JP2014068764A - Obturator - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an obturator which eliminates the risk of piercing a hole in the walls of the stomach by protruding from a bumper portion and which prevents a tip part of a tube body from being bent due to insertion resistance.SOLUTION: An obturator 20 includes an obturator body 21, the tip of which is engaged with a tube body 11 from an outer peripheral surface of the tube body 11 in the state of being inserted between the tube body 11 of a button-type gastrostomy tube 10 and a bumper portion 12, which is configured to be capable of being freely attached to/detached from the tube body 11, and which is made of a resin harder than the bumper portion 12.

Description

  The present invention relates to an obturator for a button-type gastrostomy tube.

  Conventionally, for patients who cannot take food orally, a fistula (gastric fistula) that penetrates the stomach from the outside of the body is drilled in the patient, and a gastrostomy tube is inserted there to supply nutrition directly to the stomach Has been done. There are two types of gastrostomy tubes: the button type and the tube type. The button type gastrostomy tube has a merit that the tube length is fixed, but there is little protrusion from the body surface and it does not get in the way.

  Patent Document 1 describes a button-type gastrostomy tube that includes a tube main body, a bumper portion, and a body surface locking portion, and the bumper portion is movably connected to the tube main body.

  When inserting the button-type gastrostomy tube into the gastrostomy, a rod (obturator) is inserted into the tube body and brought into contact with the tip of the bumper portion. Next, the rod is further pushed in and the button-type gastrostomy tube is inserted into the gastrostomy while the bumper portion is deformed to be elongated. When the bumper part reaches the stomach, the rod is removed from the tube body. As a result, the bumper portion returns to its original shape and is locked to the inner wall of the stomach.

  However, the rod is usually made of a metal such as stainless steel, and depending on the patient, the insertion resistance of the gastrostomy tube may be large. In such a case, in the technique described in Patent Document 1, when the rod is pushed in with a large force, the rod may protrude from the bumper portion and perforate the stomach wall.

  Therefore, in Patent Document 2, a tubular body is provided at the distal end of the tube body, and the enlarged diameter portion formed near the distal end of the obturator is in contact with the tubular body so that the distal end of the obturator does not reach the bumper portion. Has been.

JP 2004-215804 A JP 2008-178473 A

  However, in the technique described in Patent Document 2, there is a case where the distal end portion of the tube body is bent due to the insertion resistance and bent before the bumper portion is deformed, making insertion difficult. This is because the distal end surface of the tube body is flat so as not to damage the stomach wall during placement, and the insertion resistance applied to the button type gastrostomy tube is large.

  The present invention has been made in view of such a background, and it is an object of the present invention to provide an obturator that does not have a risk of perforating a stomach wall by protruding a bumper portion and that does not bend a distal end portion of a tube body due to insertion resistance. To do.

  The present invention provides a flexible tube body to be inserted into a gastrostomy, and a flexible curve that extends from the distal end of the tube body toward the radially outer side toward the proximal end side of the tube body. The button-type gastrostomy tube includes a bumper portion that is engaged with the inner wall of the stomach, and a body surface engagement portion that is provided at a proximal end of the tube body and is engaged with the body surface. An obturator that is used when the tube body is inserted into the stomach, and engages with the tube body from the outer peripheral surface of the tube body with the tip inserted between the tube body and the bumper part, and An obturator body made of a resin harder than the bumper portion, which is configured to be detachable from the tube body, is provided.

  According to the present invention, the obturator body can be engaged with the tube body from the outer peripheral surface of the tube body, with the distal end thereof being inserted between the tube body and the bumper portion. Therefore, in this state, if the obturator is inserted into the gastrostoma together with the button type gastrostomy tube, the tip of the obturator body is in contact with the inner surface of the tube tip between the tube body and the bumper part. The tube is pushed in.

  As a result, the distal end portion of the tube body is reinforced by the obturator body, and the button type gastrostomy tube can be smoothly inserted into the gastrostoma without bending the distal end portion of the tube body due to the insertion resistance. Furthermore, since the obturator body is made of a hard resin, there is no possibility of protruding from the bumper portion and perforating the stomach wall.

  Further, in the present invention, the obturator body has a cylindrical shape having an inner diameter substantially the same as the outer diameter of the tube body, and an opening for detaching the tube body is formed in the axial direction over the entire length. Preferably it is.

  In this case, since the obturator main body located outside the tube main body has a cylindrical shape, the obturator can be smoothly inserted into the gastrostoma together with the button-type gastrostomy tube.

  Moreover, in this invention, it is preferable to provide the holding part fixed to the base end of the said obturator main body on the opposite side to the said opening.

