经血管内溶栓并支架成形术治疗侧窦血栓形成  

Endovascular thrombolysis and stent angioplasty for obliteration in cerebral lateral sinuses thrombosis

作　　者：王君[1] 李宝民[1] 李生[1] 曹向宇[1] 刘新峰[1] 马玉栋[1] 

机构地区：[1]中国人民解放军总医院神经外科,北京100853

出　　处：《中国现代神经疾病杂志》2007年第5期439-442,共4页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：国家自然科学基金资助项目(项目编号:30370496)

摘　　要：目的观察静脉窦内溶栓并支架成形术治疗侧窦血栓形成的效果。方法对21例诊断明确的侧窦血栓形成患者施行经静脉窦内留置微导管连续尿激酶溶栓治疗,并辅以肝素钠全身抗凝治疗,其中9例溶栓效果欠佳者采用静脉窦内自膨式支架(Wallstent或Smart)成形术。结果经静脉窦内直接溶栓及窦内支架成形术治疗后,21例中静脉窦完全再通者11例,部分再通9例,1例未通。其中8例静脉侧支循环明显改善,建立以海绵窦代偿性引流、椎静脉丛引流以及头皮静脉代偿引流等3种方式。手术后所有患者颅内压均降至≤200mmH2O(2kPa),8例于手术后7d内再次出现不同程度颅内压水平升高,经持续肝素钠抗凝治疗后恢复至正常值水平。随访3个月～6年,20例患者症状持续缓解,未复发。结论静脉窦内持续尿激酶溶栓并支架成形术治疗侧窦血栓形成、促进静脉窦血液回流、降低颅内压安全可靠,手术后继续应用抗凝药物可以维持长期疗效。Objective To summarize the experience of treating the cerebral lateral sinuses thrombosis by using direct thrombolysis and stent angioplasty. Methods All 21 patients with lateral sinuses thrombosis were confirmed by digital substract angiography. All patients successively accepted thrombolysis therapy with urokinase by microcatheter in the sinus and due to the result was unsatisfactory 9 patients adopted auto-expansive stent （Wallstent or Smart） angioplasty, meanwhile, general anticoagulant （heparin sodium） therapy was essential. Results After contact thrombolysis and stent angioplasty in sinuses of the 21 patients with lateral sinuses thrombosis, complete recanalization was achieved in 11 patients and part recanalization in 9. Recanalization was failed only in one patient. Venous collateral circulation was strengthened obviously in 8 cases, such as cavernous sinus, vertebral venous plexus and scalp venous drainage established. After treatment, intracranial pressure （ICP） reduced to ≤ 200 mm H2O （2 kPa） in all patients, and 8 cases relapsed and ICP increased in different degree after 7 days. Anticoagulation （heparin sodium） was preseribed and ICP decreased to normal level. Condition remitted persistently and no obvious relapse was found in 20 patients during the follow-up for 3-72 months. Conclusion Successive thrombolysis with urokinase and stentt angioplasty for thrombosis of the cerebral lateral sinus were safe and effective in promoting drainage of cerebral venous blood and rapidly decreasing ICP. Postoperative anticoagulant therapy can maintain long-term curative effect.

关 键 词：脑栓塞和血栓形成 窦血栓形成 血栓溶解疗法 尿激酶 血管成形术 支架 

分 类 号：R743[医药卫生—神经病学与精神病学]