JP2010012052A - Gastric fistula catheter and gastric fistula catheter kit - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a gastric fistula catheter and a gastric fistula catheter kit with excellent operability in connecting a guide wire to the gastric fistula catheter. <P>SOLUTION: The gastric fistula catheter is composed of a tubular body with an inner lumen, a cone-shaped guide part disposed at the distal end of the tubular body, whose diameter is contracted toward the distal end, and a gastric wall fixed part disposed at the proximal end of the tubular body and having an opening communicating with the inner lumen of the tubular body to be fixed to the gastric wall. The guide part is characterized by a bending part and a wire arm. The proximal end of the bending part is fixed to the distal end of the guide part, and the bending part is bent at a prescribed angle rearward in the axial direction in a part extending forward in the axial direction to a prescribed length. The wire arm has a storing means at the distal end, which can be stored inside the guide part. <P>COPYRIGHT: (C)2010,JPO&INPIT

Description

  The present invention relates to a gastrostomy catheter and a gastrostomy catheter kit.

Percutaneous Endoscopic Gastrostomy (PEG), which enables the administration of nutrition to patients who cannot take nutrients from the oral cavity, is a minor operation compared to surgical open gastrostomy. Because it is constructed, it is less invasive and can significantly reduce medical costs, so it has become the standard method for gastrostomy in Europe and the United States.
There are generally known three methods for PEG: a pull method, a push method, and an introducer method, but the present invention is for gastrostoma that can be used in the pull method. A catheter and gastrostomy catheter kit.
As a conventional pulling method, a guide wire having a looped tip is disclosed, and a gastrostomy catheter provided with a looped wire similar to the guide wire is disclosed (for example, see Patent Document 1). . This method of connecting the guide wire and the gastrostomy catheter is to tie the looped wire attached to the distal end of the gastrostomy catheter to the looped guide wire from the mouth. The difficulty of passing the looped wire of the gastrostomy catheter through the looped guidewire and passing the long waisted gastrostomy catheter through the looped wire when tying the lark It was necessary to work.
A method of inserting and fixing a guide wire to the distal end of a gastrostomy catheter is also disclosed (see, for example, Patent Document 2). This is a method of inserting and connecting a guide wire into a hole of about 1.5 mm in the conical tip of the gastrostomy catheter, but it is necessary to aim at a small diameter hole and insert the guide wire. Yes, it was not easy to implement.

Japanese National Patent Publication No. 6-503243 WO2003 / 103566

  An object of the present invention is to provide a gastrostomy catheter and a gastrostomy catheter kit excellent in operability in connecting a guide wire and a gastrostomy catheter.

Such an object is achieved by the present invention described in the following (1) to (9).
(1) A cylindrical main body having a lumen, a conical guide portion that is provided at a distal end portion of the cylindrical main body and has a diameter that decreases in a distal direction, and a cylindrical end portion that is provided at a proximal end portion of the cylindrical main body. A gastric wall fixing part having an opening attached in communication with the lumen of the main body and being fixed to the gastric wall,
The guiding portion includes a bent portion that is fixed at a distal end of the guiding portion and extends to a predetermined length in the forward direction of the axis and is bent at a predetermined angle in the rearward direction of the axis, and the guiding portion at the distal end. A gastrostomy catheter, comprising: a wire arm including a storage means that can be stored in the section.
(2) The gastrostomy catheter according to (1), wherein the storage means formed at the distal end of the wire arm includes a pigtail type shape.
(3) The gastrostomy catheter according to (1) or (2), wherein the bending angle of the bent portion of the wire arm is not less than 5 degrees and not more than 30 degrees.
(4) The guide portion has at least one slit portion extending in the axial direction in which the storage means formed at the distal end portion of the wire arm can be stored inside during assembly (1) to (3) ). A gastrostomy catheter according to any of the above.
(5) The gastrostomy device according to any one of (1) to (4), wherein the guide portion has locking means that can lock the storage means formed at the distal end portion of the wire arm. catheter.
(6) A cylindrical main body, a conical guide portion provided at the distal end portion of the cylindrical main body and having a diameter decreasing toward the distal end direction, and an inner portion of the cylindrical main body provided at a proximal end portion of the cylindrical main body. A gastric wall fixing part having an opening attached in communication with the cavity and being fixed to the gastric wall,
The guide part is composed of a split part that can be split and assembled along a substantially central line in the axial direction, and a guide part piece that is attached to the distal end of the cylindrical main body and unites with the split part. And a bent portion that is bent at a predetermined angle in the rear direction of the axis at a portion that is fixed at one end to the predetermined length in the front direction of the axis, and the other end is the front end of the guide portion. A gastrostomy catheter, comprising: a wire arm fixed to the portion.
(7) The gastrostomy catheter according to (6), wherein a bending angle at the bent portion of the wire arm is not less than 5 degrees and not more than 30 degrees.
(8) On the base end side of the guide part, a concave part is provided on one inner surface of the divided part or the guide part piece, and a convex part fitted to the concave part is provided on the other inner surface. The gastrostomy catheter according to (6) or (7).
(9) The gastrostomy catheter according to any one of (1) to (8) above, and the gastrostomy catheter that is engaged with the bent portion of the wire arm from the oral cavity through the esophagus and A first snare guide wire having a snare portion at a distal end portion that leads to the outside of the body; a sheath dilator set including a puncture tube that percutaneously guides the first snare guide wire into the stomach; and the first snare portion. A gastric fistula catheter kit comprising a second snare guide wire that grips the snare portion of the guide wire and guides it from the stomach to the oral cavity via the esophagus.

