Chocolate cysts are a specific pathological type of endometriosis. In general, if a chocolate cyst is more than 2 cm in diameter, it is almost impossible to remove it completely with medication. At best, medications can only control the cyst from developing further, or slightly shrink it or relieve symptoms. Therefore, for those with larger lesion diameter and no significant improvement with medication, surgery should be performed promptly. 1.Open surgery: It is the classic treatment method. Depending on the patient’s age, lesion size, and fertility, conservative surgery or radical surgery is performed. Conservative surgery preserves the uterus and normal ovaries, preserving the reproductive function for the patient, but also leaves the hidden danger of recurrence. If the cyst is removed, the surgery should be performed with a coarse needle or electric puncture to aspirate the fluid inside the cyst or repeatedly flush it with saline to prevent the cyst contents from widely spilling out and contaminating the pelvis and causing medical diffusion of the implant, and then remove it after the fluid inside the cyst is basically aspirated and the cyst wall is reduced. 2, laparoscopic surgery: the current application is increasingly widespread, has increasingly shown that it is more valuable than open surgery, with the improvement of laparoscopic equipment and instruments, the improvement of the operator’s skills, laparoscopic can not only complete the various operations now open surgery, but also less interference with the patient, fast postoperative recovery. The principles of surgery are the same as those of open surgery. In order to make laparoscopic surgery easy to operate, sometimes a period of preoperative medication (1-3 months of leuprolide or goserelin) is also used to shrink the cyst, thin the cyst wall and reduce pelvic adhesions before surgery. 3. Ultrasound-guided puncture and injection of drugs: With the improvement of the accuracy of ultrasound equipment and the development of various interventional treatments, in recent years, ultrasound-guided transabdominal or transvaginal chocolate cyst puncture has also been carried out, in which the cyst fluid is extracted and repeatedly rinsed with saline, and then anhydrous alcohol or other corrosive agents are injected to make the cyst wall cells lose their growth activity, degeneration and necrosis, and lose their secretory function. Due to atrophy, shedding and absorption of the cyst wall cells, the cyst can shrink and repeated puncture injections can even make the cyst disappear completely. Surgical treatment should be followed by another period of medication (3-6 months of leuprolide or goserelin) to consolidate the efficacy. For patients who have not had children, they are encouraged to get pregnant as soon as possible.