JP2002369880A - Catheter for abdominal cavity/vein shunt - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a catheter for abdominal cavity/vein shunt used in a relatively easily performable new operation method so as to reduce the physical loads and economical burdens on a patient. SOLUTION: The catheter for abdominal cavity/vein shunt is composed by providing a tapered end part introduction port on one end of a catheter main body (19) composed of a polyurethane tube whose length is 90 cm, outer diameter is 3 mm and inner diameter is 2.8 mm and providing a side part introduction port composed of a plurality of through-holes on a side wall 15 cm away from the end part. At a part 37 cm away from the end part introduction port of the catheter main body (19), a discharge port (3) composed of a plurality of parallel straight slits (2) is provided.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION The ascites commonly seen in cancer and cirrhosis leads to worse prognosis and hasten the death of patients. The source of ascites is blood, so ascites should be returned to the circulating blood. The present invention relates to a catheter for peritoneal-venous shunt for transferring bodily fluid accumulated in the peritoneal cavity, that is, peritoneal fluid (or ascites) to the vascular system.

[0002]

2. Description of the Related Art As means for moving ascites into the vascular system,
U.S. Pat. No. 4,418,693 describes an example in which a tube passager is used to pass a vein tube from an abdominal incision to a neck incision through a subcutaneous tissue, and the tip is inserted into a subclavian vein.

[0003] Further, as shown in FIG.
There is also known a peritoneal-venous shunt catheter in which (21) and a peritoneal catheter (22) are connected via a pump chamber (24) provided with a check valve (23). In this case, attach the tip of the venous catheter (21) to the tip of the tunneler, insert the tunneler into the subcostal incision (25) and push it through the subcutaneous tissue towards the subclavian incision (26), The tip of the venous catheter (21) is advanced into the subclavian vein (27) so that the pump chamber (24) fits in the pump chamber pocket provided in advance, and the tip is inserted into the vena cava (28) and the right atrium ( It comes to the joint of 29).

[0004]

However, the above-mentioned surgical method has a large physical load on the patient and a large economical burden because the surgical site is wide and the tube or catheter is passed through the subcutaneous tissue. In addition, there is the disadvantage that the patient cannot be treated at home.

[0005] It is an object of the present invention to provide a catheter for peritoneal-venous shunt used in a new surgical method which can be performed relatively easily so as to reduce the physical burden and economic burden on the patient.

[0006]

DISCLOSURE OF THE INVENTION The present invention has been devised to achieve the above object, and is directed to a catheter for transferring ascites accumulated in the peritoneal cavity of a patient to a vascular system. From the subclavian vein, through the right atrium, vena cava, through the right hepatic vein, penetrates the liver and is implanted in the body to reach the peritoneal cavity, and has an inlet for ascites at one end and / or near the end, After implantation, the other end is closed, and has an outlet communicating with the right atrium or vena cava in the middle, a check valve at the outlet or between the outlet and the inlet, and the inlet is located in the peritoneal cavity. And the outlet is located in a vein.

The above-mentioned check valve is operated so as to open when the internal pressure of the catheter is higher than the external pressure by a predetermined value, and to close when the internal pressure is lower than the same value.

The first embodiment of the check valve is constituted by one or more slits formed in the catheter body, and the slits are opened when the internal pressure of the catheter exceeds the predetermined value.

[0009] A second embodiment of the above-mentioned check valve is provided with one or a plurality of liquid passage side holes formed in the catheter body,
A soft cover that covers the side hole, and both ends of the soft cover are fixed to the catheter main body, and when the catheter internal pressure exceeds the predetermined value, the middle portion of the soft cover separates from the liquid passage side hole and separates it from the outside. It is to communicate.

[0010] A third embodiment of the above-mentioned check valve is provided with one or a plurality of liquid passage side holes formed in the catheter body.
One or more soft covers covering the side holes, one end of the soft cover is fixed to the catheter body,
When the catheter internal pressure exceeds the above-mentioned predetermined value, the other end of the soft cover separates from the liquid passage side hole and communicates it with the outside.

A fourth embodiment of the check valve is constituted by an opening formed in the catheter body, and a soft sheet covering the opening and having one or a plurality of slits communicating with the opening. It is opened when the catheter internal pressure exceeds the above-mentioned predetermined value.

[0012] A fifth embodiment of the above-mentioned check valve is characterized in that one or a plurality of liquid passage side holes formed in the catheter body,
The catheter is covered with the catheter body so as to cover the side hole, and 1
A soft cover having one or a plurality of slits at positions corresponding to the side holes, and the slits are opened when the catheter internal pressure exceeds the predetermined value to allow the liquid passage side holes to communicate with the outside.

