Retention ovarian cysts is a collective concept that combines several types of voluminous tumor-like neoplasms.. They make up the majority of ovarian formations and are divided into the following types:.

follicular (more than 85%);

corpus luteum cysts (5-7%);

paraovarian (10%);

endometrioid (10-15%).

In one group they are united by the absence of cell proliferation (t. uncontrolled division as in malignant tumors) and the presence of a cavity that is filled with serous or hemorrhagic fluid.

Each of the pathologies occurs in a certain phase of the menstrual cycle - follicular, ovulatory or luteal. Some, such as a corpus luteum cyst, have a clear relationship with pregnancy.. May develop due to a disruption in the hormonal system.

More common in young and middle-aged women.

There are several types of ovarian retention cysts Follicular cyst This type refers to temporary or functional formations, exists for 1-2 menstrual cycles. The cause of the occurrence is associated with a violation of the mechanism of ovulation - the follicle is filled with serous contents instead of bursting with the release of the egg.

Main symptoms:.

formations up to 5-7 cm in size are not clinically manifested;

sometimes there is a violation of menstruation (delay, soreness, profuse bleeding);

pain in the lower abdomen (weakly expressed, localized on one side).

Symptoms appear when complications develop. These include torsion and rupture of the cyst with the development of the symptom complex of an acute abdomen.. In this case, the cystic formation mimics other diseases of the abdominal organs.. Requires emergency hospitalization in a surgical hospital and surgical intervention. The diagnosis is clarified with the help of a physical examination and data from instrumental diagnostics (ultrasound).

Clinical picture of complications:.

Sharp intense pain in the lower abdomen. More often there is a retention cyst of the right ovary, so the pain is usually localized on the right or shifts somewhat towards the womb.

Nausea, vomiting. They are a manifestation of the syndrome of intoxication. With frequent vomiting, it is necessary to conduct a differential diagnosis with rotavirus infections..

Constipation or loose stools. The symptom will depend on the location of the cystic formation and the degree of involvement of the intestine in the inflammatory process..

Temperature rise up to 39 °С. It is also a manifestation of intoxication syndrome and is present in 60-70% of women.

Vaginal discharge.

Tachycardia and low blood pressure. The second symptom is especially well manifested in the presence of internal bleeding (when the bursting follicle was located next to large vessels). Tachycardia is both a symptom of intoxication and centralization of blood circulation..

Management of patients with confirmed ovarian cyst:.

The form.

Time.

Treatment.

Uncomplicated.

6-8 weeks (1-2 phases of the menstrual cycle).

Observation, anti-inflammatory drugs and oral contraceptives are indicated.

Tactics change in the following cases:.

Pathological growth (more than 2 times increase in a short time);

changes in boundaries according to ultrasound data (uneven, blurry);

change in content (non-homogeneous, signs of additional inclusions);

Addition of additional cameras.

In the presence of one of the presented conditions, diagnostic laparoscopy is indicated to clarify treatment options (conservative or surgical). Also used for differential diagnosis with malignancies.

Complicated.

Preservation of signs of a cyst for more than 8 weeks or the presence of a clinic of torsion and rupture.

Surgical treatment. Lead tactics:.

hospitalization (in severe conditions, first in the intensive care unit);

restoration of normal red blood values \u200b\u200bin case of suspected bleeding (hemoglobin, erythrocytes);

Restoration of normal blood coagulation values \u200b\u200bin case of suspected bleeding (coagulogram parameters);

if necessary, bringing the saturation to 95-98%;

diagnostic laparoscopy (clarification of the diagnosis);

laparoscopy or laparotomy, depending on the specific situation and the required amount of intervention.

After surgery, the use of folic acid and vitamin complexes, as well as oral contraceptives, is indicated to restore the female cycle.

Options for possible operational tactics:.

unilateral oophorectomy (complete removal of the ovary);

ovarian resection (removal of only part of the ovary with a ruptured neoplasm).

The prognosis is favorable even after surgery.

