| Purpose: To retrospectively study the clinical and surgical data of three different minimally invasive surgery(MIS)methods(burr-hole drainage,neuroendoscopic surgery,microscopic surgery)for the treatment of basal ganglia hemorrhage(BGH),compare the clinical efficacy of three different minimally invasive methods,and analyze the risk factors that affect the prognosis of BGH patients under MIS treatment.Method: After passing the ethical review by the Medical Ethics Committee of our hospital,the medical records of patients with BGH treated in the neurosurgery department of our hospital from March 2016 to February 2020 were collected.After selection according to inclusion and exclusion criteria,they were classified into the endoscopy group(n=36),microscopy group(n=50),and burr-hole group(n=40)according to the surgical method.Statistical analysis was performed on clinical parameters such as preoperative clinical and imaging baseline data,operation time,hematoma clearance rate at 3 days after operation,postoperative complications(rebleeding after operation,brain infection,gastrointestinal hemorrhage),Glasgow coma scale at 7 days after operation,length of stay,hospitalization expenses,in-patient death and critical illness automatic discharge and Glasgow outcome score(GOS)at 6 months after surgery of each group,.Result: 1.Preoperative baseline data: There was no significant difference in preoperative baseline data such as demographic characteristics,admission systolic blood pressure,history of diabetes,preoperative GCS,etc.of each group(P>0.05).There were no significant differences in the preoperative imaging features such as the volume of hematoma,bleeding to ventricle,and midline shift of each group(P>0.05).2.Hematoma clearance rate at 3 days after operation: There were 86.5%±14.2% in the endoscopy group,91.0%±12.0% in the microscopy group,and 49.8%±26.1% in the burr-hole group.There were significant differences in the clearance rate of surgical hematoma among the three groups(P<0.001).Further comparison between groups showed that there was no significant difference between the endoscopy group and the microscopy group(P=0.113),while the burr-hole group and the other two groups had significant differences(P<0.001).3.Operation time: There were 91.31±24.04 minutes for endoscopy group,172.72±49.45 minutes for microscopy group and 39.45±13.52 minutes for burr-hole group.The operation time of the three groups was significantly different(P<0.001).Further comparisons between groups showed that there were significant differences in operation time among the three groups(P<0.001).4.Hospital stay: There were 19.69±12.91 days for endoscopy group,25.04±11.95 days for microscopy group,21.08±12.16 days for burr-hole group.The hospital stay of the three groups was significantly different(P=0.024).Further comparisons between groups showed that the endoscopy group and the microscopy group were significantly different(P=0.014),while the burr-hole group and the other two groups had no significant differences(P1=0.556,Bonferroni correction P2=0.038)×3>0.05).5.Hospitalization expenses: 8.60±35 million yuan for the endoscopy group,9.42±39,500 yuan for the microscopy group,and 6.16±31,100 yuan for the burr-hole group.The hospitalization expenses of the three groups were significantly different(P<0.001).Further comparison between groups showed that there was no significant difference between the endoscopy group and the microscopy group(P=0.441),while the burr-hole group and the other two groups had significant differences(P1=0.002,P2<0.001).6.GCS at 7 days after operation(P=0.534),postoperative rebleeding(P=0.200),intracranial infection(P=0.912),gastrointestinal bleeding(P=0.481),hospitalized death and critical illness automatic discharge(P=0.892)and the prognosis rate of 6 months after operation(P=0.577)among the three groups were not significantly different.7.Univariate and multivariate regression analysis have been performed successively.It is shown that advanced age,low preoperative GCS score,large preoperative hematoma,rupture of the ventricle,and postoperative rebleeding are independent risk factors that affect the prognosis of BGH patients under MIS treatment at 6 months(P<0.05).Conclusion: 1.The clearance rate of hematoma in neuroendoscopic surgery is equivalent to that of the microscopy group,and the hospital stay is significantly shortened,but it does not show significant advantages in terms of postoperative complications and good prognosis;burr-hole surgery is superior in terms of operation time and hospitalization costs,but we should pay attention to the risk of postoperative rebleeding;microscopic surgery has a high hematoma clearance rate,but the operation time and hospital stay are significantly prolonged.2.Neuroendoscopic surgery has the advantages of safety and efficiency,while microscopic and burr-hole surgery also have their own advantages and characteristics.In clinical applications,the appropriate surgical method should be selected according to the actual situation of the patient.3.Research on the risk factors that affect the prognosis of patients with basal ganglia intracerebral hemorrhage treated by minimally invasive surgery will help formulate clinical treatment strategies,promote the development of minimally invasive treatment,implement individualized treatment for patients and strive for beneficial outcomes. |
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