目的：探讨头颅CT血肿形态不规则对开颅手术治疗自发性脑出血患者术后再出血的影响。方法：连 续纳入2019年1月至2022年9月贵州医科大学附属金阳医院神经外科收治的幕上脑出血患者348例，根据 术后是否再出血分为术后再出血组32例和非再出血组316例；根据血肿形态是否规则，分为血肿形态规则 组138例和血肿形态不规则组210例。所有患者均接受开颅血肿清除术；搜集患者一般临床资料、影像资 料、术后并发症等进行相关因素单因素分析。将单因素分析中差异有统计学意义（P＜0.05）的因素进行二 元Logistic回归分析，分析血肿形态不规则对脑出血患者术后再出血的预测价值。结果：血肿形态不规则 组患者术后再出血发生率（12.86%）高于血肿形态规则组（3.62%），两者比较具有统计学差异（P＜0.05），二 元Logistic回归分析显示血肿形态不规则可预测脑出血患者开颅血肿清除术后再出血，其敏感性、特异性 分别为0.844、0.421。结论：血肿形态不规则是脑出血患者术后再出血的独立危险因素。

To explore effect of irregular hematoma morphology by preoperative CT on postoperative rebleeding in patients with spontaneous intracerebral hemorrhage after craniotomy. Methods: A total of 348 patients with intracerebral hemorrhage admitted to the neurosurgery department of Jinyang Hospital affiliated to Guizhou Medical University from January 2019 to September 2022 were consecutively enrolled. Based on postoperative rebleeding, they were divided into a postoperative rebleeding group (n=32) and a control group (n=316). According to the hematoma morphology, patients were divided into a regular hematoma morphology group (n=138) and an irregular hematoma morphology group (n=210). All patients underwent craniotomy. General clinical data, imaging data and postoperative complications were collected, and univariate analysis of related factors was performed. Factors with statistical significance (P<0.05) in the univariate analysis were further analyzed using binary logistic regression analysis to assess the predictive value of irregular hematoma morphology on postoperative rebleeding in patients with spontaneous intracerebral hemorrhage after craniotomy. Results: The incidence of postoperative rebleeding was higher in the irregular hematoma morphology group compared to the regular hematoma morphology group (12.86% v.s 3.62%), and there was a statistical difference between the two groups (P<0.05). Binary Logistic regression analysis revealed that irregular morphology could predict rebleeding in patients with intracerebral hemorrhage after craniotomy, with a sensitivity and specificity of 0.844 and 0.421, respectively. Conclusion: Irregular hematoma morphology was an independent risk factor for postoperative rebleeding in patients with intracerebral hemorrhage after craniotomy.