国际口腔医学杂志

国际口腔医学杂志 ›› 2025, Vol. 52 ›› Issue (1): 99-106.doi: 10.7518/gjkq.2025006

• 综述 • 上一篇    下一篇

显微根尖手术术区出血的管理

和慧1(),刘文超2,杨锦波3()   

  1. 1.山东第一医科大学第二附属医院口腔科 泰安 271000
    2.海军航空大学航空医疗保障中心 烟台 264000
    3.口腔疾病防治全国重点实验室;国家口腔医学中心 国家口腔疾病临床医学研究中心;四川大学华西口腔医院牙体牙髓病科 成都 610041
  • 收稿日期:2024-03-26 修回日期:2024-08-15 出版日期:2025-01-01 发布日期:2025-01-11
  • 通讯作者: 杨锦波
  • 作者简介:和慧，主治医师，硕士，Email：535994705@qq.com

Hemostasis management of microapical surgery

Hui He1(),Wenchao Liu2,Jinbo Yang3()   

  1. 1.Dept. of Stomatology, the Second Affiliated Hospital of Shandong First Medical University, Taian 271000, China
    2.Aviation Medical Support Cencer, Naval Aeronautical University, Yantai 264000, China
    3.State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2024-03-26 Revised:2024-08-15 Online:2025-01-01 Published:2025-01-11
  • Contact: Jinbo Yang

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摘要：

显微根尖手术作为保存天然牙的最后一道防线，被越来越多的临床医生所重视。血液的存在会影响手术视野、降低充填材料的密封性，从而降低手术的成功率。出血控制贯穿手术的始终，是临床操作中的一大重点及难点。本文通过对显微手术的术前、术中、术后的出血管理进行总结，以便为临床医生提供参考。

关键词: 显微根尖手术, 成功率, 止血

Abstract:

As the last line of defense to preserve natural teeth, endodontic microsurgery has attracted considerable inte-rest. The presence of blood affects the correct vision of the apical field and reduces sealing with a filling material, reducing the success rate of microsurgery. Bleeding control throughout the operation is a key and difficult point in clinical opera-tion. This paper summarizes bleeding control before, during, and after microsurgery to provide a reference for clinicians.

Key words: apical surgery, success rate, haemostasis

中图分类号: 

  • R781.05

图 1

显微根尖手术中的重要毗邻解剖结构A、B：箭头示病变波及切牙孔；C：箭头示上牙槽后动脉；D、E：箭头示病变毗邻颏孔区。"

