Objective To analyze the influencing factors of acute stress disorder(ASD)in pa-tients after surgery for gynecological malignancies,and to explore the mediating role of coping styles between illness perception and ASD.Methods Patients who underwent surgery for gynecological malignancies at our hospital from December 2021 to June 2024 were selected as the study subjects.The Stanford Acute Stress Reaction Questionnaire(SASRQ),the Brief Illness Perception Question-naire(BIPQ),and the Simplified Coping Style Questionnaire(SCSQ)were used for assessment.The bias-corrected nonparametric percentile Bootstrap method was employed to test the mediating effect.Results A total of 309 valid questionnaires were obtained after screening,with an effective response rate of 91.96％.The incidence of ASD was 44.66％(138/309).The SASRQ score of patients after radical surgery for gynecological malignancies was(40.85±7.36)points.Among patients after radi-cal surgery for gynecological malignancies,those who were nulliparous,had stage Ⅳ tumors,re-ceived postoperative chemotherapy,experienced cancer pain,had postoperative complications,had poor family functioning,and had a Social Support Rating Scale(SSRS)score ≤30 points had signifi-cantly higher SASRQ scores(P＜0.05).The levels of postoperative cortisol,procalcitonin(PCT),neutrophil-to-lymphocyte ratio(NLR),and platelet-to-lymphocyte ratio(PLR)were higher in the ASD group than those in the non-ASD group(P＜0.05).Illness perception significantly positively predicted ASD(β=0.837,95％CI,0.681 to 0.993,P＜0.001).Active coping styles played a partial mediating role between illness perception and ASD in patients with gynecological malignan-cies,accounting for 30.35％of the direct effect.Conclusion Active coping styles exert a partial mediating effect between illness perception and ASD in patients after surgery for gynecological malig-nancies.It is conductive to reduce ASD levels and enhance patients' overall rehabilitation outcomes and quality of life by improving patients' illness cognition,promoting active coping styles,and strengthening family support.