3D打印模型在经鼻内镜手术训练中的效果

Effect of using 3D printing model in endoscopic endonasal surgical practice

目的探讨在经鼻内镜手术训练中应用3D打印模型的效果。方法通过3D打印技术制作了经鼻内镜手术训练模型。于2018年1月,纳入12名没有内镜操作经验的研究生和低年资住院医生作为学员,借助该模型,重复训练内镜下"磨"、"刮"、"咬"和"吸"等操作。记录下学员们每次训练的结果,以及所有训练结束后的主观感受。结果随着训练次数的增加,学员们内镜下操作的完成速度和完成质量均逐渐提升。学员们末次练习时磨除蛋壳的耗费时间[(3.93±0.77)min vs.(2.87±0.44)min](P<0.001)、磨除蛋壳时壳膜破裂的概率(11/12 vs.4/12)(P=0.009)、去除游离蛋壳时壳膜破裂的概率(12/12 vs.6/12)(P=0.014)、吸除蛋清时蛋黄膜破裂的概率(7/12 vs.1/12)(P=0.027)以及操作训练评价总分[(2.17±0.72)分vs.(4.75±0.87分)](P<0.001)均有明显改善。同时,所有学员均表示能从练习中获益,且乐意于使用3D打印模型进行训练。结论将3D打印模型用于经鼻内镜手术训练,能够有效提高练习者的经鼻内镜下手术操作技巧,并有助于激发练习者的积极性。

Objective To explore the effect of using 3D printing model in endoscopic endonasal surgical practice. Methods The surgical training model was made using 3D printing technology. In January 2018, 12 postgraduates and low-grade resident doctors with no experiences of endoscopic endonasal surgery were recruited to participate in the surgical training used the 3D printing model as tools. Drilling, curetting, biting and aspirating under endoscope were practiced repeatedly used the eggs fixed on the 3D printing model as objects. The training results and the subjective feelings after training for each practitioner were recorded. Results As the number of training was increased, the speed and quality of the endoscopic operation for these practitioners were increased gradually. Compared with the first training, the results of the last training （the fifth time） of practitioners, including the time spent in drilling the eggshell （[3.93±0.77]） rain vs. [2.87±0.44] min） （P〈0.001）, the probability of shell membrane rupture during drilling the eggshell （11/12 vs. 4/12） （P= 0.009）, the probability of shell membrane rupture during curetting and biting the eggshell （12/12 vs. 6/12） （P=0.014）, the probability of yolk membrane rupture during aspirating the albumen （7/12 vs. 1/12） （P=0.027）, and the surgical practice score （[2.17±0.72] points vs. [4.75±0.87] points） （P〈0.001）, were improved significantly. Moreover, all of the participants subjectively stated that they could obtain benefits from the practice and willing to train with 3D printed models. Conclusion The endoscopic endonasal surgical practice using 3D printed model as tools can effectively improve the endoscopic surgical operation skills of practitioners and may contribute to stimulate the enthusiasm of practitioners.