JP2007167082A - Guide instrument of in-vivo insertion tube via gastric fistula and instrument kit for changing percutaneous gastrostoma-tube to jejunum tube via gastric fistula - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an in-vivo insertion tube guide instrument for changing a percutaneous gastrostoma-tube to a jejunum catheter tube via gastric fistula easily in short time without using an endoscope, and a kit including the in-vivo insertion tube guide instrument. <P>SOLUTION: The instrument is for guiding an in-vivo insertion tube via a gastric fistula, comprising a bending tube, a funnel body, and an anti-loosening bumper. The bending tube has a larger inner diameter than the outer diameter of the in-vivo insertion tube, and has a bending part to bend at from 20 to 40 degrees for guiding the in-vivo insertion tube. The funnel body is smoothly connected to the inner surface of one end of the bending tube. The anti-loosening bumper is disposed to surround the outer surface of the other end of the bending tube and has a cross-section larger than the cross-section of the fistula. <P>COPYRIGHT: (C)2007,JPO&INPIT

Description

  The present invention relates to a device for guiding a body insertion tube to be inserted into a body via a gastrostomy, and a transcutaneous gastrostomy tube into a transgastric jejunum tube in a short time without using an endoscope. It is an instrument kit that inserts and fixes a tube to be changed. Here, the body insertion tube is a tube for feeding nutrition and supplying medicine, and also includes a catheter.

  The device of the present invention facilitates insertion into the body insertion tube, specifically in the jejunum. In addition, the procedure using the kit of the present invention can be changed to a transgastric jejunum tube even if it is not an endoscopy specialist. There is an extremely high need at an extremely low cost because an emergency and safe treatment can be performed and no endoscope is used.

  In recent years, percutaneous endoscopic gastrostomy (PEG) using an upper gastrointestinal endoscope has attracted attention. Instruments used for the procedure are also known. See Patent Documents 1 to 6 for instruments used for PEG, and particularly Patent Documents 3 and 6 for the internal bumper of the gastrostomy tube (internal means the body).

  Central parenteral nutrition (high-calorie infusion: nutrition via infusion through a catheter placed in a thick vein) and enteral nutrition (gastric fistula: injecting nutrients through a tube inserted into the stomach from the abdominal wall) There is. Central parenteral nutrition is difficult to manage at home due to the risk of fatal infections such as sepsis and complications such as excessive and insufficient electrolytes in the blood. On the other hand, enteral nutrition is a relatively safe nutrition method, so it can be treated at home. Nonetheless, conventional gastrostomy procedures often require general anesthesia and open surgery. However, in recent years, it can be easily constructed with invasive PEG.

  Even after gastrostomy, there are many cases where tube feeding using gastrostomy cannot exert its full effect due to various causes. In such a case, in particular, as a countermeasure against aspiration pneumonia, it is often effective to change a percutaneous gastrostomy tube to a transgastric jejunum tube.

  In general, it is necessary to use an endoscope to change a percutaneous gastrostomy tube into a transgastric jejunum tube. However, in cases like the above, patients often have aspiration pneumonia or are poorly fed because they are not adequately fed, and using an endoscope is more risky and easier and less risky. Invasive techniques are required. Furthermore, in the case described above, patients who need to change to a transgastric jejunum tube are not required for upper gastrointestinal endoscopy because they have already undergone percutaneous endoscopic gastrostomy. .

  Also, due to the thin and soft nature of the tube, troubles of bending and obstruction tend to occur, and it is necessary to replace the jejunum tube more frequently than percutaneous gastrostomy tubes. Again, simple and minimally invasive techniques are required. For these reasons, there is a need for a device and kit for easily changing a percutaneous gastrostomy tube to a transgastric jejunal tube in a short time without using an endoscope, and placing the tube in place. It was.

   FIG. 1 shows a state of a transgastric jejunal tube in which a known button-type gastrostoma PB is installed in the gastrostomy hole P and is inserted through the same. The insertion of the jejunum tube is indicated by “−−− →”. On the other hand, FIG. 4 is an explanatory view of a transgastric jejunal indwelling tube T having a known T-shaped bumper, where (a) is an overall schematic diagram and (b) is a schematic diagram of a state where it is installed on the body. TO is a T-shaped external bumper, and TI is a T-shaped internal bumper. Outside means outside the body, inside means inside the body. TO is a slide type.

