重症硬脑膜静脉窦血栓的局部溶栓治疗

目的 研究重症硬脑膜静脉窦血栓的局部溶栓治疗的方法及疗效。方法 总结我院自2000年以来6例重症硬脑膜静脉窦血栓的局部溶栓治疗经验，男4例，女2例，其中4例采用一侧股动脉及对侧股静脉Seldinger穿刺，2例采用股动脉Seldinger穿刺及上矢状窦前1／3穿刺。导管置入一侧颈内动脉及静脉窦血栓处后，于颈内动脉及静脉窦血栓处先后各用尿激酶50万U，以每分钟1万U泵入，再于静脉窦血栓处泵入尿激酶持续溶栓，维持外周血中纤维蛋白原含量1．0～1．5g／L，同时予全身肝素化，维持外周血活化部分凝血活酶时间正常值的2～3倍。结果 本组6例，5例痊愈，颅内压转正常，头痛消失，无神经功能障碍，其中4例数字减影血管造影(DSA)见浅表静脉扩张消失，静脉窦显影正常，1例浅表静脉扩张明显改善，静脉窦显影较前好转；1例好转，颅内压较前降低，头痛好转，DSA见浅表静脉扩张消失，静脉窦显影正常，抗凝治疗1个月后颅内压正常，头痛消失，神经功能恢复正常。结论 重症硬脑膜静脉窦血栓采用动静脉系统联合应用尿激酶局部溶栓治疗是快速、安全、有效的方法，经股静脉途径不易到达静脉窦血栓处者，可以行上矢状窦入路。

Endovascular regional thrombolysis treatment of severe dural venous sinus thrombosis

Objective To study the way and effect of endovascular regional thrombolysis treatment of severe dural venous sinus thrombosis. Methods The experiences in 6 patients with severe dural venous sinus thrombosis treated in our hospital since 2 000 were summarized. Four cases had been treated by transfemoral arterovenous approach and 2 cases by femoral artery and superior sagittal sinus approach. 5 French catheter was positioned in the internal carotid artery and 3/2.5 French microcatheter inside the dural venous sinus thrombosis. After 500 000 U urokinase had been injected into the internal carotid artery and the thrombosis respectively by 10 000 U per minute, urokinase was injected into the thrombosed sinus continuously and fibrinogen was maintained at 1.0-1.5 g/L. The activated partial thromboplastin was retained at twice or three times longer than the standard by systemic anticoagulation with heparin. Results 5 of the 6 cases were cured. DSA was normal in the superior sagittal sinus and cortical veins in 4 cases, and DSA was improved in cortical veins and dural venous sinus in 1 case. One of the 6 cases was markedly improved, and DSA was normal in the superior sagittal sinus and cortical veins, and it was cured by anticoagulation treatment after one month. Conclusion Endovascular regional thrombolysis treatment of severe dural venous sinus thrombosis is effective, safe, and prompt. If it is difficult to position the catheter in thrombosed dural venous sinus by transfemoral venous approach, transsuperior sagittal sinus approach is a simple, effective, and cheap alternative.