Safety and Effectiveness of Ultrasound-Guided Artificial Ascites-Assisted Puncture and Sclerotherapy for Ovarian Cysts

Safety and Effectiveness of Ultrasound-Guided Artificial Ascites-Assisted Puncture and Sclerotherapy for Ovarian Cysts | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Safety and Effectiveness of Ultrasound-Guided Artificial Ascites-Assisted Puncture and Sclerotherapy for Ovarian Cysts Bin Meng, Xiaotao Wang, Qian Li, Mingmin Xu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4941075/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Ovarian cysts are a common gynecological condition that can cause significant morbidity. Ultrasound-guided sclerotherapy is a minimally invasive treatment option. This study aims to assess the safety and effectiveness of ultrasound-guided artificial ascites-assisted puncture and sclerotherapy for ovarian cysts. Methods A retrospective analysis was conducted on 100 ovarian cyst patients treated from January 2019 to June 2023 at Zhejiang Rongjun Hospital. Patients were divided into observation (44 cases) and control (56 cases) groups based on the use of artificial ascites. The primary endpoints included the incidence of pain and vagal reflex during and after surgery, and the cure rate and effective rate of sclerotherapy assessed by ultrasound at 3, 6, and 12 months post-treatment. Results The observation group experienced significantly lower rates of pain (11.36%) and vagal reflexes (4.55%) compared to the control group (35.71% and 25.00% respectively, P < 0.01). The cure rate was 93.18% in the observation group and 82.14% in the control group (P < 0.05). The effective rate was 100% in the observation group, while it was 91.07% in the control group (P < 0.05). No post-operative infections were observed in either group. Conclusion Ultrasound-guided artificial ascites-assisted puncture and sclerotherapy significantly enhances the safety and efficacy of sclerotherapy for ovarian cysts, reducing complications during and after the procedure. It is recommended for widespread clinical use. Artificial Ascites Ovarian Cysts Sclerotherapy Safety Efficacy Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Ovarian cysts are a common ailment affecting millions of women worldwide, particularly endometriosis-related ovarian cysts, which have seen an increasing incidence in recent years. Approximately 10–15% of women of reproductive age are impacted, affecting their fertility and causing persistent pain and other quality of life issues[ 1 , 2 ]. Recent studies suggest that the prevalence of ovarian cysts has been increasing due to better diagnostic techniques and increased awareness among the population[ 3 , 2 , 4 ]. While laparoscopic surgery is a common treatment known for its minimal invasiveness, it risks damaging ovarian reserve, especially after multiple operations, potentially leading to premature ovarian insufficiency[ 5 – 8 ]. Despite being minimally invasive, laparoscopic surgery may not always be the optimal approach for recurrent cysts due to its potential for significant postoperative adhesions[ 9 – 11 ]. Traditional treatment modalities like laparoscopic surgery, despite their efficacy, pose risks due to their invasive nature and high costs, driving the need for safer and more economical alternatives. Ultrasound-guided cyst sclerotherapy, a less invasive and cheaper method involving the injection of sclerosing agents to reduce cyst size, has proven effective in multiple studies[ 12 – 14 ]. However, this technique has limitations, particularly when cysts are deeply located or near vital organs, increasing the risk of accidental damage and complications such as pain and vagal reflexes[ 15 ]. These complications significantly limit its clinical applicability, and there is a growing interest in techniques that can reduce these risks. Artificial ascites, a technique involving the injection of saline solution into the peritoneal cavity under ultrasound guidance, can improve safety by distancing the target lesion from vital organs and creating a safer path for needle insertion[ 16 , 17 ]. Preliminary studies and clinical practice both domestically and internationally suggest that this method can significantly reduce the risks of intraoperative injuries and decrease pain and vagal reflex incidents, thereby enhancing patient comfort and treatment acceptability[ 15 , 18 ]. Although artificial ascites is widely used in the ablation treatment of liver tumors, existing literature on its use in cyst treatment is scarce, especially regarding prospective controlled studies that conclusively demonstrate its effectiveness. Therefore, this study aims to address this gap by evaluating the safety and efficacy of artificial ascites in ultrasound-guided sclerotherapy for ovarian cysts. Given the promising potential of artificial ascites to improve procedural safety and efficacy, this study will provide valuable insights into its clinical applicability in treating ovarian cysts. methods Study Design This retrospective cohort study analyzed 100 patients who underwent ultrasound-guided sclerotherapy for ovarian cysts at Zhejiang Rongjun Hospital from January 2019 to June 2023. The study aimed to evaluate the effectiveness and safety of artificial ascites in reducing perioperative complications. The data used in this study were derived from historical medical records and did not involve direct intervention on patients; therefore, specific Institutional Review Board (IRB) approval was not required. This research strictly followed standards for data privacy and the anonymization of medical records to ensure the confidentiality and security of participant data. Participants Inclusion criteria Inclusion criteria included women aged 18–50 years diagnosed with ovarian cysts requiring sclerotherapy, without coagulopathy or significant cardiovascular diseases, and with cysts measuring larger than 4 cm in diameter. Exclusion criteria Allergy to medications used in the treatment. Pregnant or breastfeeding women. Patients with suspicious signs of malignant transformation in their cysts based on ultrasound or other imaging studies. Preoperative evaluation of malignancy risk was performed using the Risk of Malignancy Index (RMI) score, which includes serum CA-125 levels, menopausal status, and ultrasound findings. Patients with high RMI scores suggestive of malignancy were excluded from the study. Grouping and Treatment Patients were randomly divided via electronic medical records into two groups: Observation group (44 cases): Received sclerotherapy with artificial ascites. The sclerotherapy procedure was performed under local anesthesia using an ultrasound-guided transabdominal approach. An 18-gauge PTC needle was used for the puncture, allowing precise aspiration of the cyst fluid and subsequent injection of sclerosing agents. Under ultrasound guidance, the puncture path was determined, and 300–500 ml of physiological saline solution was injected into the pelvic cavity to create a safety buffer zone(Fig. 1 , Fig. 2 ). A puncture needle was then precisely