JP2011136007A - Device for confirming indwelling state of gastrostomy catheter - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To simplify the configuration of the insertion part of an endoscope used for confirming whether or not a gastrostomy catheter is indwelled in a proper state, and to narrow a diameter. <P>SOLUTION: The insertion part 11 of the endoscope 10 is flexible in a bend direction and is capable of being inserted into the catheter tube 2 of the gastrostomy catheter 1, and the distal end hard part 11a of the insertion part 11 is provided with an observation means composed of an illumination part 13 and an observation part 14. Also, a magnetic plate 24 is provided on the outer surface of the distal end hard part 11a. An operation means 20 provided with a magnet 23 is abutted to the body surface skin; magnetic attraction force is made to act on the magnetic plate 24 provided on the insertion part 11; the direction of the distal end part of the insertion part 11 is inverted, and the part inserted into the stomach of the catheter tube 2 is settled in a visual field. By moving the operation means 20 along the body surface skin, the distal end of the insertion part 11 is turned to a desired direction. <P>COPYRIGHT: (C)2011,JPO&INPIT

Description

  The present invention, through the stomach wall from the abdominal wall, to make a fistula as a passage into the stomach, insert a gastrostomy catheter into this fistula, and directly inject drugs and nutrients into the stomach, etc. The present invention relates to an indwelling state confirmation device for a gastrostomy catheter for confirming whether or not a gastrostomy catheter placed in a fistula is placed in an appropriate state.

  For example, a gastrostomy catheter is constructed for patients who cannot take drugs or nutrients orally, such as patients with dementia, patients with oral cavity, throat, etc. In recent years, a technique of directly injecting a fluid such as a medicine or a nutrient into a stomach via a hemorrhoid catheter has been widely performed. A gastrostomy catheter basically includes a catheter tube as a passage for injecting a fluid. The distal end of the catheter tube is inserted into the stomach, and the proximal end portion is outside the abdominal cavity. Is derived. In order to securely and stably place the catheter tube inside the stomach, a stopper member such as a balloon or a bumper is provided on the outer surface of the distal end of the catheter tube. This stopper member is provided on the outer surface on the distal end side of the catheter tube, and is kept in a contracted state when inserted into the fistula, and is prevented from coming off by expanding or expanding the diameter after the distal end portion of the catheter tube enters the stomach. Demonstrate the function. In addition, the proximal end of the catheter tube is located outside the body cavity, an external stopper is provided at the proximal end portion, and the proximal end is opened as an injection port. This opening is formed by a lid. Covered.

  By constructing as described above, by removing the lid of the catheter tube, it is possible to easily perform the injection operation of drugs, nutrients, etc. When the injection operation is completed, it is only necessary to attach the lid. Therefore, there is an advantage that it can be operated even at home. This gastrostomy catheter does not need to be changed for several months to half a year, and is advantageous in that it can be used over a long period of time.

  The gastrostomy catheter needs to be removed periodically or from time to time for cleaning. The gastrostomy catheter is removed and then reattached after washing, or a new gastrostomy catheter is attached after replacement, but a route by a fistula is secured for reattachment. First, a guide wire is inserted into the catheter tube, the guide wire is led out from the distal end of the catheter tube, and the catheter tube is pulled out from the guide wire with the guide wire inserted into the stomach. In order to reattach the gastrostomy catheter, a catheter tube is inserted from the end of the guide wire, the tip of the catheter tube is inserted from the fistula into the stomach, and then a stopper comprising a balloon or a bumper, etc. The member is swelled or expanded in diameter, and the guide wire is pulled out.

  Although a gastrostomy catheter is initially constructed, when the indwelling state of the gastrostomy catheter elapses for a predetermined period, the gastrostomy catheter is replaced or re-mounted after cleaning. In this way, when the gastrostomy catheter is constructed and replaced or reattached after washing, the most important thing to note when the gastrostomy catheter is mounted and in place is that The tip of the catheter tube is surely inserted into the stomach. Here, the fistula is a passage from the abdominal wall through the stomach wall to the inside of the stomach, but if the abdominal wall and the stomach wall are separated, the tip of the catheter tube may enter the space between the abdominal wall and the stomach wall . If this state is overlooked, when the fluid is injected, a situation occurs in which the fluid enters the abdominal cavity without being injected into the stomach. Further, if the entire stopper member is not completely located inside the stomach, the catheter tube may be displaced from the stomach depending on the movement of the body.

  In order to prevent the above-described situation from occurring, it is necessary to detect whether or not the catheter tube is disposed at a normal position in the indwelling state of the gastrostomy catheter. Since the gastrostomy catheter constitutes a straight passage, a small-diameter endoscope can be inserted into the catheter tube. Therefore, it is necessary to detect the indwelling state of the gastrostomy catheter in the stomach with an endoscope.

  Here, the observation visual field of the endoscope is mainly in front of the insertion portion, and when this insertion portion is inserted into the catheter tube, the observation visual field is the front in the insertion direction. However, since the portion of the catheter tube passing through the stomach wall is in the middle of the insertion direction in the insertion portion of the endoscope, when the insertion portion is led out from the distal end of the catheter tube, it is formed on the distal end or the side of the distal end. Endoscopic observation means must be directed backwards. If the insertion portion is provided with a bending portion that can be bent by hand operation, the bending portion may be operated, but if the insertion portion is provided with a bending portion, the configuration becomes complicated, In addition, since the insertion portion needs to be thinned because it is inserted into the catheter tube, a bending portion that reverses the distal end portion by 180 degrees is provided in such a thin insertion portion. Is difficult, and the endoscope becomes very expensive.

