基于虚拟现实的增强现实技术在肝胆胰外科教学中的应用

doi:10.3877/cma.j.issn.1674-6899.2023.03.004

目的

探讨基于虚拟现实(virtual reality，VR)的增强现实(augmented reality，AR)技术在肝胆胰外科教学中的应用效果。

方法

选取2021年5月至2022年5月解放军总医院第一医学中心肝胆胰外科医学部规培研究生100名作为本次教学研究对象，按照随机数字表法将学生分成试验组(50名)和对照组(50名)。其中对照组学生采用传统的教学模式，试验组采用基于VR的AR技术进行教学，使用教学评估量表对两组学生的教学指标(基础理论知识、生理解剖、临床思维能力)进行评估对比，对两组学生的临床操作技能进行评价，并采用问卷调查表评价两组教学效果满意度。

结果

两组考核成绩评分显示，试验组在基础理论知识、生理解剖、临床思维能力方面均优于对照组(P<0.05)，总成绩明显高于照组(P<0.05)。通过对比得出，试验组学生的各项临床操作技能评分均高于对照组(P<0.05)。问卷调查显示，试验组学生在提高肝胆胰外科学习兴趣、临床实践能力、检索和查阅文献能力及理论应用临床能力等方面评分均高于对照组(P<0.05)，差异均有统计学意义。

结论

肝胆胰外科的教学难度相对较大，基于VR的AR技术教学模式在临床教学中具备独特优势，能够显著提升教学效果，进一步提高医学生的专业理论水平和临床实践技巧，并能够培养学生良好的学习兴趣和临床思维能力，值得借鉴参考。

关键词: 虚拟现实技术, 增强现实技术, 肝胆胰外科教学, 应用探讨

Objective

To explore the application effect of augmented reality (AR) technology based on virtual reality (VR) in the teaching of hepatobiliary surgery.

Methods

A total of 100 graduate students from the Department of Hepatobiliary Surgery in our hospital from May 2021 to May 2022 were selected as the teaching research objects, and were divided into experimental group (50 students) and control group (50 students) according to the random number table method. The control group adopted the traditional teaching mode, and the experimental group adopted the augmented reality technology based on virtual reality for teaching. The teaching evaluation scale was used to evaluate and compare the teaching indicators of the two groups of students, including basic theoretical knowledge, physiological anatomy and clinical thinking ability. The clinical operation skills of the two groups of students were evaluated and the satisfaction of the teaching effect of the two groups was evaluated by questionnaire.

Results

The test scores of the two groups showed that the experimental group was superior to the control group in basic theoretical knowledge, physiological anatomy and clinical thinking ability (P< 0.05), and the total score was significantly higher than the control group (P< 0.05). The results showed that the scores of clinical operation skills of experimental group were higher than those of control group (P< 0.05). According to the questionnaire survey, the scores of students in the experimental group were higher than those in the control group in terms of improving their interest in hepatobiliary surgery, clinical practice ability, literature retrieval ability and theoretical application ability (P< 0.05), and the differences between the two groups were statistically significant.

Conclusions

The teaching of hepatobiliary surgery is relatively difficult. The teaching mode of augmented reality technology based on virtual reality has unique advantages in clinical teaching, which can significantly improve the teaching effect, further improve the professional theoretical level and clinical practice skills of medical students, and cultivate students' good learning interest and clinical thinking ability, which is worthy of reference.

Key words: Virtual reality technology, Augmented reality, Hepatobiliary surgery teaching, Application discussion

图1 肝胆外科手术规划工作站

图2 AR协同系统

图3 手术视频实时输出系统

图4 手术录像点评再学习

表1 两组学生出科考核成绩比较(分，

±s)

组别	例数	入科前测试成绩	基础理论知识	生理解剖	临床思维能力	总成绩
试验组	50	65.88±4.16	37.12±1.27	38.33±2.69	18.58±2.89	94.03±5.31
对照组	50	63.46±3.94	36.43±1.45	32.26±1.72	13.76±1.76	82.62±4.07
t值		0.971	2.531	13.443	10.072	12.059
P值		0.383	0.013	<0.001	<0.001	<0.001

表1 两组学生出科考核成绩比较(分，

±s)