1 中国心胸血管麻醉学会非心脏麻醉分会, 中国医师协会心血管内科医师分会, 中国心血管健康联盟. 抗血栓药物围手术期管理多学科专家共识[J]. 中华医学杂志, 2020, 100(39): 3058-3074.
Non-cardiac Anesthesia Branch of Chinese Society of Cardiothoracic and Vascular Anesthesia, Branch of Cardiovascular Physicians of Chinese Medical Doctor Association, China Cardiovascular Health Alliance. Multidisciplinary expert consensus on perioperative management of antithrombotic drugs[J]. Nat Med J China, 2020, 100(39): 3058-3074.
2 Yang S, Shi Q, Liu J, et al. Should oral anticoagulant therapy be continued during dental extraction? A meta-analysis[J]. BMC Oral Health, 2016, 16(1): 81.
3 Lu SY, Tsai CY, Lin LH, et al. Dental extraction without stopping single or dual antiplatelet therapy: results of a retrospective cohort study[J]. Int J Oral Maxillofac Surg, 2016, 45(10): 1293-1298.
4 黄金霞, 石海涛, 潘剑. 抗凝/抗血小板治疗患者拔牙术后出血的研究进展[J]. 口腔疾病防治, 2021, 29(6): 417-421.
Huang JX, Shi HT, Pan J. Bleeding after tooth extraction in patients receiving anticoagulation/antiplatelet therapy[J]. J Prev Treat Stomatol Dis, 2021, 29(6): 417-421.
5 李珊珊, 李国珍. 长期口服抗凝药物患者拔牙围手术期的护理体会[J]. 浙江医学, 2018, 40(12): 1402-1403.
Li SS, Li GZ. Perioperative nursing experience of patients with long-term oral anticoagulation drugs during tooth extraction[J]. Zhejiang Med J, 2018, 40(12): 1402-1403.
6 Kämmerer PW, Frerich B, Liese J, et al. Oral surgery during therapy with anticoagulants-a systema-tic review[J]. Clin Oral Investig, 2015, 19(2): 171-180.
7 Mauprivez C, Khonsari RH, Razouk O, et al. Ma-nagement of dental extraction in patients under-going anticoagulant oral direct treatment: a pilot study[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2016, 122(5): e146-e155.
8 Stöllberger C. Drug interactions with new oral anticoagulants in elderly patients[J]. Expert Rev Clin Pharmacol, 2017, 10(11): 1191-1202.
9 Nutescu E, Chuatrisorn I, Hellenbart E. Drug and dietary interactions of warfarin and novel oral anticoagulants: an update[J]. J Thromb Thrombolysis, 2011, 31(3): 326-343.
10 罗卓荆, 吕国华. 脊柱外科围手术期出血防治专家共识[J]. 中国脊柱脊髓杂志, 2021, 31(5): 475-480.
Luo ZJ, Lü GH. Expert consensus on prevention and treatment of perioperative bleeding in spinal surgery[J]. Chin J Spine Spinal Cord, 2021, 31(5): 475-480.
11 Menéndez-Nieto I, Peñarrocha-Diago M, Cervera-Ballester J, et al. Efficacy of infiltrative local anesthesia and inferior alveolar nerve block in periapical surgery of lower premolars and molars: a preliminary report[J]. J Clin Exp Dent, 2020, 12(6): e581-e587.
12 辛库克 · 金. 牙髓病显微手术治疗[M]. 汪成林, 彭栗, 张玲, 译. 沈阳: 辽宁科学技术出版社, 2023.
Syngcuk K. Microsurgery in endodontics[M]. Wang CL, Peng L, Zhang L, trans. Shenyang: Liaoning Science and Technology Press, 2023.
13 Nicolielo LF, van Dessel J, Jacobs R, et al. Presurgical CBCT assessment of maxillary neurovascularization in relation to maxillary sinus augmentation procedures and posterior implant placement[J]. Surg Radiol Anat, 2014, 36(9): 915-924.
14 Flanagan D. Important arterial supply of the mandible, control of an arterial hemorrhage, and report of a hemorrhagic incident[J]. J Oral Implantol, 2003, 29(4): 165-173.
15 李志进, 郭家平. 鼻腭管区种植的研究进展[J]. 中国口腔种植学杂志, 2019, 24(2): 92-97.
Li ZJ, Guo JP. Research progress of nasopalatine canal implantation[J]. Chin J Oral Implantol, 2019, 24(2): 92-97.
16 Bharathi J, Mittal S, Tewari S, et al. Effect of the piezoelectric device on intraoperative hemorrhage control and quality of life after endodontic microsurgery: a randomized clinical study[J]. J Endod, 2021, 47(7): 1052-1060.
17 Vy CH, Baumgartner JC, Marshall JG. Cardiovascular effects and efficacy of a hemostatic agent in periradicular surgery[J]. J Endod, 2004, 30(6): 379-383.
18 Tan X, Rodrigue D. A review on porous polymeric membrane preparation. Part Ⅱ: production techniques with polyethylene, polydimethylsiloxane, po-lypropylene, polyimide, and polytetrafluoroethylene[J]. Polymers (Basel), 2019, 11(8): 1310.
19 Peñarrocha-Oltra D, Soto-Peñaloza D, Peñarrocha-Diago M, et al. Hemostatic agents in endodontic surgery of maxillary molars: a randomized controlled pilot study of polytetrafluoroethylene (PTFE) strips as an adjunct to epinephrine impregnated gauze versus aluminum chloride[J]. Med Oral Patol Oral Cir Bucal, 2020, 25(5): e634-e643.
