卵巢子宫内膜异位囊肿术后盆腔囊性包块分析

摘要

Objective: To study the natures of and rational treatment for pelvic cysts that occurs after surgical treatment of ovarian endometriotic cyst.Methods: A total of 54 patients with recurrence of pelvic cysts after surgical treatment of ovarian endometriotic cysts were retrospectively studied.The patients were treated by transvaginal ultrasound-guided puncture.The recurrence time and nature of cysts, extent of previous surgery, patient's age, medications, serum levels of CA125, as well as characteristics of imaging and cytological test of cyst fluids, were analyzed.Results: Two kinds of pelvic cysts were identified, with 24 cases of pelvic encapsulated fluids and 30 cases of ovarian endometriotic cysts.In the first 6 months after last surgery, the incidence of pelvic encapsulated fluid was 41.7％, while no ovarian endometriotic cyst was found in this time period.Most recurrences of ovarian endometriotic cysts (80％, 24/30) were found 12 months after last surgical treatment.The recurrence of pelvic cyst showed no association with the extent of previous surgery, patient's age or medications.Elevated serum levels of CA125 were found in 20％ of patients with recurrence of ovarian endometriotic cyst but in of none patients with pelvic encapsulated fluid (P＜0.05).In 12 months of followup after transvaginal puncture of the cysts, recurrence of pelvic cyst was found in only 4 patients.Conclusions: Pelvic encapsulated fluid comes earlier than recurrence of ovarian endometriotic cyst after last surgical treatment of ovarian endometriotic cyst.Transvaginal ultrasound-guided puncture is an effective treatment for the recurrence of pelvic cysts.%目的 探讨卵巢子宫内膜异位囊肿术后异位囊肿的复发和盆腔包裹积液发生的规律,以及合理有效的治疗方案.方法 比较两者发生的时间、手术范围,与年龄、服药、CA125的关系,以及影像学的特征.采用阴道超声引导下穿刺治疗,并就其囊液进行分析.结果 术后1～6月内,盆腔包裹积液发生率为41.7%(10/24),没有发生卵巢子宫内膜异位囊肿复发,两者相比(P<0.001)差异有统计学意义.术后18月以上出现的囊肿中,卵巢子宫内膜异位囊肿居多,发生率为40%(12/30)两者的发生率相比(P<0.05),差异有统计学意义.结论 子宫内膜异位症术后盆腔包裹积液出现一般早于卵巢子宫内膜异位囊肿的复发,且这种囊肿可以通过阴道超声进行介入治疗.