【摘要】 目的：总结腹腔镜模拟训练系统对不同操作组腹腔镜手术基本技能的提高情况。方法：本科实习生组、研究生无腹腔镜操作经验组、本院进修医师无腹腔镜操作经验组,分别使用腹腔镜模拟训练系统练习镜下夹取黄豆、缝合及器械打结技术,２周后进行统计学分析。结果：操作训练前,本科实习生夹取黄豆、缝合技术及器械打结技术明显不如本院研究生及进修医师（P＜0.05）,经过２周训练,较简单的技能操作如夹取黄豆和研究生及进修医师无统计学差异（P＞0.05）,较复杂的技能操作如缝合技术、绕线打结练习训练前、后和本院研究生及进修医师相比差异有统计学意义（P＜0.05）；但是3组人员训练后与训练前相比,腹腔镜的基本技能操作均显著提高（P＜0.05）。结论：腹腔镜模拟训练系统能提高腹腔镜手术操作者的基本技能,值得推广。

【关键词】 腹腔镜;教育，医学

Effect of laparoscopic training system on the basic technical skill of laparoscopic operation

【Abstrat】 Ｏbjective:To evaluate the improvement of basic technical skill of laparoscopic operation after using laparoscopic training system by different operators.Methods:Undergraduate students,postgraduate students and probationary students practised clipping soybean and making suturation and instrumental tie by using laparoscopic training system,then made statistical analysis two weeks later.Results:Before the training,the level of undergraduate students on clipping soybean and making suturation and instrumental tie was lower than the level of postgraduate and probationary students（P＜0.05）.After two weeks training,the level of undergraduate students on clipping soybean was similar to that of postgraduate and probationary students（P＞0.05）;the level of undergraduate students on making suturation and instrumental tie was lower than that of postgraduate and probationary students（P＜0.05）.But the level of different operators after training was obviously higher than that of themselves before traning（P＜0.05）.Conclusions:Laparoscopic training system can obviously improve the basic technical skill of laparoscopic operation of operators,and deserves to be expanded.

【Key words】 Laparoscopy;Education,medical

目前,腹腔镜的手术范围已由单一的腹腔镜胆囊切除术,发展到几乎可以涉及腹腔所有脏器的手术,国内已基本普及到县级基层医院,因其创伤小、痛苦少、术后康复快,深受广大医护人员及患者的好评,但腹腔镜手术基本技能的训练问题尚未得到很好的解决。我院在开展腹腔镜手术的过程中,自行研制了一套简易腹腔镜模拟训练模型,获得了国家实用新型专利,专利号为ＺL 2004 20057838.6，这套模型总结了可以在基层医院推广的训练方法,能够帮助初学者快速掌握与提高腹腔镜手术的基本技术,降低腹腔镜手术风险,提高手术成功率。现报道如下。

1 资料与方法

1.1 材料 腹腔镜模拟台一套,电视机一台,连接腹腔镜模拟台的摄像头与电视机,将摄像头对准腹腔镜模拟台操作箱内,适当调节镜头角度,开机后一个模拟腹腔模型即清楚地显示在电视平面上。训练者在箱体后方,于箱体表面依具体训练要求分别插入各种器械即可在电视画面下进行左右手器械操作的训练。

1.2 分组 本科实习生10人(A组),本院研究生无腹腔镜操作经验10人(B组)，本院进修医师无腹腔镜操作经验10人(C组),每位被测试者均已较熟练地掌握单手打结及缝合技术。分别练习镜下夹取黄豆、缝合技术及器械打结技术,具体做法是：计算１min内将散落黄豆夹取移至选定纸杯中的数量；在预先准备的缝合材料上（如纱布）做好若干标记，要求被测试者按标记间断缝合,完成1次缝合后即进行器械打结并计数,以30min内被测试者完成的缝合打结数来评价被测试者的技能。共训练２周,每天2h,２周后测试。