To investigate the influencing factors of pain during ultrasound-guided puncture sclerotherapy in the treatment of ovarian chocolate cyst (OEC).

A retrospective cohort study was conducted on 209 OEC patients undergoing ultrasound-guided puncture sclerotherapy in our department from September 2021 to September 2023. Demographic data, medical history and surgical information were collected. According to surgical approach, they were divided into transabdominal surgery group (n=57) and transvaginal surgery group (n=152). Pain scores were assessed at 5 surgical time points: needle insertion, irrigation, displacement, sclerosis, and needle withdrawal. Pain scores were compared between the 2 groups at each surgical moment. According to the pain scores at the moments of needle insertion and replacement, the patients were divided into the no/mild pain group (pain score ≤3) and the moderate/severe pain group (pain score ≥4), and the related factors of the incidence of moderate/severe pain were analyzed.

There was no statistical difference in intraoperative pain between different surgical approaches (transabdominal/transvaginal) in treating OEC under the guidance of ultrasound. At the moment of needle insertion, significantly higher incidence of moderate/severe pain was observed in the patients with a body mass index (BMI) > 23.9 kg/m² than those with BMI ≤23.9 kg/m², and those with a history of dysmenorrhea than those without (P<0.05). At the time point of displacement, BMI and history of dysmenorrhea had no correlation with the incidence of moderate/severe pain. Age, obstetric history, mode of delivery, time of menarche, menstrual volume, history of pelvic surgery, history of combined adenomyosis, size of cysts, duration of surgery, and surgical approach had no notable impacts on intraoperative pain.

Different surgical approaches for ultrasound-guided puncture sclerotherapy of OEC have no effect on pain levels at various surgical moments. From the aspect of humanistic care, transabdominal puncture should be preferred. During needle insertion and displacement, particular attention should be given to the overweight patients and those with a history of dysmenorrhea, and appropriate pain intervention measures should be formulated.

Ovarian endometriotic cyst (OEC) is a common chronic gynecological disease in women of reproductive age, which is closely associated with chronic pelvic pain and infertility. Previous single-modality treatment, such as medications, surgical enucleation, and puncture sclerotherapy are at risks for incomplete lesion removal or functional impairment of the ovarian. Therefore, postoperative combined medical therapy has become a research hotspot in clinical practice. This study aims to retrospectively analyze the clinical efficacy of ultrasound-guided sclerotherapy with lauromacrogol combined with different maintenance medications for OEC, and to identify the optimal postoperative medication regimen.

A retrospective cohort study was conducted. A total of 185 patients diagnosed with OEC in the Day Ward of our department from September 2021 to December 2025 were enrolled initially. After excluding 17 cases lost to follow-up and 15 due to other reasons, 153 patients were finally included. According to the type of postoperative maintenance medication regimens, they were divided into a dienogest group (n=55), a gonadotropin-releasing hormone agonist (GnRH-a) group (n=30), a dydrogesterone group (n=33), and a control group without pharmacological treatment (n=35). All of them were followed up for 6 months. Transvaginal color Doppler ultrasound examination was performed to measure the maximum diameter and volume of OEC before, and at 1, 3, and 6 months after operation, and the serum carbohydrate antigen 125 (CA125) levels were detected by chemiluminescence immunoassay at the same time points. Baseline characteristics of the patients were compared across the 4 groups. The efficacy and short-term complications in each group after lauromacrogol sclerotherapy were summarized. A mixed-effects model for repeated measures (MMRM) was adopted to analyze differences in the observed indicators at each follow-up time point.

① There were no significant differences in baseline data among the 4 groups except for OEC cyst fluid viscosity (mild: 31 cases, 20.26%; moderate: 69 cases, 45.10%; severe: 53 cases, 34.64%; P=0.008). ② Puncture sclerotherapy was ineffective in 11 cases (7.19%), including 3 cases in the control group, 5 in the dienogest group, 1 in the GnRH-a group, and 2 in the dydrogesterone group. One patient in the dydrogesterone group still failed to respond to the drug after 6 months of medication. The main short-term postoperative complications were fever [32.03% (49/153)], abdominal pain [15.03% (23/153)] and puncture site bleeding [5.88% (9/153)]. ③ The maximum diameter and volume of OEC in all groups were decreased gradually after operation, with no significant intergroup difference at 1 month postoperatively. At 3 months after operation, the diameter (95%CI: 3.45 to 15.65, P=0.0151) and volume (95%CI: 5.04 to 23.34, P=0.0167) were significantly lower in the dienogest group than the control group. The GnRH-a group showed statistically significant differences in the maximum diameter (95%CI: 5.21 to 18.62, P=0.0035) and the cyst volume (95%CI: 4.83 to 25.87, P=0.0292), with even more pronounced differences at 6 months postoperatively [dienogest group (95%CI: 3.66 to 15.22, P=0.0099; 95%CI: 5.89 to 19.17, P=0.0019); GnRH-a group (95%CI: 7.44 to 21.47, P=0.0005; 95%CI: 5.99 to 21.23, P=0.0038)]. No significant differences were found among the 3 medication groups, and either between the dydrogesterone group and other groups. ④ Preoperative serum CA125 levels were mostly elevated, but no significant differences were observed across groups. Postoperative CA125 levels were decreased in all groups. The CA125 levels were significantly decreased at 1 month after operation in the GnRH-a group (95%CI: 39.99 to 87.81, P<0.0001) and dydrogesterone group (95%CI: 18.00 to 53.40, P=0.0004), with no significant intergroup difference. After continuous maintenance medication, the dienogest group (95%CI: 12.68 to 37.72, P=0.0004), the GnRH-a group (95%CI: 32.67 to 58.93, P<0.0001), and the dydrogesterone group (95%CI: 23.10 to 42.50, P<0.0001) all showed significant differences compared with their own 1-month postoperative controls, but no significant intergroup differences were observed.

Maintenance therapy with dienogest or GnRH-a following ultrasound-guided lauromacrogol sclerotherapy demonstrates equally significant efficacy for OEC. OEC volume may serve as a superior imaging indicator for therapeutic response assessment.