inserted into the cyst under ultrasound guidance, and the cyst fluid was aspirated. The cyst cavity was repeatedly flushed with physiological saline until the cyst fluid became clear. The cyst was then flushed 6–8 times with 95% medical ethanol, and finally, 10 ml of polidocanol injection was retained in the cyst cavity as a sclerosing agent. Control group (56 cases): Underwent standard sclerotherapy without artificial ascites. Outcome Measures Primary outcome measures included the incidence of pain and vagal reflex assessed during and within 24 hours post-operation, and the success rate of sclerotherapy evaluated by ultrasound at 3, 6, and 12 months post-treatment to determine treatment efficacy. Pain levels were measured using the Visual Analog Scale (VAS), where patients rated their pain on a scale from 0 (no pain) to 10 (worst possible pain). The incidence of vagal reflex was documented based on clinical symptoms such as bradycardia, hypotension, and syncope observed during the procedure. Sclerotherapy Efficacy Criteria Cured: Complete cyst disappearance, cyst reduction rate > 90%, and clinical symptoms disappear. Significant Effect: Cyst reduction rate 51% − 90%, and clinical symptoms disappear. Generally Effective: Cyst reduction rate ≤ 50%, and clinical symptoms relieved. Ineffective: No cyst reduction or cyst enlargement, and no improvement in clinical symptoms. Statistical analysis Descriptive statistics (mean ± SD for continuous variables, percentages for categorical variables), independent t-tests for continuous variables, chi-square or Fisher's exact tests for categorical data, and logistic regression for multivariate analysis if initial tests showed significant differences. Statistical significance was set at P < 0.05, and all analyses were performed using SPSS 22.0. Results In this study, 100 patients with ovarian cysts were enrolled, divided into the observation group (44 cases) and the control group (56 cases) based on whether artificial ascites was used (Table 1 ). Table 1 Comparative Analysis of Treatment Outcomes Between Observation and Control Groups Indicator Observation Group (%) Control Group (%) P-value Description Age (mean ± SD) 32.1 ± 5.3 31.8 ± 5.6 0.78 Comparable age between groups BMI (mean ± SD) 24.5 ± 3.1 24.2 ± 3.3 0.68 Comparable BMI between groups Endometriosis-related 75 72.3 0.75 Higher distribution of endometriosis-related cysts Non-endometriosis-related 25 27.7 0.75 Lower distribution of non-endometriosis-related cysts Pain Incidence 11.36 35.71 < 0.01 Lower pain incidence indicates better pain management Vagal Reflex Incidence 4.55 25 < 0.01 Significant reduction in vagal reflex incidence with artificial ascites Nausea Incidence 4.5 20 0.05 No post-operative infections in either group Cure Rate 93.18 82.14 < 0.05 Higher cure rate in observation group Effective Rate 100 91.07 < 0.05 Higher effective rate in observation group The observation group had significantly lower incidences of pain (11.36% vs. 35.71%, P < 0.01) and vagal reflexes (4.55% vs. 25.00%, P < 0.01) compared to the control group, highlighting the benefits of artificial ascites in reducing procedural discomfort (Fig. 3 ). VAS Scores Comparison The mean VAS score in the observation group was significantly lower (2.3 ± 0.8) than in the control group (5.2 ± 1.1) (P < 0.01), indicating that artificial ascites can significantly reduce procedural pain (Fig. 4 ). Table 2 Sclerotherapy Efficacy Comparison Between Groups Indicator Observation Group (N = 44) Control Group (N = 56) P-value Cured 41 (93.18%) 46 (82.14%) 0.05 Generally Effective 1 (2.27%) 2 (3.57%) > 0.05 Ineffective 0 (0.0%) 5 (8.93%) < 0.05 Discussion Our study demonstrated that artificial ascites significantly reduced pain and vagal reflex incidence during ultrasound-guided percutaneous sclerotherapy for ovarian cysts. This finding aligns with previous studies highlighting the benefits of creating a physical separation between the target area and surrounding tissues to minimize complications[ 15 ]. The high success rate of sclerotherapy in both groups confirms the efficacy of this minimally invasive technique. However, the observation group, which utilized artificial ascites, showed a higher cure rate and effective rate, suggesting that artificial ascites may enhance the effectiveness of sclerotherapy. The reduced pain incidence and severity, along with the lower rate of vagal reflexes in the observation group, likely contributed to more complete and successful treatments. Pain and vagal reflexes can lead to incomplete or failed procedures; by minimizing these complications, artificial ascites ensures smoother and more effective sclerotherapy. Effectiveness in Pain Reduction The significant reduction in VAS scores in the observation group compared to the control group (2.3 vs. 5.2, P < 0.01) supports the notion that artificial ascites can mitigate pain during and after sclerotherapy. The most probable mechanism is that the physiological saline solution rapidly dilutes the sclerosing agent that leaks from the puncture site, thereby reducing its irritative symptoms and minimizing direct tissue irritation and mechanical stimulation. This aligns with previous findings by Meng et al. who observed similar reductions in pain incidence using this technique[ 15 , 19 , 20 ]. A similar reduction in procedural pain has been observed in artificial ascites-assisted radiofrequency ablation (RFA) for hepatic tumors[ 18 ]. The use of artificial ascites provided a safer distance between the liver and adjacent organs, thereby minimizing collateral damage during RFA and reducing postoperative pain[ 21 – 23 , 20 ]. Nausea and Infection Rates The incidence of nausea was recorded as a symptom often accompanying vagal reflex. In our study, patients who experienced vagal reflex also reported nausea. The observation group had a significantly lower incidence of nausea compared to the control group, consistent with the reduced vagal reflex incidence. Additionally, our study found that the post-operative infection rate was 0% in both groups, indicating that the use of artificial ascites does not increase the risk of infection. Effectiveness in Sclerotherapy Efficacy The efficacy comparison between the observation and control groups at 3, 6, and 12 months post-treatment showed that both groups had high cure rates (93.18% in the observation group vs. 82.14% in the control group, P < 0.05). The effective rate was also higher in the observation group (100%) compared to the control group (91.07%, P < 0.05). The significant difference in effective rates indicates that the artificial ascites technique likely improves sclerotherapy efficacy by providing a safer puncture path and reducing sclerosing agent leakage into surrounding tissues. Meng et al. reported that the use of artificial ascites led to better visualization during puncture and fewer complications [ 15 ]. Reduction of Vagal Reflex Incidence The significant reduction in the incidence of vagal reflex in the observation group suggests that artificial ascites helps to minimize the direct