成人急性颅内静脉窦血栓伴颅内血肿的治疗分析(附9例报告)  

Treatment of acute intracranial venous sinus thrombosis with intracerebral hemorrhage in adults(9 cases report)

作　　者：董安石[1] 钟伟健[1] 廖旭兴[1] 罗杰 周思捷 梁铭钦 刘鑫鑫 邓其峻[1] 王辉[1] DONG An-shi;ZHONG Wei-jian;LIAO Xu-xing(Department of Vascular and Interventional Neurosurgery, The First People's Hospital of Foshan, Foshan 528000, China)

机构地区：[1]佛山市第一人民医院血管及介入神经外科,佛山528000 [2]佛山市第一人民医院康复科,佛山528000

出　　处：《临床神经外科杂志》2020年第6期704-707,共4页Journal of Clinical Neurosurgery

基　　金：广东省佛山市“十三·五”医学重点专科基金(FSZDZK135006);佛山市杰出青年医学人才基金(2018132)。

摘　　要：目的探讨成人急性颅内静脉窦血栓(CVST)合并颅内血肿的治疗方案及效果。方法回顾性分析9例CVST合并颅内血肿患者的临床资料。分析出血部位与静脉窦血栓部位之间关系,相应的治疗方法及预后。结果本组患者中颞叶及颞枕叶出血者4例,主要血栓部位为横窦、乙状窦;额叶出血及额叶出血为主伴顶叶少许出血3例,血栓部位为上矢状窦前2/3;双顶叶出血1例,血栓部位为上矢状窦后1/2;丘脑出血合并顶叶出血1例,血栓部位为直窦、窦汇及上矢状窦后1/2。本组患者均使用抗凝治疗,其中4例患者单纯抗凝治疗;1例患者抗凝联合介入治疗;1例患者抗凝联合去骨瓣减压及清除血肿术;3例患者抗凝联合溶栓治疗后出现出血增多行去骨瓣减压及清除血肿术,其中2例患者术后水肿加重再次扩大减压窗。本组患者中出院时格拉斯哥预后量表评分≥4分者6例,2分(植物生存)1例,死亡2例。结论根据出血部位可大致预测静脉窦血栓部位。抗凝治疗对CVST合并颅内血肿患者有效;充分的大骨瓣减压可使病情持续进展患者获益。Objective To explore the treatment of acute cerebral venous sinus thrombosis(CVST)with intracranial hematoma in adults.Methods 9 patients with CVST complicated with intracranial hematoma were retrospectively analyzed.The relationship between bleeding site and sinus thrombosis site and the corrspondingt and prognosis treatment were studied.Results There were 4 cases of hemorrhage in temporal lobe and temporal occipital lobe.Frontal lobe hemorrhage and frontal lobe hemorrhage with parietal lobe hemorrhage in 3 patients.The main thrombus site was 2/3 of the superior sagittal sinus.Double parietal hemorrhage was found in 1 case,and the main thrombus site was 1/2 behind the superior sagittal sinus.Thalamic hemorrhage and parietal hemorrhage were found in 1 case,and the main thrombus sites were located in the straight sinuses,sinuses and 1/2 posterior to the superior sagittal sinus.4 patients received anticoagulant therapy alone,1 patient received anticoagulant therapy combined with interventional therapy,1 patient received anticoagulant therapy combined with decompression and hematoma removal surgery,3 patients were treated with anticoagulation combined with thrombolysis and craniotomy,2 of them need to be decompressed again.Among 9 patients,6 patients had GOS≥4 scores,2 died,and 1 survived.Conclusions According to the site of bleeding,the site of venous sinus thrombosis can be predicted roughly.CVST patients with intracranial hematoma can benefit from anticoagulation.Patients with progressive disease benefit from adequate large flap decompression.

关 键 词：静脉窦血栓 颅内血肿 抗凝 血管内治疗 去骨瓣减压术 

分 类 号：R651[医药卫生—外科学]