A Comparative Study On Clinical Efficacy Of Drilling Hematoma Aspiration And Drainage And Craniotomy For Hematoma Elimination In Treatment Of Intracerebral Hemorrhage

Background:Intracerebral hemorrhage(ICH)is a common disease that threatens human life worldwidely.At present,there are still many controversies on the treatment of cerebral hemorrhage,and surgical treatment,as an important treatment method,is considered to have a positive effect on the prognosis of some patients.There are many surgical methods for intracerebral hemorrhage,but the most commonly used are drilling hematoma aspiration and drainage and craniotomy for hematoma elimination.The efficacy of these two methods for intracerebral hemorrhage is still inconclusive.Objective: To compare the efficacy of these two surgical methods in the treatment of intracerebral hemorrhage and to guide the selection of surgical methods.Methods: To analysis the clinical data of patients with intracerebral hemorrhage of neurosurgery department of the Second Hospital of Dalian Medical University since September 2016-December 2018,the patients were in accordance with the following conditions: a diagnosis of spontaneous intracerebral hemorrhage(exclude traumatic intracerebral hematoma),exclude secondary intracerebral hemorrhage caused by aneurysm,arteriovenous malformation,venous sinus thrombosis,cavernous hemangioma,moyamoya disease,tumor and hemorrhagic transformation of cerebral infarction,etc.According to the surgical methods,the patients were divided into the craniotomy hematoma removal group and the drilling hematoma drainage group.Age,gender,hematoma volume,Glasgow Coma Scale,bleeding site,with or without ventricular hemorrhage and other factors that may affect the prognosis of the patients in the two groups were analyzed and compared.In the craniotomy group,craniotomy was performed under general anesthesia,hematoma was removed under microscope,and hematoma drainage was performed under local infiltration anesthesia in the drilling group,and a drainage catheter was inserted into the hematoma cavity.The hematoma was properly aspirated intraoperatively,and urokinase was injected into the hematoma cavity to dissolve the remaining hematoma postoperatively.Patients in the two groupswere treated with symptomatic treatment such as blood pressure control,introcranial pressure control,neurotrophic drugs and preventing infection.Postoperative hematoma reduction,complications,hospitalization time,hospitalization cost,Glasgow Outcome Scale,Glasgow Coma Scale and mortality were compared between the two groups.Conclusion: The average hematoma clearance rate in the craniotomy group was 89%,significantly higher than that in the drilling group(20%,P<0.001),which was more suitable for patients requiring relief of hematoma compression in a short time.However,there was no statistical difference in the prognostic indicators(fatality rate,complication rate,and GCS,GOS at discharge)between the two groups.However,the hospitalization cost of patients in the craniotomy group was significantly higher than that in the drilling group.In the data analysis,we found that there were some indicators,such as the incidence of postoperative pneumonia,although there was no statistical difference between the two groups,the P value was small(P=0.1004).This suggests that there may be statistical differences in these indicators in larger studies.