JP2006341108A - Guide tube - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a guide tube capable of facilitating the insertion of a treatment tube by drawing the guide tube preliminarily inserted in and fixed to a digestive tract toward a mouth to straighten the digestive tract, in inserting the treatment tube in the body cavity, and an insertion method of the treatment tube due to the guide tube. <P>SOLUTION: The guide tube 1 for inserting the treatment tube in the body cavity has the main lumen 8 and sub-lumen 9 piercing through the guide tube 1 as lumens over its total length and can be fixed in the digestive tract in a state that the lumens of the guide tube 1 are kept by providing a spiral or braided reinforcing material 3 in the wall of the guide tube 1 and providing a balloon 4 being a means which can fix the guide tube 1 in the digestive tract, in the vicinity of the distal end of the guide tube 1. The digestive tract is straightened by drawing the guide tube toward the mouth to insert the treatment tube in the target body cavity. <P>COPYRIGHT: (C)2007,JPO&INPIT

Description

  The present invention relates to a guide tube for introducing a therapeutic catheter, an intraluminal dilator, and an inspection tool into a body cavity.

  Specific examples of catheters, luminal dilators, and examination tools to be inserted into body cavities include insertion of treatment tubes such as ileus tubes and enteral feeding tubes for diagnosing and treating intestinal obstruction, and intestinal strictures such as the small intestine and duodenum There are intestinal stents for the purpose of releasing the above, and a small intestine endoscope for inspecting the small intestine (hereinafter collectively referred to as a therapeutic tube).

  However, in order to insert these treatment tubes from the mouth or nose into the digestive tract distal to the stomach, it is necessary to first pass a bend of nearly 180 degrees from the gastric cardia to the duodenal pyloric region along the gastrostomy. It is difficult to push the treatment tube by simply pushing it in. While attaching a weight to the tip of the treatment tube or inserting a guide wire as a stylet into the lumen of the treatment tube, The patient's body position is changed, the guide wire is inserted / removed, and the treatment tube itself is repeatedly advanced and retracted so that it is oriented and inserted into the distal end of the treatment tube.

  In order to advance the treatment tube further into the digestive tract beyond the pylorus, use the weight and guide wire at the tip in the same way and gradually push the treatment tube while changing the patient's position, Between the gastric cardia and the duodenal pylorus, there is a bend of nearly 180 degrees, so it is difficult for the pushing force to be transmitted to the tip of the treatment tube, and time and skill are required, and insertion is not possible depending on the patient. In some cases, there are problems such as pain in the nasal cavity and oral cavity of the patient due to insertion and removal of the treatment tube and prolonged X-ray exposure.

  An object of the present invention is to solve such a conventional problem, and when inserting a treatment tube into a body cavity, the guide tube fixed in the gastrointestinal tract is pulled, so that a large distance from the mouth to the pylorus can be obtained. A guide tube that secures a bent route in a straight line and facilitates subsequent insertion of the treatment tube to the pylorus and a method of using the guide tube are provided.

