| Hypertensive intracerebral hemorrhage is a common and frequently occurring disease in clinic.It has the characteristics of acute onset,severe illness,high mortality and disability rate.In China,its incidence rate accounts for about 20% ～ 30% of all strokes,while in western countries,intracerebral hemorrhage accounts for 8-15% of all strokes,and the 30 day mortality is about 40-50%.90% of the surviving patients have different degrees of disability.Epidemiological data show that stroke has been the leading cause of death among Chinese people from 1990 to 2017.In recent years,with the aging of the population,the incidence rate of intracerebral hemorrhage has been increasing year by year,and the age of onset is becoming younger and younger,which has brought a heavy burden to patients,families and society.With the improvement of surgical instruments,equipment and technology,the mortality of hypertensive intracerebral hemorrhage has decreased,but the prognosis has not improved.Poor prognosis has always been the difficulty of intracerebral hemorrhage treatment.Developing new treatment methods to improve the prognosis of intracerebral hemorrhage has important clinical and practical significance.At present,there are three most commonly used surgical methods for intracerebral hemorrhage:（1）Traditional craniotomy: mainly used for patients with large amount of bleeding,short onset time,coma and cerebral hernia.Its advantage is that the hematoma can be cleared at one time in the early stage,the bleeding responsible blood vessels can be electrocoagulated to stop bleeding,and the bone flap can be removed for decompression;The disadvantages are large exposure of incision,bone flap and brain tissue,relatively large injury,long operation time and many postoperative complications.（2）Neuroendoscopic hematoma removal: it is mainly used for patients with medium blood volume and good patient consciousness.Neuroendoscopy is similar to other endoscopic instruments.It can use its own camera to display the intraoperative image on the monitor,so that the operator can have a clearer operation field,cooperate with the sheath to provide operation channel,remove hematoma and stop bleeding.It can deal with bleeding points,completely remove hematoma,simple postoperative management,relatively small damage to scalp incision,bone window and brain tissue,and short operation time.（3）Minimally invasive drilling and drainage: simple stereotactic technology and unarmed operation are adopted,which often depends on the clinical experience of doctors,so it is impossible to accurately control the puncture direction and depth.The position of drainage tube is often not in the best position,and repeated puncture of hematoma will lead to rebleeding;After operation,urokinase should be used for many times to liquefy and drain the hematoma,so as to increase the incidence of iatrogenic intracranial infection.It is mainly used for patients who are old and weak,have a long time of onset,have medium amount of bleeding,have good liquefaction of hematoma and good state of consciousness.Since the 21st century,medicine has developed rapidly,and all kinds of advanced medical equipment have emerged one after another.Neurosurgery also tends to pursue minimally invasive surgery,which requires more safety and accuracy.Therefore,neurosurgical robot came into being.It has the characteristics of multi angle,arbitrary path selection and accurate positioning.It can meet the requirements of minimally invasive surgery to the greatest extent,make it the best partner of the operator,and provide more choices for the surgical treatment of intracerebral hemorrhage.Purpose of the study:Through the comparative study of the difference between neurosurgical remebot surgical robot and conventional minimally invasive drilling and drainage in the treatment of hypertensive intracerebral hemorrhage,the observation indexes include hematoma clearance rate,operation time,use times of urokinase,tube time,rebleeding rate,intracranial infection rate,intrapulmonary infection rate and ADL score,so as to explore a new and more effective treatment method for hypertensive intracerebral hemorrhage and improve the prognosis of patients.Research methods:The data of 100 patients with hypertensive intracerebral hemorrhage treated by minimally invasive drilling and drainage in the Department of neurovascular diseases,the first hospital of Jilin University from December 2020 to December 2021 were analyzed retrospectively.25 cases were divided into two groups: 75 cases were drilled by robot and 25 cases were drained by robot.Among them,the traditional drilling and drainage group: 58 males and 17 females,aged 30-80 years,with an average age of54.3 years;Robot surgery group: 18 males and 7 females,aged 30-76 years,with an average age of 53.2 years.Most of the patients started with sudden dizziness,headache,ineffective limb movement on one side,unclear speech and disturbance of consciousness,accompanied by nausea and vomiting.According to the preoperative GCS score table,the preoperative GCS score of the traditional drainage group was 8.4± 1.6 and that of the robot operation group was 8.5 ± 1.7.An electronic database was established for the patient data of all operations,and the patients were followed up for 3 months.The evaluation indexes were:（1）hematoma clearance rate（2）operation time（3）times of use of urokinase（4）time of catheterization（5）postoperative rebleeding rate（6）intracranial infection rate（7）intrapulmonary infection rate（8）curative effect evaluation standard.The prognosis of patients was evaluated by ADL classification method,in which grade I-II was excellent and grade III-V was poor.The two groups of patients were statistically analyzed.result:1.The average hematoma clearance rate after operation in the traditional drilling and drainage group was（36.97 ± 7.40）%,and that in the robot operation group was（65.08 ± 9.20）%.There was significant difference between the two groups（t =15.503,P < 0.001）.2.The average hematoma clearance rate during extubation in the traditional drilling and drainage group was（77.74% ± 7.11%）and that in the robot operation group was（87.24% ± 4.11%）.There was significant difference between the two groups（t= 6.317,P < 0.001）.3.The median operation time was 45（35,55）min in the traditional drilling and drainage group and 99（85135）min in the robot operation group.There was significant difference between the two groups（z = 9.760,P < 0.001）.4.The median number of urokinase injections in the traditional drilling and drainage group was 2（1,3）,and the median number of urokinase injections in the robot operation group was 1（1,2）.There was significant difference between the two groups（z = 2.650,P < 0.05）.5.The tube time in the traditional drilling and drainage group was 3（2,4）days and that in the robot operation group was 2（2,3）days.There was significant difference between the two groups（z = 2.100,P < 0.05）.6.The postoperative rebleeding rate was 12.0% in the traditional drilling and drainage group and 4.0% in the robot operation group.There was no significant difference between the two groups（P = 0.441）.7.The number of intracranial infections in the traditional drilling drainage group and the robot operation group were 14.7% and 8.0% respectively.There was no significant difference between the two groups（P = 0.607）;The pulmonary infection rates of the two groups were 38.7% and 16.0% respectively.There was significant difference between the two groups（P < 0.05）;The incidence of complications in the two groups were 53.4% and 24% respectively.There was significant difference between the two groups（P < 0.001）.8.The excellent and good rate of ADL rating after 3 months in the traditional drilling and drainage group was 48.0%,and the excellent and good rate of ADL rating after 3months in the robot operation group was 80%.There was significant difference between the two groups（P < 0.005）.Conclusion:The curative effect of minimally invasive treatment of hypertensive intracerebral hemorrhage with neurosurgical remebot surgical robot is better than that of traditional drilling and drainage,which provides a new treatment method for intracerebral hemorrhage. |
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