JP2006263485A - Catheter inserted in enteron and indwelling method thereof - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a catheter inserted in the enteron and an indwelling method thereof used for diagnosis and treatment by transnasal inserting into the interon mainly in the case of intestinal blockage. <P>SOLUTION: In this catheter, a connecting device with a built-in one-way valve is provided at the end of a body tube, and a connecting device allowing the connecting device and each lumen to be fit and connected while maintaining air-tightness is provided at the tip end of a funnel with a connector so as to be separable from each other. A guide tube can therefore be pulled out of the rear end of the catheter or changing over from the mouth to the nose can be performed. <P>COPYRIGHT: (C)2007,JPO&INPIT

Description

  The present invention relates to a catheter for insertion into the intestinal tract that is used for diagnosis and treatment by nasally inserting into the intestine mainly in cases associated with intestinal obstruction, and an indwelling method thereof.

  When diagnosing or treating intestinal obstruction, the obstruction release method is often used by inserting a catheter nasally from the esophagus through the gastric bay into the intestine and draining the intestinal contents or depressurizing the intestinal tract to reduce the internal load. Has been. The conventional catheter structure used for such applications has a guiding portion in which a plurality of metal balls, rings, and other weights that facilitate insertion of the catheter are embedded in a flexible resin in a bead shape at the distal end portion. The body tube is provided with a plurality of suction holes and a balloon that is inflated by liquid injection, and at the end of the body tube, a branch funnel connected to a branch tube communicating with each lumen is provided. At the end, a one-way valve is attached to the lumen communicating with the connector or balloon.

  The main body tube usually has 2 to 3 lumens, and basically a main lumen serving as a passage for discharging contents in the intestine to the outside of the body and a sub lumen for injecting an inflation fluid into the balloon. There is a case where another sub-lumen serving as an air introduction passage is provided to improve suction efficiency and prevent excessive suction to the intestinal wall. The insertion of the catheter into the intestinal tract is performed nasally. The guide wire inserted into the catheter is pushed in and out while adjusting the rigidity of the catheter, and further, a weight embedded in the distal end of the catheter is used. The balloon is inflated after passing through the pyloric ring serving as the exit of the stomach and passing through the Tritz ligament serving as the bending portion, and the catheter is advanced to the intestinal obstruction portion by peristaltic movement of the intestine. The intestinal contents after indwelling are sucked and discharged from the connector through the branch funnel and branch tube that are sucked from the suction hole of the main body tube and communicated through the main lumen.

  Although the method of using the catheter described above is common, it is actually difficult to pass the catheter through the pyloric ring as shown in FIG. 7, and even if it passes through the pyloric ring, the catheter bends in the stomach. If it does, the insertion force will not be transmitted to the tip and it will be difficult to insert further, especially when it cannot be left to the peristaltic movement that requires emergency. Intestinal insertion catheters are usually 2 to 3 m long tubes, and guide wires cannot be inserted or cannot be removed, and troubles such as wire breakage frequently occur. In addition, if the insertion and extraction operations are repeated without smoothly performing the insertion operation for the patient, there is a problem of causing pain due to rubbing in the nasal cavity. In addition, the insertion operation is often performed under fluoroscopy, and the prolonged insertion operation has been a problem due to exposure to patients, surgeons, staff, and the like.

Moreover, as a prior art of the branched funnel of the present invention, there is one disclosed in Patent Document 1, but since the funnel is directly connected to the end of the main body tube, it is possible to The lock mechanism for preventing the funnel from coming off cannot be installed. Especially for the latter, it is necessary to make a tight fitting such as unevenness in the connector tube to prevent the drop off, and it is used for repeated attachment and detachment operations. On the other hand, the workability was poor, and this repeated operation could damage the lumen at the end of the body tube, leading to a decrease in airtightness and connection strength.
JP 63-117768 A

  An object of the present invention is to solve such problems of the conventional system. The insertion method is fundamentally changed by making the branch funnel of the catheter for insertion into the intestinal tract easy and reliable. be able to. In other words, the method uses an endoscope to insert the guide tube orally up to the pyloric ring that is the exit of the stomach, insert the catheter into it, and place the catheter into the nasal cavity during final placement. In addition to being able to be inserted quickly without bending the catheter, it provides a system that is patient-friendly and does not rub in the nasal cavity during the insertion operation.

