【摘要】 目的为初学者建立标准的肾癌根治术学习及带教策略,并评估该学习方法的安全性和有效性。方法选择上海交通大学附属第一人民医院泌尿外科未掌握肾癌根治术的年轻主治医师6名,随机分成3组,分别为腹腔镜-开放组(即先进行腹腔镜肾癌根治术的学习和临床训练8例,再进行开放性肾癌根治术的学习和临床训练8例,最后考核);开放-腹腔镜组(即先进行开放性肾癌根治术的学习和临床训练8例,再进行腹腔镜肾癌根治术的学习和临床训练8例,最后考核);混合组(即同时进行腹腔镜/开放性肾癌根治术的学习和临床训练,间隔使用两种术式行肾癌根治术各8例,最后考核);考核办法为在指导教师指导下完成腹腔镜肾癌根治术5例,开放性肾癌根治术3例,并收集和比较其临床数据(如手术时间、出血量,术后拔除引流管时间、术后下床活动时间,住院时间等),并评估其手术效果。结果所有肾癌根治术均获成功,无一例腹腔镜肾癌根治术中转开放,最后考核中混合组的训练者学习曲线最短,多项临床评价指标明显优于其他两组。术中并发症比例三组无明显差异。结论初学者在导师指导下可以安全有效的掌握肾癌根治术的手术方法,并且在训练期间腹腔镜及开放手术的有机结合学习和训练有助于更快掌握解剖知识和手术技巧,缩短学习曲线。另外,腹腔镜肾癌根治术的学习和训练对初学者掌握解剖知识,熟悉手术步骤,更快掌握手术方法及减少手术并发症更有帮助,而开放性肾癌根治术也对更快掌握腹腔镜肾癌根治术的要点有助益。更多还原

【Abstract】 Objective To establish standard learning and teaching strategies of radical nephrectomy for beginners,and to evaluate the safety and efficacy of the learning method. Methods 6 young attending doctors as trainee,come from Department of Urology,Shanghai General Hospital,Shanghai Jiao Tong University,who did not grasp the radical nephrectomy,were randomly divided into 3 groups,respectively. Group1( Mixed group) :studying and practicing laparoscopic / open radical nephrectomy at the same time in 8 cases respectively,then evaluate; Group2( Laparoscopic- open group) : studying and practicing laparoscopic radical nephrectomy in 8cases,followed 8 cases of open radical nephrectomy,then evaluate; Group3( Open- laparoscopic group) :studying and practicing open radical nephrectomy in 8 cases,followed 8 cases of laparoscopic radical nephrectomy,then evaluate. Finally,every trainee operated 5 cases of laparoscopic radical nephrectomy and 3 cases of open radical nephrectomy under the guidance of teachers and compared of the clinical data such as operation time,bleeding volume,postoperative removal of drainage tube time,postoperative ambulation time,hospitalization time as assessment. Results all radical nephrectomy were successful,and no cases of laparoscopic radical nephrectomy converted to open. The learning curve of the mixed group was obviously shorter and the clinical indexes were better than the other two groups in the final evaluation. The complication ratio had no difference between the three groups. Conclusions beginners can learn radical nephrectomy under the guidance of a mentor safely and effectively. The learning and teaching strategies of the combination of laparoscopic and open radical nephrectomy help trainee quickly grasp the anatomical knowledge and surgical techniques,and meanwhile shorten the learning curve. Meanwhile,learning and training retroperitoneoscopic radical nephrectomy can help beginners to master the anatomy knowledge,familiar with the operation steps,quicker to grasp operation and reduce surgical complications a lot,and the open radical nephrectomy can also help trainee quickly grasp the laparoscopic radical nephrectomy operation points.更多还原