基于胸部高分辨率CT的三维重建联合PBL教学法在胸外科临床教学中的应用

贡会源; 李小军; 杨晓松; 张雷; 王彪; 耿阳

doi:10.16766/j.cnki.issn.1674-4152.002607

基于胸部高分辨率CT的三维重建联合PBL教学法在胸外科临床教学中的应用

doi: 10.16766/j.cnki.issn.1674-4152.002607

贡会源¹,
李小军^1, ,,
杨晓松²,
张雷¹,
王彪¹,
耿阳¹

1.
蚌埠医学院第一附属医院胸外科，安徽蚌埠 233004
2.
蚌埠医学院第二附属医院胸外科，安徽蚌埠 233080

基金项目:

安徽省高等学校自然科学研究项目 KJ2020A0575

安徽省中央引导地方科技发展基金项目 2020b07030008

蚌埠医学院校级质量工程重点项目 2020fyjyxm12

详细信息

通讯作者:
李小军, E-mail: 492658765@qq.com

中图分类号: R655 R814.42
计量
- 文章访问数: 176
- HTML全文浏览量: 48
- PDF下载量: 14
- 被引次数: 0
出版历程
- 收稿日期: 2021-11-16
- 网络出版日期: 2022-09-26

The application of 3D reconstruction technology based on high-resolution CT and PBL teaching model in thoracic surgery clinical teaching

1.
Department of Thoracic Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨基于胸部高分辨率CT(HRCT)的三维重建联合基于问题的教学法(PBL)在胸外科临床带教中的应用经验和效果。方法选取2019年12月—2020年10月在蚌埠医学院第一附属医院胸外科实习的60名临床医学专业的本科实习生为研究对象，按随机数字表法分为实验组和对照组，每组各30人。对照组采用常规教学模式进行临床教学, 实验组采用基于胸部HRCT的三维重建联合PBL教学法的教学模式进行临床教学。比较2种教学模式在临床教学中的应用效果。结果实验组理论知识成绩为(80.17±8.43)分，高于对照组的(77.33±13.33)分，差异无统计学意义(P＞0.05)；实验组学生的临床技能考试成绩[(82.90±7.86)分]明显高于对照组[(74.30±4.45)分，P＜0.05]。实验组学生临床思维能力增强[(9.12±0.56)分]、实践能力提升[(9.04±0.52)分]、学习兴趣及满意度[(8.62±1.65)分]、教学模式的认可度[(8.67±1.03)分]等项目评分均高于对照组[(6.72±1.26)分、(7.18±1.24)分、(7.33±1.84)分、(6.10±1.64)分，均P＜0.05]。结论基于胸部HRCT的三维重建联合PBL的教学模式，不仅增加了实习学生的学习兴趣和学习热情，也进一步提升其临床操作技能和综合分析问题的能力，教学效果满意。
- 高分辨率CT /
- 三维重建 /
- 基于问题的教学法 /
- 胸外科 /
- 临床教学
Abstract: Objective To explore the application experience and effect of 3D reconstruction technology based on chest high resolution CT (HRCT) combined with problem-based learning (PBL) in clinical teaching in thoracic surgery. Methods Sixty undergraduate interns in clinical medicine who were interns in the Thoracic Surgery Department at the First Affiliated Hospital of Bengbu Medical College from December 2019 to October 2020 were selected as the research objects. With the informed consent of the students, they were randomly divided into the experimental group and the control group, with 30 persons in each group. The control group was subjected to the conventional teaching mode for clinical teaching, whereas the experimental group adopted the 3D reconstruction technology based on chest HRCT combined with PBL teaching method. The application effects of the two teaching modes in clinical teaching were compared. Results The theoretical knowledge score of the experimental group was (80.17±8.43) points, whereas that of the control group was (77.33±13.33) points, there was no significant difference between the two groups (P>0.05). The clinical skill test scores of the students in the experimental group [(82.90±7.86) points] were significantly higher than those in the control group [(74.30±4.45) points], and the difference was statistically significant (P < 0.05). The students in the experimental group had improved clinical thinking ability [(9.12±0.56) points], improved practical ability [(9.04±0.52) points], improved learning interest and satisfaction [(8.62±1.65) points] and improved recognition degree of the teaching mode [(8.67±1.03) points] than those in the control group. The scores of the items mentioned above were higher than those of the control group [(6.72±1.26) points, (7.18±1.24) points, (7.33±1.84) points and (6.10±1.64) points, all P < 0.05]. Conclusion The 3D reconstruction of chest HRCT combined with PBL teaching mode not only increases the learning interest and enthusiasm of intern students but also improves their clinical operation skills and comprehensive analysis of problems. The teaching mode effect is satisfactory.
- High resolution CT /
- 3D reconstruction /
- Problem-based learning /
- Thoracic surgery /
- Clinical teaching

