JP2005013351A - Tube structure body for treating lacrimal passage occlusion - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a lacrimal passage occlusion treatment instrument capable of easily and securely preventing occlusion of a lacrimal passage from a lacrimal canaliculus to an inferior nasal passage. <P>SOLUTION: The tube structure body for treating the lacrimal passage occlusion comprises a flexible cylindrical body 2 disposed inside a nasolacrimal duct 15 from a lacrimal sac 13 to the inferior nasal passage 17, and a string-like holding means 3 extending from one end of the cylindrical body 2 for holding the cylindrical body 2 at a prescribed position inside the nasolacrimal duct 15. An opening piercing through a side surface of the cylindrical body 2 and a slit 2d extending from an edge of the opening to one end of the cylindrical body 2 for clasping the other end of the holding means 3 are formed at the center in the longitudinal direction of the cylindrical body 2. <P>COPYRIGHT: (C)2005,JPO&NCIPI

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to a lacrimal passage obstruction treatment device used for treatment of lacrimal passage obstruction from the lacrimal duct to the lower nasal passage among lacrimal diseases.
[0002]
[Prior art]
Among the lacrimal diseases, in the treatment of lacrimal passage obstruction from the lacrimal duct through the lacrimal sac and nasolacrimal duct to the lower nasal passage, there is a case where a so-called tubing surgical treatment is performed using a tube made of a flexible member. Yes (see, for example, Patent Document 1).
[0003]
This tube is inserted into the nasolacrimal duct through a previously formed artificially formed through hole at the boundary between the inner horn and the lacrimal sac, and then the tube passes through the nasal lacrimal duct and from the lacrimal sac through the nasolacrimal duct. The tube is placed at a predetermined position in the lacrimal passage leading to the nasal passage, and this tube forms an artificial lacrimal passage from the inner eye corner to the lower nasal passage. Then, until a new lacrimal passage is formed at the place where the tube is disposed, the lacrimal fluid flows down to the lower nasal passage through this artificial lacrimal passage.
[0004]
[Patent Document 1]
Japanese Patent Laid-Open No. 10-309292 (page 2-3, FIG. 2)
[0005]
[Problems to be solved by the invention]
By the way, in the treatment of lacrimal passage obstruction using such a tube, since there is no active means for placing the tube in a predetermined position in the lacrimal passage, the tube is displaced downward in the lacrimal passage, for example. There was a possibility that it would stop working. In addition, since it is necessary to form a through-hole at the boundary between the inner eye corner and the lacrimal sac, the operation is complicated and the physical burden on the patient is large, and the range from the nasolacrimal duct to the lower nasal passage Although effective for occlusion of the lacrimal passage, there is also a problem that occlusion of the lacrimal canal cannot be directly treated.
[0006]
The present invention has been made in view of such circumstances, and an object of the present invention is to provide a lacrimal passage obstruction treatment device that can easily and surely prevent occlusion of the lacrimal passage from the lacrimal canal to the lower nasal passage.
[0007]
[Means for Solving the Problems]
In order to solve the above-described problems and achieve the object, the present invention proposes the following means.
[0008]
That is, the present invention is a tube structure for treating lacrimal passage from the lacrimal canal to the lower nasal passage, and is a flexible tube disposed in the nasolacrimal duct from the lacrimal sac to the lower nasal passage And a string-like holding means that is disposed in the lacrimal canal and extends from one end of the cylindrical body for holding the cylindrical body in a predetermined position in the nasolacrimal duct, One end of the cylindrical body from the edge of the opening for holding the opening penetrating the side surface of the cylindrical body and the other end of the holding means at a substantially central portion in the longitudinal direction of the cylindrical body A slit extending to the side is formed.
[0009]
Here, one end of the holding means is supported by one end of the cylindrical body, and the other end of the holding means is locked to the tip of a bougie that operates the holding means. Locking means may be formed. When the holding means is formed of a flexible rod, an example of the locking means is to form a recess on the side surface of the holding means.
