概述

卵巢囊肿是指在卵巢内或表面形成的充满液体的囊状或袋状结构。女性有两个卵巢,分别位于子宫两侧,每个卵巢的大小和形状都和杏仁差不多。卵子在卵巢中发育和成熟,育龄期女性每个月都会释放卵子。

很多女性有时会出现卵巢囊肿。大多数卵巢囊肿只会产生些许不适或不会带来任何不适,并且也不会造成伤害。大多数会在几个月内未经治疗自行消失。

但卵巢囊肿(尤其是已经破裂的)也可能引起严重症状。为了保护您的健康,请定期接受盆腔检查,并了解可能提示潜在严重问题的征兆。

症状

大多数囊肿不会引起症状,并会自行消失。然而,较大的卵巢囊肿会导致:

  • 盆腔痛——囊肿一侧下腹部隐隐作痛或剧烈疼痛
  • 腹部饱胀或沉重
  • 腹胀

何时就诊

如果出现以下症状,请立即就医:

  • 突发重度腹痛或盆腔痛
  • 疼痛并伴有发热或呕吐

如果您有这些体征和症状或有休克症状——皮肤湿冷、呼吸急促、头重脚轻或虚弱,请立即就医。

When to see a doctor

Get immediate medical help if you have:

  • Sudden, severe abdominal or pelvic pain.
  • Pain with fever or vomiting.
  • Signs of shock. These include cold, clammy skin; rapid breathing; and lightheadedness or weakness.

病因

大多数卵巢囊肿均由月经周期导致(功能性囊肿)。其他类型的囊肿很少见。

功能性囊肿

卵巢通常每个月都会生长卵泡这种囊样结构。卵泡会产生雌激素和孕酮,并在排卵时释放卵子。

如果每个月正常产生的卵泡继续生长,就会发展为功能性囊肿。功能性囊肿有两个类型:

  • 滤泡囊肿。在月经周期的中点左右,卵子会冲出卵泡并沿着输卵管移动。当卵泡未破裂或释放卵子,而是继续生长时,就会形成滤泡囊肿。
  • 黄体囊肿。释放卵子时,卵泡开始为受孕产生雌激素和孕酮。这时的卵泡被称为黄体。液体有时会在卵泡内积聚,导致黄体生长成为囊肿。

功能性囊肿通常无害,很少引起疼痛,往往会在两三个月经周期内自行消失。

其他囊肿

与月经周期的正常功能无关的囊肿类型包括:

  • 皮样囊肿。也叫畸胎瘤,可能包含由胚胎细胞形成的组织(如头发、皮肤或牙齿)。在极少数情况下,皮样囊肿会变成癌性。
  • 囊腺瘤。囊腺瘤生长在卵巢表面,可能充满水样或黏液物质。
  • 子宫内膜异位瘤。子宫内膜细胞在子宫外生长的一种状况(子宫内膜异位症)会导致这类囊肿。部分组织可能附着在卵巢上,形成生长物。

皮样囊肿和囊腺瘤会变大,导致卵巢移位。这会增加卵巢疼痛性扭转(卵巢扭转)的几率。卵巢扭转也可能导致流向卵巢的血流减少或停止。

Functional cysts

Your ovaries grow small cysts called follicles each month. Follicles produce the hormones estrogen and progesterone and break open to release an egg when you ovulate.

A monthly follicle that keeps growing is known as a functional cyst. There are two types of functional cysts:

  • Follicular cyst. About halfway through your menstrual cycle, an egg bursts out of its follicle. The egg then travels down a fallopian tube. A follicular cyst begins when the follicle doesn't rupture. It doesn't release its egg and continues to grow.
  • Corpus luteum cyst. After a follicle releases its egg, it shrinks and begins producing estrogen and progesterone. These hormones are needed for conception. The follicle is now called the corpus luteum. Sometimes, the opening where the egg came from gets blocked. Fluid builds up inside the corpus luteum, causing a cyst.

Functional cysts are usually harmless. They rarely cause pain and often disappear on their own within 2 to 3 menstrual cycles.

