血液病儿童化疗或干细胞移植前拔牙的安全性研究

The safety study of dental extraction prior to chemotherapy and stem cell transplantation in children with hematologic malignancies

目的:探讨血液病儿童在大剂量化疗或造血干细胞移植前拔牙的安全性指标。方法:对65名住院血液病患儿在化疗或造血干细胞移植前实施病灶牙拔除,拔牙前检查血象,拔牙后观察止血时间,控制感染及创口愈合情况等。结果:65例患儿的102颗患牙顺利拔除。3例出现创口延期愈合,均未出现严重并发症和血液病恶化状况,并在拔牙后1～2周内顺利开始化疗或干细胞移植。结论:当血小板计数在60～300×109/L,白细胞计数在3.0～10.0×109/L时,拔牙是安全的。血小板计数在低于60×109/L时,最好提前输入新鲜血小板。白细胞计数1.5～3.0×109/L时,控制感染十分重要。

Objective： Explore the safety indexes of dental extraction prior to intensive chemotherapy or hemopoietic stem cell implantation in children with hematologic malignancies. Method：The study population included 65 pediatric inpatients with hematologic malignancies to be scheduled dental extraction before intensive chemotherapy or hemopoietic stem cell implantation. Examining the hemogram before extraction and the patients were monitored after extraction for bleeding, local or systemic infections, delayed wound healing and so on. Result： Of the 65 patients, all the 102 teeth were extracted successfully. Three patients suffered delayed wound heal which occurred 2 weeks later. No severe complication and deterioration occurred. Chemotherapy or stem cell transplantation was carried on successfully in lor 2 weeks after the extraction. Conclusion： For children with hematologic malignancies, extraction is safe while the platelet count ranged from 60 × 10^9 / L to 300 × 10^9 / L and white blood cell count ranged from 3.0 × 10^9 / L to 10.0 × 10^9 / L. Transfusion of fresh blood platelet in advance is necessary if the platelet count is lower than 60 × 10^9 / L and managing infection after extraction is of great importance if the white blood cell count is 1.5-3.0×10^9 / L.