Efficacy of Key Hole Approach versus Large Trauma Craniotomy for Hypertensive Intracerebral Hemorrhage: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 LIJian ¹ , LIUWei ² , LUHai ¹ ,  ZHENGJing ¹

1. Department of Neurosurgery Medicine, Suqian People's Hospital of Nanjing Drum Tower Hospital Group, Suqian 223800, China;
2. Department of Nursing, First People's Hospital of Suqian, Suqian 223800, China;

Corresponding?author：

ZHENGJing, Email: doctorzhengjing@163.com

Keywords：

Hypertensive intracerebral hemorrhage; Key hole approach; Large trauma craniotomy; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20140196

Video：

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Objective To systematically review the efficacy between key hole approach versus large trauma craniotomy for patients with hypertensive intracerebral hemorrhage. Methods Such databases as The Cochrane Library (Issue 3, 2013), PubMed, EMbase, WangFang Data, CNKI and VIP was searched to identify randomized controlled trials (RCTs) on key hole approach versus large trauma craniotomy for patients with hypertensive intracerebral hemorrhage from January 2005 to June 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2. Results A total of 13 studies involving 1 324 patients was included. The results of meta-analysis showed that, key hole approach was superior to large trauma craniotomy with significant differences in the fatality rate (OR=0.29, 95%CI 0.19 to 0.45, P < 0.000 01), incidence of postoperative complications (OR=0.35, 95%CI 0.21 to 0.57, P < 0.000 1), recovery time of consciousness (MD=-4.52, 95%CI-5.84 to-3.20, P < 0.000 01), neurologic impairment score after 1-month treatment (MD=-12.63, 95%CI-16.36 to-8.90, P < 0.000 01), total effectiveness (OR=3.79, 95%CI 2.54 to 5.66, P < 0.000 01), and postoperative living ability (ADL Grade I, Ⅱ). Conclusion Key hole approach is better than large trauma craniotomy for patients with hypertensive intracerebral hemorrhage. Due to limited quality and quantity of the included studies, the abovementioned conclusion still needs to be verified by conducting more high quality studies, especially conducting multicenter blinding RCTs with large sample-size.

Citation： LIJian, LIUWei, LUHai, ZHENGJing. Efficacy of Key Hole Approach versus Large Trauma Craniotomy for Hypertensive Intracerebral Hemorrhage: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2014, 14(10): 1210-1217. doi: 10.7507/1672-2531.20140196 Copy

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2.	黎文歡.高血壓腦出血外科治療進展.華夏醫學, 2008, 21(3):582-584.
3.	王忠誠.神經外科學.武漢:湖北科技出版社, 1998:686-690.
4.	腦卒中患者臨床神經功能缺損程度評分標準(1995):全國第四屆腦血管病學術會議通過.中華神經科雜志, 1996, 29(6):381-383.
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7.	韓光. 90例顱內血腫小骨窗開顱術的臨床觀察.中國現代醫生, 2008, 46(6):49-50.
8.	蘇作福.不同方法治療高血壓腦出血療效比較.中國實用醫藥, 2012, 7(16):89-90.
9.	麥曉, 歐海棠, 覃木秀, 等.不同手術方法治療高血壓腦出血的臨床觀察.河北醫學, 2010, 16(3):317-319.
10.	李玉山, 劉平, 楊子鍵.超早期手術治療74例高血壓腦出血術式比較.中國老年學雜志, 2006, 26(11):1471-1472.
11.	趙大力.兩種手術方法治療高血壓腦出血療效比較.中國醫藥指南, 2011, 9(21):231-232.
12.	胡禮虹.小骨窗開顱術與大骨瓣開顱術對高血壓腦出血的臨床療效分析.中國當代醫藥, 2012, 19(26):28-29.
13.	王贛江.小骨窗開顱術與大骨瓣開顱術治療高血壓腦出血療效比較.山東醫藥, 2011, 51(26):58-59.
14.	肖軍.小骨窗開顱術在高血壓腦出血治療中的應用研究.中國現代醫學雜志, 2010, 20(5):766-768.
15.	楊秋榮, 孫志宏, 劉棟梁, 等.小骨窗開顱術治療高血壓腦出血66例臨床分析.中國現代醫學雜志, 2008, 21(3):582-584.
16.	鐘朋彪.小骨窗開顱術治療高血壓腦出血.中國醫藥指南, 2009, 7(9):131-132.
17.	鄧海亮.小骨窗開顱術治療高血壓腦出血的臨床療效觀察.中國現代醫藥雜志, 2012, 14(8):29-31.
18.	王東玉.小骨窗顱內血腫清除術治療高血壓性腦出血的臨床分析.中國實用醫藥, 2012, 7(33):87-88.
19.	唐桂益.小骨窗微創手術治療高血壓性腦出血的臨床研究.微創醫學, 2009, 4(2):121-123.
20.	王凱, 潘秀平, 雪亮.腦出血手術方法探討與治療進展.中國臨床神經外科雜志, 2008, 13(12):764-767.
21.	陳劍峰.微創治療高血壓腦出血80例臨床治療分析.中國醫藥導刊, 2009, 11(4):78-80.
22.	李澤華.開顱血腫清除與微創鉆孔引流在治療高血壓性腦出血中的應用比較.吉林醫學, 2009, 30(3):265-266.
23.	崔鳳啟, 劉國棟, 閆立民, 等.高血壓腦出血規范化外科治療的探討.北京醫學, 2007, 29(5):313.
24.	Zhou H, Zhang Y, Liu L, et al. A prospective controlled study:Minimally invasive stereotactic puncture therapy versus conventional craniotomy in the treatment of acute intracerebral hemorrhage. BMC Neurol, 2011, 11:76.
25.	Zhu H, Wang Z, Shi W. Keyhole Endoscopic Hematoma Evacuation in Patients. Turk Neurosurg, 2012, 22(3):294-299.
26.	Gazzeri R, Galarza M, Neroni M, et al. Minimal craniotomy and matrix hemostatic sealant for the treatment of spontaneous supratentorial intracerebral hemorrhage. J Neurosurg, 2009, 110(5):939-942.
27.	尹曉亮.高血壓腦出血外科治療的進展.北京醫學, 2006, 28(3):175-177.

