Analysis of the therapeutic efficacy of hematoma evacuation under neuroendoscopy through different surgical approaches in the treatment of hypertensive intracerebral hemorrhage
Objective To explore the therapeutic efficacy of hematoma evacuation under neuroendoscopy through different surgical approaches in the treatment of hypertensive intracerebral hemorrhage.Methods 82 patients with hypertensive intracerebral hemorrhage were selected and divided into the trans-frontal approach group and the trans temporal approach group according to different surgical methods,with 41 patients in each group.The trans-frontal approach group and tran-temporal approach group underwent hematoma evacuation under neuroendoscopy through frontal and temporal lobe approaches,respectively.Both groups were followed up for 3 months after surgery.The therapeutic efficacy of two groups at 3 months after surgery was compared.The neurological function and conscious state of two groups before surgery,at 1 week and 3 weeks after surgery were compared.The levels of inflammatory mediators of two groups before surgery,and at 24 hours after surgery were compared.The levels of neurotrophic factors of two groups befoe surgery and at 3 days after surgery,and the occurrence of complications of two groups during the followed-up were compared.Results Compared with trans-temporal approach group,the postoperative drainage time was shorter and the hematoma evacuation rate was higher in the trans-frontal approach group(P<0.05).Compared with before surgery,in both groups the National Institute of Health Stroke Scale(NIHSS)score gradually decreased,and the Glasgow Coma Scale(GCS)score gradually increased at 1 week and 3 weeks after surgery(P<0.05).Compared with 1 week after surgery,the NIHSS score and GCS score of the trans-frontal approach group were better than those of the trans-temporal approach group at 3 weeks after surgery(P<0.05).Compared with before surgery,serum levels of C-reactive protein(CRP),tumor necrosis factor(TNF),PCT,and interleukin-6(IL-6)increased in two groups at 24 hours after surgery(P<0.05).Compared with before surgery,serum levels of BDNF,GFAP and NGF in two groups increased at 3 days after surgery,and the trans-frontal approach group was higher than the trans-temporal approach group(P<0.05);And serum level of NSE decreased,and the trans-frontal approach group was lower than the trans-temporal approach group(P<0.05).Conclusion Hematoma evacuation under neuroendoscopy through frontal and temporal lobe approaches has good efficacy and safety in the treatment of hypertensive intracerebral hemorrhage,and both methods have relatively small impact on inflammatory mediators.However,compared with the trans-temporal lobe approach,the trans-frontal lobe approach can shorten the postoperative drainage time of the patients,increase the rate of hematoma evacuation,and regulate the levels of neurotrophic factors in the patient's body,and improve the neurological function and conscious state of the patients.
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