目的  探讨结肠镜下息肉切除术后复发的危险因素，并基于机器学习算法构建复发风险预警模型，为防治对策提供依据。方法  回顾性收集2018年9月—2023年9月六安市人民医院1 058例初次行无痛结肠镜下息肉切除术患者的临床资料，使用单因素和多因素Logistic回归分析筛选复发危险因素。采用7∶3随机抽样分为训练集和验证集，分别通过决策树、贝叶斯及Logistic回归算法构建预测模型，并以受试者工作特征曲线（ROC）曲线下面积（AUC）、灵敏度、特异度等指标来评估模型效能。结果  单因素分析显示，性别、吸烟、代谢综合征、息肉数量、息肉位置、山田分型、组织病理学类型、切除方式、复查时间、肠息肉直径、手术时间是复发的危险因素（P＜0.05）。多因素分析显示，性别、代谢综合征、息肉数量、息肉直径、肠息肉位置、山田分型、组织学病理类型、切除方式、手术时间均是结肠息肉内镜下切除术后复发的危险因素。模型评估显示，决策树算法、贝叶斯算法、Logistic回归算法的ROC曲线下面积（AUC）分别为0.849、0.818、0.811；灵敏度分别为85.14%、81.62%、79.43%；特异度分别为81.69%、79.45%、74.18%；约登指数分别为0.534、0.551、0.573；95%CI分别为0.810~0.876、0.794~0.860、0.782~0.850；决策树算法模型效能最佳，Logistic回归算法的性能最差。结论  性别、代谢综合征、肠息肉特征（数量、直径、位置等）是术后复发的关键危险因素。决策树模型在风险预测中表现最优，可为临床制定个体化随访策略提供参考。

       Objective  To explore the  risk factors for  recurrence after painless colonoscopic polypectomy and construct a recurrence risk warning model based on machine learning algorithms to provide evidence for prevention and treatment strategies．Methods  A retrospective analysis was conducted on clinical data from 1 058 patients who underwent their first painless colonoscopy-guided polypectomy at our hospital between September 2018 and September 2023．Univariate and multivariate Logistic  regression analyses were performed to identify recurrence risk factors．The dataset was randomly divided into training and validation sets using a 7∶3 ratio．Prediction models were constructed using decision tree，Bayesian，and Logistic regression algorithms，and their performance was evaluated using metrics such as the area under the receiver operating characteristic curve（AUC），sensitivity，specificity，and others．Results  Univariate analysis revealed that gender，smoking，metabolic syndrome，number of polyps，polyp location，Yamada classification，histopathological type，resection method，follow-up time，polyp diameter，and operation duration were risk factors for recurrence（P＜0.05）．Multivariate analysis identified gender，metabolic syndrome，number of polyps，polyp diameter，polyp location，Yamada classification，histopathological type，resection method，and operation duration as independent risk factors for recurrence after endoscopic polypectomy．Model evaluation showed AUC values of 0.849，0.818，and 0.811 for the decision tree，Bayesian，and Logistic regression algorithms，respectively．Sensitivity values were 85.14%，81.62%，and 79.43%；specificity values were 81.69%，79.45%，and 74.18%；Youden’s indices were 0.534，0.551，and 0.573；and 95% confidence intervals（CIs）were 0.810–0.876，0.794–0.860，and 0.782–0.850，respectively．The  decision tree algorithm demonstrated the best predictive performance，while the Logistic regression algorithm performed the least favorably．Conclusions  Gender，metabolic syndrome，and polyp characteristics（number，diameter，location，etc．）are key  risk factors for recurrence after polypectomy．The decision tree algorithm exhibited optimal predictive efficacy，offering valuable insights for developing individualized follow-up strategies in clinical practice．

目的 探讨无痛消化内镜下高频电刀治疗对胃癌前病变的应用效果及复发率的影响。方法 选取甘肃医学院附属医院2017年1月—2020年1月收治的120例胃癌前病变患者进行回顾性分析,依照其手术治疗方案将其分为两组,各60例。对照组采取常规内镜黏膜下剥离术,观察组患者采取无痛消化内镜下高频电刀剥离治疗。对比两组的切除速度、切除面积、治愈性切除率、完全及整块切除率,对患者进行3年随访,记录其复发情况,并对比两组患者并发症情况。结果 两组的切除面积、治愈性切除率、完全切除率及整块切除率对比差异无统计学意义（P>0.05）,观察组切除速度为（27.34±8.58）mm²/min,高于对照组的（15.54±4.52）mm²/min,差异有统计学意义（P<0.05）。两组患者术后3年的总复发率（28.33% vs 30.00%）对比差异无统计学意义（P>0.05）。观察组感染、穿孔等相关并发症发生率为3.33%,低于对照组的15.00%（P<0.05）。结论 无痛消化内镜下高频电刀与常规内镜黏膜下剥离术治疗胃癌前病变相比具有显著疗效。但无痛消化内镜下高频电刀治疗可提升切除速度,降低并发症发生率。