1. Woo D, Haverbusch M, Sekar P, et al. Effect of untreated hypertension on hemorrhagic stroke. Stroke, 2004, 35(7):1703-1708.
2. 黎文歡.高血壓腦出血外科治療進展.華夏醫學, 2008, 21(3):582-584.
3. 王忠誠.神經外科學.武漢:湖北科技出版社, 1998:686-690.
4. 腦卒中患者臨床神經功能缺損程度評分標準(1995):全國第四屆腦血管病學術會議通過.中華神經科雜志, 1996, 29(6):381-383.
5. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:www.cochrane-handbook.org.
6. 王丹, 翟俊霞, 牟振云, 等. Meta分析中的異質性及其處理方法.中國循證醫學雜志, 2009, 9(10):1115-1118.
7. 韓光. 90例顱內血腫小骨窗開顱術的臨床觀察.中國現代醫生, 2008, 46(6):49-50.
8. 蘇作福.不同方法治療高血壓腦出血療效比較.中國實用醫藥, 2012, 7(16):89-90.
9. 麥曉, 歐海棠, 覃木秀, 等.不同手術方法治療高血壓腦出血的臨床觀察.河北醫學, 2010, 16(3):317-319.
10. 李玉山, 劉平, 楊子鍵.超早期手術治療74例高血壓腦出血術式比較.中國老年學雜志, 2006, 26(11):1471-1472.
11. 趙大力.兩種手術方法治療高血壓腦出血療效比較.中國醫藥指南, 2011, 9(21):231-232.
12. 胡禮虹.小骨窗開顱術與大骨瓣開顱術對高血壓腦出血的臨床療效分析.中國當代醫藥, 2012, 19(26):28-29.
13. 王贛江.小骨窗開顱術與大骨瓣開顱術治療高血壓腦出血療效比較.山東醫藥, 2011, 51(26):58-59.
14. 肖軍.小骨窗開顱術在高血壓腦出血治療中的應用研究.中國現代醫學雜志, 2010, 20(5):766-768.
15. 楊秋榮, 孫志宏, 劉棟梁, 等.小骨窗開顱術治療高血壓腦出血66例臨床分析.中國現代醫學雜志, 2008, 21(3):582-584.
16. 鐘朋彪.小骨窗開顱術治療高血壓腦出血.中國醫藥指南, 2009, 7(9):131-132.
17. 鄧海亮.小骨窗開顱術治療高血壓腦出血的臨床療效觀察.中國現代醫藥雜志, 2012, 14(8):29-31.
18. 王東玉.小骨窗顱內血腫清除術治療高血壓性腦出血的臨床分析.中國實用醫藥, 2012, 7(33):87-88.
19. 唐桂益.小骨窗微創手術治療高血壓性腦出血的臨床研究.微創醫學, 2009, 4(2):121-123.
20. 王凱, 潘秀平, 雪亮.腦出血手術方法探討與治療進展.中國臨床神經外科雜志, 2008, 13(12):764-767.
21. 陳劍峰.微創治療高血壓腦出血80例臨床治療分析.中國醫藥導刊, 2009, 11(4):78-80.
22. 李澤華.開顱血腫清除與微創鉆孔引流在治療高血壓性腦出血中的應用比較.吉林醫學, 2009, 30(3):265-266.
23. 崔鳳啟, 劉國棟, 閆立民, 等.高血壓腦出血規范化外科治療的探討.北京醫學, 2007, 29(5):313.
24. Zhou H, Zhang Y, Liu L, et al. A prospective controlled study:Minimally invasive stereotactic puncture therapy versus conventional craniotomy in the treatment of acute intracerebral hemorrhage. BMC Neurol, 2011, 11:76.
25. Zhu H, Wang Z, Shi W. Keyhole Endoscopic Hematoma Evacuation in Patients. Turk Neurosurg, 2012, 22(3):294-299.
26. Gazzeri R, Galarza M, Neroni M, et al. Minimal craniotomy and matrix hemostatic sealant for the treatment of spontaneous supratentorial intracerebral hemorrhage. J Neurosurg, 2009, 110(5):939-942.
27. 尹曉亮.高血壓腦出血外科治療的進展.北京醫學, 2006, 28(3):175-177.

Chinese Journal of Evidence-Based Medicine

Efficacy of Key Hole Approach versus Large Trauma Craniotomy for Hypertensive Intracerebral Hemorrhage: A Meta-Analysis

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