难治性颅内静脉窦血栓形成的机械碎栓治疗

Mechanical thrombectomy for intractable cerebral venous sinus thrombosis

目的研究机械性碎栓治疗难治性颅内静脉窦血栓形成患者的安全性和有效性。方法对23例抗凝治疗不能控制病情发展的颅内静脉窦血栓形成患者，施行了机械性碎栓治疗。其中，单纯机械性碎栓治疗5例，机械性碎栓联合接触性溶栓治疗的患者18例。术后规范抗凝治疗12个月，同时筛查静脉窦血栓病因，并给予相应处理。术后3个月、6个月和12个月进行临床随访，包括眼底视盘检查、GCS评分、mRS评分，腰穿和MRV或DSA检查。结果机械碎栓治疗后即刻，所有患者静脉窦主干血流恢复。患者出院前神经功能评分2．1±1．1较术前3．7±1．2明显改善（P〈0．05），GCS评分11．5±4．6较术前10．5±3．4明显改善（P〈0．05），其中mRS评分0～1分患者9例，2分6例，3分及以上7例，死亡1例，另有4例自动出院后死亡。术后3个月回访，所有患者眼底视盘水肿消失，腰穿压力恢复正常，mRS评分0～1分患者14例，2分3例，3分1例。术后12个月mRS评分0～1分患者17例，2分1例，未见患者血栓复发。结论机械碎栓是难治性颅内静脉窦血栓安全、有效的一种治疗手段。抗凝治疗不能控制症状或者是重症患者应尽早采用机械性碎栓治疗。

Objective Evaluate the safety and efficacy of mechanical throbectomy for severe and uncontrolled cerebral venous sinus thrombosis patients. Method We treated 23 patients with severe and uncontrolled cerebral venous sinus thrombosis by mechanical throbectomy, of which 5 patients were treated by the single mechanical throbectomy, 18 patients by mechanical throbectomy combined with local thrombolysis. In 12 months after the operation the patients should took anticoagulant therapy, etiopathogenisis screening, and appropriate treatment. 3months, 6 months, and 1 year after operation, we assessed the outcome at follow - up which includes the optic fundns examination, GCS score, mRS score, lumbar puncture, and MRV or DSA. Results Rapid after treatment, the occluded sinus was recanalized. when patients discharged, the mRS （2. 1 ± 1.1 vs3.7± 1.2, P 〈 0.05 ） and the GCS （ 11.5 ±4. 6vs10. 5±3.4, P 〈 0. 05 ） are better than that of pre - treated, of which the results of mRS show 9 patients got 0 1, 6 patients 2 scores, 7 patients 3 or more scores, and 1 died in hospital. 4 patients died after discharging. 3 months after operation, retinal optic disc edema disappeared and the press of lumbar puncture back to normal in all patients. 14 patients got 0 - 1 with mRS, 3 patients came out with 2 ; 1 had 3 . There was no recurrence 1 year after operation, 17 patients got 0 or 1, and lgot 2. Conclusions Mechanical throbectomy for intractable cerebral venous sinus thrombosis is safe and effective. We suggest that for patients especially who are not response to antithrombotic drugs take it as soon as possible.