Patient Question:Disease:Ovarian cyst (chocolate cyst) Description:In May 2015, ultrasound detected a cyst of about 5.5*4.5 size in the left ovary, multiple ultrasounds in several hospitals have confirmed that it is a chocolate cyst with endometriosis. I’ve been taking conservative treatment with Chinese medicine for half a year with no change. Doctors have recommended surgery to remove it. But the recurrence rate of this disease after surgery is very high. The company has been delayed and not done. The main mechanism for the formation of ovarian chocolate cysts 1, endometrial tissue in addition to the endometrium, 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, namely 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 more and more accumulation in the local area, forming blood stagnation as the main nodule-like changes, accumulation of blood over time will degenerate, the color is like coffee-like, more viscous, so called “chocolate-like cysts”, which are quite common in the ovaries. Second, the main harm of ovarian chocolate-like cysts 1, “coeliac” mainly occurs with the menstrual cycle with new bleeding, resulting in increased tension in the cystic cavity, the nerve endings on the wall of the cyst are affected by the tension and pain occurs. 2, “cochlear cysts” form an occupying effect that can obstruct or compress the fallopian tubes, affecting the fertilization of follicles or the return of fertilized eggs to the uterine cavity, leading to infertility. 3. The chlorenchyma may twist by itself or with the ovary, causing acute abdominal pain and even ovarian necrosis. Since chocolate-like cysts are caused by ectopic endometrial tissue bleeding, the effect of “stopping bleeding” can be achieved when the endometrium loses its ability to change periodically, such as entering menopause, when the endometrium is no longer influenced by estrogen, or when the ectopic endometrium is destroyed before menopause and loses its activity. The ectopic endometrium is destroyed and inactive before menopause. If systemic medications are used to control this, it will have an impact on the normal endometrial physiological cycle and is obviously not the best option. Therefore, for most patients, surgical intervention is essential. The history of the evolution of surgical 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 also removed together with the ipsilateral ovary. 2, laparoscopic surgery, without dissecting the abdominal cavity, only 2~3 holes of about 1.5cm~2cm in diameter are opened in the abdominal wall (commonly known as the belly), and the cyst is peeled off or removed together with the ovary by laparoscopic instruments using television surveillance images. It is a minimally invasive treatment, which is a popular minimally invasive technique at present. 3. Ultrasound-guided percutaneous aspiration of 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 sac”, and the puncture path can be through the lower abdomen or through the vagina (depending on whether the patient is married or not and the location of the cyst as well as the size of the obstacle on the puncture path), 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 sufficiently washed with physiological saline and then rinsed with anhydrous ethanol (now rarely used) or polyglactin (good for sclerotherapy 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 of fine puncture eye on the abdominal wall and cyst wall, and the damage to the ovarian tissue from polyglactin sclerotherapy is very slight. Recurrence after treatment of ovarian “coarctation” 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 cleaned and remains. Puncture sclerotherapy can recur because the cyst lining has not been thoroughly sclerosed. While maintaining the advantages of minimally invasive sclerotherapy, through technical improvement and innovation, it is possible to cure “coarctation” of cysts under 6cm-7cm with one sclerotherapy (cysts shrink more than 80% or even disappear completely), while cysts over 8cm usually require two sclerotherapy sessions.