Autumn means harvest, this weekend a woman and infant President Duan, Secretary Wan organized a mentor training invited a variety of cattle, the most cattle should be Zhang Kan teacher, he is absolutely world-class speakers, world-class philosophers, of course, is also a world-class scientists, discipline construction leader. One of the takeaways from today is to have the story told in full, Dean Duan said to be addicted to scientific research as a drug and to be an enthusiast like Secretary Wan.
I have been a close friend of the cochlear cyst for many years, but my understanding of it is still so superficial. I love the cochlear cyst hanging on my lips with a little bit of weakness, and silently made a pact with the cochlear cyst that I must tell its story completely and clearly. What exactly is ovarian chocolate cyst a disease like?
Ovarian chocolate cysts are the most common type of endometriosis in clinical practice. Normally, the endometrium grows in the uterine cavity and is influenced by female hormones in the body, shedding once a month to form menstruation. If the endometrial fragments shed during menstruation enter the pelvic cavity via the fallopian tube with the backflow of menstrual blood and are planted on the surface of the ovaries or other parts of the pelvis, implantation, invasion, and vascular formation will occur under the influence of some molecular biology of itself and the pelvis, which is called 3A mechanism for the formation of ectopic lesions, but how exactly does the coeliac form I personally think this explanation is not enough and have always suspected that the formation of the coeliac is related to the corpus luteum. This ectopic endometrium is also influenced by sex hormones and repeatedly sheds and bleeds with the menstrual cycle. If the lesion occurs on the ovary, there is local bleeding during each menstrual period, which increases the size of the ovary and forms a cyst containing old blood, which is brown and sticky like paste, resembling chocolate, so it is also called “chocolate cyst”. These cysts can gradually increase in size and sometimes rupture during or after menstruation, or even become cancerous.
Let’s take a look at the introduction of chocolate cysts in Baidu.
Disease Profile
Ovarian chocolate cysts are a type of endometriosis. Among them, ovarian chocolate cysts account for about 80% again. Ovarian chocolate cyst lesions can involve only one ovary, but about 50% or more of patients will have bilateral ovarian involvement. As the disease progresses, patients may develop dysmenorrhea, persistent lower abdominal pain, menstrual disorders, infertility and painful intercourse.
Pathophysiology
Ovarian chocolate cyst, also known as ovarian endometriosis cyst, is a disease caused by the “migration” of the endometrium to the ovaries, which is the most common type of endometriosis and is essentially different from ovarian cysts of tumor nature. It is the most common type of endometriosis and is fundamentally different from ovarian cysts, which are tumors. After the endometrium has migrated to the ovaries, it is still influenced by the ovarian hormone cycle. When menstruation occurs, the ectopic endometrium residing in the ovary will also experience menstrual bleeding, and the “menstrual blood” cannot be expelled from the body, so it has to be retained in the ovary. The ectopic endometrium that has fallen out of the “menstrual blood” continues to be planted in the ovary like a seed. The cysts are also called “ovarian chocolate cysts” because the blood inside the cysts is old blood that has been retained for a long time and has the appearance of chocolate paste.
As the disease progresses, the volume of the cyst increases as the blood accumulates in the cyst. When too much blood accumulates in the cystic cavity and the pressure is too high, the cyst may break through the weak part of the cystic wall and the cyst will rupture spontaneously, and some of the accumulated blood will flow out of the cyst. After some time, the spontaneous rupture of the cyst can occur again when the accumulated blood inside the cyst increases again and the pressure increases again. The blood that flows into the pelvic cavity after the rupture of the cyst irritates the peritoneum, causing severe abdominal pain and adhesions to the pelvic organs. Ovarian chocolate cysts can rupture spontaneously without a trigger. Rough or strenuous sexual intercourse, especially premenstrual sex, is often a common and important trigger for cyst rupture. Smaller ovarian chocolate cysts are usually less likely to rupture.
