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什么是卵巢巧克力囊肿破裂?卵巢巧克力囊肿破裂的症状是什么?

发布时间:2016-01-10   问大夫  责任编辑:詹敏怡

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卵巢巧克力囊肿破裂会产生急性的疼痛,痛觉会慢慢扩展到整个腹部,如果出血增加,可能血压会下降,晕眩,甚至昏倒。什么是卵巢巧克力囊肿破裂?卵巢巧克力囊肿破裂的症状是什么?下面看看吧。

卵巢巧克力囊肿破裂

盆腔子宫内膜异位症极易累及卵巢,异位的子宫内膜在卵巢组织中周期性出血使卵巢不断增大而形成巧克力囊肿。此囊肿常为双侧性,卵巢巧克力囊肿因多种因素而发生自发或在外力影响下的破裂,破裂可反复发生。破裂后陈旧性血液溢入腹腔,引起剧烈腹痛,恶心呕吐等,常须急诊处理。囊肿破裂多发生于经前期及月经期,卵巢巧克力囊肿破裂已属于妇科领域中一种新型急腹症,以往对它认识不足,常被忽视,现对其认识逐渐加深,故已引起重视。

卵巢巧克力囊肿破裂的症状是什么?

1.症状

(1)发病多在月经前或月经周期后半期(黄体期),因月经期前后囊腔内反复出血囊内压急剧增高,易自发破裂或受重力挤压或妇科检查,而使囊肿破裂。

(2)无闭经或不规则阴道出血。

(3)突发下腹剧痛,开始于一侧,继之盆腔疼痛,伴恶心呕吐。

(4)偶可出现血压下降和休克症状。

2.体征

(1)腹部有明显腹膜刺激症状,有明显压痛、反跳痛及肌紧张。

(2)偶有移动性浊音。

(3)妇科检查于盆腔一侧或双侧可触及周界不清的包块,包块常与子宫后壁相连,与子宫紧贴,不活动,有触痛。

病理病因

卵巢子宫内膜异位囊肿在下列情况下可以发生破裂:

1.经前或经期反复出血,使囊内压增加。

2.妊娠期孕激素水平增高或使用外源性孕激素治疗时,孕激素使囊壁血管增生、充血水肿、组织软化而致破裂。

3.排卵口的存在也可致囊肿破裂。

4.因受外力挤压、性生活受压或妇科检查也可使囊肿破裂。

卵巢巧克力囊肿破裂中医治疗方法

一.中药治疗:黄柏、白花舌草、乳香、没药、王不留等。

二.偏方:(以下资料仅供参考,详细需咨询医生)

1.【组成】 小茴香6g  干姜6g  延胡索15g  当归20g  川芎10g  官桂3g  赤芍10g  蒲黄10g  炒五灵脂 10g  香附12g  乌药10g

上方每日1剂,水煎成400ml,分2次温服,月经期不停药。

2.【组成】桃仁9克,杏仁9克,橘皮9克,丹皮9克,桂枝9克,甘草6克,醋30克,大黄10克,蜜(冲服)30克。

水煎服,每日1剂,日服2次。

3.【组成】桃仁3克,桂枝10克,大黄16克,芒硝10克,甘草6克,水蛭10克。

水煎服,每日1剂,日服2次。

卵巢巧克力囊肿破裂西医治疗方法

一.手术治疗

1.确诊后宜立即手术,因流出的囊液可引起盆腔粘连、不育或异位内膜的再次播散和种植。

2.年轻未生育者在吸引和彻底冲洗吸引溢入盆腔内的囊液后,做囊肿剥出术,尽量保存正常卵巢组织,对维持卵巢功能和内分泌功能有助,对日后增加孕育机会也有助。

3.双侧卵巢受累,原则上也尽量做囊肿剥出术,若囊肿与周围组织粘连紧密,强行剥出易损伤脏器时,则可用无水酒精涂在囊腔内,使囊腔内上皮层坏死,以免日后复发,术后仍宜用药物治疗。

