Clinical Study Of Complications Of Hysteroscopic Surgery And Prevention,Treatment Of Hysteroscopic Complications

Objective:To do a statistics on the incidence of intraoperative complication in 1105 cases of hysteroscopic operation within two years from2014 to 2015 in our hospital,To analyze the high risk factor of the incidence of all kinds of intraoperative complication and discuss about the according preventive measures and treating methods.To be able to direct the clinicians to better understand the hysteroscopic complications based on the above analysis and discussion,in order to try to avoid the occurrence of complications and to better ensure the safety of hysteroscopic operation.Methods:A retrospective method has been taken,the data and information about 1105 cases of patient performed with hysteroscopic operation in the gynecology department of our hospital from 2014 to 2015 have been collected through the information department of our hospital,for details please see the case clinical information table,a statistics on the incidence of intraoperative complication and all kinds of intraoperative complication in 1105cases of hysteroscopic operation was done,a statistical comparison of the incidence of complication in the grade-1,2,3 and 4 hysteroscopic operation was conducted,a statistical comparison of the incidence of intraoperative complication in operations using hysteroscopic electric resection technique and in ones using non-energy apparatus was conducted,a statistical comparison of the incidence of intraoperative complication in 412 cases of operations using hysteroscopic electric resection technique was conducted.The?~2 analysis has been adopted for the above statistical analysis,it is regarded as statistically significant when P<0.05.The hysteroscopic operation was classified according to the guidelines of diagnosis and treatment of gynecological hysteroscopic operation.There are six operational types of hysteroscopic electric resection:transcervical electric resection of myoma(TCRM),transcervical electric resection of polyp(TCRP),transcervical hysteroscopic adhesiolysis(TCRA),transcervical electric resection ofintrauterinesepta(TCRS),transcervicalresectionofresidual placenta(TCRPR),transcervical electric resection of endometrium(TCRE).There are four main types of intraoperative complication in hysteroscopic operation:TURP syndrome,perforation of uterus,metrorrhagia,and air embolism.Meanwhile,clinical observation and analysis on the high risk factors leading to complications in 16 cases have been conducted,the according preventive measures and handling methods of intraoperative complications of hysteroscopic operation were discussed.Results:1.The intraoperative complication occurred in 16 of 1105 cases of patient performed with hysteroscopic operation,of which the incidence of intraoperative complication was 1.45%.The TURP syndrome was the most common among the complications,8 cases,of which the incidence was0.72%.2.The incidence of complication of grade-1 hysteroscopic operation was the lowest,as the classification of operation went up,the operation difficulty was increased,so was the incidence of complication.3.Among 412 cases of hysteroscopic electric resection,there were 12 cases of intraoperative complication,whose incidence was 2.9%.among 360 cases of hysteroscopic operation using cryoscalpel,there was 1 case of intraoperative complication,whose incidence was 0.28%.The incidence of complication of operations using hysteroscopic electric resection was higher than that of hysteroscopic operation using cryoscalpel4.Among the five operation types of 412 cases of hysteroscopic electric resection,the incidence of intraoperative complication of TCRM was the highest,which was 4.7%,followed by TCRA and TCRPR,which was 4.3%and3%respectively.5.Among 16 cases of complication in hysteroscopic operation,there were8 cases of TURP syndrome,under the condition of keeping airway unblocked and oxygen inhalation,after the patient was given such symptomatic treatments as furosemidum for diuresis,limiting the liquid intake,a high concentration sodium supplementation through venous transfusion,and correcting the electrolyte disturbance.All of the patients had a favorable prognosis,there were8 cases of perforation of uterus,which had been healed by laparoscopic wound suture and conservative treatment,4 cases of patient having intraoperative hemorrhage were treated with intrauterine balloon compression,pitocin and Misoprostol and other drugs to promote the uterine contraction,the bleeding was successfully stopped.One case of patient having air embolism died.Discussion:1.The incidence of complication of hysteroscopic was increased,as the operation classification went up.2.the incidence of complication of operations using hysteroscopic electric resection was higher than that of hysteroscopic operation using cryoscalpel,which may be associated with such factors as the use of non-electrolyte cavity-distention media during hysteroscopic unipolar electric resection,the emission of gas and heat during the resection and so on.Due to the fact that the cryoscalpel and electric resection have both advantages and disadvantages,it is suggested that the operator should use cryoscalpel on the premise of ensuring the safety and effectiveness of operation.3.The TURP syndrome were the most common among the complications in our hospital in the past two years,which was inconsistent with the report in literatures that the perforation of uterus was the most common among the intraoperative complications of hysteroscopic operation.The high incidence of TURP in our hospital may be associated with the use of non-electrolyte cavity-distention media during hysteroscopic unipolar electric resection,the longer time and larger quantity of cavity-distention media,implementation of individual management of the pressure of hysteroscopic operation,caiculation of the fluid volume in-out uterine is not accurate.4.The intraoperative complications can be prevented by the preoperative pretreatment on the cervix and uterus through drug,necessary interventional therapy,intraoperative ultrasonic monitoring.A favorable prognosis can be achieved by an early detection and timely proper treatment of perforation of uterus and hemorrhage,the key to prevent the occurrence of TURP syndrome is to choose a proper cavity-distention pressure,and control the time of cavity-distention and the absorbed dose of cavity-distention media,a grave consequence can be prevented if an intensive care,early detection and proper treatment is in place.The air embolism rarely occurs but can be highly fatal,and according preventive measures should be taken during the operation.