子宫良性病变全子宫切除术后恶性盆腔包块影响因素分析  

Analysis of related risk factors of malignant pelvic mass after total hysterectomy for benign uterine lesions

作　　者：苑文贺 岳莹利 蔡文慧 刘萍萍[1] 张林东[1] Yuan Wenhe;Yue Yingli;Cai Wenhui;Liu Pingping;Zhang Lindong(Department of Gynaecology,The Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院妇科,郑州450052

出　　处：《河南外科学杂志》2024年第5期27-30,共4页Henan Journal of Surgery

摘　　要：目的探讨子宫良性病变全子宫切除术后盆腔包块的影响因素。方法回顾性分析2017-06—2022-06于郑州大学第三附属医院妇科行全子宫切除术后发生盆腔包块后再次手术的107例子宫良性病变患者的临床资料,根据术后病理结果将良性包块作为A组,将盆腔交界性及恶性包块作为B组。运用单因素、多因素二分类Logistic回归分析发生恶性盆腔包块的影响因素。结果107例患者中,二次手术病理证实为盆腔良性包块76例(71.0%),交界性肿瘤9例(8.4%),恶性肿瘤22例(20.6%)。卵巢子宫内膜异位囊肿23例(21.5%),是最常见的良性包块;浆液性囊腺癌13例(12.1%),是最常见的恶性包块。单因素分析结果显示,2组患者的年龄、既往腹部手术次数、子宫切除至发现盆腔包块间隔时间,以及血清CA199、CA125、HE4水平的差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄较大、子宫切除至发现盆腔包块时间间隔长,以及血清CA125、HE4升高,是发生交界性及恶性肿瘤的独立危险因素(P<0.05)。结论因良性病变行全子宫切除术后发生盆腔良性包块的概率明显高于交界性及恶性包块。患者年龄越大、术后至发生盆腔包块时间间隔越长,交界性及恶性包块的可能性越大,故需密切随访并采取干预措施。CA125、HE4血清学肿瘤标志物可帮助评估盆腔包块的性质,以选择合适的治疗方案。Objective To explore the related risk factors of pelvic mass after total hysterectomy for benign uterine lesions.Methods The clinical data of 107 patients with benign uterine lesions who underwent total hysterectomy and reoperation after total hysterectomy in gynecology department of the Third Affiliated Hospital of Zhengzhou University from June 2017 to June 2022 were retrospectively analyzed.According to the postoperative pathological results,benign mass was taken as group A,and borderline and malignant mass was taken as group B。The related risk factors of malignant pelvic mass were analyzed by univariate,multivariate and Logistic regression.Results In the clinical data of 107 patients who were pathologically confirmed after secondary surgery,the benign pelvic mass accounted for 76 cases(71.0%),the boundary tumors accounted for 9 cases(8.4%),malignant tumor accounted for 22 cases(20.6%).Ovarian endometrioma accounting for 23 cases(21.5%)was the most common pathological type of pelvic mass,and the serous cystadenocarcinoma accounting for 13 cases(12.1%)was the most common pathological type of malignant tumors.The results of univariate analysis showed that there were statistically significant differences in age,number of previous abdominal operations,interval between hysterectomy and discovery of pelvic mass,and serum CA199,CA125 and HE4 levels between the two groups(P<0.05).Multivariate logistic regression analysis showed that older age,longer interval between hysterectomy and pelvic mass,increased serum CA125 and HE4 were independent risk factors for borderline and malignant tumors(P<0.05).Conclusion The probability of pelvic benign mass after hysterectomy for benign lesions is significantly higher than that of borderline and malignant tumors.Because the patients who were older and have a longer interval between surgery and the occurrence of pelvic mass have the higher possibility of borderline and malignant tumors,so the closed follow-up and intervention measures should be taken.Preoperative CA125,HE4 serolo

关 键 词：全子宫切除术后 盆腔包块 危险因素 良性包块 恶性肿瘤 

分 类 号：R713.42[医药卫生—妇产科学]