  Therefore, Patent Document 1 discloses a configuration in which the indwelling state after the construction of the gastrostomy catheter is confirmed using an endoscope in which the bending portion is not provided in the insertion portion. In Patent Document 1, a wire is connected to the distal end of an insertion portion that is flexible in the bending direction, the wire is led out of the insertion portion by a predetermined length, and is inserted into the insertion portion from an intermediate position. It is not introduced, and is configured to be led out to the outside in the vicinity of the proximal end portion of the insertion portion. Therefore, when the proximal end portion of the wire is pulled, tension is applied to the portion led out to the outside on the distal end side, and the distal end portion of the insertion portion is bent like a bow. As a result, the distal end portion of the insertion portion is inverted, and the endoscope observation means provided at the distal end of the insertion portion can accommodate the introduction portion of the catheter tube into the stomach wall in the visual field.

JP 2009-131470 A

  Incidentally, a light guide for transmitting illumination light and an image guide as optical means for transmitting an observation image are provided in the insertion portion of Patent Document 1. These light guide and image guide are Since it is composed of ultrafine optical fibers, disconnection easily occurs when an external force acts on these optical fibers. The wire for bending the distal end portion of the insertion portion is not the entire length, but partially passes through the inside of the insertion portion. Therefore, when the distal end portion of the insertion portion is bent and inverted, As a result of the tension acting on the wire, the light guide and the image guide are pressed and there is a risk of disconnection. Therefore, in order to protect the optical fiber, the wire must be configured to be inserted through a guide sleeve or the like. For this reason, the diameter of the insertion portion is increased by at least as much as the wire and its guide sleeve are mounted. Here, since the outer diameter of the insertion portion of the endoscope is restricted by the inner diameter of the catheter tube, in order to reduce the diameter so that it can be inserted into the catheter tube, the number of light guides and image guides Therefore, there is a problem that the sharpness of the in-vivo image by the endoscope observation means is lowered.

  The present invention has been made in view of the above points, and an object of the present invention is to insert an insertion portion of an endoscope into a catheter tube of a gastrostomy catheter so that the gastrostomy catheter is in an appropriate state. In confirming whether or not it is indwelled, the configuration of the insertion portion is simplified and the diameter is reduced.

  In order to achieve the above-mentioned object, the present invention is inserted into a catheter tube of a gastrostomy catheter to check the indwelling state of the gastrostomy catheter, and can be inserted into the catheter tube and bent. An endoscope provided with an illumination unit and an observation unit at the distal end of the insertion portion having flexibility in the direction, operation means operable to direct the distal end of the insertion portion in a desired direction, The magnetic attraction force acting means is configured to cause a magnetic attraction force to act between the distal end portion and the operation means, and to follow the displacement of the operation means to displace the distal end portion of the insertion portion. It is what.

  A fistula extending from the abdominal wall through the stomach wall to the inside of the stomach is formed, and the catheter tube of the gastrostomy catheter is inserted into the fistula. A stopper member such as a balloon or a bumper is provided on the outer surface of the catheter tube, and this stopper member must be completely in the stomach.

  Therefore, even after the gastrostomy catheter was constructed and indwelled, or when the indwelling gastrostomy catheter was removed, washed, and reattached, the removed gastrostomy catheter was replaced with a new one. In any case, an endoscope is used to confirm the status of the gastrostomy catheter that is in place anyway. The endoscope is used as a flexible cord, and the endoscope is provided with a flexible cord-shaped insertion portion. The length from the distal end of the insertion portion is equal to or longer than the entire length of the catheter tube. The minute is the outer diameter that can be inserted into the catheter tube. As will be described later, when the insertion portion of the endoscope is functioned as a guide member, it is desirable that the insertion portion can be inserted into the catheter tube over the entire length thereof.

  The normal indwelling state of the gastrostomy catheter is a state where the mounting portion of the stopper member at the distal end portion of the catheter tube is completely inserted into the stomach and the stopper member is also located in the stomach. Therefore, the positional relationship between the outer surface of the catheter tube and the inner wall of the stomach is detected over almost the entire circumference of the catheter tube. For this purpose, an endoscope provided with observation means consisting of an illumination part and an observation part is used at the distal end of the insertion part. However, the endoscope is inserted into the catheter tube so that the catheter tube can be smoothly taken in and out. Therefore, the outer diameter of the insertion portion is smaller than the inner diameter of the catheter tube. However, when attaching a gastrostomy catheter, in order to ensure safety, pneumoperitoneal gas may be supplied to the inside of the stomach. It is better not to increase the value.

  The insertion portion is inserted into the catheter tube and guided from the tip to the inside of the stomach. After the insertion part is led out from the catheter tube, the direction of the insertion part is changed to face the opposite direction. This allows observation between the outer surface of the catheter tube and the stomach wall. In order to curve the insertion portion so as to be reversed, a magnetic attractive force acting means is used. A magnet made of a permanent magnet or an electromagnet is used on one of the distal end portion of the insertion portion and the operating means, and a magnetic member such as iron is provided on the other. For example, a magnetic member is provided on the endoscope side and a magnet is provided on the operation means side. Since the body cavity wall is generally permeable, when the operating means is brought into contact with the body skin and brought close to the magnetic member provided in the insertion portion, the distal end portion of the insertion portion is attracted by the magnetic action of the magnet. Is done.

