Clinical Study Of Two Kinds Of Surgical Treatment For Hypertensive Cerebral Hematomas In Basal Ganglia Region

Objective There are 47 cases who were hospitalized from January 2011 to March 2014 in the General Hospital of Ningxia Medical University.They all were diagnosed as hypertensive cerebral hematomas in basal ganglia region and with integrity clinical data.Neuroendoscopy and key-hole approach were applied to treat them who had clear indications for surgery.At the same time,they all were given drug treatment.These treatments outcomes were ananlyzed retrospectively.Method There were 47 cases with hypertensive cerebral hematomas in basal ganglia region were ananlyzed retrospectively by different surgical methods they had been given.Including 22 cases were treated by neuroendoscopy,key-hole approach were applied to treat 25 cases.First of all,the basic situation of these two groups of patients were evaluated to determine whether there were differences between these two groups when finished the collection of data before surgical treatment,including gender,consciousness,the bleeding sites,hematoma volume,age and clinical neurologic deficits degree,etc.Then,we compared the data of clinical cases on the postoperative hematoma clearance in the first time,postoperative nerve function recovery,the rehemorrhage incidence and the length of time during being in hospital.At last,we made the comparison of the overall outcome,namely the death and disability incidence(ADL)of the disease.Results The age,hematoma volume,preoperatie state of consciousness,the bleeding sites and clinical neurological deficits,the difference in the two groups were no statistically significant before surgical treatment(P>0.05).The differences in the two groups of the clinical neurological deficits degree was not statistically significant(P>0.05).Compared with the preoperative,the postoperative of two weeks,the clinical neurological deficits degree was statistically significant(P<0.01).There was significant difference in the hematoma clearance rate and the incidence of complications during hospitalization between the two groups(P< 0.05),the neuroendoscopy group was13.6%,the key-hole approach group was44.0%.Compared with the key-hole approach group,The days of recovery of neuroendoscopy group was shorter(P<0.05).There was not significant difference between the two groups for long-term outcomes and mortality during hospitalization.Conclusion(1)Although the key-hole approach with less trauma,with bleeding completely reliable under the direct vision of microscope,for the deep hematoma such as the hematoma in the basal ganglia,there are also many of defects,such as the difficulty of exposure for focus of infection,the blind corner of operative field.(2)Although the neuroendoscopy has the advantages of more flexible and multi-angle observation,which can make up for some shortcomings under the microscope during surgery,there are also many of defects,such as blurry vision after the lens there are bloody,with "fish eye effect" could easily lead to delusions and so on.