Comparative Study For Surgical Treatment And Prognosis Of Hypertensive Cerebral Hemorrhage Of The Basal Ganglia Ibasal Ganglian

Object:this paper selects 123 patients with hypertensive cerebral hemorrhage of the basal ganglia in the China-Japan union hospital of Jilin University from January 2008 to October 2010, who have surgical indications and completing data.Their methods and results of treatment were retrospectively analyzed, in order to evaluate different treatments to patients who underwent the postoperative status and the influence of the overall outcome.Methods:In this study, strictly according to the selected and exclusion designing standard, we selected 123 patients for clinical cases were studied. According to the cases accepted by the treatment, which are divided into conservative treatment group, standard craniotomy group and minimally invasive skull drilling operation group. First of all, we evaluate the status of every clinical groups before treatment (including general characteristics, consciousness, the bleeding sites, the bleeding, the operation time and clinical neurologic deficits degree, etc), to understand that the preoperative basic situation of three groups whether comparable. Then,we compare the data of clinical cases on the postoperative hematoma clearance in the first time, postoperative nerve function recovery, the rehemorrhage incidence and the length of time during being in hospital. At last,we make the comparison of the overall outcome, namely the death and disability incidence (GOS) of the disease.Results:(1) The general characteristics,preoperatie state of consciousness, the bleeding sites, the bleeding, the operation time and clinical neurological deficits, including language and body degree of clinical function lack of muscle strength, such as degree obtained by statistics test, the difference in groups were no statistically significant (P> 0.05). (2)The differences in three groups of the clinical neurological deficits degree was not statistically significant (P> 0.05).Compared with the preoperative, the conservative group has no statistically significant differences (P> 0.05)between before and after treatment, but postoperative the differences of the operation groups which are between preoperative and postoperative are statistically significant (P< 0.01). Focusing on comparison language and body strength, there is no statistically significant difference(P> 0.05),however,the conservative treatment group is statistically significantly different(P<0.05)to the operation groups. (3) The first postoperative hematoma clearance is according to the first preoperative Head CT results calculation,the craniotomy group is74.51±10.32%, and the drilling group is 35.12±8.60%.The between-group differences is statistical significance (P< 0.05). (4) After treatment, the conservative group, craniotomy group and drilling group's rehemorrhage incidences are separately 26.67%,10.00%,andl3.24%,there is no statistically significant difference (P> 0.0167, Bonferroni correction) in three groups.. (5) The conservative and operation treatment groups in the average length of hospitalization time have a statistically significant difference (P< 0.05), but the difference is not statistically significant (P> 0.05)between operation groups. (6) In six months, the poor-prognosis incidence (GOS<3)of the conservative group, craniotomy group and drilling group are 100.00%,64.10%,35.33% respectively, and mortality is 12.50%.20.51%, is 42.86%.Three groups' differences of nonconformities prognosis are statistically significant (P< 0.0167), and mortality of conservative treatment group is statistically significantly diferent(P< 0.0167)from the operation groups, and the difference between the two operation groups was not statistically significant (P> 0.0167).Conclusions:(1) The surgical operation treatment takes advantage to nerve function recovered of patiens, and lowers mortality of them, so to take surgical operation is necessary. (2)For recovery of clinical neurologic deficits, the surgical treatment to the basal ganglia cerebral hemorrhage patients has a positive impact. (3) the first hematoma clearance of craniotomy group was higher than the drilling group.so standard craniotomy is suitable for patients who have massive bleeding or appeared high cranial pressure crisis,and to facilitate necessary patients can be simultaneously do resection of the skull. (4) The standard craniotomy can not specifically reduce rehemorrhage rate after hematoma remove, so we advice to do further research. (5) The curative effect of the standard craniotomy and minimally invasive skull drilling operation which is used to treat basal ganglia hemorrhage patients with focal neurologic deficits does not be seen a statistically significant difference, but for the overall outcome, minimally invasive operation is more conducive to the prognosis of patients.