DE202017000306U1 - Catheter system for catheter-assisted pancreato-gastrostomy after pancreatic head resection - Google Patents

Abstract

Catheter system for pancreato-gastrostomy after a pancreatic head resection on a human or animal body having an abdomen (84) bounded by an abdominal wall (82), comprising a first catheter in the form of a tubular pancreatic duct catheter (10) with a tube wall (12) forming a first channel (14) for establishing a fluid conducting connection from a pancreatic duct (88) through the abdominal wall (82), the pancreatic duct catheter (10) being spaced from a first opening (18) at a first end (20 ) to a second opening (22) at a second end (24) has a first predetermined length, wherein in functional position of the pancreatic duct catheter (10) the first end (20) with the first opening (18) extraabdominal and the second end ( 24) with the second opening (22) is arranged intraabdominally in the pancreatic duct (88), characterized in that the catheter system additionally comprises a second catheter (16), which in a Kath eter housing (30) forms a second channel (32) extending a second predetermined length in the catheter housing (30) from a first catheter eye (34) at a first end (36) of the catheter housing (FIG. 30) of the second catheter (16) to a second catheter eye (38) at a second end (40) of the catheter housing (30) of the second catheter (16), wherein in functional position of the second catheter (16) on the human or animal body, the first end (36) of the catheter housing (30) of the second catheter (16) extraabdominal and the second end (40) of the catheter housing (30) of the second catheter (16) is intraabdominally arranged and the Catheter housing (30) extends through the abdominal wall (82), wherein the second channel (32) in the catheter housing (30) of the second catheter (16) for receiving the pancreatic duct catheter (10) is formed such that the pancreatic duct catheter (10) in the second channel (32) relative to the catheter-G housing (30) of the second catheter (16) is displaceable, wherein the second predetermined length of the second channel (32) in the second catheter (16) is shorter than the first predetermined length of the pancreatic duct catheter (10), wherein a third opening (42) at or spaced from the first end (36) of the catheter housing (30) of the second catheter (16) is formed such that this third opening (42) in the functional position of the second catheter (16) is arranged extraabdominal, wherein a fourth aperture (44) is disposed at or spaced from the second end (40) of the catheter housing (30) of the second catheter (16) such that said fourth aperture (44) is intraabdominally disposed in the operative position of the second catheter (16) wherein a third channel (46) is disposed and formed in the catheter housing (30) of the second catheter (16) such that said third channel (46) fluidly connects the third port (42) and the fourth port (44) , where the Catheter housing (30) of the second catheter (16) in the region of the fourth opening (44) comprises a magnetic material (58), wherein a further separate component (96) is provided of a magnetic material, which in functional position within a gastric lumen ( 94) of a stomach (90) in the abdomen (84) can be arranged, wherein the separate component (96) of the magnetic material and the magnetic material (58) in the region of the fourth opening (44) are formed such that between them forms a magnetic attraction, if they are below a predetermined distance from each other, such that the distance from each other automatically decreases.

Description

The invention relates to a catheter system for pancreato-gastrostomy after a Pankreaskopfresektion on a human or animal body having an abdomen bounded by an abdominal wall, with a first catheter in the form of an intrinsically stable, tubular pancreatic catheter with a tube wall forming a first channel for establishing a fluid-conducting connection of a pancreatic duct through the abdominal wall, wherein the pancreatic duct catheter has a first predetermined length from a first opening at a first end to a second opening at a second end, wherein in functional position of the pancreatic duct catheter End with the first opening extraabdominal and the second end with the second opening intraabdominally disposed in a pancreatic duct, according to the preamble of claim 1.

Surgical removal of the pancreatic head is a common procedure performed to treat pancreatic cancer. At the same time, this procedure is one of the most complex and complicated operations in abdominal surgery. Perioperative mortality is estimated at about 10% for Germany. The majority of the morbidity and mortality in this operation has its origin in the suture (anastomosis) of the pancreatic remnant with the intestine or the stomach. Even in the case of technically perfect execution, in certain risk constellations (soft, voluminous pancreas, narrow gait, severe obesity of the organ) frequent suture breaks occur after 5-10 days following the operation. In addition to the risk of peritonitis due to the exiting intestinal contents, the patients are acutely endangered, in particular by the congestion of arteries and the subsequent bleeding (bleeding from bleeding). This problem can be solved by interventional occlusion or bridging of the affected artery or an emergency procedure. Which method is used depends on the extent of suture breakage, coexisting sepsis, and other factors. If surgery is required, the standard procedure is removal of the remaining pancreas. However, this has considerable consequences: on the one hand, this procedure itself has a very high risk; on the other hand, it only induces diabetes mellitus (diabetes mellitus), which is relatively difficult to control. Despite all these measures, about 20% of patients still die from this complication.

Another way to solve the problem surgically is to leave the pancreas and drain through a catheter to the outside. This can reduce the operational risk. The price is a situation similar to that of an artificial intestinal outlet. Patients must carry a bag on their stomach into which about 100-300 ml of pancreatic secretions are emptied daily. The great advantage of this procedure, however, is that the sepsis can be controlled relatively well and the risk of bleeding is rather low, since the pancreatic secretion is not activated by the lack of contact with the intestinal mucosa.