Objective To explore the application effect and recurrence rate of painless endoscopic high-frequency electrocautery on gastric precancerous lesions．Methods A total of 120 patients with precancerous gastric cancer admitted to the Affiliated Hospital of Gansu Medical College from January 2017 to January 2020 were selected for retrospective analysis and divided into two groups according to their surgical treatment plan,with 60 patients in each group．The control group underwent conventional endoscopic submucosal dissection,and the patients in the observation group received painless digestive endoscopic high-frequency electric knife dissection．The resection speed,resection area,curative resection rate,complete and bulk resection rate were compared of the two groups,the patients were followed up for 3 years to record the recurrence rate,and the complications of the two groups of patients were also compared．Results There were no differences in resection area,curative resection rate,complete resection rate and total resection rate between the two groups（P>0.05）．The resection speed in the observation group was（27.34±8.58）mm²/min,which was higher than that in the control group（15.54±4.52）mm²/min（P<0.05）．There was no difference in the total recurrence rate（28.33% vs 30.00%）at 3 years after surgery between the two groups（P>0.05）．The incidence of infection,perforation and other related complications in the observation group was 3.33%,lower than that in the control group（15.00%）（P<0.05）．Conclusion sCompared with conventional endoscopic submucosal dissection,high-frequency electric knife under painless digestive endoscopy has significant efficacy in the treatment of gastric precancerous lesions．However,painless endoscopic high-frequency electrosurgical treatment can improve the resection speed and reduce the incidence of complications such as infection,perforation and bleeding．

目的 比较宫腔镜下子宫内膜息肉切除术(TCRP)后采用地屈孕酮以及少腹逐瘀汤两种不同治疗方法对预防息肉复发的效果。方法 从北京中医药大学深圳医院(龙岗)妇科2019年1月—2020年7月间收治的子宫内膜息肉患者中随机选取150例作为研究对象,采取随机数字表法将患者随机分为对照组、地屈孕酮组和少腹逐瘀汤组,每组各50例。对照组患者实施TCRP治疗,地屈孕酮组实施TCRP+地屈孕酮治疗,少腹逐瘀汤组实施TCRP+地屈孕酮+少腹逐瘀汤治疗,术后对3组患者随访12个月,比较3组患者干预3、6、12个月息肉复发情况、子宫内膜厚度以及不良情况应发生率。结果 治疗第6、12个月时,地屈孕酮组及少腹逐瘀汤组复发率情况均低于对照组(P＜0.05),地屈孕酮组及少腹逐瘀汤组子宫内膜息肉复发率比较差异无统计学意义(P＞0.05)。少腹逐瘀汤组及地屈孕酮组3次复查子宫内膜厚度均小于对照组(P＜0.05);少腹逐瘀汤组治疗12个月时子宫内膜厚度小于地屈孕酮组(P＜0.05)。3组患者不良反应发生率比较,差异不具有统计学意义(P＞0.05)。结论 宫腔镜下息肉切除术后加服少腹逐瘀汤与地屈孕酮片对宫腔镜下子宫内膜息肉切除术后患者进行干预,可有效降低患者子宫内膜息肉复发率,促进患者术后月经恢复正常,且将两者联合应用疗效安全,具有较高的应用价值。

目的 分析早、中期肝细胞癌（HCC）切除术后早期（≤2年）复发的危险因素并探讨术前系统免疫炎症指数（SII）对早、中期HCC术后早期复发的预测价值。方法 回顾性研究2017年10月—2020年10月于我院接受肝癌根治性切除术的238例早中期HCC患者,收集基线资料,通过1∶1倾向性评分匹配（PSM）均衡组间协变量获取早期复发组及未复发组各69例;单因素和多因素Logistic回归分析影响术后早期HCC复发的相关因素,构建列线图模型,临床决策曲线（DCA）评估列线图预测模型在临床的应用效果;受试者操作特征（ROC）曲线评价预测效能,根据最高约登指数确定截断点。结果 单因素及多因素Logistic回归分析结果均提示微血管侵犯（MVI）及术前系统免疫炎症指数（SII）高水平是术后早期复发的独立危险因素;列线图模型有较好的预测效能;ROC曲线计算出SII最佳临界值为696.85×10⁹／L。结论 术前高水平SII可能对预测HCC患者术后早期复发具有潜在价值。

