目的:探讨 3D 打印手术训练模型在机器人辅助腹腔镜泌尿外科手术术前访视中的应用效果。方法:选取 2023 年 4 月—2023 年 9 月浙江省人民医院接受机器人辅助腹腔镜泌尿外科手术的 150 例患者,并按照收治的时间顺序分组。2023 年 4 月—2023 年 6 月收治的 74 例患者纳入对照组,2023 年 7 月—2023 年 9 月收治的 76 例患者纳入观察组。观察组采用 3D 打 印手术训练模型联合口述及视频宣教术前访视模式,对照组采用口述及视频宣教术前访视模式。比较两组患者访视前、麻 醉诱导前焦虑与信息需求评分,以及术前 1 d 6:00(T0)、术日早上 6:00(T1)、术后第 1 d 6:00(T2)、术后第 3 d 6:00(T3)不同时间点血清白细胞介素 6(IL-6)、血管紧张素Ⅱ(Ang Ⅱ)、促肾上腺皮质激素(ACTH)、皮质醇(Cor)、 平均动脉压(MAP)、心率(HR)各生理应激指标变化;比较两组患者访视前、麻醉诱导前手术认知度及术前准备完善率。 结果:麻醉诱导前,观察组的焦虑和手术信息需求评分低于对照组,且观察组麻醉诱导前的评分低于访视前(P<0.001)。 与术前时间点相比,两组患者术后各时间点的各指标呈下降趋势;与对照组比较,观察组在 T1 时间点的 IL-6、Ang Ⅱ、 ACTH、Cor、MAP 及 HR 各生理应激指标更低(P<0.05),在 T0、T2、T3 时间点各指标的数值相近(P>0.05);两组组内 各生理应激指标总体分布存在统计学差异(P<0.001)。麻醉诱导前观察组手术认知度高于对照组,观察组术前准备完善率 优于对照组(P<0.05)。结论:3D 打印手术训练模型联合口述及视频宣教的术前访视模式能有效降低机器人辅助腹腔镜泌 尿外科手术患者的心理应激反应和生理应激反应,提高患者手术认知度及术前准备完善率。
Objective: To explore the application effect of 3D printing surgical training models in the preoperative assessment of robotassisted laparoscopic urologic surgery. Methods: 150 patients who underwent robot-assisted laparoscopic urological surgery in Zhejiang Provincial People’s Hospital from April 2023 to September 2023 were selected, and 74 of them from April 2023 to June 2023 were assigned to the control group (oral and video health education), While 76 of them from July 2023 to September 2023 were assigned to the observation group (3D printed surgical training model combined with oral and video health education). The preoperative anxiety and information demand scores were compared between the two groups. The scores of anxiety and information demand before the visit and anesthesia induction, as well as the physiological stress indicators including interleukin 6 (IL-6), angiotensin Ⅱ (Ang Ⅱ ), adrenocorticotropic hormone (ACTH), cortisol (Cor), average arterial pressure (MAP), and heart rate (HR) at 6 a.m. 1 d before surgery (T0), day of surgery (T1), 1 d after surgery (T2), and 3 d after surgry (T3) were compared between the two groups. The surgical awareness and perfection rate of preoperative preparation before the visit and induction of anesthesia were also compared between the groups. Results: Before the induction of anesthesia, the scores of anxiety and surgical information demand in the observation group were lower than those in the control group, and the above scores of the observation group before the induction of anesthesia were lower than those before the visit (P<0.001). Compared with that before surgery, indicators in the two groups showed a decreasing trend at postoperative timepoints. Compared with the control group, the physiological stress indicators of IL- 6, Ang Ⅱ , ACTH, Cor, MAP, and HR were lower in the observation group at the T1 timepoint (P<0.05), and the they were similar at the T0, T2, and T3 timepoints (P>0.05). The distribution of overall physiological stress indicators was statistically different in both groups (P<0.001). Before the induction of anesthesia, the surgical awareness and the perfection rate of preoperative preparation were higher in the observation group than those in the control group (P<0.05). Conclusion: 3D printing surgical training model combined with oral and video health education can effectively reduce the psychological and physiological stress responses of patients who underwent robot-assisted laparoscopic urological surgery, improve their surgical awareness, and enhance the preparation rate before surgery.