From the EP 1 980 2787 A1 is a gastroenterological medical device, in particular a stent for the bile or pancreatic duct, known. This stent has a tubular, intrinsically stable carrier, which is provided with a bonded to the support surface spacer layer and bonded to the spacer layer layer of an electronegative glycoseaminoglycan.

From the DE 197 34 890 C1 A catheter is known for processing and removing soft or hard substances. In a catheter housing, a suction channel is formed with at least one suction opening. Optionally, an infusion channel is provided for supplying irrigation fluid which opens to a body-side end. The catheter system consists of a multi-lumen tube containing a drive shaft of a machining tool, a suction channel for the delivery of separated particles and an infusion channel ("flushing lumen") with an infusion opening as a flushing system.

The invention has for its object to provide a device for a pancreato-gastrostomy after a Pancreaskopfresektion available, whereby the risks of surgery in the context of pancreato-gastrostomy reduced and yet the long-term wearing an external bag to derive pancreatic secretion should be avoided ,

This object is achieved by a catheter system of o. G. Art solved with the features characterized in claim 1. Advantageous embodiments of the invention are described in the further claims.

For this purpose, it is provided according to the invention in a catheter system of the type mentioned above, that the catheter system additionally comprises a second catheter, which forms a second channel in a catheter housing, which extends over a second predetermined length in the catheter housing of a first catheter eye extends at a first end of the catheter housing of the second catheter to a second catheter eye at a second end of the catheter housing of the second catheter, wherein in functional position of the second Catheter to the human or animal body, the first end of the catheter housing of the second catheter is extraabdominally disposed and the second end of the catheter housing of the second catheter is intraabdominally and the catheter housing extends through the abdominal wall, the second channel in the Catheter housing of the second catheter for receiving the pancreatic duct catheter is designed such that the pancreatic duct catheter is displaceable in the second channel relative to the catheter housing of the second catheter, wherein the second predetermined length of the second channel in the second catheter is shorter as the first predetermined length of the pancreatic duct catheter, wherein a first opening is formed at or spaced from the first end of the catheter housing of the second catheter such that this first opening is extraabdominally disposed in the operative position of the second catheter, wherein a second opening on the or spaced from the second End of the catheter housing of the second catheter is arranged such that this second opening is disposed intraabdominal in the functional position of the second catheter, wherein a third channel in the catheter housing of the second catheter is arranged and formed such that this third channel, the first opening and the second opening fluid-conductively connects to each other, wherein the catheter housing of the second catheter in the region of the second opening comprises a magnetic material, wherein a further separate component is provided of a magnetic material which can be arranged in functional position within a gastric lumen of a stomach in the abdomen is, wherein the separate component of the magnetic material and the magnetic material in the region of the fourth opening are formed such that a magnetic attraction force forms between them when they are below a predetermined distance from each other, such that the A is distance from each other automatically reduced.

This has the advantage that in the functional position of the catheter system by relative displacement of the second catheter relative to the pancreatic duct catheter, the second opening on a stomach wall in the abdomen can be positioned and fixed, so that in the region of the second opening access to a stomach lumen through the stomach wall can be created by means of magnetic force by pinching the stomach wall between the catheter housing of the second catheter and the further separate component within the gastric lumen.

A particularly high magnetic force with rapidly progressing arrosion is achieved by the fact that the magnetic material in the region of the fourth opening on the catheter housing of the second catheter from a soft magnetic material or a hard magnetic material, in particular as a permanent magnet, is formed and / or the further separate component of a soft magnetic material or a hard magnetic material, in particular as a permanent magnet, is formed.

An automatic fixation of the further separate component under the magnetic attraction between the further separate component and the catheter housing of the second catheter exactly on the fourth opening is achieved in that the catheter housing of the second catheter in the region of the second opening a survey or a Has trough.

A particularly high clamping force, which acts on the stomach wall between the further separate component and the catheter housing, and thus a temporally rapid erosion while simultaneously reliably fixing the further separate component on the second opening is achieved in that the further separate component formed spherical is.

A simple and reliable fixation of the second catheter to the stomach wall, for example by means of sewn with a resorbable thread, achieved by the fact that on or adjacent to the second end of the catheter housing of the second catheter, an eyelet is formed.

An additional discharge of pancreatic fluid in functional position of the catheter system is achieved in that in the catheter housing of the second catheter, a drainage channel is formed which extends from at least one opening at the second end of the catheter housing of the second catheter to at least one opening on extending first end of the catheter housing of the second catheter.

A functionally reliable patency or opening of the second channel is achieved even after prolonged lying time of the catheter system in that in the third channel, a detachable obturator is arranged, which extends through the entire third channel and protrudes at the third opening.

Respective guides for introducing a final drainage catheter from extra-abdominal, which establishes a fluid-conducting connection between the pancreatic duct and the gastric lumen, are provided by a gastric guide wire is provided, which extends from extra-abdominal via the third opening, through the opened third channel and the fourth opening to the stomach lumen intraabdominally and that a pancreatic guide wire is provided which extends from extra-abdominal via the first channel to the pancreatic duct intra-abdominal.

