Objective To analyze the influencing factors of uterine perforation during hysteroscopic surgery, and explore targeted preventive measures. Methods A retrospective analysis was performed on the clinical data of 1 000 patients undergoing hysteroscopic surgery. Patients were divided into a perforation group (21 cases) and a non-perforation group (979 cases) according to the occurrence of intraoperative uterine perforation. Clinical data were compared between the two groups. A multivariate Logistic regression model was used to analyze the influencing factors for uterine perforation during hysteroscopic surgery. Results A total of 1 000 patients were enrolled in this study. Intraoperative uterine perforation occurred in 21 cases, with an incidence rate of 2.10%. Of these, 1 case had left lateral uterine wall perforation, 4 cases had fundal uterine perforation, 5 cases had anterior uterine wall perforation, and 11 cases had posterior uterine wall perforation. The proportions of patients aged ≥50 years, gravidity ≥3, parity ≥2, uterine malformation, history of intrauterine surgery, moderate-to-severe intrauterine adhesion, multiple uterine fibroids, and poor cervical ripening in the perforation group were higher than those in the non-perforation group (P<0.05). Multivariate Logistic regression analysis showed that parity ≥2, uterine malformation, moderate-to-severe intrauterine adhesion and poor cervical ripening were independent risk factors for uterine perforation during hysteroscopic surgery (P<0.05). Conclusion Parity ≥2, uterine malformation, moderate-to-severe intrauterine adhesion and poor cervical ripening were influencing factors for uterine perforation during hysteroscopic surgery. In clinical practice, measures including accurate preoperative evaluation, standardized intraoperative operation and improvement of professional skills of the surgical team should be adopted to reduce the incidence of intraoperative uterine perforation and improve surgical safety.

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