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Circumcision Device Expands Access in Developing Countries
中国商环扩展包皮环切术在发展中国家的可及性
 
Medscape Medical News

中国商环扩展包皮环切术在发展中国家的可及性

作者:Neil Canavan
日期:Jul 12, 2013

【马来西亚 吉隆坡】一种被称为商环的用于男性包皮环切的新型器械已经在肯尼亚和赞比亚进行的一项超过1000人参与的现场研究中 被证明是安全和相对疼痛少的方法。

一次商环包皮环切术所需要的时间只是传统手术方法时间的一小部分,经过简单的培训,基层健康护理人员也能使用这种方法。

"男性包皮环切是减少非洲次撒哈拉地区HIV感染最有前途的方法之一",来自纽约两性健康的Mark Barone医生表示,"不幸的是,虽然我们知道包皮环切降低男性获得HIV感染的风险,但是,手术本身却是实现它的益处的一个障碍。"

传统包皮环切术需要20~40分钟完成一个手术,需要缝合,"而且常常有相当量的出血。使用商环包皮环切术能将手术时间减少至5~7分钟,无需缝合,几乎没有出血,"他解释说。

Barone医生在这里举行的"第7届国际艾滋病学会大会:HIV发病机制、治疗和预防"上报告了商环安全性和有效性的研究结果。研究人员在非洲的10个项目点研究了商环在1161名男性中的临床结果,随访至术后42天。包皮环切术后与手术相关的不良事件发生率很低(1.6%);不过,有2人由于疼痛在术后7天随访之前就要求拆环。

正如预期,完全愈合的时间是35-42天。整体上,21.3%的男性报告说在手术当天恢复正常活动,95.0%的男性报告说在第3天恢复正常活动。

"大多数男性真的很喜欢这个手术方法,"Barone医生说。他们喜欢他们的阴茎术后的外观,大多数人说他们愿意将商环手术推荐给其他人。"

无外科手术经验的医护人员进行了97.0%的手术,70.5%的包皮环切手术是在那些先前没有商环经验的项目点完成的。19名手术提供者参与了这项研究,与传统手术相比,17人更偏爱商环手术。

据报道商环手术方法的简便和低成本将促进在发展中国家中作为HIV预防策略中的一部分的男性包皮环切倡议。"至关重要的是要有更多的男性包皮环切方法可选择,以帮助增加这一干预方法的影响。"Barone医生说。"我们需要匹配我们的资源,使那些有意愿接受包皮环切的男性能够获得这种方法。"


乌干达人的商环经验

来自乌干达拉卡伊健康科学计划的Godfrey Kigozi医生也报告了他们使用商环的经验。

"我们最近完成了一个有500名男性参与的项目,比较了商环与背切法,"Kigozi医生告诉Medscape Medical News说。"我们观察到少数使用商环的术后问题----只是少数----伤口愈合需要稍微长一些时间。我们也遇到一个问题,就是我们研究中的一些男性在伤口完全愈合前就恢复了性交。伤口愈合需要一个月。"

不过,商环手术本身非常快速。"大约只需6分钟,而背切法需要差不多20分钟。" "我发现商环非常适合农村地区使用。可能需要常规手术服务以备某些男性由于某些解剖学特征之需,但是总的说来,我认为稍加培训可以消除大多数不良事件。"

Barone医生和Kigozi医生披露没有相关经济利益关系。


第7届国际艾滋病学会大会:HIV发病机制、治疗和预防。摘要 WELBC042. 2013年7月3日报告

Medscape Medical News (c) 2013 WebMD, LLC

http://www.medscape.com/viewarticle/807753

 

Circumcision Device Expands Access in Developing Countries

Neil Canavan
Jul 12, 2013


KUALA LUMPUR, Malaysia — A novel device called the Shang Ring that is used to perform male circumcision has been shown to be safe and relatively pain-free in a field trial of more than 1000 men in Kenya and Zambia.

A Shang Ring circumcision takes a fraction of the time of conventional surgical methods and requires minimal training, so even lower-level healthcare providers can use it.

"Male circumcision is one of the most promising improvements for reducing HIV infection in sub-Saharan Africa," said Mark Barone, DVM, MS, from EngenderHealth in New York. "Unfortunately, even though we know that circumcision reduces the incidence of men acquiring HIV, the procedure itself is a barrier to realizing this benefit."

Conventional circumcision can take 20 to 40 minutes to perform, suturing is required, "and usually there is a fair amount of bleeding. Using the Shang Ring reduces the procedure time to 5 to 7 minutes, requires no suturing, and there is almost no bleeding," he explained.

Dr. Barone presented data on the safety and efficacy of the Shang Ring here at the 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention.

Investigators studied the device in 1161 men at 10 sites in Africa and followed patients for up to 42 days after undergoing a circumcision. Rates of postcircumcision procedure-related adverse events were low (1.6%); however, 2 men had to have the device removed before the day 7 visit because of pain.

Time to complete healing was 35 to 42 days, as was expected. Overall, 21.3% of the men reported returning to normal activities on the day of circumcision, and 95.0% reported doing so by the third day.

"The vast majority of the men really liked the procedure," Dr. Barone noted. They liked the cosmetic appearance of their penis, and most said they would recommend the ring procedure to others."

Nonphysicians performed 97.0% of the procedures, and 70.5% of the circumcisions were conducted at sites without previous Shang Ring experience. Of the 19 providers involved in the study, 17 preferred the Shang Ring to conventional surgery.

The simplicity and low cost of this method will reportedly facilitate the male circumcision initiatives that are part of HIV prevention strategies in developing countries.

"It's vital to have additional options for male circumcision to help increase the impact of this approach," said Dr. Barone. "We need to align our resources so that men who are interested in being circumcised have access."


Ugandan Experience With the Shang Ring

Godfrey Kigozi, MBChB, MPH, from the Rakai Health Sciences Program in Kalisizo, Uganda, has also had experience with the Shang Ring.

"We did a program recently on about 500 men and compared the ring with the dorsal slit method," Dr. Kigozi told Medscape Medical News. "We saw a few more postoperative problems with the ring — just a few — and wound healing took a bit longer. We did have an issue of some of the men in our study resuming intercourse before complete healing had occurred. It does take a month to heal."

The procedure itself is, however, much faster. "It was roughly 6 minutes, as opposed to nearly 20 to perform the dorsal slit."

"I found it to be very good for the rural setting. Backup surgical services might be needed for men who have certain anatomic characteristics, but overall, I think a bit more training would eliminate most adverse events."

Dr. Barone and Dr. Kigozi have disclosed no relevant financial relationships.


7th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention: Abstract WELBC042. Presented July 3, 2013.

Medscape Medical News (c) 2013 WebMD, LLC

Send comments and news tips to news@medscape.net.

Cite this article: Circumcision Device Expands Access in Developing Countries. Medscape. Jul 12, 2013.

 
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