JP2011092451A - Gastrostoma sheath - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a gastrostoma sheath preventing the sheath from being drawn into the stomach even without being gripped when inserting a button type gastrostoma catheter, and allowing the one hand to be free when inserting the button type gastrostoma catheter, thereby enabling an operator for allowing even one operator to use a guide wire by him/herself and improving facility and safety in a procedure. <P>SOLUTION: The gastrostoma sheath 1 is used for indwelling or exchanging the gastrostoma catheter including: a tube internally having a passage for supplying nutrition or chemical, etc., to the stomach from an external part; and an indwelling part which is attached to the distal end of the tube and formed to have a dome shape swelling outward in the diameter direction of the tube. The sheath includes: a cylindrical sheath body 11 with both ends opened to insert the gastrostoma catheter; and a flat, hollow, and disk-like grip 12 fixed by at least two joint pieces 114 which are extended outward in the diameter direction of the sheath body from the proximal end of the sheath body. <P>COPYRIGHT: (C)2011,JPO&INPIT

Description

  The present invention relates to a sheath for gastrostoma.

As a method of administering nutrition to a patient who cannot take nutrition through the mouth, generally, intravenous nutrition administration, transgastric nutrition administration with a tube inserted into the stomach or the like from the nose, and enteral administration from a gastrostomy Nutrition is administered.
In recent years, enteral nutrition and administration thereof have been frequently used for enteral nutrition management by percutaneous endoscopic gastrostomy (PEG).

  Conventionally, there are generally known methods for installing PEG, such as the Pull method and Push method in which a gastrostomy tube is inserted from the mouth side, and the Introducer method in which the gastrostomy tube is inserted into the stomach through a sheath from the body surface. It has been.

  In the Pull method and the Push method, in order to pass the gastrostomy tube through the pharynx, there is a possibility of wound infection at the site where the gastrostomy tube is placed, and it is necessary to insert an endoscope twice. Has drawbacks. On the other hand, the Introducer method has an advantage that the gastrostomy tube does not pass through the pharynx, so that the risk of the above-mentioned wound infection is low, and the endoscope only needs to be inserted once. However, it is necessary to puncture a thick puncture needle without using a guide wire, and only a small balloon catheter can be placed through the sheath. Have a problem.

In recent years, in the Introducer method, a new technique for inserting and placing a large-diameter button-type gastrostomy catheter directly into the stomach from the outside of the body through the abdominal wall is becoming widespread.
In this method, using a device called a gastric wall abdominal wall fixing tool, the abdominal wall and the stomach wall are fixed with sutures, a fistula is opened in the abdominal wall and the stomach wall under the guide wire, and an obturator is formed in the fistula under the guide wire. It is possible to insert and place a large-diameter button-type gastrostomy catheter in which the indwelling portion is stretched by an extension tool called “extension device”.

  The button-type gastrostomy catheter used in this method is provided with a tube part installed in the fistula as an introduction passage for introducing a nutrient or a drug solution percutaneously from the outside of the body into the stomach, and attached to the distal end of the tube part. The indwelling portion formed in a dome shape (or a hook shape) projecting radially outward by a plurality of elastically deformable strip-shaped members, and attached to the proximal end side of the tube portion and radially outward of the tube And an extracorporeal fixing portion that extends and contacts the body surface. And by extending an indwelling part using an obturator, it deform | transforms into a diameter-reduced state (extends in the virtual extension direction of the tube part front end side), and reduces the insertion resistance to a fistula. If the obturator is removed after the indwelling portion is inserted into the stomach, the indwelling portion becomes the original shape, that is, the shape protruding radially outward, thereby preventing the gastrostomy catheter from deviating from the body.

