孤立性囊-神经节血肿开颅与定向抽吸加溶栓治疗的比较：回顾性分析。

Comparison of Craniotomy and Stereotactic Aspiration Plus Thrombolysis in Isolated Capsulo-Ganglionic Hematoma: A Retrospective Analyses.

机构信息

Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh, India.

Department of Neurosurgery, Ramkrishna Care Hospital, Raipur, Chhattisgarh, India.

出版信息

Neurol India. 2022 Mar-Apr;70(2):535-542. doi: 10.4103/0028-3886.344635.

DOI:10.4103/0028-3886.344635

PMID:35532616

Abstract

BACKGROUND

Published trials and meta-analyses have suggested the role of surgery in select patients of hypertensive intracerebral hematoma.

OBJECTIVE

This study compares two methods of hematoma aspiration, craniotomy, and stereotactic aspiration.

METHODS AND MATERIAL

We conducted retrospective analyses of patients who underwent surgery for capsule-ganglionic hematoma during Jan-2015-Dec-2019. Surgical, intensive-care parameters, and neurological outcomes were compared. Patients operated for Capsule-Ganglionic hypertensive hematomas, Glasgow Coma Scale (GCS) 5-12, hematoma volume ≥30 ml, no concomitant IVH, age <80 years were included.

RESULTS

A total of 173 patients were included (90 craniotomy and 83 stereotactic aspiration groups). Both groups were equivalent in preoperative parameters (P > 0.5). There were no significant differences in residual hematoma volumes, surgical site infections/Meningitis, and chances of re-bleed between the two groups (P > 0.05). The number of days on ventilation, ICU-stay, and hospital-stay were higher in craniotomy group (P < 0.001). Mean Modified Ranking Score (MRS) was lower (P 0.01) in the stereotactic aspiration group. A higher number of patients in the stereotactic aspiration group achieved good MRS (0-2) (P 0.02). Overall case-fatality rate was 38/173 (21.96%) (craniotomy - 24/90 (26.66%), stereotactic aspiration - 14/83 (16.86%), P 0.12). In left-side hematomas, mean MRS was not different between both methods, whereas it differed in the right-side hematomas. On step-wise logistic regression analysis, predicting parameters for the poor outcome (MRS 3-6) were GCS 5-8 (Odds Ratio (OR) 2.38), Left-side (OR 1.75), and craniotomy as a method of evacuation (OR 1.70).

CONCLUSIONS

Stereotactic aspiration of the hematoma has the superior edge over craniotomy. Neurological and care parameters are significantly better with stereotactic aspiration. Its safety and surgical performance parallel craniotomy.

摘要

背景

已发表的试验和荟萃分析表明，手术在某些高血压性脑出血患者中具有作用。

目的

本研究比较了血肿抽吸术、开颅术和立体定向抽吸术两种方法。

方法和材料

我们对 2015 年 1 月至 2019 年 12 月期间接受囊状-神经节血肿手术的患者进行了回顾性分析。比较了手术、重症监护参数和神经结局。纳入的患者为囊状-神经节高血压性血肿、格拉斯哥昏迷量表（GCS）5-12、血肿量≥30ml、无伴发 IVH、年龄<80 岁。

结果

共纳入 173 例患者（开颅术 90 例，立体定向抽吸术 83 例）。两组术前参数相当（P>0.5）。两组残余血肿量、手术部位感染/脑膜炎和再出血几率无显著差异（P>0.05）。开颅术组通气时间、重症监护病房停留时间和住院时间较高（P<0.001）。立体定向抽吸术组平均改良 Rankin 评分（MRS）较低（P<0.01）。立体定向抽吸术组有更多的患者达到良好的 MRS（0-2）（P<0.02）。总体病死率为 38/173（21.96%）（开颅术组 24/90（26.66%），立体定向抽吸术组 14/83（16.86%），P=0.12）。在左侧血肿中，两种方法的平均 MRS 无差异，而右侧血肿的 MRS 则不同。在逐步逻辑回归分析中，预测 MRS 3-6 不良结局的参数为 GCS 5-8（优势比（OR）2.38）、左侧（OR 1.75）和开颅术作为清除方法（OR 1.70）。