That is, the first invention of the present invention is an intestinal insertion catheter provided with a guiding portion in which a weight such as a metal sphere, a ring or a coil is embedded in the tip portion, and a balloon that facilitates insertion of the catheter by peristaltic motion. It is a catheter for intestinal tract insertion, characterized in that the main tube and the branch tube with a connector attached to the terminal are detachable, and more specifically, the airtightness of each lumen at the end of the main tube and the tip of the branch funnel A connecting device capable of connecting and fitting both of them while maintaining the connection strength can be secured at a connection strength of 1 kg / cm ² or more, and the connecting device provided at the end of the body tube is connected to the inside of the balloon of the connecting device. On the other hand, a valve is provided, and a locking mechanism is provided in a connecting device between the main body tube and the branch funnel. Furthermore, in the second invention, after inserting a main body tube connected with a branch funnel through a guide tube inserted in advance to the pyloric ring, which is the exit of the stomach orally, using an endoscope or the like, and then placed in a target position. After inflating the balloon and fixing the catheter tip, remove the branch funnel, remove the guide tube, and then use the nelaton catheter or the like to remove the rear end of the body tube from the nasal cavity and connect it to the branch funnel. The indwelling method of the catheter for insertion into the intestinal tract.

  As described above, the catheter for insertion into the intestinal tract according to the present invention allows the branch funnel with a connector installed at the rear end to be attached to and detached from the main body tube, so that the nasal cavity placement method by oral insertion can be performed, and the invasion to the patient is small. It is possible to carry out, and since a connecting device incorporating a one-way valve is provided at the end of the main body tube, the balloon can be inflated even when the catheter is operated when the branch funnel is removed, and the distal end of the catheter can be fixed in the digestive tract lumen. Since the connecting device of both the tube and the branch funnel can be securely connected by the lock mechanism, the catheter can be inserted and placed in a simpler and safer manner for the operator.

  Hereinafter, the present invention will be described in detail with reference to the drawings. 1 is a side view showing the structure of an intestinal insertion catheter according to an embodiment of the present invention, FIG. 2 is a three-dimensional perspective view showing the appearance of the coupling device of FIG. 1, and FIG. 3 is a side sectional view of FIG. 4 is a side view showing another embodiment of the locking mechanism of the coupling device of the present invention, FIG. 5 is a front view showing the arrangement of the lumens of the coupling device of FIG. 1, and FIG. FIG.

  As shown in FIG. 1, the catheter for intestinal tract insertion according to the present invention has the same basic structure and material as the conventional one, but the body tube (1) and the branch funnel (2) are detachable. It has a structure. A weight such as a metal ball (4) is embedded in the guide portion at the tip of the body tube (1), and a main lumen that leads to the suction hole (5) for discharging the intestinal contents is provided near the tip. A fluid injection subroutine for inflating the balloon (3), and an air introduction subroutine for improving the suction effect by the suction hole (5) and preventing excessive suction pressure from being applied. A connecting device (6) for connecting to the branch funnel (2) is installed at the end. The branch funnel (2) has a connecting device (7) for connecting to the connecting device (6) of the main body tube (1) at the tip, and a connector (10) or one of them corresponding to each use of each lumen. A valve (9) is connected in a gas-liquid flow through a branch tube (8).