目的 评估内镜下切开联合丝裂霉素C注射治疗复发性食管良性狭窄的疗效和安全性。方法 对2021年6月—2022年5月在厦门大学附属中山医院消化内科接受内镜下切开联合或不联合丝裂霉素C注射的43例复发性食管良性狭窄患者进行回顾性分析,分为切开组与切开联合丝裂霉素C注射组,对比2组间狭窄缓解率、并发症及预防狭窄复发的效果。结果 2组患者均顺利完成治疗,无严重并发症发生。2组患者治疗后狭窄缓解率无显著差异（P>0.05）。随访12个月,切开联合丝裂霉素C注射组在狭窄缓解时长、狭窄复发再次扩张次数及扩张间隔均优于切开组（P<0.05）。结论 内镜下切开联合丝裂霉素C注射治疗安全、有效,虽然治疗后狭窄缓解率与单纯切开无显著差异,但可延长狭窄缓解期,改善狭窄复发后重复扩张的频率及间隔时间。

Objective To evaluate the efficacy and safety of endoscopic incision combined with mitomycin C injection in the treatment of recurrent benign esophageal stenosis．Methods A retrospective analysis was conducted on 43 patients with recurrent benign esophageal stenosis who received endoscopic incision combined with or without mitomycin C injection in the Department of Gastroenterology,Zhongshan Hospital of Xiamen University from June 2021 to May 2022．Patients were divided into incision group and incision combined with mitomycin C injection group．The stenosis remission rate,complications and preventive effect of stenosis recurrence were compared between the two groups．Results All patients in the two groups successfully completed the treatment without serious complications．There was no significant difference in the stenosis remission rate between the two groups after treatment（P>0.05）．In the follow-up 12 months after treatment,incision combined with mitomycin C injection group was better than incision group in the duration of stenosis remission,the number of stenosis recurrence and dilation interval（P<0.05）．Conclusions Endoscopic incision combined with mitomycin C injection is safe and effective．Although the remission rate of stenosis after treatment is not significantly different from that of incision alone,it can prolong the remission period of stenosis and improve the frequency and interval of repeated dilation after stenosis recurrence．

目的 统计分析Ⅲ型食管闭锁与食管气管瘘(esophageal atresia and tracheoesophageal fistula,EA-TEF)术后气管食管瘘复发(recurrent tracheoesophageal fistula,RTEF)的高危因素,并计算高危因素预测RTEF的能力。方法 回顾分析2015年9月—2021年1 月我院EA-TEF患儿的临床资料,并根据术后是否气管食管瘘复发分成复发组(recurrent组,R组)及无复发组(not recurrent组,NR组),比较两组患儿的基本情况、开放手术或胸腔镜手术、手术时间、气管食管瘘结扎方式等术中情况,统计分析RTEF的高危因素,分析其预测RTEF的能力。结果 研究期间共纳入Ⅲ型食管闭锁患儿154例,男98例,女56 例,R组11例,NR组143例,单因素对比分析R组与NR组患儿除吻合口瘘外其余均无统计学差异,其中R组吻合口瘘6人,占该组54.55%;NR组13人,占该组9.10%,P<0.001;Logistic回归模型调整后可见有吻合口瘘相对于无吻合口瘘发生RTEF的风险增加12倍(OR=12.000,95%CI:3.216~44.771)。结论 RTEF与患儿基本情况、术中情况无关,与吻合口瘘显著相关,且有吻合口瘘的患儿出现RTEF风险是无吻合口瘘患儿的12倍。

Objective To statistical analyze the high-risk factors of recurrent tracheoesophageal fistula (RTEF) after the repair of type Ⅲ esophageal atresia and tracheoesophageal fistula (EA-TEF),and evaluate the ability of these high-risk factors predicting RTEF. Methods Retrospectively analyzed the clinical data of children with type Ⅲ EA-TEF in our hospital from September 2015 to January 2021. Patients were divided into two groups (recurrent and non-recurrent group,R and NR group) according to whether there was RTEF. The general situation of those patients, situation during surgery like open or thoracoscopic surgery,operation time,method of tracheoesophageal fistula ligation were compared. Those factors of two groups were analyzed, the high-risk factors of RTEF were summarized, and Logistic regression analysis on the high-risk factors was performed to analyze the ability of predicting RTEF. Results A total of 154 infants with type Ⅲ EA-TEF were included in the study, 98 males, 56 females. There were 11 cases in R group, 143 cases in NR group. Univariate comparative analysis was carried out on R group and NR group, and no statistical differences were found except in anastomotic fistula. There were 6 patients in R group with anastomotic fistula, accounting for 54.55%, and 13 patients in NR group, accounting for 9.10%,P< 0.001. After adjusting the Logistic regression model with the high-risk factors, there was 12-fold increase in the risk of RTEF with anastomotic fistula (OR=12.000, 95%CI: 3.216~44.771) compared with no anastomotic fistula. Conclusion RTEF was not related to patients' general situation or surgery situation, but significantly related to anastomotic fistula. Patients who with anastomotic fistula had a 12-fold increase in the risk of RTEF compared with no anastomotic fistula.

