| Objective：Quantitative stratification of the hematoma volume to compare theclinical efficacy of the basal ganglia hemorrhage, edema volume of brain tissue, theincidence of complications associated with surgery, and economic efficiency indicatorsin minimally invasive surgery with craniotomy hematoma surgery the differencebetween the two surgical explore the best indications of the two surgical procedures toguide clinical standardized treatment of patients with basal ganglia hemorrhage.Method：In strict accordance with the trials design，inclusion and exclusion criteriato select cases collected from November2010to February2013，Dalian CentralHospital，Department of Neurology, ICU，neurosurgery admitted253cases receivedminimally invasive hematoma aspiration or craniotomy hematoma in the treatment ofhypertensive basal ganglia retrospective case-control analysis，in accordance withhematoma volume30-50ml，51-70ml and71-100ml patients grouped compare the sameinterval hematoma volume two different surgical patients after2weeks when the stateof consciousness and neurological function deficit， postoperative recovery ofneurological function and mortality of3months，re-bleeding rate，the differencebetween intracranial infection rate after4-6days around the brain tissue edema volume，length of stay and spend indicator，in accordance with the count data applications X2test/rank tests, measurement data application test to be used for statistical analysis.Result:l.Before the operation there was no significant difference between twosurgical groups patients in the following factors including general characteristic，consciousness（GCS score）， basic medical history（hypertension，diabetes）positionof intracerebral hemorrhage,etc. 2. Comparing two surgical patients after two weeks when the state ofconsciousness (GCS score): hematoma volume30-50ml minimally invasive group ofpatients with GCS average value of10.52±2.73points, corresponding to the craniotomy9.46±2.11points, two group were significantly different (p <0.05); hematoma volume51-70ml minimally invasive group of patients with GCS average value of8.61±2.67points, craniotomy group GCS corresponding to an average value of8.16±2.59points,no significant difference(P>0.05); hematoma volume71-100ml minimally invasivegroup of patients with GCS average value of5.88±1.60, corresponding to thecraniotomy group of patients with GCS average value of6.15±1.43points, a statisticallysignificant difference (p <0.05).3. compare the two surgical postoperative neurological deficit (NIHSS scale score):hematoma volume30-50ml minimally invasive group of patients with NIHSS averagevalue of11.49±2.73points, corresponding to the average value of the craniotomygroup of patients with NIHSS14.35±3.11points, statistically significant difference (p<0.05); hematoma volume51-70ml minimally invasive group of patients with NIHSSaverage value of16.50±2.69points, the craniotomy group of patients with NIHSScorresponding average value of17.43±2.28points, NIHSS average value of twogroups of patients, no significant difference (P>0.05);Hematoma volume71-100mlminimally invasive group of patients with NIHSS average value of20.61±2.74points,the craniotomy group of patients with NIHSS corresponding average value of19.92±2.12points, a statistically significant difference (p <0.05).4. Comparing two surgical mortality of patients after3months: hematoma volume30-50ml of mortality in patients with minimally invasive group was12%,corresponding to the craniotomy group of patients with a mortality rate of28%, the twogroups there were significant differences (p<0.05); hematoma volume51-70mlminimally invasive group of patients, the mortality rate was38.9%, corresponding tothe craniotomy group.Patient mortality rate was42.1%, no significant difference (P>0.05); hematoma volume71-100ml in patients with minimally invasive group, themortality rate was77.8%, corresponding craniotomy group was72.1%, with nostatistically significant difference (P>0.05).5. Comparison of two patients after operation3months, the recovery ofneurological function (Rankin score improved), craniotomy hematoma volume30-50mlminimally invasive group, the recovery of nerve function was significantly higher thanthat of the corresponding, there is significant difference between the two groups (p<0.05); degree of craniotomy group nervous functions of the patients with hematomavolume51-70ml minimally invasive group patients and the corresponding recovery wassimilar, no significant differences between the