Efficacy and prognostic factors of neuroendoscopic intracerebral hematoma evacuation in the treatment of hypertension-related intracerebral hemorrhage_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Li ¹ , LIU Huixiang ¹ , MA Chao ² , WANG Zhong ² ,  YE Jingwei ¹

1. Department of Neurosurgery, the Affiliated Zhangjiagang Hospital of Soochow University, Zhangjiagang 215600, P.R.China;
2. Department of Neurosurgery, the First Affiliated Hospital of Soochow University, Suzhou 215006, P.R.China;

Corresponding?author：

YE Jingwei, Email: zjgyjw825@163.com

Keywords：

Evacuation of intracerebral hematoma under neuroendoscope; Evacuation of intracerebral hematoma by craniotomy; Hypertension-related intracerebral hemorrhage; Efficacy; Prognostic factor

DOI：

10.7507/1672-2531.202004086

Video：

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Objectives To explore the efficacy and prognostic factors of neuroendoscopic intracerebral hematoma evacuation in the treatment of hypertension-related intracerebral hemorrhage.Methods A total of 122 patients with hypertension-related intracerebral hemorrhage treated in our hospital from October 2015 to May 2019 were categorized into experimental group (n=62) and control group (n=60). The experimental group was treated with endoscopic intracerebral hematoma removal, while the control group was treated with traditional craniotomy. The operative indexes, postoperative recovery, serum endothelin, IL-6, CRP levels and the incidence of postoperative complications were observed and compared between the two groups, and the relevant factors affecting the prognosis of patients undergoing neuroendoscopic intracerebral hematoma evacuation were analyzed.Results The operation time, intraoperative blood loss, hematoma clearance rate, ICU treatment time, the volume of brain edema 7 days after operation, the postoperative intracranial pressure, NIHSS score and ADL score in experimental group were significantly superior to those in control group. The levels of serum endothelin, IL-6 and CRP in the experimental group were significantly lower than those in the control group after operation. The incidence of complications in the experimental group was lower than that in control group. Univariate analysis showed that the prognosis of patients undergoing neuroendoscopic evacuation of intracerebral hematoma was significantly correlated with the history of hypertension, preoperative GCS score, the amount of bleeding and whether been broken into the ventricle (P<0.05), but not with age, sex and location of hemorrhage (P>0.05). Multivariate logistic regression analysis showed that the history of hypertension above 10 years, blood loss above 50 mL, intraventricular rupture and preoperative GCS score were the risk factors affecting the prognosis of patients undergoing neuroendoscopic intracerebral hematoma evacuation.Conclusions Compared with traditional craniotomy, neuroendoscopic evacuation of intracerebral hematoma has the advantages of better curative effect and lower incidence of postoperative complications in the treatment of hypertension-related intracerebral hemorrhage. The history of hypertension above 10 years, bleeding volume above 50 mL, breaking into the ventricle and preoperative GCS score are the risk factors affecting the prognosis of patients undergoing neuroendoscopic intracerebral hematoma evacuation.

Citation： ZHANG Li, LIU Huixiang, MA Chao, WANG Zhong, YE Jingwei. Efficacy and prognostic factors of neuroendoscopic intracerebral hematoma evacuation in the treatment of hypertension-related intracerebral hemorrhage. Chinese Journal of Evidence-Based Medicine, 2020, 20(12): 1379-1384. doi: 10.7507/1672-2531.202004086 Copy