stimulation of the vagus nerve during the procedure. One key mechanism is that the physiological saline solution rapidly dilutes the sclerosing agent that may leak from the puncture site, thereby reducing its irritative symptoms and minimizing direct tissue irritation. This rapid dilution of the sclerosing agent not only mitigates its immediate irritant effects but also prevents the diffusion of the agent to nearby sensitive structures, such as nerves, which could otherwise trigger a vagal reflex. The physical separation created by the artificial ascites also contributes to this protective effect by providing a buffer zone that further minimizes the risk of inadvertent nerve stimulation. Sclerosing Agent Mechanism Both 95% medical ethanol and polidocanol work as sclerosing agents by denaturing the cellular proteins of the cyst wall, impairing its fluid secretion function. This results in sterile inflammation within the cyst cavity, leading to subsequent collapse, atrophy, adhesion, and closure of the cyst wall, which is then absorbed by the body. The chemical action causes the cyst wall cells' proteins to coagulate and degenerate, impairing their ability to secrete fluids. Consequently, sterile inflammation occurs within the cyst cavity, leading to subsequent collapse, atrophy, adhesion, and closure of the cyst wall, which is then absorbed by the body[ 24 – 28 ]. T Thus, this mechanism provides a clear pathophysiological basis for the reduction of ovarian cysts through sclerotherapy. Clinical Implications Given the findings of this study, artificial ascites offers a practical and safe method to improve procedural comfort and efficacy during ultrasound-guided sclerotherapy. This is particularly useful in cases where cysts are located deep within the pelvis or near vital organs, as these situations increase the risk of accidental damage and complications. Moreover, its application can be extended to other minimally invasive abdominal procedures to further enhance patient safety and procedural success. Artificial ascites has potential applications beyond ovarian cyst sclerotherapy. It has been increasingly used in ultrasound-guided ablation treatments for uterine fibroids and adenomyosis. In these procedures, artificial ascites helps to create a clear separation between the target tissue and surrounding organs, such as the bowel and bladder, thereby minimizing the risk of thermal injury to these structures. This technique not only improves the safety of the procedure but also enhances the precision of the ablation. Limitations and Future Directions While encouraging, the retrospective design and the moderate sample size of this study may limit the generalizability of the findings. Future research should include prospective randomized controlled trials to validate the effectiveness of artificial ascites across a broader demographic and explore its potential applications in other minimally invasive abdominal surgeries, such as liver or pancreatic interventions. Additionally, studies should aim to standardize the optimal volume of artificial ascites to maximize safety and efficacy. Furthermore, the physical isolation mechanism of artificial ascites has proven applications in thermal ablation treatments for thyroid nodules and breast nodules, where it is commonly used to protect surrounding tissues by creating a buffer zone with injected fluids. This technique's efficacy in reducing thermal damage to non-target tissues during ablation has been well-documented and is widely accepted in clinical practice[ 29 – 33 ]. However, the application of fluid injection to alleviate conditions caused by constrictive adhesions remains underexplored. Such techniques could potentially be used to relieve compression in conditions like stenosing tenosynovitis, adhesive fasciitis, and peripheral nerve compression caused by surrounding adhesions. These areas represent promising avenues for future research, focusing on developing methods to inject therapeutic fluids that can effectively reduce adhesion and improve mobility without surgery. Initial studies could explore the feasibility, safety, and efficacy of this approach, potentially leading to novel treatments for a range of compressive syndromes. Future Directions Future investigations should aim to expand on these findings by exploring the impact of artificial ascites on different types and sizes of ovarian cysts and potentially extending its use to other surgical contexts to further enhance patient safety and procedural success[ 34 ]. Conclusions This study conclusively demonstrates that ultrasound-guided artificial ascites-assisted puncture and sclerotherapy significantly improve the safety and efficacy of treatment for ovarian cysts. The observation group showed a substantial reduction in the incidence of pain (11.36% vs. 35.71%, P < 0.01) and vagal reflexes (4.55% vs. 25.00%, P < 0.01) compared to the control group. Additionally, the cure rate in the observation group was significantly higher (93.18% vs. 82.14%, P < 0.05), and the effective rate was also notably higher (100% vs. 91.07%, P < 0.05). The observation group also experienced a significantly lower incidence of nausea (4.50% vs. 20.00%, P < 0.01), with no post-operative infections in either group. Given its excellent safety profile and effectiveness, the application of artificial ascites in clinical practice is recommended, particularly for complex cases involving deep-seated or anatomically challenging cysts. This technique can also be explored for other minimally invasive abdominal interventions to further enhance patient safety and procedural success. Abbreviations VAS Visual Analog Scale IRB Institutional Review Board PTC Percutaneous Transhepatic Cholangiography RMI Risk of Malignancy Index BMI Body Mass Index RFA Radiofrequency Ablation Declarations Funding: This research was supported by the Jiaxing Public Welfare Research Plan (Grant No. 2019AY32014). Conflict of Interest: The authors declare that they have no competing interests. Ethical Approval: This study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of Zhejiang Rongjun Hospital. Acknowledgements The authors would like to express their gratitude to the Jiaxing Public Welfare Research Plan for their financial support of this study (Grant No. 2019AY32014). This funding has significantly contributed to the successful completion of the research presented in this paper. Authors' Contributions All authors participated in the design of the study and/or patient enrolment and met the criteria for authorship. Bin Meng and Mingmin Xu contributed to the study design, study conduct and supervision, scientific overview, data analysis, and manuscript editing. Bin Meng was directly involved in the clinical diagnosis of the patients, collected and analyzed the clinical data of the subjects, analyzed the data, and drafted the original manuscript. Xiaotao Wang and Qian Li were involved in the data curation, formal analysis, and investigation. Xiaotao Wang and Qian Li also contributed to the resources and project administration. The manuscript has been substantially revised by Bin Meng and Mingmin Xu. All authors read and approved the final manuscript. Availability of Data and Materials The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. The data used in this study were derived from historical medical records at Zhejiang Rongjun Hospital and all personal identifiers have been removed to ensure patient confidentiality. Ethics Approval and Consent to Participate This study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of Zhejiang Rongjun Hospital. Informed consent was obtained from all participants. Consent for Publication Not applicable. Author Details 1 Department of Interventional Ultrasound, Zhejiang Rongjun Hospital, Jiaxing, China Competing Interests The authors declare that they have no competing interests. References Bareghamyan H, Chopikyan A, Petrosyan M, Shahverdyan N, Harutyunyan A. Influence of ovarian cysts on ovarian reserve and fertility: A case-control study. Int J Gynecol Obstet. 