| Objective:To explore and evaluate the efficacy of neuronavigation assisted endoscopic hematoma removal and minimally invasive hematoma puncture and drainage in the treatment of different hypertensive intracerebral hemorrhage patients.Methods: Retrospective analysis was made on 196 patients who were admitted to neurosurgery from January 2020 to October 2022 and diagnosed as hypertensive intracerebral hemorrhage,who received neuronavigation assisted endoscopic hematoma clearance or minimally invasive hematoma puncture and drainage,and who met the inclusion and exclusion criteria.According to the surgical procedure,patients in the neuroendoscopic group(n=46)and the puncture drainage group(n=54)were divided into two groups.Patients in the neuroendoscopic group underwent neuroendoscopic hematoma removal surgery with the assistance of neuronavigation,while patients in the puncture drainage group underwent minimally invasive hematoma puncture drainage surgery.Collect general patient information,record surgical time,hospital stay,and intraoperative bleeding volume.On the 1st and 7th day after surgery,the head CT was re examined and the hematoma clearance rate was calculated.The postoperative rebleeding rate and mortality rate were recorded,and the differences in the above indicators among patients undergoing the two surgeries were analyzed and stratified.Results:1.In terms of overall efficacy results between the neuroendoscopic group and the puncture drainage group,the surgical time in the neuroendoscopic group was significantly longer than that in the puncture drainage group,and the difference was statistically significant(P<0.05);The intraoperative blood output in the neuroendoscopic group was higher than that in the puncture and drainage group,with a statistically significant difference(P<0.05);The hospitalization time during surgery in the neuroendoscopic group was slightly shorter than that in the puncture and drainage group,but the difference between the two groups was not statistically significant(P>0.05);The hematoma clearance rate in the endoscopic group was significantly higher than that in the puncture and drainage group on the 1st and 7th day after surgery,with a statistically significant difference(P<0.05).At 3 months after surgery,the GOS and ADL scores in the endoscopic group were significantly higher than those in the puncture and drainage group,with statistical significance(P<0.05).The mortality rate and rebleeding rate in the endoscopic group were lower than those in the puncture and drainage group,with statistically significant differences(P<0.05).2.Layered analysis found that patients with advanced age,significant bleeding,GCS scores of 3-8,and cerebral hemorrhage breaking into the ventricles had significantly longer surgical time and more intraoperative bleeding(P<0.05).The hematoma clearance rate was significantly lower on the 1st and 7th days after surgery(P<0.05),and the rate of rebleeding and mortality were higher(P<0.05).3.The neuroendoscopic group of elderly patients and non elderly subgroups,subgroups with significant and non significant bleeding,subgroups with GCS scores(GCS 3-8,9-15),subgroups with or without ventricular rupture,surgical time,surgical bleeding volume,hematoma clearance rate at 1 and 7 days after surgery,GOS score at 3 months after surgery,and ADL score were all higher than those in the puncture and drainage group(P<0.05).4.In the comparison between the neuroendoscopic group and the puncture drainage group in the subgroup of elderly and non elderly patients,the puncture drainage group of non elderly patients had the shortest surgical time,and there was a statistically significant difference compared to the neuroendoscopic group(P<0.05);There was no statistically significant difference in the length of stay between the groups(P>0.05);The neuroendoscopic group of non elderly patients had the highest hematoma clearance rate on the 1st and 7th day after surgery,and there was a statistically significant difference compared to the puncture and drainage group(P<0.05);The non elderly puncture group had the highest rebleeding rate and mortality rate,and there was a statistically significant difference compared to the neuroendoscopic group(P<0.05);There was a statistically significant difference in the GOS and ADL scores at 3 months after surgery between the non elderly patients in the neuroendoscopic group and the puncture and drainage group(P<0.05).5.In the comparison between the neuroendoscopic group and the puncture drainage group in the subgroup of massive bleeding and non massive bleeding,the neuroendoscopic group with massive bleeding had the longest surgical time and the highest amount of bleeding,and the difference was statistically significant compared to the puncture drainage group(P<0.05);The