Today, a chocolate cyst of 28mm* 18mm was found in the left ovary, and the right ovary was fine. How can teachers be treated safely and effectively?

Chocolate cyst of ovary: a "bomb" buried in pelvic cavity

At about 10 in the evening, Ms. Gong suddenly felt a sharp pain in her right lower abdomen, accompanied by nausea, vomiting, anal distension and other symptoms, so she had to go to the emergency room of the hospital quickly. According to the medical history and gynecological examination, the doctor suspected that the ovarian chocolate cyst was ruptured, and immediately punctured the posterior fornix of vagina to extract viscous chocolate paste liquid. Emergency laparotomy confirmed that the chocolate cyst on the right ovary was ruptured, and there was also a chocolate cyst on the left ovary with a diameter of about 2 cm. So he had a right ovarian resection and a left ovarian chocolate cyst peeling operation, sucked out the chocolate liquid in the pelvic cavity and washed it with normal saline. In order to prevent recurrence, she was told to take gestrinone for 3 months after discharge and follow up regularly.

Ovarian chocolate cyst, also known as ovarian endometriosis cyst, is a disease caused by the "migration" of endometrium into the ovary. It is the most common type of endometriosis, which is essentially different from ovarian cysts with tumor properties. After the endometrium "migrates" to the ovary, it will still be periodically affected by ovarian sex hormones. When menstruation comes, the ectopic endometrium in the "expatriate" ovary will also have "menstrual"-like bleeding, and "menstrual blood" cannot be excreted, so it has to stay in the ovary. Ectopic endometrium that falls off after menstruation continues to be planted in the ovary like a seed, which is such a cycle. Month after month, year after year, the menstrual blood remaining in the ovary accumulates more and more, forming a cyst from small to large, which is called "ovarian endometriosis cyst" in medicine. Because the blood in the cyst is old blood that has been preserved for a long time, it is also called "chocolate paste".

With the extension of the course of disease, the hematocele in the ovarian chocolate cyst is increasing, and the volume of the cyst is also increasing. When there is too much blood in the capsule cavity and the pressure is too high, the weak part of the capsule wall can rupture, the cyst spontaneously ruptures, and some blood flows out of the capsule. After the pressure is reduced, the rupture of the capsule wall can often heal itself. After a period of time, the blood in the capsule increases again, the pressure rises again, and spontaneous rupture can occur again. Hemorrhage flowing into pelvic cavity after cyst rupture stimulates peritoneum, causing severe abdominal pain, which can cause pelvic organ adhesion. Chocolate cyst of ovary can rupture spontaneously without inducement. Rough or violent sex life, especially premenstrual sex life, is often an important cause of cyst rupture.

Small chocolate cyst of ovary, usually not easy to rupture. The drug treatment effect of ovarian chocolate cyst is poor, and it is difficult to eliminate chocolate cyst. When the cyst grows to more than 3 cm, the risk of spontaneous rupture begins to appear and gradually increases. When it grows to a certain scale, spontaneous rupture is often difficult to avoid. Therefore, it is indeed a "bomb" hidden in the pelvic cavity, and it may "explode" at any time.

Because the ovarian chocolate cyst is ruptured, it is an old hematocele, not a lot of fresh bleeding, except abdominal pain, which generally does not affect vital signs and will not cause shock. Some people think that since there is no danger to life, whether conservative treatment without surgery can be taken to avoid the pain of patients undergoing surgery. In fact, after conservative treatment, the cyst wall ruptured and healed, and the symptoms disappeared, but spontaneous rupture may occur soon. Repeated attacks and suffering, and the more attacks, the heavier pelvic adhesion, abdominal pain caused by pelvic adhesion and other symptoms, will make her "worse", miserable.

Therefore, those diagnosed as ovarian chocolate cyst with a diameter of more than 3 cm should be operated to eliminate the danger of "bomb" explosion. At this time, chocolate cyst peeling is often used in surgery, so that normal ovarian tissue can be preserved to the maximum extent, and traditional open surgery or laparoscopic surgery can achieve the therapeutic purpose. It is of great significance to take medicine after operation to consolidate the curative effect and prevent the recurrence of ovarian chocolate cyst.