2024;165(2):424–30. Farkas AH, Abumusa H, Rossiter B. Structural Gynecological Disease: Fibroids, Endometriosis, Ovarian Cysts. Med Clin N Am. 2023;107(2):317–28. Senarath S, Ades A, Nanayakkara P. Ovarian cysts in pregnancy: a narrative review. J Obstet Gynaecol. 2021;41(2):169–75. Mobeen S, Apostol R. Ovarian Cyst. 2024. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4941075","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":355812661,"identity":"3efde45f-45c6-4966-99b1-8c8965ad796a","order_by":0,"name":"Bin Meng","email":"","orcid":"","institution":"Zhejiang Rongjun Hospital","correspondingAuthor":false,"prefix":"","firstName":"Bin","middleName":"","lastName":"Meng","suffix":""},{"id":355812662,"identity":"2e50248e-89db-4f88-8f5c-1ca1f1e39229","order_by":1,"name":"Xiaotao Wang","email":"","orcid":"","institution":"Zhejiang Rongjun Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xiaotao","middleName":"","lastName":"Wang","suffix":""},{"id":355812663,"identity":"3a72c28a-6fea-479e-9d7e-5f0caaca571e","order_by":2,"name":"Qian Li","email":"","orcid":"","institution":"Zhejiang Rongjun Hospital","correspondingAuthor":false,"prefix":"","firstName":"Qian","middleName":"","lastName":"Li","suffix":""},{"id":355812664,"identity":"78b9d0c2-95d2-43d9-a503-f96e46a5b062","order_by":3,"name":"Mingmin Xu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAuUlEQVRIiWNgGAWjYDACZhBhAMTsjY0PPpCmhedws+EM0qyTSG+T5iBGoW477+FXNwruJG64+bBBmoHBTk63gYAWs8N8adY5Bs+MDW4nNhgXMCQbmx0gqIXHzDjH4LAcSEvyDIYDiduI1cJjcPNgw2EeIrUYPwbbcoOxsZlYLWbMQC3GkmcSmxlnGBDjl/NnjD/n/Dmc2Hf8+PMfHyrs5AhqAQI2CQTbgLByEGAmLpmMglEwCkbByAUAqgdEneqG5zUAAAAASUVORK5CYII=","orcid":"","institution":"Zhejiang Rongjun Hospital","correspondingAuthor":true,"prefix":"","firstName":"Mingmin","middleName":"","lastName":"Xu","suffix":""}],"badges":[],"createdAt":"2024-08-20 00:17:55","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4941075/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4941075/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":66674824,"identity":"b74ed2ed-c026-4363-861c-062a8c14a45b","added_by":"auto","created_at":"2024-10-15 11:02:04","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":101349,"visible":true,"origin":"","legend":"\u003cp\u003eOvarian cyst obscured by the intestine and omentum in front, leading to poor visualization.\u003c/p\u003e\n\u003cp\u003eUT: Uterus; *: Ovarian cyst location\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4941075/v1/abef93f5710d3ee846102e24.jpg"},{"id":66675962,"identity":"c169a84f-5d10-4a54-8e0c-160dd170aaaa","added_by":"auto","created_at":"2024-10-15 11:10:04","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":113682,"visible":true,"origin":"","legend":"\u003cp\u003eThe ovarian cyst is clearly visualized after the injection of artificial ascites, which pushes away the intestine and omentum.\u003c/p\u003e\n\u003cp\u003eAS: Artificial Ascites; *: Ovarian cyst\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4941075/v1/8e92c9d67e7c2f65b02bff57.jpg"},{"id":66674823,"identity":"1b3f30e6-8d19-40ab-8670-cbf8b9bddec8","added_by":"auto","created_at":"2024-10-15 11:02:04","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":24343,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of pain and vagal reflex incidences between observation and control groups, demonstrating the benefits of artificial ascites in reducing procedural discomfort.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-4941075/v1/a1eb047178032ba465973630.png"},{"id":66674825,"identity":"7b7df6fe-da7a-4a21-9948-7993d4809886","added_by":"auto","created_at":"2024-10-15 11:02:04","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":15142,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of mean VAS scores between observation and control groups, showing the effect of artificial ascites in reducing procedural pain.\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-4941075/v1/2be765b6beaa6e5e8846dd5a.png"},{"id":84979743,"identity":"5f7db8e7-f6b1-4816-89e7-50bb2bab80fc","added_by":"auto","created_at":"2025-06-19 13:08:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1024765,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4941075/v1/6a174ccb-45f8-4e2f-b957-9f5a5da571b2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Safety and Effectiveness of Ultrasound-Guided Artificial Ascites-Assisted Puncture and Sclerotherapy for Ovarian Cysts","fulltext":[{"header":"Background","content":"\u003cp\u003eOvarian cysts are a common ailment affecting millions of women worldwide, particularly endometriosis-related ovarian cysts, which have seen an increasing incidence in recent years. Approximately 10\u0026ndash;15% of women of reproductive age are impacted, affecting their fertility and causing persistent pain and other quality of life issues[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Recent studies suggest that the prevalence of ovarian cysts has been increasing due to better diagnostic techniques and increased awareness among the population[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile laparoscopic surgery is a common treatment known for its minimal invasiveness, it risks damaging ovarian reserve, especially after multiple operations, potentially leading to premature ovarian insufficiency[\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Despite being minimally invasive, laparoscopic surgery may not always be the optimal approach for recurrent cysts due to its potential for significant postoperative adhesions[\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTraditional treatment modalities like laparoscopic surgery, despite their efficacy, pose risks due to their invasive nature and high costs, driving the need for safer and more economical alternatives. Ultrasound-guided cyst sclerotherapy, a less invasive and cheaper method involving the injection of sclerosing agents to reduce cyst size, has proven effective in multiple studies[\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, this technique has limitations, particularly when cysts are deeply located or near vital organs, increasing the risk of accidental damage and complications such as pain and vagal reflexes[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. These complications significantly limit its clinical applicability, and there is a growing interest in techniques that can reduce these risks.