Clinical Efficacy Comparison Of Endoscopic Surgery Versus Microscopic Evacuation In Treatment Of Spontaneous Intracerebral Hemorrhage

Objective:To evaluate the technical details and clinical efficacy of endoscopic surgery with microscopic evacuation in treatment of spontaneous intracerebral hemorrhage. To explore a more safer and effective therapeutic method in management of SICH which can reduce fatality and disability, improve outcome and quality of patients’ life.Method:Selected 30 SICH cases which satisfied the inclusion criteria and preferred surgical therapy after discussion from Jan.2013 to Jun.2014 in Shanxi Da Yi hospital. Divided 30 cases into 2 groups by surgeons’ preference: endoscopic group(15 cases) and microscopic group(15 cases). All surgeons have at least 3 years experience of endoscopic and microscopic surgery. Compared their preoperative clinical data such as age, gender,preoperative hematoma volume to ensure their comparability; Compared their technical details, clinical efficacy and prognosis indicator such as skin incision, operative time, rate of hematoma evacuation, GOS 6 months after surgery and so on. Used SPSS 17.0statistical package to analyze data: measurement data were compared with two samples t-test;count data were compared with chi-square test or Fisher’ exact test; ranked data were compared with Rank sun test; repeated measures data were compared with one-way ANOVA. ɑ=0.05.Results:There were no significant differences of preoperative clinical data between endoscopic group and microscopic group(P>0.05). The endoscopic group weresignificantly minimally invasive than microscopic group: the average of skin incision of endoscopic group(5.0±0.5)cm was significantly smaller than that of microscopic group(12.2±1.7)cm(P<0.05); the average diameter of bone flap of endoscopic group(2.0±0.4)cm was significantly smaller than that of microscopic group(10.1±1.3)cm(P<0.05). The average operative time of endoscopic group(1.4±0.5)h was significantly shorter than that of microscopic group(3.9±0.4)h(P<0.05). The average loss of blood of endoscopic group(30.7±15.6)ml was much less than that of microscopic group(482.7±11.0)ml(P<0.05).The hematoma evacuation rate of endoscopic group(93.8±4.8)% was significantly higher than that of microscopic group(82.1±5.6)%(P<0.05). Followed up and evaluated by GOS6 months after surgery, endoscopic group had 3 patients showed good recovery, 7 patients showed minor disability, 3 patients showed moderate disability, 2 patients showed severe disability; microscopic group had 1 patients showed good recovery, 4 patients showed minor disability, 4 patients showed moderate disability, 5 patients showed severe disability,1 patients showed vegetative survival. The GOS outcomes of endoscopic group were significantly better than that of microscopic group(P<0.05).Conclusions:Endoscopic surgery is a fast, minimally invasive operating technique in treatment of SICH which can obtain remarkable clinical efficacy and improve patients’ quality of life.So endoscopic surgery is worth application and spread in treatment of spontaneous intracerebral hemorrhage.