Safety And Efficacy Of Endoscopic Surgery Versus Craniotomy For Hypertensive Intracerebral Hemorrhage:Meta-analysis

Objective:To compare the efficacy and safety of endoscopic surgery(Endoscopicsurgery,ES)and craniotomy(Craniotomy,CR)in the treatment of hypertensive intracerebral hemorrhage.Method:By searching the databases of CNKI,CBM,Wanfang,VIP,PubMed,Web of science,Embase and Cochrane,we collected the related studies on ES and CR in the treatment of hypertensive intracerebral hemorrhage from January 2010 to November 2019,and analyzed the mortality,complications,prognosis,operation time and hematoma clearance rate of the two kinds of patients by Stata software for Meta-analysis.Results:A total of 2114 patients were included in 20 randomized controlled trials,including ES group(n = 1051)and CR group(n = 1063).The results of Me-ta analysis showed that: 1.In terms of postoperative mortality,ES group could reduce postoperative mortality compared with CR group(OR=0.454,95%CI0.291-0.709,P < 0.05).2.In terms of postoperative complications,the total complicati ons(OR=0.322,95% CI0.220-0.470,P<0.05),pulmonary infection(OR=0.297,95%CI0.205-0.431,P<0.05)and intracranial infection(OR= 0.312,95% CI0.150-0.652,P<0.05)were lower in the ES group than in the CR group.There was n o significant difference between the two groups in rebleeding(OR=0.632,95%CI0.333-1.191,P=0.163>0.05).3.In terms of postoperative prognosis,the ES gro up had a better prognosis than the CR group(OR=2.459,95%CI1.931-3.131,P< 0.05.The use of ADL and GOS prognostic evaluation systems and different f ollow-up time(3 months and 6 months)to evaluate the prognosis did not cha nge the overall results.4.In terms of operation time,the operation time in ESgroup was significantly shorter than that in CR group(SMD=-2.554,CI-3.019-2.089 P < 0.05).5.In terms of hematoma clearance rate,the hematoma clearan ce rate in ES group was higher than that in CR group(WMD=9.848,95%CI6.000-13.696,P < 0.05).Conclusion:ES is minimally invasive,easy to operate and visual.In HICH patients with moderate amount of bleeding,the operation time was shortened and the hematoma clearance rate was improved.the incidence of postoperative pulmonary infection,intracranial infection and death events was reduced on the whole and the prognosis was improved.However,it did not significantly reduce the incidence of postoperative rebleeding events.ES and CR have their own advantages and disadvantages,and each method has its indications.HICH is a heterogeneous disease affected by many factors.It is difficult to judge which method is more suitable for HICH patients.Therefore,it is a crucial issue to choose individualized treatment methods to benefit from different treatment methods.