Pharmacological treatment of ovarian chocolate cysts is poor and it is difficult to eliminate them. When the cyst increases to more than 3 cm, the risk of spontaneous rupture begins to appear and gradually increases, it grows to a certain size and spontaneous rupture is often difficult to avoid. Therefore, it is indeed a “bomb” hidden in the pelvic cavity that may “explode” at any time. Since the blood flowing into the pelvis from a ruptured ovarian chocolate cyst is old and not a large amount of fresh bleeding, it usually does not affect the vital signs and does not cause shock, except for abdominal pain.
Some people think that since it is not life-threatening, can conservative treatment without surgery be adopted to save the patient from surgery. In fact, otherwise, after conservative treatment, the rupture of the cyst wall heals and the symptoms disappear, but soon there is a possibility of spontaneous rupture again. The more episodes she has, the heavier the pelvic adhesions will be, and the abdominal pain caused by pelvic adhesions will add to her misery.
Therefore, those who are diagnosed with ovarian chocolate cysts with a diameter of 3 cm or more should undergo surgery to remove the risk of the “bomb” exploding. In this case, surgery is mostly performed by chocolate cyst debridement, which preserves the normal ovarian tissue to the maximum extent possible, and can be done either by traditional cesarean or laparoscopic surgery. Postoperative medication is also required to consolidate the efficacy, which is important to prevent recurrence of ovarian chocolate cysts.
The Chinese medicine introduction at the end was deleted and felt unaccountable
Early symptoms
One: abnormal dysmenorrhea: dysmenorrhea is the most obvious symptom of endometriosis, but the most easily ignored precursor.
Two: painful intercourse: this is also an obvious sign and may be accompanied by spotting bleeding, the symptoms of ovarian chocolate cysts are not very obvious.
Third: no pregnancy even without contraception: endometriosis causes a high percentage of infertility among women who are infertile.
Causes of morbidity (this part feels unreliable)
I. Endocrine factors: This factor is a common cause of ovarian cysts. Although small, the ovaries are important organs for producing eggs and ovulating, endocrine hormones and balancing endocrine secretion, and mostly occur in the fertile age when endocrine secretion is vigorous. Therefore, it is thought to be related to endocrine disorders. In addition, when you get angry when you have your period, the period will be gone, causing the garbage to be discharged, forming cysts in the ovaries. (pure nonsense)
Second, multiple miscarriages: chocolate cysts are mainly due to the endometrial debris shed from the uterine wall during menstruation due to poor drainage, not all of which can be discharged from the vagina, and a small amount of which flows backwards through the fallopian tubes to the pelvis. Anything that can affect the flow of menstrual blood from the vagina, including vaginal atresia, narrow cervical opening, posterior tilting of the uterus, adhesion of the cervical opening after multiple abortions, and sexual intercourse during menstruation, can promote the occurrence of chocolate cysts.
Third, the fallopian tube blockage: monthly ovarian follicles that are not fertilized become waste products garbage must also be excreted, and must rely on the internal hydraulic pressure to squeeze out this garbage, due to your reduced function, coupled with the fallopian tube blockage phenomenon, the garbage can not be discharged, the eggs that can not be discharged piled up in the ovaries, the formation of chocolate cysts. This part is pure fallacy
You should not have sex or you will get chocolate cysts
The actual endometrium is normally growing in the uterine cavity, and with the arrival of the monthly female physiological period, it will peel off and start growing thicker again. But because the endometrium begins to grow in the ovaries of women, but during the physiological period this part of the endometrium does not leave their own, but in the location of the ovaries sludge, as the long in the ovarian location of the endometrium continues to thicken, the sludge of the endometrium will be more and more, making the location of the ovaries appear cysts. What a bunch of nonsense!
What is the real pathogenesis?
I. Implantation theory The earliest (1921) it was believed that the occurrence of pelvic endometriosis is caused by endometrial fragments entering the pelvis through the fallopian tubes with the reflux of menstrual blood and being implanted in the ovaries or other parts of the pelvis. Clinically, menstrual blood can be found in the pelvic cavity during dissection during menstruation, and endometrium can be found in the menstrual blood. Endometriosis of the abdominal wall scar formed after cesarean surgery is a good example of the implantation theory.
