男性割礼。

Male circumcision.

出版信息

Pediatrics. 2012 Sep;130(3):e756-85. doi: 10.1542/peds.2012-1990. Epub 2012 Aug 27.

Abstract

Male circumcision consists of the surgical removal of some, or all, of the foreskin (or prepuce) from the penis. It is one of the most common procedures in the world. In the United States, the procedure is commonly performed during the newborn period. In 2007, the American Academy of Pediatrics (AAP) convened a multidisciplinary workgroup of AAP members and other stakeholders to evaluate the evidence regarding male circumcision and update the AAP's 1999 recommendations in this area. The Task Force included AAP representatives from specialty areas as well as members of the AAP Board of Directors and liaisons representing the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the Centers for Disease Control and Prevention. The Task Force members identified selected topics relevant to male circumcision and conducted a critical review of peer-reviewed literature by using the American Heart Association's template for evidence evaluation. Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks; furthermore, the benefits of newborn male circumcision justify access to this procedure for families who choose it. Specific benefits from male circumcision were identified for the prevention of urinary tract infections, acquisition of HIV, transmission of some sexually transmitted infections, and penile cancer. Male circumcision does not appear to adversely affect penile sexual function/sensitivity or sexual satisfaction. It is imperative that those providing circumcision are adequately trained and that both sterile techniques and effective pain management are used. Significant acute complications are rare. In general, untrained providers who perform circumcisions have more complications than well-trained providers who perform the procedure, regardless of whether the former are physicians, nurses, or traditional religious providers. Parents are entitled to factually correct, nonbiased information about circumcision and should receive this information from clinicians before conception or early in pregnancy, which is when parents typically make circumcision decisions. Parents should determine what is in the best interest of their child. Physicians who counsel families about this decision should provide assistance by explaining the potential benefits and risks and ensuring that parents understand that circumcision is an elective procedure. The Task Force strongly recommends the creation, revision, and enhancement of educational materials to assist parents of male infants with the care of circumcised and uncircumcised penises. The Task Force also strongly recommends the development of educational materials for providers to enhance practitioners' competency in discussing circumcision's benefits and risks with parents. The Task Force made the following recommendations:Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks, and the benefits of newborn male circumcision justify access to this procedure for those families who choose it. Parents are entitled to factually correct, nonbiased information about circumcision that should be provided before conception and early in pregnancy, when parents are most likely to be weighing the option of circumcision of a male child. Physicians counseling families about elective male circumcision should assist parents by explaining, in a nonbiased manner, the potential benefits and risks and by ensuring that they understand the elective nature of the procedure. Parents should weigh the health benefits and risks in light of their own religious, cultural, and personal preferences, as the medical benefits alone may not outweigh these other considerations for individual families. Parents of newborn boys should be instructed in the care of the penis, regardless of whether the newborn has been circumcised or not. Elective circumcision should be performed only if the infant's condition is stable and healthy. Male circumcision should be performed by trained and competent practitioners, by using sterile techniques and effective pain management. Analgesia is safe and effective in reducing the procedural pain associated with newborn circumcision; thus, adequate analgesia should be provided whenever newborn circumcision is performed.Nonpharmacologic techniques (eg, positioning, sucrose pacifiers) alone are insufficient to prevent procedural and postprocedural pain and are not recommended as the sole method of analgesia. They should be used only as analgesic adjuncts to improve infant comfort during circumcision. If used, topical creams may cause a higher incidence of skin irritation in low birth weight infants, compared with infants of normal weight; penile nerve block techniques should therefore be chosen for this group of newborns. Key professional organizations (AAP, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American Society of Anesthesiologists, the American College of Nurse Midwives, and other midlevel clinicians such as nurse practitioners) should work collaboratively to:Develop standards of trainee proficiency in the performance of anesthetic and procedure techniques, including suturing; Teach the procedure and analgesic techniques during postgraduate training programs; Develop educational materials for clinicians to enhance their own competency in discussing the benefits and risks of circumcision with parents; Offer educational materials to assist parents of male infants with the care of both circumcised and uncircumcised penises. The preventive and public health benefits associated with newborn male circumcision warrant third-party reimbursement of the procedure. The American College of Obstetricians and Gynecologists has endorsed this technical report.

