A Retrospective Study Of Three Operative Methods For Hypertensive Intracerebral Hemorrhage In Basal Ganglia Region

Obiective:The clinical effects of traditional craniotomy hematoma removal,stereotactic hematoma aspiration and neuroendoscopy hematoma removal were analyzed retrospectively,and the different characteristics of the three surgical methods were discussed.To provide a clinical reference for the treatment of hypertensive basal ganglia hemorrhage.Methods:From July 2015 to October 2017,the data of 83 patients undergoing surgical treatment in the Department of Neurosurgery,the third affiliated Hospital of Guangzhou Medical University,were collected.According to different surgical methods,27 cases of craniotomy group,26 cases of stereotactic group and 30 cases of neuroendoscopy group were divided into three groups.The patients’ gender,age and preoperative Glasgow coma(GCSs)score were collected.The baseline indexes of the bleeding site(left or right side,preoperative hematoma volume)were compared,and the data of the three groups were compared.The operative time,intraoperative blood loss,hematoma clearance rate,rebleeding rate,postoperative complications,and No death,6 months after the ADL grading was compared according to different surgical methods.Statistical analysis using SPSSl7.0 statistical software for statistical data analysis and processing.All measurement data are expressed by mean ±standard deviation,and all counting data are expressed by examples(percentage),and the test level is 0.05.Results:The baseline indexes of the three groups were similar.There were no significant differences in sex,age,preoperative hematoma volume and preoperative GCS score among the three groups.Operation time : The average operative time was 2.73 ±0.83 hours in the traditional craniotomy group,1.26 ±0.71 hours in the stereotactic puncture group and1.60 ±0.72 hours in the endoscopic group.There was significant difference between the traditional craniotomy group and the stereotactic group and the neuroendoscopy group(P = 0.034 ±0.032,respectively).There was no significant difference between stereotactic group and endoscopic group(P < 0.05).Traditional craniotomy group and stereotactic group,neuroendoscopy group.Intraoperative blood loss:The average intraoperative blood loss was 314.29±134.52 ml in the traditional craniotomy group,5.88 ±2.65 ml in the stereotactic puncture group and 40.11 ±16.7ml in the neuroendoscopy group.The blood loss in the traditional craniotomy group was significantly higher than that in the stereotactic group,and the difference between the two groups was statistically significant(P =0.034、0.032,P<0.05).The blood loss in the traditional craniotomy group was more than that in the stereotactic group,the nerve group,and the vertical craniotomy group.The volume of blood loss in the stereotactic group was less than that in the endoscopic group.Hematoma clearance rate:The average clearance rate of hematoma was 90.01±13.62 in the traditional craniotomy group,66.63 ±11.23 in the stereotactic puncture group and 88.98 ±12.17 in the neuroendoscopy group.The difference of hematoma clearance rate between traditional craniotomy group and stereotactic group was statistically significant(P = 0.003<0.05).There was no significant difference in hematoma clearance rate between traditional craniotomy group and stereotactic group(P>0.05),and hematoma clearance between stereotactic group and neuroendoscope group.The difference of rate was statistically significant(P = 0.042<0.05).Traditional craniotomy group,The hematoma clearance rate in the endoscopic group was better than that in the stereotactic group.The rate of rebleeding:The rate of postoperative rebleeding was 7.41 in the traditional craniotomy group,7.69 in the stereotactic group and no rebleeding in the endoscopic group.There was no significant difference in the rebleeding rate between the three groups.Incidence of postoperative complication : The traditional craniotomy group(55.56),stereotactic group(38.46)and endoscopic group(20 cases)had significant difference in postoperative complications.The test level was(0.05 / 3= 0.167)according to the Bonferroni method.In the traditional craniotomy group and stereotactic group,there was no significant difference in the complications between the two groups.The complications in the traditional craniotomy group and neuroendoscopy group were significantly different from those in the traditional craniotomy group and the neuroendoscopy group.There was a statistically significant difference in complications between the two groups.The incidence of complications in the endoscopic group was lower than that in the traditional craniotomy group.There was no significant difference in complications between stereotactic group and neuroendoscopy group.Mortality:In terms of mortality,the traditional craniotomy group was 11.11,the stereotactic group was 3.85 and the endoscopic group was 3.33.The difference between the three groups was not statistically significant.ADL classification in postoperative six month : In the traditional craniotomy group,the I-III grade was 66.67 in the ADL grade 6 months after operation,88.46 in the stereotactic puncture group and 83.33 in the endoscopic group.There was no significant difference between the three groups.Conclusion:1.In the treatment of hypertensive basal ganglia hemorrhage,stereotactic haematoma puncture aspiration is superior to the traditional bone flap skull hematoma removal and neuroendoscope hematoma removal during the operation time;The intraoperative blood loss was less than that of the traditional bone flap;2.Endoscopic hematoma removal is a new treatment for hypertensive basal ganglia hemorrhage,and the removal rate of hematoma is better than stereotactic hematoma aspiration,and the incidence of postoperative complications is lower than that of traditional craniotomy.3.According to the advantages and disadvantages of traditional craniotomy hematoma removal,stereotactic hematoma aspiration and neuroendoscopy hematoma removal,the patients should be evaluated comprehensively in the clinical practice,according to the advantages and disadvantages of traditional craniotomy,stereotactic hematoma aspiration and neuroendoscopic hematoma removal.The corresponding individualized operation was selected.