  ADVANTAGE OF THE INVENTION According to this invention, the gastrostomy catheter excellent in the operativity of the connection of a guide wire and a gastrostoma catheter, and the gastrostomy catheter kit can be provided.

  Hereinafter, a gastrostomy catheter and a gastrostomy catheter kit according to the present invention will be described in detail with reference to the drawings. In the description of the drawings, the same reference numerals are assigned to the same elements, and duplicate descriptions are omitted.

  FIG. 1 is a schematic view showing an embodiment of a catheter kit for gastrostoma according to the present invention. FIG. 2 is a cross-sectional view in the major axis direction of the gastrostomy catheter shown in FIG. FIG. 3 is a schematic view showing a state in which a second snare guide wire is attached to a bent portion of a wire arm installed at the distal end of the gastrostomy catheter guiding portion of FIG. 4 is a cross-sectional view taken along the line A-A ′ of FIG. 3. FIG. 5 is a schematic view showing a state in which an index force is applied to the second snare guide wire of FIG. FIG. 6 is a schematic view showing another embodiment of the gastrostomy catheter according to the present invention. FIG. 7 is a view showing a state where a second guide wire is attached to the gastrostomy catheter of FIG. FIG. 8 is a schematic view showing how to use the catheter for gastrostoma.

The gastrostomy catheter of the present invention shown in FIG. 1 includes a cylindrical main body (2) having a lumen for supplying liquid substances such as nutrients and chemicals from outside the body, and the catheter from the mouth to the stomach wall and outside the body. The cylindrical main body (2) provided at the distal end portion of the cylindrical main body (2) for guiding and having a conical guide portion (3) whose diameter decreases in the distal direction, and the proximal end portion of the cylindrical main body (2). A gastric wall fixing part (1) having an opening attached in communication with the lumen of (2) and fixed to the gastric wall;
The guide portion (3) is a bent portion (4) that is bent at a predetermined angle in the rearward direction of the axis at a portion where the base end portion is fixed to the distal end portion of the guide portion (3) and extends to a predetermined length in the forward direction of the axis. ) And storage means (7) that can be stored in the guide portion at the distal end portion.

The guide portion (3) is conically reduced in diameter toward the distal end so as to easily guide the inside of the body, and the first snare guide wire (8) for guiding the gastrostomy catheter from the mouth to the outside of the body is provided. A wire arm (6) for connection is provided, and the storage means (7) formed at the tip thereof has a pigtail shape.
Moreover, in order to store and fix the wire arm (6), the guide part (3) has a slit part (5) having a locking part (10) shown in FIG. 2, and the wire arm (6) By fixing the storage means (7) to the locking portion (10), the wire arm (6) can be stored in the guide portion (3).

