摘要
目的:探讨基于手术模拟器操作训练在眼科年轻医师小切口白内障囊外摘除手术培训的有效性评估。方法:前瞻性对照研究。选取2020/2022年在沈阳何氏眼科医院已完成至少3a住院医师规范化培训的眼科专业住院医师或刚取得主治证书的眼科主治医师共48名为研究对象,通过小切口白内障囊外摘除手术相关理论培训及考核后,随机分为模拟器手术操作训练组(试验组)和实体动物眼手术操作训练组(对照组),每组各24名。试验组和对照组医师分别使用手术模拟器和猪眼进行训练。训练结束后使用手术模拟器和实体猪眼操作对两组研究对象进行考核评分,并对两组医师的总体培训效果进行有效性评估。结果:手术模拟器考核评分及用时比较,试验组研究对象在各步骤考核用时均低于对照组(均P<0.05)。试验组研究对象在角膜穿刺注入黏弹剂、娩核及水密角膜穿刺口操作评分与对照组比较均无差异(P>0.05),其余步骤评分,试验组均高于对照组(均P<0.05)。实体动物眼考核评分,试验组研究对象各步骤考核评分均高于对照组(均P<0.05)。试验组研究对象在巩膜切口、角巩膜隧道、连续环形撕囊、水分离及转核至前房、娩核步骤手术模拟器与实体动物眼考核评分比较均无差异(P=0.068、0.126、0.960、0.520、0.206);在穿刺注入黏弹剂、隧道穿刺进入前房及水密角膜穿刺口考核中,模拟器评分均低于实体动物眼(P=0.007、0.014、<0.01);在皮质吸除、人工晶状体植入操作考核时模拟器评分要高于实体动物眼操作评分(P=0.035、<0.01)。结论:将手术模拟器操作训练应用于眼科年轻医师小切口白内障囊外摘除手术技能培训,可以显著提升医师的白内障显微手术操作技能,为建立眼科年轻医师规范化的白内障手术培训提供了新的模式及思路。
AIM:To investigate the effectiveness of surgical simulator-based small-incision extracapsular cataract extraction training for young ophthalmologists.METHODS:Prospective and controlled study.A total of 48 young participants who had completed at least 3a standardized residency training or had obtained the attending certificate in the He Eye Specialist Hospital from 2020 to 2022 were enrolled.All the participants were randomly divided into simulator surgical operation training group(experimental group,n=24)and real animal eye operation training group(control group,n=24)after passing the theoretical training and assessment of small incision extracapsular cataract extraction.The participants in the experimental group and control group were trained with the surgical simulator and pig eyes respectively.After training,the overall effectiveness of training in both groups was rated using the simulator and pig eye operation was evaluated.RESULTS:The participants in the experimental group used less time than the participants in the control group on simulator assessment(all P<0.05).The scores of injecting viscoelastics during keratonyxis,nucleus delivery and hydrate the paracentesis site steps were not different on simulator assessment between the two groups(P>0.05).For the rest of the steps,the scores of experimental group were higher than those of the control group(all P<0.05).Participants in the experimental group had significantly higher scores than control group on pig eye operation assessment(all P<0.05).In the experimental group,the scores of the scleral groove dissection,tunnel dissection,continuous circular capsulorhexis,hydrodissection and hydro-prolapse and nucleus delivery steps had no significant difference between the surgical simulator and pig eye operation(P=0.068,0.126,0.960,0.520,0.206).The scores of injecting viscoelastics during keratonyxis,tunnel puncture into anterior chamber and hydrate the paracentesis site steps were significantly lower on simulator assessment than pig eye operation(P=0.007,0.014,<0.01).The scores of the cortex removal and intraocular lens(IOL)implantation were significantly higher on simulator assessment than eye of real animal(P=0.035,<0.01).CONCLUSION:The application of surgical simulator on training small incision extracapsular cataract extraction skills for young ophthalmologists could significantly improve their skills in cataract surgery operation,providing a new mode and idea for the establishment of standardized cataract surgery training for young ophthalmologists.
作者
张斌
李军
何伟
Bin Zhang;Jun Li;Wei He(Dalian Medical University,Dalian 116023,Liaoning Province,China;He Eye Specialist Hospital,Shenyang 110034,Liaoning Province,China)
出处
《国际眼科杂志》
CAS
北大核心
2023年第9期1564-1567,共4页
International Eye Science
关键词
手术模拟器
眼科医师
白内障手术
小切口白内障囊外摘除手术培训
surgical simulator
ophthalmologist
cataract surgery
small incision extracapsular cataract extraction training