A final drainage line between the pancreatic duct and the gastric lumen, which can easily be brought from extra-abdominal to an intra-abdominal functional position, in which an abdominal fluid-tight fluid line is formed from the pancreatic duct to the gastric lumen, is provided by providing a pigtail catheter, which an inherently stable, elastically deformable material is formed and a pancreatic catheter part and a gastric sleeve, wherein the gastric sleeve is permanently connected via a thread with a remote from the pancreas end of the pancreatic catheter part, wherein the pancreatic catheter part on the pancreatic duct catheter liberated pancreatic guidewire and the gastric sleeve is threaded on the stripping of the second catheter gastric guide wire.

A functionally reliable and stationary placement of the pigtail catheter with an end in the gastric lumen without additional fixings is achieved by virtue of the pigtail catheter part having a curvature in the unloaded state at an end facing the gastric sleeve.

A particularly good discharge of fluid from the pancreatic duct is achieved in that the pancreatic duct catheter has openings in the tube wall at an end facing the pancreatic duct.

The invention will be explained in more detail below with reference to the drawing. This shows in

1 a preferred embodiment of a catheter system according to the invention in unassembled state with a first catheter and a second catheter in a partially sectioned view,

2 the preferred embodiment of the catheter system according to the invention according to 1 with assembled first and second catheters in partially sectioned view,

3 a pigtail catheter for a preferred development for the catheter system according to the invention in side view,

4 the preferred embodiment of the catheter system according to the invention according to 1 and 2 in functional position in a first functional state in partially sectioned view,

5 an enlarged detail view of abdomenseitigen part of the preferred embodiment of the catheter system according to the invention according to 1 and 2 in functional position in the first functional state according to 4 in a partially sectioned view,

6 the preferred embodiment of the catheter system according to the invention according to 1 and 2 in functional position in a second functional state in partially sectioned view,

7 the preferred embodiment of the catheter system according to the invention according to 1 and 2 in functional position in a third functional state and with a preferred development of the catheter system in the form of a pancreatic duct wire in a partially sectioned view,

8th the preferred embodiment of the catheter system according to the invention according to 1 and 2 in functional position in a fourth functional state and with a preferred development of the catheter system in the form of a stomach guide wire in a partially sectioned view,

9 the preferred embodiment of the catheter system according to the invention according to 7 and 8th in functional position in a fifth functional state, wherein the first catheter and the second catheter according to 1 and 2 are removed, in a partially sectioned view,

10 the preferred embodiment of the catheter system according to the invention according to 3 . 7 and 8th in functional position in a sixth functional state and with a preferred development of the catheter system in the form of the pigtail catheter according to FIG 3 wherein the pigtail catheter is threaded onto the pancreatic guidewire with a pancreatic catheter portion and a gastric sleeve connected to the pigtail catheter portion via a suture, in a partially sectioned view,

11 the preferred embodiment of the catheter system according to the invention according to 3 . 7 and 8th in functional position in a seventh functional state, wherein the pigtail catheter part of the pigtail catheter is advanced along the pancreatic guidewire into the pancreatic duct, in a partially sectioned view,

12 the preferred embodiment of the catheter system according to the invention according to 3 and 8th in functional position in an eighth functional state, wherein the pancreatic guide wire is removed and the gastric sleeve connected to the pigtail catheter part is advanced along the stomach guide wire into a gastric lumen, in a partially sectioned view,

13 the preferred embodiment of the catheter system according to the invention according to 3 and 8th in functional position in a ninth functional condition, the sleeve being advanced along the gastric guide wire into the gastric lumen, in partial cutaway view and

14 the preferred embodiment of the catheter system according to the invention according to 3 in functional position in a ninth functional state, wherein the sleeve is advanced along the gastric guide wire into the gastric lumen so that a pancreatic duct distal end of the pigtail catheter part is located in the gastric lumen and the gastric guide wire is removed, in a partially sectioned view,

In the 1 and 2 illustrated, preferred embodiment of a catheter system according to the invention comprises a first catheter in the form of a tubular pancreatic duct catheter 10 made of an inherently stable material and a second catheter 16 on.

The pancreatic duct catheter 10 forms in a pipe wall 12 a first channel 14 out, with the first channel 14 from a first opening 18 of the pancreatic duct catheter 10 at a first end 20 of the pancreatic duct catheter 10 up to a second opening 22 of the pancreatic duct catheter 10 at a second end 24 of the pancreatic duct catheter 10 has a first predetermined length. At the first end 20 is a drainage approach 26 arranged with plug connection. At the second end 24 is the pipe wall with a plurality of spaced through-holes 28 formed, which, for example, through the pipe wall 12 through at right angles to the first channel 14 extend. In a section 11 is the pancreatic duct catheter 10 starting from the second end 24 rectilinear and then kinks towards the second end 20 from.

