重症脑静脉窦血栓形成抽吸取栓联合静脉窦置管溶栓疗效分析

doi:10.3969/j.issn.1672-6731.2025.06.006

摘要/Abstract

摘要：

目的: 探讨重症脑静脉窦血栓形成导管抽吸取栓联合微导管静脉窦置管溶栓的有效性及安全性。方法与结果: 回顾分析2017年1月至2022年12月在西北大学附属医院·西安市第三医院接受导管抽吸取栓联合微导管静脉窦置管溶栓治疗的10例重症脑静脉窦血栓形成患者的临床资料，均顺利完成手术，1例术后即刻实现静脉窦完全再通、5例实现部分再通、4例未再通；术后90 d随访，5例实现完全再通、4例实现部分再通、1例未再通。7例术前存在颅内出血的患者，术后7 d复查头部CT原位出血均较术前吸收；2例术后7 d内新发颅内出血。术后90 d随访，1例预后不良，改良Rankin量表（mRS）评分3分，余9例预后良好（mRS评分≤ 2分）；术后12个月随访，10例均预后良好。结论: 导管抽吸取栓联合微导管静脉窦置管溶栓治疗重症脑静脉窦血栓形成可能安全、有效，可以改善患者预后。

关键词: 窦血栓形成，颅内, 危重病, 血栓切除术, 血栓溶解疗法, 预后

Abstract:

Objective: To examine the safety and efficacy of catheter aspiration combined with microcatheter venous sinus intraluminal thrombolysis in the treatment of severe cerebral venous sinus thrombosis (CVST). Methods and Results: We retrospectively analyzed the medical records of 10 patients with severe CVST who received catheter aspiration combined with microcatheter venous sinus intraluminal thrombolysis at The Affiliated Hospital of Northwest University, Xi'an No. 3 Hospital from January 2017 to December 2022. All 10 patients successfully completed the surgery. One patient achieved complete recanalization of the venous sinus immediately after the operation, 5 patients achieved partial recanalization, and 4 patients didn't recanalize. At the 90 d after the surgery, 5 patients achieved complete recanalization, 4 patients achieved partial recanalization, and one patient didn't recanalize. Among 7 patients who had intracranial hemorrhage (ICH) before the operation, head CT reexamination 7 d after the operation showed the hemorrhage at the original position was absorbed compared with that before the operation. Two patients developed newly ICH within 7 d after the operation. One patient experienced a poor prognosis [modified Rankin Scale (mRS) score of 3], while 9 had favorable prognosis (mRS ≤ 2) at 90 d after the operation. At the 12-month follow-up after the operation, all 10 patients had a favorable prognosis. Conclusions: Catheter aspiration combined with microcatheter venous sinus intraluminal thrombolysis maybe a safe and effective treatment for severe CVST, showing improvement in prognosis.

Key words: Sinus thrombosis, intracranial, Critical illness, Thrombectomy, Thrombolytic therapy, Prognosis

张静, 葛晗明, 韩楠楠, 张乐石, 刘志勤, 常明则. 重症脑静脉窦血栓形成抽吸取栓联合静脉窦置管溶栓疗效分析[J]. 中国现代神经疾病杂志, 2025, 25(6): 489-495.

Jing ZHANG, Han-ming GE, Nan-nan HAN, Le-shi ZHANG, Zhi-qin LIU, Ming-ze CHANG. Analysis of the efficacy of aspiration combined with venous sinus intraluminal thrombolysis for severe cerebral venous sinus thrombosis[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2025, 25(6): 489-495.

