Rakai Health Sciences Programme, Makerere University Kampala (MUK), School of Public Health, Kampala, Uganda.
BJU Int. 2012 Jan;109(1):104-8. doi: 10.1111/j.1464-410X.2011.10259.x. Epub 2011 May 31.
To assess the safety and efficiency of the dorsal slit and sleeve male circumcision (MC) procedures performed by physicians and clinical officers (COs).
We evaluated the time required for the MC procedure (efficiency) and moderate/severe adverse events (AEs) for MC (safety) by trained physicians and COs using the sleeve and dorsal slit MC methods in a service programme. Univariate and multiple regressions with robust variance estimation were used to assess factors associated with operative duration (linear) and AEs (logistic).
Six physicians and eight COs conducted 1934 and 3218 MCs, respectively; there were 2471 dorsal slit and 2681 sleeve MC procedures. The overall mean operative duration was 33 min for newly trained providers, which decreased to ≈20 min after ≈100 MCs. The adjusted mean operative duration for dorsal slit MC was significantly shorter than that for the sleeve MC method (Δ - 2.7 min, P < 0.001). The operative duration was longer for COs than physicians for the sleeve procedure, but not the dorsal slit procedure; however this difference reduced with increasing numbers of MCs completed. The unadjusted AE rates were 0.6% for dorsal slit MC and 1.4% for the sleeve method (P = 0.006) and 1.5% for physicians and 0.68% for COs (P = 0.003); however, there were no significant differences after multivariate adjustment. Use of bipolar cautery significantly reduced operative duration (Δ - 4.0 min, P = 0.008), but was associated with higher AE rates (adjusted odds ratio 2.13, 95% confidence interval 1.26-3.61, P = 0.005).
The dorsal slit MC method is faster than sleeve resection, and can be safely performed by non-physicians; however, use of bipolar cautery may be inadvisable in this setting.
评估医生和临床医生（CO）实施的背侧切开和套袖式男性割礼（MC）的安全性和效率。
我们通过培训医生和 CO 使用套袖和背侧切开 MC 方法在服务项目中评估 MC 手术时间（效率）和中度/重度不良事件（AE）（安全性）。使用具有稳健方差估计的单变量和多变量回归评估与手术时间（线性）和 AE（逻辑）相关的因素。
6 名医生和 8 名 CO 分别进行了 1934 例和 3218 例 MC，其中 2471 例采用背侧切开法，2681 例采用套袖 MC 法。新培训人员的总体平均手术时间为 33 分钟，在完成约 100 例 MC 后，降至 ≈20 分钟。背侧切开 MC 的调整后平均手术时间明显短于套袖 MC 方法（Δ-2.7 分钟，P<0.001）。对于套袖手术，CO 的手术时间长于医生，但对于背侧切开手术则不是；然而，随着 MC 完成数量的增加，这种差异会减小。背侧切开 MC 的未调整 AE 率为 0.6%，套袖方法为 1.4%（P=0.006），医生为 1.5%，CO 为 0.68%（P=0.003）；然而，多变量调整后没有显著差异。使用双极电凝术可显著缩短手术时间（Δ-4.0 分钟，P=0.008），但与更高的 AE 率相关（调整后的优势比为 2.13，95%置信区间为 1.26-3.61，P=0.005）。
背侧切开 MC 方法比套袖切除术更快，非医生也可以安全实施；然而，在这种情况下，使用双极电凝术可能是不可取的。
