粘膜下肌瘤宫腔镜电切术（图文演示）

10. Complications
Mechanical complications
Uterine perforation generally occurs during dilation of the cervix (dilators perforate the myometrium and uterine serosa). It is more frequent when the cervix is narrow (nulliparous and postmenopausal patients) and when there is a pronounced anteflexion or retroversion of the uterus. If perforation occurs, the procedure must be postponed. A second procedure may be attempted 2 to 3 months later, after an adequate preparation. Perforations due to the resection are rarer, but are also more serious. They can lead to intestinal, urinary tract or vascular injuries. Other accidents that may occur during difficult dilation include cervical perforation and falsely directed intramyometrial approaches.

Postoperative infection
Post-hysteroscopic endometritis occurs in 1% to 5% of cases, justifying the systematic use of intraoperative prophylactic antibiotics (McCausland, 1993).

Postoperative hemorrhage
In the case of immediate, massive postoperative bleeding, an intracavitary balloon catheter (inflated 10 to 40 mL) should be inserted and left in place for 3 hours.

Metabolic complication
The intravascular passage of glycine (Glycocolle) can lead to hemodilution. The signs of hyperhydration are nausea, vomiting, headaches and confusion upon awakening. The serum electrolytes show hyponatremia, combined with a hematocrit decrease and a hypoproteinemia. In serious cases, this complication can lead to pulmonary edema, requiring transfer of the patient to an intensive care unit. Risk factors include an operative time of over 45 minutes, an intrauterine pressure >100 mm Hg, vascular myometrial injuries and uterine perforation.

11. Reference

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