  The connection devices (6) and (7) will be described in detail with reference to FIGS. 2 and 3. The connection devices (6) and (7) are specifications that are fitted and connected to each other in a male-female manner, and in order to ensure the airtightness between the lumens. The fitting type of (12) and the connecting cavity (11) is desirable, and it is also desirable to improve the airtightness by arranging an O-ring (18) or the like on either side. Further, a one-way valve (16) using an elastic force such as a spring (17) is installed in the lumen of the connection cavity (11) communicating with the balloon (3) of the connection apparatus (6). ) And a closed state when not connected, but when connecting with the connecting device (7), for example, the one valve (16) is released by the connecting pipe (12) having a groove (19) at the tip, thereby communicating with the connecting device (7). Yes. The connecting pipe (12) may be a metal pipe or the like embedded and fixed in each lumen of the connecting device (7). However, when the number of lumens is plural as in the present invention, it is integrally formed with the connecting device (7). The product is advantageous in terms of cost, and precise alignment with respect to the catheter axis required for the present invention in both the planar direction and the depth direction is facilitated.

The connecting devices (6) and (7) need to secure a connection strength of 1 kg / cm ² or more that can be applied at the time of detention. However, when it is necessary to repeatedly attach and detach, workability is significantly impaired. Therefore, if the airtightness that can withstand the internal pressure during balloon inflation and the suction force when the intestinal contents are discharged is secured, it is desirable to loosen the fitting as much as possible. 7) Rotating the lock (13) and hooking the pawl (14) on the lock receiver (15) of the coupling device (6), or simply connecting and fitting in the catheter axial direction as shown in FIG. By providing a locking mechanism such as one that can be made, the coupling devices (6) and (7) with better workability are obtained.

  The material used for the coupling devices (6), (7), the lock (13), etc. is not particularly limited, but a hard material is desirable to ensure a reliable locking mechanism. Regarding 6), since the oral cavity is replaced with the nasal cavity as described later, it is desirable that the total length of the hard material portion is as short as possible and the outer diameter is as thin as possible, and is the same diameter as the outer diameter of the body tube (1). Is more desirable. Each is assembled to the main tube (1) and the branch funnel (2) by bonding, welding, and insert molding. Further, the arrangement of the lumens of the catheter and the lumens of the connecting devices (6) and (7) is not particularly limited. However, as shown in FIG. Therefore, it is necessary to provide a display and a fitting part for preventing the orientation of the coupling devices (6) and (7) from being wrong, but if the non-contrast shape is taken as shown in (b), these implementations are not necessarily performed. Is not necessary.

  Next, a method for using the intestinal catheter according to the present invention will be described with reference to FIGS. First, as a pre-use confirmation of the product, the main body tube (1) and the branch funnel (2) are connected, the balloon (3) is inflated, the priming is performed, and the balloon (3) is once deflated. As shown in FIG. 8, the endoscope (27) is orally inserted up to the pyloric ring, linearized as much as possible, and the guide tube (28) is followed and placed, and then the main body tube (1) is placed as shown in FIG. Push it into the guide tube (28) and insert it to the desired position. Therefore, in order to prevent the distal end position of the main body tube (1) from moving, the balloon (2) is inflated, the branch funnel (2) is removed, and the guide tube (28) is removed. Next, as shown in FIG. 10, the Neraton catheter (23) inserted from the nose is pulled out from the mouth and tied to the rear end of the body tube (1). Remove the nelaton catheter (23). Then, as shown in FIG. 11, the branch funnel (2) is connected to the end of the main body tube (1) again to complete the placement.

  Although this method is limited to an operator who can use an endoscope, it is useful as a method in which an intestinal insertion catheter can be placed without using a guide wire. Basically, this catheter can also be used in a conventional method that does not use a non-endoscopic guide tube, or it can be used in a method in which the insertion operation is performed orally and replaced with a nasal cavity placement. It is possible to reduce invasion in the nasal cavity. Conversely, if the use of the present invention with an endoscope and a guide tube is limited, the tip of the guide tube is inserted into the pyloric ring at the stomach outlet, so a weight embedded in the tip of the catheter for passing the pyloric ring is unnecessary. This is advantageous in terms of cost.

