| Objective:(1)To accurately calculate the hematoma volume of primary intracerebral hemorrhage,comparing the therapeutic effect of soft channel puncture,key-hole surgery and conservative treatment on the patients with critical state hematoma,and then providing the basis of the choice of treatment modality for the critical hematoma in basal ganglia.(2)To explore the predictive value of CT imaging heterogeneity on hematoma enlargment of primary intracerebral hemorrhage in basal ganglia.Method:(1)A retrospective analysis of the first affiliated hospital of Jishou university,218 patients were admitted with primary intracerebral hemorrhage arranged from June 2015 to December 2017,the critical hematoma volume was located in 25 ml and 35 ml by computer named3 DSlicer.There were 110 cases of conservative treatment group,54 cases of minimally invasive surgical and 54 cases of craniotomy group.Using the Modified Rankin rating Scale(Modified Rankin Scale,mRS)and the degree of nerve function defect(SSS Scale)to evaluate the near future and long-term clinical efficacy of patients.Using SPSS20.0 and R Programming Language for statistical processing.(2)A retrospective analysis of the first affiliated hospital of Jishou university,208 patientswere admitted with primary intracerebral hemorrhage arranged from June2015 to August 2017.There were 44 cases of hematoma enlargement group and 164 cases of hematoma nonenlargement.The heterogeneity of hematoma was reflected by the standard deviation of CT value(CTSD)and the irregular ratio of hematoma(IR)of hematoma on CT,and the relationship between the heterogeneity of CT imaging and the enlargement of hematoma was analyzed.Results:(1)The average volume of hematoma measured by the "2/3Sh standard method" was 35.75 ±12.73 ml,the Tada formula method was36.76±13.01 ml,and 34.99±13.48 through 3DSlicer software.There were no significant difference in the measurement of regular hematoma by three methods(P>0.05),but difference in irregular hematoma(P=0.025),and the average error of the measurement of irregular hematoma by the Tada formula method was 5.2 ml and 3DSlicer software 1.5ml respectively.The average error rate is 14.32%,5.88%,and 3DSlicer software method had a smaller error rate(P=0.015).(2)The enlargement rate of PICH was about21.15%,the first diagnosised hematoma volume in enlargement group was21.85±8.40 ml,the increased volume was 15.26±10.64 ml,non-enlargement group of the first diagnosised hematoma volume was 25.29±11.64 ml,the increased volume was 4.03±5.70 ml,there was no significant difference between two groups(P > 0.05).The CTSD of the enlarged group was12.86±2.15,and the CTSD of the unexpanded group was 9.07±1.57,and the difference was statistically significant(P<0.001).The IR of the enlarged group was 2.70±0.51,and the IR of the unexpanded group was1.50±0.33,and the difference was statistically significant(P < 0.001).ROC curve showed that when IR≥2.0,CTSD≥10.85,there was more incidenceof hematoma enlargement.Multiple factors analysis results showed that bleeding reason(OR=4.585,95%CI 1.271-16.541,P=0.020),GCS(OR=0.116,95%CI 0.019-0.729,P=0.022),CTSD(OR=0.034,95%CI0.008-0.141,P<0.001)and IR(OR=0.030,95%CI 0.007-0.139,P<0.001)were associated with hematoma expansion(P<0.05).Then a system of prediction of hemotoma enlargement was developed based that four factors,and there was a high possibility of HE when the score≥10.(3)The preoperative time,operation time and intraoperative blood loss in the soft channel punchure group were less than that in the key-hole group(P <0.05).The time of removal of hematoma and the edema of the brain tissue in key-hole group were significantly lower than that in soft channel punchure group(P < 0.05).(4)The rate of hematoma enlargement was about 19.09% in patients with conservative treatment group,and about3.70% of the patients suffered rebleeding events in operation group,conservative treatment group had a high rate of death because of hematoma enlargement(P<0.05).The compliments of soft catheter placement group was higher than key-hole group(P<0.05).The long-term prognosis of patients with conservative treatment and surgery group was not significantly different,but the neurological function recovery of microinvasive surgery group was a bitter faster than that of conservative treatment(P=.036).The hospitalization time and cost of the microinvasive group were similar(P<0.05).Multivariate analysis showed that age,hematoma typing,treatment,and complications were important factors affecting the prognosis.Conclusion:(1)Using 3DSlicer software for three dimensional imaging,can accurately calculate the volume and the surface area ofhematoma,then make a reconstruction of the space position and the morphological characteristics of the hematoma,preoperative surgery simulation design,and can be realized through the mobile phone software aided preoperative body surface location and augmented reality technology.(2)By individualized imaging,the density heterogeneity and irregular degree of morphology were quantified for the first time,and the newly warning factors for enlargement of hematoma were found.When the CT value of the standard deviation is 10.85 or more,the irregular ratio was higher than 2.0,the heterogeneity of hematoma is bigger,the probability of occurrence of hematoma enlargement is higher.In order to establish the scoring system and score more than 10 points,the probability of hematoma enlargement was significantly increased.(3)Microinvasive surgery can remove hematoma as soon as possible,shorten the time of hematoma absorption and cerebral edem,effectively reduce physical and chemical damage by hematoma.In terms of nerve function recovery,the microinvasion group was an effective treatment in saving the reversible neural function,making a great recovery. |
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