[0013] A sixth embodiment of the above-mentioned check valve is provided with one or a plurality of liquid passage side holes formed in a catheter body.
A soft cover that has one or more tongues covering the side hole and is provided on the catheter body. The tongue moves away from the liquid passage side hole when the catheter internal pressure exceeds the predetermined value. Is communicated with the outside.

It is preferable that the soft cover or the soft sheet is made of a material which is softer than the catheter body or is softer equivalently thereto.

In the catheter for peritoneal-venous shunt according to the present invention, the standard length of the catheter for peritoneal-venous shunt before operation is 70 to 100 cm. Following surgery, the right subclavian vein end is excised 10-40 cm, leaving approximately 60 cm. It is preferable that a silicone septum is provided at the cut end so that water or heparin can be injected. The standard outer diameter of a peritoneal-venous shunt catheter is 2-5 mm and the inner diameter is 1.5-4 mm.

The end of the abdominal cavity-venous shunt catheter on the side where the ascites is introduced is tapered or shell-shaped, and a portion up to about 20 cm from the end is inserted into the abdominal cavity, and about 15 cm from the end. A side inlet is provided.

A check valve is provided at about 35 to 40 cm from the end on the ascites introduction side. The valve is set to close when the pressure of ascites flowing inside the catheter decreases and the difference between the pressure and the external venous blood pressure falls to, for example, about 10 cmH ₂ O or less.

The catheter for peritoneal-venous shunt according to the present invention is indwelled in the body for a long time, and may be pulled out from the body for replacement. However, those having low tensile strength are not preferred. A soft synthetic resin which is hardly deformed and has high tensile strength, particularly polyurethane, is preferably used.

When the catheter for peritoneal-venous shunt according to the present invention is implanted in the body, the catheter is pushed inside the introducer, so that it is preferable that the catheter has excellent pushability and slipperiness, and is therefore subjected to hydrophilic treatment. Is preferred. It is also preferable to perform a heparin coating treatment to prevent blood coagulation.

[0020]

Next, an embodiment of the present invention will be described with reference to the drawings.

EXAMPLE 1 The catheter for peritoneal-venous shunt of this example has a tapered end at one end of a catheter body (19) composed of a polyurethane tube having a length of 90 cm, an outer diameter of 3 mm and an inner diameter of 2.8 mm. It has an inlet, and a side inlet formed of a plurality of through holes is provided on a side wall at a position 15 cm from the end. 37 from the end introduction port of the catheter body (19)
As shown in FIG. 1, a discharge port (3) comprising a plurality of parallel linear slits (2) is provided at the position of cm.

The plurality of slits forming the outlet (3)
When the pressure of the liquid flowing inside the catheter is higher than the external pressure by a predetermined value, the catheter is opened to allow the liquid to flow out. However, when the internal pressure is lower than this value, the polyurethane tube is closed by the shape restoring force and the backflow of the liquid is prevented. Therefore, the outlet (3)
Are also functioning as check valves.

The catheter (1) for peritoneal-venous shunt constructed as described above is connected to the right subclavian vein as shown in FIG.
From (12), the inside of the introducer was pushed through the right atrium (13), the vena cava (14), the right hepatic vein (15), through the liver (16) and into the abdominal cavity (17). The part up to 20 cm from the tip is inserted into the abdominal cavity (17). After the operation, the right subclavian vein end is resected 10 cm, and the resected end is provided with a silicone septa. The end inlet and the side inlet are placed in the peritoneal cavity, and the slit constituting the check valve is located in the vein. With this catheter (1)
Ascites collected in the patient's peritoneal cavity is transferred to the vascular system.

Embodiment 2 The catheter (4) for peritoneal-venous shunt of this embodiment is
As shown in FIG. 2, the catheter body (19) has a discharge port (5) formed of a plurality of liquid passage side holes at one intermediate side of the length thereof. The outlet (5) is covered with a rectangular soft cover (6) made of a polyurethane sheet, and both ends of the soft cover (6) are fixed to the side surface of the catheter body (19) with an adhesive (7).

Since the soft cover (6) is made of a soft plastic sheet, if the pressure of the liquid flowing inside the catheter becomes higher than the external pressure by a predetermined value, the soft cover (6) slightly expands and rises from the outlet (5). When this is opened, the liquid is allowed to flow out of the side of the soft cover (6). If the internal pressure is lower than this value, the shape of the soft sheet is restored to cover the outlet (5) and the backflow of the liquid is prevented. Therefore, the soft cover
(6) also functions as a check valve. The soft cover (6) may be made of rubber.

The other points are the same as in the first embodiment.

Embodiment 3 The catheter (41) for peritoneal-venous shunt of this embodiment comprises:
As shown in FIG. 3, each of the opposite sides of the intermediate portion of the catheter body (19) has a discharge port (5) formed of a liquid passage side hole. The outlet (5) is covered with the tip of a rectangular soft cover (6) made of polyurethane sheet.
The proximal end of (6) is attached to the side of the catheter body (19),
It is fixed with.

