JP2011045738A - Dilator for fistulization - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an instrument for measuring length of a fistula which can shorten an operation time and reduce the number of parts for a treatment tool. <P>SOLUTION: The dilator for fistulization has a scale mark on its body part. The scale mark is printed by a laser marker. <P>COPYRIGHT: (C)2011,JPO&INPIT

Description

  The present invention relates to a dilator for fistula construction used for gastrostomy construction.

In recent years, percutaneous endoscopic gastrostomy in the patient's abdomen for patients who cannot take nutrients or chemicals orally.
omy, hereinafter abbreviated as PEG. ), And enteral nutrition management has been frequently performed in which a gastrostomy is constructed and nutrition or a chemical solution is administered from the gastrostomy.

  The PEG is an operation for creating a gastrostoma by opening a fistula in the abdominal wall and stomach wall, inserting a catheter comprising an indwelling member, a tube member and an extracorporeal indwelling member into the fistula, and placing the catheter in the abdomen. (1) fixing the abdominal wall and stomach wall while inserting an endoscope into the stomach, (2) piercing the abdominal wall and stomach wall with a puncture needle to form a through hole, and (3) penetration A step of inserting a guide wire into the hole; (4) a step of inserting a fistula construction dilator along the guide wire into the through hole to expand the diameter of the through hole to form a fistula; and (5) a fistula length. (6) a step of inserting a catheter into the fistula along the guide wire, and (7) a step of removing the guide wire. In the present invention, the through-hole refers to a hole before or during expansion with a fistula construction dilator, while the fistula refers to a hole after being expanded with a fistula dilator. Point to.

  The step (5) of measuring the fistula length is a step of measuring the fistula length, that is, the total thickness of the abdominal wall and stomach wall, in order to select a catheter that matches the length of the fistula constructed. In the PEG, it is necessary to select a catheter having a tube member having an appropriate length so that the stomach wall and the abdominal wall are in close contact with each other. When a catheter with a tube member whose length is shorter than the thickness of the stomach wall and abdominal wall is attached, the nutrient channel attached to the catheter is not inserted into the stomach. It may not be accurately injected into the body and may cause peritonitis. On the other hand, when a catheter whose length is longer than the thickness of the stomach wall and abdominal wall is attached, the catheter can be fixed by sandwiching a split gauze or the like in the tube member that is outside the body, but it is extremely long When a catheter is attached, there are many portions that protrude outside the body, which may hinder the patient's life. Therefore, it is necessary to measure the fistula length in advance and select a catheter having an appropriate tube member length.

  A conventionally used fistula length measuring instrument will be described with reference to FIGS. 4 and 5. FIG. FIG. 4 shows a conventional fistula length measuring instrument in a free state, and FIG. 5 shows a conventional fistula length measuring instrument when measuring the fistula length. In FIG. 4, the fistula length measuring device 30 includes an outer tube 32 on which a scale 31 is printed, an inner shaft 33 that freely slides in the outer tube, one end of the outer tube 32 outside the body 34, and the like. The end is joined to the body outer end 35 of the inner shaft 33, and the arm member 36 having a bent shape in the free state, and only one end is joined to the body inner end 37 of the inner shaft 33, the free state Then, it consists of a protruding portion 38 that is closed along the inner shaft 33.

  Conventionally, the measurement of the fistula length has been performed as follows. First, the fistula length measuring device 30 is inserted into the fistula formed by expanding the through hole with the fistula construction dilator with the protruding portion 38 closed. Next, as shown in FIG. 5, an external force 39 is applied to the arm member 36 to deform the arm member 36 into a substantially linear shape. At this time, when the inner shaft 33 moves in the outer tube 32 toward the outside of the body, the protruding portion 38 opens. Next, with the protrusion 38 opened, the fistula length measuring device 30 is pulled outward, the protrusion 38 is brought into contact with the inner side 40 of the stomach wall, and the fistula length is measured with the scale 31. That is, the conventional fistula length measuring instrument 30 is a device that measures the fistula length by bringing the protruding portion 38 into contact with the stomach inner wall so that the base point (zero point) of the scale is aligned with the inside of the stomach wall.

