| OBJECTIVE: Recently years,with the increasing amount of the aging people,the proportion of the elderly population has increased significantly,and the incidence of cancer,hypertension,cardiovascular and cerebrovascular diseases increased significantly.In the etiology of a variety of non traumatic cerebral hemorrhage patients,hypertensive cerebral hemorrhage(HCH)is taking appart of 90% for all the HCH patients.And with the tendency of rise.In our present study,we retrospectively analyzed the data from patients with cerebral hemorrhage who received the soft directional channel hematoma aspiration for HCH treatmet.And further evaluate the operation process,effectiveness and safety.METHODS: One hundred and fifty six patients with confirmed diagnosis of HCH were retrospectively included in our study from Oct 2011 to Oct 2014.Of the included 156 cases,72 cases were treated with soft directional channel hematoma aspiration(mininvasive group)and other 84 subjects received conventional craniotomy treatment process(craniotomy group).The clinical efficacy evaluation standard score was evaluated before treatment and treatment after the first 30 days,according to the fourth cerebral vascular disease academic conference.And the clinical efficacy,side effects,and peration cost were assessed for the two groups.RESULTS:(1)30 days post-treatment,for the craniotomy group,the curative effect evaluation of 5 points was 4 cases,4 points was 7,3 points was 39,2 points was 26,and 1 point in 8 cases;For minimally invasive group after treatment,efficacy evaluation 5 points in 11 cases,4 points in 15 cases,3 points in 28 cases,2 points in 12 cases,1 point in 6 cases.The clinical efficacy is statistically significant(?2=8.72,P=0.003).The high score patients in the minimally was higher than the craniotomy group.(2)For the craniotomy group,there were 11 patiens with excellent,50 cases with effective and 8 cases with deaths.And for the experiment group there was 26 cases with excellence,54 subjects with effective and 6 cases of deaths.The excellence and effective rate was significant different between craniotomy and minimally invasive group with statistical difference(P=0.001 ? 0.04).(3)There were 8 cases of postoperative rebleeding,30 subjects of pulmonary infection,24 subjects of stress ulcer,19 cases of electrolyte disturbances and,14 cases of acute renal insufficiency in the craniotomy group after treatment.There were 6 cases of postoperative intracranial bleeding,12 cases pulmonary infection,9 cases emergency stress ulcer,19 cases of electrolyte disturbances and 5 cases of acute renal insufficiency in the experiment group after treatment.There were statistical difference for the aspects of pulmonary infection(P=0.015),stress ulcer(P=0.018),and acute renal insufficiency(P=0.028);But there was not statisical difference between the two groups for rebleeding and electrolyte disturbances(P>0.05).(4)The operation cost were 6826.7±746.2 yuan and 1015.2±102.8 yuan for the craniotomy group and experiment group respectively which incideated that the operation cost in the craniotomy group was much higher than that of experiment group(P=0.00).(5)The total hospitalization cost were 42563.4±3649.3 yuan and 24782.6±2185.7 yuan for the craniotomy group and experiment group respectively with incideated thet operation cost in the craniotomy group was much higher than that of experiment group(P=0.00).(6)The length of stay were 25.4±9.1day and 13.8±6.3 for the control and experiment group respectively with statistical difference between the two groups(P=0.000).(7)For the craniotomy group,there were 4 cases of 5 points,7 casesof 4 points,39 cases of 3 points,26 cases of 2 points and 8 cases of 1 points.The followup was performed for the 76 survival patients for 12 to 48 months.The median-follow-up period was 25 months.During the follow-up-period,there were 14 patients with an increase in the score,and the score decreased in 4 cases.For the experiment group,there were 11 cases of 5 points,15 casesof 4 points,28 cases of 3 points,8 cases of 2 points and 6 cases of 1 points.After operation,66 patients were followed up for 13 to 48 months.The median follow-up time was 26 months.During the follow-up period,there were 31 patients with an increase in the score,and 6 patients with lower scores.During the follow-up period,the increase in risk of minimally invasive group was significantly higher than that in the craniotomy group HR=0.298,95%CI=0.160-0.526,(P=0.001).And the score decreasing risk for the two groups during the follow-up period was not different HR=1.105,95%CI=0.245-3.142,(P=0.871).CONCLUSION:(1)It was effective for directional soft channel drainage of hematoma in treatment of hypertensive basal ganglia cerebral hemorrhage(2)The incidence of postoperative complications is low for directional soft channel drainage of hematoma in treatment of hypertensive basal ganglia cerebral hemorrhage(3)The operation cost and total hospitalization cose were low with shourter hospital stay for patients treaded with directional soft channel hematoma aspiration(4)The neurological function was relative well for patients received directional soft channel drainage of hematoma. |
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