Since the soft cover (6) is made of a soft plastic sheet, if the pressure of the liquid flowing inside the catheter becomes higher than the external pressure by a predetermined value, the tip of the soft cover (6) rises from the outlet (5). This is opened (indicated by a broken line in FIG. 3) to allow the liquid to flow out from the side of the soft cover (6). If the internal pressure is lower than this value, the outlet (5) is covered by the soft sheet shape restoring force. Close to prevent liquid backflow.
Therefore, the soft cover (6) also functions as a check valve. The soft cover (6) may be made of rubber.

The other points are the same as in the first embodiment.

Embodiment 4 The catheter (43) for peritoneal-venous shunt of this embodiment is
As shown in FIG. 4, the catheter body (19) has an outlet (5) formed of a liquid passage side hole only at an upper portion in the middle of the length. The outlet (5) is covered with a distal end of a rectangular soft cover (6) made of polyurethane sheet, and the proximal end of the soft cover (6) is fixed to the side surface of the catheter body (19) with a fixing portion (42). Have been.

The other points are the same as the third embodiment.

Example 5 The catheter (8) for peritoneal-venous shunt of this example is
As shown in FIG. 5, an oval opening (9) is opened at one side of the catheter main body (19) at its middle, and a soft sheet (10) covering this opening (9) is attached to the catheter main body (19). An outlet (11) formed of a cross-shaped slit is formed in the center of the soft sheet (10) and is fixed to the opening edge of the opening (19) with an adhesive (18).

When the pressure of the liquid flowing through the inside of the catheter becomes higher than the external pressure by a predetermined value, the cross-shaped slit constituting the outlet (11) opens against the elasticity of the soft sheet (10) and allows the liquid to flow out. However, if the internal pressure is lower than this value,
It closes by the elastic restoring force of (10) to prevent the liquid from flowing backward. Therefore, the outlet (1
1) also functions as a check valve. The soft sheet (10) is preferably made of rubber, but may be made of soft plastic.

The other points are the same as in the first embodiment.

Example 6 The peritoneal-venous shunt catheter (20) of this example
As shown in FIG. 6, outlets (31) and (32) each having an elliptical liquid passage side hole are opened in the opposite side portion of the catheter body (19) in the middle of its length. ) (32) is covered with a cylindrical soft cover (33) on the catheter body (19), and the soft cover (33) has a linear shape at a position corresponding to the outlets (31) and (32). A slit (34) is formed.

When the pressure of the liquid flowing inside the catheter becomes higher than the external pressure by a predetermined value, the slit (34) becomes a soft cover (3).
When the internal pressure is lower than this value, the soft cover (33) closes due to the elastic restoring force and prevents the liquid from flowing backward. Therefore, the slit (34)
Also functions as a check valve. The soft sheet (10) is preferably made of rubber, but may be made of soft plastic.

The other points are the same as in the first embodiment.

Example 7 The catheter (35) for peritoneal-venous shunt of this example comprises:
As shown in FIG. 7, a discharge port (36) composed of a circular liquid passage side hole is opened on one side portion of the length of the catheter body (19), and a plurality of tongues covering this discharge port (36) are provided. A cylindrical soft cover (38) having a portion (37) is provided outside the catheter body (19).

Since the soft cover (38) is made of a soft plastic sheet, when the pressure of the liquid flowing inside the catheter becomes higher than the external pressure by a predetermined value, the tongue portion (37) of the soft cover (38) is connected to the outlet (36). When the internal pressure is lower than this value, the liquid sheet closes and covers the discharge port (36) due to the shape restoring force of the soft sheet to prevent the liquid from flowing back. Therefore, the tongue (37) of the soft cover (38) also functions as a check valve. The soft cover (6) may be made of rubber.

The other points are the same as in the first embodiment.

[0041]

As described above, the peritoneal-venous shunt catheter according to the present invention penetrates the liver from the right subclavian vein through the right atrium, vena cava, and right hepatic vein into the peritoneal cavity. Being implanted, implantation surgery can be performed more easily than conventional surgical methods, and the physical and economic burden on the patient can be reduced.

[Brief description of the drawings]

FIG. 1 is a plan view showing an intermediate portion of a peritoneal-venous shunt catheter according to Embodiment 1 of the present invention.

FIG. 2 (a) is a side view showing an intermediate portion of a catheter for peritoneal-venous shunt according to Embodiment 2 of the present invention,
FIG. 2B is a plan view thereof.

FIG. 3 (a) is a plan view showing an intermediate portion of a peritoneal-venous shunt catheter according to Embodiment 3 of the present invention;
FIG. 3B is a longitudinal sectional view thereof.

