Abstract: [Abstract] Objective To explore the analysis of diagnosis and curing treatment of ovarian cysts by ultrasound-guided percutaneous puncture. Methods Ultrasound-guided percutaneous puncture technique was applied to aspirate cyst fluid for qualitative curing treatment, and the accuracy of diagnosis and treatment effect were observed. Results 103 cases of ovarian cysts, chocolate cysts by puncture aspiration combined with pathological histological examination, the diagnosis rate was 100% and the cure rate was 96%. The diagnosis rate of plasmacytoma was 100% and the cure rate was 42% according to the color of the extracted cystic fluid and protein characterization test.
[Abstract] Objective To explore the analysis of diagnosis and curettage of ovarian cysts by ultrasound-guided percutaneous puncture. Methods The ultrasound-guided percutaneous puncture technique was applied, and the cyst fluid was extracted for qualitative curing treatment to observe the accuracy of diagnosis and treatment effect. Results: 103 cases of ovarian cysts, chocolate cysts were diagnosed with 100% diagnosis rate and 96% cure rate by puncture fluid aspiration combined with pathological histological examination; plasmacytoma was diagnosed with 100% diagnosis rate and 42% cure rate according to the color of the aspirated cyst fluid and protein characterization test, with 31.7% significant rate, 26.3% ineffective rate and 50% ineffective glucose curing; mucinous cystadenoma, ovarian leather-like teratoma, mucinous cyst Mucinous cystadenoma, ovarian leathery teratoma and mucinous cystic adenoma can only provide a reference basis for clinical diagnosis and cannot be cured. Conclusion Ultrasound-guided percutaneous puncture of ovarian cysts is easy to perform, less invasive, with high diagnostic and cure rates, and is worth promoting in clinical practice.
Keywords ultrasound-guided percutaneous puncture, ovarian cyst, anhydrous alcohol, curing treatment, ultrasound-guided percutaneous puncture of ovarian cysts has been carried out in our hospital for more than 4 years, we performed puncture aspiration of 103 cases of ovarian cysts with minimal trauma to characterize and cure the procedure, and the results were satisfactory to achieve the diagnostic and therapeutic purposes, which are analyzed and reported as follows.
1. Information and methods
1.1 General data All 103 cases in this group were outpatients and inpatients of our hospital, aged 16-66 years, average 22 years, with medical history of 2-10 years, 8 unmarried cases, 95 married cases, 42 cases of left adnexal cysts (46 cysts), 48 cases of right side (51 cysts), 15 cases of bilateral (18 cysts). The largest cyst occupied the abdominopelvic cavity, and the smallest one was about 82.5px×80px; with lower abdominal distension and pain and irregular menstruation in 67 cases. Ultrasound examination was performed before surgery in all cases, and chocolate cysts and simple ovarian cysts were diagnosed in 86 cases, and the nature was to be diagnosed in 17 cases.
1.2 Methods Instruments used: American GE-200 ultrasound diagnostic instrument with a probe frequency of 3.5 MHz. equipment: puncture frame, guide needle, 18-20G puncture aspiration needle and puncture sterilization kit. Drugs:anhydrous alcohol, 50% glucose, 0.25% lidocaine and saline.
1.2.1 Preoperative preparation Routine blood and urine routine, platelets, bleeding and clotting time, liver and kidney function and electrocardiogram examination were performed.
1.2.2 Puncture aspiration treatment method Patients were placed in the supine position, firstly, the size of the cyst was scanned with a common probe, the puncture site was determined, the toxin was cleared, the sterile towel was spread, the sterile puncture probe was replaced, the entry point, puncture route and depth were determined again, 0.25% lidocaine was used for local anesthesia, an incision of about 0.2-7.5 px was cut with a blade, a puncture holder was added to the probe, a guide needle was attached, the patient was instructed to hold his breath and then the puncture needle was made to enter the cyst The patient is instructed to hold his breath, then the puncture needle is allowed to enter the center of the cyst and the cyst fluid is aspirated with a syringe. If the cyst fluid is chocolate-colored or yellowish (positive protein characterization test), the former can be flushed with 95% alcohol or saline; the latter does not need to be flushed; both chocolate cysts and plasmacytoma can be cured with anhydrous alcohol, and the amount saved is 1/6 to 1/5 of the cyst fluid. if the aspirated cyst fluid is milky yellow, milky white viscous jelly-like or blood-like fluid, anhydrous alcohol curing treatment cannot be injected. The puncture needle was withdrawn, covered with sterile gauze, fixed with adhesive tape, and left after 40-60 min of postoperative lying down with stable vital signs.
2.Results
In this group, there were 103 cases, 46 cases of left adnexa, 48 cases of right adnexa, 15 cases of left and right sides, totaling 115 cysts, all of which were successfully punctured in one time.