In the transgastric jejunal indwelling tube T having a known T-shaped bumper, it is difficult to insert it from the gastric fistula P along the shape of the stomach toward the pylorus. This is because T has flexibility (flexibility) but is difficult to bend to the curvature of the anatomical curvature of the stomach. Therefore, it was difficult to easily change a percutaneous gastrostomy tube into a transgastric jejunum tube in a short time even using an endoscope.
U.S. Patent No. US 5112310 `` Apparatus and methods for percutaneous endoscopic gastrostomy ''Grobe; James L. US Patent No. 5167627 `` Stoma creator gastrostomy device and method for placement of a feeding tube ''Clegg; Robert D. U.S. Pat.No. 5,391,159 `` Gastrostomy tube with improved internal retaining member ''Hirsch; William H. JP 2005-512669 gazette “Method of implanting percutaneous endoscopic gastrostomy / jejunostomy tube in patient and access needle used in said method” Boston Scientific Limited US Patent No. 6673058 `` Temporary dilating tip for gastro-intestinal tubes ''Snow; Todd JP 2003-290320 No. "Gastrostomy tube" Top

  An object of the present invention is to provide an instrument that facilitates insertion of an in-vivo insertion tube (a tube for feeding or supplying medicine or a catheter) that is inserted into the body via a gastrostomy. In addition, the present invention provides a kit for easily changing a percutaneous gastrostomy tube into a transgastric jejunum tube in a short time without using an endoscope, and placing and fixing the tube. The procedure using this instrument and kit can be changed to a transgastric jejunum tube even if you are not an endoscopy specialist. Therefore, there is a need for an extremely low cost and extremely high need because an endoscope is not used.

  The body insertion tube guide device A according to the present invention (Claim 1) is a device for guiding a body insertion tube via a gastrostomy, and has an inner diameter larger than the body insertion tube outer diameter and the body insertion tube from 20 degrees to 40 degrees. A bent tube having a bent portion to be bent and guided, a funnel body smoothly connected to the inner surface of one end of the bent tube, and an outer periphery of the other end of the bent tube A pull-out preventing bumper having a cross section larger than the cross-section of the stoma formed therein (see FIG. 2).

  The bending tube 1 of the in-vivo insertion tube guide apparatus A of the present invention is characterized by bending at an angle θ (see FIG. 2A). The bending angle θ is in the range of 20 degrees to 40 degrees, and is preferably 30 degrees in terms of anatomy. By bending at this angle, it is easy to insert the device A main body through the gastrostoma along the shape of the stomach. The jejunum indwelling tube is naturally inserted with the instrument A without resistance.

  It is preferable that a mark indicating the bending direction is on the insertion side (near side) so that the bending direction can be easily recognized when the instrument A is inserted. That is, it is preferable that a mark indicating the bending direction of the bent tube 1 is marked on the funnel 2.

  In order to facilitate the placement of the device A in the body, in addition to the pull-out prevention bumper BI (Claim 3), the device has a slide hole having an outer diameter larger than that of the bent tube, and the bent tube is passed through the slide hole. It is preferable to have a body surface holding bumper that can slide between the body and the pull-out preventing bumper.

  In order to guide the transgastric jejunal tube with the device A and then further invade it, and to easily move the transgastric jejunum tube into the jejunum in a short time, the device A is gently attached to the distal end of the body of the device A. It is preferable that the convex shape D has a mountain shape. The soft transgastric jejunal tube does not deflect in the stomach when the tip D of the device A is in close contact with the pylorus. That is, (Claim 4), it is preferable that the other end portion of the bent tube has a gently convex shape.

  The device A of the present plan is preferably made of silicon resin, as in the case of conventional devices. Since silicon resin is opaque to X-rays, it is difficult to see shadows with X-rays. For this reason, it is preferable that an X-ray opaque mark is marked for convenience during operation. That is, (Claim 5), it is preferable that radiopaque marks m are marked at substantially equal intervals in the tube length direction of the pull-out preventing bumper BI and the bent tube 1 (see FIG. 2A).

  In FIG. 2A, the pull-out prevention bumper BI mark is omitted. With these marks, the position and direction of the tube can be easily confirmed by X-ray fluoroscopy during and after insertion. In particular, if the mark can be visually confirmed by fluoroscopy when the tube tip is guided to the pylorus, rapid guidance can be performed. The material of the mark may be a radiopaque resin. The mark may be marked by a known method such as printing or embedding. Moreover, even if it is not a radiopaque material, X-ray | X_line visual recognition may be made by changing thickness in the range which does not hinder insertion in a body, such as providing an unevenness | corrugation in a marking position.

  FIG. 7 shows an explanatory view of the tip of the instrument A of the present invention. C is the other end of the bent tube 1 and is the outlet of the body insertion tube, D is a gentle convex portion provided so that C is in close contact with the pylorus, and H is the body of the pull-out prevention bumper BI. It is a dent for insertion of an optical tutor provided on the front holding bumper BO side. 7, (a) and (c) are normal states, and (b) and (d) are states in which the optolator E is inserted into H and the BI is deformed to pass through the gastrostomy (shown by PA). It is.

