Andolf E, Casslén B, Jörgensen C, Buchhave P, Lecander I
Department of Obstetrics and Gynecology, University Hospital, Lund, Sweden.
Obstet Gynecol. 1995 Oct;86(4 Pt 1):529-35. doi: 10.1016/0029-7844(95)00239-n.
To determine whether concentrations of gonadal steroids and fibrinolytic indices in fluid from benign ovarian cysts can discriminate between functional and neoplastic cysts and predict recurrence after ultrasound-guided puncture.
Concentrations of gonadal steroids and components of the plasminogen-activating system were measured in cyst fluid obtained at ultrasound-guided puncture of 96 ovarian cysts and were related to subsequent cyst recurrence. In 83 patients who had surgery for benign ovarian cysts, components of the plasminogen-activating system in the cyst fluid were correlated with the histopathologic diagnosis.
Higher levels of plasminogen activators and lower levels of inhibitors were found in those 54 cysts that recurred after puncture and in cysts with low levels (below 2000 pmol/L) of estradiol (E2). This enzyme-inhibitor balance resulted in high fibrinolytic activity. In contrast, cysts with high E2 levels (above 2000 pmol/L) had lower levels of activators, higher levels of inhibitors, and virtually no fibrinolytic activity. A high E2 concentration in cyst fluid was the single best predictor of no recurrence after puncture. Sixteen of 18 cysts in postmenopausal women recurred, and all had low levels of E2. However, an index based on cyst fluid volume and concentrations of E2 and urokinase predicted recurrence even better. A high concentration of urokinase in the fluid correlated with neoplastic histology of the cysts obtained at laparotomy.
The fluid content of ovarian steroids and plasminogen activators and inhibitors is related to histopathology and recurrence after puncture of benign ovarian cysts. Puncture and assay of these components may minimize surgery on functional cysts.
确定良性卵巢囊肿液中性腺类固醇浓度和纤溶指标能否区分功能性囊肿和肿瘤性囊肿，并预测超声引导下穿刺后的复发情况。
对96例卵巢囊肿在超声引导下穿刺获取的囊肿液进行性腺类固醇浓度及纤溶酶原激活系统各成分的检测，并与后续囊肿复发情况相关联。对83例行良性卵巢囊肿手术的患者，检测囊肿液中纤溶酶原激活系统各成分，并与组织病理学诊断相关联。
穿刺后复发的54个囊肿以及雌二醇（E2）水平低（低于2000 pmol/L）的囊肿中，纤溶酶原激活剂水平较高，抑制剂水平较低。这种酶-抑制剂平衡导致了高纤溶活性。相比之下，E2水平高（高于2000 pmol/L）的囊肿激活剂水平较低，抑制剂水平较高，几乎没有纤溶活性。囊肿液中高E2浓度是穿刺后无复发的唯一最佳预测指标。绝经后妇女的18个囊肿中有16个复发，且所有囊肿E2水平均低。然而，基于囊肿液体积、E2和尿激酶浓度的指标预测复发效果更好。囊肿液中高浓度尿激酶与剖腹手术获取囊肿的肿瘤组织学相关。
卵巢类固醇、纤溶酶原激活剂和抑制剂的液体含量与良性卵巢囊肿穿刺后的组织病理学及复发相关。对这些成分进行穿刺和检测可减少对功能性囊肿的手术。
