Department of Women's and Children's Health, Paediatric Surgery Unit, Padua University Hospital, University of Padua, Italy.
Department of Reproduction and Growth, Paediatric Surgery Unit, Arcispedale Sant'Anna, University of Ferrara, Italy.
Afr J Paediatr Surg. 2020 Jul-Dec;17(3 & 4):90-94. doi: 10.4103/ajps.AJPS_24_20.
The circumcision is the most frequent procedure in paediatric surgery worldwide, performed for medical and ritual purposes. In developing countries, because of the difficult accessibility to healthcare, even a common procedure could be unsafe.
The aim of the article is to compare the perioperative and anaesthesiological management of circumcision in children between two Italian and two sub-Saharan African hospitals.
Medical records of paediatric circumcision from January 2014 to December 2016 have been reviewed. The involved hospitals were: Padua (Italy), Ferrara (Italy), Sao José em Bor (Guinea Bissau) and Yaoundé (Cameroun).
In Padua, 77 circumcisions were performed, 19 of these (24.6%) were ritual. In 75 children (97.4%), locoregional anaesthesia (LRA) together with sedation was used; only one complication (1.3%) occurred. In Ferrara, 200 interventions were done, 140 (70%) ritual; general anaesthesia was administered to 183 (93.5%) patients. There were five complications (2.5%). In Bissau, 53 procedures were performed, 21 (39.6%) ritual; in 34 children (64.1%), LRA with sedation was preferred. Two complications (3.8%) were reported. In Yaoundé, 60 children were circumcised, 15 (25%) for ritual purposes; in 51 (85%), only LRA was performed; there was only one (1.7%) complication. In the African hospital, no post-operative analgesia was administered.
Despite the different anaesthesiological techniques, the study shows no difference in rate of complications for the in-hospital setting. Training of the local medical team in pain management and post-operative care should be emphasised.
割礼是全球小儿外科最常见的手术，其施行目的既有医疗方面的，也有宗教仪式方面的。在发展中国家，由于医疗服务难以普及，即使是常规手术也可能存在安全隐患。
本文旨在比较两家意大利医院和两家撒哈拉以南非洲医院的小儿割礼围术期和麻醉管理。
回顾了 2014 年 1 月至 2016 年 12 月期间进行的小儿割礼医疗记录。涉及的医院分别为：意大利帕多瓦、意大利费拉拉、几内亚比绍圣若泽-博尔和喀麦隆雅温得。
在帕多瓦，共进行了 77 例割礼，其中 19 例（24.6%）为宗教仪式性质。在 75 例儿童（97.4%）中，采用了局部麻醉（LRA）联合镇静；仅发生 1 例（1.3%）并发症。在费拉拉，共进行了 200 例手术，其中 140 例（70%）为宗教仪式性质；183 例（93.5%）患者采用全身麻醉。发生了 5 例（2.5%）并发症。在比绍，共进行了 53 例手术，其中 21 例（39.6%）为宗教仪式性质；34 例儿童（64.1%）采用 LRA 联合镇静。报告了 2 例（3.8%）并发症。在雅温得，共对 60 名儿童进行了割礼，其中 15 例（25%）为宗教仪式性质；51 例（85%）仅采用了 LRA；仅发生 1 例（1.7%）并发症。在非洲医院，术后未给予任何止痛治疗。
尽管麻醉技术不同，但研究结果表明，院内并发症发生率无差异。应强调对当地医疗团队进行疼痛管理和术后护理的培训。