[0010]
Moreover, you may provide the identification means which shows the position of the said latching means in the other end part of the said holding means. An example of the identification means is to make the color of the holding means at least in the vicinity of the locking means different from other portions of the holding means.
[0011]
DETAILED DESCRIPTION OF THE INVENTION
Hereinafter, an embodiment of a tube structure for treating lacrimal passage according to the present invention (hereinafter abbreviated as “tube structure” as necessary) will be described with reference to FIGS. 1 to 7.
[0012]
As shown in FIG. 1, the tube structure 1 includes a cylindrical body 2 formed of a flexible soft elastic material such as a silicone resin, and is supported by one end 2 a of the cylindrical body 2. And a rod (holding means) 3 formed of a flexible soft elastic material such as silicone resin. The rod 3 has a solid string shape smaller in diameter than the inner diameter of the cylindrical body 2, and its one end 3 a is inserted into a hole 2 b formed in one end 2 a of the cylindrical body 2 so as to form a cylindrical shape. The body 2 is supported on one end 2a.
[0013]
By making the cylindrical body 2 and the rod 3 constituting the tube structure 1 made of a soft elastic material, the tube structure 1 can be easily handled when placed in the lacrimal passage or removed from the lacrimal passage. Moreover, since the tube structure 1 follows the shape of the lacrimal passage when the tube structure 1 is placed in the lacrimal passage, the physical burden on the patient is reduced and the period until the formation of a new lacrimal passage is shortened. The
[0014]
At the center in the longitudinal direction of the cylindrical body 2, an opening 2 c that penetrates the side surface of the cylindrical body 2, and the edge of the opening 2 c along the longitudinal direction of the cylindrical body 2, A slit 2d extending to one end side is formed. Specifically, the opening 2c is such that the side surface of the cylindrical body 2 is not deformed (bent) due to the presence of the opening 2c at the center in the longitudinal direction of the cylindrical body 2. The slit 2d is formed by cutting the side surface of the cylindrical body 2 toward one end from the center of the opening 2c along the circumferential direction of the cylindrical body 2. .
[0015]
In the present embodiment, the cylindrical body 2 has an overall length of about 100 mm, an outer diameter of about 3 mm to 3.5 mm, and an inner diameter of about 2 mm to 2.5 mm. The opening 2c has an elliptical shape having a major axis of about 2.0 mm and a minor axis of about 1.5 mm. When the cylindrical body 2 is viewed from the side, the major axis substantially coincides with the longitudinal direction of the cylindrical body 2. Open to do. Furthermore, the slit 2d is formed over about 20 mm from the apex on the one end side of the opening 2c toward the one end side of the cylindrical body 2.
[0016]
As shown in FIG. 2, the other end 3b of the rod 3 is formed with a mortar-shaped recess 3c formed by cutting out a part of the side surface. In addition, in order to easily identify the concave portion 3c by visual observation, the surface 3d of the concave portion 3c has a color different from other portions of the rod 3 except the surface 3d.
[0017]
In the present embodiment, the total length of the rod 3 (the amount of extension from the one end 2a of the cylindrical body 2) is about 200 mm to 300 mm, and the outer diameter is about 0.5 mm to 0.8 mm. Further, a recess 3c having a depth of about 0.4 mm to 0.5 mm is formed at a position of about 2 mm to 3 mm from the other end surface of the rod 3.
[0018]
Next, the usage method of the tube structure 1 which has the above structure is demonstrated.
First, as shown in FIG. 3, the lacrimal sac 13 is incised in the vicinity of the inner eye corner 10, and an opening 14 for communicating the lacrimal sac 13 and the outside is formed in this portion. For example, as shown in FIG. 4 (a), a lacrimal bougie 4 is prepared in which both ends of the gripping portion 4a are formed so that the needle-like portions 4b having a diameter smaller than the gripping portion 4a are coaxial with each other. As shown in b), the tip of the needle-like portion 4b is brought into contact with a recess 3c formed in the other end 3b of the rod 3 from one end side of the rod 3, so that the other end 3b is brought into contact with the needle 3b. The tip of the shaped part 4b is locked.
