[Severe complications of hysteroscopic surgeries: an analysis of 35 cases].

OBJECTIVE

To investigate the methods of earlier diagnosis, treatment and precautions on the severe complications of hysteroscopic procedures.

METHODS

There were 12 921 cases of diagnostic hysteroscopy and 2 221 cases of operative hysteroscopy were performed. For diagnostic hysteroscopy B ultrasonography were scaned meanwhile and fluid media were used to distend the uterus. For operation hysteroscopy B ultrasonography or laparoscopy was used for monitoring.

RESULTS

Thirty five cases of severe complications encountered. There were 9 cases of severe intraoperative bleeding. Foley catheter inserting, bleeding spots coagulating, uterine cavity tampon or hysterectomy were used to stop intraoperative and postoperative bleeding successfully. Eleven cases of uterine perforation were treated by conservativetherapy, laparoscopy or hysterectomy. An air embolism happened on hysteroscopic examination was survived with aggressive rescue. There were 4 cases of postoperative infection that had history of pelvic inflammatory disease and cured by antibiotics. Diuretic agent and saline infusion were used to treat 5 cases of transurethral resection of prostate (TURP) syndrome effectively. For 4 cases of post-ablationsterilization syndrome (PASS) dilating the cervix canal and expelling the hematometra, transcervical resection of adhesions or hysterectomy were managed effectively. One case of endometrial adenocarcinoma stage I a was diagnosed 8 years after transcervical resection of endometrium (TCRE) & transcervical resection of polyp (TCRP), and radical hysterectomy plus selective pelvic lymphadenectomy was performed.

CONCLUSIONS

Foley catheter insertion is a simple and efficient method to stop uterine bleeding. Uterine adhesion is a high risk factor of uterine perforation. Monitoring by B ultrasonography or laparoscopy could not prevent uterine perforation. Prevention was essential for air embolism. Control the pressure of irrigating flow and operating time can reduce the incidence of TURP syndrome. To intensify follow-up is the best method to detect PASS and uterine adenocarcinoma.