操作性较强，通过反复地模拟训练，克服了恐慌心理，增加了今后临床操作时的信心，同时更加深入地了解了操作流程，提高了临床操作技能。结论胆胰管循序插管培训方法，可在不增加培训成本的前提下，先后完成胆胰管的插管培训，增加了操作次数和操作难度，可以取得较好的培训效果。

Objective To explore a new approach of sequential cannulation in bile duct and pancreatic duct in the pig model for ERCP training. Methods A group of 5 trainees received 5 to 10 sessions of training of bile duct cannulation first, the results were evaluated by ERCP experts. When the trainees passed the assessment, they received next phase of training of pancreatic duct cannulation. A ＂3 scores system＂ was used to evaluate the level of operation before and after the training conducted by experts. Results All participants successfully completed the sequential cannulation training. Compared with the operation level before training, the insertion time of ERCP after training was shortened （ 5.2 ± 1.5 min vs. 2. 5 ± 0. 7 min, P 〈 O. 05 ）, and the operating skills were also improved significantly （ 1.3 ± 0. 5 vs. 2. 7 ± 0. 5, P 〈 0. 05 ）. The training project was accepted very well by all participants. Conclusion The sequential cannulation in bile duct and pancreatic duct in pig model is of good cost-effectiveness and can get better training results under the premise of increasing the operating frequency and operating difficulties.