Different Interventions For Patients With Spontaneous Supratentorial Intracerebral Hemorrhage On The Prognosis: A Systematic Review And Real World Study

Objectives According to a systematic review and Real world study,the effectiveness and safety of different surgical methods(Conventional craniotomy,Endoscopy surgery and Minimally invasive puncture and drilling)and conservative treatment on patients with spontaneous supratentorial intracerebral hemorrhage were compared,respectively,and further explored the optimal treatment for these patients.Methods Firstly,we gave a comprehensive search of the following databases: Pub Med,Medline,OVID,EMBASE,and Cochrane Library,and had a data extraction and quality assessment for the included studies.Statistical analyses were performed using Revman software(version 5.3)and Stata(version 13.0).Subsequently,the clinical data of patients with spontaneous intracerebral hemorrhage in North China University of Science and Technology affiliated hospital from July 2017 to July 2019 was collected retrospectively to construct research database.Selected study variables and screened out cases by research purposes.After balanced the baseline variables in different groups by propensity score matching method,the short-term prognosis of patients with spontaneous supratentorial intracerebral hemorrhage(SSICH)by surgical treatment and conservative treatment,Conventional craniotomy(CC)and Endoscopy surgery(ES)and minimally invasive puncture and drilling(MIS)was explored,respectively.Results According to a systematic review,the CC,ES,MIS not only improved the survival rate and prognosis of SSICH patients,but also had the lower risk of intracranial rebleeding and the lower proportion of patients with serious disability.Among them,ES was the most reasonable and effective intervention.In the real world study,the research database was consist of 560 spontaneous intracerebral hemorrhage patients' clinical data after data cleaned.According to research purposes,495 SSICH patients were included in the study finally.After setting matching ratio 1:1 and matching tolerance 0.1 and propensity score matching,the surgical treatment and conservative treatment,CC and ES,CC and MIS,ES and MIS included in 158,60,26,60,respectively.Compared the surgical treatment and conservative treatment,the rate of pneumonia in surgical group was significantly higher than conservative group(P<0.05);No significant difference was observed in other complications.The prognosis of conservative group was better than surgical group,but the mortality was higher(P<0.05).Besides,the hospital stays and hospitalization costs of surgical group were higher than conservative group(P<0.05).Compared the CC and ES,the operation time and intraoperative blood loss of ES group were lower than CC group(P<0.05).There was no statistically difference in complications,short-term prognosis,hospital stays between two groups.But,the hospitalization costs of ES group were significantly higher than CC group(P<0.05).Compared the CC and MIS,the operation time and intraoperative blood loss of MIS group were significantly lower than CC group(P<0.05).However,there was no significant difference in complications,short-term prognosis,hospital stays between two groups.But,the hospitalization costs of CC group were significantly higher than MIS group(P<0.05).Compared the ES and MIS,the operation time and intraoperative blood loss of MIS group were significantly lower than ES group(P<0.05).There was no significant difference in rate of pneumonia,rebleeding,short-term prognosis and hospital stays between two groups.The intracranial infection of MIS group was significantly higher than ES group,however,the hospitalization costs of ES group were higher than MIS group(P<0.05).Conclusions Surgical treatment can be found to be superior to conservative treatment in a systematic review,and ES is the optimal treatment for SSICH patients.Based on the real world study,there is no significant advantage on short-term prognosis of SSICH patients in surgical treatment than conservative treatment.In surgical methods,there are only a few operative and economic advantages in MIS than CC and ES.So,the optimal treatment of SSICH patients can't be confirmed at present,it is need to further study to definite in the future.Figure 12;Table 13;Reference 116...