  By operating the operation means, the observation means provided at the distal end of the insertion portion can be displaced to an observable position at a portion between the outer surface of the catheter tube and the stomach wall. Here, an observation means is provided at the distal end of the insertion portion. The observation field of view by this observation means is a direct-view type with a view in front of the insertion portion or a direction perpendicular to the axis of the insertion portion. There is a side view type and a perspective type with a diagonal front or diagonal rear as a field of view. In the case of a direct-view type endoscope, since the distal end surface of the insertion portion needs to be directed to the site to be observed, the magnetic member is attached to the side surface portion near the distal end of the insertion portion. In the case of a side-view type endoscope, a magnetic member is provided on the distal end surface of the insertion portion. Furthermore, in the perspective type endoscope, a slope portion is provided at a position different from the slope surface provided with the observation means at the distal end portion of the insertion portion, and a magnetic member is attached to the slope portion.

  It is necessary to observe almost the entire circumference of the outer surface of the catheter tube by observation means. For this purpose, the operation means is operated so as to be moved from the outside of the body along the circumference of the catheter tube, and the distal end portion of the insertion portion on which the magnetic attractive force acts is caused to follow and move. Can do. Here, when a magnet is provided on the operating means side, the entire magnet is not provided as a magnet, but is provided in a part of the main body that is moved along the body skin. Thereby, the directivity of the insertion portion is improved. The operation means may be displaced completely independently of the indwelling gastrostomy catheter. However, since the operation by the operation means moves around the catheter tube, the operation means is related to the catheter tube. It is also possible to set the movement range according to the characteristics. For this purpose, the main body of the operating means can be configured as a ring-shaped member surrounding the periphery of the catheter tube, and a magnet can be provided on a part of the ring-shaped member. It is also possible to adopt a configuration that can move in the radial direction as well as the rotational direction. Furthermore, when using an electromagnet, it can also be comprised from the magnetic field sheet | seat which arranged the predetermined number electromagnet in the matrix form on the sheet-like member. Then, by sequentially exciting the electromagnets of the magnetic field sheet, the distal end portion of the insertion portion can be displaced in a desired direction.

  Endoscopes have a flexible cord provided with illumination means and observation means at the tip, and the illumination means is generally a light guide that transmits illumination light from the outside. It is also possible to adopt a structure in which a light emitter is provided at the tip of the light source. As the light emitter, an LED (light emitting diode), an LD (laser diode), or the like can be used, and further, a laser excitation type light emitting element or the like can be used. On the other hand, as an observation means, an image guide or a solid-state image sensor is used. When a solid-state image sensor is used, the video signal can be transmitted via a cable or wirelessly.

  The optical fiber and signal cable that make up the light guide and image guide are inserted into the insertion section, but the insertion member is the minimum necessary to reduce the diameter, and a member that moves relative to the inside of the insertion section is provided. Absent. When the illumination unit that constitutes the observation means is composed of a light emitter, the observation unit is composed of a solid-state imaging device, and a video signal from the solid-state imaging device is transmitted wirelessly, a capsule endoscope should be used. Can do. In the case of this capsule endoscope, since it is necessary to be inserted into and removed from the catheter tube, a flexible cord is connected to the casing of the capsule endoscope, and the insertion portion is the capsule endoscope. And a code.

  It is inserted into the catheter tube of the gastrostomy catheter from the distal end of the insertion portion, whether the insertion member such as an optical fiber or a signal cable is inserted into the inside or a simple cord. Therefore, the insertion portion can also exert a function as a guide wire when the gastrostomy catheter is detached. That is, the insertion portion is inserted into the catheter tube, and the distal end thereof is led out from the distal end of the catheter tube. In this state, the gastrostomy catheter can be detached from the proximal end side of the insertion portion. This ensures that the fistula is formed after the gastrostomy catheter is removed. In addition, when replacing the gastrostomy catheter or reattaching it by washing, the catheter tube of the gastrostomy catheter is inserted from the proximal end of the insertion part and pushed into the fistula to enter the stomach. To guide. Therefore, the insertion portion must have an outer diameter that is smaller than the inner diameter of the catheter tube over its entire length. After the catheter tube is inserted into the fistula, the operation means is operated and bent so that the distal end of the insertion portion functioning as a guide wire is reversed, and whether or not the catheter tube is in an appropriate detention state. Can be confirmed. And an insertion part will be set as the structure connected to a control apparatus so that attachment or detachment is possible, and the base end part of an insertion part is made to function as a connector connected to a control apparatus.

  Whether or not the gastrostomy catheter is placed in an appropriate state by inserting an insertion portion made of a flexible cord member in the endoscope into the catheter tube of the indwelling gastrostomy catheter However, since the structure of the insertion portion is simplified and the insertion member can be omitted or minimized, the insertion portion can be reduced in diameter and the insertion member can be reduced. Can be prevented from being damaged.