  For example, any of the fistula length measuring device disclosed in US Pat. No. 6,764,453 of Patent Document 1 and the fistula length measuring device disclosed in US Pat. No. 5,356,382 of Patent Document 2 However, as described above, the protrusion that is closed in the free state is inserted into the stomach and then opened in the stomach, and the open protrusion and the inside of the stomach wall are brought into contact with each other, so that the base point of the scale is placed inside the stomach wall. It is to match.

US Pat. No. 6,764,453 US Pat. No. 5,356,382

  However, since the above-mentioned hole length measuring device is composed of a plurality of parts, the molding and assembling steps are complicated and expensive. And after expanding a through-hole with a dilator for fistula construction and forming a fistula, this dilator for fistula construction is pulled out, and a fistula length measuring device which is another instrument is inserted, (5) Since it is necessary to perform the process of measuring the fistula length, there are problems that the operation time becomes long and the number of parts of the treatment tool increases.

  Therefore, the subject of this invention is providing the fistula length measuring device which can shorten the operation time and can reduce the number of parts of a processing tool.

  As a result of intensive studies to solve the above-described problems in the prior art, the present inventors attach a scale to the trunk portion of the dilator for fistula construction so that the fistula dilator is a fistula. Since it can also serve as a length measuring device, it has been found that the operation time can be reduced and the number of parts of the processing tool can be reduced, and the present invention has been completed.

  That is, this invention provides the dilator for fistula construction which has a scale in a trunk | drum.

  According to the expander for fistula construction of the present invention, it is possible to shorten the operation time of fistula construction and reduce the number of parts of the processing tool.

The schematic diagram of the dilator for fistula construction of the example of embodiment of this invention is shown. It is an end surface enlarged view of the front-end | tip 12 of the large diameter member front-end | tip part 5 (tip 16 of the small diameter member front-end | tip part 9). It is a schematic diagram explaining a fistula length measurement process. 1 shows a conventional fistula length measuring instrument in a free state. The conventional fistula length measuring device at the time of fistula length measurement is shown.

  An expander for fistula construction according to an embodiment of the present invention will be described with reference to FIG. FIG. 1 shows a schematic diagram of a dilator for fistula construction according to an embodiment of the present invention, and (I-1) in FIG. 1 is a schematic diagram showing a small-diameter member and a large-diameter member before insertion, (I-2) in FIG. 1 is a schematic view showing a dilator for fistula construction in a state where a small-diameter member is inserted into a large-diameter member, and (I-3) in FIG. 1 is (I-2) FIG. In FIG. 1, the fistula construction dilator 1 is composed of a large-diameter member 3 and a small-diameter member 7. As shown in (I-1) in FIG. 1, the large-diameter member 3 includes a cylindrical large-diameter member body portion 4, a large-diameter member distal end portion 5 whose diameter decreases toward the distal end, and the large-diameter member. The large-diameter member-side connector 6 is provided at the end of the member body 4, and the scale 2 is attached to the large-diameter member body 4. The small-diameter member 7 includes a cylindrical small-diameter member body portion 8, a small-diameter member tip portion 9 whose diameter decreases toward the tip, and a small-diameter member side attached to the end of the small-diameter member body portion 8. It consists of a connector 10. Then, as shown in FIG. 1 (I-2), the small diameter member 7 is inserted into the large diameter member 3, and the large diameter member side connector 6 and the small diameter member side connector 10 cause the large diameter member The small-diameter member 7 is fixed to the member 3 to form the fistula dilator 1.

  The large diameter member 3 is hollow and has a structure in which the small diameter member 7 can be inserted.