HTML全文

图 1 肋骨肿瘤三维重建图像及对应CT图像

注：右侧第8肋骨肿瘤(左侧为三维重建图像，右侧为CT横断面图像，箭头部位为肿瘤)。

Figure 1. 3D reconstructed image of rib tumor and corresponding CT image

下载: 全尺寸图片幻灯片

图 2 肺部结节三维重建图像及对应CT图像

注：右上肺结节(左侧为三维重建图像，右侧为CT横断面图像，箭头部位为肺结节)。

Figure 2. Three-dimensional reconstruction of pulmonary nodules and corresponding CT images

下载: 全尺寸图片幻灯片

图 3 肺隔离症三维重建图像及对应CT图像

注：左下肺隔离症(左侧为三维重建图像，右侧为CT横断面图像，箭头部位为源于降主动脉的异常血管)。

Figure 3. Three-dimensional reconstruction image of pulmonary sequestration and corresponding CT image

下载: 全尺寸图片幻灯片

表 1 2组实习生出科考核成绩比较(x ±s，分)

Table 1. The examination results of the two groups of interns were compared(x ±s, scores)

组别	人数	理论知识考核成绩	临床技能考核成绩
实验组	30	80.17±8.43	82.90±7.86
对照组	30	77.33±13.33	74.30±4.45
t值		0.986	5.215
P值		0.328	< 0.001

下载: 导出CSV

表 2 2组实习生对教学模式的问卷调查评分比较(x ±s，分)

Table 2. Comparison of the questionnaire scores of the two groups of interns on the teaching model(x ±s, scores)

组别	例数	临床思维能力增强	临床实践能力提升	文献查阅能力提高	学习兴趣及满意度	教学模式认可度
实验组	30	9.12±0.56	9.04±0.52	7.48±1.53	8.62±1.65	8.67±1.03
对照组	30	6.72±1.26	7.18±1.24	7.10±1.23	7.33±1.84	6.10±1.64
t值		9.534	7.577	1.060	2.836	7.269
P值		< 0.001	< 0.001	0.293	0.008	< 0.001

下载: 导出CSV

参考文献(20)