Second, the theory of chemotaxis, which suggests that ovarian and pelvic endometriosis is caused by the chemotaxis of the mesothelial cell layer of the peritoneum. The paramedian duct is developed from the primitive peritoneal invagination, and the germinal epithelium of the ovary, the pelvic peritoneum, and the atretic peritoneal recesses, such as the peritoneal sheath (nuchal duct) in the groin, the rectovaginal septum, and the umbilicus, are all differentiated from the epithelium of the corpora cavernosa. All tissues arising from the somatic epithelium have the potential ability to differentiate into tissues that are almost indistinguishable from the endometrium, and thus peritoneal mesothelial cells may be prone to differentiate into ectopic endometrium when stimulated by mechanical (including tubal aeration, posterior uterine position, cervical obstruction), inflammatory, and ectopic pregnancy factors. The germinating epithelium on the ovarian surface has more potential for differentiation because it is the primitive corpora lutea epithelium. Under the influence of hormones and inflammation, they can differentiate into the various tissues that can be formed during embryonic life, including the endometrium. The ovary is the most commonly involved site in extrinsic endometriosis and is easily explained by the chemotaxis theory. The implantation theory cannot explain the occurrence of endometriosis beyond the pelvis.
III. Immunological theory In 1980, Weed et al. reported that there were lymphocytes and plasma cells infiltrating around the ectopic endometrium, and macrophages containing iron heme deposits and varying degrees of fibrosis. They attributed this to the ectopic endothelial lesion as a foreign body that activated the immune system of the body. Since then, many scholars have explored the etiology and pathogenesis of endothelia from cellular immunity and humoral immunity. (a) defective cellular immune function 1. defective T lymphocyte function; 2. defective natural killer cell (NK) function: NK cells are a heterogeneous group of multifunctional immune cells whose function is characterized by the ability to kill certain tumor cells or virus-infected cells without the presence of antibodies or sensitization by antigens, and they play an important role in immune monitoring in vivo. (ii) Defective humoral immune function Other theories about the occurrence of endometriosis include: (i) the theory of lymphatic dissemination. It is believed that the endometrium can be disseminated via lymphatic tracts, and endometrial tissue has been found in the parametrial and internal iliac lymph nodes. However, the weakness of this theory is that endometrial tissue is rarely seen in the center of regional lymph nodes and the frequent sites do not conform to normal lymphatic drainage; (2) the theory of blood flow dissemination. According to the literature, ectopic endometrium has been found in veins, pleura, liver parenchyma, kidney, upper arm, and lower extremity. Some scholars believe that it is most likely that the endometrium has spread to the above tissues and organs through the bloodstream, and has caused experimental endometriosis in the lungs of rabbits. However, it has been suggested that although these cases may be due to hematogenous dissemination, localized metaplasia cannot be excluded because the pleura is also differentiated from the epithelium of the corpora cavernosa. During the embryonic period when the germ and mesonephric ducts are created, it is possible that the epithelium of the corpora cavernosa may become ectopic in them, and later the tissue may metastasize and form endometriosis in each of these areas.
4. Lang-type endometriosis determinism Differential diagnosis of other diseases 1. ectopic pregnancy rupture or miscarriage This disease has acute abdominal pain, signs of intra-abdominal bleeding and pelvic masses, similar to the rupture of ovarian endometriotic cysts. However, there is no previous history of endometriosis and dysmenorrhea with history of menopause. It can be differentiated based on blood and urine HCG tests and posterior vault aspiration. 2. There is no previous history of dysmenorrhea, no signs of internal bleeding after acute abdominal pain, no significant abdominal wall tenderness and rebound pain, and no mobile turbid sounds. The circumference of the mass is clear on gynecologic examination, the mass is painful on pressure, and there are no nodules in the rectal fossa of the uterus, which can be identified by ultrasound. 3. acute appendicitis right ovarian endometriotic cyst rupture is easily confused with acute appendicitis. The most obvious pressure point for acute appendicitis is at the appendiceal maiotic point on the abdominal wall and there are no nodules in the utero-rectal fossa. The patient has fever and elevated blood leukocytes, and posterior vault aspiration can also aid in the diagnosis, if it is pus. 4. ovarian corpus luteum rupture This disease occurs mostly before menstruation, no history of dysmenorrhea, abdominal pressure pain, rebound pain is not obvious, no nodules in the uterine rectal sink, and the posterior vault puncture fluid is dark red non-clotting blood, not coffee-colored fluid.