[0019]
Next, in the state shown in FIG. 4B, the other end 3b is inserted into the superior lacrimal tubule 11 through the opening 14 together with the tip of the needle-like portion 4b. Then, by pushing the lacrimal bougie 4 toward the upper lacrimal point 11a, the rod 3 locked to the tip of the needle-like portion 4b moves together with the needle-like portion 4b into the upper lacrimal tubule 11 toward the upper lacrimal point 11a. Moving.
[0020]
When the other end 3b reaches the upper punctum 11a together with the tip of the needle 4b, the rod 3 is appropriately pulled out from the upper punctum 11a, and then the needle 4b is pulled out from the opening. Further, the tip of the needle-like portion 4b is brought into contact with the recess 3c again to engage the other end 3b with the tip of the needle-like portion 4b. In this state, the other end 3b is brought to the tip of the needle-like portion 4b. At the same time, it is inserted into the lower lacrimal tubule 12 through the lower punctum 12a. Then, by pushing the lacrimal passage bougie 4 to the lacrimal sac 13 side, the rod 3 locked to the tip of the needle-like portion 4b moves along with the needle-like portion 4b to the lacrimal sac 13 side. .
[0021]
When the other end portion 3b reaches the lacrimal sac 13 together with the tip of the needle-like portion 4b, the rod 3 is appropriately pulled out from the opening 14, and then the needle-like portion 4b is pulled out from the lower punctum point 12a. As a result, as shown in FIG. 3, the rod 3 loops from the opening 14 side into the upper lacrimal tubule 11 and the lower lacrimal tubule 12 (hereinafter, abbreviated as “the lacrimal tubules 11 and 12” as necessary). The rod 3 is inserted in a loop shape, and the movement of the rod 3 toward the lacrimal sac 13 is prevented by the loop-shaped rod 3. The instrument used for inserting the rod 3 into the lacrimal tubules 11 and 12 is not limited to the lacrimal passage bougie 4, and the other end 3 b of the rod 3 is held in the lacrimal tubules 11 and 12. Anything that can be inserted (for example, a bougie provided with a clamping means to be described later) may be used.
[0022]
Further, the other end 3 b drawn out from the opening 14 is inserted into the tubular body 2 from the end surface on the one end 2 a side of the tubular body 2 on which the rod 3 is supported, and is pulled out from the other end of the tubular body 2.
[0023]
Next, the needle-like part 4b of the lacrimal bougie 4 is inserted from the opening 2c of the cylindrical body 2 toward the other end side of the cylindrical body 2, and as shown in FIG. The edge part of the end side is brought into contact with the end surface of the grip part 4a of the lacrimal passage bougie 4. As a result, further movement of the cylindrical body 2 toward the grip portion 4a (upper right in the figure) is prevented.
[0024]
The other end of the cylindrical body 2 is connected to the lower nasolacrimal duct 15 from the lacrimal sac 13 to the lower nasal passage 17 through the opening 14 together with the tip of the needle-like part 4 b inserted into the cylindrical body 2. Insert into. Further, by pushing the lacrimal bougie 4 toward the lower nasal passage 17, the cylindrical body 2 locked to the needle-like portion 4 b moves together with the needle-like portion 4 b into the nasolacrimal duct 15 toward the lower nasal passage 17. As a result, the cylindrical body 2 is disposed together with the rod 3 in the nasolacrimal duct 15 extending from the lacrimal sac 13 to the lower nasal passage 17. That is, as a result of the above operation, as shown in FIG. 5, the tube structure 1 is continuously arranged in the lacrimal passage from the lacrimal tubules 11 and 12 to the lacrimal sac 13, the nasolacrimal duct 15, and the lower nasal passage 17. Established.
[0025]
In this case, as described above, the total length of the cylindrical body 2 is about 100 mm, whereas the total length of the nasolacrimal duct 15 from the lacrimal sac 13 to the lower nasal passage 17 is generally about 50 mm. In the state shown in FIG. 5, the opening 2 c formed in the central portion in the longitudinal direction of the cylindrical body 2 is positioned near the boundary between the nasal cavity 16 and the outside.
