The Recent Therapeutic Effect By Interventional Ultrasound Combined With Gestrinone In Treatment Of Ovarian Endometrioma

Ovarian endometrioma is the most common pathological type of endometriosis.The majority of cysts are medium in size.It is called ovarian chocolate cyst,because of the chocolate like fluid in the cyst.It is found almost exclusively in women of reproduetive age. Ovarian endometrioma have became one of the common gynecology diseases,and its incidence is rising year after year.International gynecology and obstetrics scope has pay close attention to it.Dysmennorrhea,chronic pelvic pain and infertility seriously affect the health of body and mind and the quality of life of women. Laparoscopy is generally standard of diagnosis ovarian endom- etrioma,the disease with high misdiagnose rate,hard to mend,high recurrence rate.Laparoscopy is expensive and has to be done under whole body anesthesia,with exclusively surgery risk.Chocolate cyst always accompany pelvic and abdominal cavity adhesion ,which cause more difficult to laparoscopy or laparotomy.Cysts rupture during operation,recur and aggravate pelvic and abdominal cavity adhesion are also possible. Patients especially young,childless,recurrent patients are worry a lot about those possibility. The therapeutic effect by single drugs treament is not satisfactory.Patient's condition is procrastinated.Side effects and expensive prices of drugs have aggravated financial,body and mind burden of patients.Puncture under the guide of transvaginal color-ultrasound in treatment of ovarian endometrioma is a simple and easy method with out cut open stomach.The method is acceptive not only beneficial for fertility,but also safe and efficacious.During recent decate,the method has been extensive developed in clinic to enhance diagnosis rate and reduce blindness of treatment,but the recurrence rate is still at a high level.In order to explore more thorough,safe and efficacious treatment, we evaluate the recent efficacy of puncture guided by transvaginal color-ultrasound using anhydrous ethanol combined with Gestrinone in the treatment of ovarian endometrioma.Objective: To evaluate the recent efficacy of puncture guided by transvaginal color-ultrasound using anhydrous ethanol combined with Gestrinone in the treatment of ovarian endometrioma.Methods: 38 cases of patients who were clinically diagnosed endometriotic cyst were enrolled in the second affiliated hospital of Dalian Medical University from Sep.2005to Jun.2007.37 cases of total cases with ovarian endometriotic cysts were punctured and aspirated obsolete blood until the cyst nearly empty.Dilute the fluid with normal saline ,if it is hard to aspirate. Then injected anhydrous ethanol to flush the walls of cysts and kept alcohol in the cysts for 15 minutes,repeated one time.At the end,injected and retained about 5 ml anhydrous ethanol into the cysts. 1 case with colloid aspirate was turned to laparotomy,and the pathological diagnosis is mucinous cystadenoma. 37 cases of patients who were diagnosed by cytology analyses of cystic fluid were divided into two groups.Medication group(22 cases):after puncture, Gestrinone 2.5mg,begain took orally from the first day of menses,twice a week,for 3 months.Contrast group(15 cases):without medicine after puncture.The follow-up time was above 6 months.The necessity of combined with Gestrinone in the treatment of ovarian endometrioma after sclerosing the walls of endometriotic cyst was evaluated by comparing medication group with contrast group on curative effect .Results: Average quantity of aspirate, average quantity of anhydrous ethanol injected into cysts,average operative time and diameters of remained cysts between the two groups had no obvious difference(p>0.05). The effect of medication group was higher than that of contrast group ( 68.2%,26.7%) ,but the recurrent rate is lower(31.8%,73.3%), the difference was significant(p<0.05).Conclusions:Transvaginal puncture under the guide of transvaginal color-ultrasound in treatment of ovarian endometrioma is a simple, safe and efficacious method.It is a feasible mini-invasive technique for diagnosis and treatment of ovarian mendometrioma. Gestrinone maintenance treatment after puncture can control symptom effectively and urge focus atrophy,moreover decrease recurrent rate. The recent efficacy is reliable.