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. 神经内镜手术与开颅血肿清除术治疗高血压脑出血的疗效对比. 中国老年学杂志, 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. 立体定向引导下的前额锁孔入路神经内镜血肿清除术治疗高血压脑出血. 中西医结合心脑血管病杂志, 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.	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国脑出血诊治指南(2014). 中华神经科杂志, 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, 张施远, 等. 神经内镜血肿清除术与立体定向血肿抽吸术治疗高血压性脑出血的随机对照研究. 河北医科大学学报, 2015, (1): 9-12.
9.	彭逸龙, 伍益, 陈少霭, 等. 神经内镜与传统开颅血肿清除术治疗高血压脑出血的疗效比较. 中国微侵袭神经外科杂志, 2016, 21(5): 217-218.
10.	于远君. 微创颅内血肿清除术治疗高血压脑出血的临床预后及影响因素探究. 中国伤残医学, 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.	时国兵. 小骨窗显微手术治疗基底节区高血压脑出血的预后相关因素分析及疗效观察. 临床和实验医学杂志, 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, 王洪财, 陈茂送, 等. 小骨窗微创手术与神经内镜下血肿清除治疗高血压性脑出血的疗效比较. 现代实用医学, 2013, 25(6): 620-622.
15.	陈涛. 神经内镜微创手术对高血压脑出血患者血肿清除率、手术失血量及预后的影响. 中国冶金工业医学杂志, 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, 刘伟, 刘冰, 等. 神经内镜微创与开颅微创血肿清除术治疗高血压脑出血的临床疗效比较. 安徽医药, 2018, 22(4): 674-677.
18.	严洪立, 关俊文, 李永红, 等. 基于增强现实理论的神经外科头颅体表定位系统. 生物医学工程学杂志, 2019, 36(3): 428-434.
19.	邓发斌, 游潮, 李浩. 微创颅内血肿清除术治疗高血压脑出血的预后影响因素分析. 现代预防医学, 2010, 37(13): 2549-2551.
20.	钟明华, 古君, 张尔永. 血浆IL-6, CRP和TNF-α水平在主动脉夹层患者病程中的变化及意义. 四川大学学报(医学版), 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. 神经内镜手术与开颅血肿清除术治疗高血压脑出血的疗效对比. 中国老年学杂志, 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. 立体定向引导下的前额锁孔入路神经内镜血肿清除术治疗高血压脑出血. 中西医结合心脑血管病杂志, 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. 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国脑出血诊治指南(2014). 中华神经科杂志, 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, 张施远, 等. 神经内镜血肿清除术与立体定向血肿抽吸术治疗高血压性脑出血的随机对照研究. 河北医科大学学报, 2015, (1): 9-12.
9. 彭逸龙, 伍益, 陈少霭, 等. 神经内镜与传统开颅血肿清除术治疗高血压脑出血的疗效比较. 中国微侵袭神经外科杂志, 2016, 21(5): 217-218.
10. 于远君. 微创颅内血肿清除术治疗高血压脑出血的临床预后及影响因素探究. 中国伤残医学, 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. 时国兵. 小骨窗显微手术治疗基底节区高血压脑出血的预后相关因素分析及疗效观察. 临床和实验医学杂志, 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, 王洪财, 陈茂送, 等. 小骨窗微创手术与神经内镜下血肿清除治疗高血压性脑出血的疗效比较. 现代实用医学, 2013, 25(6): 620-622.
15. 陈涛. 神经内镜微创手术对高血压脑出血患者血肿清除率、手术失血量及预后的影响. 中国冶金工业医学杂志, 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, 刘伟, 刘冰, 等. 神经内镜微创与开颅微创血肿清除术治疗高血压脑出血的临床疗效比较. 安徽医药, 2018, 22(4): 674-677.
18. 严洪立, 关俊文, 李永红, 等. 基于增强现实理论的神经外科头颅体表定位系统. 生物医学工程学杂志, 2019, 36(3): 428-434.
19. 邓发斌, 游潮, 李浩. 微创颅内血肿清除术治疗高血压脑出血的预后影响因素分析. 现代预防医学, 2010, 37(13): 2549-2551.
20. 钟明华, 古君, 张尔永. 血浆IL-6, CRP和TNF-α水平在主动脉夹层患者病程中的变化及意义. 四川大学学报(医学版), 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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