根管治疗转诊病例的分析评估

[摘要] 目的 通过对根管治疗转诊病例的分析，为建立完善的根管治疗转诊制度提供临床依据。方法 随机选取2011年4—6月转诊到四川大学华西口腔医院牙体牙髓病科行根管治疗的312例患者的355颗患牙为研究对象，调查问卷方式记录患者的信息，评估根管治疗难度及转诊原因。结果 355颗转诊患牙中，最多的为下颌第一磨牙（17%），

转诊原因中比例最大的是根管钙化（30%），其次是根管再治疗（24%）。72%的患牙的根管治疗难度为Ⅲ度，治疗难度为Ⅰ度的仅占7％。不同来源患者的治疗难度间的差异无统计学意义（P=0.9）。结论 建立完善的根管治疗转诊

制度需要每位医生的配合，治疗前应首先评估根管治疗难度以确定治疗或转诊，根据治疗难度分诊至不同层次的医生进行治疗。

[关键词] 根管治疗； 转诊； 难度评估

[中图分类号] R 781.05 [文献标志码] A [doi] 10.3969/j.issn.1000-1182.2012.05.011

Assessment of referral cases for root canal therapy Niu Xiaoyang1, Zhang Lan1, Zheng Qinghua1, Duan Xing-yu1, Huang Dingming2. （1. State Key Laboratory of Oral Diseases, Sichuan University, Chengdu 610041, China; 2. Dept. of Conservative Dentistry and Endodontics, West China School of Stomatology, Sichuan University, Chengdu 610041, China）

[Abstract] Objective To assess referral cases for root canal therapy to provide clinical evidence with establishment of referral system. Methods A questionnaire was designed to collect 312 cases（355 teeth） referred to Department of

Conservative Dentistry and Endodontics, West China School of Stomatology, Sichuan University for root canal therapy from April to June in 2011. The questionnaire consisted of questions such as age, gender, occupation, general disease and medical histories of patients, sources. Difficulty of treatment before therapy and reasons for referral were evaluated. Results In 355 referral teeth, the most were mandibular first molars（17%）, the greatest percentage of reasons were

calcified root canals（30%）, the second was root canal retreatment（24%）. 72% of teeth belong to the complicated dif-

ficulty（Class Ⅲ）, while 7% were listed as the uncomplicated difficulty（Class Ⅰ）. No significantly difference from dif-

ferent sources was found（P=0.9）. Conclusion Establishment of referral system needs cooperation with every dentist.

Difficulty of cases for root canal therapy before treatment should be first evaluated to treat or to refer. Referral cases for root canal therapy should be treated by endodontist of corresponding level according to the difficulty.

[Key words] root canal therapy； referral； difficulty assessment

根管治疗是通过清除根管内的坏死物质，进行适当的消毒，充填根管，以去除根管内容物对根尖周围组织的不良刺激，防止发生根尖周病变或促进根尖周病变愈合的一种治疗方法。临床上根管治疗病例的难度不一，复杂疑难病例的治疗难度大，成功率低。为提高治疗的成功率，医生必须在治疗前对根管治疗病例的难度进行评估以确定治疗或转诊，美国牙髓病学协会、加拿大牙髓病学协会等欧美国家均制定了各自的评估标准，但我国目前尚无统一的根管治疗难度评价体系。四川大学华西口腔医院牙体牙髓病科经过长期的临床研究，结合循证医学的研究方法，设计出了适合我国国情的科学规范、具有可操作性的根管治疗难度评估标准[1]。此标准包括

全身因素、口腔因素、根管系统因素及其他因素，全身因素为患者是否有心血管疾病、脑血管疾病、出血性疾病、糖尿病等全身性疾病及麻醉史，口腔因素为患者张口度、咽反射、唾液分泌量、牙齿的排列及咬合关系、是否有其他口腔疾病或是否有牙科恐惧症，根管系统因素涉及牙齿的位置、长度、根管数目、弯曲度、钙化度及根尖孔直径，其他因素包括是否已做修复体及是否有根管治疗史、牙体损