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中华胃肠内镜电子杂志

中华胃肠内镜电子杂志 ›› 2022, Vol. 09 ›› Issue (02) : 112 -116. doi: 10.3877/cma.j.issn.2095-7157.2022.02.021

教学园地

活体猪模型在超级微创内镜隧道法黏膜下剥离手术培训中的应用
刘圣圳1, 柴宁莉1, 令狐恩强1,†(), 李惠凯1, 冯秀雪1, 翟亚奇1, 高飞2, 王祥耀1, 王楠钧1, 赵晨怡1, 徐宁3   
  1. 1. 100853　北京，解放军总医院第一医学中心消化内科
    2. 100853　北京，解放军总医院第一医学中心消化内科；350303　福建，解放军73123部队
    3. 100853　北京，解放军总医院第一医学中心消化内科；100094　北京，联勤保障部队第九八四医院
  • 收稿日期:2022-04-01 出版日期:2022-05-15
  • 通信作者: 令狐恩强
  • 基金资助:
    国家重点研发计划(2016YFC1303601)

Establishment of an in-vivo porcine model in surgical training of super minimally invasive endoscopic tunneling submucosal dissection

Shengzhen Liu1, Ningli Chai1, Enqiang Linghu1,†(), Huikai Li1, Xiuxue Feng1, Yaqi Zhai1, Fei Gao2, Xiangyao Wang1, Nanjun Wang1, Chenyi Zhao1, Ning Xu3   

  1. 1. Department of Gastroenterology and Hepatology, First Medical Center of the Chinese PLA General Hospital, Beijing 100853, China
    2. Department of Gastroenterology and Hepatology, First Medical Center of the Chinese PLA General Hospital, Beijing 100853, China; Unit 73123, PLA Ground Force, Fujian 350303, China
    3. Department of Gastroenterology and Hepatology, First Medical Center of the Chinese PLA General Hospital, Beijing 100853, China；No. 984 Hospital of PLA, Beijing 100094, China
  • Received:2022-04-01 Published:2022-05-15
  • Corresponding author: Enqiang Linghu
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刘圣圳, 柴宁莉, 令狐恩强, 李惠凯, 冯秀雪, 翟亚奇, 高飞, 王祥耀, 王楠钧, 赵晨怡, 徐宁. 活体猪模型在超级微创内镜隧道法黏膜下剥离手术培训中的应用[J]. 中华胃肠内镜电子杂志, 2022, 09(02): 112-116.

Shengzhen Liu, Ningli Chai, Enqiang Linghu, Huikai Li, Xiuxue Feng, Yaqi Zhai, Fei Gao, Xiangyao Wang, Nanjun Wang, Chenyi Zhao, Ning Xu. Establishment of an in-vivo porcine model in surgical training of super minimally invasive endoscopic tunneling submucosal dissection[J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2022, 09(02): 112-116.

目的

对活体猪模型在超级微创内镜隧道法黏膜下剥离手术(ESTD)培训进行初步的探讨。

方法

对消化内镜培训者进行为期3个月的隧道法黏膜下剥离术的动物培训，共操作活猪8头，分别建立超级微创内镜黏膜下剥离术(ESD)和ESTD动物训练模型。训练者进行手术理论学习，在高年资医师的指导下进行ESTD术和ESD术，记录ESD和ESTD的总体操作时间，隧道长度，创面面积大小，操作速度(创面面积/时间)。使用调查问卷检测学员培训前后的能力变化。数据使用SPSS.23统计软件进行分析。

结果

ESD和ESTD手术解剖模型在手术训练中，未出现不可处理的术中大出血和术后延迟性出血。ESTD模型出现食管小穿孔2例，均使用软组织夹进行封闭处理，2种手术模型均无延迟穿孔。分别有1例ESTD和3例的ESD未完成而需要高级医师接手，未出现动物死亡的情况。

结论

活体猪模型用于内镜隧道法黏膜下剥离手术培训安全且可行，相对于传统ESD手术在黏膜下剥离的培训过程更有优势。

关键词: 内镜黏膜下隧道剥离术, 活体猪模型, 教学培训, 模拟手术
Objective

This study aim to established an in-vivo porcine model for the training of super minimally invasive endoscopic dissection (ESTD).

Methods

The trainees were trained for 3 months, and a total of 8 live pigs were operated. Super minimally invasive endoscopic submucosal dissection (ESD) and ESTD animal training models were established. The trainees studied the surgical theory, performed ESTD and ESD under the guidance of senior doctors. We recorded the overall operation time, tunnel length, wound area size, and operation speed (wound area/ time). A questionnaire was used to detect changes in competence before and after training. Data were analyzed using the SPSS.23 statistical software.

Results

The ESD and ESTD surgical anatomy models showed no ununtreated intraoperative major bleeding and delayed postoperative bleeding during surgical training. Two cases of small esophageal perforation appeared in ESTD models, all were closed with soft tissue clips. None of the surgical models had delayed perforation. There ESD cases and one ESTD case were unfinished and senior doctors needed to take over, and no animal died.

Conclusion

The in-vivo porcine model is effective and feasible for endoscopic tunneling and submucosal dissection surgery training, which is beneficial to improve the endoscopic learning curve of trainees.

Key words: Endoscopic submucosal tunnel dissection, In-vivo porcine model model, Teaching and training, Simulation surgery
图1 ESD和ESTD活猪培训模型的内镜下操作示意图及术后标本注：A：ESD模型标记病变后Dual刀标记后黏膜下注射并切开；B：ESD模型边黏膜下注射边分离黏膜下层；C：ESD模型完整剥离病变并进行创面止血；D：ESD模型术后标本处理E.ESTD模型病变进行标记；F：ESTD模型黏膜下注射的同时三角刀建立黏膜下隧道；G：ESTD模型完整病变后创面止血；H: ESTD模型术后标本处理
表1 ESD和ESTD在动物培训中的术者相关评价
项目 ESD ESTD P值
内镜年限(年) 4.25±1.98 4.22±2.86 0.884
胃肠镜数(例) 5601±512 4044±497 0.321
手术总时长(min) 66.88±39.27 52.56±23.04 0.541
  标记时间 15.63±12.08 10.33±2.35 0.023
  切开时间 16.25±5.18 18.78±6.50 0.481
  剥离时间 30.00±23.76 22.28±9.39 0.049
  止血时间 8.75±5.82 10.00±5.00 0.691
标本面积(cm2) 8.23±8.09 4.82±3.47 0.370
剥离速度(cm2/min) 0.18±0.22 0.11±0.15 0.673
手术完成度总评分 3.29±0.95 3.00±0.93 0.815
  标记评分 3.22±0.85 3.63±0.52 0.606
  注射评分 3.14±0.90 3.13±0.84 0.743
  切开评分 3.00±0.82 3.01±0.93 0.512
  剥离评分 3.02±1.07 2.50±1.20 0.321
  止血评分 3.14±0.90 2.63±1.41 0.665
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