That is, the present invention
(1) A guide tube for inserting a catheter, an intraluminal dilator, and an inspection instrument into a body cavity, having a lumen that penetrates the entire length of the guide tube, and spiral in the wall constituting the guide tube Or, by having a braided reinforcing material, even if the guide tube is bent when inserted into the body cavity, the space of the lumen can be maintained without blocking the guide tube, and a catheter, an intraluminal expander, and A guide tube characterized by being able to insert an inspection instrument into a target body cavity;
(2) The guide tube comprises at least one means for fixing the guide tube to the digestive tract in the vicinity of the distal end thereof,
(3) The guide tube has a balloon in the vicinity of the distal end of the guide tube that can prevent the guide tube from coming out of the body cavity by injecting and inflating a fluid when inserted into the body cavity (1) Guide tube as described,
(4) The guide tube according to any one of (1) to (3), wherein the reinforcing material is a metal wire or plastic fiber,
(5) The guide tube according to claim 4, wherein the outer diameter of the metal wire or plastic fiber is 0.1 to 0.5 mm, and / or the distance between adjacent metal wires or plastic fibers is greater than at least 0.4 mm.
(6) The guide tube according to any one of (1) to (5), wherein the reinforcing member is provided in the wall over a length of 2/3 or less of the entire length from the proximal end of the guide tube.
(7) Any of (1) to (6), wherein the body cavity is a digestive organ and a mechanism for fixing the guide tube at the patient's mouth with the mouthpiece after the guide tube is inserted is provided at the proximal end of the guide tube The guide tube,
(8) The guide tube according to (7), wherein the digestive organ is a digestive device distal to the stomach,
(9) The guide tube according to (7), wherein the mechanism is detachable from the mouthpiece.
(10) The guide tube according to any one of (1) to (9), wherein the distal tip of the guide tube is thinner than the other tube portions, and the tip of the guide tube has a shape cut obliquely. ,
(11) The guide tube according to any one of (1) to (10), wherein a lubrication treatment is performed on at least one of the inner and outer surfaces of the guide tube or the entire surface thereof,
(12) The guide tube according to any one of (1) to (11), wherein a rib-like protrusion is formed on at least a part of the inner surface of the guide tube in the length direction,
It is.

  As described above, by using the guide tube according to the present invention, the route from the mouth to the pylorus can be secured in a straight line while maintaining the space of the tube lumen, and the subsequent treatment tube can be easily inserted to the pylorus. As a result, the time required to insert the treatment tube can be greatly shortened, so that the patient's X-ray exposure can be reduced. Further, since it is not necessary to operate the treatment tube passed through the nasal cavity when the treatment tube is inserted into the digestive tract, damage to the nasal mucosa can be minimized and pain in the nasal cavity of the patient can be reduced.

  Hereinafter, the present invention will be described in detail with reference to the drawings. 1 is a side view showing a structure of a guide tube according to an embodiment of the present invention, FIG. 2 is a cross-sectional view showing a cut surface of the guide tube, and FIGS. 3A and 3B are made of metal wire or plastic fiber. The schematic diagram of the spiral or braided reinforcing material is shown.

As one embodiment of the guide tube according to the present invention, an example in which the means for fixing the guide tube in the digestive tract is a balloon is shown in FIG. The guide tube of the present invention comprises a main lumen (8) into which a treatment tube can be inserted and a sub-lumen (9) for injecting and discharging fluid to and from a balloon (4) which is a means for fixing the guide tube in the digestive tract. A guide tube main body (1) having a mouthpiece (2) for fixing the guide tube to the patient's mouth, and a spiral or braided reinforcement made of metal wire or plastic fiber provided in the wall of the guide tube main body (1) (3) Balloon (4) as means for fixing the guide tube in the digestive tract, branch pipe (5) connected to the sub-lumen (9) and for injecting and discharging fluid to the balloon (4) and with a one-way valve It consists of a syringe connector (6) and a cap (7) for fixing the mouthpiece (2) at the proximal end of the guide tube to the tube.

  The total length of the guide tube main body (1) is not particularly limited, but it needs to be at least a length that can reach the pyloric ring, which is the exit of the stomach, and is preferably 50 cm or longer. In consideration of the length and operability, 50 to 100 cm is desirable. The inner diameter of the guide tube body (1) is required to be at least larger than the outer diameter of the treatment tube to be used, but is not particularly limited because it depends on the size of the treatment tube to be used. In consideration of the slip, it is desirable that the outer diameter of the treatment tube inserted into the guide tube is 1% or more larger.

  The outer diameter of the guide tube body (1) is determined by the inner diameter of the guide tube and the thickness of the guide tube. However, if the outer diameter exceeds 25 mm, insertion into the gastrointestinal tract becomes very difficult and the patient's pain increases at the same time. It is desirable that it is 25 mm or less. As a material of the guide tube body (1), a synthetic resin such as polyvinyl chloride resin, polyurethane resin, polyolefin elastomer, styrene elastomer or silicone rubber, fluorinated polyethylene resin, or a combination of two or more of these resins is used. be able to.

