JP2015061548A - Guide tube for endoscope - Google Patents

Abstract

PROBLEM TO BE SOLVED: To solve the problem that, when an opening for puncture is widely provided on an outer peripheral surface of an overtube, it is preferable from a viewpoint of ensuring a path for making a puncture needle enter, however, when observing the entry of the puncture needle by an endoscope, there is a case where an inner balloon is not inflated with good visibility.SOLUTION: A guide tube for endoscope comprises: a main body tube having a tip side opening to be inserted into an esophagus between both tips of a through hole for inserting an endoscope, which obliquely intersects with a center axis of the through hole, and a puncture opening provided on a wall surface of the tip side for inserting a puncture needle; an outer balloon covering the puncture opening and provided on an outer peripheral surface of the main body tube, which is inflated to an outer peripheral direction of the main body tube; and an inner balloon provided to block the puncture opening, which is inflated toward the through hole according to the inflation of the outer balloon. An opening angle around the center axis, of the puncture opening is less than 180 degrees.

Description

  The present invention relates to an endoscope guide tube.

  In recent years, percutaneous trans-esophageal gastro-tubing (PTEG) has been actively performed. PTEG uses a non-bursting balloon to puncture the cervical esophagus to create a cervical esophageal fistula, guide an indwelling tube inserted into the esophagus from the same part, and reach its tip to the stomach, duodenum or small intestine Let As an instrument used for PTEG treatment, a guide tube with a non-rupture type balloon with an inner balloon that can effectively observe the state of the puncture needle entering the guide tube with an endoscope is known.

JP 2012-239571 A

  Increasing the puncture opening provided on the outer peripheral surface of the overtube is preferable from the viewpoint of securing a path for the puncture needle to enter, but when observing the entry of the puncture needle with an endoscope, the inner balloon is highly visible. In some cases, it did not expand.

  The guide tube for an endoscope in a specific aspect of the present invention includes a distal end side opening in which a distal end side inserted into the esophagus is oblique to the central axis of the through hole among both ends of the through hole penetrating the endoscope; A main body tube having a puncture opening that allows a puncture needle to pass through, provided on the wall surface on the distal end side, an outer balloon that is provided on the outer peripheral surface of the main body tube so as to cover the puncture opening and is inflated in the outer peripheral direction of the main body tube; The puncture opening includes an inner balloon provided to close the puncture opening and inflated toward the through hole in accordance with the expansion of the outer balloon, and the puncture opening has an opening angle of less than 180 degrees around the central axis.

  It should be noted that the above summary of the invention does not enumerate all the necessary features of the present invention. In addition, a sub-combination of these feature groups can also be an invention.

It is a schematic diagram which shows the usage example of the guide tube which concerns on this embodiment. It is an expansion perspective view of the front-end | tip part of a guide tube. It is the front end side view and orthogonal cross-sectional view of a guide tube. It is an orthogonal sectional view at the time of balloon inflation. It is a figure explaining the relationship between the front end side opening of a guide tube, and a puncture opening. It is a figure explaining the variation of the guide tube which provided the some puncture opening. It is side sectional drawing of the front-end | tip part of the guide tube in another Example. It is side sectional drawing of the front-end | tip part in other Example. It is side sectional drawing of a part of outer balloon. It is side sectional drawing explaining the variation of the hanging part of an outer balloon. It is a side sectional view explaining other variations of an outer balloon.

  Hereinafter, the present invention will be described through embodiments of the invention, but the following embodiments do not limit the invention according to the claims. In addition, not all the combinations of features described in the embodiments are essential for the solving means of the invention.

  FIG. 1 is a schematic diagram illustrating a usage example of the guide tube 100 according to the present embodiment. The guide tube 100 is an endoscope insertion type soft tube used for PTEG treatment. The figure shows a scene of PTEG treatment in which a non-ruptured outer balloon 120 provided at the distal end of the guide tube 100 is inflated in the subject's esophagus 902 and the puncture needle 700 punctures the outer balloon 120. Indicates. The subject is turning his head to the right.

  The guide tube 100 is configured by attaching an outer balloon 120 or the like that can be inflated and deflated to a main body tube 110 having a through-hole through which the endoscope 600 is inserted. It is desirable that the main body tube 110 has a thin outer diameter as much as possible while ensuring an inner diameter into which the endoscope 600 to be used can be inserted. That is, the flexibility which can be led into the body without causing pain to the subject is required. On the other hand, the rigidity which prevents a through-hole being obstruct | occluded by bending is also requested | required. From such a viewpoint, a synthetic resin such as a soft vinyl chloride resin, a polyurethane resin, or a silicone rubber having moderate flexibility and elasticity at normal room temperature and body temperature can be used as the material of the main body tube 110.

  The through hole of the main body tube 110 penetrates from the proximal end side opening 111 located on the outer side of the body to the distal end side opening 112 located on the inner side of the body tube in use. The front end side opening 112 is cut so as to be oblique with respect to the central axis of the through hole, thereby forming an elliptical shape. The outer peripheral surface of the main tube 110 or the inner wall surface of the through hole is preferably subjected to a lubrication treatment. For example, a coating of collagen, polyvinyl pyrrolidone, polyacrylamide or the like and kneading of silicone oil are practical.

