不同培训方式在显微外科血管吻合培训中的比较

景金珠; 梁震; 张萌; 郭文峰; 张威; 闫国强; 相磊

doi:10.3760/cma.j.cn116021-20230724-01604

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不同培训方式在显微外科血管吻合培训中的比较

临床教学 | 更新时间：2025-05-30

- 不同培训方式在显微外科血管吻合培训中的比较
- Comparison of different training methods for microsurgical vascular anastomosis
- 中华医学教育探索杂志 2025年24卷第5期页码：681-685
- 作者机构：
  
  首都医科大学附属北京积水潭医院/北京市创伤骨科研究所动物实验室，北京 100035
- 作者简介：
  
  相磊，Email：xianglei-322@163.com
- 基金信息：
- DOI：10.3760/cma.j.cn116021-20230724-01604
  中图分类号： R319
- 收稿日期：2023-07-24，
  
  纸质出版日期：2025-05-20
- 稿件说明：
移动端阅览
景金珠, 梁震, 张萌, 等. 不同培训方式在显微外科血管吻合培训中的比较[J]. 中华医学教育探索杂志, 2025, 24(5): 681-685.

Jing Jinzhu, Liang Zhen, Zhang Meng, et al. Comparison of different training methods for microsurgical vascular anastomosis[J]. Chinese journal of medical education research, 2025, 24(5): 681-685.
景金珠, 梁震, 张萌, 等. 不同培训方式在显微外科血管吻合培训中的比较[J]. 中华医学教育探索杂志, 2025, 24(5): 681-685. DOI： 10.3760/cma.j.cn116021-20230724-01604.

Jing Jinzhu, Liang Zhen, Zhang Meng, et al. Comparison of different training methods for microsurgical vascular anastomosis[J]. Chinese journal of medical education research, 2025, 24(5): 681-685. DOI： 10.3760/cma.j.cn116021-20230724-01604.

摘要

目的

比较不同培训方式在显微外科血管吻合培训中的优缺点及培训成本差异，为建立系统化的培训形式、提高临床医师的显微外科技能和临床水平提供基础。

方法

受训医师来自各基层医院及国外医院来华交流团体，本研究随机选取2018至2023年几组数据统计。显微外科血管吻合培训共10 d，其中1 d为理论学习，9 d为实操训练。培训医师共48人，分为A、B、C 3组，每组16人。A组单人操作；B组双人配合操作；C组前4 d双人配合操作，后5 d单人操作。应用软件GraphPad Prism 8.3.0单因素方差分析各组间吻合血管时间与吻合血管数量差异，

0.05说明变量数据中存在具有统计学意义的显著性差异。统计3种培训方式的成本支出情况并对培训人员开展问卷调查。

结果

3组血管吻合培训方式随培训日程的进行，吻合速度与吻合数量均呈逐渐升高的趋势。单根血管吻合时间A1 d与B1 d（

=0.335）、A1 d与C1 d（

=0.064）相比差异无统计学意义，其他时间差异均有统计学意义（

0.05）；B1 d与C1 d（

=0.196）、B3 d与C3 d（

=0.115）血管吻合时间差异无统计学意义，第5、7、9天差异均有统计学意义（

0.05）。吻合断端数量A1 d与B1 d（

=0.081）、A3 d与B3 d（

=0.160）、B1 d与C1 d（

=0.695）、B3 d与C3 d（

=0.520）差异无统计学意义，第5、7、9天差异均有统计学意义（

0.05）；A1 d与C1 d（

=0.123）吻合血管的数量差异无统计学意义，其他时间差异均有统计学意义（

0.05）。培训成本方面，A组最高，B组最低，C组介于两者之间。培训问卷调查显示，日常工作中应用此项技术的比例为100.00%（48/48），希望不定期参加此项技术培训的医师比例为100.00%（48/48），就职机构没有培训条件的比例为37.50%（18/48），缺乏必要的仪器设备的比例为35.42%（17/48），实验动物不好获取的比例为68.75%（33/48），因缺少实验动物麻醉、保定、安乐死等动物实验技术而无法开展相关培训的比例为91.67%（44/48），显微外科血管吻合培训存在较大的社会需求。

结论

3种培训方式相比各有优缺点，A种方式适用于小范围培训；B种方式适用于经费充足、人员基数大、使用频率高的培训；C种方式是显微外科血管吻合培训的最优选择，既能训练血管吻合术全流程，也能训练协作配合吻合术。

Abstract

Objective

To compare the advantages and disadvantages and training costs of different training methods for microsurgical vascular anastomosis

and to provide a basis for establishing a systematic training model and improving surgeons microsurgical skills and clinical competence.

Methods

Doctors came from various primary hospitals and exchange groups from foreign hospitals to China

and several groups of data statistics from 2018-2023 were randomly selected for this study. The microsurgical vascular anastomosis training lasted 10 days

including 1 day of theoretical study and 9 days of practical training. A total of 48 doctors were equally divided into group A (one-person operation)

group B (two-person cooperation)

and group C (two-person cooperation in the first four days and one-person operation in the last five days). The differences in anastomosis time and number of anastomoses between the groups were analysed by one-way ANOVA using the software GraphPad Prism 8.3.0

with

0.05 indicating that there were statistically significant differences in the variable data. The cost of the three training methods was investigated

and a questionnaire survey of the trainees was conducted.

Results

For all the three groups

the speed of anastomosis and the number of anastomoses increased with the course of training. The duration of single-vessel anastomosis was significantly different between groups A and B as well as between groups A and C at all time points except on day 1 (A1 d vs. B1 d

=0.335; A1 d vs. C1 d

=0.064;

0.05 for all the other time points); groups B and C showed no significant differences on day 1 (

=0.196) and day 3 (

=0.115) but had significant differences on days 5

and 9 (all

0.05) in the duration of anastomosis. The

number of anastomoses was not significantly different between A1 d and B1 d (

=0.081)

between A3 d and B3 d (

=0.160)

between B1 d and C1 d (

=0.695)

between B3 d and C3 d (

=0.520)

and between A1 d and C1 d (

=0.123)

with significant differences at the other time points (all

0.05). The training costs were group A

group C

group B. The training questionnaire showed that the proportion of trainees who applied this technique in their daily work was 100.00% (48/48)

the proportion of those who wished to participate in the training of this technique occasionally was 100.00% (48/48)

the proportion of participants whose institutions had no relevant training conditions was 37.50% (18/48)

the proportion of those whose institutions lacked necessary instruments and equipment was 35.42% (17/48)

the proportion of those who had difficulties in access to laboratory animals was 68.75% (33/48)

and the proportion of inability to carry out relevant training due to the lack of animal experimentation techniques such as anesthesia

preservation

and euthanasia was 91.67% (44/48)

indicating that there is a great need for microsurgical vascular anastomosis training.

Conclusions

The three training modes have their own advantages and disadvantages. The A mode is suitable for small-scale training. The B mode is suitable for training with adequate funds

a large number of personnel

and a high use frequency. The C mode is the best choice for microsurgical vascular anastomosis training

in which trainees can not only practice the whole vascular anastomosis process but also cooperative skills for anastomosis.

关键词

Keywords

references

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