A Systematic Reviews About The Comparison Between Key-hole Approach For Removal Of Hematoma And Traditional Conventional Open Craniotomy For Removal Of Hematoma For The Treatment Of Hypertensive Cerebral Hemorrhage

Objective:Comparative study of key-hole approach for removal of hematoma (KHA) andtraditional conventional open craniotomy for removal of hematoma (COC) in the treatment ofhypertensive cerebral hemorrhage in the near future curative effect (postoperative1months) andthe forward curative effect (after6months).For clinical hypertension cerebral hemorrhagesurgery operation choice to provide evidence of evidence-based medicine.Methods: Retrieveing comprehensively,according to the system evaluation guidance offered onCochrane Library (CL)，combined computer retrieval with manual retrieval, to search theCochrane Library (CL)(12,2013), Pubmed (2000-2013.11), Embase (2000-2013.11), BIOSIS(2000-2013.11), OVID (2000-2013.11), CBM (1989-2013.11), CNKI (1992-2013.11), Wanfang(2000-2013.11), VIP(1994-2013.11).Manual retrieval "Chinese journal of neurosurgery," Chinesejournal of clinical neurosurgery,"Chinese journal of minimal invasive neurosurgery.Collect allthe relevant randomized controlled trials about the key-hole approach for removal of hematomaand traditional conventional open craniotomy for removal of hematoma in the treatment ofhypertensive cerebral hemorrhage. And then evaluate the quality of these research and extractiondata.Finally, using professional software Rev-Man5.2to meta-analysis and qualitative analysisof relevant data.Results:42clinical randomized controlled trials,2932patients were included in this systemreview. Meta analysis results show that:(1)The key-hole approach for removal of hematomagroup is superior to traditional conventional open craniotomy for removal of hematoma group (P<0.00001, OR=5.51,95CI%4.18~7.27) in the clinical total effective rate.（2）The recentmortality of COC group is higher than the KHA group (P <0.00001, OR=0.36,95%CI0.28~0.46).(3)The operation time (P <0.00001, SMD=1.51,95%CI1.64~1.39)and hospitalizationtime (P <0.000001, SMD=2.20,95%CI2.72~1.67).of patient in the KHA group are shortercompared with the COC group. However, the result of the research reported large heterogeneity (I2>50%), and there are risk of publication bias exists, so that the results with lower reliability.(4)Patients with hypertensive cerebral hemorrhage in COC more likely to occur the postoperativecomplications, such as postoperative re-bleeding(P=0.007, RR=0.007,95%CI0.31~0.83)，pulmonary infection (P <0.00001, RR=0.51,95%CI0.38~0.69)，gastrointestinal bleeding (P=0.0008, RR=0.0008,95%CI0.34~0.75)，and multiple organ failure (P=0.007, RR=0.007,95%CI0.20~0.77) compared with the patient in KHA group.(5)The long-term clinical effect ofpatients in the KHA group are better than the patients in the COC group.Conclusion: The key-hole approach for removal of hematoma treatment of hypertensivecerebral hemorrhage is more effective and safer compared to traditional conventional opencraniotomy for removal of hematoma.