The second catheter 16 points in a catheter housing 30 a second channel 32 which extends over a second predetermined length in the catheter housing 30 from a first catheter eye 34 at a first end 36 of the catheter housing 30 of the second catheter 16 to a second catheter eye 38 at a second end 40 of the catheter housing 30 of the second catheter 16 extends. On the catheter housing 30 is still at or adjacent to the first end 36 a third opening 42 and at or adjacent to the second end 40 a fourth opening 44 educated. A third channel 46 extends in the catheter housing 30 from the third opening 42 to the fourth opening 44 such that this third channel 46 the third opening 42 with the fourth opening 44 fluid conducting connects. In the third channel 46 is a detachable obturator 48 arranged, which has a fluid-conducting patency of the third channel 46 ensures. In the catheter housing 30 is still a drainage channel 50 formed, which extends from a fifth opening 52 at the first end 36 of the catheter housing 30 to one or more sixth openings 54 at the second end 40 of the catheter housing 30 extends. At the fifth opening 52 is a connector 53 for the drainage channel 50 intended. At or adjacent to the second end 40 of the catheter housing 30 is on the outside of the catheter housing 30 an eyelet 56 educated.

At or adjacent to the second end 40 of the catheter housing 30 and the fourth opening 44 around is on the catheter housing 30 or on the outside of a magnetic material 58 intended. This magnetic material covers or forms the outside of the catheter housing 30 for example, over half the circumference of the catheter housing 30 , In the area of the fourth opening 44 forms the outside of the catheter housing 30 for example, an apex (summit, peak, crest elevation) or a depression (depression, depression) relative to the fourth opening 44 surrounding outside of the catheter housing 30 , The magnetic material 58 For example, is a soft magnetic material, ie in a magnetic field with low strength magnetizable (magnetic coercive force H _c less than 1000 A / m), or a hard magnetic material (coercive force H _c greater than 1000 A / m), ie in the case of a hard magnetic material is the Part of the catheter housing 30 with the magnetic material 58 designed as a permanent magnet.

The first length of the first channel 14 of the pancreatic duct catheter 10 is longer than the second length of the second channel of the second catheter 16 , in particular, already a length of the rectilinear section 11 of the pancreatic duct catheter 10 is longer than the second length of the second channel 32 of the second catheter 16 ,

An outer diameter of the pipe wall 12 of the pancreatic duct catheter 10 especially in the area of the first section 11 of the pancreatic duct catheter 10 , and an inner diameter of the second channel 32 in the catheter housing 30 of the second catheter 16 are designed such that the pancreatic duct catheter 10 in the second channel 32 in the catheter housing 30 of the second catheter 16 insertable and along the canal 32 or relative to the catheter housing 30 is linearly displaceable, as with arrow 60 in 2 indicated. This allows a distance between the second (proximal) end 24 of the pancreatic catheter 10 and the second (proximal) end 40 of the catheter housing 30 be varied.

In the 3 shown, preferred embodiment of the catheter system according to the invention is a pigtail catheter 62 which is a pancreatic catheter part 64 and a stomach sleeve 66 having. At least the pancreatic catheter part 64 , but optionally also the stomach sleeve 66 , is made of an inherently stable, elastically deformable material. The pancreatic catheter part 64 is tubular, so that in a wall 68 of the pancreatic catheter part 64 a fluid-conducting channel between openings 70 at a first end 71 of the pancreatic catheter part 64 and at a second end 73 of the pancreatic catheter part 64 is trained. In rest position, ie without external forces, is the pancreatic catheter part 64 J-shaped with a long rectilinear section 72 a short straight-line section 74 and one of these two sections 72 and 74 connecting arcuate section 76 , The stomach pod 66 is tubular and has a thread 80 with the first end 71 of the pancreatic catheter part 64 connected. At the long straight section 72 of the pancreatic catheter part 64 are adjacent to the second end 73 Through holes 77 in the wall 68 of the pancreatic catheter part 64 trained so that secretions from the pancreatic duct not only through the opening 70 at the second end 73 of the pancreatic catheter part 64 but also at several other points of the wall 68 in the pancreatic catheter part 64 trained fluid-conducting channel can drain. Continue on the long straight section 72 of the pancreatic catheter part 64 adjacent to the second end 73 one or more barbs 78 on the outside of the wall 68 formed, which is a stable and reliable support of the second end 73 and a predetermined portion in the region adjacent to the second end 73 the long rectilinear section 72 of the pancreatic catheter part 64 support or ensure within the pancreatic duct.

In functional position of the pigtail catheter 62 is the second end 73 of the pancreatic catheter part 64 in a pancreatic duct and the first end 71 of the pancreatic catheter part 64 arranged in a gastric lumen, wherein the pancreatic catheter part 64 is arranged through the stomach wall or through an opening in the stomach wall extending therethrough. This puts the pancreatic catheter part 64 with its fluid-conducting channel, a fluid-conducting connection between the pancreatic duct and the gastric lumen, so that secretions from the pancreatic duct is diverted into the stomach lumen and not uncontrollably drained into the abdomen after a Pankreaskopfresektion, causing unwanted damage and the death of the patient would lead. The operative arrangement of the pigtail catheter 62 in its functional position by means of the rest of the catheter system will be explained later.

