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1、·890·中华外科杂志2002年12月第40卷第12期ChinJSurg,December2002,Vol.40,No.12·颅内血管支架·经血管内溶栓和支架成形治疗脑静脉窦闭塞李宝民郭梅李生王茂强【摘要】目的介绍应用静脉窦内直接溶栓和支架成形治疗脑静脉窦闭塞的初步经验。方法17例患者均经DSA证实为静脉窦内血栓形成。单一部位血栓3例,多发性血栓14例;脑动静脉循环时间均延长至13s以上。所有患者先采用血管内直接溶栓治疗,先在静脉窦内留置微导管5d,同时局部输入尿激酶150万U/d,并口服华法令3～5mg。其中4例经复查造影见静脉窦仍狭窄明显,再置放Smart支架进行窦内成形。结果17例患者
2、经静脉窦内接触性溶栓、支架成形术后静脉窦完全再通9例,部分再通8例。治疗后7例颅内压恢复正常,8例于术后7d内再次有不同程度的颅内压升高,经持续抗凝后使颅内压恢复正常,仅2例颅内压高于280mmH2O。术后对患者随访3个月～5年,15例症状持续缓解。结论对静脉窦血栓采用持续溶栓和支架成形可直接促进脑静脉血液回流,从而降低颅内压。【关键词】窦血栓形成,颅内;脑静脉;缩窄,病理性;支架;血栓溶解疗法EndovascularthrombolysisandstentangioplastyforobliterationincerebralvenoussinusesLIBaomin,GUOMei,LIS
3、heng,WANGMaoqiang.DepartmentofInterventioanlRadiology,GeneralHospital,People′sLiberationArmy,Beijing100853,China【Abstract】ObjectiveTosummarizetheexperienceoftreatingtheobliterationofthecerebralvenoussinusin17patientsbyusingdirectthromblysisandstentangioplasty.MethodsAll17patientswiththrombosisandst
4、enosisofthevenoussinuswereconfirmedbydigitalsubstractangiography.Ofthese3patientshadthrombosisinasinglesinusand14hadthrombosisinmultiplesinuses.Thecirculatingtimewasprolongedforover13seconds.Themicro2catheterwaspreservedinthesinusfor5days,followedbyinfusionofurokinase115millionunitsandoralwafarin3-
5、5mgeachday.Stentangioplastywasdonefor4patientswithobviousstenosisofthevenoussinusdetectedbyDSAafterthrombosis.ResultsAftercontactthrombosisandstentangioplastyinsinusesofthe17patients,remarkablerecanalizationofobliteratedsinuseswasachieved.Aftertreatment,intracranialhypertensionpressure(ICP)returned
6、tonormalin7patients,and8thrombosisrelapsedindifferentdegreeafter7days.Anticoagulationwaspreseribed.Only2patientsshowedtheICPabove280mmH2O.Noobviousrelapsewasfoundin15patientsduringthefollow2upfor3-60months.ConclusionOurresultsdemonstratedthatsuccessivethrombolysisandstentangioplastyforocclusionandt
7、hrombosisofthevenoussinusareeffectiveinpromotingdrainageofcerebralvenousbloodandrapidlydecreasingICP.【Keywords】Sinusthrombosis,intracranial;Cerebralveins;Constriction,pathologic;Stent;Thrombolytictherapy静脉系