  The distal tip of the guide tube body (1) is preferably cut at an angle, and in particular, resistance to insertion into the gastrointestinal tract can be eliminated, and entrainment of the gastrointestinal mucosa into the tube during insertion can be prevented 20 A shape cut at an angle in the range of ˜70 ° is preferable. Further, it is more preferable that the edge of the cut portion is rounded so as not to damage the patient's body. The outer diameter of the distal end portion of the guide tube body (1) whose distal end portion is narrower than the adjacent tube portion is in the range of 10 to 100 mm from the distal end of the guide tube in order to reduce resistance to insertion into the digestive tract. It is preferable to gradually become thinner.

  The reinforcing material (3) such as a spiral shape or a braid shape in the wall of the guide tube is composed of a metal wire or a plastic fiber. Furthermore, the role of the reinforcing material (3) is to make the outer diameter of the entire guide tube as thin as possible, and even if the guide tube is bent in the digestive tract, it can prevent the tube lumen from being blocked with sufficient strength, and from the outside of the guide tube. The treatment tube inserted into the guide tube lumen should be firmly grasped by hand.

  The reinforcing material (3) is preferably a stainless steel wire, a nitinol wire, a polyamide fiber, a polypropylene fiber or the like, and the wire diameter is preferably in the range of 0.1 to 0.5 mm. And / or the space | interval of the metal wire or synthetic resin fiber which adjoins mutually is at least 0.4 mm or more, Preferably it is a space | interval of 1.5-5 mm. The angle formed by the intersecting metal wires or fibers is preferably 40 to 140 degrees.

  The guide tube provided with a reinforcing material does not block the tube lumen even if the guide tube is bent in the digestive tract, and the treatment tube inserted into the guide tube lumen by hand can be firmly grasped from the outside of the guide tube The one with the performance is preferable. Depending on the outer diameter and inner diameter of the guide tube, the guide tube with a length of 3cm can be used in the range of 1-15kgf when the guide tube is crushed by 5mm in the diameter direction of the main lumen of the guide tube. 1 to 10 kgf, more preferably 1 to 3 kgf.

  Further, the reinforcing material (3) may be provided over the entire length of the guide tube. However, by providing the reinforcing material, the guide tube becomes hard and the insertability into the digestive tract is easily deteriorated and the digestive tract is easily damaged. In addition, since the guide tube is fixed in the digestive tract and the proximal end of the guide tube is pulled to the mouth side, the bending in the digestive tract can be straightened. It is preferable that the distal end of the guide tube is not provided with a reinforcing material so as to avoid damage to the digestive tract and not hinder the movement of the treatment tube, and from the proximal end of the guide tube to 2/3 or less of the entire length. It is desirable to provide in the position.

  In addition, the hardness of the entire guide tube is a very important factor from the viewpoint of not hindering the insertion property of the guide tube into the digestive tract and the operability of the treatment tube. The stress ratio when crushing 3 cm in length in the diameter direction of the main lumen of the guide tube is preferably in the range of 1: 1.3 to 1:18, more preferably in the range of 1: 1.3 to 1: 2. is there.

  The means for fixing the guide tube in the digestive tract may be a balloon as in the embodiment, or may have one having a shape such as a malecot or one or more means selected from these. . Since the gastrointestinal tract for fixing the guide tube is soft tissue and easily damaged, the means for fixing the guide tube is preferably as soft and firm as possible, and a balloon is particularly preferable. The shape of the means for fixing the guide tube may be any shape as long as the guide tube body (1) can be firmly fixed by the pyloric ring that is the exit of the stomach.

  As a specific example, when the fixing means is expanded, a spherical shape or a conical shape whose outer diameter gradually increases from the distal end to the proximal end of the guide tube or a cross section in which the balloon is cut in the longitudinal direction of the guide tube The shape is a shape having an elliptical cross-sectional shape having a major axis in the guide tube outer diameter direction and a minor axis in the guide tube longitudinal direction. It is preferable that the shape is easy to insert into the pylorus and difficult to come out of the pyloric ring.