It is an external appearance perspective view of the gastrostomy catheter with which the indwelling state confirmation apparatus is mounted | worn. It is a front view which shows the state with which the gastrostomy catheter is mounted | worn in the regular state. 1 is a configuration explanatory diagram of an indwelling state confirmation device for a gastrostomy catheter showing an embodiment of the present invention. FIG. FIG. 4 is an external view showing a distal end portion and operation means of the endoscope of FIG. 3. It is sectional drawing which shows the state which reduced the diameter of the bumper of the gastrostomy catheter. It is sectional drawing which shows the state which has inserted the insertion part of the endoscope for confirming the indwelling state to the gastrostomy catheter, Comprising: It is a figure which shows the state immediately after the insertion part has penetrated the catheter tube. It is sectional drawing which shows the state which has inserted the insertion part of the endoscope for confirming the indwelling state to the gastrostomy catheter, Comprising: It is a figure which shows the state which the insertion part reversed the front-end | tip of a catheter tube. It is sectional drawing which shows the state which has inserted the insertion part of the endoscope for confirming the indwelling state to a gastrostomy catheter, Comprising: The insertion state to the stomach inner wall of a catheter tube by an observation means by operation of an operation means It is a figure which shows the state which is observing. It is an external view which shows the other form of an operation means. It is an external view which shows another form of an operation means. It is composition explanatory drawing which shows the further another form of an operation means. It is an external view of the front-end | tip part of the insertion part comprised as a side view type thing as another example of the endoscope used in order to confirm the indwelling state of a gastrostomy catheter. It is a schematic block diagram of the capsule endoscope as another example of an endoscope. It is structure explanatory drawing which shows the other example of the illumination part provided in the endoscope. It is an external appearance perspective view which shows the gastrostomy catheter of a different structure from FIG.

    Hereinafter, embodiments of the present invention will be described with reference to the drawings. First, FIG.1 and FIG.2 shows the whole structure of a gastrostomy catheter. This gastrostomy catheter has a bumper and is of a button type. The bumper is used as a stopper member. The stopper member is not only a bumper but also a balloon member. Further, the button type is a lid member attached to the injection port, and not only the button type but also a tube connected one can be used. The type of gastrostomy catheter to which the indwelling state confirmation device according to the present invention is attached is not limited to that shown in FIG.

  The gastrostomy catheter 1 has a catheter tube 2 having a passage for injecting a fluid such as a drug or a nutrient, and a bumper 3 is provided at the distal end of the catheter tube 2, and is a proximal end side note. A button 4 is detachably attached to the entrance 2a. The bumper 3 is composed of a bumper structure 5 connected to the distal end of the catheter tube 2, and one end portion of each of the bumper structural bodies 5 is fixed to the distal end of the catheter tube 2 or the catheter tube. 2 is formed integrally with the fixed portion, protrudes in the radial direction every 90 degrees, and is folded inward from a state protruding a predetermined amount from the outer surface of the catheter tube 2. The other end of the bumper structure 5 is fixed to an inner cylinder 6 that is slidably inserted into the catheter tube 2.

  The bumper structure 5 is brazed to the state shown in FIG. 1 in which the diameter is increased and the intermediate portion protrudes. At this time, the inner cylinder 6 is held in a state of being inserted into the catheter tube 2 by a predetermined length. Therefore, when the inner cylinder 6 is pushed in the direction of pushing out from the distal end of the catheter tube 2, the bumper structure 5 is deformed so as to be linearized, and the bumper 3 is reduced in diameter. And if the pressing force with respect to the inner cylinder 6 is cancelled | released, the bumper structure 5 will be restored | restored to a protrusion state, and will return to the original diameter expansion state. At this time, the inner cylinder 6 slides toward the proximal end of the catheter tube 2. The state in which the diameter of the bumper 3 is expanded is an operating state that functions as a stopper member. When the diameter of the bumper 3 is reduced, the bumper 3 can be inserted into and removed from the fistula.

  The button 4 is provided on a connecting strip 7 made of a flexible member extending from the catheter tube 2. Therefore, the base end portion of the catheter tube 2 is covered by folding the connecting strip 7 and fitting the button 4 to the injection port 2a. A portion of the catheter tube 2 where the injection port 2a is provided is provided with a pair of flange portions 8 and 8 protruding outward in the radial direction.

  Accordingly, the bumper 3 exhibits a stopper function on the inner side of the stomach, and the flange portion 8 functions as an external stopper that prevents the entire catheter tube 2 from entering the body. Here, as is apparent from FIG. 2, the gastrostomy catheter 1 is inserted into the fistula GP by providing a fistula GP extending from the body skin to the stomach wall SW from the abdominal wall AW to the stomach. The correct placement state of the gastrostomy catheter 1 is the state shown in FIG. However, since the abdominal cavity NA exists between the abdominal wall AW and the stomach wall SW, the gastrostomy catheter 1 enters the abdominal cavity NA, and the bumper structure 5 constituting the bumper 3 as an internal stopper member is provided. If it is located at the site of the abdominal cavity NA, it is in an incomplete indwelling state, and if a fluid such as a drug or nutrient is supplied into the catheter tube 2, it may flow into the abdominal cavity NA. Therefore, after the gastrostomy catheter 1 is constructed, it is confirmed whether or not the gastrostomy catheter 1 is placed in a normal state at the latest before injecting the medicine or nutrient.

  The apparatus for confirming the indwelling state of the gastrostomy catheter 1 includes the endoscope 10 and the operation means 20 shown in FIG. The endoscope 10 includes an insertion unit 11 and a control device 12. The insertion portion 11 is made of a cord-like member having flexibility at least in the bending direction, and preferably having flexibility, and the distal end portion is a distal end hard portion 11a. The distal end hard part 11a is provided with observation means as shown in FIG. The observation means includes an illumination unit 13 and an observation unit 14. Here, the illustrated endoscope 10 is a direct-viewing type in which an illumination part 13 and an observation part 14 are provided on the distal end surface of the distal end hard part 11a of the insertion part 11, and the front of the insertion part 11 is an observation field of view. is there.

