| Objective: To investigate influence on ovar ian function in wom en withovarian endometriotic cyst after ultrasound-guided sclerotherapy.Method:1The object of research1.1Experimental group: Our object of research are the patients who werediagnosed with ovarian chocolate cysts after color Doppler ultrasoundexamination and confirmed by pathology in our hosptial gynecologicalultrasound room from1,2010to1,2012meet the conditions of theinterventional treatment and prepared for anhydrous ethanol sclerotherapy forovarian chocolate cyst guided by ultrasound-guided.A total of85women weredivided into four groups,30patients with unilateral ovarian endometriotic cystless than35y (A),15patients with unilateral ovarian endometriotic cyst no lessthan35y (B),25patients with bilateral ovarian endometriotic cyst less than35y (C) and15patients with bilateral ovarian endometriotic cyst no less than35y (B).1.2Control group: Our40objects of research are the patients who werediagnosed with ovarian simple cyst after color Doppler ultrasoundexamination and confirmed by pathology in our hosptial gynecologicalultrasound room from1,2010to1,2012meet the conditions of theinterventional treatment and prepared for anhydrous ethanol sclerotherapy ofthe ovarian simple cyst under ultrasound guidance.1.3Inclusion criteria:1Two groups both made preoperative gynecologicalcavity ultrasound screen, the experimental group ultrasound examinationconfirmed ovarian chocolate cysts and the control group ultrasound confirmedan ovarian cyst2Two groups to be exam preoperative serum CA125toexclude for the lutealhematoma, follicular cysts and other malignant tumors by any possibility;3Cyst volume diameter was between2-10cm;4No seriousmedical illness, no history of alcohol allergy, two groups of patients had notcephalosporins and hormonal drug use before surgery in3months;no sexualintercourse after menstrual clean;5Two groups should be no vaginalinflammation by transvaginal puncture examination.6The experimental grouppatients proved to be a large number of red blood cells after puncture fluidwhile the control group was simple cyst fluid not contain a large number ofred blood cells.7The experimental group refused medication voluntarily;8Two groups were following up for one year and complete information. Bothgroups are the same operator.2Research MethodsBoth groups were asked to perform anhydrous ethanol sclerotherapy forovarian cyst guided by ultrasound-guided in3-7days after menstrual clean inour hospital gynecological room.3Outcomes measurement3.1The levels of follicle-stimulating hormone FSH estradion2E2andprogesterone P were measured with chemiluminescent immunoassay inpatients with ovarian cyst before operation and postoperative3months,6months and12months in3th day after menstrual clean, hFSH is divided into<5mIU/mL,5-10mIU/mL,,10-40mIU/mL, and>40mIU/mLFSH≤10IU/L ratio was calculated, which is ovarian function normal ratio.3.2Ovarian stromal blood flow was measured in patients with ovarian cystbefore operation and postoperative3months,6months and12months in3thdays after menstrual clean. Ovarian stromal blood flow related to menstrualcycles, patients were asked to test the day when menses was clean and theplace where ovarian blood flow was showed best. The condition of Vs, Vd andRI on ovarian bilateral artery was Understood.3.3Ovarian cysts disappear in6-12months as cured; The cyst volume isreduced to1/2as markedly effective, to shrink more than1/3as effective andto less than1/3as ineffective. Afterwards,we calculate the cure rate andfollow-up on natural pregnancy rate after cyst puncturing. 4Statistical methodData expressed as mean±standard deviation was made statistics bySPSS13.0software. Firstly, we made analysis of variance of multiple sets ofdata, and then make the result of the previous step test with the Dunnet t, andcount data with the χ2test. P <0.05was considered statistically significant.Results:1Basic characteristics of the ovarian cyst puncture objectThis study included125cases, including85cases of ovarian chocolatecysts patients, mean age (33.1±11.2years),40cases of simple cysts, theaverage age (30.2±8.9) years of age, the difference was not statisticallysignificant. Preoperative serum CA125levels, the difference of ovarianchocolate cysts group (68.76±18.93) U/ml, simple cyst group (25.12±6.67)U/ml was statistically significant (P <0.05).2Changes of blood hormonal before and after an ovarian cyst punctureLevels of the sex hormone of experimental groupA,B and control groupwith ovarian simple cyst