目的

探讨影响超声引导下医用无水乙醇硬化治疗卵巢子宫内膜异位囊肿疗效的相关因素。

方法

回顾性纳入2022年6月至2023年11月浙江大学附属浙江医院超声医学中心接受超声引导下医用无水乙醇硬化治疗的42个卵巢子宫内膜异位囊肿。根据术后12个月超声随访测量结果，计算囊肿体积缩小率（VRR），随后将患者分为疗效欠佳组（VRR≤50%）和有效组（VRR＞50%）。采用χ²检验和t检验分析比较2组年龄、病程、血清癌抗原12-5（CA12-5）水平、术前囊肿最大径、囊肿基线体积、囊壁厚度、内部回声及是否存在单发的纤细分隔方面的差异，探讨2组间疗效差异可能的影响因素。最终，通过多因素Logistic回归分析构建疗效欠佳的列线图预测模型，并采用受试者操作特征曲线、Hosmer-Lemeshow检验、校准曲线及临床决策曲线对列线图模型效能进行系统验证。

结果

42个囊肿包括疗效欠佳组9个（9/42，21.4%）与有效组33个（33/42，78.6%），囊肿终末体积为分别为（177.64±28.66）cm³、（29.07±4.94）cm³，平均VRR分别为48.09%、85.98%。疗效欠佳组术前囊肿最大径及基线体积大于有效组［（9.43±2.07）cm vs （7.50±1.34）cm；（342.97±165.25）cm³ vs （176.46±88.52）cm³］，血清CA12-5水平亦较高［（71.69±12.78）U/ml vs（56.06±16.11）U/ml］，差异具有统计学意义（t=-3.706，P=0.001；t=-4.326，P＜0.001；t=-2.682，P=0.011）。同时，2组在病程、囊肿内部回声和囊壁厚度方面差异也具有统计学意义（P＜0.05），而2组年龄和囊内分隔比较，差异无统计学意义（P＞0.05）。进一步多因素Logistic回归分析显示，术前囊肿最大径和囊壁厚度≥3 mm是影响疗效的2个独立危险因素（回归系数=0.817、2.149，OR=2.263、8.575，P=0.021、0.033）。基于此构建的列线图模型具有良好的区分度、准确性及临床应用价值。

结论

术前囊肿最大径、囊壁厚度≥3 mm是影响超声引导下医用无水乙醇硬化治疗卵巢子宫内膜异位囊肿疗效的2个独立危险因素。基于此构建的列线图模型可以识别预期疗效欠佳的高风险人群，为临床决策提供参考。

Objective

To identify the factors associated with the ineffectiveness of ultrasoundguided medical anhydrous ethanol sclerotherapy for ovarian endometrial cysts.

Methods

This retrospective study included 42 ovarian endometrial cysts that underwent ultrasound-guided medical anhydrous ethanol sclerotherapy at the Ultrasound Medical Center of Zhejiang Hospital from June 2022 to November 2023.The volume reduction rate （VRR%） of the cysts was calculated based on the ultrasound measurements at the 12-month follow-up. The patients were then divided into an ineffective group （VRR% ≤ 50%） and an effective group （VRR% ＞ 50%）. The χ² test and t-test were employed to compare intergroup differences in age， disease duration， serum cancer antigen 12-5 （CA12-5） levels， initial maximum diameter and volume，cyst wall thickness， internal echogenicity， and presence of fine septa. Multivariate logistic regression analysis was performed to identify risk factors for the ineffectiveness of ultrasound-guided medical anhydrous ethanol sclerotherapy to construct a nomogram model， which was validated by receiver operating characteristic curve analysis， Hosmer-Lemeshow test， calibration curves， and decision curve analysis.

Results

Among the 42 cysts， 9 were in the ineffective group （9/42， 21.4%） and 33 in the effective group （33/42， 78.6%）. Final cyst volumes were （177.64±28.66） cm³ versus （29.07±4.94） cm³ in the ineffective group and effective group， with a mean VRR of 48.09% and 85.98%， respectively. The ineffective group exhibited significantly larger initial maximum diameter ［（9.43±2.07） cm vs （7.50±1.34） cm， t=-3.706， P=0.001］， greater initial volume ［（342.97±165.25） cm³ vs （176.46±88.52） cm³， t=-4.326， P＜0.001］， and higher CA12-5 levels［（71.69±12.78） U/ml vs （56.06±16.11） U/ml， t=-2.682， P=0.011］. Significant intergroup differences were observed in disease duration， internal echogenicity， and cyst wall thickness （P＜0.05） between the two groups， though there was no statistically significant difference in age or intracystic septation （P＞0.05）.Multivariate logistic regression identified initial maximum diameter （odds ratio ［OR］=2.263， P=0.021） and cyst wall thickness ≥ 3 mm （OR=8.575， P=0.033） as independent risk factors. The constructed nomogram demonstrated excellent discrimination （AUC=0.891）， calibration， and clinical applicability.

Conclusion

The initial maximum diameter and cyst wall thickness ≥ 3 mm are independent risk factors for the ineffectiveness of ultrasound-guided medical anhydrous ethanol sclerotherapy of ovarian endometrial cysts. The nomogram model constructed based on these factors can help physicians early identify high-risk patients with poor efficacy.