  As shown in FIGS. 7B and 7D, for convenience of passing the instrument A of the present invention through the gastrostoma (Claim 6), the pull-out preventing bumper has a concave portion for locking the convex portion at the tip of the obturator. Is preferred. The bending-out preventing bumper BI of the bent tube 1 is passed through the fistula while being deformed by E.

  Furthermore, it is good to use the stylet F (FIG.3 (b)) for guide | inducing the pull-out prevention bumper BI to the pylorus side after inserting in a stomach. F has a bent portion having a bent angle substantially the same as the bent angle θ of the bent tube 1. Further, F needs to have a length that protrudes from the tip C of the device A so as not to damage the inside of the stomach.

  In particular, it is preferable to construct a kit having the device A of the present invention in order to easily change a percutaneous gastrostomy tube into a transgastric jejunum tube in a short time (described later).

  With the device A of the present invention, it becomes easy to insert an in-vivo insertion tube (nutrition supply or medicine supply tube, catheter) to be inserted into the body via a gastric fistula. It is also possible to change a percutaneous gastrostomy tube into a transgastric jejunum tube easily and in a short time without using an endoscope. If the device A and the kit including A are used, a procedure for changing to a transgastric jejunal tube can be performed even if the patient is not an endoscopy specialist. Even in a private hospital where there is no specialist, it is possible to deal with troubles of gastrostomy tube patients urgently and safely, and the cost is extremely low because no endoscope is used.

  Again, the procedure conventionally performed under an endoscope can be performed in a short time under X-ray fluoroscopy. Because the jejunum indwelling tube can be inserted easily, it was necessary to wait for the improvement of pneumonia in cases where aspiration pneumonia occurred in the lung, etc. The tube can be replaced immediately because it is non-invasive.

  Also, if the jejunum catheter is pulled out into the stomach due to natural removal of the tube when the patient is placed in the jejunum tube, or if the device A of the present invention is fixed, the pull-out prevention bumper BI is slid and bent. If the distal end C of the tube 1 is moved to the gastric pylorus side, a body insertion tube such as a jejunum catheter can be easily reinserted without using an endoscope or a guide wire.

  Again, the conventional transgastric jejunal catheter placement, which has been performed using an endoscope, can be easily performed without being an endoscopy specialist. Until now, the insertion of a jejunal catheter has to be transported to a facility where an endoscopist is present, which often leads to adaptation of the procedure. Since it can be inserted under fluoroscopy using the instrument of the present invention, it can be introduced in many facilities. Moreover, since an endoscope is not used, even a patient with a poor general condition can be placed. The insertion time can be left in about 5 minutes. A procedure to save many gastrostomy patients with aspiration pneumonia worsened before the general condition worsens. Since it is not an endoscopic technique, it has a low health score and is advantageous in terms of medical economy.

  It is preferred to construct a kit having the device A of the present invention. That is, (Claim 7) is a device kit for changing a percutaneous gastrostomy tube into a transgastric jejunal catheter tube, and is locked at least in the recess of the body insertion tube guide device A and the pull-out prevention anchor An instrument kit including an obturator E having a distal end portion and a stylet F having a bending portion having a bending angle substantially the same as the bending angle of the bending tube.

  The material and size of the in-vivo insertion tube guide device A are preferably made of silicone resin, shaft diameters 22F and 24F, and a length of 25 cm. The obturator E is preferably metallic, inflexible (not flexed), shaft diameter 10F, and length 10cm. The stylet F is made of metal, is flexible (bends), and has the same shape as the insertion tube to be inserted into the body. At the time of nutrient injection, an indwelling tube having a length of about 60 cm passing through the body insertion tube guide device A is used.

The change from the percutaneous gastrostomy tube to the transgastric jejunal catheter tube by the device A of the present invention is shown in FIG. 6 from the state shown in FIG. 5 after the gastrostomy tube already constructed is removed. Illustrated as a change to state. That is, FIG. 5 shows a state in which C of the in-vivo insertion tube guide device A of the present invention is brought into close contact with the pyloric ring to change from a percutaneous gastrostomy tube to a transgastric jejunal catheter tube. The insertion direction and position of the jejunal catheter tube are indicated by “... →”. On the other hand, in FIG. 6, after fixing the in-vivo insertion tube guide device A of the present invention to the abdominal wall, the transgastric jejunal catheter tube is used to place and fix the transgastric jejunal catheter tube. It is explanatory drawing of the state which has inject | poured the chemical | medical agent, Comprising: Inflow of a nutrient is shown by "...->". Even if the jejunal catheter tube indwelled in the state of FIG. 6 causes troubles such as obstruction and bending, it is possible to return to the state of FIG. 5 using the instrument A and replace the jejunal catheter tube. It is.