  The size of the means for fixing the guide tube is difficult to limit because the size of the pyloric bulb varies depending on the physique of the person, but the maximum expansion diameter in the concentric direction of the guide tube and the length of the guide tube It is preferable that the maximum expansion width is in the range of 30 to 150 mm. Since the installation position of the means for fixing the guide tube varies depending on the length of the guide tube, it is not particularly limited, but is preferably in the range of 0 to 50 cm from the distal end of the guide tube.

  The material that can be used for the means for fixing the guide tube is, when the means for fixing is a balloon (4), polyurethane elastomer, soft polyvinyl chloride resin, silicone rubber, polyamide elastomer, polyethylene resin, isoprene rubber, natural rubber, A polyolefin-based elastomer or the like or a material in which two or more kinds of resins are mixed can be used. Further, an X-ray opaque material can be mixed with these materials. The mixing of the radiopaque material is particularly desirable because the position of the means for fixing the guide tube can be easily determined. As the radiopaque material, bismuth oxide, bismuth carbonate, barium sulfate, or the like can be used.

  In addition, when it is difficult to mix and use the radiopaque material directly to the means for fixing the guide tube, the radiopaque material or the material before or after the position where the means for fixing the guide tube body (1) is installed. May be bonded to a synthetic resin, an adhesive or the like to form a belt. The branch pipe (5) connected to the sub-lumen (9) of the guide tube has sufficient strength to withstand the pressure to inject a fluid into the balloon (4) and expand, and is made of polyvinyl chloride resin, silicone resin, polyurethane resin. Polyamide resin, polyethylene resin, fluorinated polyethylene resin and the like can be used.

  The cap (7) for fixing the mouthpiece (2) to the guide tube has a claw that can be fitted and fixed in a hole provided in the mouthpiece (2), and is a proximal end of the guide tube body (1). It is preferable to be made of a material that can be fixed to the guide tube and that can easily adhere to the guide tube and can withstand repeated fitting with the mouthpiece (2). As the material of the cap (7), polyvinyl chloride resin, polypropylene resin, polyacetal resin, ABS resin and the like are preferable.

  The material of the mouthpiece (2) needs to be a material that can withstand repeated attachment and detachment with the cap (7) for fixing the mouthpiece (2) to the guide tube, such as polyvinyl chloride resin, polypropylene resin, polyacetal resin, ABS resin or the like is preferable.

  A lubrication treatment can be applied to a part of or the entire surface of at least one of the inner and outer sides of the guide tube in order to improve sliding with the treatment tube, and there are various lubrication materials used for the treatment. Hydrogel can be used, but collagen, polyvinyl pyrrolidone, polyacrylamide and the like are preferable in view of toxicity to the human body.

  Lubricating material is fixed to the guide tube by coating these hydrogels in solution on the guide tube and then cross-linking with glutaraldehyde, or by coating these hydrogel monomers with a polymerization initiator. There are a method of crosslinking, a method of coating a guide tube with a solution of hydrogel modified with a crosslinking agent such as a photoreactive crosslinking agent, and fixing by light irradiation.

  It is also possible to provide a plurality of ribs extending in the length direction on the inside of the guide tube. This rib reduces the contact area between the treatment tube and the guide tube, and when the guide tube is bent, the lumen is also broken. As a result, it is possible to improve the sliding property between the guide tube and the treatment tube.

  The rib provided on the inside of the guide tube is obtained by extrusion molding integrally with the guide tube, and the size of the rib depends on the inner diameter of the guide tube and the size of the treatment tube used by being inserted into the guide tube. It is important to have a size that allows a sufficient gap between the tube and the outer diameter of the treatment tube to be inserted, and it is desirable that the height and maximum width of the rib be in the range of 0.5 mm to 10 mm. Is preferably the same length as the entire length of the guide tube. However, if it is desired to make the vicinity of the distal end on the distal side of the guide tube flexible, it is not necessary to provide a rib only in this portion.