基金项目:浙江省医药卫生科技计划项目(2024KY035)
Foundation Item: Medical and Health Technology Plan Project of Zhejiang Province(2024KY035)
引用格式:喻晓芬,何茫茫,袁琳琳 .3D 打印手术训练模型在机器人辅助腹腔镜泌尿外科手术术前访视中的应用研究 [J]. 机器人外科学杂志 (中英文),2025,6(3):421-426.
Citation: YU X F, HE M M, YUAN L L. Application of 3D printing surgical training models in the preoperative assessment of robot-assisted laparoscopic urologic surgery[J]. Chinese Journal of Robotic Surgery, 2025, 6(3): 421-426.
通讯作者(Corresponding Author):喻晓芬(YU Xiaofen),Email:yxf4800@163.com
[1] Larach J T, Flynn J, Tew M, et al. Robotic versus laparoscopic proctectomy: a comparative study of short‑term economic and clinical outcomes[J]. Int J Colorectal Dis, 2023, 38(1): 161.
[2] Zong L, Seto Y, Aikou S, et al. Efficacy evaluation of subtotal and total gastrectomies in robotic surgery for gastric cancer compared with that in open and laparoscopic resections: a Meta‑analysis[J]. PLoS One, 2014, 9(7): e103312.
[3] GU L, YIN C, JIA T, et al. Robotic surgery in China[J]. Innovation (Camb), 2023, 4(5): 100499.
[4] 王林辉 . 机器人辅助腹腔镜技术在泌尿外科的临床应用 : 中国 15 年 数据分析 [J]. 第二军医大学学报 , 2020, 41(7): 697-700.
[5] Gabriel, Ogaya-Piniés. Current status of robotic surgery in urology [J]. Archivos Espanoles De Urologia, 2019, 72(3): 225-226.
[6] Panteleimonitis S, Pickering O, Ahmad M, et al. Robotic rectal cancer surgery results from a European multicentre case series of 240 resections and comparative analysis between cases performed with the Da Vinci Si and Xi systems[J].Laparoscopic, Endoscopic and Robotic Surery, 2020, 3(1): 6-11.
[7] Eastwood D, Manson N, Bigney E, et al. Improving postoperative patient reported benefifits and satisfaction following spinal fusion with a single preoperative education session [J]. Spine J, 2019, 19(5): 840-845.
[8] 余霞 , 朱泉 , 刘一卓 . 基于多学科协作模式的术前访视对初次手术患 者心理应激的影响 [J]. 中国实用护理杂志 , 2019, 35(31): 2417-2422.
[9] 高真真 . 聚焦解决模式联合微视频在达芬奇机器人宫颈癌根治术病 人术前访视中的应用效果 [J]. 全科护理 , 2022, 20(27): 3821-3823.
[10] 丁亚云 , 徐爱娟 . 手机移动视频在术前访视护理中的应用 [J]. 解放军 护理杂志 , 2018, 35(19): 75-76.
[11] 牛会鹏 . 多媒体技术联合健康教育应用于术前访视对手术患者心 理状态及应激反应的影响 [J]. 齐齐哈尔医学院学报 , 2020, 41(10): 1294-1296.
[12] 徐艳杰 , 郭劲峰 , 向承红 , 等 . 多媒体式术前访视在腹腔镜无张力腹 股沟疝患者的应用 [J/CD]. 中华疝和腹壁外科杂志 ( 电子版 ), 2020, 14(1): 87-89.
[13] 喻晓芬 , 洪敏 , 蒋怡 , 等 . 品管圈活动在患者术前访视中的应用 [J]. 中华现代护理杂志 , 2013, 19(22): 2697-2701.
