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目的应用离体猪肝构建简单、经济、能模拟出血和胆漏的腹腔镜肝切除术培训模型,并对培训模型进行评价。方法将新鲜的保留肝门和小段肝后下腔静脉的猪肝放置在组装的腹腔镜培训装置中,用红色明胶液体灌注肝静脉、门静脉、肝动脉以模拟肝脏血流,黄色明胶液体灌注胆总管模拟肝脏胆汁。首先由3名腹腔镜专家对此模型进行各种方式的肝切除操作并提出改进意见,结合专家意见,对模型进行改进。其次,由6名具有腹腔镜经验的肝胆外科医生对最终模型进行肝切除操作,用5分量表对最终模型的解剖结构、质地、血流情况等指标进行评分。结果与真实手术环境相比,对最终模型解剖结构的评分是4.6±0.3,质地的评分是4.9±0.1,血流情况评分是4.7±0.3,胆漏情况评分是4.6±0.2。结论此培训模型构建简单、经济、能较真实的模拟术中出血、胆漏,可以用于腹腔镜肝切除术的高级培训。
Objective To construct a simple and economical laparoscopic liver resection training model which can simulate hemorrhage and bile leakage in vitro, and evaluate the training model. Methods Fresh liver patella and small posterior hepatic inferior vena cava were placed in the assembled laparoscopic training device. The hepatic vein, portal vein and hepatic artery were infused with red gelatin to simulate the hepatic blood flow. The yellow gelatin liquid was infused into the laparoscopic training device. Explorer simulates liver bile. First of all, three laparoscopic experts on this model for a variety of liver resection operations and suggestions for improvement, combined with expert opinion, to improve the model. Second, six laparoscopic liver and gallbladder surgeons performed hepatectomy on the final model. Five-point scale was used to assess the anatomical structure, texture and blood flow of the final model. Results Compared with the real operating environment, the final model anatomy score was 4.6 ± 0.3, the texture score was 4.9 ± 0.1, the blood flow score was 4.7 ± 0.3, and the biliary leakage score was 4.6 ± 0.2. Conclusion This training model is simple, economical and can simulate intraoperative bleeding and bile leakage. It can be used for advanced training in laparoscopic liver resection.