Vick Laura R, Vick Kenneth D, Borman Karen R, Salameh J R
Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi 39216, USA.
J Surg Educ. 2007 Nov-Dec;64(6):365-8. doi: 10.1016/j.jsurg.2007.04.006.
Surgical simulation modules for "open" surgery are limited and not well studied or validated. Available simulation modules use either synthetic material, which is convenient but may not mimic what is observed or felt in the operating room, or live animal laboratories, which can simulate human tissue but are costly and not readily available. An intestinal anastomosis simulation was devised with thawed porcine intestine. In this study, the face, content, and construct validities of this simulation module were analyzed for both hand-sewn and stapled anastomoses.
Participants were timed on performing a 2-layered, hand-sewn anastomosis, as well as a side-to-side, functional, end-to-end, stapled anastomosis on thawed porcine small bowel. Anastomoses were examined for adequacy and measured for luminal narrowing and bursting pressure by intraluminal saline infusion. Questionnaires were answered regarding impressions with the simulation modules. Face, content, and construct validities were evaluated by comparing junior residents to senior residents and faculty. Data collected were analyzed with 2-sample t-tests.
Both hand-sewn and stapled anastomoses showed strong face and content validity. Overall impressions of these inanimate simulation modules were a positive experience as reflected by the comments of participants. For hand-sewn anastomoses, a significant difference was found between junior and senior group times (50.0 +/- 17.2 vs 33.0 +/- 9.7 minutes, p = 0.013) as well as PGY-1 and faculty times (64.0 +/- 7.2 vs 28.0 +/- 3.8 minutes, p = 0.001). Bursting pressures varied between both groups and were not significant. For stapled anastomoses, no difference was noted between the various groups in completion time or bursting pressure.
Hand-sewn and stapled inanimate intestinal anastomoses are a valid simulation of intraoperative experience based on the face and content validities. Although stapled anastomosis does not have good construct validity, the more challenging hand-sewn anastomosis does differentiate between various skill levels.
用于“开放式”手术的外科模拟模块有限，且未得到充分研究或验证。现有的模拟模块要么使用合成材料，这种材料使用方便，但可能无法模拟在手术室中观察到或感觉到的情况；要么使用活体动物实验室，这种方式可以模拟人体组织，但成本高昂且不易实现。本研究设计了一种使用解冻猪肠的肠吻合模拟方法。在本研究中，对手缝和吻合器吻合两种方式下该模拟模块的表面效度、内容效度和结构效度进行了分析。
记录参与者进行两层手缝吻合以及在解冻猪小肠上进行侧侧、功能性端端吻合器吻合的时间。检查吻合情况，并通过腔内注入生理盐水测量管腔狭窄和破裂压力。就对模拟模块的印象填写问卷。通过比较低年资住院医师与高年资住院医师及教员来评估表面效度、内容效度和结构效度。收集的数据采用双样本t检验进行分析。
手缝和吻合器吻合均显示出较强的表面效度和内容效度。参与者的评论反映出，这些无生命模拟模块总体上给人留下了积极的体验。对于手缝吻合，低年资组与高年资组的时间存在显著差异（50.0±17.2分钟对33.0±9.7分钟，p = 0.013），以及PGY-1组与教员组的时间也存在显著差异（64.0±7.2分钟对28.0±3.8分钟，p = 0.001）。两组的破裂压力有所不同，但无统计学意义。对于吻合器吻合，不同组在完成时间或破裂压力方面未发现差异。
基于表面效度和内容效度，手缝和吻合器无生命肠吻合是术中体验的有效模拟。虽然吻合器吻合的结构效度不佳，但更具挑战性的手缝吻合确实能够区分不同的技能水平。
