泌尿模拟机在经皮肾穿刺教学中的应用

Application of Computer Virtual Simulation on Percutaneous Nephrolithotomy Teaching

目的:通过模拟机对泌尿外科不同阶段的医师在经皮肾穿刺实际操作前培训,探索临床医师教育中应用模拟机培训的效果。方法:通过对经皮肾穿刺无经验的泌尿外科专科医师89人、外科轮转住院医师及研究生共27人,临床医学本科实习学生共38人在URO Mentor泌尿模拟机上进行X线引导经皮肾穿刺训练,记录培训开始时分别成功穿刺进入指定两个肾盏所需总时间及在X线曝光时间,并根据泌尿模拟系统评价进行完成度的评估,进行充分训练之后,再次考核。结果:培训前后X线引导经皮肾穿刺成功率有所提高(P<0.05),穿刺成功用时及在X线曝光时间显著减少(P<0.05)。比较三组学员培训成绩,有泌尿外科工作经验的专科学员,培训前穿刺成功率及X线曝光时间较后两组好(P<0.05),而轮转医师与实习医学生培训前成绩则无显著性差异(P>0.05);培训后前两组成绩无显著性差异(P>0.05),但比实习医学生组均有显著性差异(P<0.05)。结论:使用泌尿模拟机对无经皮肾穿刺经验的泌尿外科专科医师、外科轮转住院医师及研究生,训练X线引导下经皮肾穿刺技术,能明显帮助学员认识穿刺路径周围的解剖结构、操作手感及步骤,在术中观察实时荧光图像,有利于医师更快的掌握该技术,对有临床经验学员进行培训更为适宜。

Objective：To study the effect of using computer virtual reality simulation for percutaneous renal puncture training.Methods：According to the clinical experience,trainees were divided into 3 groups.89 urologists without experience of percutaneous renal puncture,27 surgical residents and masters,38 clinical students accepted the training with virtual reality simulation.Results：In 3 groups,there were significant differences in success rate of percutaneous renal puncture with virtual reality simulation after training（P〈0.05）.We compared 3 groups’ scores.Before training,the scores of urologists were significant differences better than other 2 groups.After training,the scores of urologists and surgical residents were no significant differences（P〉0.05）,these 2 groups’ scores were significant differences better than clinical students（P〈0.05）.Conclusion：The training of percutaneous renal puncture with virtual reality simulation was beneficial to all the trainees.In this study,we found the better training effect was gained on trainees of clinical experience.