In 4 and 5 are functionally identical parts with the same reference numerals, as in 1 and 2 so that their explanation to the above description of 1 and 2 is referenced. 4 illustrates the application and functional position of the catheter system. This is in functional position on a human or animal body, which is one of an abdominal wall 82 limited abdomen 84 has arranged. In the abdomen 82 of the human or animal body are a pancreas 86 with a pancreatic duct 88 and a stomach 90 with a stomach wall 92 and a stomach lumen 94 ,

How out 4 and 5 can be seen, the catheter system additionally has a separate separate component 96 made of a magnetic material. The magnetic material of the further separate component 96 is, for example, a soft magnetic material, ie magnetizable in a magnetic field of low strength (magnetic coercive field H _c less than 1000 A / m), or a hard magnetic material, ie the magnetization can only be changed or extinguished (demagnetized) with a high field strength magnetic field ( Coercive force H _c greater than 1,000 Nm), ie in the case of a hard magnetic material is the further separate component 96 designed as a permanent magnet. At the further separate component 96 is a thread 98 attached to which the further separate component 96 can be gripped and mechanically manipulated by means of a gripping device, for example on an endoscope.

At the 4 and 5 apparent functional position in a first functional state is the second catheter 16 with the catheter housing 30 passed through an opening in the abdominal wall and the catheter housing 30 is by means of the eyelet 56 (in 4 and 5 not shown) on the stomach wall 92 Sewn by means of a resorbing suture (thread), so that the catheter housing 30 fixed from the outside, ie abdomenseitig, to the stomach wall 92 applies, with that side of the catheter housing 30 on the stomach wall 92 abuts the fourth opening 44 and the magnetic material 58 having. Due to the relative mobility of the pancreatic duct catheter 10 in the second channel 32 relative to the catheter housing 30 can the pancreatic duct catheter 10 until the pancreatic duct 88 be advanced.

In the functional position of the catheter system, as in 4 and 5 shown are the first end 20 of the pancreatic duct catheter 10 , the first end 36 of the catheter housing 30 , the third opening 42 of the catheter housing 30 and the fifth opening 52 at the first end 36 of the catheter housing 30 arranged extraabdominally. Furthermore, in the functional position of the catheter system, as in 4 and 5 represented, the second end 24 of the pancreatic duct catheter 10 , the second end 40 of the catheter housing 30 , the third opening 44 of the catheter housing 30 , the magnetic material 58 and the sixth openings 54 at the second end 40 of the catheter housing 30 itraabdominally arranged. Thus, in the functional position in the first functional state, the catheter system after a Pankreaskopfresektion a fluid-conducting connection of the pancreatic duct 88 through the abdominal wall 82 through to an extra-abdominal location, so that in this first functional state, first the secretion from the pancreatic duct 88 is derived extraabdominal and can be collected there for example by means of a bag. By a magnetic attraction presses the other separate component 96 from the stomach lumen 94 from the stomach wall 92 against the catheter housing 30 wherein the outer surface is the catheter housing 30 is formed such that the further separate component 96 as close as possible to the fourth opening 44 against the catheter housing 30 suppressed. For this purpose, the outer surface of the catheter housing 30 in the area of the fourth opening 44 For example, an apex or a trough, so that the further separate component 96 , which is spherical in the illustrated embodiment, automatically under the magnetic attraction just above the fourth opening 44 to come to rest. By the pressure on the stomach wall 92 it comes to the fourth opening 44 around or in the area of the fourth opening 44 to erosion (tissue destruction), so that after a certain time an opening in the stomach wall 92 exactly in the area of the fourth opening 44 is trained.

The automatic positioning of the further separate component 96 over the fourth opening 44 through a hollow in the area of the fourth opening 44 results from the fact that the magnetic attraction force rolling of the spherical further separate component 96 prevented over a Muldenrand away. However, this must initially the other separate component 96 first manually very precisely over or on the fourth opening 44 be positioned.

The automatic positioning of the further separate component 96 over the fourth opening 44 through an apex in the area of the fourth opening 44 results from the fact that an angle between a surface of the spherical further separate component 96 and the outside of the catheter housing 30 is greater in the direction of the apex, as on the other, remote from the apex side of the spherical further separate component 96 and thereby the trapped tissue is less bulged towards the apex than in the opposite direction. This results in a resultant force on the ball in the direction of the apex. Here, the other separate component 96 only near the fourth opening 44 be positioned manually and the magnetic attraction together with the previously explained effect of the different curvature of the trapped tissue leads to an automatic movement of the other separate component 96 to a position on the fourth opening 44 ,

The catheter system according to the invention is used to perform a catheter-based pancreato-gastrostomy after a Pankreaskopfresektion, wherein a fluid-conducting connection between the pancreatic duct 88 and the stomach lumen 94 not immediately with the first intervention of the Pankreaskopfresektion but temporally delayed on the patient is carried out. How the catheter system according to the invention makes this possible will be explained in more detail below.

When using the catheter system according to the invention, an external discharge of the pancreatic secretase is made possible primarily immediately after the pancreatic head resection, and a connection from the pancreatic duct is made only after a second, temporally later step, after stabilization of the patient 88 to the stomach lumen 94 created the secretion instead of extraabdominally in the stomach lumen 94 and to spare the patient the long-term wearing of an extra-abdominal bag for secretion discharge. This can be used both in the presence of a failed suture connection (anastomotic leakage) in the context of an emergency surgery as well as prophylactically in an excessive high-risk situation.

