Efficacy of Key Hole Approach versus Large Trauma Craniotomy for Hypertensive Intracerebral Hemorrhage: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 LIJian ¹ , LIUWei ² , LUHai ¹ ,  ZHENGJing ¹

1. Department of Neurosurgery Medicine, Suqian People's Hospital of Nanjing Drum Tower Hospital Group, Suqian 223800, China;
2. Department of Nursing, First People's Hospital of Suqian, Suqian 223800, China;

Corresponding author：

ZHENGJing, Email: doctorzhengjing@163.com

Keywords：

Hypertensive intracerebral hemorrhage; Key hole approach; Large trauma craniotomy; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20140196

Video：

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Objective To systematically review the efficacy between key hole approach versus large trauma craniotomy for patients with hypertensive intracerebral hemorrhage. Methods Such databases as The Cochrane Library (Issue 3, 2013), PubMed, EMbase, WangFang Data, CNKI and VIP was searched to identify randomized controlled trials (RCTs) on key hole approach versus large trauma craniotomy for patients with hypertensive intracerebral hemorrhage from January 2005 to June 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2. Results A total of 13 studies involving 1 324 patients was included. The results of meta-analysis showed that, key hole approach was superior to large trauma craniotomy with significant differences in the fatality rate (OR=0.29, 95%CI 0.19 to 0.45, P < 0.000 01), incidence of postoperative complications (OR=0.35, 95%CI 0.21 to 0.57, P < 0.000 1), recovery time of consciousness (MD=-4.52, 95%CI-5.84 to-3.20, P < 0.000 01), neurologic impairment score after 1-month treatment (MD=-12.63, 95%CI-16.36 to-8.90, P < 0.000 01), total effectiveness (OR=3.79, 95%CI 2.54 to 5.66, P < 0.000 01), and postoperative living ability (ADL Grade I, Ⅱ). Conclusion Key hole approach is better than large trauma craniotomy for patients with hypertensive intracerebral hemorrhage. Due to limited quality and quantity of the included studies, the abovementioned conclusion still needs to be verified by conducting more high quality studies, especially conducting multicenter blinding RCTs with large sample-size.

Citation： LIJian, LIUWei, LUHai, ZHENGJing. Efficacy of Key Hole Approach versus Large Trauma Craniotomy for Hypertensive Intracerebral Hemorrhage: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2014, 14(10): 1210-1217. doi: 10.7507/1672-2531.20140196 Copy

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2.	黎文欢.高血压脑出血外科治疗进展.华夏医学, 2008, 21(3):582-584.
3.	王忠诚.神经外科学.武汉:湖北科技出版社, 1998:686-690.
4.	脑卒中患者临床神经功能缺损程度评分标准(1995):全国第四届脑血管病学术会议通过.中华神经科杂志, 1996, 29(6):381-383.
5.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:www.cochrane-handbook.org.
6.	王丹, 翟俊霞, 牟振云, 等. Meta分析中的异质性及其处理方法.中国循证医学杂志, 2009, 9(10):1115-1118.
7.	韩光. 90例颅内血肿小骨窗开颅术的临床观察.中国现代医生, 2008, 46(6):49-50.
8.	苏作福.不同方法治疗高血压脑出血疗效比较.中国实用医药, 2012, 7(16):89-90.
9.	麦晓, 欧海棠, 覃木秀, 等.不同手术方法治疗高血压脑出血的临床观察.河北医学, 2010, 16(3):317-319.
10.	李玉山, 刘平, 杨子键.超早期手术治疗74例高血压脑出血术式比较.中国老年学杂志, 2006, 26(11):1471-1472.
11.	赵大力.两种手术方法治疗高血压脑出血疗效比较.中国医药指南, 2011, 9(21):231-232.
12.	胡礼虹.小骨窗开颅术与大骨瓣开颅术对高血压脑出血的临床疗效分析.中国当代医药, 2012, 19(26):28-29.
13.	王赣江.小骨窗开颅术与大骨瓣开颅术治疗高血压脑出血疗效比较.山东医药, 2011, 51(26):58-59.
14.	肖军.小骨窗开颅术在高血压脑出血治疗中的应用研究.中国现代医学杂志, 2010, 20(5):766-768.
15.	杨秋荣, 孙志宏, 刘栋梁, 等.小骨窗开颅术治疗高血压脑出血66例临床分析.中国现代医学杂志, 2008, 21(3):582-584.
16.	钟朋彪.小骨窗开颅术治疗高血压脑出血.中国医药指南, 2009, 7(9):131-132.
17.	邓海亮.小骨窗开颅术治疗高血压脑出血的临床疗效观察.中国现代医药杂志, 2012, 14(8):29-31.
18.	王东玉.小骨窗颅内血肿清除术治疗高血压性脑出血的临床分析.中国实用医药, 2012, 7(33):87-88.
19.	唐桂益.小骨窗微创手术治疗高血压性脑出血的临床研究.微创医学, 2009, 4(2):121-123.
20.	王凯, 潘秀平, 雪亮.脑出血手术方法探讨与治疗进展.中国临床神经外科杂志, 2008, 13(12):764-767.
21.	陈剑峰.微创治疗高血压脑出血80例临床治疗分析.中国医药导刊, 2009, 11(4):78-80.
22.	李泽华.开颅血肿清除与微创钻孔引流在治疗高血压性脑出血中的应用比较.吉林医学, 2009, 30(3):265-266.
23.	崔凤启, 刘国栋, 闫立民, 等.高血压脑出血规范化外科治疗的探讨.北京医学, 2007, 29(5):313.
24.	Zhou H, Zhang Y, Liu L, et al. A prospective controlled study:Minimally invasive stereotactic puncture therapy versus conventional craniotomy in the treatment of acute intracerebral hemorrhage. BMC Neurol, 2011, 11:76.
25.	Zhu H, Wang Z, Shi W. Keyhole Endoscopic Hematoma Evacuation in Patients. Turk Neurosurg, 2012, 22(3):294-299.
26.	Gazzeri R, Galarza M, Neroni M, et al. Minimal craniotomy and matrix hemostatic sealant for the treatment of spontaneous supratentorial intracerebral hemorrhage. J Neurosurg, 2009, 110(5):939-942.
27.	尹晓亮.高血压脑出血外科治疗的进展.北京医学, 2006, 28(3):175-177.

