| Objective: To compare and analyze the efficacy differences of two kinds of minimally invasive surgery（neuroendoscope assisted hematoma removal +extraventricular drainage,microscope assisted small bone window hematoma removal +extraventricular drainage）in patients with hypertensive basal ganglia hemorrhage breaking into the ventricle（HBGHBIV）,and summarize their respective advantages and disadvantages,so as to provide scientific basis for the selection of relevant surgical treatment methods in clinic.Methods: 1.Through the retrospective analysis of HBGHBIV patients treated in our hospital from June 2019 to June 2021,the patients were divided into endoscope group and microscope group according to the surgical methods.2.The changes of hematoma clearance rate of brain parenchyma before operation and 1 and 7 days after operation,the changes of ventricular graeb score 1 and 7 days after operation,the operation time,the retention time of ventricular drainage tube,postoperative complications,gos score 6 months after operation and other relevant data results were compared between the two groups,and the curative effects were comprehensively analyzed.Results: 1.General data: There were no significant differences between the two groups in gender,age,site of disease,preoperative GCS score and other preoperative medical records（P > 0.05）.There were no significant differences in the amount of parenchymal hematoma,Graeb score and other preoperative imaging results among all groups（P > 0.05）.2.Elimination of partial hematoma in the brain parenchyma: The average hematoma clearance rates of brain parenchyma on the 1st and 7th day after operation in the endoscopic group were（86.42 ± 2.08）%,（94.58 ± 1.27）%,respectively;The average hematoma clearance rates of the microscope group were（76.31±2.87）%,（91.73± 2.31）%.The hematoma clearance effects of the two groups were better,but there was a significant difference in the hematoma clearance efficiency of the brain parenchyma between the two groups（P < 0.05）.The hematoma clearance efficiency of neuroendoscopic surgery was higher than that of microscope surgery.3.Changes of ventricular hematoma: it is mainly evaluated by ventricular graeb score.In the endoscopic group,the median change rate of ventricular graeb score 1 day after operation was 50%,and the interquartile spacing was10%;The median change rate of ventricular graeb score 7 days after operation was 80%,and the interquartile interval was11.01%.The median change rate of graeb score on the first day after operation in the microscope group was 38.75%,and the interquartile spacing was 9.52%;The median change rate of graeb score at 7 days after operation was 66.67%,and the interquartile interval was 8.93%.The surgical methods of the two groups had a certain effect on the removal of intraventricular hematoma.There was a significant difference in the change rate of graeb between the two groups（P < 0.05）.The effect of neuroendoscopic surgery on the removal of partial intraventricular hematoma was better than microscopic surgery.4.Comparison of related surgical indicators between the two groups: including operation time,postoperative GCS score at 7d,and postoperative complications.The average operation time of Endoscopy Group was（130.56 ± 20.69）min,while that of microscope group was（148.02 ± 22.35）min.there was no significant difference between the two groups（P > 0.05）.The median GCS score of Endoscopy Group 7 days after operation was 13 points,and the interquartile interval was 2 points.The median GCS score of the microscope group was 11 points and the interquartile interval was 2 points.There was significant difference between the two groups（P < 0.05）.The median retention time of extraventricular drainage tube in endoscopic group was 2 days and the interquartile interval was 1 day.The median retention time of the drainage tube in the microscope group was 3 days and the interquartile interval was 1.25 days.There was significant difference between the two groups（P < 0.05）.The incidence of postoperative complications was13.89% in the Endoscopy Group and 18.42% in the microscope group.Through statistical analysis,it was found that there was no significant difference between the two groups（P > 0.05）.5.Comparison of prognosis at 6 months after operation: the GOS score at 6 months after operation was evaluated in the two groups.There were 22 patients with good prognosis in the endoscopic group.The good prognosis rate of this group was 61.11%.There were 14 patients with good prognosis in the microscope group,and the good prognosis rate was 36.84%,with significant difference（P < 0.05）.Neuroendoscopic surgery can better improve the prognosis of patients.Conclusion: Neuroendoscopic surgery and microsurgery can benefit hbghbiv patients.Through the comparative analysis of the therapeutic effects of neuroendoscopic surgery and microsurgery,it can be found that neuroendoscopic surgery is significantly better than microsurgery in effectively removing hematoma,reducing the time of extraventricular drainage,improving the postoperative state of patients,and improving the prognosis of patients.Therefore,neuroendoscopic surgery is a relatively safe and efficient treatment method,which is worthy of vigorous promotion and application. |
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