CN103050040A - 腹腔镜妇科肿瘤手术模拟教学的手术平面模型 - Google Patents
腹腔镜妇科肿瘤手术模拟教学的手术平面模型 Download PDFInfo
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Abstract
宫颈癌根治术是治疗宫颈癌的术式，100多年前由韦特海姆提出，成为宫颈癌手术治疗的经典，使宫颈癌5年存活率达到80％～90％.但该术式损伤大，术后膀胱功能障碍发生70％-85％，影响术后生活。腹腔镜宫颈癌根治神经保留手术可改善宫颈癌术后的膀胱功能，保护腹下神经，是保护膀胱和直肠功能的重要手术环节。如何通过模拟教学以安全有效地方法教导医生，医学生手术技能使得学生在进入手术之前即可接触“病人”，并可在真正的手术中避免手术中此神经的破坏。模拟教学不但需要手术仪器，更重要的是要有模型“病人”。此发明将以解剖平面及可重复操作模拟手术模型作为手术的教学基础，以使学生掌握解剖位置及手术分离技巧，这项发明将会给世界外科手术模拟教学带来新的发展。
Description
一种用于妇科肿瘤腹腔镜手术模拟教学的模型，尤其是对宫颈癌根治神经保留手术的模拟教学的手术平面模型。腹下神经及入盆腔的分支是支配膀胱排尿的主要神经。所述的本发明所涉及腹腔镜模拟教学的手术平面模型，此模型可以用于腹腔镜模拟教学，以明确的解剖平面及模拟教导医生，医医学生如何寻找，分离下腹下神经神经，以避免手术中此神经的破坏.
技术领域
保留神经的根治术：
上世纪初Wertheim提出经腹广泛性子宫切除术(radical hysterectomy)及盆腔淋巴结清扫术，奠定了宫颈癌根治术的基础，成为宫颈癌手术治疗的经典，1950年Meigs进行改良推广后一直沿用至今，使宫颈癌5年存活率达到80％～90％.但该术式损伤大，手术后常出现下尿道和(或)膀胱功能，直肠功能和性功能的障碍，尤其膀胱功能障碍发生率达70％-85％[1]，影响患者宫颈癌术后生活.盆腔神经损伤是造成盆腔脏器功能障碍的主要原因.1921年Okaba-yashi最旱提出盆腔神经保留手术.随后技术也用于直肠癌，前列腺癌根治术.大量临床资料证实該技术可成功保留膀胱功能和性功能.腹腔镜手术神经保护治疗宫颈癌可明显改善术后的膀胱功能，从而大大的提高了子宫切除术手术效果[2].
保护上腹下丛，腹下神經、下腹下丛是保护膀胱和直肠功能的重要手术环节。上腹下丛由交感神经组成的是支配膀胱存储尿液功能的。如果损坏这个神经膀胱将由副交感神经控制，膀胱储尿体积变小，压力增高。下腹下丛由副交感神经神经组成支配排尿功能。如果损坏下腹下丛神经病人将会失去排尿感觉，无法启动排尿。腹下神经连接两个丛。如果它被切断，病人将会有混合的症状， 由最初的膀胱储尿体积变小，压力增高，跟着产生大量残余尿状态。这可能会导致永久保留导尿管。
损伤上腹下丛可以发生分离腹主动脉淋巴结或骶前淋巴结时。尤其是当夹起主韧带或宫骶韧带时，可能会发生下腹下丛神经损伤。下腹下丛损伤也可能会发生在从侧壁分离主韧带时，或从后壁分离膀胱子宫韧带及切除阴道旁组织。详细了解这些神经的解剖及周围血管解剖关系是进行根治术的基础。
模拟教学：
医学是实践性科学.传统的医学教学，是在病人-活人身上教学，或死人-尸体身上教学.医学模拟教学的发展从而改变传统的医学教学，病例模拟教学法，急救护理，技能操作等等.医学模拟教学以其无风险性，操作的可控性和临床病例多样性等优势得到了国际医学教育界的充分认可.近年来模拟教学模型的材料有了很大改善，越来越多好的模型渐渐产生.
