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| Curative Effect of Minimally Invasive Surgery in Treatment of Hypertensive Intracerebral Hemorrhage and Study on the Influencing Factors of Rebleeding |
| HU Xue-an, HU Shi-jie, LV Chao,et al |
| Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University,Shannxi 710032 ,China |
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Abstract 【Objective】To study the therapeutic effect of stereotactic combined with minimally invasive surgical treatment of hypertensive cerebral hemorrhage, and the risk factors of postoperative hemorrhage of hypertensive intracerebral hemorrhage. 【Methods】Retrospective analysis of clinical data of 80 cases of hypertensive cerebral hemorrhage admitted by the Department of Neurosurgery in our hospital from January 2014 to January 2016 was conducted. According to the different operation method, they were divided into observation group and control group, 40 cases in each group. The observation group was treated by stereotactic combined with minimally invasive surgery, the control group was treated with conventional big bone flap craniotomy, and the curative effect was compared between the two groups. Multivariate Logistic regression analysis was used to analyze the risk factors of postoperative rebleeding.【Results】 Operation time, hematoma absorption time, ambulation time and hospitalization time with the observation group were shorter than those of the control group, while the amount of intraoperative bleeding, hematoma size were less than the control group, the differences were statistically significant (mean P<0.05). The score of neurological deficits in the observation group was (7.5±2.5), which was significantly lower than that of the control group (11.6±2.6), and the difference was statistically significant (t=4.05,P<0.05). Incidence of postoperative rebleeding, upper gastrointestinal bleeding and central high fever in the observation group was 2.5% (1/40), significantly lower than that of the control group 22.5% (9/40), the difference was statistically significant (χ2=5.36,P<0.05). The combined diabetes mellitus, blood coagulation dysfunction, intraventricular hematoma, hematoma >40.0 mL , basal ganglia sited bleeding and irregular shape hematoma were the risk factors of the recurrence of hypertensive intracerebral hemorrhage, and all of them have statistical difference (mean P<0.05, OR>1). Among them, blood coagulation dysfunction, basal ganglia sited bleeding and irregular shape hematoma were high risk factors (>2 OR). Whether coronary heart disease was complicated with and stereotactic combined minimally invasive surgery consisted of the protective factors of rebleeding (P<0.05, OR<1).【Conclusion】 Compared with the traditional therapy, stereotactic combined with minimally invasive surgical treatment for hypertensive intracerebral hemorrhage has the advantages of shorter operative time, less bleeding, earlier bed-off , shorter hospital stay, fewer complications and less nervous dysfunction. In order to reduce the risk factors of rebleeding, particular attention should be paid to the high risk factors, such as the abnormal coagulation function, the bleeding site and the shape of hematoma.
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2016, Vol. 33 
