脑静脉窦血栓个性化治疗的临床研究

Individualized endovascular treatment of cerebral venous thrombosis： analysis of 168 patients

目的针对脑静脉窦血栓的不同发病特点，探讨多种形式的经血管内途径和综合处理的个性化治疗方案。方法经头颅MR和全脑数字减影血管造影（DSA）明确诊断168例脑静脉窦血栓患者，分别采用：（1）经颈内静脉途径直接溶栓26例；（2）经颈动脉途径溶栓98例；（3）静脉窦内支架成形术9例；（4）单纯抗凝治疗20例；（5）对合并颅内出血的脑静脉血栓的治疗15例。结果共随访6～168个月，有效率为97．6％；复发率为6．6％；并发症为1．2％；病死率0．6％。经过较为规范的静脉窦溶栓和抗凝，多数患者可以达到静脉窦再通、恢复主引流；部分患者虽然静脉窦并没有再通或影像恢复不理想，但是侧枝引流系统明显加强，随着颅压下降，临床症状也逐渐改善。结论根据脑静脉窦血栓发病的不同特点，选择个性化的治疗方式能获得良好的治疗效果。

Objective To investigate the effects of individualized endovascular treatment on cerebral venous thrombosis of different types. Methods 168 patients with cerebral venous thrombosis underwent individualized endovascular treatment： direct thrombolysis via internal jugular vein in 26 cases, injection of urokinase via common carotid artery in 98 cases, stent angioplasty in venous sinus in 9, simple anticoagulant therapy in 20 cases, and treating combined intracranial hemorrhage simultaneously in 15 cases. Follow-up was conducted for 6 - 168 moths. Results Follow-up showed that the effective rate was 97.6%, recurrence rate was 6. 6% , complication incidence rate was 1.2% , and death rate was 0. 6%. Venous sinus recanalization occurred and primary drainage rebounded in most cases. Lateral drainage was strengthened in some cases whose venous sinuses did not recover ideally. The symptoms of most cases were alleviated along with the decrease of intracranial pressure. Conclusion Individualized endovascular treatment based on the characteristics of the disease is effective in treatment of cerebral venous thrombosis.