As shown in FIG. 1, the wire arm (6) normally protrudes outside the guiding portion (3), and as shown in FIG. 4, the wire arm (6) is formed in the concave portion of the locking portion (10). Since the storage means (7) is accommodated and fixed by the spring property with the bent portion (4) as a fulcrum, the structure is difficult to come off.
The bending angle at the bent portion (4) is preferably 5 degrees or more and 30 degrees or less in order to prevent plastic deformation.
In addition, by providing one or more bent portions (4) in the middle of the wire arm (6) and the storage means (7) as well as the leading end of the guide portion, the bending angle of each bent portion is reduced and plastic deformation is prevented. It is also possible to prevent.

  Further, the shape of the storage means (7) is made into a pigtail-type circular shape as shown in the figure, and the locking portion (10) is also made circular in the same manner, so that the engagement distance becomes longer and the shape becomes more difficult to come off. You can also.

The stomach wall fixing part (1) and the cylindrical main body (2) are preferably formed of an elastic material. For example, polyurethane resin, silicone rubber and the like can be mentioned, and silicone rubber having low tissue reactivity in the body is preferable.
Examples of the material for the wire arm (6) include metals, resins, and the like, but it is more preferable that the wire arms (6) be thin, springy, and strong.

The material of the guiding portion (3) is preferably a thermoplastic resin, a metal, a rubber material with high hardness, or the like, but considering the complicated shape, it is more preferable to be a thermoplastic resin having strength and good workability. preferable.
Although the connection method of the induction | guidance | derivation part (3) and a wire arm (6) is not specifically limited, Fitting, adhesion | attachment, insert molding, integral molding, etc. can be used.
The connection method between the guide portion (3) and the cylindrical main body (2), and the cylindrical main body (2) and the stomach wall fixing portion (1) is not particularly limited, and fitting, adhesion, insert molding, integral molding, or the like is used. be able to.

  As shown in FIG. 6, the gastrostomy catheter according to another embodiment of the present invention is provided at the distal end of the cylindrical main body (2) and the cylindrical main body (2) and decreases in diameter toward the distal direction. A gastric wall fixed to the gastric wall having a conical guiding portion (3) and an opening provided at the proximal end of the cylindrical main body (2) and connected to the lumen of the cylindrical main body (2) The fixed part (1) and the guide part (3) are attached to the split part (12) that can be divided and assembled along the substantially central line in the axial direction, and the split part (12 ) And the guiding part piece (11), and the guiding part (3) has one end fixed to the distal end of the dividing part (12) and extends to a predetermined length in the axial front direction. A wire arm having a bent portion (4) bent at a predetermined angle in the rearward direction of the axis at the portion, and having the other end fixed to the distal end of the guide piece (11) ( ) To have.

  The bending angle at the bending portion (4) is preferably 5 degrees or more and 30 degrees or less as in the case of the gastrostomy catheter shown in FIG. 1, but because the dividing section (12) is fixed by a fixing method described later, The bent portion (4) preferably does not self-expand.

  On the base end side of the guide portion (3), a concave portion (13) is fitted on one inner surface of the divided portion (12) to the guide portion piece (11), and the concave portion is fitted on the other inner surface. It is preferable that a convex portion (14) to be joined is attached. The shape shown in FIG. 7 is obtained by press-fitting the convex portion (14) of the dividing portion (12) into the concave portion (13) of the guide piece (11). Although not shown, the shape of the concavo-convex portion may be a snap fit type.

Examples of the material of the bent portion (4) include metals and resins, but it is more preferable that the material be thin and strong.
The material of the guide piece (11) and the divided part (12) is preferably a resin, metal, rubber material with high hardness, etc., but considering the complicated shape, it is a resin having strength and good workability. It is more preferable.

  Although the connection method of a bending part (4), an induction | guidance | derivation part piece (11), and a division | segmentation part (12) is not specifically limited, A fitting, adhesion | attachment, insert molding, integral molding, etc. can be used.

