| The incidence of endometriosis cyst is increasing in recent years. It has become a commen disease in gynecology department. Endometriosis cyst destroies ovary tissue, causes dysmenorrheal, menstrual dysfunction and even infertility. Although this disease is binigh, its cellproliferation, invasiveness, recurrence are all malignancy. There are several tranditional therapies such as surgical procedure, laproscopy and drug treatment. But the effectiveness is limited. These methods also cause problems of the function of ovary destroyed and recurrence postoperative. Drug therapy only controls the symptom temporaily but cannot make cyst disappear. When stop using the drug, the symptom recurs in a short tiame. And many side effects are cannot avoid.So drug therapy cannot be used for a long time. Using ultrasound guided interventiongal puncture matching anhydrous ethanol injected coagulation therapy to treat endometriosis cyst, the completely cured rate is about 80%.The endometriosis cyst is a estrogenic–dependent disease. According to this principle, giving GnRHa as a subsidiary therapy after ultrasound puncture interventional treatment toincreasing the completely cured rate. The mechanism is through decreasing the secretion of human pituitary gonadotropin(HPG) to lower the FSH and LH level.So the body is in low estriol and estradiol condition. GnRHa can restrain the ovary directly. The effection is equal to medical ovary resect. The enchometria atrophies. The completely cured rate is increases effectively.Objective:Evaluating effect of Ultrasound Guided Puncturing endometriosis, suckingcyst fluid, influx anhydrous ethanol to coagulate the wallof the cyst and matching GnRHa to cure chocolate cyst of ovary. Materials and Methods1.To analyze a total of 136 patients with endometriosis cyst in China-Japan union fridendship hospital from January 2005 to March 2007. 72 cases were chose as drug treatment group randomly. Giving them GnRHa after Ultrasound Guided Intentional Puncture therapy. The other 64 cases are treater as control group . Giving no other treatment.2.Using Semens SEQUOIA 512 Colour Doppler Ultrasound Diagnostic machine as transabdominal biopsy with abdominal probe frequency 2.5~4.0 MHz. Transvaginal biopsy using American ALT UltraMark 9 HDI Colour Doppler Ultrasound Diagnostic machine with the transvaginal probe frequency 7.5 MHz. Puncture Needle is 16G~22G trocar . Cogulatr sclerose chemical is anhydrous ethanol.3.Method of transabdominal puncture operation: The patient is in supine position. Orientete the cyst through ultrasound, lay sterilized cloth,1% lidocaine local infiltration anaethesia. Handed or use a puncture guide trestle. Using Ultrasound guided to keep away from blood vessel and intestine (especially pay attention to the recurrent patients who have been postoperatived or puncture treated, and the patients who suffer intestinal adhesion because of chronic abdominal pain). Puncture the needle to the cyst quickly, keep the point of the needle in the middle of the cyst, pull out the rush pith of the needle, suck the cyst fluid. If the cyst fluid is too thick, using physiological brine or small quantity 25% heparin to dilute and wash repeatly. When the fluid sucked is almost limpid, pouring into anhydrousethanol less than the quantity sucked several times. This process is as pouring into anhydrous ethanol gradiently. When the density of the anhydrous ethanol≥90%, sucking all the andydrous ethanol quickly and then pouring in slowly several times. This action means twist and rub the wall of the cyst to strengthen the andydrous ethanol in the cyst for 3 minites. Then suck it out, pull out the pipe. The operation is over.4.Method of Transvaginal Puncture Operation: The patient is in obstetric position. Sterilize the vulua and vagina, lay sterilized cloth. Orientate the cyst through transvaginal probe with puncture guide trestle and puncture needle.No anesthesia. Keep away from the blood vessel and intestine. When the needle puncyured into the cyst, do the same as the former part.5.Method of Drug Therapy Group: Give Triptorelin 3.75mg/month,im,6 months. If the patient complainting of hot , perspire, bone lose, articulation ache and other perimenopause