The Study Of The Clinical Effect Of Neuroendoscopy In The Treatment Of Hypertensive Intracerebral Hemorrage

Objective: By comparing endoscopic surgery,microsurgery,and minimally invasive drilling and drainage,the clinical effect of endoscopic surgery for hypertensive cerebral hemorrhage in basal ganglia was investigated.Methods: The 120 cases with hypertension cerebral hemorrhage in basal ganglia region in the First Central Hospital of Baoding City from Jan 2015 to Jan 2018 were retrospectively analyzed.The patients were divided as followed by operation methods: endoscopy group(40 cases),microscope group(40 cases)and minimally invasive drilling drainage group(40 cases).Comparing the three groups of patients with ordinary materials(such as gender,age,hematoma volume),GCS scores,operative blood loss,operative time-consuming,and hematoma removal amount for the first time of three surgical methods in operative situation.The number of postoperative rebleeding cases of the three surgical methods was compared.The intracranial pressure levels at the time,24 h and 5d after the three surgical methods was compared.Complications,length of stay and average stay of the patients were recorded.The prognosis of the patients in 6 months after the surgery was evaluated by mRS score.All data analysis was performed by SPSS22.0 statistical software,and was used to test the measurement data.T-test was used for comparison between groups.According to the test standard,when P<0.05,the difference was statistically significant.Results:1.Comparison of General information with baseline dataThe 120 cases about hypertension cerebral hemorrhage in basal ganglia region were divided into endoscopic group(40 cases),microscopic surgery group(40 cases)and borehole drainage group(40 cases)according to different ways of surgery.There were no statistical differences(P > 0.05)in age,gender,location,the IVH,CCS scoring as compared to the onset of the operation time,preoperative hematoma volume of three groups of patients.2.Comparison of intraoperative conditionsAmong the three groups,the intraoperative time-consuming and Intraoperative blood loss in the endoscopy group,which was higher than that in the drilling group and lower than the microscope group,with statistical difference(P<0.05);The clearance rate of the first hematoma was the highest in the endoscopic group and the lowest in the drilling and drainage group.The clearance rate of the microscope group was between the two groups,and there was a significant difference among the three groups(P < 0.05).3.Postoperative GCS scorePreoperative GCS score of the three groups have no significant difference(P>0.05),also there was no significant difference in postoperative GCS score(P>0.05),but look from improvement,to improve the preoperative endoscopic group 1.56±1.23,and microscopic group increased by 1.12±0.46 points,drilling group increased by 0.86±0.34 points,endoscopic group is obviously better than the microscopic and drilling group,there are statistically significant difference(P<0.05).4.Comparison of the postoperative complications and postoperative bleeding againAmong the three groups of patients,the lowest incidence of intracranial infection and pulmonary infection was observed in the endoscopic group.The highest incidence of intracranial infection and pulmonary infection was observed in the microscopic group.drilling group between the two groups.The incidence of intracranial infection were statistically significant among the three groups(P<0.05).The incidence of pulmonary infection of the endoscopy group was significantly lower than the other two groups(P<0.05).In comparison of postoperative re-bleeding,4 patients in the endoscopic group,accounting for 10% of the total number;6 patients in the microscopic group(15.00%)and 5 patients in the drilling group(12.50%),respectively.The proportion of postoperative re-bleeding in the endoscopic group was was the lowest.However,there was no statistical difference among the three groups(P>0.05).There are 3 deaths(7.50%)in the endoscopic group and 9 deaths(22.50%)in the microscopic group and 9 deaths(22.50%)in the drilling group.The mortality of the endoscopic group was significantly lower than that in the microscopic group(22.50%)and the drilling group(22.50%)(P<0.05).5.Intracranial pressure at postoperative time,24 h and 5dThe intracranial pressure levels in the endoscopic group of the postoperative time,24 h and 5d after operation were 16.98±6.57(mmHg),15.23±4.35(mmHg)and 14.17±3.67(mmHg)respectively.There was no statistical differences as compared tothe microscopic group(17.57±3.56(mmHg),16.88±3.45(mmHg)and 16.00±3.24(mmHg)(P>0.05).However,the intracranial pressure levels in the endoscopic group was obviously lower than that of the drilling group(24.45±6.46(mmHg),20.50±5.89(mmHg)and 19.53±5.23(mmHg)(P<0.05).6.Length of stayAmong the three groups,the hospitalization days in the endoscopy group(15.54± 3.45 days)was lower than that in the microscope group(19.10±5.46 days)and the drilling group(20.45±4.34 days)(P<0.05).7.mRS scoreSix months after the surgery,the mRS score in the endoscopy group,the drilling group and the microscope group was 2.34±0.60,3.10± 0.86 and 2.76±0.80.The mRS score in the endoscopy group is significantly decreased as compared to the other two groups(P<0.05).Conclusion: The endoscopic surgery for hypertensive cerebral hemorrhage in basal ganglia had more hematoma clearance for the first time,less trauma and less postoperative complications to the brain,which is thus worth being applied and promoted in clinical practice.