\u003c/p\u003e \u003cp\u003eArtificial ascites, a technique involving the injection of saline solution into the peritoneal cavity under ultrasound guidance, can improve safety by distancing the target lesion from vital organs and creating a safer path for needle insertion[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Preliminary studies and clinical practice both domestically and internationally suggest that this method can significantly reduce the risks of intraoperative injuries and decrease pain and vagal reflex incidents, thereby enhancing patient comfort and treatment acceptability[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough artificial ascites is widely used in the ablation treatment of liver tumors, existing literature on its use in cyst treatment is scarce, especially regarding prospective controlled studies that conclusively demonstrate its effectiveness. Therefore, this study aims to address this gap by evaluating the safety and efficacy of artificial ascites in ultrasound-guided sclerotherapy for ovarian cysts. Given the promising potential of artificial ascites to improve procedural safety and efficacy, this study will provide valuable insights into its clinical applicability in treating ovarian cysts.\u003c/p\u003e"},{"header":"methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003e This retrospective cohort study analyzed 100 patients who underwent ultrasound-guided sclerotherapy for ovarian cysts at Zhejiang Rongjun Hospital from January 2019 to June 2023. The study aimed to evaluate the effectiveness and safety of artificial ascites in reducing perioperative complications. The data used in this study were derived from historical medical records and did not involve direct intervention on patients; therefore, specific Institutional Review Board (IRB) approval was not required. This research strictly followed standards for data privacy and the anonymization of medical records to ensure the confidentiality and security of participant data.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003eInclusion criteria\u003c/h2\u003e \u003cp\u003eInclusion criteria included women aged 18\u0026ndash;50 years diagnosed with ovarian cysts requiring sclerotherapy, without coagulopathy or significant cardiovascular diseases, and with cysts measuring larger than 4 cm in diameter.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eExclusion criteria\u003c/h2\u003e \u003cp\u003eAllergy to medications used in the treatment.\u003c/p\u003e \u003cp\u003ePregnant or breastfeeding women.\u003c/p\u003e \u003cp\u003ePatients with suspicious signs of malignant transformation in their cysts based on ultrasound or other imaging studies.\u003c/p\u003e \u003cp\u003ePreoperative evaluation of malignancy risk was performed using the Risk of Malignancy Index (RMI) score, which includes serum CA-125 levels, menopausal status, and ultrasound findings. Patients with high RMI scores suggestive of malignancy were excluded from the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003eGrouping and Treatment\u003c/h2\u003e \u003cp\u003ePatients were randomly divided via electronic medical records into two groups:\u003c/p\u003e \u003cp\u003eObservation group (44 cases): Received sclerotherapy with artificial ascites.\u003c/p\u003e \u003cp\u003eThe sclerotherapy procedure was performed under local anesthesia using an ultrasound-guided transabdominal approach. An 18-gauge PTC needle was used for the puncture, allowing precise aspiration of the cyst fluid and subsequent injection of sclerosing agents. Under ultrasound guidance, the puncture path was determined, and 300\u0026ndash;500 ml of physiological saline solution was injected into the pelvic cavity to create a safety buffer zone(Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). A puncture needle was then precisely inserted into the cyst under ultrasound guidance, and the cyst fluid was aspirated. The cyst cavity was repeatedly flushed with physiological saline until the cyst fluid became clear. The cyst was then flushed 6\u0026ndash;8 times with 95% medical ethanol, and finally, 10 ml of polidocanol injection was retained in the cyst cavity as a sclerosing agent.\u003c/p\u003e \u003cp\u003eControl group (56 cases): Underwent standard sclerotherapy without artificial ascites.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eOutcome Measures\u003c/h2\u003e \u003cp\u003ePrimary outcome measures included the incidence of pain and vagal reflex assessed during and within 24 hours post-operation, and the success rate of sclerotherapy evaluated by ultrasound at 3, 6, and 12 months post-treatment to determine treatment efficacy. Pain levels were measured using the Visual Analog Scale (VAS), where patients rated their pain on a scale from 0 (no pain) to 10 (worst possible pain). The incidence of vagal reflex was documented based on clinical symptoms such as bradycardia, hypotension, and syncope observed during the procedure.\u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eSclerotherapy Efficacy Criteria\u003c/h2\u003e \u003cp\u003eCured: Complete cyst disappearance, cyst reduction rate\u0026thinsp;\u0026gt;\u0026thinsp;90%, and clinical symptoms disappear.\u003c/p\u003e \u003cp\u003eSignificant Effect: Cyst reduction rate 51% \u0026minus;\u0026thinsp;90%, and clinical symptoms disappear.\u003c/p\u003e \u003cp\u003eGenerally Effective: Cyst reduction rate\u0026thinsp;\u0026le;\u0026thinsp;50%, and clinical symptoms relieved.\u003c/p\u003e \u003cp\u003eIneffective: No cyst reduction or cyst enlargement, and no improvement in clinical symptoms.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD for continuous variables, percentages for categorical variables), independent t-tests for continuous variables, chi-square or Fisher's exact tests for categorical data, and logistic regression for multivariate analysis if initial tests showed significant differences. Statistical significance was set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, and all analyses were performed using SPSS 22.0.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eIn this study, 100 patients with ovarian cysts were enrolled, divided into the observation group (44 cases) and the control group (56 cases) based on whether artificial ascites was used (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparative Analysis of Treatment Outcomes Between Observation and Control Groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndicator\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObservation Group (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl Group (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDescription\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.8\u0026thinsp;\u0026plusmn;\u0026thinsp;5.