It is explanatory drawing of the anatomical positional relationship of a stomach and a gastrostoma tube, and insertion of the jejunum indwelling tube is shown by "---->". Explanatory drawing of the body insertion tube guide instrument A of this invention. (A) is an explanation of the overall configuration and θ, and (b) is an explanation of the sliding movement of the outer body surface holding bumper BO. The device is preferably made of silicon and has a shaft diameter of shaft diameters 22F and 24F and a length of 25 cm. Explanatory drawing of the opturator E and the stylet F. The optolator E is metallic, rigid, shaft diameter 10F, length 10 cm, and the stylet F is made of metal, is movable, has the same shape as the indwelling tube, and has a bent portion with a substantially same bending angle θ. It is explanatory drawing of the transgastric jejunal indwelling tube T with a well-known well-known T-shaped bumper, (a) is a whole schematic diagram, (b) is the state schematic diagram installed in the body. It is explanatory drawing of the state which is changing from a percutaneous gastrostomy tube to a transgastric jejunal catheter tube using the body insertion tube guide instrument A of this invention, and transgastric jejunal catheter tube insertion The direction is indicated by “... →”. It is explanatory drawing of the state which indwelled and fixed the transgastric jejunal catheter tube using the in-vivo insertion tube guide instrument A of this invention, and inject | poured the nutrient, Comprising: Indwelling of a transgastric jejunal catheter tube The position and the inflow of nutrients are indicated by “... →”. It is explanatory drawing of the pull-out prevention bumper BI part of the body insertion tube guide instrument A of this invention, Comprising: (a), (c) is a normal state, (b), (d) inserts the optimulator E in H. The state in which the BI is deformed to pass through the hole (indicated by PA) of the gastrostomy part.

Explanation of symbols

1 Bent tube having a bent portion that guides the body insertion tube by bending 20 to 40 degrees
2 Funnel body A smoothly connected to the inner surface of one end of the bending tube A body insertion tube guide device of the present invention
BI The pull-out prevention bumper of the present invention, commonly referred to as “internal bumper”, meaning that the inside is installed inside the body BO The body surface holding bumper of the present invention, commonly referred to as “external bumper”, which is installed outside the body Meaning C A gentle mountain-shaped convex portion E that is the other end of the bent tube 1 and the outlet DC of the body insertion tube is in close contact with the pylorus. Is a dent for insertion of an optolator provided on the BI side of the HBO, which has a bend of approximately the same bending angle θ as the mark M indicating the direction (bending direction) of the tube m confirming the insertion direction (position in the body) of the tube Radiopaque mark P for gastrostomy tube construction position PA dotted line PB indicating gastrostomy position Known button type gastrostoma T Transgastric jejunal indwelling chew with known T-shaped bumper TO T-shaped external bumper, slide type, external bumper for TI T-shaped bumper, meaning that it is installed outside the body, and bent tube of θ A, which means that it is installed inside the body Bending angle

Claims (7)

A device for guiding the insertion tube through the gastrostomy,
An inner diameter larger than the outer diameter of the body insertion tube, and
A bent tube having a bent portion for bending and guiding the body insertion tube by 20 to 40 degrees;
A funnel smoothly connected to the inner surface of one end of the bent tube;
An in-vivo insertion tube guide device having a pull-out prevention bumper having a larger cross section than a fistula cross section disposed so as to surround the outer periphery of the other end portion of the bent tube. The in-vivo insertion tube guide device according to claim 1, wherein a mark indicating a bending direction of the bending tube is marked on the funnel body. It has a slide hole larger than the outer diameter of the bent tube, and the bent tube is passed through the slide hole,
The in-vivo insertion tube guide device according to claim 1 or 2, further comprising a body surface pressing bamber capable of sliding between the funnel body and the pull-out preventing bamber. The other end portion of the bending tube has a gentle convex shape having a mountain shape, and the insertion guide device for insertion into a body according to any one of claims 1 to 3. The in-vivo insertion tube guide device according to any one of claims 1 to 4, wherein radiopaque marks are marked at approximately equal intervals in the tube length direction of the pull-out prevention bumper and the bent tube. The in-vivo insertion tube guide device according to any one of claims 1 to 5, further comprising a recess for locking the protrusion at the tip of the obturator to the pull-out prevention bumper. An instrument kit for changing a percutaneous gastrostomy tube into a transgastric jejunal catheter tube,
At least a body insertion tube guide device according to claim 6,
An obturator having a tip portion that is locked to the recess of the pull-out prevention bumper;
A device kit comprising a stylet having a bent portion having a bent angle substantially the same as the bent angle of the bent tube

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