| BACKGROUND:Hypertensive intracerebral hemorrhage is the second common type of stroke,accounting for 10%to 15%of all stroke events,the mortality rate of the hypertensive intracerebral hemorrhage is high,just 12%to 39%survivors have the ability to live independently.About 55%to 70%of hypertensive cerebral hemorrhage is occurred in basal ganglia region,with much higher morbidity rate and mortality rate.At present,the treatments of basal ganglia cerebral hemorrhage are mainly Internal medicine treatment and surgical treatment.As the popularity of minimally invasive surgery,a large number of clinical studies in recent years have shown that early surgical removal of hematoma could improve the clinical prognosis,including survival rate and long term living quality.In recent years,with the extensive application of microscopy,neuroendoscopy and neuronavigation technology in neurosurgery,surgical operations have become more and more accurate and minimally invasive,and corresponding surgical complications have become fewer.Complete neuroendoscopy and keyhole microscopy are two preferred methods for the evacuation of basal ganglia hematoma.Neuroendoscopic surgery is widely used in the treatment of basal ganglia hemorrhage due to its advantages of less operative injury,lighter traction of brain tissue and higher evacuation rate of hematoma.Recently,some clinical studies have reported that keyhole assisted brain retractor microsurgery could reduce the brain compression injury compare to traditional brain platens,obtaining good results in cerebral hemorrhage.But which operation method is better between neuro-endoscopic surgery and tubular brain retractor assisted keyhole microsurgery,there is seldom repor in domestic and overseas.OBJECT:To compare the surgical operation characteristic,clinical state and prognosis after surgical operation via multi-angle analysis between neuro-endoscopic surgery and keyhole assisted tubular brain retractor microsurgery using in basal ganglia hemorrhage hematoma clearance,then evaluate clinical feasibility and corresponding advantag,es and disadvantages between these two surgical procedures.METHODS:Eighty-four cases who were suffering from basal ganglia hemorrhage and receiving treatment at department of neurosurgery of Shunde Hospital of Southern Medical University were selected as the object of this study.Among these 84 cases,44 cases were performed neuro-endoscopic surgery,assigned to neuro-endoscopic group,called endoscopic group,the other 40 cases were performed keyhole assisted tubular brain retractor microsurgery,assigned to keyhole assisted brain retractor microsurgery group,called microscope group.We first compare the basic information between these two groups and perform a propensity score match,for guaranteeing these two groups have a consistency and could go on statistical comparison.Then we compare the other entries’ statistical difference including the volume of hematoma during operation,the duration of operation,the hematoma clearance rate at one day after operation,recurrence rate of bleeding,the Glasgow Coma Scale(GCS)at one week after operation,common complication occurrence rate after operation,the Glasgow Outcome Scale(GOS)and Activity of Daily Living Scale(ADL)at three months late after operation,and the medical costs.We use the SPSS20.0 software to.analyze the date.RESULTS:1.By Propensity Score Matching,there is no difference between these two group patients’ general information,including gender ratios,average ages,the time from basal ganglia hemorrhage onset to operation,the volume of hematoma before operation,the GCS score before operation,position of hematoma.2.Comparing to microscope group patients,the volume of hematoma during operation is lesser,the length of operation is shorter,and the common complication occurrence rate after operation is lower in endoscopic group patients,and the difiference are significantly;But there is no significantly difference in the hematoma clearance rate at one day after operation,recurrence rate of bleeding,the Glasgow Coma Scale(GCS)at one week after operation,and the long-term prognosis(GOS and ADL at three months later after operation)between these two groups.3.Comparing to microscope group patients,the cases which suffer from postoperative pulmonary infections,postoperative cerebral edema and cerebral embolism,and the total number of cases are lower in endoscopic group patients,the difference is significantly.But there is no statistical difference between these two groups in postoperative recurrence rate bleeding,postoperative urinary system infection,venous thrombus,hemorrhage of digestive tract,infection of incisional wound and postoperative epilepsy.4.The long-term clinical results are similar between these two groups,based on clinical prognosis and activity of daily living,but is slightly better endoscopic group.The in-commission rate of GOS is 45.45%and 39.39%,and in-commission rate of ADL is 36.33%and 33.33%in endoscopic group patients and microscope group patients,respectively.5.To patient with basal gan lia hematoma,choosing neuro-endoscopic surgery as the therapy method need much higher surgery cost and slightly lower general treatment cost,but need obvious lower medical cost in all-in cost,anesthesia cost,cost related with treatment of complications,cost of nursing care,cost of medical checkups and other medical costs than choosing therapy keyhole assisted brain retractor microsurgery method,and the difference is significantly.CONCLUSION:To patient with basal ganglia hematoma,choosing neuro-endoscopic surgery could get slightly better long-term prognosis,less volume of hematoma during operation,shorter length of operation,lower common complication occurrence rate after operation,and less medical cost.As a conclusion,neuro-endoscopic surgery is more appropriate than keyhole assisted brain retractor microsurgery in surgical treatment of basal ganglia hematoma. |
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