  Since the outer diameter of the large-diameter member body 4 is the same as the inner diameter of the fistula to be constructed, it is appropriately selected depending on the outer diameter of the tube member of the catheter to be placed. That is, the outer diameter of the large-diameter member body 4 is substantially the same as the outer diameter of the tube member or 0.5 to 3.0 mm larger than the outer diameter of the tube member, preferably 1.0 to 2. 0 mm larger. And in order to reduce the burden on the patient, the outer diameter of the large-diameter member body 4 is preferably slightly larger than the outer diameter of the tube member of the catheter, and the outer diameter of the tube member of the catheter is usually Since it is 6-12 mm, preferably 7-9 mm, the outer diameter of the large-diameter member body 4 is usually 7-13 mm, preferably 8-10 mm.

  The inner diameter of the large-diameter member body portion 4 is not particularly limited as long as the small-diameter member 7 can be inserted, but is preferably 4 to 10 mm, particularly preferably 5 to 7 mm.

  The large-diameter member distal end portion 5 has a conical shape whose outer diameter decreases toward the distal end. The inner diameter and outer diameter of the distal end of the large-diameter member distal end portion 5 will be described with reference to FIG. FIG. 2 is an enlarged view of the end surface of the tip 12 of the large-diameter member tip 5. In FIG. 2 (II-1), the inner diameter 13 of the tip 12 of the large-diameter member tip 5 is substantially the same as the outer diameter of the small-diameter member body 8, and the size of the small-diameter member body 8 It is selected appropriately. Further, as the outer diameter 14 of the distal end 12 of the large diameter member distal end portion 5 is closer to the value of the inner diameter 13 of the distal end 12 of the large diameter member distal end portion 5, the through hole is expanded by the fistula construction dilator. At this time, it is preferable in that the resistance at the tip 12 is reduced, and most preferably the same as the inner diameter 13 of the tip 12 of the large-diameter member tip 5 as shown in FIG. 2 (II-2).

  The total length 15 of the large-diameter member 3 is at least the total length of the part grasped by the operator, the thickness of the abdominal wall and the thickness of the stomach wall, preferably 50 to 300 mm, particularly preferably 180 to 230 mm.

  The scale 2 is attached to the large-diameter member body 4. That is, the portion to which the scale 2 is attached is a portion excluding the large-diameter member tip 5 of the large-diameter member 3. The base point 11 of the scale 2, that is, the zero point 11 is an arbitrary position of the large-diameter member body portion 4, and the scale 2 is attached from the base point 11 toward the end of the large-diameter member 3. ing. The scale 2 is not particularly limited, but is preferably a horizontal bar and a number attached at regular intervals from the base point 11 toward the end. The scale interval of the scale 2 is not particularly limited, but is preferably 5 mm interval, and it is desirable that a numerical value is given to a portion to be particularly emphasized. Moreover, the scale may be attached | subjected only to the position corresponding to the length of the existing catheter. The base point 11 must be confirmed by an endoscope in the stomach at the time of measuring the fistula length, so that it is easy to confirm under the endoscope, that is, the horizontal bar indicating the base point of the scale is the other side. Preferably it is thicker than the bar or the number 0 is larger than the other numbers. The scale 2 is a scale printed with an ink color or a printing method so that the distinction between the scale 2 and the large-diameter member 3 other than the scale 2 is clear so that the scale is easy to see. However, the scale printed with silicone ink is particularly preferable because sufficient peel strength is obtained and the distinction between the scale 2 and the large-diameter member 3 other than the scale 2 becomes clear. In addition, when the fistula dilator 1 is inserted into the stomach, no matter which direction the scale 2 is oriented, the base point 11 can be easily confirmed under an endoscope. It is preferable that a horizontal bar is attached over the entire circumference of the large-diameter member body 4. The range of the scale 2 is not particularly limited. However, since the length of the fistula is usually 5 to 50 mm, the scale may be practically provided in the range of 0 to 100 mm.

