Varma T R, Patel R H
Department of Obstetrics and Gynecology, St George's Hospital Medical School, London, England.
Acta Obstet Gynecol Scand. 1988;67(7):579-84. doi: 10.3109/00016348809004267.
For the past two decades, significant advances have been made in the treatment of anovulation. The use of therapeutic agents for induction of ovulation, however, has given rise to several adverse reactions, the most important and serious of such complications being the ovarian hyperstimulation syndrome (OHSS), which can be fatal. It is characterized by gross ovarian enlargement, ascites, pleural effusion, hemoconcentration and thromboembolic disorder, which are potentially lethal conditions. The main pathogenic mechanism is considered to be increased capillary permeability, especially of the ovarian vessels, causing acute body fluid shift from the intravascular compartment to the peritoneal and pleural cavities. An experimental model of OHSS suggests that prostaglandins mediate this increased capillary permeability and transudation. Management is based on the concept of the pathogenic mechanism and includes maintenance of intravascular volume by plasma volume expanders, reduction of capillary permeability and prevention of thromboembolic complications. Surgical intervention is indicated only in cases of ovarian torsion or rupture and should be as conservative as possible.
在过去的二十年里，无排卵治疗取得了重大进展。然而，使用诱导排卵的治疗药物引发了多种不良反应，其中最重要且最严重的并发症是卵巢过度刺激综合征（OHSS），这可能是致命的。其特征为卵巢显著肿大、腹水、胸腔积液、血液浓缩和血栓栓塞性疾病，这些均为潜在的致命状况。主要致病机制被认为是毛细血管通透性增加，尤其是卵巢血管的通透性增加，导致急性体液从血管内间隙转移至腹腔和胸腔。OHSS的实验模型表明，前列腺素介导了这种毛细血管通透性增加和渗出。治疗基于致病机制的理念，包括使用血浆容量扩充剂维持血管内容量、降低毛细血管通透性以及预防血栓栓塞性并发症。仅在卵巢扭转或破裂的情况下才需要进行手术干预，且应尽可能保守。