  In this case, the grasping portion can be grasped, and the obturator and the button-type gastrostomy tube can be engaged and released, and these operations are facilitated.

The perspective view which shows the obturator and button type gastrostomy tube which concern on embodiment of this invention. It is sectional drawing explaining the state which inserts a button type gastrostomy tube into a gastrostoma using an obturator, and shows the state which attached the obturator to the button type gastrostomy tube. It is sectional drawing explaining the state which inserts a button type gastrostomy tube into a gastrostoma using an obturator, and shows the state in which a bumper part is passing the gastrostoma. It is sectional drawing explaining the state which inserts a button type gastrostomy tube into a gastrostoma using an obturator, and shows the state which the bumper part passed through the gastrostomy. It is sectional drawing explaining the state which inserts a button type gastrostomy tube into a gastrostoma using an obturator, and shows the state which removed the obturator after inserting a button type gastrostomy tube.

  Hereinafter, an obturator 20 used when a button type gastrostomy tube 10 according to an embodiment of the present invention is inserted will be described with reference to the drawings.

  As shown in FIG. 1, a button-type gastrostomy tube 10 (hereinafter also simply referred to as a tube 10) includes a cylindrical tube body 11 and a flexible bumper portion 12 provided at the tip of the tube body 11. And a body surface engaging portion 13 extending radially outward at the proximal end of the tube main body 11.

  The tube main body 11 and the body surface latching | locking part 13 are formed from resin, such as a polyurethane. The bumper portion 12 is made of a resin softer than the resin on which the tube main body 11 and the body surface locking portion 13 are formed, such as silicon rubber.

  The bumper portion 12 includes a continuous portion 12a provided at the tip of the tube main body 11 so as to extend radially outward, and an annular sliding portion 12b that is slidable on the outer peripheral surface of the tube main body 11. . The continuous portion 12a and the sliding portion 12b are connected by four pieces of curved portions 12c that are curved outward in the radial direction of the tube body 11 and are provided at equal intervals in the circumferential direction. In addition, the number of the curved parts 12c is arbitrary.

  A cap 14 is connected to the body surface locking portion 13. The cap 14 is provided with a protrusion 14a that is inserted into the tube main body 11 from the base end and can close the base end of the tube main body 11. And the body surface latching | locking part 13 is formed with the opening 13a in which the cap 14 is fitted. Further, the cap 14 is provided with a slip stopper 14b.

  The distal end of the tube body 11 and the bumper portion 12 may be fixed or not fixed. It is sufficient that at least the bumper portion 12 is configured not to come out from the tube main body 11.

  The obturator 20 includes an obturator body 21, a flange portion 22 formed at the proximal end of the obturator body 21, and a grip portion 23 fixed to the flange portion 22.

  The obturator body 21 has an inner diameter that is substantially the same as the outer diameter of the tube body 11, and its length is slightly shorter than the length from the tip of the tube body 11 to the joint between the tube body 11 and the body surface locking portion 13. It is formed in a cylindrical shape.

  And the opening 21a is formed in the obturator main body 21 over the full length along the axial direction, and the cross-sectional shape of the obturator main body 21 is C-shaped. The flange portion 22 is formed with a notch 22a continuous with the opening 21a in the obturator body 21 along the axial direction.

  In this manner, the outer peripheral surface of the tube body 11 is wrapped in the hollow portion in the obturator body 21 and engaged with the tube body 11. In other words, the tube main body 11 is accommodated in the obturator main body 21.

  The tube body 11 is configured to be detachable from the obturator body 21 through the opening 21a. The width of the opening 21 a is set so that the tube main body 11 and the obturator main body 21 can be easily engaged and the tube main body 11 is stably accommodated in the obturator main body 21. For example, the width of the opening 21 a is about half to three-fourths of the inner diameter of the obturator body 21.

  The opening 21a is formed so as to be narrow at the tip. This is because when the tube 10 is inserted using the obturator 20, the tube 10 is inserted without being inclined so that a substantially uniform force is applied in the circumferential direction.

  The grasping portion 23 has a shape suitable for the operator to grasp with two fingers, and is a substantially rectangular parallelepiped here. The grip part 23 is fixed to the side opposite to the notch 22a.

  The obturator 20 is made of a resin harder than the tube body 11 such as ABS (acrylonitrile, butadiene, styrene copolymer synthetic resin), high-density polyethylene, that is, rigid plastics.

  Next, a method for inserting the button-type gastrostomy tube 10 using the obturator 20 according to the embodiment of the present invention into the gastrostomy 31 will be described with reference to the drawings.