two groups (P>0.05); minimally invasivehematoma volume71-100ml craniotomy in the recovery of nerve function is better thanthat of the corresponding, but the two groups had no statistical difference (P>0.05)6. Compare two surgical patients’ surgery-related incidence of majorcomplications: hematoma volume30-50ml patients, minimally invasive groupre-bleeding rate was8%, corresponding to a the craniotomy group of re-bleeding rate of14%, minimally invasive group of patients re-bleeding rate lower than the craniotomygroup, but no significant difference between the two groups; minimally invasive group,intracranial infection rate of2%, craniotomy intracranial infection rates correspondingto4%, with no statistically significant difference; hematoma the amount of51-70mlpatients minimally invasive group re-bleeding rate was25%, corresponding to thecraniotomy group re-bleeding rate of23.6%, with no statistically significant difference;minimally invasive group, intracranial infection rate was8.32%, corresponding to thecraniotomy cranial with in the infection rate was5.2%, with no statistically significantdifference; hematoma volume71-100ml patients minimally invasive group re-bleedingrate was36.1%, corresponding to the craniotomy group re-bleeding rate of27.9%,craniotomy low re-bleeding in the minimally invasive group, but the two groups nosignificant difference; minimally invasive group intracranial infection rate was27.7%,corresponding to a the craniotomy group of intracranial infection rate is16.5%, nosignificant difference between the two groups.7. Comparing two surgical patients after4-6days brain tissue edema volume: thevolume of hematoma30-50ml patients minimally invasive group cerebral edemavolume average of11.19±9.5ml, corresponding craniotomy group was16.68±10.04ml,the difference was statistically significant (p <0.05); hematoma volume51-70mlpatients minimally invasive group, cerebral edema volume average of20.36±5.49ml,corresponding craniotomy group to19.67±4.74ml, no significant difference (P>0.05);hematoma volume71-100ml patients minimally invasive group, cerebral edemavolume average of34.77±6.97ml, corresponding to the craniotomy group was29.91±7.63ml statistically significant(p <0.05).8. Comparing two surgical patient hospital days: hematoma volume30-50mlpatients, minimally invasive group, the average days in hospital were16.28±5.52days,corresponding craniotomy group were19.58±7.14days, there was statistically significant difference (p <0.05); hematoma volume of51-70ml and71-100mlpatients, the average days in hospital of minimally invasive group were less thancraniotomy group, but no significant difference (P>0.05). Two surgical patients totalhospital costs: minimally invasive hematoma volume group, the total hospital costswere lower than craniotomy group, and there is a statistically significant difference (p<0.05).Conclusions:1.Hematoma volume30-50ml hypertensive basal gangliahemorrhage, compared with craniectomy hematoma, minimally invasive surgery canreduce the mortality rate of patients to promote awareness and postoperative recovery ofneurological function after low bleeding around the brain tissue edema reaction degreeof light, can significantly shorten a patient’s hospital stay and reduce hospital spendingthe range hematoma volume patients may be more suitable for minimally invasivesurgery.2. For hematoma volume51-70ml hypertensive basal ganglia hemorrhage, twosurgical patients with postoperative mortality and recovery of neurological function,incidence of complications associated with surgery, brain tissue edema volume andother indicators showed no significant difference, but minimally invasive surgery,shorter hospital stay, less spending, such as economic considerations, feasible tominimally invasive surgery.3. For hematoma volume71-100ml hypertensive basal ganglia hemorrhage, thecraniectomy hematoma surgery brain edema volume craniectomy group wassignificantly less than the corresponding minimally invasive group, postoperativebleeding, intracranial infection rate,3months after the recovery of neurological functionand mortality indicators also better than the trend of minimally invasive surgerycraniectomy hematoma, hematoma volume of patients of this interval the degree ofcerebral edema reaction midline shift craniectomy hematoma the surgery helps to fullyreduce intracranial pressure, cerebral hemorrhage patients may be more suitable for thisinterval hematoma volume. |
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