Department of General Surgery, University of Utah, 30 North 1900 East, Salt Lake City, Utah. 84132, USA.
World J Surg. 2011 Apr;35(4):751-9. doi: 10.1007/s00268-011-0965-2.
Although laparoscopic cholecystectomy was first introduced in Mongolia in 1994, the benefits of the laparoscopic approach have been largely unavailable to the majority of the population. The burden of gallbladder disease in Mongolia is significant. Despite the barriers to expanding laparoscopic surgery in Mongolia (lack of physical resources and adequate training opportunities, a difficult political situation, and an austere environment), the Health Sciences University of Mongolia (HSUM) began looking for ways to further the development of laparoscopy for the entire country, including the rural areas where half the population resides.
Combined didactic and practical training courses lasting 2 weeks were developed collaboratively by a private nongovernmental organization and HSUM. The courses were taught at tertiary care centers in the capital city (Ulaanbaatar) and in a smaller, rural city (Erdenet), the regional northern referral center. Demographic data, preoperative diagnosis, ultrasound and operative findings, operative times, length of hospital stay, and intraoperative and postoperative complication rates were compared from 2007-2008 from hospitals in Ulaanbaatar and Erdenet.
A total of 36 surgeons participated in the training classes, and a total of 410 laparoscopic cholecystectomies were performed. Ultrasound was used as a diagnostic tool in all cases. There was no significant difference in intraoperative or postoperative complications between hospitals in the capital, where the procedures were performed by skilled laparoscopic surgeons, and in Erdenet, where the training courses first introduced laparoscopic cholecystectomy. Neither were there differences in complication rates between cases during the teaching and nonteaching periods.
Laparoscopic cholecystectomy can be expanded safely to the regional diagnostic referral centers in rural Mongolia through short-term training courses as a method to markedly improve access and outcomes for the 50% of the country previously denied the benefits of minimally invasive surgery.
尽管腹腔镜胆囊切除术于 1994 年在蒙古首次引入，但大部分人仍无法从中受益。胆囊疾病在蒙古的负担很大。尽管蒙古在扩大腹腔镜手术方面存在障碍（缺乏物质资源和充足的培训机会、困难的政治局势和严峻的环境），但蒙古健康科学大学（HSUM）开始寻找方法，为包括居住在农村地区的一半人口在内的全国推广腹腔镜手术。
由一家私立非政府组织和 HSUM 合作开发了为期两周的理论与实践相结合的培训课程。这些课程在首都乌兰巴托（Ulaanbaatar）和较小的农村城市额尔德尼（Erdenet），即地区北部转诊中心的三级保健中心教授。从 2007 年至 2008 年，比较了乌兰巴托和额尔德尼医院的数据，包括人口统计学数据、术前诊断、超声和手术结果、手术时间、住院时间以及术中术后并发症发生率。
共有 36 名外科医生参加了培训课程，共进行了 410 例腹腔镜胆囊切除术。所有病例均使用超声作为诊断工具。在首都熟练腹腔镜外科医生实施手术的医院与首次引入腹腔镜胆囊切除术的额尔德尼医院之间，术中或术后并发症无显著差异。在教学和非教学期间，病例的并发症发生率也没有差异。
通过短期培训课程，可以将腹腔镜胆囊切除术安全扩展到蒙古农村地区的区域诊断转诊中心，从而显著改善该国 50%以前无法接受微创手术益处的人群的获得途径和结果。