  When inserting the tube 10 into the gastrostoma 31, first, the obturator 20 is attached to the tube 10 as shown in FIG. Specifically, the surgeon supports the tube 10 with the fingers of one hand, holds the grip portion 23 with the fingers of the other hand, and moves the obturator body 21 between the tube body 11 and the bumper portion 12. The tip is inserted obliquely from above through the opening 21a. Then, the obturator body 21 is strongly pressed against the tube body 11 so that the proximal end side of the tube body 11 enters the notch 22a of the flange portion 22. Thereby, the tube main body 11 enters the obturator main body 21 through the opening 21a.

  Thus, the tube body 11 can be easily inserted into the obturator body 21 through the opening 21a by strongly pressing the obturator 20 against the tube body 11 from the opening 21a side.

  Next, the tube 10 is inserted into the gastrostoma 31 together with the obturator 20. At this time, as shown in FIG. 3, the bumper portion 12 is pushed in such that the inner surface of the connection portion with the tube main body 11 abuts on the tip of the obturator main body 21 and contacts the abdominal wall 32 or the stomach wall 33. 11 is pushed toward the proximal end side, and the sliding portion 12b moves toward the proximal end side while sliding the tube main body 11, whereby the bending portion 12c extends along the gastrostomy 31. Thereby, the tube 10 can be smoothly inserted into the gastrostoma 31.

  Further, when the tube 10 is pushed into the gastrostoma 31 together with the obturator 20 and the base end side of the bumper portion 12 protrudes from the gastrostoma 31 into the stomach as shown in FIG. 4, the bumper portion 12 is restored to its original force by its own restoring force. Return to shape. Thereby, the bumper part 12 is latched by the inner wall of the stomach.

  Thus, when the tube 10 is inserted into the gastrostoma 31 together with the obturator 20, the distal end of the obturator 20 comes into contact with the inner surface between the tube main body 11 and the bumper portion 12. And since the obturator 20 is resin, even if the obturator 20 is pushed in strongly, there is no possibility that the tip of the obturator 20 protrudes from the tube 10 and perforates the stomach wall.

  Further, it can be said that the obturator 20 reinforces (assists) the tube body 11 when pushed. In other words, the obturator main body 21 is integrated with the tube main body 11 when pushed in, and has such a strength that the tube main body 11 is not bent by the insertion resistance. There is no. Note that the tip of the obturator body 21 is preferably flat so as not to damage the bumper portion 12, but the outer peripheral surface side may be a tapered surface if importance is attached to the ease of insertion.

  Next, as shown in FIG. 5, the obturator 20 is removed from the tube 10. Specifically, the surgeon supports the tube 10 with a finger of one hand, grips the grip portion 23 with the finger of the other hand, and pulls out the obturator 20 from the tube 10. At this time, the obturator 20 can be detached from the tube 10 through the opening 21 a and easily extracted from the gastrostomy 31.

  Finally, the opening 13 a is closed by the protrusion 14 a of the cap 14. When injecting a nutrient from the tube 10 into the stomach, the cap 14 is removed and a tube or the like (not shown) for injecting the nutrient into the tube 10 is connected.

  Although the obturator 20 for the button-type gastrostomy tube 10 according to the embodiment of the present invention has been described above, the obturator according to the present invention is not limited to the described embodiment, and can be variously modified as appropriate.

  DESCRIPTION OF SYMBOLS 10 ... Button type gastrostomy tube (tube), 11 ... Tube main body, 12 ... Bumper part, 13 ... Body surface latching part, 14 ... Cap, 20 ... Obturator, 21 ... Obturator main body, 21a ... Opening, 22 ... Flange part 23 ... Grasping part, 31 ... Gastrostomy.

Claims (3)

A tube body that is flexible and is inserted into the gastrostomy, and has a bending portion that is flexible and extends from the distal end of the tube body toward the radially outer side toward the proximal end side of the tube body. The bumper portion of the button-type gastrostomy tube having a bumper portion that is locked to the inner wall of the stomach and a body surface locking portion that is provided at the proximal end of the tube body and is locked to the body surface is placed in the stomach. An obturator used when inserting,
The tip is engaged between the tube body from the outer peripheral surface of the tube body with the tip inserted between the tube body and the bumper part, and is configured to be detachable from the tube body, and is harder than the bumper part. An obturator comprising an obturator body made of resin.   The obturator body has a cylindrical shape having an inner diameter substantially the same as the outer diameter of the tube body, and an opening for detaching the tube body is formed in the axial direction over the entire length. The obturator according to claim 1.   The obturator according to claim 2, further comprising a gripping portion fixed to the base end of the obturator main body on the side opposite to the opening.

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