symptoms, we could use hormone opposed therapy (Conjugated Estrogens Teblets 0.625mg+medroxyprogesterone5.0mg , po, sid ) to counteract the symptoms. And this therapy has no influence to the curative effect.6.The evaluating standards of the completely cured rate and recurrence rate1) Completely cured: cyst disappears or shrinks more than 2/3, the wall of the cyst wrinkles, clinical symptom disappears.2) Effective: cyst shrinks more than 1/2,clinical symptom mitigates.3) Noneffective: cyst shrinks less than 1/2,clinical symptom dose not mitigate.4) Recurrence: the completely cured cyst recurrence.Reexamine ultrasoundgraph in 1 month, 3 months, and 6 months after treated. The 6th month's ultrasoundgraph is considered as the standard of the completely cured rate and recurrence rate. We can observed the patients'who could reexamined regularly for 2 years after operation.7. Recording the patients'datas, the process of puncture and the following reexamining results. Perserved those into disks.8. Using statistics SPSS11.0 software to dispose of X2 test. There is a significant difference when P﹤0.05.Results and DiscussionsDeug Therapy Group: Reexamining ultrasoundgraph in 1 month, 3 months, and 6 months after operation. The 6th month's result is considered as the evaluating standard. In this group,67 cases were completely cured, 5 cases were effect,7 cases were recurrented. The 7 cases'thickness of the cyst wall≥0.5cm.The Control Group: The total 64 cases reexamined ultrasoundgraph in 1 month, 3 months and 6 months after operation. The 6th month's result is considered as the evaluating standard. In this group, 41 cases were completely cured,21 cases were effect,2 cases were no effect, 19 cases were recurrent. Giving the two group'26 cases ultrasound guided interventional puncture matching anhydrous ethanol injected coagulation therapy once again. 20 cases were completely cured after 6 month. The other 6 cases were recurrented. The 6 cases'thickness of the cyst wall≥0.5cm.4 cases of them chose laparoscope therapy. 2 cases chose surgery. The GnRHa drug therapy group's completely cured rate is 93.06%,much higher than the control group's 64.06%.(P﹤0.001).Add the 26 recurrent cases in 6 months after operation to the 18 effectcases who transfered to recurrence, the total is 44 cases. Supposed them as new cases and statisticed another time. Giving them ultrasound guided interventional puncture matching anhydrous ethanol injected coagulation therapy once again, giving GnRHa ,evaluating the completely cured rate and the recurrence rate. We did not satistic the recurrence rate because the observation has't been completed. There is no significant difference between and the former'.(84.09% vs 93.06,P>0.05)The thickness of the cyst wall≥0.5cm in the total 44 recurrent cases. This may be point out that the endometrisisi gland is in the wall of uterus, result in high recurrence rate. The other reasons such as the coagulated blood clot on the wall of the cyst cannot be washed completely, the density and effective time of anhydrous ethanol cannot be controlled exactle, the recurrence of the small cyst ,even plantation and so on. Those all could cause high recurrence rate.The influence to menses is very small. The difference has no statistic significiance. This proves that the therapy has no influence to ovary.Conclusions:1.Using ultrasound guided interventional puncture matching anhydrous ethanol injected coagulation therapy to treat endometriosis cyst is a safe ,effective,cheap and simple therapy. And this method has no influence to the function of ovary.2.Giving GnRHa after using ultrasound guided interventional puncture to treat endometriosis cyst could increase the completely treated rate and decrease the recurrence rate.3.Choose proper cases could increase the completely cured rate anddecrease the recurrence rate.4.Using ultrasound guided interventional puncture matching anhydrous ethanol injected coagulation therapy to treat endometriosis cyst has it'defect. Some malignant cyst cannot be found through ultrasoundgraph. Examining blood CA-125 and blood endometrium antibody to assist characterize diagnosis preoperative is very necessary.
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