1.	浦奔放. 神經內鏡手術與開顱血腫清除術治療高血壓腦出血的療效對比. 中國老年學雜志, 2014, 34(3): 786-787.
2.	Yamada T, Shima T, Okada Y, et al. Impaired cerebral circulation and the effect of glycerol infusion in the acute stage of hypertensive intracerebral hematoma. No To Shinkei, 1990, 42(3): 303-309.
3.	Lin WM, Yang TY, Weng HH, et al. Brain microbleeds: distribution and influence on hematoma and perihematomal edema in patients with primary intracerebral hemorrhage. Neuroradiol J, 2013, 26(2): 184-190.
4.	康湧, 范益民. 立體定向引導下的前額鎖孔入路神經內鏡血腫清除術治療高血壓腦出血. 中西醫結合心腦血管病雜志, 2014, 21(7): 852-853.
5.	Tzaan WC, Lee ST, Lui TN. Combined use of stereotactic aspiration and intracerebral streptokinase infusion in the surgical treatment of hypertensive intracerebral hemorrhage. J Formos Med Assoc, 1997, 96(12): 962-967.
6.	中華醫學會神經病學分會, 中華醫學會神經病學分會腦血管病學組. 中國腦出血診治指南(2014). 中華神經科雜志, 2015, 48(6): 435-444.
7.	Berwaerts J, Dijkhuizen RS, Robb OJ, et al. Prediction of functional outcome and in-hospital mortality after admission with oral anticoagulant-related intracerebral hemorrhage. Stroke, 2000, 31(11): 2558-2562.
8.	石海平, 曾春, 張施遠, 等. 神經內鏡血腫清除術與立體定向血腫抽吸術治療高血壓性腦出血的隨機對照研究. 河北醫科大學學報, 2015, (1): 9-12.
9.	彭逸龍, 伍益, 陳少靄, 等. 神經內鏡與傳統開顱血腫清除術治療高血壓腦出血的療效比較. 中國微侵襲神經外科雜志, 2016, 21(5): 217-218.
10.	于遠君. 微創顱內血腫清除術治療高血壓腦出血的臨床預后及影響因素探究. 中國傷殘醫學, 2018, 26(6): 57-58.
11.	Diaz P, Maillo A. Intracerebral hemorrhage following chronic subdural hematoma evacuation: report of two cases and review of the literature. Neurocirugia (Astur), 2003, 14(4): 333-336.
12.	時國兵. 小骨窗顯微手術治療基底節區高血壓腦出血的預后相關因素分析及療效觀察. 臨床和實驗醫學雜志, 2013, 12(7): 521-522, 525.
13.	Ma J, Li H, Liu Y, et al. Effects of intensive blood pressure lowering on intracerebral hemorrhage outcomes: a meta-analysis of randomized controlled trials. Turk Neurosurg, 2015, 25(4): 544-551.
14.	王波定, 王洪財, 陳茂送, 等. 小骨窗微創手術與神經內鏡下血腫清除治療高血壓性腦出血的療效比較. 現代實用醫學, 2013, 25(6): 620-622.
15.	陳濤. 神經內鏡微創手術對高血壓腦出血患者血腫清除率、手術失血量及預后的影響. 中國冶金工業醫學雜志, 2018, 35(4): 467-468.
16.	Shibao S, Akiyama T, Yoshida K, et al. Chronic encapsulated intracerebral hematoma: endoscopic removal as minimally invasive surgery for a patient with alcoholic cirrhosis. NMC Case Rep J, 2017, 4(2): 51-53.
17.	邱翔, 劉偉, 劉冰, 等. 神經內鏡微創與開顱微創血腫清除術治療高血壓腦出血的臨床療效比較. 安徽醫藥, 2018, 22(4): 674-677.
18.	嚴洪立, 關俊文, 李永紅, 等. 基于增強現實理論的神經外科頭顱體表定位系統. 生物醫學工程學雜志, 2019, 36(3): 428-434.
19.	鄧發斌, 游潮, 李浩. 微創顱內血腫清除術治療高血壓腦出血的預后影響因素分析. 現代預防醫學, 2010, 37(13): 2549-2551.
20.	鐘明華, 古君, 張爾永. 血漿IL-6, CRP和TNF-α水平在主動脈夾層患者病程中的變化及意義. 四川大學學報(醫學版), 2015, 46(2): 234-237.
21.	Wang T, Huang Y, Zhang MY, et al. [Gly14]-Humanin offers neuroprotection through glycogen synthase kinase-3β inhibition in a mouse model of intracerebral hemorrhage. Behav Brain Res, 2013, 247: 132-139.

