CT-guided Aspiration Of Putamen Hematoma With Directional-installed Soft-tube

Objective: To explore the efficiency and indications of CT-Guided aspiration by minimally invasive installed soft tube to evacuate putamen hematoma.Methods: A retrospective study was carried out on hypertensive cerebral hemorrhage of putamen patients with surgical operation admitted in the second affiliated hospital of Dalian Medical University from Jan. 2004 to Dec.2007. According to the inclusion criteria and exclusion criteria, 130 cases were enrolled. These patients were divided into two groups by surgical modality: mini-invasive group and craniotomy group. After operation, the two group's tubes were left as drainage in place for further administration of urokinase (uk) and aspiration of the residual dissolved hematoma. The neurology functional deficiency of the two groups were measured before surgical treatment and 30th day after surgical treatment according to the Scandinavia Stroke Scale and Stroke Seale formulated by the forth national stroke conference. The efficiency was compared between two groups. The post-operation complications, the relationship between volume and SSS30, the relationship between GCS score and SSS30, the operational expense were described. All the unordered categorical variables were tested by X~2 test, the ordinal categorical variables were tested by Rank Sun test, and all the numerical variables were test by T test.Results:1.The rate of good and excellent of mini-invasive group is higher than craniotomy group (p<0.05), the rate of death of mini-invasive group is not obviously lower than that of craniotomy (p>0.05).2.The post-operation complications, the mini-invasive group is better than the craniotomy group in pulmonary infection, stress ulcer, acute renal failure and recurrent hemorrhage, the difference was significant (p<0.05), but no significant in electrolyte disorders(p>0.05).3.Analysis of the putamen hematoma patients with 30th day Scandinavia Stroke Scale Sore showed a linear trend positive to GCS score of 25～110 mL hematoma volume and negative to hematoma volume.4.For volume of 25～90mL, and the GCS score≥8, the efficacy of mini-invasive group was superior to that of the craniotomy one, the difference was significant (p<0.05). For volume of >90 mL, and the GCS score≤7, the efficacy between two groups, there is no difference(p>0.05).5.Compare to the operational expensive, the mini-invasive group was lower to the craniotomy one, the difference was significant (p<0.01).Conclusion:1.For patients with putamen hematoma, the larger volume,the lower GCS score, the prognoses and therapeutic efficacy was worse. The hematoma volume and the GCS score were the most strongly predictional factors.2.As for the post-operation complications, the mini-invasive group is better than the craniotomy group in pulmonary infection, stress ulcer,acute renal failure and recurrent hemorrhage, the difference was significant (p<0.05).3. For the putamen hematoma of 25～90mL and GCS score≥8, which cases is apt to the mini-invasive group.4. CT-Guided stereo tactic aspiration by mini-interventional installed soft tube to treat putamen hematoma is not only little damage, convenient and cheap but also safe and effective.