止血障害のある患者におけるレーザー支援抜歯

Laser-assisted tooth extraction in patients with impaired hemostasis.

抄録

はじめに:

止血障害を有する患者に対して効率的な歯科医療を提供することは，外科的操作後あるいは操作中の出血が長引くなどの困難や問題と結びついている。

Introduction: The provision of efficient dental care to patients with hemostatic disorders is tied to difficulties and problems, such as prolonged bleeding after or during surgical manipulation.

目的:

は，血小板減少症の患者において，抜歯のさまざまな段階でエルビウムレーザーを使用し，口腔手術の効率を向上させることであった．

Aim: was to increase the efficiency of oral surgery in patients with thrombocytopenia with the use of erbium laser on different stages of tooth extraction.

方法:

外来で抜歯を行う患者（n＝96）を選び，血小板減少が確認された患者（年齢44±15.4，19～74歳）を1群に，止血障害がない患者（年齢47.6±15.3，19～81歳）を2群に割り付けた（p＞0.05）。1群では，波長2490nmのエルビウムレーザーを非接触で使用し，円形歯根膜の剥離と抜歯後のソケットの掻爬の2段階で手術を行った．2群（コントロール）では、従来のアルゴリズムに従った治療が行われた。手術前に，両群とも血小板の血液検査を行い，さらに，1群については，出血の持続時間と総凝固量を評価した．術後は両群とも軟部組織の疼痛と浮腫、止血時間を評価した。

Methods: Patients (n = 96) were selected for tooth extraction on an outpatient basis: patients with confirmed thrombocytopenia (age 44 ± 15.4, 19-74) were included in the 1 group, and patients without impaired hemostasis (age 47.6 ± 15.3, 19-81) were included in the 2 group (p > 0.05). In the 1st group, operation with the use of erbium laser with with a wavelength of 2490 nm in a noncontact mode was performed in two stages: separation of a circular tooth ligament and curettage of the socket after tooth extraction. In the 2 group (control), the treatment was provided according to a traditional algorithm. Before the operation, the lab blood tests for thrombocytes were performed in both groups; moreover, for the 1st group, the duration of bleeding and total coagulation were evaluated. In the postoperative period, pain and edema of soft tissues and hemostasis duration were assessed in both groups.

結果:

本研究の結果、1群ではエルビウムレーザーの使用により、対照群に比べ止血時間を短縮でき（80.9±35.9秒と175±67.5秒、p＜0.01）、抜歯後の術後出血の確率が同程度になりました（p＜0.5）。また，術後の疼痛や軟部組織の浮腫は，1群では少なかった（p＜0.001）．

Results: According to the results of our research, the use of erbium laser in the 1 group allowed us to decrease hemostasis duration compared with the control group of patients (80.9 ± 35.9 and 175 ± 67.5 sec, p < 0.01) and reach the similar probability of postoperative bleeding after tooth extraction (p < 0.5). Pain and edema of soft tissues in dynamics after operation were less in the 1 group (p < 0.001).

結論:

エルビウムレーザーの使用は、出血などの術後合併症予防や抜歯後の歯槽上皮化生を促進するために、止血不全の患者の外科治療にうまく使用できる最新の方法である。

Conclusion: Application of erbium laser is an up-to-date method that can be successfully used in surgical treatment in patients with hemostasis failure for bleeding and other postoperative complications prevention and stimulation of the alveolar epithelialization after tooth extraction.