[0026]
When the tube structure 1 is disposed in the lacrimal passage, the lacrimal passage bougie 4 is pulled upward from the opening 14, and then the other end 3 b of the rod 3 is pulled to the other end side of the cylindrical body 2. The slack of the rod 3 inserted into the cylindrical body 2 through the small tubes 11 and 12 is adjusted, and the cylindrical body 2 is moved to an appropriate position in the nasolacrimal duct 15 from the lacrimal sac 13 to the lower nasal passage 17. Deploy. In this state, the cylindrical body 2 and the rod 3 are appropriately cut at a position where at least the slit 2d of the cylindrical body 2 remains, and the other end 3b of the rod 3 after cutting is held between the slits 2d. Furthermore, it is pulled to one end side (upward) of the cylindrical body 2 along the longitudinal direction of the cylindrical body 2. Then, as shown in FIG. 6, the other end portion 3 b is supported by the cylindrical body 2 while being sandwiched by the slit 2 d located at the lower end portion of the lower nasal passage 17. In this case, since the other end 3b is clamped by the slit 2d while being pressed from the left and right by the elasticity of the cylindrical body 2, the slit 2d is forcibly opened or the other end 3b is pulled downward. Unless it is, the slit 2d will not come out. The opening 14 formed in the lacrimal sac 13 is appropriately closed by a method such as suturing.
[0027]
The tube structure 1 is placed in the lacrimal passage in the state shown in FIG. 6 until a new lacrimal passage is formed at a place where the tube structure 1 is disposed. In this case, in the tube structure 1, the rod 3 inserted into the lacrimal tubules 11 and 12 and reaching the lacrimal sac 13 is used for treatment of lacrimal passage obstruction in the lacrimal tubules 11 and 12 and the lacrimal sac 13. . The tubular body 2 disposed in the nasolacrimal duct 15 extending from the lacrimal sac 13 to the lower nasal passage 17 is used for treatment of lacrimal tract obstruction in the nasolacrimal duct 15. In addition, lacrimal fluid flows to the lacrimal sac 13 through the lacrimal tubules 11 and 12 in which the rod 3 is disposed, and further flows down to the lower nasal passage 17 through the artificial lacrimal passage formed in the cylindrical body 2. .
[0028]
After the tube structure 1 is placed in the lacrimal passage, when a predetermined period elapses, the other end 3b sandwiched by the slit 2d is pulled downward to release the holding of the rod 3 by the slit 2d. Then, the lower end portion of the cylindrical body 2 located at the lower end portion of the lower nasal passage 17 is pulled downward, and the rod 3 supported by the cylindrical body 2 and the one end 2a of the cylindrical body 2 is sequentially lowered downward from the nasal cavity 16. By pulling out, the tube structure 1 is removed from the lacrimal passage. In this case, since the slit 2d is located at the lower end portion of the lower nasal passage 17, the other end portion 3b of the rod 3 is clamped to the slit 2d and released from the slit 2d, and from the lacrimal passage of the tube structure 1. The removal can be easily performed by operating an instrument such as tweezers inserted from the nasal cavity 16 into the lower nasal passage 17.
[0029]
As described above, in this tube structure 1, the rod 3 is disposed in the lacrimal tubules 11 and 12 and the lacrimal sac 13, and the tube is placed in the nasolacrimal duct 15 extending from the lacrimal sac 13 to the lower nasal passage 17. By disposing the rod-like body 2, the lacrimal passage occlusion at each site from the lacrimal tubules 11 and 12 to the lacrimal sac 13, the nasolacrimal duct 15, and the lower nasal passage 17 can be treated simultaneously with the same tube structure 1. Is possible. In particular, the arrangement of the rod 3 in the lacrimal tubules 11 and 12 is excellent in that the obstruction of the lacrimal tubules 11 and 12, which has been impossible in the past, can be directly treated. .
