宫内节育器作用机制的动物实验研究

取四种异物(不锈钢、塑料、铜丝、硅胶)置于兔子宫内,观察异物对胚泡着床、宫腔内环境及子宫内膜局部组织的形态学的影响。结果:(1)凡四种不同异物所在处均无胚泡着床,(2)子宫腔洗液中蛋白氮、白细胞计数及其分类、免疫反应与血凝因子的变化无统计学意义,但发现蛋白氮含量与中性粒细胞成正相关;(3)经显微镜、扫描电镜、透射电镜观察,见内膜表面腺体的分泌物增多,形成之屏障覆盖于内膜表面。内膜表面有糜烂及溃疡面,并伴有白细胞浸润;(4)偶见内膜坏死、出血。提示异物抗生育的作用在于阻碍胚泡着床,而影响胚泡着床的原因则在于异物对局部引起的机械性压迫或刺激的组织反应。

MODE OF ACTION OF INTRAUTERINE DEVICES

The intrauterine foreign bodies (IUFB) used in a series of the authors' experiments were made of stainless steel, plastics, copper wire, and silicone rubber. The experiments were done as follows: Firstly, the implantive influence of IUFB was examined. It was found (1) that the embryo might be implanted above or below the position of the foreign body but not at the position of the foreign body and (2) that the existing 5 different kinds of foreign bodies possessed the same antifertility effect. Secondly, the washing fluid of uterine cavities with foreign bodies was examined for studying biochemical component, immunologic reaction in respect of blood coagulating factors and white cell counts and its differential counts. The results of these experiments did not give any significant statistical meaning except in so far as the protein nitrogen and white cell counts were concerned. The authors have investigated the results of the contrast group by statistical methods, which showed no significant change, but it was found that the polymorphonuclear leukocyte counts are proportional to the amount of protein nitrogen contained. In the experiments, the authors did not observe any relationship existing between the uterine foreign bodies and the increase of macrophages. Thirdly, the morphology of the endometrium in contact with intrauterine foreign bodies was examined by light, scanning, and transmission electron microscopy. The results of these observations showed that the phenomenon of the endometrium can be divided into 3 conditions: (1) the accumulated mucus formed a thin or thick layer like a screen covering the surface of the endometrium; (2) the erosions and ulcers appeared on the surface of the endometrium with some white cell infiltration; and (3) sometimes, necrosis of the endometrium and bleeding ensued, 1 or another of these phenomena might happen in all the samples but one. The authors, therefore, conclude that the antifertility effect of an interauterine foreign body must prevent the embryo from implantation. This effect may be caused by the pressure and stimulation of the foreign bodies, which induce unspecialized reaction with moderate exudation and necrosis in the tissue.