[14] 喻晓芬 , 王知非 . 医护团队仿真模拟配合机器人手术的方法及效 果 [J]. 中华护理杂志 , 2016, 51(8): 943-946.
[15] 喻晓芬 , 何茫茫 . 模块化培训模式在机器人手术配合训练中的应 用 [J]. 机器人外科学杂志 ( 中英文 ), 2022, 3(3): 217-223.
[16] 吴昊 , 刘延军 , 马正良 , 等 . 阿姆斯特丹术前焦虑与信息量表中文版 的信效度研究 [J]. 中华行为医学与脑科学杂志 , 2016, 25(2): 179-182.
[17] 高长青 , 杨明 , 王刚 , 等 . 全机器人不开胸心脏手术 4 例 [J]. 中华胸 心血管外科杂志 , 2007, 23(1): 19-21.
[18] Westborg I, Monestam E. Optimizing number of postoperative visits after cataract surgery: safety perspective[J]. J Cataract Refract Surg, 2017, 43(9): 1184-1189.
[19] 姚冲 , 高兴莲 , 王曾妍 , 等 . 基于 APP 移动信息技术在手术患者术 前访视临床实践与效果分析 [J]. 中国实用护理杂志 , 2017, 33(20): 1535-1539.
[20] 闫凯凯 , 付秀荣 , 张彩虹 , 等 . 微信平台在达芬奇机器人辅助腹腔 镜前列腺癌根治术患者术前访视的应用效果 [J]. 国际护理学杂志 , 2019, 38(16): 2500-2502, 2559.
[21] 陈小娣 , 沈波 , 陆佳音 , 等 . 手术流程微电影在术前访视中的应用及 效果评价 [J]. 护理与康复 , 2015, 14(12): 1176-1177.
[22] Sandberg E H, Sharma R, Wiklund R, et al.Clinicians consistently exceed a typical person’s short-term memory during preoperative teaching[J]. Anesthesia & Analgesia, 2008, 107(3): 972-978.
[23] Szameitat A J, Saylik R, Parton A.Neuroticism related differences in the functional neuroanatomical correlates of multitasking.An fMRI study[J]. Neuroscience Letters, 2016, 635(2): 51-55.
[24] PAN Y S, HU Y F, TIAN F B, et al.Effects of epidural preemptive analgesia on stress reaction in retroperitoneal laparoscopic adrenalectomy surgery: a randomized controlled study[J].Int J Clin Exp Med, 2015, 8(6): 9862-9868.
[25] 唐彪 , 欧阳正晟 . 腹腔镜下肝切除术的临床疗效及对细胞免疫功能 的影响 [J]. 腹腔镜外科杂志 , 2017, 22(9): 648-652.
[26] Nirvanappa A C, Mohan C D, Rangappa S, et al. Novel synthetic oxazines target NF-κB in colon cancer in vitro and inflammatory bowel disease in vivo[J]. PLoS One, 2017, 12(4): e0175659.
[27] 李燕姿 , 梅娜 , 高明芳 , 等 . 标准化术前访视及心理干预对择期手术 患者心理的影响 [J]. 中国医学伦理学 , 2015, 28(6): 983-985.
[28] YUAN X, LIU X, JING Q, et al.The application of full-size threedimensional individual printed model combined with three-dimensional digital demonstration can facilitate patient’s preoperative comprehension to robotic-assisted laparoscopic partial nephrectomy[J].Perioper Med (Lond), 2022, 11(1): 22-30.
[29] GUO H C, WANG Y, DAI J, et al.Application of 3D printing in the surgical planning of hypertrophic obstructive cardiomyopathy and physician-patient communication: a preliminary study[J].J Thorac Dis, 2018, 10(2): 867-873.
[30] 王心菀 , 喻晓芬 .3D 打印手术训练模型在微创肝脏手术术前医患沟 通中的应用 [J]. 浙江临床医学 , 2024, 26(26): 1211-1214.