Next, the gastrostomy catheter kit of the present invention will be described.
The gastrostomy catheter kit according to the present invention is engaged with the gastrostomy catheter (24) and the bent portion (4) of the wire arm (6) to pass the gastrostomy catheter (24) from the oral cavity through the esophagus. Then, a first snare guide wire (8) having a snare portion (9) at the distal end leading to the stomach and the outside of the body, and puncture for guiding the first snare guide wire (8) percutaneously into the stomach A sheath dilator set including a tube (20), and a second snare guide wire that grasps the snare portion (9) of the first snare guide wire (8) and guides it from the stomach to the outside of the oral cavity via the esophagus (21).

As shown in FIG. 8 (a), the puncture tube (20) is inserted into the stomach (23) from the body surface side through the abdominal wall while confirming the inside of the stomach (23) with an endoscope (22). insert.
Next, the snare part (9) side of the first snare guide wire (8) is passed through the puncture tube (23) and inserted into the stomach (23). The first snare guide wire (8) is grasped by the second snare guide wire (21), and the first snare guide wire (8) is placed outside the oral cavity together with the endoscope as shown in FIG. 8 (b). ) Snare portion (9) is taken out.

The method of use up to this point is no different from the conventional invention, and the method of connecting the gastrostomy catheter (24) and the first snare guide wire (8) described below is different from the conventional invention.
In the conventional method (for example, refer to Patent Document 1), the first snare guide wire (8) and a loop-shaped wire attached to the distal end of the gastrostomy catheter are tied together.
In this method, the gastrostomy catheter itself must be passed through a loop-shaped wire attached to the distal end of the gastrostomy catheter when tying, and the gastrostomy catheter is deformed in an unreasonable manner. In some cases, the catheter was deformed or crushed.
Another conventional method (for example, see Patent Document 2) is a method in which a guide wire is inserted and connected to a hole of about 1.5 mm in the conical tip of a gastrostomy catheter. Therefore, it is difficult for the surgeon to insert a guide wire with a specific aim.
Since the gastrostomy catheter (24) of the present invention does not need to be passed through the loop-shaped wire as described above, the catheter does not deform or collapse, and the first snare guide wire (8) When connecting the gastrostomy catheter (24) to the gastrostomy, the connection can be made with a rough aim, so that the procedure can be advanced without applying stress to the operator.
The connection method of the present invention will be described below.

  In the case of the gastrostomy catheter shown in FIG. 1, the snare portion (9) of the first snare guide wire (8) taken out of the oral cavity is passed through the wire arm (6), and the first snare guide After guiding the wire (8) to the bent portion (4), the wire arm (6) is pushed into the slit portion (5), and the storage means (7) is pulled to the locking portion (10) as shown in FIG. The state shown in FIG. 3 is obtained in which the wire arm (6) is closed by being hooked and fixed.

  In the case of the gastrostomy catheter shown in FIG. 6, the snare portion (9) of the first snare guide wire (8) is guided to the bent portion (4) of the wire arm (6) through the divided portion (12). After that, the convex part (14) of the dividing part (12) is press-fitted into the concave part (13) of the guiding part piece (11), thereby obtaining the state of FIG.

  The first snare guide wire (8) is flexible, and when an index force is applied, the snare portion (9) is closed as shown in FIG.

The method of use after the connection between the gastrostomy catheter (24) and the first snare guide wire (8) is the same as that of the conventional invention, but its method of use will be described.
As shown in FIG. 8C in the state of FIG. 3 or FIG. 7, the first snare guide wire (8) protruding from the body surface is indexed, and the gastrostomy catheter is guided into the stomach.

  Next, as shown in FIG. 8 (d), the puncture tube (20) is removed from the body, and it is confirmed with an endoscope (not shown) that the stomach wall fixing portion (1) is placed on the stomach wall. Secure the catheter to the body surface. At the time of connection with a nutrition bag etc., the suitable part of a cylindrical main body (2) can be cut | disconnected, and it can connect with connection tubes, such as a nutrition bag.

  Instead of the first snare guide wire (8), the straight guide wire is bent at an arbitrary position, and the bent portion is used as a substitute for the snare portion (9) and engaged with the bent portion (4). The method may be used.

  The gastrostomy catheter and gastrostomy catheter kit of the present invention have been described based on the embodiments. However, these embodiments are merely examples, and various modifications are possible, and such modifications are also within the scope of the present invention.

