阶梯式显微血管吻合训练方案的可行性研究与文献回顾

The stepped training program of microvascular anastomosis:Feasibility research and literature review

目的探讨采用阶梯式显微血管吻合训练方案的训练效果和意义。方法选取72名来自各级医院且尚未进行过血管吻合操作训练的神经外科医生作为研究对象,分为对照组和实验组,各36人。选取288只健康雄性SD大鼠。实验组分3个阶段在手术显微镜下对大鼠行颈总动脉端端吻合术、颈总动脉端侧吻合术、股动脉-股静脉端侧吻合术训练。对照组分3个阶段均行大鼠股动脉-股静脉端侧吻合术的常规训练。两组每阶段每人完成1只大鼠。培训结束后两组均进行显微镜下颈总动脉端端吻合术考核,完成后检查并统计吻合时间(自放置阻断夹至松开阻断夹)、术后即时血管通畅率、术后24 h血管通畅率、术后大鼠存活率,并且进行分析比较。结果考核中实验组有效完成实验大鼠29只,平均吻合时间为(45.20±4.79)min,术后即时血管通畅率为86.2%(25/29),术后24 h血管通畅率为82.8%(24/29),术后存活率为86.2%(25/29)。对照组有效完成实验大鼠30只,平均吻合时间为(42.60±4.26)min,术后即时血管通畅率为63.3%(19/30),术后24 h血管通畅率为56.7%(17/30),术后存活率为60.0%(18/30)。两组间平均血管吻合时间、术后即时和24 h通畅率、术后存活率的差异有统计学意义(均P<0.05)。结论“阶梯式显微血管吻合技术训练方法”从简单过渡到复杂、贴合临床工作实际要求,可以使受训者逐步掌握各种血管吻合技术、有效提升学员的技术水平,使其更接近临床水准。

Objective To investigate the effectiveness and significance of the stepped training program of microvascular anastomosis.Methods A total of 72 neurosurgeons who came from the hospitals at different levels and did not undergo the training of vascular anastomosis were selected and divided into control group and experimental group,with 36 neurosurgeons in each group,and a total of 288 healthy male Sprague-Dawley rats were selected.The neurosurgeons in the experimental group received the training in three stages,i.e.,end-to-end common carotid artery anastomosis,end-to-side common carotid artery anastomosis,and end-to-side femoral vein-femoral artery anastomosis under the operating microscope,while those in the control group received the conventional training of end-to-side femoral artery-vein anastomosis in all three stages.Each individual completed the surgery for one rat in each stage.After the training,the neurosurgeons in both groups underwent microscopic assessment of end-to-end common carotid artery anastomosis, and thetwo groups were examined and compared in terms of the time of vascular anastomosis (from the placement of the clip to therelease of the clip), vascular patency rate immediately after surgery, vascular patency rate at 24 hours after surgery, andthe postoperative survival rate of rats. Results In the experimental group, the surgery was effectively completed for 29rats, with a mean anastomosis time of 45.2±4.79 minutes, a vascular patency rate of 86.2% (25/29) immediately aftersurgery and 82.8% (24/29) at 24 hours after surgery, and a postoperative survival rate of 86.2% (25/29). In the controlgroup, the surgery was effectively completed for 30 rats, with a mean anastomosis time of 42.6±4.26 minutes, a vascularpatency rate of 63.3% (19/30) immediately after surgery and 56.7% (17/30) at 24 hours after surgery, and a postoperativesurvival rate of 60.0% (18/30). There were significant differences between the two groups in the mean time of vascularanastomosis, vascular patency rate immediately after surgery and at 24 hours after surgery, and postoperative survival rate(all P <0.05). Conclusion Literature review shows that existing anastomosis training programs fail to achieve satisfactorytraining results. The stepped training program of microvascular anastomosis, from simple to complex, can better meet theactual requirements of clinical work, helping trainees to gradually master various vascular anastomosis techniques andeffectively improving their technical abilities. Long-term training is still needed to help trainees become truly qualified forclinical work.