OBJECTIVE To analyse the cause, diagnosis, treatment and preventive methods of uterine perforation resulting from hysteroscopic electro-surgeries. METHODS Data of cases with uterine perforation were collected from 5 hospitals where overall 3,541 hysteroscopic electro-surgeries were done from May 1990 to July 2002. There were 1 468 transcervical resections of endometrium (TCRE), 797 cases of transcervical resection of myoma (TCRM), 783 cases of transcervical resection of endometrial polyp (TCRP), 189 cases of transcervical resection of uterine septa (TCRS), 112 cases of transcervical resection of uterine adhesion (TCRA) and 192 cases of transcervical removal of foreign body (TCRF). All operations were performed under B-ultrasonographic or laparoscopic monitoring. Cervical dilator stick was inserted into cervical canal or 200 micro g of misoprostol put in the posterior fornix the evening before operation. The procedures were done according to different indications and purposes. Cases of uterine perforation were divided into two groups: caused by approaching (entry-related) and by surgical instruments (technique-related). RESULTS Totally sixteen cases (0.45%) of uterine perforation occurred. Seven cases occurred during cervical dilatation and 1 during hysteroscopy inserting lentry-related. Eight cases were technique-related caused by electrode. The incidences of uterine perforation of different operations were: TCRA 4.46% (5/112), TCRF 3.12% (6/192), TCRE 0.27% (4/1 468), TCRM 0.13% (1/797). TCRP and TCRS none. These 16 cases were all diagnosed during operations. 10 cases (62%) by B ultrasound and (or) laparoscopy, 6 cases (38%) by hysteroscopy and clinical features. 13 cases were complete uterine perforations, among them 2 were diagnosed by laparoscopic monitoring, 5 by B-ultrasonic monitoring, 4 by hysteroscopy and 2 by symptoms and B-ultrasound, 3 cases were incomplete uterine perforations in which 2 were diagnosed by laparoscopic monitoring and one by B-ultrasound monitoring. CONCLUSIONS Half of uterine perforation cases were entry-related, so attention has to be paid to entry of Hegar or hysteroscopy (i.e., not dilate the cervix as possible and introduce the scope under direct vision). The other half were related to surgeons' experience and type of operation. TCRA and TCRF run more risks. B-ultrasound and (or) laparoscopy monitoring during hysteroscopic electro-surgery may help to prevent but not completely avoid uterine perforation.

中文翻译：

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宫腔镜电外科子宫穿孔16例分析

目的分析宫腔镜电外科引起的子宫穿孔的原因，诊断，治疗及预防方法。方法收集1990年5月至2002年7月共进行3 541例宫腔镜电切手术的5家医院的子宫穿孔病例数据。行子宫内膜宫颈切除术（TCRE）1 468例，经子宫肌瘤切除术（TCRM）797例。 783例经子宫内膜息肉切除术（TCRP），189例经子宫隔子宫切除术（TCRS），112例经宫颈粘膜子宫切除术（TCRA）和192例经子宫颈切除异物（TCRF）。所有操作均在B超或腹腔镜监测下进行。在手术前一天晚上，将宫颈扩张器棒插入宫颈管或将200微克米索前列醇放入后穹ni。该程序是根据不同的适应症和目的进行的。子宫穿孔病例分为两类：进近引起（与进入有关）和手术器械引起（与技术有关）。结果共发生子宫穿孔16例（0.45％）。宫颈扩张术中发生7例，宫腔镜检查中发生1例与酒后相关。电极引起的技术相关病例8例。不同手术的子宫穿孔发生率分别为：TCRA 4.46％（5/112），TCRF 3.12％（6/192），TCRE 0.27％（4/1 468），TCRM 0.13％（1/797）。TCRP和TCRS没有。这16例均在手术中被诊断出。B超和（或）腹腔镜检查10例（62％），宫腔镜检查和临床表现6例（38％）。子宫完全穿孔13例，其中腹腔镜检查诊断为2例，B超检查为5例，宫腔镜检查为4例，B超检查为2例，子宫穿孔不全3例，腹腔镜检查为2例。一台由B超检查。结论一半的子宫穿孔病例与进入有关，因此必须注意Hegar或宫腔镜的进入（即，不要尽可能扩大子宫颈并引入直视下的范围）。另一半与外科医生的经验和手术类型有关。TCRA和TCRF面临更多风险。