1 is a schematic view showing an embodiment of a gastrostomy catheter according to the present invention. It is sectional drawing of the major axis direction of the catheter for gastrostoma of FIG. FIG. 2 is a schematic view showing a state in which a first snare guide wire is attached to a bent portion of a wire arm installed at the distal end of the gastrostomy catheter guiding portion of FIG. FIG. 4 is a cross-sectional view taken along the line A-A ′ of FIG. 3. FIG. 4 is an overview showing a state in which an index force is applied to the first snare guide wire of FIG. 3. FIG. 6 is a schematic view showing another embodiment of a gastrostomy catheter according to the present invention. FIG. 7 is a view showing a state in which a first snare guide wire is attached to the gastrostomy catheter of FIG. 6. It is the schematic which shows the usage method of the catheter for gastrostoma.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Gastric wall fixing | fixed part 2 Cylindrical main body 3 Guide part 4 Bending part 5 Slit part 6 Wire arm 7 Storage means 8 First snare type guide wire 9 Snare part 10 Locking part 11 Guide part piece 12 Dividing part 13 Concave part 14 Convex Shaped part 20 Puncture tube 21 Second snare guide wire 22 Endoscope 23 Stomach 24 Gastrostomy catheter

Claims (9)

A cylindrical main body having a lumen; a conical guiding portion provided at a distal end portion of the cylindrical main body, the diameter of the cylindrical main body being reduced in a distal direction; and a proximal end portion of the cylindrical main body. A gastric wall fixing portion that has an opening attached in communication with the lumen and is fixed to the gastric wall, and
The guiding portion includes a bent portion that is fixed at a distal end of the guiding portion and extends to a predetermined length in the forward direction of the axis and is bent at a predetermined angle in the rearward direction of the axis, and the guiding portion at the distal end. A gastrostomy catheter, comprising: a wire arm including a storage means that can be stored in the section.   The gastrostomy catheter according to claim 1, wherein the storage means formed at the distal end of the wire arm includes a pigtail type shape.   The gastrostomy catheter according to claim 1 or 2, wherein a bending angle of the bent portion of the wire arm is not less than 5 degrees and not more than 30 degrees.   The said guide | induction part has at least 1 slit part extended in the axial direction which can accommodate the accommodating means formed in the front-end | tip part of the said wire arm at the time of an assembly in any one of Claim 1 thru | or 3 The catheter for gastrostoma as described.   The gastrostomy catheter according to any one of claims 1 to 4, further comprising a locking means that can lock a storage means formed at a distal end portion of the wire arm inside the guide portion. A cylindrical main body, a conical guide portion provided at the distal end portion of the cylindrical main body and having a diameter reduced toward the distal end direction, and provided at a proximal end portion of the cylindrical main body and communicating with a lumen of the cylindrical main body A gastric wall fixing portion that has an opening attached thereto and is fixed to the gastric wall,
The guide part is composed of a split part that can be split and assembled along a substantially central line in the axial direction, and a guide part piece that is attached to the distal end of the cylindrical main body and unites with the split part. And a bent portion that is bent at a predetermined angle in the rear direction of the axis at a portion that is fixed at one end to the predetermined length in the front direction of the axis, and the other end is the front end of the guide portion. A gastrostomy catheter, comprising: a wire arm fixed to the portion.   The gastrostomy catheter according to claim 6, wherein a bending angle at a bent portion of the wire arm is not less than 5 degrees and not more than 30 degrees.   On the base end side of the guide part, a concave part is attached to one inner surface of the divided part or the guide part piece, and a convex part fitted to the concave part is attached to the other inner surface. Item 8. A gastrostomy catheter according to Item 6 or 7.   The gastrostomy catheter according to any one of claims 1 to 8, and a distal end portion that engages with a bent portion of the wire arm and guides the gastrostomy catheter from the oral cavity into the stomach and outside the body via the esophagus. A first snare guidewire having a snare portion in the sheath, a sheath dilator set including a puncture tube for percutaneously guiding the first snare guidewire into the stomach, and a snare of the first snare guidewire A gastric fistula catheter kit, characterized in that a second snare guide wire is gripped and guided from the stomach to the outside of the oral cavity via the esophagus.

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