[0030]
Further, since the rod 3 is inserted into the lacrimal tubules 11 and 12 so as to form a loop, the rod 3 is prevented from moving toward the lacrimal sac 13, so that the rod 3 is supported by the cylindrical body 2. Accordingly, further movement of the tube structure 1 in the lacrimal passage is prevented, and as a result, the tube structure 1 is disposed at a predetermined position in the lacrimal passage without causing a positional shift or the like over a long period of time. Is possible. Furthermore, the holding of the rod 3 with respect to the cylindrical body 2 and the release of the holding can be easily and reliably performed by an extremely simple operation of holding the other end 3b of the rod 3 into the slit 2d and releasing the holding. Similarly, the tube structure 1 can be easily removed from the lacrimal passage by a very simple operation of pulling the lower end of the cylindrical body 2 downward. In addition, since it is not necessary to form a through-hole or the like at the boundary between the inner eye corner 10 and the lacrimal sac 13, the physical burden on the patient is small.
[0031]
Further, since the recess 3 c is formed in the other end 3 b of the rod 3, when the rod 3 is inserted into the lacrimal tubules 11 and 12, the recess 3 c is formed at the tip of the needle-like portion 4 b of the lacrimal passage bougie 4. By engaging and pushing the lacrimal bougie 4, the rod 3 together with the lacrimal bougie 4 can be reliably inserted in the pushing direction. Therefore, although the rod 3 is a soft elastic material that is fine enough to be inserted into the lacrimal tubules 11 and 12 and is flexible, the rod 3 can be easily and reliably inserted into the lacrimal tubules 11 and 12. Can be inserted.
[0032]
Furthermore, since the surface 3d of the recess 3c has a color different from that of the rod 3 except for the surface 3d, the position of the recess 3c can be easily grasped. It can be easily engaged with the tip of the needle-like portion 4b of the bougie 4.
[0033]
The technical scope of the present invention is not limited to the above embodiment, and various modifications can be made without departing from the spirit of the present invention.
For example, in the above embodiment, the recess 3c is formed in the other end 3b of the rod 3 as a locking means for locking the other end 3b of the rod 3 to the tip of the needle-like portion 4b. As the locking means, for example, as shown in FIG. 7, a slit-shaped cut 31 may be formed on the surface of the other end 3 b of the rod 3. In this case, for example, the cut 31 has an inclination angle of about 45 ° toward the one end side with respect to the surface of the rod 3 at a position of about 2 mm to 3 mm from the other end surface of the rod 3. Is about 0.4 mm to 5 mm. Further, for the purpose of easily grasping the position of the cut 31, it is desirable to make the vicinity of the portion where the cut 31 is open in the surface of the rod 3 a color different from that of the rod 3 except for this portion. .
[0034]
In the above embodiment, as a holding means for holding the cylindrical body 2 at a predetermined position in the nasolacrimal duct, a flexible soft elastic material supported by one end 2a of the cylindrical body 2 is used. However, the rod 3 may be formed integrally with the tubular body 2 by extending a part of the tubular body 2 from the one end 2a thereof into a thread shape.
[0035]
Further, as the holding means, a twisted yarn or a material obtained by applying a resin coating to the twisted yarn, or a material obtained by impregnating the twisted yarn with a resin may be used. In this case, since it is difficult to provide a locking means such as the above-described recess 3c at the other end of the holding means, the instrument used for inserting the holding means into the lacrimal tubules 11 and 12 is used. Instead of the lacrimal passage bougie 4, for example, a slit-like holding means is provided at the tip, and this holding means can be inserted into the lacrimal tubules 11 and 12 while holding the other end of the holding means (not shown). ) Etc.).
[0036]
【The invention's effect】
As described above, the tube structure according to the present invention includes a flexible cylindrical body disposed in the nasolacrimal duct from the lacrimal sac to the lower nasal passage, and the cylindrical body in the nasolacrimal duct. And a string-like holding means extending from one end of the cylindrical body. Therefore, further movement of the tube structure including the cylindrical body in the lacrimal passage is prevented by the holding means, and as a result, the tube structure is moved to a predetermined position in the lacrimal passage for a long time. It becomes possible to arrange | position without raising.
