| ObjectiveBy comparing the clinical efficacy of neuroendoscopic hematoma clearance and craniotomy hematoma clearance in patients with hypertensive intracerebral hemorrhage,to explore the indications of the two different surgical schemes,and to analyze the surgical opportunity for the treatment of hypertensive basal ganglia hemorrhage,so as to provide reference for optimizing and improving clinical treatment.Methods207 patients with hypertensive cerebral hemorrhage admitted to the Department of Neurosurgery of our hospital from January 2018 to January 2020 were analyzed.According to the operation form of the research object,they were divided into neuroendoscopic hematoma clearance group and craniotomy hematoma removal group;at the same time,combined with the specific level of hematoma volume,the patients who received the two surgical methods were divided into three groups,namely ≤40ml,40 ml ～ 50 ml and ≥50ml groups.The mortality of the two groups at the time of 2 weeks and 3 months after the operation was compared and analyzed before and 2 weeks after operation.The differences of GCS and NIHSS scores between the two groups were recorded.The recovery of neurological function of the patients who were still alive 3 months after operation was recorded.The complications were observed and compared.The volume of edema around the brain tissue,length of hospital stay and cost of hospitalization at 4-6 days after operation were compared.The difference in the good rate of ADL of the patients who were still alive 3 months after operation was analyzed.Results1.There were no significant differences in age,gender,duration of hypertension(years),duration of diabetes(years),systolic blood pressure(mm Hg),diastolic blood pressure(mm Hg),hematoma volume(ML)and GCS score at admission between the two groups(P>0.05).2.At 2 weeks and 3 months after operation,the mortality of patients with hematoma volume ≤40ml,40ml～50ml and ≥50ml was not statistically significant(P>0.05).3.Among the patients who did not die at 2 weeks after operation,when the hematoma volume was less than or equal to 40 ml,there were significant differences in GCS and NIHSS scores between the two groups(P<0.05);when the hematoma volume was 40 ml ～ 50 ml and ≥50 ml,there was no statistical difference between the two groups(P>0.05).4.At 3 months after operation,the Mrs scores of patients with hematoma volume less than or equal to 40 ml were statistically different between the two groups(P<0.05);when the hematoma volume was within the range of 40ml～50ml and ≥50ml,there was no significant difference in the Mrs scores of patients with different surgical methods(P>0.05).In the patients who did not die at 2 weeks after operation,there was no significant difference in the incidence of rebleeding and postoperative infection in patients with hematoma volume ≤40ml,40ml～50ml and ≥50ml between the two groups(P>0.05).5.For patients with hematoma volume ≤40ml,compared with patients in craniotomy hematoma clearance group,the edema volume around brain tissue in neuroendoscopic hematoma removal group was significantly smaller than that in craniotomy hematoma clearance group,and the difference was statistically significant(P<0.05);for patients with hematoma volume within 40ml-50 ml,there was no significant difference between the two groups in the edema volume at this time point(P>0.05);the hematoma volume was ≥50ml compared with patients in craniotomy group,the volume of edema around brain tissue in neuroendoscopic hematoma clearance group was significantly larger than that in craniotomy group(P<0.05).6.The hospitalization time of patients with hematoma volume≤40ml,40ml～50ml and ≥50ml in neuroendoscopic hematoma clearance group was significantly shorter than that in craniotomy group,and the difference was statistically significant(P<0.05).7.The hospitalization expenses of patients with hematoma volume≤40ml,40ml～50ml and ≥50ml in neuroendoscopic hematoma removal group were significantly less than those in craniotomy group(P<0.05).8.The ADL good rate of patients who did not die at 3 months after operation in neuroendoscopic hematoma removal group was higher than that in craniotomy hematoma removal group,and the difference was statistically significant(P<0.05).Conclusions1.Compared with craniotomy,patients with intracerebral hemorrhage with hematoma volume less than or equal to 40 ml have better surgical effect by using neuroendoscopy.Moreover,it has the characteristics of mild edema around brain tissue,short hospitalization time,low treatment cost and good prognosis,which has a better effect on the rehabilitation of neurological function of patients.Therefore,patients with hematoma volume less than or equal to 40 ml are more recommended to take neuroendoscopic hematoma clearance.2.There was no significant difference between neuroendoscopy and craniotomy in mortality,recovery of neurological function,degree of edema around brain tissue and postoperative complications in patients with intracerebral hemorrhage with hematoma volume ranging from 40 ml to 50 ml.However,neuroendoscopic hematoma clearance is better than craniotomy in terms of hospitalization time and treatment cost.3.The patients with intracerebral hemorrhage whose hematoma volume is more than or equal to 50 ml,craniotomy is better than neuroendoscopic hematoma removal.This is because it has less effect on the edema volume of peripheral brain tissue and can effectively reduce the intracranial pressure of patients. |
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