[1]	李辉, 方文涛. 黄金时代中国胸外科的机遇和挑战[J]. 中华外科杂志, 2019, 57(1): 29-33. LI H, FANG W T. Opportunities and challenges for Chinese thoracic surgery in the golden age[J]. Chinese Journal of Surgery, 2019, 57(1): 29-33.
[2]	李小军. CBL联合PBL的双轨教学法在胸外科临床教学中的应用[J]. 中华全科医学, 2019, 17(8): 1396-1398. doi: 10.16766/j.cnki.issn.1674-4152.000953 LI X J. The application of CBL combined with PBL in thoracic surgery clinical teaching[J]. Chinese Journal of General Practice, 2019, 17(8): 1396-1398. doi: 10.16766/j.cnki.issn.1674-4152.000953
[3]	耿阳, 张雷, 李小军, 等. CBL、PBL联合Paper Review教学在胸外科教学中的应用[J]. 中国继续医学教育, 2021, 13(6): 4-7. doi: 10.3969/j.issn.1674-9308.2021.06.002 GENG Y, ZHANG L, LI X J, et al. Application of CBL and PBL combined with paper review teaching in thoracic surgery teaching[J]. China Continuing Medical Education, 2021, 13(6): 4-7. doi: 10.3969/j.issn.1674-9308.2021.06.002
[4]	许彬东, 黄国忠, 陈豪, 等. 胸心外科临床实习教学的现状与解决方法探讨[J]. 安徽医药, 2018, 22(7): 1427-1430. doi: 10.3969/j.issn.1009-6469.2018.07.055 XU B D, HUANG G Z, CHEN H, et al. Status and consideration on cardiovascular surgery clinical practice teaching[J]. Anhui Medical and Pharmaceutical Journal, 2018, 22(7): 1427-1430. doi: 10.3969/j.issn.1009-6469.2018.07.055
[5]	汪泉, 翟瑄, 李洪波. 对临床医学规范化培训教育和五年制本科临床实习教育的思考[J]. 现代医药卫生, 2020, 36(20): 3335-3338. doi: 10.3969/j.issn.1009-5519.2020.20.047 WANG Q, ZAI X, LI H B. Thoughts on standardized training education of clinical medicine and five-year undergraduate clinical practice education[J]. Journal of Modern Medicine & Health, 2020, 36(20): 3335-3338. doi: 10.3969/j.issn.1009-5519.2020.20.047
[6]	NEVILLE A, NORMAN G, WHITE R. McMaster at 50: Lessons learned from five decades of PBL[J]. Adv Health Sci Educ Theory Pract, 2019, 24(5): 853-863. doi: 10.1007/s10459-019-09908-2
[7]	刘京松. PBL教学法在胸外科临床带教中的应用观察[J]. 软件(教育现代化)(电子版), 2019(7): 174. https://www.cnki.com.cn/Article/CJFDTOTAL-JXUY201832013.htm LIU J S. Application of PBL teaching method in clinical teaching of thoracic surgery[J]. Education Mornization, 2019(7): 174. https://www.cnki.com.cn/Article/CJFDTOTAL-JXUY201832013.htm
[8]	何丹, 初建虎. CBL结合PBL的双轨教学法在胸外科教学中的应用[J]. 继续医学教育, 2020, 34(5): 6-7. https://www.cnki.com.cn/Article/CJFDTOTAL-JYJY202005005.htm HE D, CHU J H. Application of CBL combined with PBL in the teaching of thoracic surgery department[J]. Continuing Medical Education, 2020, 34(5): 6-7. https://www.cnki.com.cn/Article/CJFDTOTAL-JYJY202005005.htm
[9]	任开明, 于泳. PBL结合CBL教学法在胸外科规范化培训中的应用[J]. 中国继续医学教育, 2020, 12(8): 17-19. https://www.cnki.com.cn/Article/CJFDTOTAL-JXUY202008007.htm REN K M, YU Y. Application of PBL combined with CBL teaching method in standardized training of thoracic department[J]. China Continuing Medical Education, 2020, 12(8): 17-19. https://www.cnki.com.cn/Article/CJFDTOTAL-JXUY202008007.htm
[10]	王文凭, 杨玉赏, 陈龙奇. 手术视频联合PBL教学在胸外科实习教学中的应用及探讨[J]. 中国继续医学教育, 2020, 12(14): 40-43. https://www.cnki.com.cn/Article/CJFDTOTAL-JXUY202014015.htm WANG W P, YANG Y S, CHEN L Q. Theapplication of surgical video and PBL teaching model in practical learning at thoracic surgery department[J]. China Continuing Medical Education, 2020, 12(14): 40-43. https://www.cnki.com.cn/Article/CJFDTOTAL-JXUY202014015.htm
[11]	杨晓梅, 马锋, 贾卓奇, 等. 翻转课堂结合PBL教学模式在胸外科临床教学中的应用[J]. 医学教育研究与实践, 2020, 28(5): 900-903. https://www.cnki.com.cn/Article/CJFDTOTAL-XBYX202005045.htm YANG X M, MA F, JIA Z Q, et al. Application of flipped class combined with PBL teaching method in clinical practice teaching in thoracic surgery[J]. Medical Education Research and Practice, 2020, 28(5): 900-903. https://www.cnki.com.cn/Article/CJFDTOTAL-XBYX202005045.htm