  Under such circumstances, a method of inserting a button-type gastrostomy catheter through a sheath has been disclosed for the purpose of more easily inserting a button-type gastrostomy catheter and reducing insertion resistance. (For example, see Patent Document 1)

JP 2009-72344 A

  However, when inserting a button-type gastrostomy catheter through the sheath, it is necessary to hold the sheath with one hand to prevent the sheath from being pulled into the stomach, and to operate the obturator with the other hand. It is virtually impossible for one operator to use a guide wire when inserting a button-type gastrostomy catheter. For this reason, there arises a problem that, when a problem such as the sheath dropping out before the placement of the button type catheter is completed, the subsequent placement of the button type gastrostomy catheter is difficult.

  The present invention has been made in view of the above, and when inserting a button-type gastrostomy catheter, the sheath can be prevented from being pulled into the stomach without grasping the sheath, and one hand can be freely moved when inserting the catheter. It is an object of the present invention to provide a sheath for gastrostoma that allows a single operator to use a guide wire and can improve the convenience and safety of the procedure.

The object is achieved by the present invention described in the following (1) and (2).
That is, the present invention
(1) a tube portion having a passage for supplying nutrients or chemicals from the outside of the body into the stomach;
A sheath for gastrostoma used at the time of indwelling or exchanging a gastrostoma catheter, comprising: a body indwelling portion formed in a dome shape extending outward in the radial direction of the tube portion attached to a distal end portion of the tube portion; There,
A cylindrical sheath body having both ends opened to which the gastrostomy catheter is inserted, and a flat hollow fixed by at least two joint pieces extending from the proximal end portion of the sheath body in the radially outward direction of the sheath body. With a disk-shaped handle,
A sheath for gastrostoma characterized by comprising:
(2) The sheath body extends from the distal end portion to the proximal end portion of the outer wall of the sheath body and has a pair of notch grooves that are non-penetrating from the lumen of the sheath body (1 ) Sheath for gastrostoma.

According to the present invention, when inserting a button-type gastrostomy catheter, the sheath can be prevented from being pulled into the stomach without grasping the sheath, and one hand can be freed when the button-type gastrostomy catheter is inserted. Thus, even a single surgeon can use a guide wire, and a gastrostomy sheath that can improve the convenience and safety of the procedure can be provided.

The perspective view of the sheath for gastrostoma of this invention is shown. (A) The front view of the sheath for gastrostoma of this invention is shown. (B) The top view of the sheath for gastrostoma of this invention is shown. The front view just before putting the button for gastrostoma extended with the obturator in the sheath for gastrostoma of this invention is shown. The front view of the button for gastrostoma immediately before putting the button for gastrostoma extended with the obturator in the sheath for gastrostoma of this invention, and the schematic of the sheath for gastrostoma inserted are shown. It is an expanded sectional view which shows the structure of the sheath for gastrostoma of this invention of the structure which formed the notch groove | channel in the circumferential direction 2 places of a sheath main body. The front view of the state which covered the dilator with the sheath for gastrostoma of this invention is shown. The perspective view of the 2nd Example of the sheath for gastrostoma of this invention is shown. (A) The front view of the 2nd Example of the sheath for gastrostoma of this invention is shown. (B) The top view of the 2nd Example of the sheath for gastrostoma of this invention is shown. The perspective view of the 3rd Example of the sheath for gastrostoma of this invention is shown. (A) The front view of the 3rd Example of the sheath for gastrostoma of this invention is shown. (B) The top view of the 3rd Example of the sheath for gastrostoma of this invention is shown. The perspective view of the 4th Example of the sheath for gastrostoma of this invention is shown. (A) The front view of the 4th Example of the sheath for gastrostoma of this invention is shown. (B) The top view of the 4th Example of the sheath for gastrostoma of this invention is shown.

Hereinafter, preferred embodiments of the sheath for gastrostoma of the present invention will be described with reference to the drawings.
In the following description, the vertical direction is defined, but this is defined for the sake of simplicity in explaining the relative relationship of the components of the present invention. It does not limit the direction during use.
In all the drawings, common constituent elements are denoted by the same reference numerals, and detailed description will be appropriately omitted in the following description. In the drawing, the upper side is the upper end side and the lower side is the lower end side.

