The Prognostic Analysis Of Drilling Drainage Operation And Craniotomy In The Treatment Of HICH

Purpose: To compare the advantages and disadvantages and curative effectof drilling drainage operation and craniotomy in the treatment of HICH,provide the basis evidence for the clinical choice of appropriate surgicalapproach.Methods: Retrospective analysis85cases of HICH patient informationfrom2010to2012in our hospital, bone flap craniotomy group are40cases,skull drilling drainage group45cases. Preoperation, we compared the generalcharacteristics(sex, age), the degree of neurological deficits, the amount ofbleeding, the bleeding site, and the opportunity of surgery about the twogroups. According the evaluation standard in the fourth academic conferenceon cerebral vascular disease, evaluate patients' situation of neurologicalimpairment and the severity of the disease. There is a total of45scores. Theheavier impairment is, the higher scores are. Light degree is0-15scores.Middle degree is16-30scores.Serious degree is31-45scores. The factors ofneurological impairment, complication incidence, fatality rate, rebleedingrate,operation time between the two groups after treatment for one monthwere compared.Results:1There were no statistical differences between the two groups in thefollowing factors,including age,general characteristics,the bleeding site, theamount of bleeding, degree of neurological deficits before treatment and thetiming of surgery.2One month after operation, the scores of neurological impairment degree inboth groups are lower than preoperation. p<0.05, There was statisticaldifference. Comparision the neurological impairment between craniotomy anddrilling drainage after operation, p<0.05in light degree group and middle degree group,.There was statistical difference. And the neurologicalimpairment between craniotomy and drilling drainage after operation, p>0.05.There was no statistical difference. Drilling drainage operation is moreeffective for improving the degree of neurological deficits for light degreepatients and middle degree patients. But there was no statistical difference inthe treatment of severe degree patients.3The scores of neurological impairment degree after surgery in both groupsare lower than preoperation in different amount of bleeding. p<0.05, Therewas statistical difference. After operation, the degree of neurologicalimpairment between craniotomy and drilling drainage has statistical difference,both in hematoma volume less than40ml group and between40to60ml group.p<0.05. But in hematoma volume more than60ml group, p>0.05, There wasno statistical difference. Drilling drainage operation is more effective forimproving the degree of neurological deficits for the patients whose hematomavolume was less than60ml. There was no statistical difference in treatmentfor the patients whose hematoma volume was more than60ml.4There was statistical difference between the two groups in the incidence ofpulmonary infection and gastrointestinal bleeding during hospital.For thepulmonary infection, drilling drainage operation group is18%,craniotomygroup is35%. And for the gastrointestinal,drilling drainage operation group is9%,craniotomy group is18%.5There was no statistical difference between the two groups in the fatality rateduring hospital,Drilling drainage operation group is20%,craniotomy groupis20%.6There was statistical difference between the two groups in the rebleedingrate during hospital. Drilling drainage operation group is18%,craniotomygroup is5%.7The average operation time of drilling drainage operation group is36.2±11.3min,and for craniotomy group,it's149.7±10.9min. There was statisticaldifference between two groups. The first volume of hematoma in drillingdrainage operation group is39.9±7.6(％),which in craniotomy group is 76.1±8.2(％).There was statistical difference between two groups.Conclutions:1Craniotomy and drilling drainage are effective in treating HICH. The degreeof neurologic impairment after surgery is lower than preoperation.2Disease classification is closely related to efficacy. Clinical neurologicaldeficit is more severe, the prognosis is worse. The patients who are in middledegree group preoperative have a better prognosis than serious degree group.And light degree group are better than middle group. For the patients who isbelong to light degree group or middle group, drilling drainage is moreeffective for improving the degree of neurological deficits. But there was nostatistical difference in treatment of severe patients.3The amount of bleeding is more great, the clinical neurological deficit ismore severe. The prognosis of patients after surgery is worse. The patientswhose hematoma volume was less than60ml, drilling drainage is moreeffective for improving the degree of neurological deficits. There was nostatistical difference in treatment for the patients whose hematoma volumewas more than60ml.4Craniotomy can remove more hematoma than drilling drainage operation forthe first time. The average time of craniotomy was longer than drillingdrainage operation. The complication rate of Craniotomy is higher than thedrilling drainage operation. The rebleeding rate of Craniotomy was higherthan drilling technique. There was no statistical difference in fatality rate.