| Objective To explore the short-term and long-term clinical efficacy and complications of internal medicine and different surgical methods for the treatment of supratentorial hypertensive cerebral hemorrhage.Methods The clinical data of 132 patients with supratentorial hypertensive cerebral hemorrhage in our department were retrospectively analyzed.The patients were divided into conservative treatment group(63 cases)and surgical treatment group(69 cases)according to different treatment methods.Surgical treatment group were divided into craniotomy group(41 cases,hematoma evacuation under conventional microscope craniotomy),minimally invasive puncture group(16 cases,soft-channel puncture hematoma drainage),endoscopy group(12 cases,endoscopically assisted minimally invasive surgery).National Institute of Health stroke scale(NIHSS)were used to assess the neurological status of patients 1 month after treatment(NIHSS <5 is considered to be a good prognosis in the short term,instead the short-term prognosis is poor).After 3 months of follow-up,Glasgow Outcome Scale(GOS)was used to assess the prognosis status of patients(grades I-III have a bad long-term prognosis;Grades IV to V have a good long-term prognosis).The hospitalization time,short-term and long-term clinical efficacy and complications of each group were compared,and intracranial hematoma clearance rate,operation time and intraoperative blood loss in the operation group were observed.Results 1.Conservative treatment group(63 cases)includes 35 males and 28 females,aged 39-80 years old,mean(62.4±8.8)years old,intracranial hematoma volume(32.5±3.4)ml,GCS score(9.6±1.3).There were 24 males and 17 females in the craniotomy group,aged 31-79 years old,mean(59.2±11.2)years old,intracranial hematoma volume(34.5±3.1)ml,GCS(9.3±1.2).Minimally invasive puncture group includes 9 males and 7 females,aged 44-78 years old,mean(64.4±9.4)years old,intracranial hematoma volume(35.8±2.6)ml,GCS(9.6±0.9).Endoscopic group includes 5 males and female 7 cases,age 45 to 76 years old,mean(62.3 ± 8.2)years old,intracranial hematoma volume(34.6 ± 3.1)ml,GCS(9.3 ± 1.0).Through comparative analysis,no significant differences were found in general data,intracranial hematoma volume,and GCS score(P>0.05).2.In terms of surgery-related indicators,in the craniotomy group,hematoma clearance rate(86.2±4.1)%,operation time(172.5±8.1)min,intraoperative blood loss(324.7±29.2)ml.In minimally invasive puncture group hematoma clearance rate(75.4 ±5.2)%,operation time(45.9±6.2)min,intraoperative blood loss(18.4±8.9)ml.In the endoscopic group,hematoma clearance rate(91.7±2.6)%,operation time(111.6±8.6)min,intraoperative blood loss(80.8 ± 22.6)ml.The clearance rate of intracranial hematoma in the endoscopic group,craniotomy group and minimally invasive puncture group was gradually reduced.In terms of the operation time and intraoperative blood loss volume,craniotomy group,endoscopy group and minimally invasive puncture group were successively decreased(P<0.05).3.In terms of clinical efficacy,20 patients with a NIHSS score of less than 5,accounting for 31.7%,29 patients with a GOS grade IV to V,accounting for 46% in the conservative treatment group.31 patients with a NIHSS score of less than 5,accounting for 44.9%,45 cases of GOS grade IV~V,accounting for 65.2% in the surgical treatment group.18 cases of NIHSS score less than 5,accounting for 43.9%,25 patients of GOS grade IV~V,accounting for 61% in the craniotomy group.7 patients with NIHSS score less than 5,accounting for 43.8 %,and 11 patients with GOS grade IV to V,accounting for 68.8% in the minimally invasive puncture group.6 patients with NIHSS scores less than 5,accounting for 50%,and 9 patients with GOS grade IV to V,accounting for 75% in the endoscopy group.The short-term clinical efficacy was significantly better in the surgical group than in the conservative treatment group.The difference was statistically significant.There was no significant difference in the short-term clinical efficacy between the surgical groups.The long-term clinical efficacy was significantly better in the surgical group than in the conservative group.Endoscopy group,minimally invasive puncture group,the craniotomy group,and the conservative group were successively decreased,and the differences between the groups were statistically significant.4.In terms of complications,the overall complication(n/%)was 49/77.7 in the conservative treatment group,31/44.9 in the surgical group,21/51.2 in the craniotomy group,and 6/37.5 in the minimally invasive puncture group.4/33.3 in the endoscopy group.The overall complications were higher in the conservative treatment group than in the surgery group.The difference was statistically significant.The endoscopy group and the minimally invasive puncture group were lower than the craniotomy group and the endoscopy group was the lowest.The difference was statistically significant.In the conservative treatment group,7 patients with hematoma enlargement gave up surgery to save life and continued conservative treatment,and eventually died.In the craniotomy group,1 case died of intracranial infection,severe pulmonary infection to respiratory failure,and 1 case of epilepsy caused by intracranial rebleeding.5.In the hospitalization time(d),the conservative treatment group was 35.5±6.6,the surgical treatment group was 25.9±6.3;the craniotomy group was 30.9±7.1,the minimally invasive puncture group was 22.8±6.1,and the endoscopic group was 24.1±5.6.The hospitalization time was significantly longer in the conservative treatment group than in the surgery group.The difference was statistically significant.The craniotomy group was longer than the puncture group and the endoscopy group.The difference was statistically significant.The difference in the hospitalization time between the minimally invasive puncture group and the endoscopy group is not statistically significant.Conclusion 1.Surgical treatment of patients with supratentorial hypertensive cerebral hemorrhage can shorten hospitalization time,reduce total complications,and improve short-term and long-term clinical outcomes compared with conservative treatment.2.Compared with the hematoma evacuation under conventional microscope craniotomy,endoscopic and minimally invasive puncture can reduce the operation time,intraoperative bleeding,total complications,hospitalization time,cannot improve the short-term clinical efficacy,but can improve the long-term clinical efficacy.3.Compared with minimally invasive puncture hematoma drainage,endoscopically assisted intracranial hematoma evacuation can reduce overall complications,significantly improve blood hematoma clearance rate,cannot shorten hospitalization time and improve the recent clinical efficacy but can improve long-term clinical efficacy. |
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