Meta - Analysis Of Hypertensive Cerebral Hemorrhage Treated By Small Bone Flap Hematoma Removal And Puncture And Drainage

Objective To compare the clinical efficacy on the activity of daily life between the keyhole surgery and aspiration and drainage of hematoma in the treatment of hypertensive intracerebral hemorrhage.Methods 66 cases of hypertensive cerebral hemorrhage patients from March 2012 to July 2015 In our hospital were retrospectively analyzed. The GCS score, bleeding site, hematoma volume and the different operative methods on patients were used for statistical analysis, and compare the postoperative patients prognosis.Results Hematoma of the small bone window dissection was performed in 47 cases of 66 cases, preoperative GCS more than 8 points accounting for 46 cases (97.9%), GCS< 8 accounting for 1 cases (2.1%). Basal ganglia hemorrhage accounted for 31 cases(65.9%), thalamus hemorrhage accounted for 6 cases(12.7%), small cerebral hemorrhage accountied for 4 cases(8.5%),Cortical bleeding accounted for 6 cases (12.8%); The hematoma volume 60-80 ml accounted for 8 cases (17.0%),40-60 ml for 34 cases (72.3%).< 40 ml for 5 case (10.6%).Aspiration and drainage of hematoma of 19 cases, preoperative GCS ore than 13 points accounted for 17 cases (89.5%),9-12 accounted for 2 cases(10.5%); The thalamus hemorrhage breaking into the ventricles accounted for 8 cases (42.1%), Intraventricular hemorrhage accounted for 11 cases(57.9%), The hematoma volume 60-80 ml accounted for 1 cases (5.2%),40-60 ml for 16 cases (84.2%).< 40 ml for 2 case (10.5%).The application of the x2 test and Spearman correlation test that the amount of bleeding, different surgical operation,and the site of bleeding there is a significant correlation (p<0.05).Aspiration and drainage of hematoma was significantly superior than the keyhole surgery in activity of daily life comparison within 6 months after the surgery, The mortality of keyhole surgery was significantly under than aspiration and drainage of hematoma.Conclusion Prognosis of patients are closely related with preoperative GCS score, the bleeding site and hematoma volume. The choice of Operation method and timing of surgery also seriously affects the quality of life of patients prognosis.Objective: To compare the clinical efficacy on the activity of daily life between the keyhole surgery and aspiration and drainage of hematoma in the treatment of hypertensive intracerebral hemorrhage.Methods PubMed, Medline database, OVID, Wanfang full-text database, CNKI database, Chinese VIP journals of science and technology database, CBM disk database, SCIENCEDIRECT database etc, are retrieved according to the requirements of systems evaluation. Randomized controlled trials of all the keyhole surgery and aspiration and drainage of hematoma in the treatment of hypertensive intracerebral hemorrhage were included.20 randomized control groups (a total number of 4752 cases of patients) were included, and literature data were extracted and underwent quality assessment. Evaluated the relevant data systematically using RevMan 5.3, and analyzed the mortality and prognosis of two approaches by Meta-analysis.Results Meta-analysis indicated 1, There was no significant difference between the mortality of hypertensive intracerebral hemorrhage patients which underwent surgical treatment in super-early stage[P= 0.02, ORcombined= 1.37,95% CI (0.29,6.59)]; 2, Aspiration and drainage of hematoma was significantly superior than the keyhole surgery in activity of daily life (ADL I-III) comparison within 6 months after the surgery, [P= 0.25, ORcombined= 2.47,95% CI (0.38,0.88)], P＜0.05; 3. The mortality of keyhole surgery was significantly under than aspiration and drainage of hematoma [P = 0.24, ORcombined= 0.81,95% CI (0.66-0.98)], P<0.05; 4,There was no statistically significant difference of rebleeding rate [P= 0.27, ORcombined= 1.41,95% CI (0.76～ 2.61)]; 5, The lung infection rate of keyhole surgery was significantly higher than aspiration and drainage of hematoma [P= 0.002, ORcombined= 1.8,95% CI (1.25～ 2.58)], P<0.05;6,There was no significant difference of gastrointestinal bleeding rate in keyhole surgery and aspiration and drainage of hematoma [P= 0.16, ORcombined= 1.44,95% CI (0.87～2.38)], P> 0.05; 7, There was no significant difference of urinary tract infection rate between keyhole surgery and aspiration and drainage of hematoma [P= 1.04, ORcombined= 1.04,95% CI (0.55～1.99)], P> 0.05.Conclusions(1) There was no significant of the mortalities between the two approaches of overall mortality of Super-Early surgical treatment of hypertensive in tracerebral hemorrhage.(2) Aspiration and drainage of hematoma was superior than the keyhole surgery in activity of daily life (ADL Ⅰ-Ⅲ)) comparison within 6 months after the surgery.(3) The mortality of a keyhole surgery in treatment of hypertensive intracerebral hemorrhage was lower than the aspiration and drainage of hematoma.(4) The rebleeding rates after keyhole surgery was basically the same with aspiration and drainage of hematoma for the treatment of hypertensive intracerebral hemorrhage, and it is not statistically significant.(5) In the complications after keyhole surgery and aspiration and drainage of hematoma for the treatment of hypertensive intracerebral hemorrhage, the lung infection rate of aspiration and drainage of hematoma was lower than the keyhole surgery; There was no significant difference of tract infection between the gastrointestinal bleeding and urinary.