Zipper J, Kessel E
Department of Obstetrics and Gynecology, Sótero del Río Hospital, University of Chile, Santiago, Chile.
Department of Public Health and Preventive Medicine, Oregon Health Sciences University, Portland, Oregon, USA.
Int J Gynaecol Obstet. 2003 Dec;83 Suppl 2:S7-S11. doi: 10.1016/S0020-7292(03)90084-1.
To trace development of quinacrine sterilization (QS).
Review of published reports.
The high prevalence of septic abortion among high parity women in Santiago, Chile, motivated Zipper to find a safe, inexpensive method of non-surgical female sterilization. Various cytotoxic drugs were tried in rats. Because quinacrine was already accepted for intrapleural injection it was chosen for the first clinical trial. A slurry consisting of quinacrine and xylocaine was instilled into the uterine cavity with a transcervical syringe. Reasonable efficacy was noted and a limited scar of the intramural tube demonstrated. However, a side effect of cortical excitation and reports of 3 deaths ended this approach. Zipper and Wheeler hypothesized that the difficulty was due to rapid absorption of quinacrine under pressure and designed a pellet form that dissolves slowly and could be delivered transcervically using a modified IUD inserter. A standard protocol of 252 mg in seven 36 mg pellets placed at the uterine fundus on two occasions a month apart has now been widely used with considerable evidence for safety and efficacy. Indeed, protection is greater than 98% at 2 years of use.
QS is ready for widespread use, especially where surgical sterilization is not safely available or when women are poor candidates for surgery or have such a fear of surgery that they will not seek surgical sterilization.
追溯喹吖因绝育法（QS）的发展历程。
回顾已发表的报告。
智利圣地亚哥高龄经产妇女中败血症性流产的高发生率促使齐珀去寻找一种安全、廉价的非手术女性绝育方法。在大鼠身上试验了各种细胞毒性药物。由于喹吖因已被批准用于胸膜腔内注射，所以被选用于首次临床试验。用经宫颈注射器将由喹吖因和利多卡因组成的混悬液注入宫腔。观察到了合理的疗效，且显示出壁内输卵管有局限性瘢痕形成。然而，皮质兴奋的副作用以及3例死亡报告终止了这种方法。齐珀和惠勒推测困难在于喹吖因在压力下吸收过快，并设计了一种能缓慢溶解的药丸剂型，可使用改良的宫内节育器放置器经宫颈给药。现在广泛使用的标准方案是每月分两次在子宫底部放置7粒36毫克的药丸，总量为252毫克，有大量证据表明其安全性和有效性。事实上，使用2年时的避孕效果大于98%。
喹吖因绝育法已可广泛应用，尤其适用于无法安全进行手术绝育的情况，或女性不适合手术绝育或因极度恐惧手术而不愿寻求手术绝育的情况。