1. Woo D, Haverbusch M, Sekar P, et al. Effect of untreated hypertension on hemorrhagic stroke. Stroke, 2004, 35(7):1703-1708.
2. 黎文欢.高血压脑出血外科治疗进展.华夏医学, 2008, 21(3):582-584.
3. 王忠诚.神经外科学.武汉:湖北科技出版社, 1998:686-690.
4. 脑卒中患者临床神经功能缺损程度评分标准(1995):全国第四届脑血管病学术会议通过.中华神经科杂志, 1996, 29(6):381-383.
5. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:www.cochrane-handbook.org.
6. 王丹, 翟俊霞, 牟振云, 等. Meta分析中的异质性及其处理方法.中国循证医学杂志, 2009, 9(10):1115-1118.
7. 韩光. 90例颅内血肿小骨窗开颅术的临床观察.中国现代医生, 2008, 46(6):49-50.
8. 苏作福.不同方法治疗高血压脑出血疗效比较.中国实用医药, 2012, 7(16):89-90.
9. 麦晓, 欧海棠, 覃木秀, 等.不同手术方法治疗高血压脑出血的临床观察.河北医学, 2010, 16(3):317-319.
10. 李玉山, 刘平, 杨子键.超早期手术治疗74例高血压脑出血术式比较.中国老年学杂志, 2006, 26(11):1471-1472.
11. 赵大力.两种手术方法治疗高血压脑出血疗效比较.中国医药指南, 2011, 9(21):231-232.
12. 胡礼虹.小骨窗开颅术与大骨瓣开颅术对高血压脑出血的临床疗效分析.中国当代医药, 2012, 19(26):28-29.
13. 王赣江.小骨窗开颅术与大骨瓣开颅术治疗高血压脑出血疗效比较.山东医药, 2011, 51(26):58-59.
14. 肖军.小骨窗开颅术在高血压脑出血治疗中的应用研究.中国现代医学杂志, 2010, 20(5):766-768.
15. 杨秋荣, 孙志宏, 刘栋梁, 等.小骨窗开颅术治疗高血压脑出血66例临床分析.中国现代医学杂志, 2008, 21(3):582-584.
16. 钟朋彪.小骨窗开颅术治疗高血压脑出血.中国医药指南, 2009, 7(9):131-132.
17. 邓海亮.小骨窗开颅术治疗高血压脑出血的临床疗效观察.中国现代医药杂志, 2012, 14(8):29-31.
18. 王东玉.小骨窗颅内血肿清除术治疗高血压性脑出血的临床分析.中国实用医药, 2012, 7(33):87-88.
19. 唐桂益.小骨窗微创手术治疗高血压性脑出血的临床研究.微创医学, 2009, 4(2):121-123.
20. 王凯, 潘秀平, 雪亮.脑出血手术方法探讨与治疗进展.中国临床神经外科杂志, 2008, 13(12):764-767.
21. 陈剑峰.微创治疗高血压脑出血80例临床治疗分析.中国医药导刊, 2009, 11(4):78-80.
22. 李泽华.开颅血肿清除与微创钻孔引流在治疗高血压性脑出血中的应用比较.吉林医学, 2009, 30(3):265-266.
23. 崔凤启, 刘国栋, 闫立民, 等.高血压脑出血规范化外科治疗的探讨.北京医学, 2007, 29(5):313.
24. Zhou H, Zhang Y, Liu L, et al. A prospective controlled study:Minimally invasive stereotactic puncture therapy versus conventional craniotomy in the treatment of acute intracerebral hemorrhage. BMC Neurol, 2011, 11:76.
25. Zhu H, Wang Z, Shi W. Keyhole Endoscopic Hematoma Evacuation in Patients. Turk Neurosurg, 2012, 22(3):294-299.
26. Gazzeri R, Galarza M, Neroni M, et al. Minimal craniotomy and matrix hemostatic sealant for the treatment of spontaneous supratentorial intracerebral hemorrhage. J Neurosurg, 2009, 110(5):939-942.
27. 尹晓亮.高血压脑出血外科治疗的进展.北京医学, 2006, 28(3):175-177.

Chinese Journal of Evidence-Based Medicine

Efficacy of Key Hole Approach versus Large Trauma Craniotomy for Hypertensive Intracerebral Hemorrhage: A Meta-Analysis

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