For this purpose, in the present case, the previously explained catheter system consists of two telescoped catheters 10 and 16 proposed. The inner catheter (pancreatic duct catheter 10 ) is as far as possible in the pancreatic duct 88 and drains the secretion through the abdominal wall 82 outward. About this first catheter 10 is the second catheter 16 pushed the secretion from the cut surface of the pancreas 86 over the drainage channel 50 and the sixth opening 54 as well as the fifth opening 52 also drained to the outside. Approximately 3 cm from the anterior orifice of this catheter (second end 40 of the catheter housing 30 ) is located a metal part of the magnetic material 58 which occupies approximately half the circumference of the catheter housing and, for example, something convex (about 10% of the catheter diameter) is curved. At this metal part is also the eyelet 56 appropriate. This will be the second catheter 16 fixed to the posterior wall of the stomach with resorbable suture material. On the apex of the vault opens the third channel 46 in the fourth opening 44 , on the from outside the abdominal wall 82 a guidewire can be advanced. This third channel 46 is orthogradally directed to the posterior stomach wall after suture fixation. The third channel 46 is first through the obturator 48 closed to the patency of the third channel 46 to ensure even after a longer period of use. The first operation is ended in this situation. The catheter system is in the functional position in the first functional state, as in 4 and 6 shown.

The connection between the pancreatic duct and the stomach lumen takes place in ten steps. All steps are controlled by gastroscopy and / or fluoroscopy. The in terms of the 4 and 5 described arrangement of the catheter system in the functional position in a first functional state is carried out in a first step. For example, under gastroscopic control in the first step, the further separate component 96 in the form of a strongly permanent-magnetic body with a spherical shape in the stomach 90 brought in. This then spontaneously fixates on the metal part of the two catheters 16 with the magnetic material 58 , which was fixed to the stomach posterior wall.

The further steps two to ten are carried out in a later second operative intervention. After recovery of the patient, but not earlier than 6 weeks postoperatively, the catheter system described in the second surgical procedure becomes a derivative of the pancreatic secretion into the gastric lumen 94 respectively. The waiting time is necessary so that a firm, dense to the abdominal drainage cavity 100 ( 9 to 14 ) arises. This drainage cave 100 results from a connective tissue growth on the outside of the catheter system (fibrosis). The drainage cavity 100 is in the 9 to 14 indicated by dashed lines, but already in the functional states according to the 6 to 8th present, but not shown for reasons of clarity. The drainage cavity 100 lies in the 6 to 8th close to the outside of the second catheter 16 and at the portion of the first catheter 10 between the pancreas 86 and the second catheter eye 38 of the catheter housing 30 at. The further steps two to ten of the second surgical procedure are described below with reference to the 6 to 14 explained.

In 6 are functionally identical parts with the same reference numerals, as in 1 . 2 . 4 and 5 so that their explanation to the above description of 1 . 2 . 4 and 5 is referenced. 6 illustrates the catheter system in functional position in a second functional state after a second step of the second surgical procedure. The pressure caused by the magnetic force on the tissue of the stomach wall 92 between the further separate component 96 and the magnetic material 58 on the catheter housing 30 acts, leads to an erosion of the gastric posterior wall in the region of the fourth opening 44 so that over a period of about a week, a perforation between the stomach lumen 94 and the drainage cavity 100 in the stomach wall 92 arises. The metal part (magnetic material 58 ) of the catheter housing 30 with the mouth (fourth opening 44 ) of the third channel 46 (Probing passage) must be from the stomach lumen 94 be clearly visible. In this case, the magnetic body is using the attached to him tether / loop 98 gastroscopically removed.

In 7 are functionally identical parts with the same reference numerals, as in 1 . 2 . 4 and 5 so that their explanation to the above description of 1 . 2 . 4 and 5 is referenced. 7 illustrates the catheter system in functional position in a third functional state after a third step of the second surgical procedure. In the third step, first a pancreatic guide wire 102 (Guidewire pancreatic duct) via the first channel 14 of the pancreatic duct catheter 10 into the pancreatic duct 88 advanced.

In 8th are functionally identical parts with the same reference numerals, as in 1 . 2 . 4 and 5 so that their explanation to the above description of 1 . 2 . 4 and 5 is referenced. 8th illustrates the catheter system in functional position in a fourth functional state after a fourth step of the second surgical procedure. The fourth step becomes the obturator 48 from the third channel 48 (Gastric canal) and a stomach guide wire 104 in the stomach lumen 94 over the third channel 48 advanced.

In 9 are functionally identical parts with the same reference numerals, as in 1 . 2 . 4 and 5 so that their explanation to the above description of 1 . 2 . 4 and 5 is referenced. 9 illustrates the catheter system in functional position in a fifth functional state after a fifth step of the second surgical procedure. In the fifth step become the first catheter 10 and the second catheter 16 leaving the two guide wires 102 and 104 away.

