Wang Yahui, Xu Lei, Chen Li, Tong Jinyi
Department of Obstetrics and Gynecology, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang Province, China.
Department of Respiratory, Suzhou Research Center of Medical School, Affiliated Hospital of Medical School, Suzhou Hospital, Nanjing University, Suzhou, China.
BMC Womens Health. 2025 Feb 15;25(1):66. doi: 10.1186/s12905-025-03583-9.
Hysteroscopic surgery, a minimally invasive technique prevalent in gynecology, exhibits an overall complication rate between 0.22% and 3.7%. Pulmonary bleeding post-hysteroscopy represents an exceedingly rare complication with only three reported cases to date; two involving high-viscosity solutions and one with hypertonicity solutions. Negative-pressure pulmonary hemorrhage, a seldomly encountered and lethal complication, manifests post-upper airway obstruction, with minimal documented cases, none within hysteroscopic procedures.
Regarding the case study, a 38-year-old female underwent hysteroscopic surgery and received 1600 milliliters of isosmotic low-viscosity uterine distension media (physiological saline) during the procedure. The patient experienced a transient upper airway obstruction lasting one minute due to anesthetic medication. 1 h after surgery, she exhibited positional coughing, expectorated pinkish diluted sputum, and displayed symptoms of hypoxemia. Physical examination revealed bilateral moist rales in the lung fields, while cardiac auscultation did not detect any abnormal murmurs. Diagnostic procedures included chest CT, echocardiography, and complete blood count. The chest CT illustrated diffusely reticular and patchy ground-glass opacities in both lungs, confirming the diagnosis of pulmonary edema with pulmonary bleeding. Treatment with dexamethasone and furosemide led to rapid improvement, meeting discharge criteria within 24 h post-surgery. Postoperative follow-ups showed no discomfort symptoms in the patient, with normal chest X-ray results.
In conclusion, the observed upper airway obstruction during hysteroscopic surgery seemingly reduced the safe absorption threshold of isosmotic uterine distension media. Therefore, gynecologists and anesthesiologists should remain vigilant about this potential complication.
宫腔镜手术是妇科常见的一种微创技术，总体并发症发生率在0.22%至3.7%之间。宫腔镜术后肺出血是一种极为罕见的并发症，迄今为止仅报告了3例；其中2例涉及高粘度溶液，1例涉及高渗溶液。负压性肺出血是一种罕见且致命的并发症，发生在上气道梗阻后，记录在案的病例极少，宫腔镜手术中尚无相关病例。
在该病例研究中，一名38岁女性接受了宫腔镜手术，术中使用了1600毫升等渗低粘度子宫扩张介质（生理盐水）。由于麻醉药物作用，患者经历了持续1分钟的短暂上气道梗阻。术后1小时，她出现体位性咳嗽，咳出粉红色稀释痰液，并表现出低氧血症症状。体格检查发现双肺野有湿啰音，而心脏听诊未发现任何异常杂音。诊断程序包括胸部CT、超声心动图和全血细胞计数。胸部CT显示双肺弥漫性网状和斑片状磨玻璃影，确诊为肺水肿伴肺出血。地塞米松和呋塞米治疗后病情迅速改善，术后24小时内达到出院标准。术后随访显示患者无不适症状，胸部X线检查结果正常。
总之，宫腔镜手术中观察到的上气道梗阻似乎降低了等渗子宫扩张介质的安全吸收阈值。因此，妇科医生和麻醉医生应警惕这种潜在并发症。