  Here, the nelaton catheter mounting portion (24), which is an accessory for simplifying the method of use, will be described with reference to FIG. FIG. 6 shows an embodiment, wherein (a) is a view before fixing the attachment portion (24) and the nelaton catheter (23), and (b) is a fixed view. The attachment portion (24) has a cylindrical shape, and the distal end portion is rounded so as not to damage the nasal cavity in order to transfer the orally inserted body tube (1) to the nose using a nelaton catheter as described above. The shape is desirable, and the end is provided with a pawl (26) that fits with the lock receiver (20) of the coupling device (6) of the main body tube (1), and is provided with a stopper (25) in the approximate center. After the catheter (23) is inserted into the attachment portion (24), when the stopper (25) is fitted, the nelaton catheter (23) is fixed. The material and dimensions are short and thin, preferably a hard material, similar to the connecting device (9), but it is also desirable that only the rounded shape at the tip is made of a soft material. By replacing and attaching the main attachment portion (24) and the branch funnel (2) to the main body tube (1), it is possible to simplify operations such as binding to the end of the main body tube (1).

It is a side view which shows the structure of the catheter for intestine insertion used as one Example of this invention. It is a three-dimensional perspective view which shows the structure of the connection apparatus of the catheter for intestinal tube insertion used as one Example of this invention. It is a sectional side view which shows the structure of the connection apparatus of the catheter for intestine insertion which becomes one Example of this invention. It is a side view which shows the locking mechanism of the coupling device of the catheter for intestinal tract insertion used as the other Example of this invention. It is a front view which shows each lumen arrangement | positioning of the connection apparatus of the catheter for intestinal tract insertion used as two types of Examples of this invention. It is side sectional drawing which shows the structure of the nelaton catheter attachment part used as the accessory of the catheter for intestinal tract insertion which becomes one Example of this invention. It is a schematic diagram which shows the indwelling method of the conventional catheter for insertion in an intestinal tract. It is a schematic diagram which shows the indwelling method of the catheter for intestinal tract insertion of this invention. It is a schematic diagram which shows the indwelling method of the catheter for intestinal tract insertion of this invention. It is a schematic diagram which shows the indwelling method of the catheter for intestinal tract insertion of this invention. It is a schematic diagram which shows the indwelling method of the catheter for intestinal tract insertion of this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Main body tube 2 Branching funnel 3 Balloon 4 Metal ball 5 Suction hole 6 Connecting device 7 Connecting device 8 Branching tube 9 One-way valve
10 Connector
11 Connecting cavity
12 Connecting pipe
13 Lock
14th
15 Lock receiver
16 One-way valve
17 Spring
18 O-ring
19 groove
20 lock
21
22 Lock receiver
23 Neraton catheter
24 Mounting part
25 Stopper
26th
27 Endoscope
28 Guide tube

Claims (6)

  In the intestinal insertion catheter provided with a guide part with a metal ball, a weight such as a ring or coil embedded in the tip, and a balloon that facilitates insertion of the catheter by peristaltic movement, a connector is attached to the main tube and the terminal. A catheter for insertion into the intestinal tract, wherein the branch funnel is detachable. A connecting device capable of connecting and fitting both ends of the body tube and the tip of the branch funnel while maintaining airtightness for each lumen is provided, and a connection strength at the time of connection of 1 kg / cm ² or more can be secured. 2. The catheter for intestinal tract insertion according to 1.  The catheter for insertion in an intestinal tract according to claim 1 or 2, wherein a one-way valve is installed in a communication path with a balloon of a connecting device provided at an end of the main body tube.  The catheter for insertion into the intestinal tract according to claim 2 or 3, wherein a locking mechanism is provided in a connecting device between the main body tube and the branch funnel.  The catheter for intestinal tract insertion according to any one of claims 1 to 4, wherein a nelaton catheter attachment portion is provided at an end of the main body tube.  Insert a main body tube with a branch funnel into a guide tube that has been inserted orally to the pyloric ring, which is the exit of the stomach, using an endoscope, etc., and place it at the target position. After fixing the tube, the branch funnel is removed, the guide tube is further removed, and then the rear end of the main body tube is retrogradely removed from the nasal cavity using a nelaton catheter or the like and connected to the branch funnel. Indwelling method.

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