目的 本文主要探讨信迪利单抗联合化疗治疗复发转移食管癌的临床有效性和安全性。方法 选取2018年1月—2020年1月我院收治的复发转移食管癌患者共98例纳入研究。按照随机数字表法将患者分为对照组(49例)和观察组(49例),对照组给予多西他赛75 mg/m²+顺铂75 mg/m²治疗,观察组在对照组的基础上给予信迪利单抗(200 mg)治疗,分析比较2组临床疗效及不良反应,主要评估指标是随访期间患者中位生存时间。结果 观察组临床治疗有效率高于对照组(P<0.05);与治疗前比较,2组治疗后血清糖类抗原-199(CA-199)、癌胚抗原(CEA)及肿瘤特异生长因子(TSGF)水平均降低(P<0.05);与对照组比较,观察组治疗后血清CA-199 、CEA及TSGF水平降低(P<0.05);2组临床不良反应主要以恶心呕吐、皮疹等为主,观察组免疫相关不良事件发生率高于对照组(P<0.05),但总不良反应发生率比较无差异(P>0.05);随访至2020年10月,观察组中位OS为16个月(5～27个月),对照组中位总生存期(OS)为9个月(3～23个月),观察组中位OS长于对照组(P<0.001)。结论 信迪利单抗联合化疗可提高复发转移食管癌的临床治疗效果,降低肿瘤抗原水平,延长患者生存时间,且临床较为安全。

目的 探究阿司匹林联合低分子肝素治疗高凝状态复发性流产(RSA)的临床效果。方法 选择2018年9月—2019年9月我院收治的80例高凝状态RSA患者,随机分为两组,各40例。比较两组胎儿的结局情况;比较两组治疗前、妊娠12周后D-二聚体、血小板聚集率;比较两组用药安全性。结果 观察组足月产率、活产率高于对照组,流产率低于对照组,差异有统计学意义(P＜0.05);治疗后,观察组D-二聚体、血小板聚集率均低于对照组,差异有统计学意义(P＜0.05);两组不良反应率之间,差异无统计学意义(P＞0.05)。结论 阿司匹林、低分子肝素联合治疗高凝状态RSA的效果显著,可以改善胎儿结局,降低D-二聚体、血小板聚集率,改善孕妇机体高凝状态,且安全性高。

目的 分析芳香化酶(CYP19)基因多态性与子宫内膜异位症(endometriosis,EMs)术后复发的关系。方法 回顾性分析2019年2月—2020年2月于我院接受手术的110例EMs患者临床资料,按照术后12个月是否复发分为未复发组(62例)、复发组(48例),通过聚合酶链反应-限制性片段长度多态性(PCR-RFLP)技术测定两组CYP19基因115T/C、240A/G、1531C/T位点的单核苷酸多态性(single nucletide polymorphism,SNP),并分析不同位点对应VAS评分、r-AFS评分的差异。结果 复发组CYP19基因115T/C、1531C/T位点不同基因型及等位基因频率与未复发组相比,差异均无统计学意义(P＞0.05);复发组CYP19基因240A/G位点AG基因型频率比未复发组高(P＜0.05),AA基因型频率比未复发组低(P＜0.05);两组240A/G位点等位基因频率相比,差异有统计学意义(P＜0.05);CYP19基因240A/G位点AG 型VAS评分、r-AFS评分＞GG型＞AA型,差异有统计学意义(P＜0.05);CYP19基因115T/C、1531C/T位点不同基因型的VAS评分、r-AFS评分相比,差异均无统计学意义(P＞0.05)。结论 CYP19基因240A/G位点多态性与EMs术后复发、疼痛程度及病情密切相关,且携带G等位基因的基因型(AG+GG)可能是术后复发的风险因素。