  The illumination unit 13 is equipped with an illumination lens, and the observation unit 14 is provided with an objective lens. In addition, the light guide has an exit end facing the illumination lens, and a solid-state image sensor is mounted at the imaging position of the objective lens. The light guide is composed of a bundle of ultrafine optical fibers, as indicated by reference numeral 15 in FIG. Also, a plurality of signal cables 16 connected to the solid-state image sensor are derived. Accordingly, the light guide 15 and the signal cable 16 extend over the entire length of the insertion portion 11 inside the insertion portion 11, and the base end portion thereof is a connector portion 17. The connector portion 17 becomes a light guide bar 18 to which the light guide 15 is connected at the center position, and a predetermined number of electrodes (not shown) are provided around the light guide bar 18.

  The control device 12 includes a light source device and a video signal processing circuit. When the connector portion 17 of the insertion portion 11 is connected to the socket portion 12a of the control device 12, the light guide 15 is illuminated by the light source device. The video signal transmitted through the signal cable 16 from the solid-state imaging device provided at the distal end hard portion 11a of the insertion portion 11 through the signal cable 16 is subjected to signal processing by the video signal processing circuit of the control device 12, and is monitored. The video will be displayed on the screen.

  The operating means 20 is for moving the distal end hard portion 11a of the insertion portion 11, and is constituted by a disc-shaped main body portion 21 provided with a gripping portion 22 protruding therefrom. And the main-body part 21 is provided with the magnet 23 which consists of a permanent magnet or an electromagnet, for example. On the other hand, the distal end hard portion 11a of the insertion portion 11 of the endoscope 10 is entirely composed of a non-magnetic member such as plastic, and is composed of a magnetic member on its side surface and functions as a magnetic attractive force acting means. A plate 24 is attached. Therefore, when the magnetic plate 24 provided on the distal end hard portion 11 a of the insertion portion 11 is brought close to the operation means 20, the magnet 23 provided on the main body portion 21 is attracted.

The present embodiment is configured as described above. In constructing the gastrostomy catheter 1, a fistula GP extending from the body skin to the stomach is first drilled. Then, the catheter tube 2 of the gastrostomy catheter 1 is inserted into the fistula GP. At this time, from the viewpoint of ensuring safety, an abdominal gas such as CO ₂ gas is supplied into the stomach. Thus, it is desirable that the stomach be in an expanded state. Then, as shown in FIG. 5, the inner cylinder 6 is operated to be pushed out from the distal end within the catheter tube 2 using the inner cylinder pushing member 9. The bumper structure 5 constituting the bumper 3 is in a reduced diameter state that is stretched so as to be almost linear. In this state, the catheter tube 2 is inserted into the fistula GP. When the catheter tube 2 enters to a predetermined depth, the inner cylinder pushing member 9 is pulled out from the catheter tube 2 and the pushing force against the inner cylinder 6 is released. As a result, the four bumper structures 5 constituting the bumper 3 are restored to the curved state, and the inner cylinder 6 is retracted toward the inside of the catheter tube 2, thereby exhibiting a stopper function. .

  After constructing the gastrostomy catheter 1, it is confirmed whether or not the gastrostomy catheter 1 is placed in a normal state. In addition, after the gastrostomy catheter 1 is replaced, or after re-installation after washing or the like, the indwelling state is also confirmed. For this purpose, as shown in FIG. 6, with the button 4 removed from the injection port 2a, the insertion portion 11 of the endoscope 10 is inserted into the injection port 2a, and the distal end hard portion 11a is inserted into the catheter tube 2. The inner tube 6 is passed from the tip of the stomach and introduced into the stomach. Here, the observation means including the illumination unit 13 and the observation unit 14 provided on the distal end hard portion 11a of the insertion portion 11 is a direct-view type with its visual field facing the front of the insertion portion 11, so that the distal end is hard. It is necessary to turn the portion 11a in the direction of the catheter tube 2 of the gastrostomy catheter 1 by changing the direction. Therefore, the stomach wall SW can be used as a reversal wall.

  When the insertion portion 11 led out from the catheter tube 2 continues to be pushed into the catheter tube 2 as it is, it comes into contact with the stomach wall surface on the opposite side to the side where the catheter tube 2 is inserted. Here, the insertion portion 11 has a flexible structure except for the distal end hard portion 11a, and as a result, when it comes into contact with the stomach wall surface, the distal end hard portion 11a is inverted as shown in FIG. Become. When the distal end hard portion 11a is inverted, the magnetic plate 24 provided on the distal end hard portion 11a faces the side where the catheter tube 2 is inserted, that is, upward in the figure. Since the bending direction of the insertion portion 11 is directional, it is desirable to attach a bending ridge to the proximal end portion of the insertion portion 11 from the distal end hard portion 11a. Then, if the bending angle of the portion with the bending fold is increased, it will naturally bend in a desired direction without being brought into contact with the stomach wall surface.

  However, if the insertion portion 11 is provided with a large bending rod such as 90 degrees or more, there is a possibility that the insertion operation into the catheter tube 2 may be hindered. For this purpose, for example, as shown by reference numeral 30 in FIG. 6, a pocket is provided in the brazed portion of the insertion portion 11, and a wire for direct evolution, that is, a stylet 31 is provided inside the pocket 30. The insertion portion 11 can be straightened by the stylet 31 without being inserted. Therefore, when inserting the insertion portion 11 into the catheter tube 2, the stylet 31 is inserted into the pocket 30, and the stylet 31 is pulled out after the distal end hard portion 11 a is led out from the distal end of the catheter tube 2. Then, it will bend in the brazed direction. Since the stylet 31 is provided on the outer surface of the insertion portion 11, it does not damage the insertion member inside the insertion portion 11.