  1 and 2 show a first embodiment of a gastrostomy sheath 1 according to the present invention. FIG. 1 is a perspective view, FIG. 2 (a) is a front view, and FIG. 2 (b) is a plan view. Show.

The gastrostomy sheath 1 of the present invention is temporarily placed in a hole formed with the dilator 5 (hereinafter referred to as “fistula”) in gastrostomy. In this indwelling state, the gastrostomy catheter 2 is inserted into the stomach through the internal passage 113 of the gastrostomy sheath 1.
As shown in FIGS. 1, 2 (a) and 2 (b), the gastrostomy sheath 1 extends from the proximal end portion of the sheath body 11 to the outside in the radial direction of the sheath body 11. It is composed of a flat hollow disc-shaped handle 12 fixed by at least two joint pieces 114 that are taken out.

  The sheath body 11 has an internal passage 113 for inserting a gastrostomy catheter 2 (hereinafter also referred to as a gastrostomy button) (see FIG. 3). Further, the internal passage 113 is also used for inserting the dilator 5 as shown in FIG.

  The sheath 1 for gastrostoma of the present invention includes a handle 12 fixed by at least two joint pieces 114 extending from the proximal end portion of the sheath body 11 to the radially outer side of the sheath body 11. By providing the handle 12 having such a shape, when the gastrostomy button 2 is inserted, the sheath itself can be prevented from being pulled into the body against the insertion resistance, and the operator can freely use one hand. Therefore, the guide wire can be operated alone.

The handle 12 and the sheath body 11 are
The base end portion of the sheath body 11 (fixed by a tongue-like joint piece 114 extending from the upper end side in FIG. 1 to the radially outer side of the sheath body 11. This joint piece 114 is fixed as shown in FIG. The sheath body 11 and the joint piece 114 may be fixed with an adhesive, although the fixing method is not particularly limited. It is preferable to form integrally with the sheath body 11. By forming it integrally, the manufacturing process can be reduced, and there is no need to worry about poor adhesion to the sheath body 11. From the sheath body 11 to the joint piece. The method of forming 114 is not particularly limited, but when the sheath body 11 is cut from the resin tube and manufactured, the sheath body 11 and the sheath tube 11 are cut from the resin tube. It is preferable to to form.

A method for fixing the handle 12 and the joint piece 114 is not particularly limited, but the handle 12 is preferably formed of two flat members. For example, as shown in FIG. 2, it is preferable that the first handle member 121 and the second handle member 122 are overlapped and fixed with an adhesive so that the joint piece 114 is sandwiched therebetween.
The first handle member 121 and the second handle member 122 may be configured as separate members or may be formed by integral molding.

  The material of the handle member is not particularly limited, but a material having rubber elasticity such as polyethylene resin, polypropylene resin, polyacetal resin, silicone rubber, or elastomer can be used. Among these, hard resins such as polyethylene resin and polyacetal resin are preferable. By using a hard resin, it is possible to reliably prevent the sheath from being pulled into the stomach.

  Moreover, it is preferable that the front-end | tip part of the sheath 1 for gastrostoma is provided with the taper part 112 so that the level | step difference with the dilator (dilator) body part 51 for forming a fistula may be eliminated. By providing the tapered portion 112, it is possible to reduce insertion resistance when the dilator 5 covered with the gastrostomy sheath 1 is inserted into the abdominal wall and stomach wall. The method for forming the tapered portion 112 is not particularly limited, but it can be provided by a method such as heat forming of a tube. Further, by adjusting the inner diameter, it is possible to regulate the displacement of the gastrostomy sheath 1 with respect to the trunk portion 51 of the dilator 5.

In the gastrostoma sheath 1, it is desirable that the inner diameter of the sheath body 11 is the same size as the outer diameter of the tube portion 21 of the gastrostoma button 2 in order to reduce insertion resistance.
However, the indwelling portion 22 of the gastrostomy button 2 has a maximum outer diameter in the initial state before the diameter reduction larger than the outer diameter of the tube portion 21 and is larger in the radial direction from the tube portion 21 for indwelling in the body. It is formed to overhang. For this reason, it is technically difficult to reduce the diameter of the indwelling portion 22 having a greatly protruding shape to the same outer diameter as the tube portion 21. .