https://journal11.magtechjournal.com/cjcnn/CN/Y2025/V25/I6/489

图/表 3

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序号	性别	年龄（岁）	发病形式	临床症状	病因或诱因	血栓累及部位	术前颅内出血	mRS/GCS（评分）
序号	性别	年龄（岁）	发病形式	临床症状	病因或诱因	血栓累及部位	术前颅内出血	入院时	术前
1	女性	37	急性	头痛，局灶性神经功能缺损，意识障碍	未明确	上矢状窦、横窦	有	3/12	4/10
2	男性	19	亚急性	头痛，局灶性神经功能缺损，癫痫发作，意识障碍	凝血酶基因变异	上矢状窦、横窦	无	4/12	4/10
3	女性	49	急性	头痛，意识障碍	口服避孕药	横窦、乙状窦、直窦	无	5/8	5/8
4	女性	38	亚急性	头痛，视力下降	蛋白S缺陷症	上矢状窦、横窦	无	2/15	2/15
5	女性	28	亚急性	头痛，神经功能缺损，癫痫发作，意识障碍	产褥期	上矢状窦、横窦、直窦、广泛皮质静脉	有	4/8	5/7
6	女性	46	亚急性	头痛，癫痫发作	未明确	上矢状窦、横窦、乙状窦	有	3/13	3/13
7	男性	41	亚急性	头痛，视力下降	抗磷脂抗体综合征	上矢状窦、横窦	有	0/15	4/9
8	女性	32	亚急性	头痛，局灶性神经功能缺损，意识障碍，癫痫发作	产褥期	横窦、乙状窦	有	2/12	3/10
9	女性	43	急性	头痛，癫痫发作	未明确	上矢状窦、横窦、乙状窦	有	2/14	2/14
10	女性	56	亚急性	头痛，局灶性神经功能缺损，癫痫发作	原发性血小板增多症	上矢状窦、横窦、乙状窦	有	4/15	4/15

序号	性别	年龄（岁）	发病形式	临床症状	病因或诱因	血栓累及部位	术前颅内出血	mRS/GCS（评分）
序号	性别	年龄（岁）	发病形式	临床症状	病因或诱因	血栓累及部位	术前颅内出血	入院时	术前
1	女性	37	急性	头痛，局灶性神经功能缺损，意识障碍	未明确	上矢状窦、横窦	有	3/12	4/10
2	男性	19	亚急性	头痛，局灶性神经功能缺损，癫痫发作，意识障碍	凝血酶基因变异	上矢状窦、横窦	无	4/12	4/10
3	女性	49	急性	头痛，意识障碍	口服避孕药	横窦、乙状窦、直窦	无	5/8	5/8
4	女性	38	亚急性	头痛，视力下降	蛋白S缺陷症	上矢状窦、横窦	无	2/15	2/15
5	女性	28	亚急性	头痛，神经功能缺损，癫痫发作，意识障碍	产褥期	上矢状窦、横窦、直窦、广泛皮质静脉	有	4/8	5/7
6	女性	46	亚急性	头痛，癫痫发作	未明确	上矢状窦、横窦、乙状窦	有	3/13	3/13
7	男性	41	亚急性	头痛，视力下降	抗磷脂抗体综合征	上矢状窦、横窦	有	0/15	4/9
8	女性	32	亚急性	头痛，局灶性神经功能缺损，意识障碍，癫痫发作	产褥期	横窦、乙状窦	有	2/12	3/10
9	女性	43	急性	头痛，癫痫发作	未明确	上矢状窦、横窦、乙状窦	有	2/14	2/14
10	女性	56	亚急性	头痛，局灶性神经功能缺损，癫痫发作	原发性血小板增多症	上矢状窦、横窦、乙状窦	有	4/15	4/15

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Analysis of the efficacy of aspiration combined with venous sinus intraluminal thrombolysis for severe cerebral venous sinus thrombosis

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序号	确诊至手术时间（d）	手术时间（min）	置管时间（d）	尿激酶剂量（× 10 ³ U）	术后7 d颅内出血或血肿增加	静脉窦再通		住院时间（d）	术后mRS（评分）
序号	确诊至手术时间（d）	手术时间（min）	置管时间（d）	尿激酶剂量（× 10 ³ U）	术后7 d颅内出血或血肿增加	术后即刻	术后90 d	住院时间（d）	90 d	12个月
1	4	71	5	300	否	完全再通	完全再通	12	0	0
2	1	162	5	300	是（置管过程中临床症状加重，复查头部CT显示颅内出血）	未再通	未再通	35	0	0
3	8	117	5	300	否	未再通	完全再通	28	1	1
4	3	152	5	300	否	部分再通	完全再通	21	0	0
5	2	224	7	500	是（临床症状未加重）	未再通	部分再通	43	3	1
6	1	76	3	300	否	部分再通	完全再通	14	0	0
7	16	85	3	300	否	未再通	部分再通	39	2	1
8	3	91	7	300	否	部分再通	部分再通	32	0	0
9	1	170	7	300	否（抗PF4抗体阳性及HIT，拔管4 d后出现癫痫发作，复查头部CT显示小脑出血）	部分再通	部分再通	52	1	0
10	4	132	7	300	否	部分再通	完全再通	18	0	0

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2 重症脑静脉窦血栓形成抽吸取栓联合静脉窦置管溶栓疗效分析

Analysis of the efficacy of aspiration combined with venous sinus intraluminal thrombolysis for severe cerebral venous sinus thrombosis

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