MRC Tropical Epidemiology Group, Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
BMC Urol. 2010 Feb 16;10:2. doi: 10.1186/1471-2490-10-2.
Approximately one in three men are circumcised globally, but there are relatively few data on the safety of the procedure. The aim of this paper is to summarize the literature on frequency of adverse events following pediatric circumcision, with a focus on developing countries.
PubMed and other databasess were searched with keywords and MeSH terms including infant/newborn/pediatric/child, circumcision, complications and adverse events. Searches included all available years and were conducted on November 6th 2007 and updated on February 14th 2009. Additional searches of the Arabic literature included searches of relevant databases and University libraries for research theses on male circumcision.Studies were included if they contained data to estimate frequency of adverse events following neonatal, infant and child circumcision. There was no language restriction. A total of 1349 published papers were identified, of which 52 studies from 21 countries met the inclusion criteria. The Arabic literature searches identified 46 potentially relevant papers, of which six were included.
Sixteen prospective studies evaluated complications following neonatal and infant circumcision. Most studies reported no severe adverse events (SAE), but two studies reported SAE frequency of 2%. The median frequency of any complication was 1.5% (range 0-16%). Child circumcision by medical providers tended to be associated with more complications (median frequency 6%; range 2-14%) than for neonates and infants. Traditional circumcision as a rite of passage is associated with substantially greater risks, more severe complications than medical circumcision or traditional circumcision among neonates.
Studies report few severe complications following circumcision. However, mild or moderate complications are seen, especially when circumcision is undertaken at older ages, by inexperienced providers or in non-sterile conditions. Pediatric circumcision will continue to be practiced for cultural, medical and as a long-term HIV/STI prevention strategy. Risk-reduction strategies including improved training of providers, and provision of appropriate sterile equipment, are urgently needed.
全球约有三分之一的男性接受过割礼，但关于该手术安全性的数据相对较少。本文旨在总结儿童割礼后不良事件的文献，重点关注发展中国家。
使用关键词和 MeSH 术语在 PubMed 和其他数据库中进行搜索，包括婴儿/新生儿/儿科/儿童、割礼、并发症和不良事件。搜索包括所有可用年份，并于 2007 年 11 月 6 日进行，并于 2009 年 2 月 14 日更新。对阿拉伯文献的额外搜索包括对相关数据库和大学图书馆中有关男性割礼的研究论文的搜索。如果研究包含有关新生儿、婴儿和儿童割礼后不良事件频率的估计数据，则将其纳入研究。没有语言限制。共确定了 1349 篇已发表的论文，其中 52 项来自 21 个国家的研究符合纳入标准。对阿拉伯文献的搜索确定了 46 篇可能相关的论文，其中 6 篇被纳入。
16 项前瞻性研究评估了新生儿和婴儿割礼后的并发症。大多数研究报告没有严重不良事件（SAE），但有两项研究报告 SAE 频率为 2%。任何并发症的中位数频率为 1.5%（范围 0-16%）。医疗服务提供者进行的儿童割礼往往与更多的并发症相关（中位数频率为 6%；范围 2-14%），而不是新生儿和婴儿。作为成年礼的传统割礼与更大的风险相关，与医疗割礼或新生儿的传统割礼相比，并发症更严重。
研究报告割礼后发生严重并发症的情况较少。然而，尤其是在年龄较大时、由经验不足的提供者进行或在非无菌条件下进行时，会出现轻度或中度并发症。儿科割礼将继续作为一种文化、医疗和长期 HIV/性传播感染预防策略进行。迫切需要采取减少风险的策略，包括提高提供者的培训和提供适当的无菌设备。
