简易离体猪胃模型在内镜黏膜下剥离术培训中的应用效果

Application effect of simple isolated porcine stomach model in ESD training

目的设计一种简易离体猪胃模型,通过举办8期胃内镜黏膜下剥离术(ESD)培训班来评估其应用效果。方法前瞻性研究2018年12月-2020年10月重庆医科大学附属第一医院消化内科设计的一种简易离体猪胃模型,探讨其在ESD学员培训中的应用效果。共举办8期猪胃ESD手把手教学培训班,选用12个猪胃,共培训学员72例,其中公立医院46例、私立医院26例。将当天新鲜购买未经冷冻的重量在0.6~0.9 kg的猪胃洗净后,用民用缝衣针线或医用外科缝合针线将猪胃缝合完整,仅保留食管入口,再将猪胃固定于厚度为2 cm的珍珠棉泡沫板上(长60 cm,宽40 cm),每个猪胃需要固定5个点,猪胃与泡沫板之间预先放置手术电刀所需的电极板,胃镜通过食管入口后,用外科止血钳夹闭食管入口处,防止漏气。将上述装置平放于手术平台上,尽量防止移动。ESD手术流程参照传统ESD操作流程进行,通过评估手术操作时间、完整切除率、完成率、成功率和后期能否独立开展ESD工作等来判断该模型的应用效果。结果所有学员在培训当天使用该模型独立完成1例ESD操作,多采用口袋法完成ESD,完成时间为30~50 min,平均(38.6±5.3)min,完整切除率为95%,完成率为98%,成功率为98%,整个过程中医生和助手均不需要对模型进行按压或校正,胃腔始终能保持扩张状态。部分学员熟练操作后,甚至可以在没有助手辅助的情况下独立完成整个ESD。通过培训,学员返回自己医院后,可以独立制作该模型进行反复的ESD练习,有3名医生通过培训后,能独立进行临床ESD工作。结论简易离体猪胃模型设计简单,所需材料容易获得,缝合方式可靠,基本不会漏气,视野清晰,手术操作流畅,可以良好地模拟ESD操作,值得临床推广应用。

Objective A simple isolated porcine stomach model was designed and its application effect was evaluated by conducting 8 sessions of endoscopic submucosal dissection(ESD)training courses.Methods A simple isolated porcine stomach model was designed to evaluate its application effect in ESD training for the trainees of 8 phases of ESD training from December 2018 to October 2020 using prospective research methods.A total of 8 seasons of hand-holding training courses on endoscopic porcine gastric mucous membrane dissection were held,with 12 porcine stoma selected.A total of 72 trainees participated in the 8 seasons of training courses,including 46 students from public hospitals and 26 students from private hospitals.A simple isolated porcine stomach model is one in which the porcine stomach is sewn onto a foam board with a suture.Porcine stomach for the day to buy fresh porcine stomach without frozen,weight between 0.6~0.9 kg,wash it after the needle and thread to the porcine stomach full of suture,retain only the entrance to the esophagus,suturing needle selecting civil needles or medical surgical suture needle and thread,then the porcine stomach with suture method in the thickness of 2 cm of pearl cotton foam sheet(60 cm long and 40 cm wide),every porcine stomach need to fixed 5 points,porcine stomach and foam board placed in advance between electric knife surgery required plate electrode,gastroscope after esophageal entrance,the entrance of the esophagus with surgical hemostatic forceps clip,in order to prevent leakage.Lay the device flat on the operating platform to prevent its movement as much as possible.The operation process of ESD is carried out by referring to the traditional operation process of ESD,and the application effect of this model is judged by the operation time,complete resection rate,completion rate,success rate,and whether the ESD work can be carried out independently in the later period.Results All students in the use of the training day model case of ESD operating independently,many pockets method is adopted to improve the ESD,completion time between 30~50 min,(38.6±5.3)min on average,a complete resection rate is 95%,completion rate is 98%,success rate is 98%,the whole process of the doctor and his aides are not need to press or the model calibration,gastric cavity have always been able to keep expanding in operating state.After the students are skilled in operation,they can even complete the whole ESD independently without the assistance of assistants.After passing the training,the trainees can make the model independently for repeated ESD exercises after returning to their own hospital.Three doctors could independently carry out clinical ESD work after the training.Conclusion The simple isolated porcine stomach model is simple in design,easy to obtain the required materials,reliable suture method,basically no air leakage,clear field of vision,smooth operation,can well simulate clinical ESD operation,it is worthy of popularization and application.