Other cysts

There are other types of cysts that are not related to menstrual cycles:

  • Dermoid cyst. Also called a teratoma, this cyst forms from reproductive cells that make eggs in the ovary (germ cells). The cyst can contain tissue, such as hair, skin or teeth. This type of cyst is rarely cancer.
  • Cystadenoma. This type of cyst develops from cells on the surface of an ovary. The cyst might be filled with a watery or mucous material. A cystadenoma can grow very large.
  • Endometrioma. Endometriosis is a condition that causes cells similar to those that line the inside of the uterus to grow outside the uterus. Some of the tissue can attach to the ovary and form a cyst. This is called an endometrioma.

Dermoid cysts and cystadenomas can become large and move the ovary out of position. This increases the chance of painful twisting of the ovary, called ovarian torsion. Ovarian torsion may reduce or stop blood flow to the ovary.

视频:排卵

排卵是指从一个卵巢中释放出一颗卵子。它通常发生于月经周期的中期,但具体时间可能有差异。

准备排卵期间,子宫内膜变厚。大脑中的垂体腺刺激其中一个卵巢释放卵子。卵巢表面的卵泡壁破裂。卵子排出。

指状结构的菌毛将卵子扫入临近的输卵管。卵子经过输卵管,输卵管壁反复收缩,在一定程度上推动卵子。卵子可能在输卵管内结合精子受精。

如果卵子受精成功,卵子和精子会结合形成一个单细胞实体,称为受精卵。当受精卵沿着输卵管向子宫移动时,它开始迅速分裂,形成一簇称为胚泡的细胞,看上去像一颗小小的覆盆子。胚泡到达子宫后着床于子宫内膜,受孕开始。

未受精的卵子会被身体吸收,甚至可能没到达子宫之前就被吸收。约两周后,子宫内膜经阴道脱落。这就是月经。

风险因素

形成卵巢囊肿的风险因以下情况提高:

  • 激素问题。包括服用促排卵生育药克罗米芬 (Clomid)。
  • 怀孕。有时,您排卵时形成的囊肿在整个孕期停留在卵巢上。
  • 子宫内膜异位症。这种病导致子宫内膜细胞在子宫外生长。其中一些组织会附着到卵巢上并形成生长物。
  • 盆腔重度感染。如果感染扩散到卵巢,会导致囊肿。
  • 陈旧性卵巢囊肿。如果您曾得过囊肿,则可能形成更多囊肿。

并发症

有些女性在盆腔检查时发现不太常见的囊肿。绝经后发生的囊性卵巢肿块可能为癌性(恶性)。所以定期做盆腔检查很重要。

与卵巢囊肿相关的罕见并发症包括:

  • 卵巢扭转。囊肿增大会导致卵巢移动,增加卵巢疼痛性扭转(卵巢扭转)的几率。症状可能包括突然发生的重度盆腔痛、恶心和呕吐。卵巢扭转也可使流向卵巢的血流减少或停止。
  • 破裂。囊肿破裂可引起剧烈疼痛和内部出血。囊肿越大,破裂风险越大。影响骨盆的剧烈活动(例如阴道性交)也会增加风险。

预防

虽然没有办法预防卵巢囊肿,但定期的盆腔检查有助于尽早诊断卵巢的变化。注意您每月经期的变化,包括异常经期症状,尤其是持续几个周期以上的症状。将令您感到担忧的变化告知您的医生。

Aug. 06, 2022
  1. FAQs: Ovarian cysts. American College of Obstetricians and Gynecologists. https://www.acog.org/womens-health/faqs/ovarian-cysts. Accessed April 9, 2022.
  2. Ovarian cysts. Office on Women's Health. https://www.womenshealth.gov/a-z-topics/ovarian-cysts. Accessed April 9, 2022.
  3. Muto MG. Approach to the patient with an adnexal mass. https://www.uptodate.com/contents/search. Accessed April 9, 2022.
  4. Sharp HT. Evaluation and management of ruptured ovarian cyst. https://www.uptodate.com/contents/search. Accessed April 9, 2022.
  5. Hochberg L, et al. Types of adnexal masses. https://www.uptodate.com/contents/search. Accessed April 9, 2022.
  6. American College of Obstetricians and Gynecologists. Practice Bulletin No. 174: Evaluation and management of adnexal masses. Obstetrics & Gynecology. 2016; doi:10.1097/AOG.0000000000001768.
  7. Burnett TL (expert opinion). Mayo Clinic. April 15, 2022.