经肛全直肠系膜切除术结构化培训后学员学习效果的评价分析

Evaluation of the learning effect of students after structured training of transanal total mesorectal excision

目的通过分析接受经肛全直肠系膜切除术(taTME)结构化培训后学员所开展的临床工作,探讨结构化培训的效果及意义。方法采用回顾性研究分析,统计分析自培训后开展的20例ta TME手术的相关手术指标,术后并发症情况以及主观熟练度评价。结果将20例患者根据时间先后进行分组比较,分为前10例(A组)和后10例(B组)。在手术出血量、是否行预防性造口、吻合口漏的发生上差异无统计学意义;在手术时间上,总手术时间两组比较差异无统计学意义,会阴部手术时间(t=2.557,P=0.05)和经肛平台摆放时间(t=4.575,P<0.01)上B组患者明显少于A组。吻合方式上后期B组手工吻合的患者要远多于前期A组的患者;手术者对于两组患者前列腺或阴道后壁辨认情况、荷包缝合情况的评价指标差异无统计学意义,但在对吻合口质量的评价上差异有统计学意义(t=8.667,P<0.05)。结论在开展taTME手术前,通过结构化培训这种合理的教学方式,可使临床医生深入掌握盆底肛周的解剖结构,缩短学习曲线,提高手术安全性及保护患者的权益。

Objective To explore the effect and significance of structured training through the clinical work carried out by the trainees after undergoing structured training of transanal total mesorectal excision(taTME).Methods Statistical analysis of 20 surgical outcomes,postoperative complications,and subjective proficiency evaluation of taTME surgery performed after training through retrospective analysis.Results Twenty patients were divided into the first 10 cases(group A)and the latter 10 cases(group B)for grouping comparison.There was no statistical difference in the occurrence of surgical bleeding,preventive ostomy and anastomotic leakage,and there was no difference in the total operation time between the two groups,the time of perineal operation(t=2.557,P=0.05)and the time of the anus platform(t=4.575,P<0.01)were significantly lower than that of group A.There were more patients with manual anastomosis in group B than those in group A.There was no statistical difference in the evaluation indexes of prostate or vaginal posterior wall identification and suture of the two groups of patients.There were statistical differences in the evaluation of the quality of the anastomosis(t=8.667,P<0.05).Conclusion Before carrying out a taTME operation,through structured training,this reasonable teaching method can enable clinicians to deeply grasp the anatomical structure of pelvic perianal,shorten the learning curve,improve the safety of operation and protect the rights and interests of patients.