4.对年龄较大且已有子女对侧卵巢正常、子宫无受累者为避免日后复发,也可考虑作患侧附件切除。

5.卵巢巧克力囊肿破裂者手术时宜彻底清洗腹腔,尽量切除病灶,松解粘连,术后关腹前,腹腔内放入庆大霉素8万U,地塞米松5mg,玻璃酸酶(透明质酸酶)1000U,生理盐水250ml,以防术后粘连。

6.术后一般仍宜服用治疗子宫内膜异位症的药物,以防止肉眼未能检出的病灶或囊液污染腹腔引起新的播散和种植病灶的产生。

二.药物治疗

(1)高效孕激素:单纯高效孕激素治疗可抑制子宫内膜增生,使异位的宫内膜萎缩,患者出现停经。一般采用甲羟孕酮(甲孕酮)、炔诺孕酮(18-甲基炔诺酮)等。治疗期间如出现突破性阴道出血,可加少量雌激素,如炔雌醇0.03mg/d或结合雌激素(倍美力)0.625mg/d。治疗后的妊娠率与假孕疗法相当,但副反应较轻,患者多能坚持治疗。

(2)达那唑(Danazol):是一种人工合成的17α-乙炔睾酮的衍生物,具有轻度雄激素活性。它通过抑制垂体促性腺激素的合成与分泌,以抑制卵泡的发育,使血浆雌激素水平降低;同时,它还可能与雌激素受体结合,导致子宫内膜和异位的子宫内膜萎缩,患者出现闭经,因而又称此种治疗为假绝经疗法。体外实验证明达那唑可抑制淋巴细胞增生和自身抗体的产生,具有免疫抑制作用。推测达那唑还可能通过净化盆腔内环境,减少自身抗体的产生等而提高受孕能力。常用剂量为400~600mg/d,分2~3次口服,于月经期第1天开始服药,连续6个月。症状缓解率达90%~100%,停药1~2个月内可恢复排卵。治疗后的妊娠率为30%~50%。若1年内未妊娠,其复发率为23%~30%。

达那唑的不良反应,除可出现痤疮,乳房变小、毛发增多,声调低沉及体重增加等轻度男性化表现外,少数可致肝脏损害,出现血清转氨酶升高,故治疗期间需定期检查肝功能,如发现异常应及时停药,一般在停药2~3周后肝功能可恢复正常。

(3)孕三烯酮(18-甲基三稀炔诺酮):为19-去甲睾酮的衍生物,作用机制与达那唑相似,但雄激素作用较弱。由于它在体内的半衰期较长,故不必每天服药。通常从月经期第1天开始服药,每次服2.5mg,每周服2次。治疗后的妊娠率与达那唑相近,但不良反应较轻,较少出现肝脏损害,停药后的复发率亦较高。有人报道停药1年的复发率为25%。   (4)促性腺激素释放激素动剂(GnRH-a):是人工合成的10肽类化合物,其作用与垂体促性腺激素释放激素(GnRH)相同,但其活性比GnRH强50~100倍。持续给予GnRH-a后,垂体的GnRH受体将被耗尽而呈现降调作用,使促性腺激素分泌减少,卵巢功能明显受抑制而闭经。体内雌激素水平极低,故一般称之为“药物性卵巢切除”。

卵巢巧克力囊肿破裂如何预防?

1.巧克力囊肿的患者多数为育龄妇女,发病时间多在经期或行经前期(即月经周期的后半期)。

2.典型的表现为突发的剧烈下腹痛,逐渐延及全腹,可伴有低热或轻度白细胞升高,同时伴有明显的腹膜刺激征,即腹部肌肉紧张、压痛和反跳痛。

CA125,子宫内膜异位症患者的血清卵巢癌相关抗原(CA125),可以升高,与卵巢浆液性囊腺癌鉴别在于后者升高幅度远高于子宫内膜移位症患者。不孕,该病患者不孕率达到40%。

治疗,原则有生育要求者采用激素治疗,具体治疗由专业医师进行指导。

预后:如不能迅速止血或凝血块脱落等也可引起出血,重者可危及生命,但此很少见。保守性手术和卵巢功能保留性手术的患者,手术后的复发率较高。较少数有恶变。

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