Objective To analyze the relationship between aromatase (CYP19) gene polymorphism and recurrence of endometriosis (EMs) after surgery. Methods The clinical data of 110 patients with EMs who underwent the operation in our hospital from February 2019 to February 2020 were analyzed retrospectively. The patients were divided into non-relapsing group (62 cases) and relapsing group (48 cases) by 12 months followed-up outcomes. The single nucleotide polymorphism (SNP) of 115T/C, 240A/G and 1531C/T sites of CYP19 gene were detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), and the differences of VAS and r-AFS scores between the two groups were analyzed. Results The genotypes and allele frequencies of 115T/C and 1531C/T of CYP19 gene in relapsing group were not significantly different from those in non-relapsing group (P>0.05). The AG genotype frequency of 240A/G site of CYP19 gene in relapsing group was higher than that in non-relapsing group (P<0.05), while the AA genotype frequency was significantly lower than that in non-relapsing group (P<0.05). There were significant differences in the allele frequencies of 240A/G site (P<0.05). The scores of VAS and r-AFS of AG＞GG＞AA, with significant differences (P<0.05). There were no significant differences in the VAS and r-AFS scores of CYP19 gene at 115T/C and 1531C/T site (P>0.05). Conclusion The 240A/G polymorphism of the CYP19 gene is closely related to postoperative recurrence, pain degree and condition of EMs, and the genotypes carrying the G allele (AG+GG) may be the risk factor of postoperative recurrence.

目的 探讨分析30岁及以下青年乳腺癌患者术后首次复发转移特点,以期指导术后随访,早期发现转移病灶。方法 回顾性分析2003年1月—2018年8月在梅州市人民医院收治的年龄≤30岁乳腺癌患者73例,所有患者均行根治性手术治疗,分析临床病理特点及术后首次复发转移特点。结果 共纳入23例三阴性(31.5%)、20例luminal B(HER2-)型(27.4%)、12例HER-2阳性型(16.4%)、10例 Luminal B(HER2+)型(13.7%)、4例Luminal A型(5.5%)和4例分型不明(5.5%)。中位随访28.4个月,7例三阴性(7/23, 30.4%)、 6例HER-2阳性型(6/12, 50.0%)、 4例Luminal B(HER2-)型(4/20, 20.0%) 和3例 Luminal B(HER2+)型(3/10, 30.0%)出现复发转移。复发转移患者中,90.0%合并远处转移,75.0%合并内脏转移,其中HER-2阳性型均合并内脏转移;92.3%(12/13)激素受体阴性患者复发转移发生在术后2年内。三阴性患者最常见远处转移部位是远处淋巴结,HER-2阳性型患者最常见远处转移部位是肝,luminal B(HER2+)型患者最常见远处转移部位是肺和骨,luminal B(HER2-)型患者最常见远处转移部位是肺和远处淋巴结。结论 ≤30岁青年乳腺癌患者术后首次复发转移多合并远处转移,激素受体阴性患者容易早期复发,不同分子分型患者具有不同的好发远处转移部位。

Objective We retrospectively investigated the first recurrent pattern after radical surgery in breast cancer patients aged ≤30 years, so as to guide postoperative follow-up and early detection of recurrent lesions. Methods A total of 73 consecutive early breast cancer patients aged ≤30years admitted to Meizhou People's Hospital from January 2003 to August 2018 were included. Retrospective analysis was conducted to analyze the clinicpathologic characteristics and characteristics of first recurrent pattern. Results 23 triple negative(31.5%), 20 Luminal B(27.4%), 12 HER2 enriched (16.4%), 10 Luminal/HER2+(13.7%), 4 Luminal A(5.5%) and 4 undifined subtypes(5.5%) were included. After a median follow-up of 28.4 months, 20 patients relapsed, which included 7 triple-negative(7/23, 30.4%), 6 HER2-enriched (6/12, 50.0%), 4 luminal B(4/20, 20.0%) and 3 luminal/HER2+(3/10, 30.0%) subtypes. 90.0% of patients combined with distant metastasis. 75.0% of patients had visceral metastasis, which included all the recurrent HER-2 enriched patients. 92.3% of hormone receptor negative(HR-) patients had a RFS less than 2 years. The most common metastatic sites in triple-negative, HER-2-enriched, luminal/HER2+ and luminal B subtypes were distant nodes, liver, lung and bone, distant nodes and lung, respectively. Conclusion The first recurrent pattern mainly presented as distant metastasis in breast cancer patients aged≤30 years, with early relapse in patients with HR- diseases. Different molecular subtypes of breast cancer favor different distant metastatic sites.