  After the insertion part 11 has entered the stomach, the operating means 20 is brought into contact with the body skin. Here, since the grip part 22 is provided in the main body part 21 of the operation means 20, the grip part 22 is gripped for operation. The main body portion 21 is provided with a magnet 23. When the magnet 23 is brought close to the magnetic plate 24 provided in the insertion portion 11, a magnetic attraction force acts on the insertion portion 11, and the operation means 20 is connected to the catheter. When approaching the tube 2, as shown in FIG. 8, the observation visual field by the observation unit 14 is directed to the boundary between the catheter tube 2 and the stomach wall SW. Here, the catheter tube 2 is provided with a bumper 3, and the bumper 3 is disposed at a lower position of a portion of the catheter tube 2 introduced into the stomach from the stomach wall SW. Since the observation site | part of the part 14 is a site | part between the bumper 3 and the stomach wall SW in the catheter tube 2, it can confirm reliably whether an indwelling state is appropriate.

  Since it is necessary to observe almost the entire circumference of the catheter tube 2, the operating means 20 is moved so as to scan around the constructed gastrostomy catheter 1. As a result, the insertion portion 11 on which the magnetic attractive force is applied follows and rotates around the catheter tube 2, so whether or not the catheter tube 2 in the gastrostomy catheter 1 is properly placed over the entire circumference. Can be confirmed. When the insertion portion 11 is rotated about the catheter tube 2, the distal end hard portion 11 a of the insertion portion 11 can be made smoother by rotating an external portion around the axis from the injection port 2 a of the insertion portion 11. Will rotate.

  When the distal end hard portion 11a of the insertion portion 11 is rotated on the outer peripheral portion of the catheter tube 2 as described above, the catheter tube 2 is placed in a normal state, and a fluid is injected into the gastrostomy catheter 1. In addition, if the gastrostomy catheter 1 is properly placed in the stomach, it is confirmed by the endoscope 10 that the gastrostomy catheter 1 is placed in a normal state. On the other hand, when it is detected that the catheter tube 2 is in an incomplete state, the catheter tube 2 is once pulled out of the fistula GP and operated to be inserted again. At this time, by holding the insertion portion 11 of the endoscope 10 inserted into the stomach, the insertion / removal operation of the catheter tube 2 with respect to the fistula GP can be performed easily and safely. . Then, after remounting, the indwelling state of the catheter tube 2 in the stomach wall SW is confirmed by the observation unit 14 of the insertion unit 11 of the endoscope 10 in the same manner as described above.

  By the way, if the gastrostomy catheter 1 is kept in use for a long period of time, the gastrostomy catheter 1 may be exchanged at an appropriate time or the entire gastrostomy catheter 1 may be washed to prevent the gastrostomy catheter 1 from becoming dirty. And reuse. That is, the existing gastrostomy catheter 1 is removed and a new gastrostomy catheter 1 is remounted. At this time, a guide wire is used in order to secure a route by the fistula GP and to guide the new gastrostomy catheter 1 into the stomach without fail, and this guide wire is used as a catheter tube in the existing gastrostomy catheter 1. Then, the gastrostomy catheter 1 is removed with the guide wire as a handle. Therefore, the insertion portion 11 of the endoscope 10 can also function as this guide wire.

  For this purpose, the insertion part 11 is inserted into the catheter tube 2. The insertion portion 11 is led out from the distal end of the catheter tube 2 and enters the stomach. On the other hand, the inner cylinder pushing member pushes the end surface of the inner cylinder 6 provided inside the catheter tube 2 and operates to push the inner cylinder 6 from the distal end of the catheter tube 2. As a result, the bumper structure 5 constituting the bumper 4 is stretched to reduce the outer diameter, thereby eliminating the function as a stopper. In this state, the catheter tube 2 into which the inner cylinder pushing member is inserted is taken out from the fistula GP. However, since the insertion part 11 has been introduced into the stomach, the fistula GP is secured.

  Here, the insertion portion 11 has a base end portion as a connector portion 17, which is connected to the socket portion 12 a of the control device 12. The insertion portion 11 is used as a guide wire. When functioning, it is not necessary to transmit illumination light, and a signal from the solid-state imaging device is not taken out. Therefore, the connector portion 17 is removed from the socket portion 12a. The gastrostomy catheter 1 taken out in this manner is operated so that the catheter tube 2 is moved to the proximal end side of the insertion portion 11 and pulled out from the connector portion 17. As a result, the existing gastrostomy catheter 1 is removed.

  Next, the catheter tube 2 of the new gastrostomy catheter 1 to be used after replacement is inserted through the insertion portion 11. At this time, the inner cylinder pushing member 9 is attached to the catheter tube 2 to keep the bumper 3 in a reduced diameter state, and the gastrostomy catheter 1 is inserted into the fistula GP with the insertion portion 11 as a guide means. It is inserted so that the catheter tube 2 advances to the depth position, that is, the inside of the stomach. Thereafter, the inner cylinder pushing member 9 is detached from the catheter tube 2 to expand the diameter of the bumper 3 to be in an operating state. As a result, a new gastrostomy catheter 1 is attached. From this state, the insertion portion 11 of the endoscope 10 inserted into the catheter tube 2 is attracted by the magnetic action of the magnet 23 of the operation means 20, and the operation means 20 is moved around the catheter tube 2. By doing so, the indwelling state of the gastrostomy catheter 1 is confirmed. Then, after it is confirmed that the gastrostomy catheter 1 is placed in an appropriate state, the gastrostomy catheter 1 can be injected with a fluid or the like by removing the insertion portion 11 from the catheter tube 2, that is, used. It becomes a state.