The method for attaching the scale 2 to the large-diameter member body portion 4 is not particularly limited. For example, a method of printing by hot stamp (thermal transfer), a method of printing by silicone ink, a method of printing by UV curable ink, Examples of the method include printing with a laser marker such as a CO ₂ laser marker, an LD laser marker, and a YAG laser marker. However, there is no particular limitation as long as printing on the large-diameter member body 4 is possible. Among these, the method of printing with silicone ink has a short ink curing time, and thus can reduce the manufacturing time, and the film thickness printing is possible. Therefore, the scale 2 is visually easy to see compared to other printing methods. The scale 2 and the large-diameter member 3 other than the scale 2 are preferable in that the distinction is clear. Of these, the method of printing with a laser marker is preferable in that printing can be performed in a short time and no ink is required, and the method of printing with a YAG laser marker is particularly preferable in that the scale 2 becomes clear. . Also, the method of printing with UV curable ink is generally widely used as a method of printing on resin, so existing equipment can be used and no new capital investment is required, so printing can be performed at low cost. Is preferable. Also, since the fluororesin has self-lubricating properties, chemical resistance, and excellent mechanical properties, the large-diameter member body 4 and the large-diameter member tip 5 of the large-diameter member 3 and the small-diameter member As the material of the small-diameter member body portion 8 and the small-diameter member front end portion 7, the fluororesin is often used. However, the fluororesin may be difficult to print, and in that case, a device for printing on the fluororesin is required. For example, when printing is performed with silicone ink or UV curable ink, if the material of the large-diameter member body 4 is the fluororesin, the ink may be repelled or sufficient peel strength may not be obtained. In this case, surface treatment such as plasma treatment may be performed in advance. If the material of the large-diameter member body 4 is polyvinylidene difluoride resin (PVDF resin), printing with UV curable ink is possible without performing surface treatment or the like in advance. In addition, in the method of printing with silicone ink, printing by screen printing is possible, and in the method of printing by UV curable ink, printing by rotary printing is performed on the entire circumference of a circular member in one operation. It is preferable in that printing can be performed over the entire area.

  The small diameter member 7 is hollow and has a structure in which a guide wire can be inserted.

  Although the outer diameter of the small-diameter member body portion 8 is not particularly limited, the small-diameter member 7 is usually a puncture needle having an inner diameter of 1.0 to 1.3 mm and an outer diameter of 1.4 to 1.7 mm. Since the through-hole formed by penetrating the abdominal wall and stomach wall is the first member to be expanded, making it too large compared to the outer diameter of the puncture needle increases the burden on the patient. Therefore, the outer diameter of the small-diameter member body portion 8 is preferably 2 to 8 mm, particularly preferably 2.5 to 4.5 mm.

  The inner diameter of the small-diameter member body 8 is not particularly limited as long as the guide wire can be inserted into the small-diameter member 7, but is preferably 1.3 to 6 mm, particularly preferably 1.4 to 1. .8 mm.

  The small-diameter member distal end portion 9 has a conical shape whose outer diameter decreases toward the distal end. The inner diameter 17 of the tip 16 of the small-diameter member tip 9 is not particularly limited as long as the small-diameter member 7 (or the fistula construction expander 1) can slide along the guide wire. It is appropriately selected depending on the outer diameter of the guide wire. The clearance between the tip 16 of the small-diameter member tip 9 and the guide wire, that is, the difference between the outer diameter 17 of the tip 16 and the outer diameter of the guide wire is 0 to 0.2 mm, preferably 0.02. ~ 0.09 mm. Usually, a 0.035 "guide wire having an outer diameter of 0.89 mm is used as the guide wire. Therefore, when the 0.035" guide wire is used, the inner diameter 17 of the tip 16 of the small diameter member tip 9 is used. Is preferably 0.9 to 1.1 mm, particularly preferably 0.92 to 0.98 mm. Further, when the outer diameter 18 of the distal end 16 of the small diameter member distal end portion 9 is closer to the value of the inner diameter 17 of the distal end 16 of the small diameter member distal end portion 9, when the through hole is expanded by the fistula construction dilator. It is preferable in that resistance at the tip 16 is reduced, and most preferably the same as the inner diameter 17 of the tip 16 of the small diameter member tip 9. The inner diameter and outer diameter of the tip 16 of the small diameter member tip 9 are the same as the tip 12 of the large diameter member tip 5 shown in FIG.