1. 浦奔放. 神經內鏡手術與開顱血腫清除術治療高血壓腦出血的療效對比. 中國老年學雜志, 2014, 34(3): 786-787.
2. Yamada T, Shima T, Okada Y, et al. Impaired cerebral circulation and the effect of glycerol infusion in the acute stage of hypertensive intracerebral hematoma. No To Shinkei, 1990, 42(3): 303-309.
3. Lin WM, Yang TY, Weng HH, et al. Brain microbleeds: distribution and influence on hematoma and perihematomal edema in patients with primary intracerebral hemorrhage. Neuroradiol J, 2013, 26(2): 184-190.
4. 康湧, 范益民. 立體定向引導下的前額鎖孔入路神經內鏡血腫清除術治療高血壓腦出血. 中西醫結合心腦血管病雜志, 2014, 21(7): 852-853.
5. Tzaan WC, Lee ST, Lui TN. Combined use of stereotactic aspiration and intracerebral streptokinase infusion in the surgical treatment of hypertensive intracerebral hemorrhage. J Formos Med Assoc, 1997, 96(12): 962-967.
6. 中華醫學會神經病學分會, 中華醫學會神經病學分會腦血管病學組. 中國腦出血診治指南(2014). 中華神經科雜志, 2015, 48(6): 435-444.
7. Berwaerts J, Dijkhuizen RS, Robb OJ, et al. Prediction of functional outcome and in-hospital mortality after admission with oral anticoagulant-related intracerebral hemorrhage. Stroke, 2000, 31(11): 2558-2562.
8. 石海平, 曾春, 張施遠, 等. 神經內鏡血腫清除術與立體定向血腫抽吸術治療高血壓性腦出血的隨機對照研究. 河北醫科大學學報, 2015, (1): 9-12.
9. 彭逸龍, 伍益, 陳少靄, 等. 神經內鏡與傳統開顱血腫清除術治療高血壓腦出血的療效比較. 中國微侵襲神經外科雜志, 2016, 21(5): 217-218.
10. 于遠君. 微創顱內血腫清除術治療高血壓腦出血的臨床預后及影響因素探究. 中國傷殘醫學, 2018, 26(6): 57-58.
11. Diaz P, Maillo A. Intracerebral hemorrhage following chronic subdural hematoma evacuation: report of two cases and review of the literature. Neurocirugia (Astur), 2003, 14(4): 333-336.
12. 時國兵. 小骨窗顯微手術治療基底節區高血壓腦出血的預后相關因素分析及療效觀察. 臨床和實驗醫學雜志, 2013, 12(7): 521-522, 525.
13. Ma J, Li H, Liu Y, et al. Effects of intensive blood pressure lowering on intracerebral hemorrhage outcomes: a meta-analysis of randomized controlled trials. Turk Neurosurg, 2015, 25(4): 544-551.
14. 王波定, 王洪財, 陳茂送, 等. 小骨窗微創手術與神經內鏡下血腫清除治療高血壓性腦出血的療效比較. 現代實用醫學, 2013, 25(6): 620-622.
15. 陳濤. 神經內鏡微創手術對高血壓腦出血患者血腫清除率、手術失血量及預后的影響. 中國冶金工業醫學雜志, 2018, 35(4): 467-468.
16. Shibao S, Akiyama T, Yoshida K, et al. Chronic encapsulated intracerebral hematoma: endoscopic removal as minimally invasive surgery for a patient with alcoholic cirrhosis. NMC Case Rep J, 2017, 4(2): 51-53.
17. 邱翔, 劉偉, 劉冰, 等. 神經內鏡微創與開顱微創血腫清除術治療高血壓腦出血的臨床療效比較. 安徽醫藥, 2018, 22(4): 674-677.
18. 嚴洪立, 關俊文, 李永紅, 等. 基于增強現實理論的神經外科頭顱體表定位系統. 生物醫學工程學雜志, 2019, 36(3): 428-434.
19. 鄧發斌, 游潮, 李浩. 微創顱內血腫清除術治療高血壓腦出血的預后影響因素分析. 現代預防醫學, 2010, 37(13): 2549-2551.
20. 鐘明華, 古君, 張爾永. 血漿IL-6, CRP和TNF-α水平在主動脈夾層患者病程中的變化及意義. 四川大學學報(醫學版), 2015, 46(2): 234-237.
21. Wang T, Huang Y, Zhang MY, et al. [Gly14]-Humanin offers neuroprotection through glycogen synthase kinase-3β inhibition in a mouse model of intracerebral hemorrhage. Behav Brain Res, 2013, 247: 132-139.

Chinese Journal of Evidence-Based Medicine

Efficacy and prognostic factors of neuroendoscopic intracerebral hematoma evacuation in the treatment of hypertension-related intracerebral hemorrhage

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