  The cross-sectional shape of the rib is not particularly limited, but it is desirable that the contact area between the guide tube lumen and the treatment tube be as small as possible, and it is a substantially triangular shape that narrows from the lumen wall of the guide tube toward the center of the lumen. A shape having a cross-sectional shape is particularly desirable.

  One embodiment of the method of using the guide tube of the present invention is as shown in FIG. 4, in which an endoscope is attached to the lumen of the guide tube, and the tip of the guide tube extends from the mouth to the pyloric bulb of the duodenum together with the endoscope. insert. Next, the endoscope and the guide tube are operated under fluoroscopy, and the balloon provided at the distal portion of the guide tube is positioned at the pyloric sphere. Subsequently, the balloon is expanded to fix the guide tube (FIG. 5). Next, the guide tube is pulled to the mouth side to straighten the digestive tract from the pyloric bulb to the mouth. Then, pull out the endoscope from the guide tube (Fig. 5), insert the treatment tube into the lumen of the straightened guide tube (Fig. 6), push the treatment tube to the target digestive tract, and finally deflate the balloon The guide tube is removed from the digestive tract. (Fig. 7)

It is a side view which shows the structure of the guide tube used as one Example of this invention. It is sectional drawing which shows the cut surface of the guide tube used as one Example of this invention. The schematic diagram of the helical structure and braided structure by the metal wire or plastic fiber which become one Example of this invention is shown. 1 shows a method of inserting a therapeutic tube into the digestive tract using the guide tube of the present invention. 1 shows a method of inserting a therapeutic tube into the digestive tract using the guide tube of the present invention. 1 shows a method of inserting a therapeutic tube into the digestive tract using the guide tube of the present invention. 1 shows a method of inserting a therapeutic tube into the digestive tract using the guide tube of the present invention.

Explanation of symbols

1 Guide tube body 2 Mouthpiece 3 Reinforcement material 4 Balloon 5 Branch pipe 6 One-valve syringe connector 7 Cap 8 Main lumen 9 Sub-lumen

Claims (12)

  A guide tube for inserting a catheter, an intraluminal dilator, and a testing instrument into a body cavity, having a lumen that penetrates the entire length of the guide tube, and spiral or braided in the wall that constitutes the guide tube With this reinforcing material, the space of the lumen can be maintained without blocking the guide tube even if the guide tube is bent when it is inserted into the body cavity, and the catheter, intraluminal dilator, and inspection instrument can be held through this lumen. Can be inserted into a target body cavity.   The guide tube according to claim 1, further comprising at least one means for fixing the guide tube to the digestive tract in the vicinity of a distal end thereof.   The guide according to claim 1, wherein the guide tube has a balloon in the vicinity of the distal end of the guide tube that can prevent the guide tube from coming out of the body cavity by inflating by injecting fluid when inserted into the body cavity. tube. The guide tube according to claim 1, wherein the reinforcing material is a metal wire or a plastic fiber.   The guide tube according to claim 4, wherein the outer diameter of the metal wire or plastic fiber is 0.1 to 0.5 mm, and / or the distance between adjacent metal wires or plastic fibers is at least greater than 0.4 mm.   The guide tube according to any one of claims 1 to 5, wherein the reinforcing member is provided in the wall over a length of 2/3 or less of the entire length from the proximal end of the guide tube.   The guide tube according to any one of claims 1 to 6, wherein the body tube is a digestive organ and a mechanism for fixing the guide tube to the patient's mouth by the mouthpiece after inserting the guide tube is provided at the proximal end of the guide tube.   The guide tube according to claim 7, wherein the digestive organ is a digestive device distal to the stomach.   The guide tube according to claim 7, wherein the mechanism is detachable from the mouthpiece.   The guide tube according to any one of claims 1 to 9, wherein a distal tip of the guide tube is thinner than other tube portions, and the tip of the guide tube has a shape cut obliquely.   The guide tube according to any one of claims 1 to 10, wherein a lubrication treatment is performed on a part or all of at least one of the inner and outer sides of the guide tube. The guide tube according to any one of claims 1 to 11, wherein a rib-like protrusion is formed on at least a part of the inner surface of the guide tube in the length direction.

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