[Ovarian cysts: strategy and prognosis].
The management of an adnexal masses involves several steps: establish the diagnosis of organic ovarian cyst, avoiding a useless and iatrogenic surgery of a functional cyst, knowing that functional cysts may persist more than 3 months and may occur even on low-dose oral contraceptives; cure painful cysts, by ultrasound guided aspiration of some functional cysts or laparoscopic detorsion of twisted adnexae; exclude malignancy, with the help of ultrasound, Doppler and Ca-125 preoperatively, then laparoscopic examination and pathology; failed diagnosis of cancer becomes rare (1 out of 300 laparoscopic surgeries for ovarian cyst); the association of a benign ultrasound and Doppler pattern and of a Ca-125 lower than 35 mUI/ml is almost pathognomonic of a benign cyst; cure benign ovarian cysts with a minimum of surgical trauma; in our series, 84.4% of ovarian cysts are managed laparoscopically, 11.1% by elective laparotomy, 4.5% by laparotomy after an attempt at laparoscopic surgery (that implies that the patient must be informed of the risk of laparotomy); adapt the surgical technique to the pathologic type and size of the cyst, with a high rate of laparotomy in large dermoid cysts, and a high rate of (salpingo-)oophorectomy in peri or postmenopausal cysts; ensure an adequate therapy of early ovarian carcinomas, avoiding understadification and undertreatment; prevent ovarian cancer by a careful long-term follow-up of patients with benign ovarian cysts and by the use of bilateral oophorectomy in postmenopausal patients.
Querleu
D
D
Clinique universitaire de gynécologie-obstétrique, Roubaix.
Parmentier
D
D
Chevallier
L
L
D000359:Aftercare; D018394:CA-125 Antigen / Q000097:blood; D002985:Clinical Protocols; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007258:Informed Consent; D010535:Laparoscopy / Q000379:methods; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D010048:Ovarian Cysts / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D010051:Ovarian Neoplasms / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D010052:Ovariectomy / Q000379:methods; D017698:Postmenopause; D017697:Premenopause; D011379:Prognosis; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler
D018394:CA-125 Antigen
Kystes de l'ovaire: stratégie et pronostic.