Department of Neurosurgery, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Radiation Oncology and Comprehensive Cancer Center, The University of Michigan, Ann Arbor, Michigan, USA.
Stroke Vasc Neurol. 2019 Mar 2;4(1):14-21. doi: 10.1136/svn-2018-000200. eCollection 2019 Mar.
We aimed to compare the therapeutic effects of stereotactic aspiration and best medical management in patients who developed supratentorial hypertensive intracerebral haemorrhage (HICH) with a volume of haemorrhage between 20 and 40 mL.
The clinical data of 220 patients with supratentorial HICH with a volume between 20 and 40 mL were retrospectively analysed. Among them, 142 received stereotactic aspiration surgery (stereotactic aspiration group) and 78 received best medical management (conservative group). All were followed up for 6 months. Multivariate logistic regression and Kaplan-Meier survival curves were used to compare the outcome between the two groups.
The rebleeding rate was lower in the group that had stereotactic aspiration when compared with the group with medical treatment (6 [4.2%] vs 9 [11.5%], χ=4.364, p=0.037). After 6 months, although the mortality rate did not differ significantly between the two groups (8 cases [5.6%] vs 10 cases [12.8%], χ=3.461, p=0.063), the rate of a favourable outcome was higher in the group who received stereotactic aspiration (χ=15.870, p=0.000). Logistic regression identified that medical treatment (OR=1.64, p=0.000) was an independent risk factor for an unfavourable outcome. The Kaplan-Meier curves indicated that the median favourable outcome time in the stereotactic aspiration group was 59.5 days compared with that in the medically treated group (87.0 days). The log-rank test indicated that the prognosis at 6 months was better for those treated with stereotactic haematoma aspiration (χ=29.866, p=0.000). However, the 6-month survival rate was similar between the two groups (χ=3.253, p=0.068).
Stereotactic haematoma aspiration significantly improved the quality of life, although did not effectively reduce the rate of mortality. When selected appropriately, patients with HICH may benefit from this type of surgical intervention.
比较立体定向抽吸术与最佳药物治疗对血肿量为 20-40ml 的幕上高血压性脑出血（HICH）患者的治疗效果。
回顾性分析 220 例幕上 HICH 血肿量为 20-40ml 的患者的临床资料。其中 142 例行立体定向抽吸术（立体定向抽吸组），78 例行最佳药物治疗（保守组）。所有患者均随访 6 个月。采用多因素 logistic 回归和 Kaplan-Meier 生存曲线比较两组患者的预后。
与药物治疗组相比，立体定向抽吸组的再出血率较低（6 例[4.2%]比 9 例[11.5%]，χ=4.364，p=0.037）。6 个月后，两组死亡率差异无统计学意义（8 例[5.6%]比 10 例[12.8%]，χ=3.461，p=0.063），但立体定向抽吸组的预后良好率较高（χ=15.870，p=0.000）。logistic 回归分析发现，药物治疗（OR=1.64，p=0.000）是预后不良的独立危险因素。Kaplan-Meier 曲线表明，立体定向抽吸组预后良好的中位时间为 59.5 天，而药物治疗组为 87.0 天。对数秩检验表明，立体定向血肿抽吸治疗的预后在 6 个月时更好（χ=29.866，p=0.000）。然而，两组 6 个月的生存率相似（χ=3.253，p=0.068）。
立体定向血肿抽吸术可显著改善生活质量，虽然不能有效降低死亡率。当选择合适的患者时，HICH 患者可能受益于这种手术干预。
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