[12]	郭艺辉. 医学图像信息可视化关键技术研究与探讨[J]. 电子元器件与信息技术, 2021, 5(5): 216-218. https://www.cnki.com.cn/Article/CJFDTOTAL-DYXU202105096.htm GUO Y H. Research and discussion on the key technology of medical image information visualization[J]. Electronic Component and Information Technology, 2021, 5(5): 216-218. https://www.cnki.com.cn/Article/CJFDTOTAL-DYXU202105096.htm
[13]	刘涛, 牛国旗, 陈辉, 等. 3D打印结合VR技术在经皮椎弓根穿刺教学中的应用效果[J]. 安徽医学, 2021, 42(6): 692-695. https://www.cnki.com.cn/Article/CJFDTOTAL-AHYX202106028.htm LIU T, NIU G Q, CHEN H, et al. The application effect of 3D printing combined virtual reality (VR) technology in teaching of percutaneous pedicle puncture[J]. Anhui Medical Journal, 2021, 42(6): 692-695. https://www.cnki.com.cn/Article/CJFDTOTAL-AHYX202106028.htm
[14]	游杰, 张国中, 高祥龙, 等. PET/CT联合CT三维重建在鉴别早期肺腺癌不同病理亚型中的价值[J]. 中国肺癌杂志, 2021, 24(7): 468-474. https://www.cnki.com.cn/Article/CJFDTOTAL-FAIZ202107003.htm YOU J, ZHANG G Z, GAO X L, et al. Value of PET/CT combined with CT three-dimensional reconstruction in distinguishing different pathological subtypes of early lung adenocarcinoma[J]. Chinese Journal of Lung Cancer, 2021, 24(7): 468-474. https://www.cnki.com.cn/Article/CJFDTOTAL-FAIZ202107003.htm
[15]	喻海波, 黄海锋, 张二勇. 三维可视化技术在外科诊治Mirizzi综合征中的应用[J]. 肝胆胰外科杂志, 2020, 32(8): 479-483. https://www.cnki.com.cn/Article/CJFDTOTAL-GDYW202008009.htm YU H B, HUANG H F, ZHANG E Y. Application of three-dimensional visualization in surgical diagnosis and treatment for Mirizzi syndrome[J]. Journal of Hepatopancreatobiliary Surgery, 2020, 32(8): 479-483. https://www.cnki.com.cn/Article/CJFDTOTAL-GDYW202008009.htm
[16]	崔庆赢, 陈思宇, 聂焱, 等. Mimics软件在牙槽突裂骨移植术前骨缺损量评估中的应用[J]. 昆明医科大学学报, 2019, 40(10): 27-31. https://www.cnki.com.cn/Article/CJFDTOTAL-KMYX201910010.htm CUI Q Y, CHEN S Y, NIE Y, et al. Application of Mimics calculating the volume of alveolar cleft defect before surgery[J]. Journal of Kunming Medical University, 2019, 40(10): 27-31. https://www.cnki.com.cn/Article/CJFDTOTAL-KMYX201910010.htm
[17]	史文松, 常国涛, 郑慧禹, 等. 三维重建在胸外科教学的应用[J]. 中国保健营养, 2020, 30(9): 32-33. https://www.cnki.com.cn/Article/CJFDTOTAL-JXUY202112018.htm SHI W S, CHANG G T, ZHENG H Y, et al. Application of 3D reconstruction in thoracic surgery[J]. China Health Care & Nutrition, 2020, 30(9): 32-33. https://www.cnki.com.cn/Article/CJFDTOTAL-JXUY202112018.htm
[18]	常浩, 冯敏, 杨依迪, 等. 基于薄层CT的三维重建技术在胸外科教学中的应用[J]. 中国继续医学教育, 2021, 13(12): 65-69. https://www.cnki.com.cn/Article/CJFDTOTAL-JXUY202112018.htm CHANG H, FENG M, YANG Y D, et al. Application of three-dimensional reconstruction technology based on thin layer CT in thoracic surgery teaching[J]. China Continuing Medical Education, 2021, 13(12): 65-69. https://www.cnki.com.cn/Article/CJFDTOTAL-JXUY202112018.htm
[19]	张晋, 孙良璋. 三维重建技术在肺肿瘤临床教学中的应用探讨[J]. 中国继续医学教育, 2017, 9(26): 34-35. https://www.cnki.com.cn/Article/CJFDTOTAL-JXUY201726020.htm ZHANG J, SUN L Z. The application of three-dimensional reconstruction in lung tumor clinical teaching[J]. China Continuing Medical Education, 2017, 9(26): 34-35. https://www.cnki.com.cn/Article/CJFDTOTAL-JXUY201726020.htm
[20]	于跃, 王伟, 叶俊, 等. 三维影像重建技术在胸外科规培生肺段解剖教学中的应用研究[J]. 科技视界, 2019(1): 180-181. https://www.cnki.com.cn/Article/CJFDTOTAL-KJSJ201901077.htm YU Y, WANG W, YE J, et al. Application of three-dimensional imaging reconstruction technology in the teaching of pulmonary segmental anatomy for standardization training residents in the department of thoracic surgery[J]. Science & Technology Vision, 2019(1): 180-181. https://www.cnki.com.cn/Article/CJFDTOTAL-KJSJ201901077.htm