1, the main formation mechanism of ovarian chocolate-like cysts 1, in addition to the endometrium, endometrial tissue can also exist in many other parts of the body, such as the ovaries, uterine smooth muscle, peritoneum, mesentery, bladder wall, thyroid gland, nasal mucosa, lip mucosa, etc., especially in the ovaries and uterine smooth muscle layer is most common, occurring outside the endometrium become endometrium (tissue) The resulting clinical manifestations are collectively referred to as endometriosis. 2, ectopic endometrium (tissue) also has the same monthly cyclic changes of orthotopic endometrium, i.e. proliferation, shedding, repair, etc., and menstrual blood is discharged from the vagina, while ectopic endometrial tissue has basically no normal discharge channel when bleeding occurs and accumulates more and more in the local area, forming nodule-like changes with blood stagnation as the main body, and the accumulated blood will degenerate after a long time, with coffee-like color and thicker consistency, so it is called “This is quite common in the ovary, and some people call it chocolate cyst directly, because this cyst is not made of chocolate, and the product is not chocolate. The main harm of ovarian chocolate like cysts 1, “coarse cysts” mainly with the menstrual cycle occurs new bleeding, resulting in increased tension in the cystic cavity, the cyst wall nerve endings affected by tension and pain; 2, “coarse cysts” to form the occupying effect can obstruct or compress the fallopian tubes, affecting the fertilization of the follicle or the return of the fertilized egg to the uterine cavity, leading to infertility. 3. The coelecystic sac may twist by itself or with the ovary, causing acute abdominal pain and even ovarian necrosis. 4. “Coeliac disease” can also conceal some combined ovarian tumors, which may delay the diagnosis and treatment. Since chocolate-like cysts are caused by ectopic endometrial tissue bleeding, the principle of “hemostatic” treatment can be achieved as long as the endometrium loses its ability to change periodically, such as entering menopause when the endometrium is no longer affected by estrogen; or before menopause when the ectopic The endometrium is destroyed and inactive. If systemic medication is used to control this, it will have an impact on the normal endometrial physiological cycle and is clearly not the best choice. It has also been shown that pharmacological treatment is often of limited effectiveness and that surgical intervention is essential for most patients. The history of the evolution of surgical treatment techniques shows that minimally invasive is the inevitable trend of development. In most cases, the cyst can be removed successfully, but in some cases it is removed together with the ipsilateral ovary. 2.Laparoscopic surgery, without dissecting the abdominal cavity, only 2~3 holes of about 1.5~2.0cm in diameter are made in the abdominal wall (commonly known as belly), and the cysts are removed or removed together with the ovaries by laparoscopic instruments using television surveillance images. It is a minimally invasive treatment and is still a popular minimally invasive technique. 3. Ultrasound-guided percutaneous aspiration of the accumulated blood combined with sclerotherapy, which also belongs to the surgical category. Under the guidance and monitoring of ultrasound image, a 1.1mm diameter metal needle is used to accurately puncture into the “coarctation bursa”, and the puncture route can be through the lower abdomen or through the vagina (depending on whether the patient is married or not, the location of the cyst and the size of the obstacle on the puncture route), and the old blood that has accumulated for a long time is first aspirated, and the cyst cavity is fully cleaned with The cystic cavity is then rinsed with anhydrous ethanol (now used sparingly) or polyglactin (good for sclerosis and without the painful irritation of alcohol), which causes necrosis of the endothelial cells of the cystic cavity and loss of the ability to “bleed” again. Sclerotherapy does not remove the cyst from the body, but causes necrosis of the cyst lining, and the necrotic tissue is gradually absorbed by the body to achieve the goal of treatment. The biggest advantage of puncture sclerotherapy is that it is truly minimally invasive, causing only 1.1mm fine puncture eye on the abdominal wall and cyst wall, and the damage to the ovarian tissue caused by polyglactin sclerotherapy is very slight. IV. Key technical aspects of coarctation sclerotherapy 1. Safety aspects: The puncture paths are divided into transabdominal and transvaginal, and transabdominal puncture must avoid the intestinal canal and iliac vessels. Transvaginal puncture must avoid uterine arteries and ovarian arteries. It is very important to use better ultrasound equipment and color Doppler ultrasound to strictly check and design the puncture path. 2. Healing session: The “coelomic bursa” is full of blood for many hours, and the water in the stagnant blood is absorbed away, so the concentration of the accumulated blood keeps increasing, forming a thick, even slabby “blood sludge”. The first thing to do when puncturing is to thoroughly clean off these blood sludge before using sclerosing agent, otherwise anhydrous alcohol once encountered blood agglutination, puncture needle is blocked, can not be suctioned, it is difficult to form the effect of treatment. Secondly, when injecting sclerosing agent do not let the sclerosing agent stay statically in the cystic cavity, which is not conducive to the sclerosing agent and the cystic wall lining tissue to fully contact and play the role of sclerosis, to let the sclerosing agent flow and fully harden the cystic wall. Such a technical improvement should not be underestimated, and if it is not followed, the therapeutic effect is to be discounted. A large number of case data show that, on the premise of maintaining the advantages of minimally invasive sclerotherapy, through technical improvement and innovation, it is entirely possible to achieve the effect of one sclerotherapy and cure for “coarctation” below 6~7 (cysts shrink by more than 80%, or even disappear completely). cysts above 7~8 usually require two sclerotherapy sessions. V. Recurrence of ovarian “coarctation” after treatment Whether it is open surgical excision, laparoscopic removal, or ultrasound-guided sclerotherapy, recurrence of “coarctation” exists. However, it is important to note that the regrowth of a treated cyst is called a recurrence, while the continued growth of small or even invisible microscopic cystic “germ” that was originally present cannot be considered a recurrence because they have not been treated at all. Open surgical or laparoscopic removal can result in recurrence because the lining is not cleared and remains. Puncture sclerotherapy can recur because the cyst lining has not been sclerosed thoroughly. Then, regardless of the method of treatment for cyst recurrence, minimally invasive treatment should undoubtedly be the priority when treating again, and the advantages of minimally invasive and easily repeatable puncture sclerotherapy come to the fore. If recurrence persists after 2-3 sclerotherapy sessions, it is necessary to use a combination of drugs that inhibit the cyclic proliferation and secretion of the endothelium, i.e. “menopause”, to consolidate the effect of treatment. With this article, I wish all women a happy “March 8” holiday. Happy 8th Day! It is honorable and rewarding for male doctors to provide services for your health.