卵巢巧克力囊肿自发破裂致急腹症临床特点分析

A Clinical Study of Spontaneous Rupture of Ovarian Endometrial Cysts as an Acute Abdomen

目的探讨卵巢巧克力囊肿自发破裂的误诊原因、治疗及复发,提高卵巢巧克力囊肿破裂的诊断率.方法研究65例卵巢巧克力囊肿自发破裂患者的临床特点、诊断及治疗方法,以195例未破裂患者作为对照进行回顾性分析.结果卵巢巧克力囊肿破裂组较未破裂组年龄、痛经发生率、术前确诊率、腹腔镜手术率及术后复发率等差异有统计学意义(P<0.05);囊肿大小、手术范围等差异无统计学意义(P>0.05);卵巢巧克力囊肿破裂时,子宫直肠窝内穿刺大多(21/24)能抽出具有特征性的暗褐色咖啡样液体.结论卵巢巧克力囊肿破裂50%以上患者无痛经史,误诊率高,正确诊断的关键在于对本病的认识,后穹窿穿刺出暗褐色咖啡样液体有助于诊断.本病一旦确诊多需手术治疗,手术范围应根据病变范围、患者年龄及生育要求等全面考虑后决定.

Objective To study the misdiagnosis causes, treatment and relapse factors of spontaneous ruptured ovarian endometrial cysts, and so as to improve the diagnosis and therapy of this disease. Method The clinical features, diagnosis and treatment of 65 cases of ruptured ovarian endometrial cysts and 195 cases of unruptured ovarian cysts were retrospectively analyzed. Results Between the two groups, there were significant differences in the age, dysmenorrheal rate, preoperative diagnosis rate, laparoscopic surgery rate and postoperative recurrent rate （P 〈 0.05） , while there was no significant difference in the diameter of the cysts and the extent of surgery （P 〉 0.05） . For most of the ruptured cases （21/24） , the characteristic dark brown liquid could be extracted by performing a recto-uterine pouch puncture. Conclusions More than 50% of the ruptured endometrial ovarian cysts don＇t have the history of dysmenorrheal, and the misdiagnosis rate is high. To improve the diagnosis, clinicians need to get a well-rounded understanding of its complexity, and the puncture and fluids from the recto-uterine pouch is important to diagnose. Most of the confirmed cases need surgical treatment, and the extent of operation depend not only on the patient＇s age and birth demand but also on the lesion range.