摘要

男性割礼包括手术切除部分或全部阴茎包皮(或包皮)。它是世界上最常见的手术之一。在美国,该手术通常在新生儿期进行。2007 年,美国儿科学会(AAP)召集了一组多学科工作组,成员包括 AAP 成员和其他利益攸关方,以评估有关男性割礼的证据,并更新 AAP 在这一领域的 1999 年建议。工作组包括来自专业领域的 AAP 代表,以及 AAP 董事会成员和代表美国家庭医生学会、美国妇产科医师学会和疾病控制与预防中心的联络人。工作组确定了与男性割礼相关的选定主题,并使用美国心脏协会的证据评估模板对同行评议文献进行了批判性审查。对现有证据的评估表明,新生儿男性割礼的健康益处大于风险;此外,新生儿男性割礼的益处证明了为选择该手术的家庭提供这种手术的合理性。已确定男性割礼具有预防尿路感染、获得 HIV、传播某些性传播感染和阴茎癌的具体益处。男性割礼似乎不会对阴茎的性功能/敏感性或性满意度产生不利影响。至关重要的是,提供割礼的人必须经过充分培训,并且必须使用无菌技术和有效的疼痛管理。严重的急性并发症很少见。一般来说,未经训练的提供者进行割礼比训练有素的提供者进行割礼的并发症更多,无论前者是医生、护士还是传统的宗教提供者。父母有权获得有关割礼的真实、公正的信息,并且应该在怀孕前或怀孕早期从临床医生那里获得这些信息,因为父母通常会在这个时候决定割礼。父母应该确定什么是最符合他们孩子的利益。向这些家庭提供有关这一决定咨询的医生应通过解释潜在的益处和风险来提供帮助,并确保父母了解割礼是一种选择性手术。工作组强烈建议创建、修订和增强教育材料,以帮助男婴的父母照顾割礼和未割礼的阴茎。工作组还强烈建议为提供者制定教育材料,以增强他们在与父母讨论割礼的益处和风险方面的能力。工作组提出了以下建议:

  • 对现有证据的评估表明,新生儿男性割礼的健康益处大于风险,并且新生儿男性割礼的益处为选择该手术的家庭提供了这种手术的机会。

  • 父母有权获得有关割礼的真实、公正的信息,并且应该在怀孕前和怀孕早期从临床医生那里获得这些信息,因为父母通常会在这个时候决定割礼。

  • 向选择进行选择性男性割礼的家庭提供咨询的医生应通过以公正的方式解释潜在的益处和风险,并确保他们了解手术的选择性性质,来为父母提供帮助。

  • 父母应该根据自己的宗教、文化和个人喜好来权衡健康益处和风险,因为对于个别家庭来说,医疗益处可能并不足以超过其他考虑因素。

  • 无论新生儿是否接受割礼,都应向其父母传授照顾阴茎的方法。

  • 应仅在婴儿病情稳定且健康的情况下进行选择性割礼。

  • 男性割礼应由经过培训和合格的从业者进行,使用无菌技术和有效的疼痛管理。

  • 镇痛剂是安全有效的,可以减轻新生儿割礼相关的手术疼痛;因此,只要进行新生儿割礼,就应提供足够的镇痛剂。

  • 非药物治疗技术(例如,定位、奶嘴)单独使用不足以预防手术和术后疼痛,不建议作为唯一的镇痛方法。它们应该仅作为镇痛辅助手段,以改善割礼期间婴儿的舒适度。

  • 如果使用,局部乳膏可能会导致低体重婴儿的皮肤刺激发生率高于正常体重婴儿;因此,对于这组新生儿,应选择阴茎神经阻滞技术。

  • 主要的专业组织(AAP、美国家庭医生学会、美国妇产科医师学会、美国麻醉师学会、美国护理助产士学会以及其他中级临床医生,如护士从业者)应合作:

  • 制定麻醉和手术技术的学员熟练程度标准,包括缝合;

  • 在研究生培训计划中教授该程序和镇痛技术;

  • 制定临床医生的教育材料,以增强他们与父母讨论割礼益处和风险的能力;

  • 为帮助男婴父母照顾割礼和未割礼的阴茎提供教育材料。

  • 与新生儿男性割礼相关的预防和公共卫生益处证明了该手术的第三方报销是合理的。美国妇产科医师学会已经认可了这份技术报告。

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