Analysis Of The Efficacy Of The Treatment Of Hypertensive Intracerebral Hemorrhage By Endoscopic

Background: Hypertensive intracerebral hemorrhage(HICH),whose incidence rate,mortality rate,disability rate,and recurrence rate are higher,has done great harm to people’s life and health.The neurological damage caused by the mass effect of hematoma and various toxic substances released by hematoma dissolution,is enerally recognized as the main pathological and pathophysiological mechanisms leading to clinical symptoms.Therefore,the prognosis of patients can be improved by removal of intracerebral hematoma as soon as possible in early stage.However,the large-scale prospective randomized controlled study based on the surgical trial in intracerebral hemorrhage(STICH)demonstrated that: the surgical procedures and conservative medical management had no statistical significance on the prognosis of patients,and no significant change was observed in the neural functional recovery,but the further studies of STICH II trial showed that the patients with serious condition,poor prognosis or young age and superficial hemorrhage may benefited from surgical treatment.The secondary damage and aggravated clinical symptoms due to the injury of the important tissues surrounding the hematoma caused by intraoperative operation may caused this results.Along with the application of minimally invasive surgery represented by keyhole approach craniotomy and neuroendoscopy into the clinic,the interference on brain tissue during the operative process was alleviated,and the clinical effect was recognized gradually.Both the neuroendoscopy and small window craniotomy has characteristics of minimally invasive surgery such as short operative time,high hematoma clearance rate and less postoperative complications,all are more close with the indications of hypertensive intracerebral hemorrhage,but their clinical effect need to be confirmed further.Urokinase has been widely used in the patients after cerebral hemorrhage operation due to its widely recognized clinical effect in promoting the dissolution and discharge of hematoma,however,there are no related reports on the application,method and dosage of urokinase during the operative process.Objective: To compare and analyze the therapeutic efficacy of neuroendoscopy evacuation between neuroendoscopy and keyhole approach crannectomy on the hypertensive intracerebral hemorrhage,and to explore the feasibility and safety of using urokinase during the operative process.Methods: This study was in strict accordance with the inclusion and exclusion criteria of designed cases.Totally 65 cases of patients with supratentorial hypertensive intracerebral hemorrhage underwent neuroendoscopy or keyhole approach craniotomy evacuation of hematoma in the Huaihe Hospital of Henan University from October 2015 to October 2017 were collected,with 30 cases in neuroendoscopy evacuation of hematoma as neuroendoscopy group(group A)and 35 cases in keyhole approach crannectomy evacuation of hematoma as keyhole approach craniotomy group(group B).The general conditions,such as age,gender,degree of neurological deficit,bleeding amount,with or without intraventricular hemorrhage and GCS score of the patients in two groups before treatment were collected to confirm the comparability and feasibility between the two groups.The operative time,hematoma clearance rate,intraoperatve blood amount,the incidence of rehaemorrhagia,mortality rate,postoperative complications,degree of nervous functional defects 1 week after operation,and ADL score 1 month and 6 month post-operation of the patients in two groups were compared and analyzed.23 cases discovered the use of urokinase during operative process were served as urokinase-treated group(group C),42 cases discovered without the use of urokinase during operative process were served as urokinase-untreated group(group D),and the hematoma clearance rate,the incidence of rehaemorrhagia,and ADL score 1 month and 6 month post-operation of the patients in two groups were compared and analyzed.The above-mentioned indexes were statistically analyzed by SPSS 20.0 software.Results:(1)no statistically significant differences between the group A and group B in the age,gender,bleeding amount,with or without intraventricular hemorrhage,GCS score,and degree of neurological deficit before operation were discovered(P >0.05).(2)The average operative time was(1.50±0.79)h in group A and(1.93±0.1)in groyp B,and the difference was statistically significant(P <0.05).The average blood loss volume was(33.83±8.27)mL in group A and(79.28±15.6)mL in group B,and the difference was statistically significant(P <0.05).The hematoma clearance rate was(85.06±8.66)% in group A and(79.4±9.38)% in group B,and the difference was statistically significant(P <0.05).(3)The patients with postoperative brain infection was 4 cases in group A and 1 case in group,and the difference was not statistically significant(P >0.05);the incidence of postoperative complications of pulmonary infection,upper gastrointestinal hemorrhage,urinary tract infection,depression and anxiety reaction,and epilepsy in group A were lower than that in group B,but only difference in pulmonary infection between the two group had statistical significance(P <0.05).(4)The degree of neural functional recovery 1 week post-operation of the patients in both groups were improved compared with before operation,but the degree of neural functional recovery of group A was better than that of group,and the difference was statistically significant(P <0.05).(5)The rate of favorable prognosis 1 month post-operation was 83.3% in group A and 60% in group B,the rate of favorable prognosis 6 month post-operation was 90% in group A and 68.5% in group B,and the difference was statistically significant(P <0.05).However,there was no statistical inter-groups difference in the prognosis 6 month post-operation compared with that of 1 month post-operation(P>0.05).(6)The hematoma clearance rate was(86.79±7.55)% in group C and(79.4±9.39)% in group D,and the difference was statistically significant(P <0.05).The patients with postoperative rehaemorrhagia was 3 cases(10%)in group C and 4 cases(11.4%)in group D,and the difference was not statistically significant(P >0.05).The rate of favorable prognosis 1 month post-operation was 86.9% in group C and 71.4% in group D,the rate of favorable prognosis 6 month post-operation was 95.6% in group C and 75.2% in group D,and the difference was statistically significant(P <0.05).Conclusion: 1.There are no differences between neuroendoscopy evacuation of hematoma and keyhole approach crannectomy evacuation of hematoma in the incidence of complications of upper gastrointestinal hemorrhage,urinary tract infection,intracranial infection,depression and anxiety reaction.2.The operative time,hematoma clearance rate,the incidence of pulmonary infection,intraoperative blood loss amount,the recovery degree of neurological deficit and long-term curative efficacy of neuroendoscopy evacuation of hematoma are better than those of keyhole approach crannectomy evacuation of hematoma.3.The use of urokinase during the operative process is safe and effective,which has certain positive significance on prognosis,but the intraoperative use method and dosage of urokinase need further studies.