  The materials of the large-diameter member body 4 and the large-diameter member tip 5 of the large-diameter member 3 and the small-diameter member body 8 and the small-diameter member tip 9 of the small-diameter member 7 are not particularly limited, but are biocompatible. It is preferable that the material is excellent in properties, does not crush or buckle when expanded, and is slippery. For example, polytetrafluoroethylene resin (PTFE resin), polyvinylidene difluoride resin (PVDF resin) ), A fluororesin such as tetrafluoroethylene / hexafluoropropylene copolymer resin (FEP resin) is preferable. Further, vinyl chloride resin, polyethylene resin, nylon resin, etc. are resins having lower strength than the PTFE resin and the fluororesin, but the large-diameter member body 4 of the large-diameter member 3 and the tip of the large-diameter member By selecting the thickness of the portion 5 and the small diameter member body portion 8 and the small diameter member distal end portion 9 of the small diameter member 7, it can be used. In addition, when resins such as vinyl chloride resin, polyethylene resin, and nylon resin are difficult to slide, resins such as vinyl chloride resin, polyethylene resin, and nylon resin are used by applying hydrophilic treatment to the surface. It becomes possible. When the scale 2 is a scale printed with UV curable ink, the material of the large-diameter member body portion 4 on which the scale 2 is printed is a polyvinylidene difluoride resin. This is preferable because printing can be performed without surface treatment. The large-diameter member 3 and the small-diameter member 7 can contain a metal compound. When printing with a laser marker, the large-diameter member 3 and the small-diameter member 7 contain 1 to 20 mass of the metal compound in that the printing becomes clear. It is particularly preferable that the metal compound is contained in an amount of 3 to 10% by mass. The metal compound is preferably bismuth oxide. Moreover, since the color of the scale 2 can be changed by selecting the type of the metal compound, the large diameter member other than the scale 2 and the scale 2 can be selected by appropriately selecting the type of the metal compound. The distinction from 3 can be made clear. The large-diameter member body portion 4 and the large-diameter member tip portion 5 may be integrally formed or may be formed by bonding a cylindrical part and a conical part. Similarly, the small-diameter member body portion 8 and the small-diameter member distal end portion 9 may be integrally formed, or a cylindrical part and a conical part may be bonded together. .

  The large diameter member side connector 6 is attached to the end of the large diameter member 3, and the small diameter member side connector 10 is attached to the end of the small diameter member 7. The large-diameter member-side connector 6 and the small-diameter member-side connector 10 are configured so that the large-diameter member-side connector 10 is fitted into the large-diameter member-side connector 6 when the through-hole is expanded. This is a member for fixing the small diameter member 7 inserted into the member to the large diameter member 3. The large-diameter member-side connector 6 and the small-diameter member-side connector 10 can be arbitrarily attached. However, when the through-hole is expanded, the large-diameter member 3 and the small-diameter member 7 are integrated. Expansion of the through hole from the outer diameter of the small-diameter member body portion 8 to the outer diameter of the small-diameter member body portion 8, and the size from the outer diameter of the small-diameter member body portion 8 to the outer diameter of the large-diameter member body portion 4 It is preferable that the large-diameter member-side connector 6 and the small-diameter member-side connector 10 are attached in that the operation time can be shortened. In this case, the large-diameter member side connector 6 and the small-diameter member side connector 10 are particularly preferably provided with a lock mechanism.

