超声对颅内静脉窦血栓患者颈内静脉介入治疗效果的评估  

Evaluation of the treatment effect of internal jugular vein intervention therapy in patients with cerebral venous sinus thrombosis with color Doppler ultrasound

作　　者：贾凌云[1] 华扬[1] 吉训明[2] 罗涛[3] 张开元[4] 

机构地区：[1]首都医科大学宣武医院血管超声诊断科,北京100053 [2]首都医科大学宣武医院神经外科,北京100053 [3]首都医科大学宣武医院血管外科,北京100053 [4]首都医科大学宣武医院放射科,北京100053

出　　处：《中国脑血管病杂志》2016年第7期360-364,共5页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金(81200912);教育部高等学校博士学科点专项科研基金(20111107120001);首都卫生发展科研专项(2011200104)

摘　　要：目的探讨应用彩色多普勒超声(CDU)检查颅内静脉窦血栓(CVST)患者颈内静脉(IJV)介入治疗的可行性和有效性。方法回顾性纳入12例经CDU诊断,MR静脉成像(MRV)和(或)DSA确诊的13支IJV病变(管腔局限狭窄9例,长段纤细2例,1例为右侧IJV局限性狭窄,左侧IJV长段纤细)并行IJV介入治疗(IJV支架置入5例和球囊扩张7例)的CVST患者。在IJV介入治疗前1周和治疗后1周、6个月、1年、2年应用CDU检查,比较IJV管径及最大血流速度(V_(max))的变化,分析介入治疗的成功率和远期疗效。结果治疗后1周CDU检查显示,13支IJV狭窄部位管径较术前明显增加(4.7±2.1)mm比[(2.3±1.3)mm,t=5.325,P<0.01)]。IJV血流速度较术前得到改善[局限性狭窄10支(50±15)cm/s比(87±24)cm/s,t=6.285,P<0.01]。对12例中6例(支架置入和球囊扩张各3例)患者进行了平均(18±7)个月的随访,2例球囊扩张术后患者发生了再狭窄。结论对于存在IJV病变的CVST患者,初步观察显示IJV介入治疗可以改善病变管腔及血流动力学,但介入治疗,尤其是球囊扩张术后再狭窄发生率较高。CDU可以作为IJV狭窄病变远期疗效的客观评估手段。Objective To investigate the feasibility and effectiveness of internal jugular vein （IJV） intervention therapy in patients with cerebral venous sinus thrombosis （CVST） with color Doppler ultrasound （CDU）. Methods Twelve patients with CVST diagnosed by CDU and the 13 IJV lesions （localized luminal stenosis in 9 cases ,venous long-segment slender in 2 cases,and right IJV localized luminal stenosis,and long-segment slender on the left in 1 case） confirmed by magnetic resonance venography （MRV） and/or digital subtraction angiography （DSA） were enrolled retrospectively. CDU examinations were used at 1 week before and after IJV intervention therapy,6 months, 1 year,and 2 years. The changes of the maximum diameter and the maximum velocity （Vmax） of the IJV were compared. The success rate and the long-term efficacy of the intervention therapy were analyzed. Results One week after treatment, the CDU examinations showed that the diameter of IJV stenosis in 13 IJV were increased significantly compared with those before procedure （4.7 ±2.1 mm vs. 2.3 ± 1.3 mm;t =5. 325 ,P 〈0.01 ）. The velocity of blood flow of IJ-V was improved compared with before procedure （localized stenosis in 10 IJV [ 50 ± 15 cm/s vs.87 ± 24 cm/s ] ;t = 6.285 ,P 〈 0. 01 ）. Six of the 12 patients were followed up for a mean of 18 ± 7 months, two patients had restenosis after balloon dilatation. Conclusions For CVST patients with IJV lesions,the preliminary observation has indicated that LIV intervention therapy may improve the lesion lumen and hemodynamics. However, the intervention therapy, especially after balloon dilatation, the incidence of restenosis is higher. CDU can be used as an objective evaluation means for the long-term efficacy of LIV stenosis.

关 键 词：窦血栓形成 颅内 颈静脉 超声检查 多普勒 彩色 支架 球囊扩张 

分 类 号：R743.32[医药卫生—神经病学与精神病学]