摘要
目的:探讨卵巢子宫内膜异位囊肿(OEMC)患者腹腔镜术后复发危险因素及风险模型。方法:回顾性收集2018年7月-2021年8月在芜湖市第一人民医院及华东师范大学附属芜湖医院就诊的OEMC患者165例,均行保守性腹腔镜卵巢囊肿剥除术,依据术后3年内复发情况分为复发组(41例)与未复发组(124例)。收集患者年龄、美国生殖医学学会(ASRM)分期、术前D-二聚体(D-D)、术前系统性免疫炎症指数(SII)等资料,logistic回归分析OEMC患者腹腔镜术后复发影响因素并据此构建列线图风险模型,受试者工作特征(ROC)曲线评价该风险模型的预测效能,H-L检验该模型的校准能力。结果:OEMC患者术后3年内复发率24.9%(41/165)。logistic回归结果显示,年龄小、ASRM分期Ⅲ~Ⅳ期、术前D-D水平升高、术前SII升高、术后未用药是OEMC患者腹腔镜术后复发的影响因素。绘制ROC曲线显示,列线图风险模型预测OEMC患者腹腔镜术后复发的曲线下面积为0.907,预测灵敏度85.4%、特异度83.9%;H-L拟合优度检验显示该风险模型与实际观测值比较无统计学意义(P>0.05)。结论:年龄小、ASRM分期Ⅲ~Ⅳ期、术前D-D升高、术前SII升高、术后未用药是OEMC患者腹腔镜术后复发影响因素,据此构建的列线图风险模型具有较好的预测效能与校准度,可用于临床早期评估与针对性管理。
Objective: To investigate the risk factors and the risk model of the ovarian endometriosis cyst(OEMC) recurrence of patients after laparoscopic surgery. Methods: 165 patients with OEMC whom had undergone conservative laparoscopic ovarian cyst removal in the hospital from July 2018 to August 2021 were collected in this study retrospectively. These patients were divided into group A(41 cases with the recurrence of OEMC) and group B(124 cases without the recurrence of OEMC) according to the OEMC recurrence situation of the patients within 3 years after surgery. The data, such as the age, the stage of OEMC evaluated by American society for reproductive medicine(ASRM), the level of preoperative D-dimer(D-D) and the preoperative systemic immune inflammation index(SII) value of the patients in the two groups were collected. Logistic regression analysis was performed to analyze the factors affecting the recurrence of OEMC of the patients after laparoscopic surgery, and a nomogram risk model was constructed according to these influencing factors. Receiver operating characteristic(ROC) curve was used to evaluate the prediction efficiency of the risk model for the OEMC recurrence of the patients, and H-L tested was used to identify the calibration ability of the model. Results: The recurrence rate of OEMC of the patients within 3 years after surgery was 24.9%(41/165). Logistic regression results showed that the younger age, the ASRM staging Ⅲ-Ⅳ, the high preoperative D-D level, the increased preoperative SII value, and no medication used after surgery of the patients were the influencing factors of their OEMC recurrence after laparoscopic surgery.The drawn ROC curve showed that the area under the curve,the sensitivity and the specificity of the nomogram risk model for predicting the OEMC recurrence of the patients after laparoscopic surgery were 0.907,85.4% and 83.9%,respectively.H-L goodness-of-fit test showed that there was no significant difference between the prediction of the risk model and the actual observed value(P>0.05).Conclusion:The age,the ASRM staging Ⅲ-Ⅳ,the increased preoperative D-D level and the preoperative SII value,and no postoperative medication used of the patients are the factors influencing their OEMC recurrence after laparoscopic surgery,and the risk model constructed based on these influencing factors has good predictive efficacy and calibration degree,and which can be used for the early clinical assessment and the targeted management for the patients with OEMC after laparoscopic surgery.
作者
岳艳
谢德玲
YUE Yan;XIE Deling(Wuhu First People's Hospital,Wuhu,Anhui Province,241000;Wuhu Hospital Affiliated to East China Normal University,Wuhu,Anhui Province.)
出处
《中国计划生育学杂志》
2025年第2期404-408,共5页
Chinese Journal of Family Planning
基金
芜湖市第一人民医院院内科研(2022WYY047N)
华东师范大学附属芜湖医院院内科研(2024-KY-140)。