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eComparable age between groups\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eComparable BMI between groups\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndometriosis-related\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHigher distribution of endometriosis-related cysts\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-endometriosis-related\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLower distribution of non-endometriosis-related cysts\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain Incidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLower pain incidence indicates better pain management\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVagal Reflex Incidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSignificant reduction in vagal reflex incidence with artificial ascites\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNausea Incidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSignificant reduction in nausea incidence with artificial ascites\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfection Rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo post-operative infections in either group\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCure Rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e93.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHigher cure rate in observation group\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEffective Rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHigher effective rate in observation group\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe observation group had significantly lower incidences of pain (11.36% vs. 35.71%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and vagal reflexes (4.55% vs. 25.00%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) compared to the control group, highlighting the benefits of artificial ascites in reducing procedural discomfort (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eVAS Scores Comparison\u003c/h2\u003e \u003cp\u003eThe mean VAS score in the observation group was significantly lower (2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8) than in the control group (5.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), indicating that artificial ascites can significantly reduce procedural pain (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSclerotherapy Efficacy Comparison Between Groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndicator\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObservation Group (N\u0026thinsp;=\u0026thinsp;44)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl Group (N\u0026thinsp;=\u0026thinsp;56)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCured\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41 (93.18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46 (82.14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSignificant Effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (4.55%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (5.36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGenerally Effective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (2.27%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (3.57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIneffective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (8.93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study demonstrated that artificial ascites significantly reduced pain and vagal reflex incidence during ultrasound-guided percutaneous sclerotherapy for ovarian cysts. This finding aligns with previous studies highlighting the benefits of creating a physical separation between the target area and surrounding tissues to minimize complications[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The high success rate of sclerotherapy in both groups confirms the efficacy of this minimally invasive technique. However, the observation group, which utilized artificial ascites, showed a higher cure rate and effective rate, suggesting that artificial ascites may enhance the effectiveness of sclerotherapy. The reduced pain incidence and severity, along with the lower rate of vagal reflexes in the observation group, likely contributed to more complete and successful treatments. Pain and vagal reflexes can lead to incomplete or failed procedures; by minimizing these complications, artificial ascites ensures smoother and more effective sclerotherapy.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eEffectiveness in Pain Reduction\u003c/h2\u003e \u003cp\u003eThe significant reduction in VAS scores in the observation group compared to the control group (2.3 vs. 5.2, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) supports the notion that artificial ascites can mitigate pain during and after sclerotherapy. The most probable mechanism is that the physiological saline solution rapidly dilutes the sclerosing agent that leaks from the puncture site, thereby reducing its irritative symptoms and minimizing direct tissue irritation and mechanical stimulation. This aligns with previous findings by Meng et al. who observed similar reductions in pain incidence using this technique[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. A similar reduction in procedural pain has been observed in artificial ascites-assisted radiofrequency ablation (RFA) for hepatic tumors[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The use of artificial ascites provided a safer distance between the liver and adjacent organs, thereby minimizing collateral damage during RFA and reducing postoperative pain[\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eNausea and Infection Rates\u003c/h2\u003e \u003cp\u003eThe incidence of nausea was recorded as a symptom often accompanying vagal reflex. In our study, patients who experienced vagal reflex also reported nausea. The observation group had a significantly lower incidence of nausea compared to the control group, consistent with the reduced vagal reflex incidence. Additionally, our study found that the post-operative infection rate was 0% in both groups, indicating that the use of artificial ascites does not increase the risk of infection.