Comparison of endoscopic and open surgery in life-threatening large spontaneous supratentorial intracerebral hemorrhage: A propensity-matched analysis
Comparison of endoscopic and open surgery in life-threatening large spontaneous supratentorial intracerebral hemorrhage: A propensity-matched analysis
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DOI：
10.1177/17474930221130892
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发表时间：
2022-09
影响因子：
6.7
通讯作者：
Kun Lin;Zhi cheng Lin;Yin hai Tang;D. Wei;Chuang Gao;Rongcai Jiang
中科院分区：
文献类型：
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作者：
Kun Lin;Zhi cheng Lin;Yin hai Tang;D. Wei;Chuang Gao;Rongcai Jiang
背景资料：传统上，开放手术（OS），包括标准开颅术（SC）和去骨瓣减压术（DC）和血肿清除术，用于治疗危及生命的自发性幕上大面积脑出血（ICH）。近年来，内窥镜手术（ES），微创手术治疗，已获得越来越多的普及。然而，ES治疗危及生命的大ICH的安全性和有效性尚不确定。目的：本研究的目的是评估ES治疗危及生命的大出血的有效性和安全性，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月期间接受ES或OS治疗的术前格拉斯哥昏迷量表（GCS）评分≥ 8分的连续幕上ICH患者的临床和影像学资料。为了尽量减少病例选择中的偏倚，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5分格拉斯哥结局量表（GOS）的基于卒中的二分（有利或不利）结局。有利结局定义为6个月时GOS评分为4 - 5分。还进行了敏感性分析，以确保结果的稳健性。结果如下：在695例因自发性ICH接受手术治疗的患者中，确定191例患者合格，其中ES组58例患者，OS组133例患者。倾向评分匹配改善了协变量平衡，并为所有分析生成了可比较的队列（53例ES和106例OS）。ES组6个月时有利结局的主要结局发生率较高（ES 20/53（37.7%）vs. OS 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）。敏感性分析结果稳定。结论：ES是危及生命的自发性幕上大面积ICH患者的安全治疗方法，可能比OS获得更好的结局。
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); p = 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.