Luxman D, Cohen J R, Gordon D, Wolman I, Wolf Y, David M P
Department of Obstetrics and Gynecology "B," Serlin Maternity Hospital, Sourasky Medical Center, Tel Aviv University, Israel.
J Reprod Med. 1996 Oct;41(10):771-4.
Severe ovarian hyperstimulation syndrome is a life-threatening complication of ovulation induction. The clinical picture includes ovarian enlargement, accumulation of ascites and pleural effusion, increased coagulability and electrolyte disorders. Accumulation of ascites increases the intraabdominal pressure so that breathing difficulties ensue. Paracentesis is the only treatment that can immediately prevent respiratory deterioration.
Nine women with severe ovarian hyperstimulation syndrome were treated by paracentesis for the drainage of massive ascites. Unilateral vulvar edema developed in all cases in which the lower abdomen was the puncturing site. This phenomenon was not observed when paracentesis was carried out through the upper abdomen. The edema resolved spontaneously over the subsequent 10 days.
Apparently the puncturing needle created a fistulous tract through which the ascitic fluid was forced, by the increased intraabdominal pressure, into the subcutaneous tissues, presenting as unilateral vulvar edema. This can be prevented by using one of the abdominal hypochondriac regions as the puncturing site. This phenomenon is self-limited and causes only mild discomfort without late sequelae.
重度卵巢过度刺激综合征是促排卵的一种危及生命的并发症。临床表现包括卵巢增大、腹水和胸腔积液积聚、凝血性增加及电解质紊乱。腹水积聚增加腹内压，从而导致呼吸困难。腹腔穿刺术是唯一能立即预防呼吸功能恶化的治疗方法。
9例重度卵巢过度刺激综合征患者接受腹腔穿刺术以引流大量腹水。所有在下腹部进行穿刺的病例均出现单侧外阴水肿。通过上腹部进行腹腔穿刺术时未观察到这种现象。水肿在随后10天内自行消退。
显然，穿刺针形成了一个瘘管通道，通过该通道，腹水在腹内压增加的作用下被挤入皮下组织，表现为单侧外阴水肿。通过使用季肋区之一作为穿刺部位可预防这种情况。这种现象是自限性的，仅引起轻度不适，无晚期后遗症。