In 10 are functionally identical parts with the same reference numerals, as in 1 . 2 . 4 and 5 so that their explanation to the above description of 1 . 2 . 4 and 5 is referenced. 10 illustrates the catheter system in functional position in one sixth functional state after a sixth step of the second surgical procedure. In the sixth step is on the pancreatic guide wire 102 in the pancreatic duct 88 the pancreatic catheter part 64 of the pigtail catheter 62 threaded. The pancreatic catheter part 64 has barbs 78 ( 3 ) or an analogous system for anchoring in the pancreatic duct 88 , In addition, the pancreatic catheter part 64 with the tear-resistant strongly fixed thread 80 at the proximal (outwardly facing) end (first end 71 ) Mistake. At this approximately 10 cm long thread 80 is the stomach sleeve 66 Also tear-resistant (insoluble in force effects, as they are common in surgical procedures) appropriate. The stomach pod 66 is on the stomach guide wire 104 that in the stomach lumen 94 ends, threaded.

In 11 are functionally identical parts with the same reference numerals, as in 1 . 2 . 4 and 5 so that their explanation to the above description of 1 . 2 . 4 and 5 is referenced. 11 illustrates the catheter system in functional position in a seventh functional state after a seventh step of the second surgical procedure. The seventh step is the pancreatic duct catheter part 64 along the pancreatic guidewire 102 in the pancreatic duct 88 placed and the stomach sleeve 66 along the stomach guide wire 104 in the stomach lumen 94 advanced. With a pusher catheter 106 for the stomach 90 now becomes the pancreatic catheter part 64 under fluoroscopic control along the pancreatic guidewire 102 maximum far into the pancreatic duct 88 brought in. This is the stomach sleeve 66 along the stomach guide wire 104 pulled afterwards or with a pusher catheter 108 for the pancreatic duct 88 along the stomach guide wire 104 Slightly pushed afterwards until the stomach sleeve 66 gastroscopic in the gastric lumen 94 is detectable.

In 12 are functionally identical parts with the same reference numerals, as in 1 . 2 . 4 and 5 so that their explanation to the above description of 1 . 2 . 4 and 5 is referenced. 12 Figure 12 illustrates the catheter system in functional position in an eighth functional state after an eighth step of the second surgical procedure. In the eighth step, the pancreatic guide wire becomes 102 away. When removing the pancreatic guidewire 102 Must be the location of the stomach pod 66 to be controlled.

In 13 are functionally identical parts with the same reference numerals, as in 1 . 2 . 4 and 5 so that their explanation to the above description of 1 . 2 . 4 and 5 is referenced. 13 illustrates the catheter system in functional position in a ninth functional state after a ninth step of the second surgical procedure. In the ninth step becomes the short rectilinear section 74 of the pancreatic catheter part 64 in the stomach lumen 94 arranged. After correct position of the long rectilinear section 72 of the pancreatic catheter part 64 in the pancreatic duct 88 becomes the stomach sleeve 66 with the pusher catheter 106 for the stomach 90 in the stomach lumen 94 advanced so far, until the first end 71 of the pancreatic catheter part 64 in the stomach lumen 94 lies. This must be done extremely carefully to avoid dislocation of the long rectilinear section 72 of the pancreatic catheter part 64 from the pancreatic duct 88 to avoid.

In 14 are functionally identical parts with the same reference numerals, as in 1 . 2 . 4 and 5 so that their explanation to the above description of 1 . 2 . 4 and 5 is referenced. 14 illustrates the catheter system in functional position in a tenth functional state after a tenth step of the second surgical procedure. In the tenth step, the stomach guide wire 106 away. The pancreatic secretion now flows along the pancreatic catheter part 64 in the stomach lumen 94 , The drainage cavity 100 obliterated independently after a few days.

QUOTES INCLUDE IN THE DESCRIPTION

This list of the documents listed by the applicant has been generated automatically and is included solely for the better information of the reader. The list is not part of the German patent or utility model application. The DPMA assumes no liability for any errors or omissions.

Cited patent literature

• EP 19802787 A1 [0004]
• DE 19734890 C1 [0005]

Claims (12)

