介入治疗烧伤后下肢深静脉血栓形成13例

Interventional therapy of deep venous thrombosis of lower limb after burn: initial experience in 13 cases

目的探讨烧伤后下肢深静脉血栓形成(DVT)患者介入治疗效果及其特殊性。方法回顾性分析13例烧伤并发下肢DVT患者临床资料。其中男7例,女6例;年龄37~67岁,中位年龄46.1岁;火焰伤9例,电击伤2例,热液伤2例;烧伤面积为1%~88%,平均(37.08±30.60)%;11例伴发下肢烧伤,其中8例双下肢烧伤;5例伴发吸入性损伤;烧伤后13~72 d发现DVT,平均(38.69±16.83)d。所有患者均接受介入治疗并观察疗效。结果介入手术技术均获成功(13/13)。3例经右侧颈内静脉入路,10例经健侧股静脉入路分别接受下腔静脉滤器(IVCF)置入及抗凝治疗;7例留置溶栓导管接受接触溶栓,4例静脉溶栓,2例未溶栓治疗。未发生有症状的肺栓塞。介入治疗有效率为84.6%(11/13)。结论介入治疗烧伤后DVT安全、可靠,但在穿刺点选择、是否留置溶栓导管方面有其特殊性。

Objective To discuss the curative effect and specificity of interventional therapy for deep venous thrombosis （DVT） of lower limb in burned patients. Methods The clinical data of 13 patients with lower limb DVT after burn, including 7 males and 6 females with a median age of 46.1 years （37-67 years）, were retrospectively analyzed. The causes of burn included flame burn （n=9）, electric injury （n=2） and hydrothermal burn （n=2）. The burned area was 1%-88% of the total body surface, with a mean of （37.08± 30.60） %. Lower limb DVT complicated by lower limb burn was observed in 11 patients, among them bum of both lower limbs was seen in 8 patients. Lower limb DVT associated with inhalation injury was found in 5 patients. Clinically, lower limb DVT was usually detected in 13-72 days after bum, with a mean of （38.69±16.83） days. Interventional treatment was carried out in all 13 patients, and the curative effect was assessed. Results Technical success of interventional treatment was obtained in all 13 patients. Both inferior vena cava filter placement via right internal jugular vein approach （n=3） or via unaffected-side femoral vein approach （n=10） and anticoagulant therapy were conducted. Catheter-directed thrombolysis was employed in 7 patients, intravenous thrombolysis was adopted in 4 patients, and no thrombolysis therapy was used in 2 patients. No pulmonary embolism occurred. The curative effect rate of interventional treatment was 84.6% （11/ 13）. Conclusion For the treatment of lower limb DVT after burn, interventional therapy is safe and reliable, but the selection of puncture site and the use or not use of indwelling catheter for thrombolysis should be carefully taken into consideration.（J Intervent Radiol, 2017, 26： 527-530）