Isaacson Glenn, Ianacone David C, Wolfson Marla R
Department of Otolaryngology - Head & Neck Surgery, Temple University School of Medicine, United States; Department of Pediatrics, Temple University School of Medicine, United States.
Department of Otolaryngology - Head & Neck Surgery, Temple University School of Medicine, United States; Department of Pediatrics, Temple University School of Medicine, United States; Department of Medicine, Temple University School of Medicine, United States; Department of Physiology, Temple University School of Medicine, United States; Department of Thoracic Medicine and Surgery, Temple University School of Medicine, United States; The Centers for Inflammation, Translation and Clinical Lung Research, Temple University School of Medicine, United States; CENTRe: Collaborative for Environmental and Neonatal Therapeutics Research, Temple University School of Medicine, United States.
Int J Pediatr Otorhinolaryngol. 2015 Dec;79(12):2196-9. doi: 10.1016/j.ijporl.2015.10.002. Epub 2015 Oct 23.
Medical students and residents in training have limited opportunities to develop pediatric endoscopy skills and would benefit from a realistic simulation model. We sought to develop such a model for flexible endoscopy using fresh head and neck tissue from young sheep.
Tissue was collected from pre-pubescent sheep (n=5; mean age: 4 months; mean mass: 28kg) following humane euthanasia at the end of an in vivo protocol. No live animals were used in this study. The head and neck of the sheep were disarticulated 4-6cm above the sternal notch and stored at 5°C for 1-5 days. With the preparation was supported in supine position, flexible nasopharyngolaryngoscopy and transnasal endoscopic intubation were performed with video recording.
Five sheep were studied. Endoscopy was performed by a medical student under direct supervision by a pediatric otolaryngologist. Differences between ovine and human pediatric airway anatomy were defined.
Despite variations in proportion and structure, the experience of passing a flexible nasopharyngoscope through a sheep's airway is remarkably similar to pediatric endoscopy. The nasal anatomy is elongated, but very much like a child's in terms of anatomy, color and texture. The tactile feedback is nearly identical. Annoying secretions and their associated "whiteout" phenomena nicely simulate these challenges in pediatric endoscopy. When performing transnasal intubation, navigating to the larynx and advancing an endotracheal tube under guidance have the look and feel of the pediatric procedure. Issues of cost, availability, risk of zoonotic infection, and ethics are discussed.
医学生和住院医师在培训期间发展儿科内镜技能的机会有限，而逼真的模拟模型将对他们有所帮助。我们试图利用幼年绵羊的新鲜头颈部组织开发一种用于柔性内镜检查的模型。
在一项体内实验方案结束后，对青春期前的绵羊（n = 5；平均年龄：4个月；平均体重：28kg）实施安乐死后收集组织。本研究未使用活体动物。将绵羊的头颈部在胸骨切迹上方4 - 6厘米处离断，并在5°C下保存1 - 5天。在准备好的标本处于仰卧位的情况下，进行柔性鼻咽喉镜检查和经鼻内镜插管，并进行视频记录。
对5只绵羊进行了研究。一名医学生在儿科耳鼻喉科医生的直接监督下进行了内镜检查。明确了绵羊与人类儿童气道解剖结构的差异。
尽管在比例和结构上存在差异，但通过绵羊气道插入柔性鼻咽喉镜的体验与儿科内镜检查非常相似。鼻腔解剖结构较长，但在解剖结构、颜色和质地方面与儿童的非常相似。触觉反馈几乎相同。恼人的分泌物及其相关的“白茫茫”现象很好地模拟了儿科内镜检查中的这些挑战。在进行经鼻插管时，在引导下导航至喉部并推进气管内导管的过程与儿科操作的外观和感觉相似。还讨论了成本、可用性、人畜共患感染风险和伦理问题。