  Further, depending on the case or the preference of the operator, first, only the small diameter member 7 is inserted into the through-hole immediately after being formed with the puncture needle, and the small diameter member body portion 8 is inserted from the outer diameter of the puncture needle. The through-hole is expanded to a size up to the outer diameter of the small-diameter member, then the position of the small-diameter member 7 is fixed, the large-diameter member 3 is inserted into the through-hole, and the small-diameter member body portion 8 is Expansion from the diameter to the outer diameter of the large-diameter member body portion 4 can be performed. In this case, the large-diameter member-side connector 6 and the small-diameter member-side connector 10 are not necessary.

  The large diameter member 3 and the small diameter member 7 may be bonded in advance.

  The large-diameter member-side connector 6 and the small-diameter member-side connector 10 are provided by press-fit fixing, adhesive fixing, or the like, so that the workability is good and the chemical resistance is such that cracks do not occur even when contacting with a curing agent or the like. is required. The material of the large diameter member side connector 6 and the small diameter member side connector 10 is not particularly limited, but is preferably a hard plastic such as a hard vinyl chloride resin.

  In a state where the small diameter member 7 is inserted into the large diameter member 3 and the small diameter member 7 is fixed to the large diameter member 3 with the large diameter member side connector 6 and the small diameter member side connector 10, the small diameter member 7 Part of the large-diameter member protrudes from the tip 12 of the large-diameter member tip 5. The length 19 of the small-diameter member 7 protruding from the tip 12 of the large-diameter member tip 5 is not particularly limited, but is preferably 5 to 200 mm, particularly preferably 10 to 60 mm. If the length 19 is less than the above range, the flexibility to bend by being guided by the guide wire tends to be poor, and the stomach wall may be pierced. By selecting a flexible material, it is possible to prevent the stomach wall from being damaged even if the length 19 is less than the above range. As such a flexible material, ethylene-tetrafluoroethylene can be used. Examples thereof include a copolymer (ETFE), a fluoroethylene-fluoropropylene copolymer (FEP), and polytetrafluoroethylene (PTFE). On the other hand, when the length 19 exceeds the above range, workability tends to deteriorate.

  1 is composed of the large-diameter member 3 and the small-diameter member 7, that is, two members having different outer diameters of the body portion. When 1 is used, the through hole is expanded in two stages, but the number of members having different outer diameters of the body portion is not particularly limited.

  For example, an intermediate diameter member is prepared in which the outer diameter of the body portion is between the outer diameter of the body portion of the large diameter member 3 and the outer diameter of the body portion of the small diameter member 7. The medium diameter member is inserted into the medium diameter member, and the small diameter member 7 is inserted into the medium diameter member to form a fistula construction dilator. According to the fistula construction dilator, The through hole is expanded in three stages. In this case, the fistula dilator is a fistula dilator composed of a large-diameter member, a medium-diameter member, and a small-diameter member, and the large-diameter member has a large cylindrical shape with a scale. It consists of a diameter member body part, a large diameter member tip part whose diameter decreases toward the tip, and a large diameter member side connector attached to the end of the large diameter member body part. Medium-diameter member body, a medium-diameter member tip portion whose diameter decreases toward the tip, and a medium-diameter member-side connector attached to the end of the medium-diameter member body portion, the small-diameter member, A cylindrical small-diameter member body portion, a small-diameter member tip portion whose diameter decreases toward the tip portion, and a small-diameter member-side connector attached to the end of the small-diameter member body portion.

  In addition, when there are a plurality of members, the member to which the scale is attached may be any member, but the scale is attached to the body portion of the member having the largest outer diameter of the body portion. Since the fistula length is measured immediately before the catheter is placed, the fistula length can be measured in a state closest to the state when the catheter is placed.