(1) The cyst fluid aspirated was coffee-colored and diagnosed as chocolate cysts, which were treated with anhydrous alcohol curing. 96% of the cysts disappeared and dysmenorrhea disappeared or significantly reduced after 5 to 28 months of follow-up, and 3 cases of infertility after 2 to 3 years of marriage were pregnant, with a diagnosis rate of 100% and a cure rate of 96% in combination with pathological tissue examination.
(2) The diagnosis of plasmacytoma was made by aspiration of yellowish cystic fluid and positive protein characterization test. 10 cases were treated with 50% glucose curing, and the cysts did not shrink when reviewed within 2 years as invalid. 38 cases were treated with anhydrous alcohol curing, and 16 cases (42.1%) were reviewed within 2 years, and the cysts shrank less than 75px; 1 case was infertile for 9 years after marriage, and the pregnancy occurred 17 months after treatment; the cysts shrank 1/3 to 1/2 12 cases, accounting for 31.6%; 10 cases, accounting for 26.3%, had cysts of the same size or increasing in size, and the diagnosis rate was 100% when combined with pathological examination.
(3) The milky yellow or milky white jelly-like material was extremely difficult to extract, insoluble in alcohol, ineffective in curing treatment, low qualitative diagnostic rate, and only provided a reference basis for clinical diagnosis. The former was diagnosed as ovarian sebaceous teratoma by pathological histological examination, and the latter as ovarian mucinous cystadenoma in one case with 4 months of pregnancy and one case and 6 months of pregnancy.
(4) Blood cystic fluid was withdrawn and pathological histological examination was performed in 2 cases, and plasmacytic cystic adenocarcinoma was diagnosed, and in 2 cases no abnormal cells were seen except for blood cells, which absolutely could not be cured for treatment. In this group of curing treatment, there was distension and pain in the lower abdomen within 2h after surgery, which gradually disappeared later, and all patients had no bleeding and infection. 2 cases of chocolate cyst had symptoms of dizziness, chill and sweating after surgery due to repeated rinsing with alcohol, and the examination was clear, with red face and body temperature, and normal pulse and blood pressure; there was no liquid dark area in the abdominopelvic cavity by ultrasound exploration, and the symptoms disappeared after rest and oral 50% glucose.
3. Discussion
Ovarian cysts are common in gynecology and can occur at any age, but are more common in fertile women. The former is a specific cystic structure that can originate from the follicles or corpus luteum of the ovary and is a retained cyst that is not an ovarian tumor and usually disappears on its own. The latter is a pathological tumor, divided into two categories: benign and malignant. In the past, the nature of the tumor could be basically identified by analyzing its morphological changes through imaging, but the accuracy rate is still unsatisfactory, and surgical treatment is the main treatment, which is highly damaging. In this group of patients, 44 cases of chocolate cysts were initially diagnosed by CT and B ultrasound, and by puncture fluid aspiration pathological examination, 2 cases were diagnosed as plasmacytotic ovarian cysts, 1 case was diagnosed as mucinous cystadenoma, 52 cases of plasmacytotic cysts, and 4 cases were diagnosed as ovarian chocolate cysts by a light coffee color and pathological examination. Therefore, ultrasound-guided puncture aspiration can basically determine the nature and choose the treatment method as long as it is based on the color of the aspirated cystic fluid and protein characterization test to avoid delaying the disease, with a high success rate of surgery and few complications, requiring the operator to be clinically experienced and technically skilled in operation. Operation process should pay attention to:
(1) Choose a short puncture path;
(2) Avoid the intestinal canal, bladder, uterus and blood vessels in the abdominopelvic cavity;
(3) Needle can only be successful once to the center of the cyst, unsuccessful to be recovered after 1 week and then puncture, can not be repeated several times, so as to avoid multiple punctures of the cyst wall, cystic fluid overflow, plasmacytic cyst overflow easy infection or injection of solidifying agents cause severe abdominal pain; chocolate cyst overflow, easy implantation;
(4) Multiple cysts are best punctured first to cure the largest, and then puncture the other cysts after closure;
(5) It is best not to aspirate all the fluid before flushing to avoid the needle tip sticking to the cyst wall;
(6)When rinsing with saline or 95% alcohol while injecting, the amount of injection can be increased when the amount of injection matches the amount of retraction;
(7) If the amount of injection does not match the amount of retraction, and the patient has severe abdominal pain, the wall of the bursa may be punctured, immediately stop the injection of alcohol and retraction, inject 5-10ml of 2% lidocaine into the bursa, keep the observation for 3-5min and then do not inject alcohol again whether the abdominal pain is relieved or not;
(8) The number of alcohol flushing cysts should not be too many to avoid alcoholic reaction.
B ultrasound-guided percutaneous puncture for diagnosis and treatment of ovarian cysts is a new technology developed on the basis of ultrasound imaging to further meet the needs of clinical diagnosis and treatment, which is mainly done under the guidance of real-time ultrasound surveillance to aspirate cystic fluid and inject drugs into the cyst so as to achieve the purpose of diagnosis and treatment, which is easy to operate, low cost, less painful to patients, accurate guidance and high cure rate, and worthy of clinical promotion.