组别	例数	入科前测试成绩	基础理论知识	生理解剖	临床思维能力	总成绩
试验组	50	65.88±4.16	37.12±1.27	38.33±2.69	18.58±2.89	94.03±5.31
对照组	50	63.46±3.94	36.43±1.45	32.26±1.72	13.76±1.76	82.62±4.07
t值		0.971	2.531	13.443	10.072	12.059
P值		0.383	0.013	<0.001	<0.001	<0.001

表2 两组临床操作技能评分(分，

±s)

组别	例数	入科前成绩	主观评价	肝胆解剖	肝段解剖	病灶解剖	手术模拟	总分
试验组	50	52.88±1.15	19.17±1.33	19.62±2.15	19.02±3.56	19.42±2.62	19.68±2.31	±
对照组	50	54.01±2.508	17.33±2.07	18.53±2.32	16.97±2.87	16.53±2.45	15.36±3.07	±
t值		0.448	5.288	2.437	3.170	5.697	7.951
P值		0.6605	<0.001	0.017	0.002	<0.001	<0.001

表2 两组临床操作技能评分(分，

±s)

组别	例数	入科前成绩	主观评价	肝胆解剖	肝段解剖	病灶解剖	手术模拟	总分
试验组	50	52.88±1.15	19.17±1.33	19.62±2.15	19.02±3.56	19.42±2.62	19.68±2.31	±
对照组	50	54.01±2.508	17.33±2.07	18.53±2.32	16.97±2.87	16.53±2.45	15.36±3.07	±
t值		0.448	5.288	2.437	3.170	5.697	7.951
P值		0.6605	<0.001	0.017	0.002	<0.001	<0.001

表3 两组各项教学效果评价比较

内容		试验组(n＝50)	对照组(n＝50)	χ²值	P值
提高肝胆胰外科学习兴趣	是	39	26	7.429	0.006
	否	11	24
提高临床实践能力	是	41	27	9.007	0.003
	否	9	23
提高检索和查阅文献能力	是	42	33	4.320	0.038
	否	8	17
提高理论应用临床能力	是	46	37	5.741	0.017
	否	4	13

表3 两组各项教学效果评价比较

内容		试验组(n＝50)	对照组(n＝50)	χ²值	P值
提高肝胆胰外科学习兴趣	是	39	26	7.429	0.006
	否	11	24
提高临床实践能力	是	41	27	9.007	0.003
	否	9	23
提高检索和查阅文献能力	是	42	33	4.320	0.038
	否	8	17
提高理论应用临床能力	是	46	37	5.741	0.017
	否	4	13

