| Part I: Application of Digital Subtraction Angiography (DSA) for Surgical Treatment of Sacral TumorsObjective: To study and evaluate the efficacy of digital subtraction angiography in the surgical treatment of sacral tumor.Methods: The preoperative DSA was performed by intra-arterial catheterization through the femoral artery in 39 cases of the malignant sacral tumor and 19 cases of the benign sacral tumor, respectively. On the basis of pathologic tests, the image appearance of DSA in 58 sacral tumors was evaluated by the arterial feeders and vascularization of the tumors, tumorous hyperplastic vessels surrounding and inside the tumor, the tumor mass and staining of blood in tumor.Results: In 39 cases of malignant lesions who had DSA performed, tumorous hyperplastic vessels surrounding and inside the tumor and vascular dilatation, palisade arrangements, deviation of the arterial branches, venous cisterne were seen in arterial phases in 36 cases (92.31%) of malignant lesions. Staining of blood was seen in arterial, capillary and venous phase in 37 cases (94.87%) of malignant lesions, the tumor masswas seen in the tumor in the same cases. While in 19 cases of benign lesions, abnormality of the vasculature surrounding and inside the tumor were seen in arterial phases in 5 cases (26.32%) of benign lesions, staining of blood was found at the end of arterial phases and in capillary phases in 3 cases (15.79%) of benign lesions. Total positive rate of the pictures on DSA in tumorous hyperplastic vessels surrounding and inside the tumor and the tumor mass and staining of blood was significantly higher in malignant sacral tumors than in benign lesions (P<0.05).Conclusion: The pictures of sacral tumors on DSA were clear and diagnostic. The tumorous hyerplasticvessels and tumor stain around and inside the tumor lesions were the characteristic of the malignant sacral tumors while no abnormality of vasculature and staining of blood were seen in the benign lesions. DSA provided valuable help for diagnosis of sacral tumors and the surgical treatment of sacral tumors.Part II: Evaluation of the Anorectal and Bladder Function after Sacrifice of the Sacral NervesObjective: To evaluate the anorectal and bladder functions after sacral nerve division in patients with sacral bone tumors.Methods: To describe the retrospective analysis of bowel and bladderfunction in patients who had different nerve roots sacrificed in 12 months, 58 patients were identified in different periods.Results: In 58 patients who had the sacral nerves resection, 23 patients who had bilateral SI-S3 nerve roots preserved, normal bowel and bladder function was retained in 20 lesions (86.96%) and 18 lesions (78.26%) within3 months, respectively, normal bowel and bladder function was retained in 3 lesions (13.04%) and 2 lesions (8.70%) during 3-12 months, respectively. In 12 patients who had bilateral SI, S2 nerve roots preserved, normal bowel and bladder function was retained in 2 lesions (16.66%) and 1 lesion (8.33%) within 3 months, respectively, normal bowel and bladder function was retained in 1 lesion (8.33%) and 3 lesions (25.00%) during 3-12 months, respectively; In 8 patients who had bilateral SI, S2 nerve roots and unilateral S3 preserved, normal bowel and bladder function was retained in4 lesions (50.00%) and 5 lesion (62.50%) within 3 months, respectively, normal bowel and bladder function was retained in 1 lesion (12.50%) during 3-12 months, respectively; In 4 patients who had unilateral S1-S5 sacral nerves were preserved, normal bowel and bladder function was retained in 3 lesions (75.00%) within 3 months, respectively; In 5 patients who had bilateral SI sacral nerves preserved, all had abnormal bowel and bladder function within 12 months; Preservation of normal bowel and bladder function was significantly higher in patients who had bilateral SI-S3 sacral nerves preserved than in other lesions (P<0.05); There was no significantdifference in normal bowel and bladder function among groups who had at least unilateral SI-S3 nerve roots preserved (P>0.05); There was significant difference in normal bowel and bladder function between lesions who had bilateral SI nerves preserved together with all sacral nerves sacrificed and the other groups (P<0.05); There was significant difference in normal bowel and bladder function within and after 3 months (P<0.05); There was no significant difference between normal bowel and bladder function preservation after different sacral resection (P>0.05).Conclusion: Preservation of at least unilateral SI-S3 nerve roots preserved bowel and bladder function in the majority of patients. Normal bowel and bladder function continually improved in the majority of patients within 3 months; there was no significant difference between normal bowel function and bladder function preservation after different sacral resection. |
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