育龄期女性颅内静脉窦血栓形成临床分析及血管内治疗

Clinical analysis of women of reproductive age with cerebral venous sinus and thrombsis endovascular therapy

目的探讨育龄期女性颅内静脉窦血栓形成的易患因素、临床特点及血管内治疗的疗效。方法回顾性分析26例确诊为颅内静脉窦血栓形成并进行多种途径联合的血管内治疗并协同长期抗凝治疗的育龄期女性患者(18～45岁)的临床资料。结果26例病人中妊娠期及产后8例,口服避孕药史者5例,服用减肥药史者1例,血小板增多症2例,以头部胀痛、视力下降、出血性脑梗塞为其主要临床表现;头颅MRI及MRV和脑血管造影检查为该病确诊依据;经治疗后24例病人临床症状明显改善,有效率达92.3%(24/26),死亡率3.8%(1/26),并发症发生率3.8%(1/26);本组中15例接受门诊和电话随访2个月至3年,疗效稳定,目前无一例复发。结论育龄期女性颅内静脉窦血栓形成与妊娠、分娩、口服避孕药等所致血液高凝状态有关,育龄期女性不明原因颅高压应尽早行头颅MRI及MRV和脑血管造影检查以明确诊断,血管内治疗协同长期抗凝治疗有较高疗效。

Objective To study the predisposing factors, the imaging characteristics and the effects of endovascular therapy. Methods In this retrospectively study, the clinical data of 26 women of reproductive age with diagnosed CVST and treated by multiple modality endovascular thrombolysis combined with long-time anticoagulation therapy were analized. Results Among 26：8 cases are pregnancy and puerperium, 5 cases used oral contraceptive, 1 cases used lose-weight medicine, 2 cases are ET, Headache, visual disturhanees and hemorrhagic infarction were the main symptoms. The diagnosis depends on the MRI combine with MRV and DSA. The clinical symptoms improved rapidly after endovascular and antieoagulation therapy, the effective rate reached 92.3%（24/26）. In this patients, the morbidity rate was 3.8%（1/26）, and mortality was 3.8%（1/26）. Of 15 cases was followed up from 4 monthes to 3 years,the effects is steady and no obvious recurrence. Conclusion CVST in women of reproductive age is related with blood high coagulation duo to the pefipartum period and oral contraceptives use. Unidentifled causes of high intracranial pressures in women of reproductive age should be performed MRI combine with MRV and DSA as early as to diagnosis. Endovascular therapy combine with long-time anticoagulation therapy have a higher effects.