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eEffectiveness in Sclerotherapy Efficacy\u003c/h2\u003e \u003cp\u003eThe efficacy comparison between the observation and control groups at 3, 6, and 12 months post-treatment showed that both groups had high cure rates (93.18% in the observation group vs. 82.14% in the control group, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The effective rate was also higher in the observation group (100%) compared to the control group (91.07%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The significant difference in effective rates indicates that the artificial ascites technique likely improves sclerotherapy efficacy by providing a safer puncture path and reducing sclerosing agent leakage into surrounding tissues. Meng et al. reported that the use of artificial ascites led to better visualization during puncture and fewer complications [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eReduction of Vagal Reflex Incidence\u003c/h2\u003e \u003cp\u003eThe significant reduction in the incidence of vagal reflex in the observation group suggests that artificial ascites helps to minimize the direct stimulation of the vagus nerve during the procedure. One key mechanism is that the physiological saline solution rapidly dilutes the sclerosing agent that may leak from the puncture site, thereby reducing its irritative symptoms and minimizing direct tissue irritation. This rapid dilution of the sclerosing agent not only mitigates its immediate irritant effects but also prevents the diffusion of the agent to nearby sensitive structures, such as nerves, which could otherwise trigger a vagal reflex. The physical separation created by the artificial ascites also contributes to this protective effect by providing a buffer zone that further minimizes the risk of inadvertent nerve stimulation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eSclerosing Agent Mechanism\u003c/h2\u003e \u003cp\u003eBoth 95% medical ethanol and polidocanol work as sclerosing agents by denaturing the cellular proteins of the cyst wall, impairing its fluid secretion function. This results in sterile inflammation within the cyst cavity, leading to subsequent collapse, atrophy, adhesion, and closure of the cyst wall, which is then absorbed by the body. The chemical action causes the cyst wall cells' proteins to coagulate and degenerate, impairing their ability to secrete fluids. Consequently, sterile inflammation occurs within the cyst cavity, leading to subsequent collapse, atrophy, adhesion, and closure of the cyst wall, which is then absorbed by the body[\u003cspan additionalcitationids=\"CR25 CR26 CR27\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. T Thus, this mechanism provides a clear pathophysiological basis for the reduction of ovarian cysts through sclerotherapy.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eClinical Implications\u003c/h2\u003e \u003cp\u003eGiven the findings of this study, artificial ascites offers a practical and safe method to improve procedural comfort and efficacy during ultrasound-guided sclerotherapy. This is particularly useful in cases where cysts are located deep within the pelvis or near vital organs, as these situations increase the risk of accidental damage and complications. Moreover, its application can be extended to other minimally invasive abdominal procedures to further enhance patient safety and procedural success.\u003c/p\u003e \u003cp\u003eArtificial ascites has potential applications beyond ovarian cyst sclerotherapy. It has been increasingly used in ultrasound-guided ablation treatments for uterine fibroids and adenomyosis. In these procedures, artificial ascites helps to create a clear separation between the target tissue and surrounding organs, such as the bowel and bladder, thereby minimizing the risk of thermal injury to these structures. This technique not only improves the safety of the procedure but also enhances the precision of the ablation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and Future Directions\u003c/h2\u003e \u003cp\u003eWhile encouraging, the retrospective design and the moderate sample size of this study may limit the generalizability of the findings. Future research should include prospective randomized controlled trials to validate the effectiveness of artificial ascites across a broader demographic and explore its potential applications in other minimally invasive abdominal surgeries, such as liver or pancreatic interventions. Additionally, studies should aim to standardize the optimal volume of artificial ascites to maximize safety and efficacy.\u003c/p\u003e \u003cp\u003eFurthermore, the physical isolation mechanism of artificial ascites has proven applications in thermal ablation treatments for thyroid nodules and breast nodules, where it is commonly used to protect surrounding tissues by creating a buffer zone with injected fluids. This technique's efficacy in reducing thermal damage to non-target tissues during ablation has been well-documented and is widely accepted in clinical practice[\u003cspan additionalcitationids=\"CR30 CR31 CR32\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. However, the application of fluid injection to alleviate conditions caused by constrictive adhesions remains underexplored. Such techniques could potentially be used to relieve compression in conditions like stenosing tenosynovitis, adhesive fasciitis, and peripheral nerve compression caused by surrounding adhesions. These areas represent promising avenues for future research, focusing on developing methods to inject therapeutic fluids that can effectively reduce adhesion and improve mobility without surgery. Initial studies could explore the feasibility, safety, and efficacy of this approach, potentially leading to novel treatments for a range of compressive syndromes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eFuture Directions\u003c/h2\u003e \u003cp\u003eFuture investigations should aim to expand on these findings by exploring the impact of artificial ascites on different types and sizes of ovarian cysts and potentially extending its use to other surgical contexts to further enhance patient safety and procedural success[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study conclusively demonstrates that ultrasound-guided artificial ascites-assisted puncture and sclerotherapy significantly improve the safety and efficacy of treatment for ovarian cysts. The observation group showed a substantial reduction in the incidence of pain (11.36% vs. 35.71%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and vagal reflexes (4.55% vs. 25.00%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) compared to the control group. Additionally, the cure rate in the observation group was significantly higher (93.18% vs. 82.14%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and the effective rate was also notably higher (100% vs. 91.07%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The observation group also experienced a significantly lower incidence of nausea (4.50% vs. 20.00%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), with no post-operative infections in either group.\u003c/p\u003e \u003cp\u003eGiven its excellent safety profile and effectiveness, the application of artificial ascites in clinical practice is recommended, particularly for complex cases involving deep-seated or anatomically challenging cysts. This technique can also be explored for other minimally invasive abdominal interventions to further enhance patient safety and procedural success.