[0037]
Further, in the tube structure according to the present invention, the edge of the opening for sandwiching the opening penetrating the side surface of the cylindrical body and the other end of the holding means at the substantially central portion in the longitudinal direction of the cylindrical body. A slit extending from the portion to one end side of the cylindrical body is formed. Accordingly, the holding means can be held and released from the cylindrical body easily and reliably by an extremely simple operation of holding the other end of the holding means in the slit and releasing the holding.
[0038]
Further, in the tube structure according to the present invention, one end of the holding means is supported by one end of the cylindrical body, and the other end is provided at the other end of the holding means, and the other end is provided at the tip of the bougie that operates the holding means. Locking means for locking is formed. Therefore, when inserting the cylindrical body into, for example, the lacrimal canal, the holding means is easily and surely inserted in the pushing direction together with the bougie by engaging the locking means with the tip of the bougie and pushing the bougie. Can do.
[0039]
Furthermore, in the tube structure according to the present invention, an identification means for indicating the position of the locking means is provided at the other end of the holding means. Accordingly, the position of the holding means can be easily grasped, and as a result, the holding means can be easily engaged with the tip of the bougie.
[Brief description of the drawings]
FIG. 1 is a perspective view showing an embodiment of a tube structure for treatment of lacrimal passage according to the present invention.
2 is an enlarged view of the other end of the rod of the tube structure for lacrimal passage obstruction treatment shown in FIG. 1. FIG.
FIG. 3 is a schematic view showing a state in which the rod of the lacrimal passage obstruction treatment tube structure shown in FIG. 1 is disposed in the lacrimal canal.
4 is a perspective view showing a use state of the tube structure for lacrimal passage obstruction treatment shown in FIG. 1. FIG.
FIG. 5 is a schematic view showing a state in which the tube structure for lacrimal passage obstruction treatment shown in FIG. 1 is arranged from the lacrimal sac to the lower nasal passage.
6 is a schematic view showing a final indwelling state of the tube structure for treatment of lacrimal passage shown in FIG. 1. FIG.
FIG. 7 is an enlarged view of the other end of the rod showing another embodiment of the tube structure for treatment of lacrimal passage according to the present invention.
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 1 Tube structure 2 for lacrimal passage obstruction treatment Cylindrical body 2a One end 2c of cylindrical body Opening 2d Slit 3 Rod (holding means)
3a One end 3b of the rod 3b The other end 3c of the rod Recess (locking means)
31 cutting (locking means)

Claims (5)

A tube structure for treating lacrimal passage from the lacrimal canal to the lower nasal passage,
A flexible tubular body disposed in the nasolacrimal duct from the lacrimal sac to the lower nasal passage;
A string-like holding means disposed in the lacrimal tubule and extending from one end of the cylindrical body for holding the cylindrical body at a predetermined position in the nasolacrimal duct,
From the edge of the opening for sandwiching the opening passing through the side surface of the cylindrical body and the other end of the holding means at a substantially central portion in the longitudinal direction of the cylindrical body. A tube structure for treatment of lacrimal passage obstruction, wherein a slit extending to one end side is formed. One end of the holding means is supported by one end of the cylindrical body, and the other end of the holding means is engaged with the other end of the holding means for engaging the tip of a bougie for operating the holding means. 2. A tube structure for lacrimal passage obstruction treatment according to claim 1, wherein a stop means is formed. 3. The tube structure for treating lacrimal passage according to claim 2, wherein the holding means is formed of a flexible rod, and the locking means is a recess formed on a side surface of the rod. . The tube structure for treatment of lacrimal passage according to claim 2 or 3, wherein an identification means for indicating a position of the locking means is provided at the other end of the holding means. 5. The lacrimal tract obstruction treatment according to claim 4, wherein the identification means is provided by making the color of the holding means at least in the vicinity of the locking means different from other portions of the holding means. Tube structure.

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