1	史俊芬，李芳. 分阶段目标教学法在肝胆外科护理教学中的应用[J]．内蒙古医科大学学报，2020(S2)：3.
2	Chamberlain RS, Klaassen Z, Paragi PR. Complex hepatobiliary surgery in the community setting: is it safe and feasible？[J]. Am J Surg, 2011, 202(3)：273-280.
3	文韬，邵月，汪克建，等. 基于问题教学法联合讨论会模式在肝胆外科规培生临床能力培养中的应用研究[J]. 重庆医学，2019, 48(12)：2151-2153.
4	Mao RQ, Lan L, Kay J, et al. Immersive virtual reality for surgical training: a systematic review[J]. J Surg Res, 2021, 268：40-58.
5	Fang CH, Zhang P, Lau YY, et al. From digital virtual human, three-dimensional visualization to digital intelligence in liver surgery[J]. Zhonghua Wai Ke Za Zhi, 2020, 58(1)：17-21.
6	Joda T, Gallucci GO, Wismeijer D, et al. Augmented and virtual reality in dental medicine: A systematic review[J]. Comput Biol Med, 2019, 108：93-100.
7	Tsilimigras DI, Pawlik TM, Moris D. Textbook outcomes in hepatobiliary and pancreatic surgery[J]. World J Gastroenterol, 2021, 27(15)：1524-1530.
8	Agranat JS, Miller JB, Douglas VP, et al. The scope of three-dimensional digital visualization systems in vitreoretinal surgery[J]. Clin Ophthalmol, 2019, 13：2093-2096.
9	Shuhaiber JH. Augmented reality in surgery[J]. Arch Surg, 2004, 139(2)：170-174.
10	Qiang M, Zhang K, Chen Y, et al. Computer-assisted virtual surgical technology in pre-operative design for the reconstruction of calcaneal fracture malunion[J]. Int Orthop, 2019, 43(7)：1669-1677.
11	Chen L, Zhang F, Zhan W, et al. Optimization of virtual and real registration technology based on augmented reality in a surgical navigation system[J]. Biomed Eng Online, 2020, 19(1)：1.
12	Thornblade LW, Fong Y. Simulation-based training in robotic surgery: contemporary and future methods[J]. J Laparoendosc Adv Surg Tech A, 2021, 31(5)：556-560.
13	Guo Y, Li M, Zhang X, et al. The usefulness of three-dimensional ultrasound fusion imaging for precise needle placement in liver thermal ablation: a phantom and an in vivo simulation study[J]. Int J Hyperthermia, 2022, 39(1)：564-571.
14	Budjan J, Schoenberg SO, Riffel P. Fast abdominal magnetic resonance imaging[J]. Rofo, 2016, 188(6)：551-558.
15	Huber T, Hanke LI, Boedecker C, et al. Patient-individualized resection planning in liver surgery using 3D print and virtual reality (i-LiVR)-a study protocol for a prospective randomized controlled trial[J]. Trials, 2022, 23(1)：403.
16	刘荣，赵国栋，孙玉宁，等. 5G远程机器人手术动物实验研究[J/CD]. 中华腔镜外科杂志(电子版), 2019, 12(1)：45-48.
17	李宬润，马永富，梁朝阳，等. 三维虚拟现实导航胸腔镜下肺叶切除技术初探[J/CD]. 中华腔镜外科杂志(电子版), 2016, 9(5)：307-309.
18	Dirven S, Allen JE. Physical and virtual modelling of the head and neck for surgical simulation and training[J]. Curr Opin Otolaryngol Head Neck Surg, 2016, 24(6)：463-468.
19	Iskander M, Ogunsola T, Ramachandran R, et al. Virtual reality and augmented reality in ophthalmology: a contemporary prospective[J]. Asia Pac J Ophthalmol (Phila), 2021, 10(3)：244-252.

[1]	吴雁格, 阿依宝塔·沙那别克, 周璐平, 吕嘉怡, 郑庆华, 王诗达, 王亚. Simodont系统辅助照明条件对口腔临床技能训练的影响[J]. 中华口腔医学研究杂志(电子版), 2020, 14(06): 377-383.
[2]	范晔, 郭洁汝, 王旖旎, 赵静, 张椿. 虚拟现实技术辅助胸部战创伤分级救治模式[J]. 中华肺部疾病杂志(电子版), 2021, 14(02): 256-258.
[3]	马良飞, 尹翎, 方婷, 曾西西, 佟佳璇, 马献昆. 重复经颅磁刺激联合虚拟现实技术对脑卒中后认知障碍的影响[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(06): 346-351.
[4]	余程冬, 朱东东. 虚拟现实技术在脑卒中后康复中的研究进展[J]. 中华脑科疾病与康复杂志(电子版), 2022, 12(03): 178-182.
[5]	王晶, 卫哲. 虚拟现实技术结合注意力训练法促进脑卒中功能康复的研究[J]. 中华脑科疾病与康复杂志(电子版), 2019, 09(05): 267-270.
[6]	黄爱茹, 付婧, 余茜. 多模块3D虚拟现实技术联合重复经颅磁刺激治疗卒中后认知功能障碍的效果[J]. 中华临床医师杂志(电子版), 2022, 16(11): 1089-1095.
[7]	党宝齐, 高凡, 袁媛, 陆明. 基于虚拟现实技术的功能锻炼对术后脑出血患者神经功能康复的作用[J]. 中华临床医师杂志(电子版), 2022, 16(01): 43-47.
[8]	张巍, 郝明, 王琨, 柴伟, 唐佩福. 中国骨科医师教育模式的变迁[J]. 中华临床医师杂志(电子版), 2017, 11(11): 1912-1916.
[9]	常飞飞, 曹迎春, 吴晓冰, 王晓涵. 基于虚拟现实技术任务导向性训练对脑卒中多病共存患者功能状态的影响[J]. 中华脑血管病杂志(电子版), 2023, 17(02): 124-129.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

The application of virtual reality-based augmented reality technology in hepatobiliary and pancreatic surgery education

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

The application of virtual reality-based augmented reality technology in hepatobiliary and pancreatic surgery education