中华神经外科杂志
中華神經外科雜誌
중화신경외과잡지
Chinese Journal of Neurosurgery
2012年
3期
260-263
,共4页
李广文%曾现伟%季泰令%王斌%陈健%缪中荣%贾建平%魏岗之%凌锋%吉训明
李廣文%曾現偉%季泰令%王斌%陳健%繆中榮%賈建平%魏崗之%凌鋒%吉訓明
리엄문%증현위%계태령%왕빈%진건%무중영%가건평%위강지%릉봉%길훈명
静脉窦%血栓%机械碎栓
靜脈竇%血栓%機械碎栓
정맥두%혈전%궤계쇄전
Venous sinus%Thrombosis%Mechanical throbectomy
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.
目的 研究機械性碎栓治療難治性顱內靜脈竇血栓形成患者的安全性和有效性.方法 對23例抗凝治療不能控製病情髮展的顱內靜脈竇血栓形成患者,施行瞭機械性碎栓治療.其中,單純機械性碎栓治療5例,機械性碎栓聯閤接觸性溶栓治療的患者18例.術後規範抗凝治療12箇月,同時篩查靜脈竇血栓病因,併給予相應處理.術後3箇月、6箇月和12箇月進行臨床隨訪,包括眼底視盤檢查、GCS評分、mRS評分,腰穿和MRV或DSA檢查.結果 機械碎栓治療後即刻,所有患者靜脈竇主榦血流恢複.患者齣院前神經功能評分2.1±1.1較術前3.7±1.2明顯改善(P＜0.05),GCS評分11.5±4.6較術前10.5±3.4明顯改善(P＜0.05),其中mRS評分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例自動齣院後死亡.術後3箇月迴訪,所有患者眼底視盤水腫消失,腰穿壓力恢複正常,mRS評分0～1分患者14例,2分3例,3分1例.術後12箇月mRS評分0～1分患者17例,2分1例,未見患者血栓複髮.結論 機械碎栓是難治性顱內靜脈竇血栓安全、有效的一種治療手段.抗凝治療不能控製癥狀或者是重癥患者應儘早採用機械性碎栓治療.
목적 연구궤계성쇄전치료난치성로내정맥두혈전형성환자적안전성화유효성.방법 대23례항응치료불능공제병정발전적로내정맥두혈전형성환자,시행료궤계성쇄전치료.기중,단순궤계성쇄전치료5례,궤계성쇄전연합접촉성용전치료적환자18례.술후규범항응치료12개월,동시사사정맥두혈전병인,병급여상응처리.술후3개월、6개월화12개월진행림상수방,포괄안저시반검사、GCS평분、mRS평분,요천화MRV혹DSA검사.결과 궤계쇄전치료후즉각,소유환자정맥두주간혈류회복.환자출원전신경공능평분2.1±1.1교술전3.7±1.2명현개선(P＜0.05),GCS평분11.5±4.6교술전10.5±3.4명현개선(P＜0.05),기중mRS평분0～1분환자9례,2분6례,3분급이상7례,사망1례,령유4례자동출원후사망.술후3개월회방,소유환자안저시반수종소실,요천압력회복정상,mRS평분0～1분환자14례,2분3례,3분1례.술후12개월mRS평분0～1분환자17례,2분1례,미견환자혈전복발.결론 궤계쇄전시난치성로내정맥두혈전안전、유효적일충치료수단.항응치료불능공제증상혹자시중증환자응진조채용궤계성쇄전치료.
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 fundus 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 ± 1.1vs3.7 ± 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 1got 2.Condusious Mechanical throbectomy for intractable cerebral venous sinus thrombosis is safe and effective.We suggest that for patients especially who are not response to antithrombotic druga take it as soon as possible.