endoscopic group with non massive bleeding had the least hospitalization time,but there was no statistically significant difference compared to other groups(P>0.05);The endoscopic group with non massive bleeding had the highest hematoma clearance rate on the 1st day after surgery,and there was no statistically significant difference compared to the puncture and drainage group(P>0.05);The endoscopic group and puncture drainage group had the highest hematoma clearance rate on the 1st day after surgery,and there was no statistically significant difference between the two groups(P>0.05);The group with massive bleeding puncture and drainage had the highest rebleeding rate and mortality rate,and there were statistically significant differences compared to other groups(P<0.05);The group with massive bleeding and puncture drainage had the lowest GOS score at 3 months after surgery,and there was a statistically significant difference compared to other groups(P<0.05);The patients in the non massive bleeding neuroendoscopic group had the highest ADL score at 3 months after surgery,but there was no statistically significant difference compared to other groups(P>0.05).6.In the subgroup comparison of GCS scores of 3-8 and 9-15,the neuroendoscopic group and puncture drainage group showed that patients in the GCS score of 3-8 had the longest surgical time and the highest bleeding volume,and the differences were statistically significant compared with other groups(P<0.05);Patients in the endoscopic group with GCS scores of 9-15 had the shortest hospitalization time,but there was no statistically significant difference compared to other groups(P>0.05);The neuroendoscopic group with GCS scores of 9-15 had the highest hematoma clearance rate on the 1st and 7th day after surgery,and there was a statistically significant difference compared to other groups(P<0.05);The patients in the puncture drainage group with GCS scores of3-8 had the highest rebleeding rate and mortality rate,and there was a statistically significant difference compared to other groups(P<0.05);The GOS score of patients in the endoscopic group was the highest,with a GCS score of9-15,and there was a statistically significant difference compared to other groups(P<0.05);The ADL score of patients in the endoscopic group was the highest,with a GCS score of 9-15,and there was a statistically significant difference compared to other groups(P<0.05).7.In the comparison of whether to break into the ventricle subgroup between the neuroendoscopic group and the puncture drainage group,the neuroendoscopic group with broken into the ventricle had the longest surgical time,and there was a statistically significant difference compared to other groups(P<0.05);The group with intraventricular neuroendoscopy had the highest intraoperative bleeding volume,with a statistically significant difference compared to other groups(P<0.05);The hospitalization time of the puncture drainage group was the longest,and there was a statistically significant difference compared to other groups(P<0.05);The group without intraventricular neuroendoscopy had the highest hematoma clearance rate on the 1st and 7th day after surgery,with a statistically significant difference compared to other groups(P<0.05);The group of puncture and drainage into the ventricle had the highest rate of rebleeding and mortality compared to other groups,and there was a statistically significant difference(P<0.05);The GOS and ADL scores were the highest in the group without breaking into the ventricles of the brain at 3 months after surgery,but there was no statistically significant difference compared to the group without breaking into the ventricles of the brain puncture and drainage(P>0.05),and there was a statistically significant difference compared to other groups(P<0.05).Conclusion:Neuronavigation assisted endoscopic hematoma clearance surgery can improve the hematoma clearance rate in patients with hypertensive intracerebral hemorrhage.Neuronavigation assisted endoscopic hematoma removal surgery can prevent normal brain tissue damage in patients with hypertensive intracerebral hemorrhage.It has a significant effect on reducing the incidence and mortality of postoperative complications and improving patient prognosis.Neuronavigation assisted endoscopic hematoma removal is a safe and effective surgical approach for hypertensive intracerebral hemorrhage.However,when selecting surgical plans for HICH patients in clinical practice,it is necessary to consider the patient’s condition and choose a more suitable surgical plan for the patient.This study is a retrospective,small sample,and non randomized controlled clinical study,and further prospective randomized controlled studies with large samples are needed to confirm it. |
PDF Full Text Request