Catheter system for pancreato-gastrostomy after a pancreatic head resection on a human or animal body, which is from a abdominal wall ( 82 ) limited abdomen ( 84 ) with a first catheter in the form of a tubular pancreatic duct catheter ( 10 ) with a pipe wall ( 12 ), which has a first channel ( 14 ), for establishing a fluid-conducting connection of a pancreatic duct ( 88 ) through the abdominal wall ( 82 ), wherein the pancreatic duct catheter ( 10 ) from a first opening ( 18 ) at a first end ( 20 ) to a second opening ( 22 ) at a second end ( 24 ) has a first predetermined length, wherein in functional position of the pancreatic duct catheter ( 10 ) the first end ( 20 ) with the first opening ( 18 ) extraabdominal and the second end ( 24 ) with the second opening ( 22 ) intraabdominally in the pancreatic duct ( 88 ), characterized in that the catheter system additionally comprises a second catheter ( 16 ), which in a catheter housing ( 30 ) a second channel ( 32 ) which extends for a second predetermined length in the catheter housing (FIG. 30 ) from a first catheter eye ( 34 ) at a first end ( 36 ) of the catheter housing ( 30 ) of the second catheter ( 16 ) to a second catheter eye ( 38 ) at a second end ( 40 ) of the catheter housing ( 30 ) of the second catheter ( 16 ), wherein in functional position of the second catheter ( 16 ) on the human or animal body the first end ( 36 ) of the catheter housing ( 30 ) of the second catheter ( 16 ) extraabdominal and the second end ( 40 ) of the catheter housing ( 30 ) of the second catheter ( 16 ) is disposed intraabdominally and the catheter housing ( 30 ) through the abdominal wall ( 82 ), wherein the second channel ( 32 ) in the catheter housing ( 30 ) of the second catheter ( 16 ) for receiving the pancreatic duct catheter ( 10 ) is designed such that the pancreatic duct catheter ( 10 ) in the second channel ( 32 ) relative to the catheter housing ( 30 ) of the second catheter ( 16 ) is displaceable, wherein the second predetermined length of the second channel ( 32 ) in the second catheter ( 16 ) is shorter than the first predetermined length of the pancreatic duct catheter ( 10 ), with a third opening ( 42 ) at or spaced from the first end ( 36 ) of the catheter housing ( 30 ) of the second catheter ( 16 ) is formed such that this third opening ( 42 ) in the functional position of the second catheter ( 16 ) is arranged extraabdominal, with a fourth opening ( 44 ) at or spaced from the second end ( 40 ) of the catheter housing ( 30 ) of the second catheter ( 16 ) is arranged such that this fourth opening ( 44 ) in the functional position of the second catheter ( 16 ) is disposed intraabdominally, with a third channel ( 46 ) in the catheter housing ( 30 ) of the second catheter ( 16 ) is arranged and configured such that this third channel ( 46 ) the third opening ( 42 ) and the fourth opening ( 44 ) fluidly connecting, wherein the catheter housing ( 30 ) of the second catheter ( 16 ) in the region of the fourth opening ( 44 ) a magnetic material ( 58 ), wherein a further separate component ( 96 ) is provided from a magnetic material, which in functional position within a gastric lumen ( 94 ) of a stomach ( 90 ) in the abdomen ( 84 ) can be arranged, wherein the separate component ( 96 ) of the magnetic material and the magnetic material ( 58 ) in the region of the fourth opening ( 44 ) are formed such that a magnetic attraction force forms between them when they fall below a predetermined distance from each other, such that the distance from each other is automatically reduced. Catheter system according to claim 1, characterized in that the magnetic material ( 58 ) in the region of the fourth opening ( 44 ) on the catheter housing ( 30 ) of the second catheter ( 16 ) is formed of a soft magnetic material or a hard magnetic material, in particular as a permanent magnet, and / or that the further separate component ( 96 ) is formed of a soft magnetic material or a hard magnetic material, in particular as a permanent magnet. Catheter system according to claim 1 or 2, characterized in that the catheter housing ( 30 ) of the second catheter ( 16 ) in the region of the fourth opening ( 44 ) has a survey or a trough. Catheter system according to at least one of the preceding claims, characterized in that the further separate component ( 96 ) is spherical. Catheter system according to at least one of the preceding claims, characterized in that at or adjacent to the second end ( 40 ) of the catheter housing ( 30 ) of the second catheter ( 16 ) an eyelet ( 56 ) is trained. Catheter system according to at least one of the preceding claims, characterized in that in the catheter housing ( 30 ) of the second catheter ( 16 ) a drainage channel ( 50 ), which extends from at least one opening ( 54 ) at the second end ( 40 ) of the catheter housing ( 30 ) of the second catheter ( 16 ) to at least one opening ( 52 ) at the first end ( 36 ) of the catheter housing ( 30 ) of the second catheter ( 16 ). Catheter system according to at least one of the preceding claims, characterized in that in the third channel ( 46 ) a detachable obturator ( 48 ), which extends through the entire third channel ( 46 ) and at the third opening ( 42 ) stands out. Catheter system according to at least one of the preceding claims, characterized in that a gastric guide wire ( 104 ) which extends from extra-abdominal via the third opening ( 42 ), through the opened third channel ( 46 ) and the fourth opening ( 44 ) into the stomach lumen ( 94 ) extends intra-abdominally. Catheter system according to at least one of the preceding claims, characterized in that a pancreatic guide wire ( 102 ) which extends from extra-abdominal via the first channel ( 14 ) into the pancreatic duct ( 88 ) extends intra-abdominally. Catheter system according to claims 8 and 9, characterized in that a pigtail catheter ( 62 ) is provided, which is formed of an elastically deformable material and a pancreatic catheter part ( 64 ) and a stomach sleeve ( 66 ), wherein the gastric sleeve ( 66 ) over a thread ( 80 ) with one of the pancreas ( 86 ) facing away from the end ( 71 ) of the pancreatic catheter part ( 64 ) connected is. Catheter system according to claim 10, characterized in that the pancreatic catheter part ( 64 ) on one of the stomach sleeve ( 66 ) facing end ( 71 ) in the unloaded state a curvature ( 76 ) having. Catheter system according to at least one of the preceding claims, characterized in that the pancreatic duct catheter ( 10 ) at a pancreatic duct ( 88 ) facing end ( 24 ) Openings ( 28 ) in the pipe wall ( 12 ) having.

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