FIG. 4 is a longitudinal sectional view showing an intermediate portion of a peritoneal-venous shunt catheter according to Embodiment 4 of the present invention.

FIG. 5 is a plan view showing an intermediate portion of a peritoneal-venous shunt catheter according to Embodiment 5 of the present invention.

FIG. 6 (a) is a plan view showing an intermediate portion of a peritoneal-venous shunt catheter according to Embodiment 6 of the present invention;
FIG. 6B is a longitudinal sectional view thereof.

FIG. 7 is a perspective view showing an intermediate portion of a peritoneal-venous shunt catheter according to Embodiment 7 of the present invention.

FIG. 8 is a front view showing a state in which the catheter for peritoneal-venous shunt according to the first embodiment of the present invention is implanted in the body.

FIG. 9 is a front view showing a state in which a conventional venous catheter is implanted in a body.

[Explanation of symbols]

1,4,8,20,35,43: Catheter for peritoneal-venous shunt 2,34: Slit 3,5,11,31,32,36: Outlet 6,33,38: Soft cover 7,18: Adhesion Agent 9: Opening 10: Soft sheet 19: Catheter 37; Tongue 42: Fixing part

 ────────────────────────────────────────────────── ─── Continuing on the front page (72) Inventor Hiroshi Inoue 3-8-8 Edobori, Nishi-ku, Osaka Medico Suhirata Center Building Medico Suhirata Co., Ltd. (72) Inventor Hiroshi Takahashi 179 Karibacho, Hodogaya-ku, Yokohama, Kanagawa Prefecture. F term (reference) 4C077 AA20 BB10 DD21 DD26 FF04 KK25 NN20 PP14 PP16

Claims (9)

[Claims] 1. A catheter for transferring ascites accumulated in the peritoneal cavity of a patient to a vascular system, wherein the catheter penetrates the liver through the right subclavian vein, the right atrium, the vena cava, and the right hepatic vein to enter the peritoneal cavity. Implanted into the body so that it has an inlet for ascites at one end and / or the side near one end, the other end is closed after implantation, and an outlet for communicating with the right atrium or vena cava in the middle A ventilating valve provided at the outlet or between the inlet and the inlet, wherein the inlet is placed in the peritoneal cavity and the outlet is located in a vein;
Intravenous shunt catheter. 2. The catheter for peritoneal-venous shunt according to claim 1, wherein the check valve operates to open when the internal pressure of the catheter becomes higher than the external pressure by a predetermined value and close when the internal pressure becomes lower than the same value. 3. The check valve according to claim 1, wherein the check valve comprises one or more slits formed in the catheter body, and the slit opens when the catheter internal pressure exceeds the predetermined value.
3. A catheter for peritoneal-venous shunt according to claim 2. 4. The check valve according to claim 1, wherein the check valve comprises one or a plurality of through-holes formed in the catheter body and a soft cover covering the side holes, and both ends of the soft cover are fixed to the catheter body. 3. The catheter for peritoneal-venous shunt according to claim 2, wherein when the catheter internal pressure exceeds the predetermined value, the intermediate portion of the soft cover is separated from the liquid passage side hole and communicates with the outside. 5. The check valve according to claim 1, wherein the check valve comprises one or a plurality of liquid passage side holes formed in the catheter body, and one or a plurality of soft covers covering the side holes. 3. The catheter for abdominal cavity-venous shunt according to claim 2, wherein when the catheter internal pressure exceeds the predetermined value, the other end of the soft cover is separated from the fluid passage side hole and communicates with the outside. 6. The check valve according to claim 1, wherein the check valve comprises an opening formed in the catheter body, and a soft sheet covering the opening and having one or more slits communicating with the opening. 3. The catheter for peritoneal-venous shunt according to claim 2, which opens when a predetermined value is exceeded. 7. The non-return valve is provided on one or a plurality of liquid passage side holes formed in the catheter body, and is provided on the catheter body so as to cover the side holes, and one or more slits are formed in the side hole. 3. The catheter for peritoneal-venous shunt according to claim 2, comprising a soft cover provided at a corresponding position, wherein the slit is opened when an internal pressure of the catheter exceeds the predetermined value, and the fluid passage side hole communicates with the outside. 8. The non-return valve has one or a plurality of liquid passage side holes formed in the catheter body, and one or a plurality of tongues covering the side holes, and is covered by the catheter body. 3. The catheter for abdominal cavity-venous shunt according to claim 2, wherein the tongue is constituted by a soft cover, and when the internal pressure of the catheter exceeds the predetermined value, the tongue is separated from the fluid passage side hole and communicates with the outside. 9. The catheter for peritoneal-venous shunt according to claim 1, wherein the soft cover or the soft sheet is made of a material that is softer than the catheter main body or a material softer equivalent thereto.