The Clinical Research On The Timing Of Surgery And Surgical Approach For The Patients With Different Parts Of The Hypertensive Intracerebral Hemorrhage

Objective To investigate the influence of timing of surgery and surgical approach on the patients with hypertensive intracerebral hemorrhage at the different sites.Methods Retrospectively analyzed the clinical datas of 106 hypertensive cerebral hemorrhage patients with surgery in department of Neurosurgery, Chaohu Hospital of Anhui Medical University from March 2006 to August 2013. According to the time from onset to surgery, these patients were divided into three groups: the ultra-early group(≤6h,n=53),the early group(6-24 h,n=30)and the delayed group(>24h,n=23). Taking different surgical methods based on the site of bleeding,then according to these surgical approaches, patients were divided into three groups: 52 cases were with the treatment of small bone window hematoma evacuation(the small bone window group),including 35 cases of basal ganglia, 11 cases of subcortical, and 6 cases of cerebellar hemorrhage. 34 cases were with the treatment of trauma craniotomy hematoma removing surgery(the craniectomy group), including 21 cases of basal ganglia and 13 cases of cerebellar hemisphere. 20 cases were with the treatment of lateral external drainage(the external drainage group), including 8 cases of brain stem hemorrhage broken into ventricles and 12 cases of thalamic hemorrhage rupturing into ventricle. Compared the GOS(glassgow outcome scale) after one month(5 or 4 points means gotten good curative efficacy) and the ADL(Activities of daily living)classification situation after six months( Ⅰ~ Ⅲ grade level were gotten good curative efficacy efficacy)of the patients with the three different surgical approaches and three different timing of surgery.Results The results of the surgery after one month showed the recent excellent rate(81.13%,43/53)in the ultra-early group was higher than the early group(50.00%,15/50)and delayed group(43.48%,10/23), the difference was statistically significant(P <0.01), while the difference between the early group and the delayed group was no statistically significant(P> 0.05). The results of the surgery after six month showed the long-dated excellent rate(94.23%,49/52)in the ultra-early group was higher than early group(51.72%,15/29)and delayed group(50.00%,11/22), the difference was statistically significant(P <0.01), while the difference between the early group and the delayed group was no statistically significant(P> 0.05).The difference of the recent excellent rate in the GOS score(71.15%(37/52),52.94%(18/34),65.00%(13/20)) and the long-dated excellent rate in the ADL Ⅰ~ Ⅲ grade level( 76.47%(39/51),68.75%(22/32),75.00%(15/20)) between the small bone window group, the craniotomy group and the external drainage group were no statistically significant(P> 0.05).Conclusion Patients with hypertensive intra-cerebral hemorrhage in different parts should be selected different surgical methods and appropriate timing of surgery for individualized treatment, then obtain the corresponding efficacy.