  On the other hand, the inner passage 113 of the gastrostomy sheath 1 is preferably formed to have a size substantially equal to the maximum outer diameter of the dilator 5, and the maximum outer diameter of the dilator 5, that is, the outer diameter of the dilator body 51 is This is an important factor in determining the size of the fistula formed. This fistula size is preferably approximately the same as the outer diameter of the tube portion 21 of the gastrostomy button 2 or larger by 1 to 2 mm or more.

The sheath body 11 of the sheath for gastrostoma 1 of the present invention extends from the distal end portion of the outer wall of the sheath body 11 to the proximal end portion, and is a pair of notch grooves 111A that are non-penetrating from the lumen of the sheath body 11. It is preferable to have.
Here, by setting the maximum outer diameter of the indwelling portion 22 in which the gastrostomy button 2 is extended to be slightly larger than the inner diameter of the internal passage 113 of the sheath body 11, the indwelling portion 22 that has been extended at the time of insertion is used as the sheath. The body 11 can be torn.
Further, it is desirable that the diameter of the internal passage 113 of the gastrostomy sheath 1 is larger than the outer diameter of the most distal portion of the indwelling portion 22 in order to improve the insertability.

  3 and 4 are diagrams for explaining the case where the gastrostomy button 2 is inserted into the gastrostomy sheath 1 of the present invention, which is brought into the expanded state (reduced diameter state) by the obturator 3. The gastrostomy button 2 to be inserted into the sheath body 11 of the gastrostomy sheath 1 is formed such that the maximum outer diameter in the reduced diameter state of the indwelling portion 22 is larger than the diameter of the internal passage 113 of the gastrostomy sheath 1. .

  Since the outer diameter of the most distal portion of the indwelling portion 22 is smaller than the diameter of the internal passage 113 of the gastrostomy sheath 1, insertion into and passage through the internal passage 113 is easy. When a portion of the indwelling portion 22 whose outer diameter is larger than the diameter of the internal passage 113 of the gastrostomy sheath 1 is about to pass through the internal passage 113, the pair of cutout grooves 111A of the sheath body 11 are formed with the gastrostomy button. It will tear by the insertion resistance of 2 indwelling part.

  The material constituting the sheath body 11 is not particularly limited, but polyethylene resin, polypropylene resin, polytetrafluoroethylene resin (PTFE), tetrafluoroethylene / hexafluoropropylene copolymer (FEP), tetrafluoroethylene / ethylene. A fluororesin such as a copolymer (ETFE) is preferred. Among these, it is particularly preferable that the resin is composed of a fluororesin having a low frictional resistance. When the gastrostomy button 2 is inserted, the frictional resistance when passing through the internal passage 113 is reduced, and the gastrostomy button is reduced. 2 can be reduced.

  A configuration for tearing the sheath body 11 by inserting a portion of the indwelling portion 22 having an outer diameter larger than the diameter of the inner passage 113 of the gastrostomy sheath 1 is not particularly limited. A configuration using a PTFE tube that is oriented in the longitudinal direction so as to be vertically tearable as the main body 11, extends from the distal end portion of the sheath main body 11 to the proximal end portion, and the lumen of the sheath main body 11 A configuration in which the thickness of the sheath body 11 is locally thinned by a pair of non-penetrating cut grooves 111A (notches) is preferable. Moreover, the structure which formed the part already cut | disconnected in the sheath main body 11 by the slit (notch part) extended along the longitudinal direction of the sheath main body 11 can also be used. When the cutout portion such as the cut groove and the slit is formed as described above, the sheath body 11 is divided along the entire length in the longitudinal direction along the formation portion of the cutout portion by the insertion of the indwelling portion 22.