Disease prevention
The etiology of ovarian chocolate cysts is not yet clear, but it is closely related to uterine surgery, mainly abortion. Therefore, implementation of contraception and elimination of abortion can help prevent the occurrence of ovarian chocolate cysts. The treatment of ovarian chocolate cysts is quite tricky, so prevention of chocolate cysts is especially important. Studies have found that the occurrence of ovarian chocolate cysts is associated with ectopic endometrium that has long since entered the pelvis.
It follows that the key to preventing ovarian chocolate cysts lies in how to avoid the occurrence of endometriosis. According to the “risk factors” associated with the development of endometriosis, preventive measures can be taken in the following areas.
1, pay attention to adjust their emotions, maintain an optimistic and cheerful state of mind, so that the function of the body’s immune system is normal.
2, to pay attention to their own warmth, avoid feeling cold.
3, during menstruation, prohibit all strenuous sports and heavy physical labor.
4. If you are found to have endometriosis and ovarian chocolate cysts greater than 4cm, you must pay attention to maintain emotional stability during menstruation or midmenstruation and avoid overexertion, because once the tension in the cyst cavity suddenly rises, the cyst wall will rupture and an acute abdomen will form.
5. Try to do abortion and scraping as little as possible and do family planning.
6, the menstrual period to do their own health care, pay attention to control their emotions, do not sulk, otherwise it will lead to endocrine changes.
7, girls should avoid fright during puberty, so as not to lead to amenorrhea can be formed overflow.
8, women must be prohibited from having sex during menstruation.
Auxiliary examination
The formation of chocolate cysts is mainly due to endometriosis occurring in the ovary, which is the most common type of endometriosis and does not belong to tumor, but is a kind of cyst of both sexes, but the possibility of cancer cannot be excluded. It is not a tumor and is a cyst of both sexes, but cancer cannot be ruled out. Endometriosis in the ovary is affected by sex hormones in the ovary for a long time, so every time a woman has her period, the endometrium in the ovary bleeds and cannot be expelled from the body and is trapped in the ovary. The main methods of examination for ovarian chocolate cysts are as follows.
1.B ultrasound examination: Ultrasound examination will reveal irregular cystic cavities where the adnexa and uterus are connected in women, and there will be liquid messy echoes or uneven echogenicity in the cystic cavity, and some patients have liquid darkness in the rectal uterine recesses during the examination.
2, MRI examination: MRI performance is very uncertain and variable, mainly related to the sequence of pulses used and the composition of the lesion, if the patient is a completely hemorrhagic lesion in the examination of TT-weighted images will show a relatively uniform density of high signal.
3.Laparoscopy: Laparoscopy is the best method to diagnose ovarian chocolate cysts in clinical practice, mainly by peering into the pelvis with the assistance of laparoscopy, which can precisely find the location and cause of endometriosis and make accurate diagnosis.
4.CA (ovarian cancer-associated antigen) value determination: ovarian cancer-associated antigen is always a high molecular glycoprotein, which mainly exists in the tissue of renal duct derivatives and redundant organisms in the epithelial parietal cavity of the embryonic body, and it can specifically bind with monoclonal antibodies, which is useful for the diagnosis of ovarian wound spleen cancer.
Clinically chocolate cysts present in a thousand different ways and there are various surgical approaches, but the main central question is how to protect ovarian function? How to peel cleanly? One of the factors to prevent recurrence of chocolate cysts is related to surgical techniques, the skills learned from the United States Stanford nezhat teacher let me do a lot of successful surgery, pregnancy is also a lot, has let the graduate student statistics for nearly 10 years, like the study of chocolate cysts teachers can communicate more Oh, around the parents have chocolate cysts must remember to recommend to me ah, tumors I dare not spell, chocolate cysts can still sunshine Technology yo!
The actual tumor I don’t dare to spell, but the coarctation can still be a technique yo!