| Objective:By adopting prospective case-control study method to observe the mechanism effects of using the Chinese medicine (ectopicâ… , Decoction), which activating blood and dissolving stasis eliminating mass killing embryo to treat unruptured tubal pregnancy. By using electron microscopy, immunohistochemistry staining method to detect surgical obtained pregnancy oviduct mucous cell and villi from patients who choose surgery after using traditional Chinese medicine therapy (observation group) and surgical specimens from patients who choose the surgery directly (control group), in the field of the ultrastructural morphology changes of oviduct epithelial cells, Bcl-2 expression intensity of villus, mucous membrane estrogen receptor (ER), progesterone hormone receptor (PR) expression intensity, in order to investigate the functional mechanism of using the Chinese medicine which activating blood and dissolving stasis eliminating mass killing embryo for treating tubal pregnancy, such study has positive influence in enriching the theory of Chinese medicine gynecology, setting basis for clinical dialectics medication, developing the traditional Chinese medicine for treating tubal pregnancy has not damaged, providing the scientific theoretical basis how to the treat the unruptured tubal pregnancy with the Chinese medicine.Method:1. Case Source:patients who were in hospital at Guangzhou University of Chinese Medicine First Affiliated Hospital of gynecological department during 2008.9-2010.2. Collecting the patients who met the inclusion standard,15 cases in observation group,15 cases in control group.2. Grouping:â‘ Observation Group:ectopic pregnancy I Recipe (Salvia miltiorrhiza Bunge 15g, Paeonia veitchii Lynch 15g, peach kernel 15g) plus Radices trichosanthis 20g, Lithospermum erythrorhizon 15g, centipede 6g, day 1, twice water simmer a day. Prepared uniformly by Guangzhou University of Chinese Medicine Preparation of the First Affiliated Hospital Pharmacy. Patients who have been treated with Chinese medicine for 3 to 8 days require a surgery treating, the cutted oviduct have been collected.â‘¡Control group:Tubal pregnancy patients request surgical treatment directly, the cutted oviduct have been collected.3. Using in situ hybridization method detects bcl-2 expression intensity of tubal pregnancy tissue. Immunohistochemical SP method to measure the tunica mucosa tubae uterinae ER, PR expression.4. Test the ultrastructure of the fallopian tube mucosa cell by electron microscop, observe the ultrastructure morphological difference between oviduct observation group and control group.5. Data processing:According to the data distribution of two independent samples using Wilcoxon test and two independent samples t test, analysis of statistical software with spss10.0Results:1. Tubal pregnancy villus Bcl-2 immunohistochemical staining intensity in the observation group and the control group were significantly different, (P<0.05);2. Tubal pregnancy oviduct mucosa ER immunohistochemical staining intensity comparisons show no significant difference (P> 0.05);3. Tubal pregnancy oviduct mucosa PR immunohistochemistry Comparison of staining intensity are significantly different (P<0.05), The observation group have a higher level of PR expression;4. Observation group and control group by transmission electron microscopy ultrastructure of mucosal cells tubal pregnancy are significant differences. It is found that the observation group oviducts have few microvilli, more endoplasmic reticulum, mitochondria denser, structure disappeared in mitochondria and nuclear condensation. Self-scoring of their scoring was carried out, proved by statistical analysis, this difference was significant. The mucosal cell damage of the observation group was significantly higher. The Mann-Whitney U test (bilateral), the control group and observation group oviduct ciliated epithelial cells in transmission electron microscopy of microvilli difference between groups P=0.000<0.05, significant few in the observation group oviduct ciliated epithelial microvilli sparse compared with the control group; Mitochondrial change difference between groups P=0.001<0.05, significant difference in the observation group oviduct epithelial cells mitochondria serious injury than the control group; Nuclear change difference between groups P=0.045<0.05, significant difference in the observation group oviduct epithelial cells nuclei serious injury than the control group; Difference between the groups within the endoplasmic reticulum P=0.007<0.05, significant difference in the observation group oviduct epithelial cells mitochondria serious injury than the control group; Difference between the groups of intracellular vacuoles P=0.143> 0.05, not statistically significant.Conclusion:1. The Chinese medicine which activating blood and dissolving stasis eliminating mass killing embryo, can lower Tubal pregnancy villi Bcl-2 expression may hinder Bcl-2 antiapoptotic, Promote apoptosis of embryonic tissue of tubal pregnancy, prevent embryo growth which could lead to fallopian tube to withstand high tension and may cause tubal rupture, thereby reduce the surgery rate as a result of tubal rupture.2. The Chinese medicine which activating blood and dissolving stasis eliminating mass killing embryo, can enhance pregnancy oviduct mucosa PR expression, Thereby reducing the oviduct of receptivity for the embryo, leading to embryonic death.3. The Chinese medicine which activating blood and dissolving stasis eliminating mass killing embryo, have no statistically significant effect on expression of the pregnancy oviduct mucosa ER4. The Chinese medicine which activating blood and dissolving stasis eliminating mass killing embryo, has an obvious effect on cell ultrastructure of the oviduct. There are significant effects on the cilia microvilli, mitochondria, nucleus, endoplasmic reticulum structure, Considering activating blood and dissolving stasis eliminate mass kill embryo Chinese medicine affect the normal physiological processes of the fallopian tubes mucosal cell metabolism, reduce nutrients provided for the implantation of the embryo in the fallopian tube to promote apoptosis of embryonic tissue.
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