CAJ | 학술논문

目的探讨以颅内静脉窦血栓形成(CVST)病程为基础而选择个体化治疗方案的疗效及安全性.方法收集2010年8月至2011年8月首都医科大学宣武医院以及厦门大学附属中山医院确诊的43例CVST患者,根据患者病程长短采用不同治疗方案.22例急性期(1周内)患者采用系统抗凝治疗；11例急性期抗凝治疗无效者和8例亚急性期(1周至1个月内)患者采用局部静脉窦接触性溶栓联合机械性碎栓治疗；13例慢性期(大于1个月)患者采用机械性碎栓联合球囊成形术或支架辅助静脉窦成形术.术后均积极治疗原发病,持续抗凝1年.随访3～6个月,平均4.5个月.结果出院时有41例患者的症状、体征明显改善,其中头痛缓解29例(67.4％),视力障碍改善28例(28/31,90.3％)；脑脊液压力均降至250 mm H2O(1 mm H2O =0.0098 kPa)以下,恢复正常32例(74.4％)；1例手术失败；1例并发硬膜下血肿,经保守治疗后血肿吸收.总有效率95.4％ (41/43),直接与手术相关的并发症发生率3.1％(1/32),无死亡.3个月随访39例患者,症状均消失,脑脊液压力恢复正常36例(92.3％),视乳头水肿消退37例(94.9％).6个月随访16例患者,脑血管造影证实8例患者静脉窦主干通畅；5例患者静脉窦主干部分再通；3例支架辅助静脉窦成形术患者显示支架无移位,静脉窦保持通畅.结论以患者病程为基础对CVST进行的个体化治疗是安全、有效的.
목적 탐토이로내정맥두혈전형성(CVST)병정위기출이선택개체화치료방안적료효급안전성.방법 수집2010년8월지2011년8월수도의과대학선무의원이급하문대학부속중산의원학진적43례CVST환자,근거환자병정장단채용불동치료방안.22례급성기(1주내)환자채용계통항응치료；11례급성기항응치료무효자화8례아급성기(1주지1개월내)환자채용국부정맥두접촉성용전연합궤계성쇄전치료；13례만성기(대우1개월)환자채용궤계성쇄전연합구낭성형술혹지가보조정맥두성형술.술후균적겁치료원발병,지속항응1년.수방3～6개월,평균4.5개월.결과 출원시유41례환자적증상、체정명현개선,기중두통완해29례(67.4％),시력장애개선28례(28/31,90.3％)；뇌척액압력균강지250 mm H2O(1 mm H2O =0.0098 kPa)이하,회복정상32례(74.4％)；1례수술실패；1례병발경막하혈종,경보수치료후혈종흡수.총유효솔95.4％ (41/43),직접여수술상관적병발증발생솔3.1％(1/32),무사망.3개월수방39례환자,증상균소실,뇌척액압력회복정상36례(92.3％),시유두수종소퇴37례(94.9％).6개월수방16례환자,뇌혈관조영증실8례환자정맥두주간통창；5례환자정맥두주간부분재통；3례지가보조정맥두성형술환자현시지가무이위,정맥두보지통창.결론 이환자병정위기출대CVST진행적개체화치료시안전、유효적.
Objective To discuss the individualizing schedule of endovascular treatment for intracranial venous sinus thrombosis based on the clinical feature and the stage of the disease.Methods Forty-three patients diagnosed with intracranial venous sinus thrombosis in Xuanwu Hospital,Capital University of Medical Sciences and in Zhongshan Hospital Xiamen University during period of August 2010 to August 2011 were treated with endovascular therapy designed individually based on the clinical stage of the disease development.Of all 43 cases,22 cases with acute onset (＜ 1 week after the onset) were treated with standard anticoagulant therapy ; 11 cases who failed to respond to anticoagulant therapy and 8 cases with subacute onset (1 week to 1 month) received intravenous thrombolysis and mechanical thrombus maceration;and 13 cases with chronic course (＞ 1 month) were given mechanical thrombus maceration combined with balloon dilation vascular surgery or stent-assisted venous sinus surgery,with taking anticoagulant for 12months.The patients were followed up for 3 to 6 months (mean 4.5 months).Results Their symptoms and signs were all significantly improved,with headache relief in 29 cases(67.4％),vision improvement in 28cases (28/31,90.3％),cerebrospinal fluidpressure decrease to normal level in 32 cases(32/43,74.4％) ;no improvement in 1 case,and a complication of subdural hematoma in 1 case.Three months follow-up of 39 patients,symptoms disappeared,the pressure cerebrospinal fluid in 36 cases returned to normal (94.3％),the papilledema in 37 cases subsided (94.9％).After 6 months,16 patients were followed up with an angiography; 8 of them were found venous sinus clear,5 were found partial recanalization of venous sinus trunk,cortical veins and deep venous was partially compensation,and 3 cases with stent-assisted venous sinus surgery were found the stent not shifted or collapsed,and venous sinuses maintained patency.Conclusions Endovascular treatment for patients with intracranial venous sinus thrombosis should be treated with individually designed therapy based on their clinical features and the stage of the disease.The individualized treatment was effective and safe.