FIG. 1, FIG. 2 (a), (b), FIG. 3, and FIG. 4 illustrate the structure which specifically formed the notch groove 111A in the sheath main body 11 as a notch part.
As shown in FIG. 5, the cutout groove 111 </ b> A is formed in the sheath body 11 so as not to penetrate through the sheath body 11 as described above. The sheath body 11 has an uncut portion 111a in which the thickness of the sheath body 11 is locally reduced on the groove bottom side of the notch groove 111A. The notch groove 111A is preferably provided so as to be opposed to two places in the circumferential direction of the sheath body 11. Further, the joint piece 114 is provided at a position avoiding the notch groove 111A, but when the sheath body 11 is longitudinally split by insertion of the gastrostomy button 2, a portion that becomes a split body of the sheath body 11 (hereinafter referred to as a split body). Depending on the piece 115), it is provided on each divided piece 115.

The notch (notch groove 111A) is preferably formed in a wedge shape whose cross-sectional shape increases in opening width from the inner surface side to the outer surface side of the sheath body 11.
In the case of the cutout portion having the cross-sectional shape, when the sheath body 11 is deformed so as to be pushed outward in the radial direction by the indwelling portion 22 inserted into the internal passage 113, the cross section of the cutout portion is also pushed up. Thus, cutting of the non-cutting portion 111a starting from the notch portion is likely to occur.

The notch can be formed by, for example, laser processing or machining of the sheath body 11.
In particular, the laser processing is preferable in that the opening width of the notch can be easily adjusted, and a wedge-shaped notch having a cross-sectional shape can be easily formed by adjusting the focal position of the laser.

  7 and 8 show a second embodiment of the sheath 1 for gastrostoma of the present invention, and FIGS. 9 and 10 show a third embodiment of the sheath 1 for gastrostoma of the present invention. is there. By curving and attaching the flat hollow disk-shaped handle 12, the handle 12 can be easily grasped when the sheath 1 for gastrostoma is removed. 7 and 8, the handle 12 is bent and attached to the sheath body 11 so that the convex side is upward, and the sheath for gastrostoma can be removed by grasping the center of the handle 12. it can. 9 and 10, the handle 12 is bent and attached to the sheath body 11 so that the convex side is downward, and the gastrostomy sheath can be removed by grasping both ends of the handle 12. it can.

  11 and 12 show a fourth embodiment of the gastrostomy sheath of the present invention. By attaching an arch-shaped handle 123 to the flat hollow disc-shaped handle 12, the handle 12 can be easily grasped when the sheath 1 for gastrostoma is removed. The handle 123 is attached so as to face two places on the upper surface of the handle 12.

DESCRIPTION OF SYMBOLS 1 Gastrostomy sheath 11 Sheath body 111A Notch groove 111a Uncut part 112 Tapered part 113 Internal passage 114 Joint piece 115 Split piece part 12 Handle 121 First handle member 122 Second handle member 123 Handle 2 For gastrostoma Catheter (gastrostomy button)
DESCRIPTION OF SYMBOLS 21 Tube part 22 Indwelling part 3 Obturator 4 Guide wire 5 Dilator 51 Dilator trunk | drum 61 Abdominal wall 62 Gastric wall 63 Suture thread

Claims (2)

A tube portion having a passage for supplying nutrients or liquid medicines from the outside of the body into the stomach;
A sheath for gastrostoma used at the time of indwelling or exchanging a gastrostoma catheter, comprising: a body indwelling portion formed in a dome shape extending outward in the radial direction of the tube portion attached to a distal end portion of the tube portion; There,
A cylindrical sheath body having both ends opened to which the gastrostomy catheter is inserted, and a flat hollow fixed by at least two joint pieces extending radially outward of the sheath body from the proximal end portion of the sheath body With a disk-shaped handle,
A sheath for gastrostoma characterized by comprising:   The sheath body extends from a distal end portion to a proximal end portion of the outer wall of the sheath body, and has a pair of notch grooves that are non-penetrating with the lumen of the sheath body. Sheath for gastrostoma.

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