颅内静脉窦血栓形成的临床特点、治疗方式及其疗效分析

Clinical characteristics, treatments and curative effects of cerebral venous sinus thrombosis

目的探讨颅内静脉窦血栓形成（CYST）的临床特点、治疗方案选择及其疗效。方法回顾性收集南方医科大学珠江医院神经外科自2012年1月至2016年12月收治确诊的90例CVST患者的临床资料，针对患者年龄、性别、发病诱因、临床表现、发病部位、治疗方式及其疗效等内容进行综合分析，其中抗感染＋抗凝治疗7例、单纯抗凝治疗61例、支架取栓＋抗凝治疗4例、支架取栓＋局部溶栓＋抗凝治疗18例。结果90例患者中男性41例，女性49例；年龄4～75岁；发病诱因与感染相关7例，血液成分异常27例，妊娠、产褥期16例，有口服避孕药史6例；头痛是最常见的临床表8（69例，76．70％），其次为癫痫（37例，41．11％）、意识障碍（25例，27．78％），且临床症状表现并不单一；发病部位最常见为上矢状窦（68例，75．56％）及横窦（56例，62．22％）。抗感染＋抗凝治疗患者中疗效显著4例（57．14％），单纯抗凝治疗患者中疗效显著43例（70．49％），支架取栓＋抗凝治疗患者中疗效显著3例（75％），支架取栓＋局部溶栓＋抗凝治疗患者中疗效显著15例（83．33％）。结论CVST的发病诱因多样，多为非感染性，其中血液成分异常、育龄女性为高发病人群；其临床表现复杂多变，缺乏特异性；不同治疗方案均可有效改善患者症状，但单纯抗凝治疗更适用于症状较轻患者，支架取栓＋局部溶栓＋抗凝治疗对于重症患者的疗效更加显著。

Objective To investigate the clinical features, treatments, and prognoses of cerebral venous sinus thrombosis （CVST）. Methods A retrospective analysis of clinical data of 90 patients with CVST, admitted to our hospital from January 2012 to December 2016, was performed. Comprehensive analysis of gender, age, risk factors, clinical manifestations, lesion locations, treatments and prognoses was performed. According to selection of clinical treatment options for patients with anticoagulant therapy, these patients were divided into four groups： anti-infection treatment combined with anticoagulant therapy group （n=7）, anticoagulant therapy group （n=61）, stent thrombectomy combined with anticoagulant therapy group （n=4）, and stent thrombectomy combined with local thrombolysis and anticoagulant therapy group （n=18）. Results These 90 patients （41 males and 49 females） ranged from 4 to 75 years old. Of these patients, 7 were related to infections, 27 were related to abnormal blood constituents, 16 were related to pregnancy and puerperium, and 6 were related to oral contraceptive. The most common clinical manifestation was headache （n=69, 76.70%）, followed by epilepsy （n=37, 41.11%） and conscious disturbance （n=25, 27.78%）, and all symptoms could occur isolatedly or simultaneously. The superior sagittal sinus （n=68） and transverse sinus （n=56） appeared to be the most frequent lesion sites. Four patients （57.14%） from antiinfection treatment combined with anticoagulant therapy group, 43 patients （70.49%） from anticoagulant treatment group, 3 （75%） from stent thrombectomy combined with anticoagulant therapy group, and 15 patients （83.33%） from stent thrombectomy combined with local thrombolysis and anticoagulant therapy group enjoyed significant curative effects. Conclusions The causes of CVST are various, most of which are non-infective; patients with abnormal blood components and women of childbearing age are of high incidence. The clinical manifestations of CVST are complicated and non-specific. The 4 therapeutic methods can improve clinical symptoms effectively; however, anticoagulant therapy is mainly used for patients with mild symptoms; and stent thrombectomy combined with local thrombolysis and anticoagulant therapy can be used for patients with severe CVST, enjoying effective treatment efficacy.