20 Lardi AM, Dreier K, Junge K, et al. The use of tranexamic acid in microsurgery-is it safe[J]. Gland Surg, 2018, 7(): S59-S63.
21 周宗科, 黄泽宇, 杨惠林, 等. 中国骨科手术加速康复围手术期氨甲环酸与抗凝血药应用的专家共识[J]. 中华骨与关节外科杂志, 2019, 12(2): 81-88.
Zhou ZK, Huang ZY, Yang HL, et al. Expert consensus on the application of tranexamic acid and anti-coagulant for the enhanced recovery after orthopedic surgery in China[J]. Chin J Bone Joint Surg, 2019, 12(2): 81-88.
22 Johnson SM, Tsang D, Dansby M, et al. New and off-label uses of tranexamic acid[J]. AACN Adv Crit Care, 2021, 32(3): 237-242.
23 韩晓, 陈哲远, 金红旭. 止血材料研究现状与展望[J]. 创伤与急危重病医学, 2022, 10(4): 243-244.
Han X, Chen ZY, Jin HX. Research status and prospect of hemostatic materials[J]. Trauma Crit Care Med, 2022, 10(4): 243-244.
24 Ehab K, Abouldahab O, Hassan A, et al. Alvogyl and absorbable gelatin sponge as palatal wound dressings following epithelialized free gingival graft harvest: a randomized clinical trial[J]. Clin Oral Investig, 2020, 24(4): 1517-1525.
25 Zhou Y, Ma X, Li Z, et al. Efficacy, safety, and phy-sicochemical properties of a flowable hemostatic agent made from absorbable gelatin sponge via va-cuum pressure steam sterilization[J]. J Biomater Appl, 2021, 35(7): 776-789.
26 陈昊. 凝血酶冻干粉用于长期服用华法林患者拔牙后止血的效果[J]. 临床医学研究与实践, 2020, 5(31): 109-110.
Chen H. Effect of thrombin lyophilized powder on hemostasis after tooth extraction in patients taking warfarin for a long time[J]. Clin Res Pract, 2020, 5(31): 109-110.
27 郑萍, 李志珂. 围手术期非血液制品止血药物应用管理专家共识(广东)[J].中国医院药学杂志, 2024, 44(5): 485-494, 519.
Zheng P, Li ZK. Expert consensus on the management of non-blood hemostatic drugs during peri-operative period (Guangdong) [J]. Chin J Hosp Pha-rm, 2024, 44(5): 485-494, 519.
28 Zhang CL, Li ZH, Li QH, et al. Properties and osteogenicity of two calcium sulfate materials with micro or nano morphology[J]. J Nanosci Nanotechnol, 2016, 16(3): 2277-2282.
29 郑先雨, 何家才. 医用硫酸钙OsteoSet修复颌骨缺损的疗效评价[J]. 中国修复重建外科杂志, 2012, 26(1): 87-90.
Zheng XY, He JC. Effect evaluation of medical calcium sulfate-OsteoSet in repairing jaw bone defect[J]. Chin J Reparat Reconstr Surg, 2012, 26(1): 87-90.
30 Scarano A, Artese L, Piattelli A, et al. Hemostasis control in endodontic surgery: a comparative study of calcium sulfate versus gauzes and versus ferric sulfate[J]. J Endod, 2012, 38(1): 20-23.
31 冯凯. 口服抗凝药物患者拔牙后预防使用半水合硫酸钙的效果研究[J]. 中国现代药物应用, 2021, 15(23): 53-55.
Feng K. Study on the effect of oral calcium sulfate hemihydrate as hemostatic agent after tooth extraction[J]. Chin J Mod Drug Appl, 2021, 15(23): 53-55.
32 王春仁, 张清, 奚廷斐. 生物纸止血作用效果的体内外实验研究[J]. 中国生物医学工程学报, 2007, 26(4): 610-611, 622.
Wang CR, Zhang Q, Xi TF. In vitro and in vivo haemostatic effect studies on biopaper[J]. Chin J Biomed Eng, 2007, 26(4): 610-611, 622.
33 阚广乾, 秦荣基, 盖文龙, 等. 水解CaCO3作为交联剂制备羧甲基壳聚糖凝胶微球[J]. 山东化工, 2019, 48(9): 77-80.
Kan GQ, Qin RJ, Gai WL, et al. Preparation of carboxymethyl chitosan microspheres by hydrolyzing CaCO3 as crosslinking system[J]. Shandong Chem Ind, 2019, 48(9): 77-80.
34 Gilbert DR, Angell J, Abaza R. Evaluation of absorbable hemostatic powder for prevention of lymphoceles following robotic prostatectomy with lymphadenectomy[J]. Urology, 2016, 98: 75-80.
35 von Arx T, Jensen SS, Hänni S, et al. Haemostatic agents used in periradicular surgery: an experimental study of their efficacy and tissue reactions[J]. Int Endod J, 2006, 39(10): 800-808.
36 Lemon RR, Steele PJ, Jeansonne BG. Ferric sulfate hemostasis: effect on osseous wound healing.Ⅰ. Left in situ for maximum exposure[J]. J Endod, 1993, 19(4): 170-173.
37 Jensen SS, Yazdi PM, Hjørting-Hansen E, et al. Haemostatic effect and tissue reactions of methods and agents used for haemorrhage control in apical surgery[J]. Int Endod J, 2010, 43(1): 57-63.
38 Bao N, Zhou L, Cong Y, et al. Free fatty acids are responsible for the hidden blood loss in total hip and knee arthroplasty[J]. Med Hypotheses, 2013, 81(1): 104-107.
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