内镜手术与开颅手术治疗危及生命的特发性幕上大脑大量出血的比较：倾向评分匹配分析。
Comparison of endoscopic and open surgery in life-threatening large spontaneous supratentorial intracerebral hemorrhage: A propensity-matched analysis.
机构信息
Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.
Tianjin Neurological Institute, Key Laboratory of Post-Neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education in China and Tianjin, Tianjin, China.
出版信息
Int J Stroke. 2023 Jun;18(5):569-577. doi: 10.1177/17474930221130892. Epub 2022 Oct 15.
BACKGROUND
Conventionally, open surgery (OS), including standard craniotomy (SC) and decompressive craniectomy (DC) with hematoma evacuation, is adopted to treat life-threatening large spontaneous supratentorial intracerebral hemorrhage (ICH). Recently, endoscopic surgery (ES), a minimally invasive surgical treatment, has gained increased popularity. However, the safety and efficacy of ES for life-threatening large ICH is uncertain.
AIM
The aim of this study was to evaluate the effectiveness and safety of ES for life-threatening large ICH and compare it with traditional OS.
METHODS
We retrospectively analyzed the clinical and imaging data of consecutive supratentorial ICH patients with preoperative Glasgow Coma Scale (GCS) score ⩽ 8, who underwent ES or OS between May 2015 and October 2021. To minimize bias in case selection, propensity score matching was performed (ratio 1:2, caliper o.2). The primary outcome was a prognosis-based dichotomized (favorable or unfavorable) outcome of the 5-point Glasgow Outcome Scale (GOS) at 6 months. Favorable outcome was defined as a GOS score of 4 to 5 at 6 months. Sensitivity analysis was also performed to ensure the robustness of the findings.
RESULTS
Of 695 patients who underwent surgical treatment for spontaneous ICH, 191 patients were identified to be eligible, with 58 patients in the ES group and 133 patients in the OS group. Propensity score matching improved covariate balance and generated a comparable cohort (53 ES and 106 OS) for all analyses. The ES group had a higher incidence of the primary outcome of favorable outcome at 6 months (ES 20/53 (37.7%) vs. OS 22/106 (20.8%); propensity score-matched relative risk (RR) (95% CI) = 1.74 (1.13-2.68); = 0.013). Sensitivity analysis showed the result was stable.
CONCLUSION
ES is a safe treatment for life-threatening large spontaneous supratentorial ICH patients and may achieve better outcomes than OS.
背景
传统上，开颅手术（OS），包括标准开颅术（SC）和去骨瓣减压术（DC）伴血肿清除术，被用于治疗危及生命的大型自发性幕上脑内血肿（ICH）。最近，内镜手术（ES），一种微创的治疗方法，越来越受到欢迎。然而，ES 治疗危及生命的大型 ICH 的安全性和有效性尚不确定。
目的
本研究旨在评估 ES 治疗危及生命的大型 ICH 的有效性和安全性，并将其与传统 OS 进行比较。
方法
我们回顾性分析了 2015 年 5 月至 2021 年 10 月期间连续接受 ES 或 OS 治疗的幕上 ICH 患者的临床和影像学资料，这些患者术前格拉斯哥昏迷量表（GCS）评分≤8。为了最小化病例选择的偏倚，我们进行了倾向评分匹配（比例 1:2，卡尺 0.2）。主要结局是 6 个月时基于预后的（有利或不利）5 分格拉斯哥预后量表（GOS）的二分结果。有利结局定义为 6 个月时 GOS 评分为 4 至 5。还进行了敏感性分析以确保研究结果的稳健性。
结果
在 695 例接受自发性 ICH 手术治疗的患者中，有 191 例符合条件，其中 ES 组 58 例，OS 组 133 例。倾向评分匹配改善了协变量的平衡，并为所有分析生成了一个可比的队列（ES 组 53 例，OS 组 106 例）。ES 组在 6 个月时的主要结局（有利结局）发生率更高（ES 组 20/53 [37.7%] vs. OS 组 22/106 [20.8%]；倾向评分匹配的相对风险（RR）（95%CI）=1.74（1.13-2.68）；P=0.013）。敏感性分析显示结果稳定。
结论
ES 是治疗危及生命的大型自发性幕上 ICH 患者的安全治疗方法，可能比 OS 获得更好的结果。
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