showed no significant difference (P>0.05) betweenpre and post-operative3,6and12months.Experimental group C: The serum basa FSH levels (14.2±3.5IU/L) in25cases less than35y with bilateral ovarian endometriotic cyst increased(5.7±2.8IU/L) at3month after the operation;The3th month levels of E2(39.3±15.6pg/ml) and P(0.3±0.1ng/ml) lower than preoperation levels of E2(137.6±35.9pg/ml) and P(1.2±0.4ng/ml). The blood hFSH of15patients(60.0%) after the operation at6months returned to normal levels.Experimental group D: The serum basa FSH levels (16.8±2.4IU/L) in15cases no less than35y with bilateral ovarian endometriotic cyst increased(5.8±2.6IU/L) at3month after the operation; The3th month levels of E2(42.3±20.6pg/ml) and P (0.5±0.1ng/ml) lower than preoperation levels of E2(142.5±25.3pg/ml) and P (1.3±0.6ng/ml). The blood hFSH of5patients33.3%) after the operation at6months returned to normal levels.Two groupsof normal ovarian function ratio of the difference was statistically significant(P <0.05). 3Changes of ovarian stromal blood flowExperimental group A: at3,6and12months, the condition of ovarianblood supply status were significantly improved: Vs(24.30±7.50cm/s;25.50±8.30cm/s;25.90±8.70cm/s),Vd(9.10±4.30cm/s;9.40±5.20cm/s;10.10±4.80cm/s) were raised and RI (0.64±0.09;0.65±0.10;0.64±0.10) was decreased.Compared with preoperation levels of Vs(14.30±6.30cm/s),Vd(4.40±3.00cm/s),RI(0.75±0.09)significant differences were found before and aftersclerosed therapy (P <0.05).Experimental group B: at3,6and12months, the condition of ovarianblood supply status were significantly improved: Vs(19.90±6.50cm/s;19.20±8.70cm/s;19.8±7.40cm/s), Vd(7.80±3.60cm/s;7.70±3.80cm/s;7.56±3.65cm/s)were raised and RI (0.59±0.09;0.57±0.08;0.60±0.10) was decrease-d.Compared with preoperation levels of Vs(13.95±3.20cm/s),Vd(3.00±2.03cm/s),RI(0.75±0.09) significant differences were found before andafter sclerosed therapy (P <0.05).Experimental group C: at3,6and12months,the condition of ovarianblood supply status were significantly improved: Vs(23.32±7.5cm/s;25.80±8.90cm/s;26.00±8.60cm/s), Vd(8.20±3.5cm/s;9.00±5.10cm/s;9.80±4.50cm/s) were raised and RI(0.66±0.10;0.64±0.09;0.66±0.10)was decreased.Compared with preoperation levels of Vs(14.70±6.80cm/s),Vd(3.00±2.00cm/s),RI(0.79±0.10) significant differences were found before and aftersclerosed therapy (P <0.05).Experimental group D: at3,6and12months,the condition of ovarianblood supply status were significantly improved: Vs(18.80±7.80cm/s;18.60±7.50cm/s;19.40±8.00cm/s), Vd(7.32±3.60cm/s;8.00±3.30cm/s;7.90±3.60cm/s)were raised and RI(0.66±0.10;0.66±0.09;0.64±0.10)was decreased.Compared with preoperation levels of Vs(10.80±5.90cm/s),Vd(3.21±2.30cm/s),RI(0.79±0.10)significant differences were found before and aftersclerosed therapy (P <0.05).Control group: at3,6and12months,the condition of ovarian bloodsupply status were significantly improved:Vs (23.90±8.40cm/s;20.60±7.80cm /s;23.10±6.50cm/s), Vd(8.30±3.90cm/s;8.70±3.20cm/s;8.29±3.00cm/s)wereraised and R(I0.54±0.09;0.58±0.10;0.58±0.10)was decreased.Compared withpreoperation levels of Vs(15.40±5.10cm/s),Vd(3.31±2.30cm/s),RI(0.72±0.10)significant differences were found before and after sclerosed therapy (P<0.05).4Following-up the cure rate and pregnancy for patients of ovarian cystpunctureExperimental group: There were76with85cases of cysts volumereduced to1/2, the effective rate was89.41%.There were40with85cases ofcysts disappeared within6months; The cure rate was50%. There were7cases of ipsilateral ovarian chocolate cyst regenerated within12months and2cases of contralateral ovarian chocolate cyst regenerated.Both of cystsdisappeared within six months after treatment twice. Control group: The cruerate was40with40cases of cysts disappeared within6months; the cure ratewas100.0%..Two groups of the cure rate were statistically significant (P<0.05).5There were1natural pregnancy case of16cases in experimental group inthe12month observation period.Conclusion:1Anhydrous ethanol sclerotherapy for ovarian chocolate cysts can have acertain impact on ovarian reserve function, but most patients recover within6months after surgery.2Simple anhydrous ethanol sclerotherapy for ovarian chocolate cysts canhave a compared low cure rate, but can give a secondary treatment for cystrecurrence.3Anhydrous ethanol sclerotherapy for ovarian chocolate cysts have asmall natural pregnancy ratio. After the therapy a positive program should begiven, or take assisted reproductive technology. |
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