16 apr. 2007 SCLEROZAREA UNUI CHIST OVARIAN SIMPLU VOLUMINOS SIMPTOMATIC LA PACIENTA IN POSTMENOPAUZA CU RISC CHIRURGICAL MARE
Chiriac S.*, Taurescu Eugenia**, Chiriac Daniela**, Muntean Laura**, Cîtu C.**, Andrei C.*
* Clinica Chirurgie Politraumatologie Spitalul Clinic de Urgenta Judetean Timisoara
** Clinica de Obstetrica si Ginecologie Spitalul Clinic “Dr. Dumitru Popescu” Timisoara
Rezumat
Chisturile ovariene (OC) benigne sunt frecvente la pacientele postmenopauza (6-15%). Demonstrarea riscului malign mic, sub 1-3%, se face prin ultrasonografie (US) si determinarea CA 125 seric. Daca OC este sub 5 cm, este recomandata supravegherea US; în cazul remisiunii se renunta la monitorizare, iar în cazul cresterii se opereaza. La aceste paciente, cu chisturi persistente, se pot practica metode terapeutice minim invazive, controversate: punctia aspirativa si sclerozarea.
Pacienta RM 78 ani, chist ovarian stâng voluminous (16 cm), compresiv (incontinenta urinara etc), are contraindicatie chirurgicala (accident vascular cerebral, cardiopatie ischemica, HTA, BPCO). Explorarea amânuntita (US, CA 125, CT abdominopelvin etc) demonstreaza aspectul cu mare probabilitate benign. Se practica punctie ghidata US cu aspirarea continutului seros, citologic fara celule maligne. În final se decide sclerozarea, cu alcool.
Rezultatul astfel obtinut este clinic foarte bun, imagistic si biologic pacienta fiind urmarita în continuare. Metoda se dovedeste o optiune terapeutica viabila la pacientele cu OC simplu, simptomatic, voluminos, având contraindicatie chirurgicala.
Abstract
Benign ovarian cysts (OC) are frequent in postmenopausal women (6-15%). Proving small malignant risk, under 1-3%, can be done by ultrasonography (US) and dosage of seric CA 125. If the OC is under 5 cm, US monitoring is recommended; in case of remission the monitoring is cancelled, and in the case the cyst grows, it is operated. In these patients, with pesistent OC, controversial miniinvasive therapeutical methods can be approached: aspirative puncture and sclerosis.
Female patient, RM, 78 years old, with voluminous left OC (16 cm), and compresive phenomena (urinary incontinency etc), has surgical contraindication (cerebral vascular accident, ischemic cardiopathy, arterial hypertension, chronic obstructive bronchopneumopathy). Detailed exploration (US, CA 125, abdomino-pelvic CT etc) demonstrates a high probability of benign aspect. US guided puncture is performed, with aspiration of the serous content, the cytological exam proving no malignant cells. Ultimately, alcohol sclerosis is decided.
The clinical result is very good, the patient being under imagistic and biologic follow-up. The method proves itsself viable in patients with simple, symptomatic, voluminous OC with surgical contraindication.