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVAS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVisual Analog Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIRB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInstitutional Review Board\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePTC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePercutaneous Transhepatic Cholangiography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRisk of Malignancy Index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBody Mass Index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRFA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRadiofrequency Ablation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis research was supported by the Jiaxing Public Welfare Research Plan (Grant No. 2019AY32014).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval:\u0026nbsp;\u003c/strong\u003eThis study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of Zhejiang Rongjun Hospital.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to express their gratitude to the Jiaxing Public Welfare Research Plan for their financial support of this study (Grant No. 2019AY32014). This funding has significantly contributed to the successful completion of the research presented in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors participated in the design of the study and/or patient enrolment and met the criteria for authorship. Bin Meng and Mingmin Xu contributed to the study design, study conduct and supervision, scientific overview, data analysis, and manuscript editing. Bin Meng was directly involved in the clinical diagnosis of the patients, collected and analyzed the clinical data of the subjects, analyzed the data, and drafted the original manuscript. Xiaotao Wang and Qian Li were involved in the data curation, formal analysis, and investigation. Xiaotao Wang and Qian Li also contributed to the resources and project administration. The manuscript has been substantially revised by Bin Meng and Mingmin Xu. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. The data used in this study were derived from historical medical records at Zhejiang Rongjun Hospital and all personal identifiers have been removed to ensure patient confidentiality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of Zhejiang Rongjun Hospital. Informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1 Department of Interventional Ultrasound, Zhejiang Rongjun Hospital, Jiaxing, China\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBareghamyan H, Chopikyan A, Petrosyan M, Shahverdyan N, Harutyunyan A. Influence of ovarian cysts on ovarian reserve and fertility: A case-control study. Int J Gynecol Obstet. 2024;165(2):424\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFarkas AH, Abumusa H, Rossiter B. 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Int J Hyperther. 2021;38(1):461\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNdhlovu E, Zhang BX, Chen XP, Zhu P. Thermal ablation for hepatic tumors in high-risk locations. Clin Res Hepatol Gas. 2024;48(3):102300.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRhim H, Lim HK, Kim YS, Choi D. Percutaneous radiofrequency ablation with artificial ascites for hepatocellular carcinoma in the hepatic dome: initial experience. Am J Roentgenol. 2008;190(1):91\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang Y, Zhang L, Li Y, Wang W. Computed tomography-guided percutaneous microwave ablation with artificial ascites for problematic hepatocellular tumors. Int J Hyperther. 2020;37(1):256\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim GH, Kim PH, Shin JH, Nam IC, Chu HH, Ko HK. 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Ultrasound-Guided Thermal Ablation of Thyroid Nodules: Technicalities Progress and Clinical Applications, Especially in Malignant Thyroid Nodules. Front Oncol. 2021;11:761005.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu C, Yu Q, Wang M, et al. Efficacy and safety of microwave ablation for benign breast lesions: a systematic review and meta-analysis. Videosurgery Miniinv. 2022;17(3):418\u0026ndash;29.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang J, Li H, Lin L, Lu J, Wang H. Ultrasound-guided microwave ablation for multiple benign breast lesions: A prospective study. J Obstet Gynaecol Re. 2021;47(9):3362\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKarube M, Murakami N, Okamoto H, et al. Transvaginal artificial ascites infusion as a spacer in gynecological brachytherapy: a novel technique. J Contemp Brachyther. 2020;12(5):487\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Artificial Ascites, Ovarian Cysts, Sclerotherapy, Safety, Efficacy","lastPublishedDoi":"10.21203/rs.3.rs-4941075/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4941075/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eOvarian cysts are a common gynecological condition that can cause significant morbidity. Ultrasound-guided sclerotherapy is a minimally invasive treatment option. This study aims to assess the safety and effectiveness of ultrasound-guided artificial ascites-assisted puncture and sclerotherapy for ovarian cysts.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective analysis was conducted on 100 ovarian cyst patients treated from January 2019 to June 2023 at Zhejiang Rongjun Hospital. Patients were divided into observation (44 cases) and control (56 cases) groups based on the use of artificial ascites. The primary endpoints included the incidence of pain and vagal reflex during and after surgery, and the cure rate and effective rate of sclerotherapy assessed by ultrasound at 3, 6, and 12 months post-treatment.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe observation group experienced significantly lower rates of pain (11.36%) and vagal reflexes (4.55%) compared to the control group (35.71% and 25.00% respectively, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The cure rate was 93.18% in the observation group and 82.14% in the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The effective rate was 100% in the observation group, while it was 91.07% in the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No post-operative infections were observed in either group.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eUltrasound-guided artificial ascites-assisted puncture and sclerotherapy significantly enhances the safety and efficacy of sclerotherapy for ovarian cysts, reducing complications during and after the procedure. It is recommended for widespread clinical use.\u003c/p\u003e","manuscriptTitle":"Safety and Effectiveness of Ultrasound-Guided Artificial Ascites-Assisted Puncture and Sclerotherapy for Ovarian Cysts","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-15 11:01:59","doi":"10.21203/rs.3.rs-4941075/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"39f36f40-004e-4b3f-bedd-cd7abf8e7e96","owner":[],"postedDate":"October 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-19T13:08:09+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-15 11:01:59","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4941075","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4941075","identity":"rs-4941075","version":["v1"]},"buildId":"B-jG_2CBjPDmsCi4Wdhf-","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}