  Further, for example, by making the inner diameter of the distal end 12 of the large-diameter member distal end portion 4 of the large-diameter member 3 the same as or slightly larger than the outer diameter of the guide wire, the dilator for fistula construction operation can be formed with one member. According to the fistula construction dilator, the through-hole is expanded in one step. In this case, the expander for fistula construction includes a cylindrical body portion with a scale and a tip portion whose diameter decreases toward the tip.

  That is, the fistula expansion device for fistula construction of the present invention is a fistula expansion device having a scale on the body part.

  Next, a percutaneous endoscopic gastrostomy (PEG) using the dilator for fistula construction according to the present invention will be described. In the percutaneous endoscopic gastrostomy of the present invention, (1) a step of fixing the abdominal wall and the stomach wall while inserting the endoscope into the stomach (hereinafter also referred to as the first step), (2). ) A step of piercing the abdominal wall and stomach wall to form a through hole (hereinafter also referred to as a second step), (3) a step of inserting a guide wire into the through hole (hereinafter also referred to as a third step). ), (4) A step of inserting a dilator into the through hole along the guide wire and expanding the diameter of the through hole to form a fistula (hereinafter also referred to as an expansion step), (5) A fistula length. A step of measuring (hereinafter also referred to as a fistula length measuring step), (6) a step of inserting a catheter into the fistula along the guide wire (hereinafter also referred to as a sixth step), and (7) a guide wire. It consists of a process of removing (hereinafter also referred to as a seventh process).

  In the first step, an endoscope is inserted into the patient's stomach and air is supplied sufficiently to bring the abdominal wall and stomach wall into close contact. Next, the position of the stomach is confirmed by transmitted light from the endoscope, the abdominal skin is disinfected, and local anesthesia is performed. Subsequently, in order to prevent the relative position between the abdominal wall and the stomach wall from shifting at that site, gastric wall abdominal wall fixation is performed. A small incision is made with a scalpel in the vicinity of the stomach wall and abdominal wall fixation. This site is a catheter insertion planned site. Furthermore, at the site where a small incision is made with a scalpel, the muscle layer can be peeled off using metal forceps. By peeling the muscle layer using the metal forceps, it becomes easy to insert the fistula construction dilator and the catheter in a later step.

  In the second step, a hollow needle or a sheathed needle or the like is passed through the small incision site in the order of the abdominal wall and the stomach wall to form a through hole.

  In the third step, the guide wire is inserted into the stomach through the hollow needle or the lumen of the sheath. After the insertion is completed, the hollow needle or the sheathed needle is removed from the patient with the guide wire remaining. A sufficiently long length of the guide wire is inserted into the stomach so that the guide wire is not pulled out unexpectedly during the subsequent operation. Moreover, it is possible to prevent the guide wire from being pulled out unintentionally by fixing the guide wire that has come out of the body to the body surface or drape with forceps, tape, or the like.

  In the expansion step, the through-hole is expanded using the fistula construction expander of the present invention. As an example of the expansion process, the case where the fistula construction expander 1 shown in FIG. 1 is used will be described. First, the small diameter member 7 is inserted into the large diameter member 3, and the large diameter member 3 and the small diameter member 7 are fixed by a connector. Next, the guide wire is inserted into the small diameter member 7 of the fistula construction dilator 1 from the distal end side of the small diameter member 7. Next, the fistula construction dilator 1 is inserted into the through hole along the guide wire to expand the through hole.

  The hole length measuring step will be described with reference to FIG. FIG. 3 is a schematic diagram for explaining a fistula length measuring step using the fistula construction dilator according to the present invention, and is a view when cut along a plane parallel to the insertion direction of the fistula dilator. is there. (III-1) in FIG. 3 is a schematic diagram showing a state immediately after the expansion step is finished, and (III-2) in FIG. 3 is a schematic diagram showing a state at the time of measuring the fistula length. For convenience of description, the fistula construction dilator is shown in a side view, not a cross-sectional view.

