Purpose

To provide technical guidance on applying catheter-directed and needle-directed ethanol sclerotherapy for endometriomas and present the results of these sclerotherapy methods.

Materials and Methods

From January 2015 to March 2021, the results of the patients with symptomatic ovarian endometriomas who underwent needle-directed or catheter-directed sclerotherapy were evaluated, retrospectively. The decision to apply which sclerotherapy technique was made during the procedure for each patient considering the following factors: cyst size, cyst location, cyst viscosity, and tissue rigidity.

Results

Both needle-directed (n = 34 cysts) and catheter-directed (n = 34 cysts) sclerotherapy techniques were effective, with a 100% technical success rate and a 97% clinical success rate. In two of 34 cysts (6%) treated with needle-directed sclerotherapy, recurrence was detected and successfully retreated with catheter-directed sclerotherapy. Significant reductions in cyst size, pain, and serum cancer antigen 125 levels (p < 0.05) were noted. Serum anti-Müllerian hormone levels remained unaffected, indicating preserved ovarian reserve (p > 0.05). Among those treated for infertility, the pregnancy rate was 54% (n = 6/11). The mean ± SD cyst size decline was greater in catheter-directed sclerotherapy than needle-directed sclerotherapy (5.5 ± 3.1 cm vs. 4.0 ± 2.1 cm, p < 0.05). However, the pretreatment cyst volumes were considerably higher in catheter-directed sclerotherapy group (202.0 ± 233.5 mL vs. 78.8 ± 59.7 mL, p < 0.05) and were associated with significant post-treatment volume decrease (p < 0.05).

Conclusion

The choice between catheter-directed and needle-directed ethanol sclerotherapy should be determined during the procedure, with a preference for catheter-directed sclerotherapy when feasible. Crucial factors in making this decision include cyst size, cyst location, cyst viscosity, and tissue rigidity.

Level of evidence Level 3, non-controlled retrospective cohort study.

Graphical Abstract

中文翻译：

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乙醇硬化疗法治疗卵巢子宫内膜异位症：导管和针导向硬化疗法的技术考虑因素

目的

为子宫内膜异位囊肿应用导管引导和针引导乙醇硬化疗法提供技术指导，并介绍这些硬化疗法方法的结果。

材料和方法

回顾性评估2015年1月至2021年3月接受针刺或导管硬化治疗的有症状卵巢子宫内膜异位症患者的结果。在每位患者的手术过程中，考虑以下因素来决定应用哪种硬化疗法技术：囊肿大小、囊肿位置、囊肿粘度和组织硬度。

结果

针引导（n  = 34 个囊肿）和导管引导（n  = 34 个囊肿）硬化治疗技术均有效，技术成功率为 100%，临床成功率为 97%。在接受针引导硬化疗法治疗的 34 个囊肿中，有两个 (6%) 检测到复发，并通过导管引导硬化疗法成功消退。囊肿大小、疼痛和血清癌抗原 125 水平显着降低 ( p  < 0.05)。血清抗苗勒氏管激素水平未受影响，表明卵巢储备功能得以保留（p  > 0.05）。在接受不孕症治疗的患者中，怀孕率为 54% ( n  = 6/11)。导管导向硬化疗法的平均±标准差囊肿大小下降幅度大于针导向硬化疗法（5.5 ± 3.1 cm vs. 4.0 ± 2.1 cm，p  < 0.05）。然而，导管引导硬化治疗组的治疗前囊肿体积相当高（202.0 ± 233.5 mL vs. 78.8 ± 59.7 mL，p  < 0.05），并且与治疗后体积显着减少相关（p  < 0.05）。

结论

应在手术过程中确定导管导向和针头导向乙醇硬化疗法的选择，可行时优先选择导管导向硬化疗法。做出这一决定的关键因素包括囊肿大小、囊肿位置、囊肿粘度和组织硬度。

证据级别 3 级，非对照回顾性队列研究。

图形概要