Erb, Davis, and Kyriazis developed the application of the silicone rubber plug directly into the cornual openings of the fallopian tubes in rabbits by working through hysterotomies. Subsequently, does were exposed to bucks for periods up to 280 days, and none of the does became pregnant. Tissue sections of some tubes were studied microscopically, and no pathological findings were found. The only finding was the flattening of the cilia. This work continued through the early 1970s at Franklin Research Center and Hahnemann Medical College in Philadelphia. 2 basic concepts were developed: 1) there was direct application of catalyzed silicone rubber into the cornual ostium, and 2) the molded obturator (cornual) tip became part of the plug. The technique's success depends on the fact that silicone rubber cures (becomes a rubbery solid) in about 5 minutes without heat or chemical reaction. The formed-in-place plug is made possible because the silicone rubber in curing will cross-link to itself only with the result that the obturator tip at the cornu cross-links and becomes part of the formed-in-place plug. The procedure, as performed in humans, is outlined in detail and is diagrammed. A single hinged bivalve speculum exposes the cervix so that after the hysteroscope is inserted through the cervix into the uterine cavity, the speculum can be removed. The procedure should be performed early in the proliferative phase of the cycle, for generally visualization is better at this time because the endometrium is thinner and less vascular and succulent. Once the ostia have been identified, the aspirator is removed from the cavity. The guide assembly with its attached obturator tip is introduced through the opening channel of the scope into the uterine cavity. Once bilateral good push tests have been obtained, the assistant adds catalyst (stanous octuate) to the silicone in the nonairentraining mixer and dispenser that has been taken from the freezer. Once curing is complete, the assistant loosens the chuck holding the inner and outer guides together and pulls back on the inner guide. When both sides have been occluded, the patient has a flat plate x-ray of the pelvis done to determine proper plug formation. The method is still under investigation and a Food and Drug Administration protocol. Thus far, 1058 women have applied for the procedure. 93 were refused for various anatomic reasons. Of the remaining 956 patients, 791 or 82

作者：T P, Reed

来源：Clinical obstetrics and gynecology 1983 年 26卷 2期