  In the above-described embodiment, the distal end hard portion 11a of the insertion portion 11 is controlled using the operation means 20, but the operation means 120 shown in FIG. 9 can be used instead. The operation means 120 has a main body 121 formed in a ring shape, an insertion hole 121 a is formed in the center portion, and a permanent magnet 123 is attached to a predetermined position of the main body 121. When the catheter 123 is fitted into the insertion hole 121a of the main body 121 and the magnet 123 provided in the main body 121 is operated to rotate, the distal end hard portion 11a of the insertion portion 11 of the endoscope 10 is rotated. The provided magnetic plate 24 can be attracted and rotated.

  Further, as shown in FIG. 10, an operation unit 220 can be used. This operation means 220 is provided on a C-ring-shaped main body portion 221 that is incorporated so as to surround the catheter tube 2, and a slide member 223 provided with a gripping portion 222 at the tip of the cut-out portion is provided so as to be movable in the radial direction. The slide member 223 is composed of a magnet. The insertion hole 221a formed in the main body portion 221 of the operation means 220 is assembled so as to be fitted to the catheter tube 2, the grip portion 222 is operated, and the slide member 223 is arranged at a predetermined position in the radial direction of the main body portion 221. In this state, if the slide member 223 is moved in the radial direction while the magnetic plate 24 provided on the distal end hard portion 11a of the insertion portion 11 is sucked, the distal end hard portion 11a can be moved closer to or away from the catheter tube 2. In addition, the main body 221 can be rotated around the catheter tube 2 in a state where the observation portion 14 of the distal end hard portion 11a is adjusted so as to have a predetermined interval with respect to the outer surface of the catheter tube 2.

  Here, in FIG.9 and FIG.10 which showed the form from which 1st Embodiment differs from an operation means, it was set as the structure which moves an operation means along a body surface skin by manual operation, However, FIG. As shown, the operating means 320 is controlled from a magnetic field sheet 323 made of a sheet-like member in which a plurality of magnetic field areas 323M that are magnetized independently are formed in a matrix, and a control device 312 to which the magnetic sheet 323 is connected. Can be configured. Here, the magnetic field area 323M is composed of an electromagnet, and is turned ON / OFF by a control signal from the control means 312. A through hole 326 is formed in the magnetic field sheet 323, and the catheter tube 2 is inserted into the through hole 326. Further, two adjacent sides of the magnetic field sheet 323 are provided with an X-direction electrode portion 330X and a Y-direction electrode portion 330Y, and wirings are respectively provided to the X-direction electrode portion 330X and the Y-direction electrode portion 330Y. Each wiring is bundled as a cable 331 and connected to the control means 312. Therefore, if any electrode of the X-direction electrode portion 330X and any electrode of the Y-direction electrode portion 330Y are energized based on the control signal from the control means 312, the magnetic field area 323M at the intersection point is magnetized. Will be. The desired magnetic field area 323M can be magnetized by switching the electrodes to be energized in the X direction electrode portion 330X and the Y direction electrode portion 330Y.

  Here, the control means 312 is dedicated for controlling the magnetic sheet 323 or, like the control device 12, a light source device for transmitting illumination light to the illumination unit 13 in the endoscope 10, and the observation unit 14. And a video signal processing circuit for processing a video signal of the solid-state imaging device provided in FIG. In this case, a magnetic attractive force acts on the magnetic plate 24 provided on the distal end hard portion 11 a of the insertion portion 11 by the magnetized magnetic field area 323 M in the magnetic sheet 323. Therefore, by changing the position of the magnetic field area 323M to be magnetized, the distal end portion of the insertion portion 11 can be moved in a desired direction.

  As the endoscope used for confirming the indwelling state of the gastrostomy catheter 1, in the above-described embodiment, the direct-view type endoscope 10 is used, but instead of this, as shown in FIG. It is also possible to use a side-view type endoscope 410 in which the illumination unit 413 and the observation unit 414 are provided at the distal end hard portion 411a of the insertion unit 411. When the endoscope 410 is used, the magnetic plate 424 is configured to be attached to the distal end surface of the distal end hard portion 411a.

  Furthermore, as an endoscope used for confirming the indwelling state of the gastrostomy catheter 1, a capsule endoscope 510 shown in FIG. 13 may be used. As described above, when the capsule endoscope 510 is used, the magnetic plate 524 is attached to the casing of the capsule endoscope 510. The capsule endoscope 510 is configured to be connected with a flexible cord 511. Here, the cord 511 can be composed of a simple string.

  By the way, in the endoscope 10, the insertion portion 11 must be insertable into the catheter tube 2 of the gastrostomy catheter 1. Therefore, it is necessary to reduce the diameter of the insertion portion 11. Moreover, when the insertion portion 11 also functions as a guide wire when the gastrostomy catheter 1 is replaced, the insertion portion 11 must be able to be inserted into the catheter tube 2 over the entire length. The same applies to the insertion portion 411 of the endoscope 410. When the capsule endoscope 510 is used, the capsule endoscope 510 and the cord 511 connected to the capsule endoscope 510 are the same.

  The insertion unit 11 of the endoscope 10 is provided with an illumination unit 13 and an observation unit 14. As shown in FIG. 4, the illumination unit 13 faces the emission surface of the light guide 15, the observation unit 14 is provided with a solid-state imaging device, and the signal cable 16 connected to the solid-state imaging device is connected to the insertion unit 11. It is set as the structure extended to a base end side. The observation unit 14 may be configured to include an image guide instead of the solid-state imaging device. On the other hand, an LED lamp can be used as the illumination means in the illumination unit 13.