  Immediately after inserting the dilator 20 for fistula construction into the through-hole 28 and performing the dilation step, the abdominal wall and stomach wall 23 are present in any part of the trunk of the dilator 20 for fistula construction. To do. At this time, the position of the base point (zero point) 22 and the position of the inner side 25 of the stomach wall do not match (III-1). Therefore, while observing with the endoscope 21 inserted into the stomach 26, the fistula construction dilator 20 is further pushed or pulled out to align the position of the base point 22 with the position of the inner side 25 of the stomach wall ( Zero point adjustment) (III-2). And the scale 24 is visually observed from the body outer side 27, and the fistula length is measured. In this way, the hole length measuring step is performed. Then, after measuring the fistula length, the fistula construction dilator is removed. In the present invention, the inner side of the stomach wall refers to the surface of the stomach wall on the stomach inner side.

  In the sixth step, a catheter is inserted into the constructed fistula along the guide wire, and the catheter is placed in the constructed fistula.

  In the seventh step, the guide wire is pulled outside the body and removed from the stomach.

  The first step, the second step, the third step, the sixth step and the seventh step are not particularly limited, and are performed by a conventional percutaneous endoscopic gastrostomy. Each step can be performed in the same manner as described above. In addition, the dilation step is a method similar to the method performed in the conventional percutaneous endoscopic gastrostomy, except that the dilator for fistula construction according to the present invention is used as the dilator for fistula construction. The expansion step can be performed.

  That is, the percutaneous endoscopic gastrostomy according to the present invention includes an expansion process for expanding a through-hole using the fistula expansion device according to the present invention, and an endoscope inserted into the stomach. While observing, the base point attached to the dilator for fistula construction of the present invention and the inner side of the stomach wall are aligned, and then the percutaneous internal process has a fistula length measurement step of measuring the fistula length by visually observing the scale outside the body Endoscopic gastrostomy.

  Thus, according to the fistula expander of the present invention, in the percutaneous endoscopic gastrostomy, the fistula expander used in the previous expansion step is not removed, and is used as it is. With the endoscope already inserted in the stomach, the fistula length can be measured by a simple operation of aligning the base point of the dilator for fistula construction and the inside of the stomach wall. it can. In addition, according to the expander for fistula construction according to the present invention, the fistula length can be measured without using a dedicated instrument for fistula length measurement, so that the number of parts of the processing tool can be reduced.

  According to the present invention, it is possible to provide a fistula length measuring instrument (expansion and fistula length measuring instrument for fistula construction) with less burden on the patient, less stress on the operator, and lower cost.

DESCRIPTION OF SYMBOLS 1,20 Fistula expansion device 2 and 24 Scale 3 Large diameter member 4 Large diameter member body part 5 Large diameter member tip part 6 Large diameter member side connector 7 Small diameter member 8 Small diameter member body part 9 Small diameter member tip part 10 Small diameter Member side connector 11, 22 Base point (zero point)
12 Tip of large diameter member tip 13 Inner diameter of tip of large diameter member tip 14 Outer diameter of tip of large diameter member tip 15 Overall length of large diameter member 16 Tip of tip of small diameter member 17 Tip of tip of small diameter member Inner diameter 18 Outer diameter 19 at the tip of the small diameter member The length of the protruding small diameter member
21 Endoscope 23 Abdominal wall and stomach wall 25 Inside the stomach wall 26 Inside the stomach 27 Outside the body 28 Through-hole

Claims (6)

  An expander for fistula construction, characterized by having a scale on the body.   The dilator for fistula construction according to claim 1, wherein the scale is a scale printed with a laser marker.   The dilator for fistula construction according to claim 1, wherein the scale is a scale printed with UV curable ink.   The dilator for fistula construction according to claim 1, wherein the scale is a scale printed with silicone ink.   5. The fistula construction dilator according to claim 3, wherein a material of the fistula construction dilator is polyvinylidene difluoride.   5. The fistula construction dilator according to claim 3, wherein the fistula dilator is made of plasma-treated polyvinylidene difluoride.

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