Studies On The Bowel And Bladder Function After Sacrifice Of Sacral Nerves And Safety Of Hyperthermic Chemotherapy For Sacral Tumors

PartⅠAnalysis of the Bowel and Bladder Function after Sacrifice of the Sacral NerveObjective:To investigate and analyse the bowel and bladder function after different sacral nerve roots division.Methods:This retrospective study included 69 patients with sacral tumors who underwent different sacral nerve roots sacrificed from 1993 to 2008 in our hospital.To investigate and analyse the bowel and bladder function in different periods.Results:In 69 patients who underwent different sacral nerve roots sacrificed,4 patients who had bilateral S1 nerve roots preserved,all had abnormal bowel and bladder function; In 12 patients who had bilateral S1-S2 nerve roots preserved,normal bowel and bladder function was retained in 4 patients(33.33%) and 3 patients(25.00%);In 26 patients who had bilateral S1-S3 nerve roots preserved,normal bowel and bladder function was retained in 4 patients(88.46%) and 22 patients(84.62%);In 14 patients who had bilateral S1-S2 and unilateral S3 nerve roots preserved,normal bowel and bladder function was retained in 11 patients(78.57%) and 11 patients(78.57%);In 13 patients who had unilateral S1-S5 or bilateral S1 and unilateral S2-S5 nerve roots preserved,normal bowel and bladder function was retained in 10 patients(76.92%) and 9 patients(69.23%).In 45 patients who had normal bladder function,38 patients(84.44%) recoveried within 3 months,5 patients (11.11%) during 3-6 months,2 patients(4.44%) more than 6 months.In 48 patients who had normal bowel function,40 patients(83.33%) recoveried within 3 months,7 patients (14.58%) during 3-6 months,1 patients(2.08%) more than 6 months.Preservation of normal bowel and bladder function was significantly higher in patients who had unilateral S1-S3 sacral nerve roots at least than in other lesions(P＜0.0125);There was no significant difference in normal bowel and bladder function among group who had at least unilateral S1-S3 sacral nerve roots preserved(P＞0.0125);Recovery time within 3 months in normal bowel and bladder function was significantly higher than other time groups(P＜0.0125).Conclusion:Preservation unilateral S1-S3 sacral nerve roots at least is important for normal bowel and bladder function;There was variation of sacral nerves for control of bowel and bladder function;Normal bowel and bladder function continuely improved in the majority of patients within 3 months.PartⅡStudy of Safety of Hyperthermic Chemotherapy for Sacral TumorsObjective:To investigate the effect of hyperthermo-chemo-perfusion on cauda equina, lumbar and sacral nerve roots of rabbits,to evaluate the reliability and feasibility in the treatment of sacral tumors.Methods:30 male rabbits were randonly divided into three groups:13 rabbits were in high dose group,13 rabbits were in low dose group,different doses of carboplatin solution heated during 37.0℃to 39.0℃were irrigated respectively into opend sacral canal of rabbits and cauda equina,lumbar and sacral nerve roots were immersed for 30 minutes.4 rabbits were in control group,without special treatment.To investigate the improved Tarlov scoring,the latency of semotosensory evoked potential,the compliance of bladder and the ultrastructure in electron microscope before and after treatment.Results:1 rabbit was died of low dose group.All rabbits didn't appear abnormal action except 1 rabbit of high dose group,the mean latency of semotosensory evoked potential(ms) before and after treatment is respectively 20.94±1.07,21.28±1.03 of low dose group,21.38±1.23,21.76±1.20 of high dose group,the difference was not significant (P＞0.05).the mean maximum bladder capacity(ml) before and after treatment is respectively 61.46±8.64,64.54±8.06 of low dose group,65.17±8.80,67.58±8.52 of high dose group,the difference was also not significant(P＞0.05).There was no obvious morphological abnormity in electron microscope after hyperthermic chemotherapy.Conclusion:Hyperthermic chemotherapy of different doses of carboplatin solution in 30 minutes didn't injury cauda equina,lumbar and sacral nerve.It suggests that further study of safety of hyperthermic chemotherapy may provide a good adjunctive therapy for sacral tumors.