A randomized controlled trial of minimally invasive surgery for hypertensive lobar hemorrhage

doi:10.11958/20220338

Abstract

Abstract:

Objective To compare the therapeutic efficacy of three types of minimally invasive procedures on hypertensive lobar hemorrhage. Methods According to the different preoperative hematoma volume, 120 patients with hypertensive lobar hemorrhage were divided into the large hematoma group and the small hematoma group, with 60 patients in each group. According to the random envelope method, each group was subdivided into the small bone window group (small bone window craniotomy assisted by neuronavigation for hematoma removal), the drilling group (hematoma cavity drainage assisted by neuronavigation) and the endoscopic group (neuroendoscopic hematoma removal assisted by neuronavigation), with 20 patients in each group. The following data of patients in each group were compared, including basic data, intraoperative data (operation time, intraoperative blood loss), postoperative data, hematoma clearance rates at 6 h, 3 d and 7 d after operation, Glasgow coma index score (GCS) at 6 h, 3 d and 7 d after operation, postoperative complications (tracheotomy, intracranial infection, recurrent bleeding), drainage tube retention time and drug injection time, prognosis data, Glasgow prognosis score (GOS) at 3 months after operation. Results There were no significant differences in age, preoperative hematoma volume, bleeding location, onset to operation time and preoperative GCS score between the large hematoma group and the small hematoma group (P>0.05). In the large hematoma group and the small hematoma group, compared with the small bone window group and the endoscopic group, the drilling group had the shortest operation time, the least intraoperative blood loss, and the hematoma clearance rate was reduced at 6 h and 3 d after surgery, and the drainage tube retention time was prolonged (P<0.05). There were no significant differences in complications between the three groups. In the large hematoma group, the GCS score was higher at 6 h after surgery in the endoscopic group than that of the drilling group, and the GCS score was higher at 3 d and 7 d after surgery in the endoscopic group than that of the small bone window group and the drilling group (P<0.05). In the large hematoma group, the average injection time was longer in the drilling group than that of the small hematoma group (P<0.05). In the large hematoma group, the favorable prognostic rate was higher in the endoscopic group than that of the small bone window group and the drilling group (P<0.05), while there was no significant difference in the favorable prognostic rate between the three subgroups of the small hematoma group (P>0.05). Conclusion Hematoma cavity catheterization and drainage can shorten the operation time and reduce the intraoperative blood loss. Both neuroendoscopy and small bone window craniotomy have higher hematoma clearance rates.

Key words: intracranial hemorrhage, hypertensive, neurosurgical procedures, minimally invasive surgical, hematoma, subdural, intracranial, drainage, neuronavigation, neuroendoscopes

CLC Number:

R651.11

Figures/Tables 8

References 20

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组别	年龄（岁）	术前血肿量（mL）	出血位置						发病到手术时间（h）	术前GCS评分（分）
组别	年龄（岁）	术前血肿量（mL）	颞叶	顶叶	额叶	枕叶	颞顶叶	顶枕叶	发病到手术时间（h）	术前GCS评分（分）
小骨窗组	58.45±10.91	51.02±6.56	6	4	3	2	3	2	10.35（5.90,19.80）	12.25±3.11
钻孔组	58.75±11.30	49.61±6.56	5	5	2	3	4	1	11.05（6.50,21.00）	12.05±3.12
内镜组	58.00±12.37	51.00±6.61	4	3	2	4	4	3	11.65（6.50,22.90）	11.85±3.41
F或χ²	0.021	0.301	3.034						0.277	0.077

组别	年龄（岁）	术前血肿量（mL）	出血位置						发病到手术时间（h）	术前GCS评分（分）
组别	年龄（岁）	术前血肿量（mL）	颞叶	顶叶	额叶	枕叶	颞顶叶	顶枕叶	发病到手术时间（h）	术前GCS评分（分）
小骨窗组	58.45±10.91	51.02±6.56	6	4	3	2	3	2	10.35（5.90,19.80）	12.25±3.11
钻孔组	58.75±11.30	49.61±6.56	5	5	2	3	4	1	11.05（6.50,21.00）	12.05±3.12
内镜组	58.00±12.37	51.00±6.61	4	3	2	4	4	3	11.65（6.50,22.90）	11.85±3.41
F或χ²	0.021	0.301	3.034						0.277	0.077

组别	年龄（岁）	术前血肿量（mL）	出血位置						发病到手术时间（h）	术前GCS评分（分）
组别	年龄（岁）	术前血肿量（mL）	颞叶	顶叶	额叶	枕叶	颞顶叶	顶枕叶	发病到手术时间（h）	术前GCS评分（分）
小骨窗组	59.15±10.75	32.73±5.23	5	5	1	3	2	4	14.15（8.50,27.10）	14.55±0.89
钻孔组	59.8±10.43	31.45±5.19	4	3	2	4	4	3	15.40（8.30,26.80）	14.70±0.66
内镜组	59.40±10.02	32.23±5.26	5	4	1	4	3	3	14.15（8.30,24.10）	14.35±1.27
F或χ²	0.020	0.302	2.191						0.118	0.655

组别	年龄（岁）	术前血肿量（mL）	出血位置						发病到手术时间（h）	术前GCS评分（分）
组别	年龄（岁）	术前血肿量（mL）	颞叶	顶叶	额叶	枕叶	颞顶叶	顶枕叶	发病到手术时间（h）	术前GCS评分（分）
小骨窗组	59.15±10.75	32.73±5.23	5	5	1	3	2	4	14.15（8.50,27.10）	14.55±0.89
钻孔组	59.8±10.43	31.45±5.19	4	3	2	4	4	3	15.40（8.30,26.80）	14.70±0.66
内镜组	59.40±10.02	32.23±5.26	5	4	1	4	3	3	14.15（8.30,24.10）	14.35±1.27
F或χ²	0.020	0.302	2.191						0.118	0.655

组别	手术时间（min）	术中失血量（mL）
小骨窗组	138.8±26.56	267.70±61.32
钻孔组	69.85±14.22^a	116.15±45.66^a
内镜组	127.25±23.03^b	250.10±74.84^b
F	56.901^＊＊	36.011^＊＊