如何发展更新更适合外科手术的模型一直在研究探讨中.如何通过模拟教学以安全有效地方法教导医生，医学生手术技能使得学生在进入手术之前即可接触“病人”，并可在真正的手术中顺利找到，安全分离血管，神经，组织，以避免手术中血管神经的破坏及意外损伤。模拟教学不但需要手术仪器设备，更重要的是要有模型-“病人”。良好的模型可使学生熟练掌握解剖位置及手术技巧.以手术解剖平面模型最直观表现手术位置及血管神经关系以模拟手术的真实性，这项发明将会给外科手术模拟教学带来新的发展.
背景技术：
宫颈癌根治术使宫颈癌5年存活率达到80％～90％.如果我们可以成功的切除病人的肿瘤，但是病人手术后大小便储留失禁，这不能给病人一个真正的治愈的希望，因为病人失去了生活质量.
一种可以通过模拟教学的手术平面模型.上腹下丛，腹下神经，下腹下丛(又称盆丛)，盆内脏神经和膀胱的分支的神经保留的根治術手术平面模型.
1.解剖学注意事项，通过手术平面模型了解上腹下丛，腹下神经，下腹下丛(又称盆丛)，盆内脏神经和其膀胱的分支的解剖位置结构，了解支配膀胱主要神经.宮頸癌根治術评估术后膀胱功能的自主神经功能.
2.通过手术平面模型学习術中在處理血管及神经的位置关系，以学习操作血管及神经的分离.
发明内容：
1、腹腔镜妇科肿瘤手术模拟教学的手术平面模型，尤其是对宫颈癌手术神经保护的模拟教学的手术平面模型。
2、通过此模型以明确的手术平面及模拟教导医生，医医学生如何寻找，分离神经，以避免手术中神经的破坏，从而改变传统的在病人-活人身上教学，或死人-尸体身上教学.此手术模拟教学手术平面模型在全世界还没有，这项发明将会给全世界模拟教学带来新的篇章.
附图说明：
图1.模拟结缔组织包绕血管
图2.神经保留根治术神经及血管，输尿管位置手术平面模型图
具体实施方式：
制作图1+2所示：神经保留根治术神经及血管，输尿管位置手术平面模型图手术平面模型。
Claims (3)
1.一种用于腹腔镜手术模拟教学的模型，一种用于妇科肿瘤腹腔镜手术模拟教学的模型，在此基础上可以发展多种手术解剖平面模型，用结构疏松的材料来模拟结缔组织并结合相应器官，血管，神经，淋巴结如图1所示的血管模型，目前虽然有许多电脑仿真的手术模拟，学生可以学到解剖知识但是学不到实际触摸感觉，尤其是手的分离感觉。
2.一种权力要求如1所述的本发明所涉及的妇科肿瘤手术模拟教学的模型，尤其是对宫颈癌神经保留手术的模拟教学的手术平面模型；含有如图2所示的解剖平面；保留盆内臟神經、上腹下丛，腹下神經、下腹下丛(又称盆丛)及其膀胱支是保护膀胱排尿功能的主要神经；以往不论在解剖和宫颈癌手术中对于腹下神经神经保护的忽略，病人术后均有排尿困难，而且需要长期插尿管。
3.按权力要求如1所述的本发明所涉及腹腔镜模拟教学的模型此模型可以用于腹腔镜模拟教学，以模拟结缔组织包绕血管(动脉-红色；静脉-蓝色)；神经(白色)，淋巴结(图1+图2)并以明确的解剖平面(图2)及模拟操作教导医生，医学生如何寻找，分离腹下神经神经其膀胱支，以避免手术中此神经的破坏，影响排尿。
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