Cyst of the corpus luteum Meets relatively less often than other formations. The corpus luteum arises in the ovary under the action of the pituitary hormone, belongs to the temporary endocrine glands and produces progesterone, which ensures the introduction and fixation of the ovum into the uterus. Time of occurrence - ovulatory phase. It has a rounded shape and a yellowish tint, which gives a specific lipochromic enzyme in the walls.

Symptoms of the disease:.

clinically not manifested in 90% of women;

rarely causes menstrual irregularities;

can cause problems with conception and gestation.

If it occurs directly during pregnancy, it is one of the variants of the norm and lasts up to 10-12 weeks, after which it regresses on its own.

Frequent complications include bleeding into the formation cavity, which occurs due to good blood supply.. Tears sometimes occur, their clinical symptoms are similar to follicular cysts (symptoms of an acute abdomen), except that the pain appears more often on the left (more often there is a retention cyst of the left ovary).

Lead tactics:.

Observation of 1-3 phases of the menstrual cycle. Spontaneous resolution in most cases. Treatment should be started under the same criteria as for follicular cystic lesions (growth, borders, contents).

Treatment of a retention ovarian cyst by surgery occurs in the presence of complications. The tactics are the same as for follicular formations.. Feature - extremely rarely use laparotomy.

Removal (enucleation) of cystic formation within healthy tissues using laparoscopy.

Paraovarian cystA cystic neoplasm that is not related to classic ovarian lesions. It is formed from the embryonic germ, which is located in the wide ligament of the uterus between the uterus, ovary and fallopian tube. In rare cases, soldering with the ovary, disrupting its function.

Clinical picture:.

Most often, there are no clinical manifestations.

Since the cysts grow to large sizes (more than 20 cm), sometimes there are pulling pains in the lower abdomen. On examination, there is a slight asymmetry of the lower abdomen.

Palpation can detect a densely elastic formation in the right or left iliac region.

Irregular menstruation and problems conceiving (high risk of infertility with large cysts and long-term untreated).

Clinical picture of complications:.

Torsion and rupture - acute abdomen clinic.

Adhesions in the abdominal cavity - depending on the localization, there are symptoms of intestinal obstruction or symptoms of obstruction of the fallopian tubes.

Hemorrhage and suppuration of the cyst. They do not appear clinically until the rupture and release of the contents of the cyst into the pelvic cavity.

Retention ovarian cysts usually need to be surgically removed only if complications develop..

Expectant management during three menstrual cycles (ultrasound control every 3-4 weeks). Simultaneous use of monophasic combined oral contraceptives and a course of anti-inflammatory therapy.

Planned treatment in the absence of regression after the 3rd cycle of menstruation.

Emergency hospitalization in the presence of complications.

Two types of access are used during operations:.

laparoscopy - molar traumatic, highly effective, allows you to operate on complications;

laparotomy - wide access, good sanitation of the abdominal cavity (used for cysts larger than 10 cm).

Surgical options:.

unilateral tubo-ovariectomy (removal of the ovary, fallopian tubes);

enucleation with dissection of the leaf of the broad ligament of the uterus and intraligamental space (the ovary and fallopian tube are not affected).

The prognosis is relatively favorable.

Endometrioid cyst develops due to cells of the endometrium of the uterus migrating into the ovarian cavity. This phenomenon can occur with traumatic injuries of the uterus, recent surgical interventions on the uterus.

Clinical manifestations:.

Initially no clinical manifestations.

As the cyst progresses, something like erosions (heterotopias) appear on the surface of the cyst, from which the contents of the cyst begin to seep into the abdominal cavity.

Blurred clinic of an acute abdomen, since the penetration of cystic contents does not occur at once.

Late adhesive obstruction and, as a result, problems with conception.

Provided that endometrial cells proliferate, spotting is possible (the amount of discharge varies).

Complications and their clinic are similar to those in paraovarian cystic formations.. Management tactics (depending on the stage of endometriosis):.

Planned surgical treatment (stage 3-4 of endometriosis) - separation of adhesions, removal of a cyst with a capsule (husking). Resection of the ovary is extremely rare. After the operation, a course of hormonal therapy for 6 months is indicated..

If there are complications, emergency surgery.

The prognosis is favorable.

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