  Further, as shown in FIG. 14, an optical fiber 40 is used, laser light is incident on the incident end of the optical fiber 40, and a phosphor conversion unit 41 is provided facing the emitting end. You can also. In the phosphor conversion unit 41, a part of the excitation light by the laser from the optical fiber 40 is converted into fluorescence light, and white light is generated by the fluorescence light and the excitation light, and the portion to be illuminated from the illumination lens 42 Is irradiated. Therefore, if the phosphor conversion unit 41 uses a laser light source that emits blue wavelength light to convert the laser excitation light into fluorescent light having a wavelength ranging from red to green, the emitted light becomes white light. If comprised in this way, power consumption will be less than the case where a lamp is used as a light source.

  The gastrostomy catheter is of the above-described button type bumper stopper type, but the other type of gastrostomy catheter is the tube type balloon stopper type of gastrostomy catheter 601 shown in FIG. You can also. In the figure, reference numeral 602 denotes a catheter tube. A balloon 603 as an internal stopper member is provided in the vicinity of the distal end of the catheter tube 602, and an external stopper is provided at a position proximal to the mounting portion of the balloon 603. 608 is mounted. A connecting portion 610 is connected to the proximal end portion of the catheter tube 602. The connecting portion 610 is provided with a nutrient solution injection port 611 coaxially with the catheter tube 602. A balloon expansion port 612 is provided. Furthermore, a chemical solution injection port 613 is provided on the side portion of the connection portion 610 from the viewpoint of simultaneously injecting a nutrient and a chemical solution. These ports 611, 612, and 613 are detachably covered with caps 611a, 612a, and 613a.

  The gastrostomy catheter 601 is mounted so that the catheter tube 602 enters the stomach, and the balloon 603 is expanded by pumping air to the balloon 603 via the balloon expansion port 612. Thus, the catheter tube 602 is held so as not to fall off the stomach. In this state, the insertion portion 11 of the endoscope 10 shown in the first embodiment described above is inserted into the stomach through the catheter tube 602 from the nutrient injection port 611, and the operation means 20 is operated. Thus, the indwelling state of the gastrostomy catheter 601 is confirmed by detecting whether or not the balloon 603 is expanded inside the stomach by the observation means provided at the distal end of the insertion portion 11.

DESCRIPTION OF SYMBOLS 1,601 Gastrostomy catheter 2,602 Catheter tube 3 Bumper 10,410,510 Endoscope 11,411,511 Insertion part 12,312 Control device 13,413 Illumination part 14,314 Observation part 20,120,220,320 Operating means 21, 121, 221, 321 Main body 23, 123, 223, magnet 24, 424, 524 Magnetic plate

Claims (11)

Inserted into the catheter tube of the gastrostomy catheter to confirm the indwelling state of the gastrostomy catheter,
An endoscope that can be inserted into the catheter tube and has an illumination part and an observation part at the distal end of the insertion part having flexibility in the bending direction;
Operating means operable to direct the tip of the insertion portion in a desired direction;
A magnetic attraction force acting means for causing a magnetic attraction force to act between the distal end portion of the insertion portion and the operation means and displacing the distal end portion of the insertion portion to follow the displacement of the operation means. An indwelling state confirmation device for a gastrostomy catheter characterized by the above. The magnetic attractive force acting means includes a permanent magnet or an electromagnet provided at one of the distal end of the insertion portion and the operating means, and the other includes a magnetic member attracted by the magnet by the magnet. The indwelling state confirmation device for a gastrostomy catheter according to claim 1, wherein: The indwelling state confirmation apparatus for a gastrostomy catheter according to claim 2, wherein the magnet is provided on the operation means side. 4. The indwelling state confirmation apparatus for a gastrostomy catheter according to claim 3, wherein the operating means has a movable range independent of the catheter tube. The operation means is composed of a ring member fitted to the catheter tube, and the ring member can be rotated about an axis around the catheter tube so that the magnet can be moved in the rotation direction. 4. The indwelling state confirmation device for a gastrostomy catheter according to claim 3, wherein the device is an indwelling configuration. 6. The indwelling state confirmation device for a gastrostomy catheter according to claim 5, wherein the ring member is configured to be able to move the magnet in a radial direction. The operating means is a sheet-like member having a planar spread around the catheter tube and forming a plurality of magnetic fields that are independently magnetized, and a plurality of electromagnets that are magnetized independently. The indwelling state confirmation device for a gastrostomy catheter according to claim 1, comprising a magnetic sheet and a control device for controlling the operation of a plurality of electromagnets constituting the magnetic sheet. 2. The indwelling state confirmation apparatus for a gastrostomy catheter according to claim 1, wherein the illuminating means comprises a light guide inserted through the insertion portion or a light emitting element provided at a distal end portion of the insertion portion. 2. The indwelling state confirmation apparatus for a gastrostomy catheter according to claim 1, wherein the observation means comprises an image guide or a solid-state imaging means inserted through the insertion portion. The indwelling state confirmation device for a gastrostomy catheter according to claim 1, wherein the insertion portion of the endoscope includes a capsule endoscope and a flexible cord connected to the capsule endoscope. The insertion portion has an outer diameter smaller than an inner diameter of the catheter tube over the entire length thereof, and a proximal end portion of the insertion portion is detachably connected to a control device. The indwelling state confirmation device for a gastrostomy catheter according to 1.

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