  The main body tube 110 contains a balloon lumen 190 through which a fluid for inflating the outer balloon 120 and the like flows. Although specifically described later, the balloon lumen 190 is a thin tube provided in the main body tube independently of the through hole. The balloon lumen 190 branches off from the main body tube 110 in the vicinity of the proximal end side opening 111 and has a connector 191 at its end. The fluid is supplied from the outside via the connector 191 and collected. The fluid is not limited to a gas such as air but may be a liquid such as physiological saline.

  Here, PTEG treatment using the guide tube 100 according to the present embodiment will be briefly described. PTEG is a series of procedures for constructing an esophageal fistula in the neck, but the PTEG in this embodiment is a point in which the main tube 110 is orally inserted and the esophagus 902 is observed by the endoscope 600. Features. Bleeding from the nasal mucosa can be prevented as compared with the conventional technique of passing through the body tube nasally. In addition, since the diameter of the through hole can be secured large, the endoscope 600 can be inserted, and therefore the state in the esophagus from puncture to catheter placement can be observed. As a result, the safety and certainty of the procedure are greatly improved and the procedure time is shortened, so that the burden on the subject is reduced.

  With the endoscope 600 inserted through the through hole of the main body tube 110 to the vicinity of the outer balloon 120, the distal end side opening 112 of the main body tube 110 is advanced into the oral cavity 901 of the subject. At this time, the surgeon smoothly pushes in the main body tube 110 while reducing the discomfort of the subject by causing the elliptical plane of the distal end side opening 112 cut obliquely to enter the palate 903 side. be able to.

  When pushed further in, the distal end side opening 112 reaches the esophagus 902 near the neck, which is the target position, via the esophageal entrance part 9021. When the target position is reached, the operator injects fluid from the connector 191 to inflate the outer balloon 120 and strongly press the ultrasonic probe from the body surface side to bias the thyroid gland, trachea, carotid artery, jugular vein, etc. left and right. By locating, the puncture route from the epidermis to the esophagus is secured. Then, when the puncture needle 700 is inserted along the puncture route, the puncture needle 700 penetrates the outer balloon 120 and the tip thereof reaches the through hole of the main body tube 110. As will be described in detail later, the surgeon can confirm from the image of the endoscope 600 that the tip of the puncture needle 700 that has penetrated the outer balloon 120 reaches the through hole.

  When the operator confirms that the puncture needle 700 has reached the through-hole, the operator inserts the guide wire 800 into the lumen of the puncture needle 700. Then, when it is confirmed from the image of the endoscope 600 that the guide wire 800 has reached the through hole of the main body tube 110, the puncture needle 700 is removed.

  When the main body tube 110 is pushed into the stomach in this state, the guide wire 800 restrained by the puncture route is pulled away from the outer balloon, and the distal end portion thereof is retained in the esophagus 902. When the guide wire 800 is detached from the outer balloon 120, the operator sucks and collects the fluid, contracts the outer balloon 120, and pulls the endoscope 600 and the main body tube 110 back to the vicinity of the esophageal entrance portion 9021.

  While confirming the state in the esophagus 902 from the image of the endoscope 600, the operator inserts a dilator with a sheath from the end of the guide wire 800 from the neck epidermis side to expand the puncture site. Then, by removing the guide wire 800 and the dilator leaving the sheath, a cervical esophageal fistula leading to the esophagus is constructed. When the cervical esophageal fistula is constructed, the entire guide tube 100 together with the endoscope 600 is pulled out from the oral cavity 901. Thereafter, an indwelling tube is inserted from the cervical esophageal fistula, and the distal end thereof reaches the target stomach, duodenum or small intestine to complete a series of treatments.

  Next, the distal end portion of the guide tube 100 according to the present embodiment will be described. FIG. 2 is an enlarged perspective view of the distal end portion of the guide tube 100. In particular, the outer balloon 120 and the inner balloon 130 are shown inflated. In the figure, the main elements that are not directly observed from the appearance are shown by dotted lines, but from the viewpoint of simplifying the figure, the thickness of each element is omitted.

  As described above, the distal end of the main body tube 110 has the distal end side opening 112 that is oblique to the central axis of the through hole of the main body tube 110. An outer balloon 120 is provided on the base end side of several tens mm from the distal end side opening 112 so as to cover the outer peripheral surface of the main body tube 110. As will be described in detail later, the peripheral edge of the outer balloon 120 is hermetically bonded to the outer peripheral surface of the main body tube 110.

  A part of the outer peripheral surface of the main body tube 110 covered with the outer balloon 120 is cut into an elliptical shape, and a puncture opening 113 for guiding the puncture needle 700 to the through hole is formed. The puncture opening 113 is closed by the inner balloon 130 from the outer peripheral surface side of the main body tube 110. That is, the inner balloon 130 seals the puncture opening 113 from the outer peripheral surface side, and the outer balloon 120 covers the entire outer peripheral surface so as to wrap the inner balloon 130. The outer balloon 120, the outer peripheral surface covered with the outer balloon 120, and the space surrounded by the inner balloon 130 are formed as an airtight space. The inner balloon 130 may be configured to cover the puncture opening 113 from the inner wall surface side (through hole side) of the main body tube 110. In this case, a space surrounded by the outer balloon 120 and the inner balloon 130 across the puncture opening 113 is formed as an airtight space.

  The balloon lumen 190 is provided as a thin tube in the tube wall of the main body tube 110 and extends from the proximal end side to the puncture opening 113. At the end of the balloon lumen 190, the tube wall is partially cut off from the outer peripheral surface side, and communicates with the outer peripheral surface side. The inner balloon 130 is also provided with a hole at the communication point. Therefore, the balloon lumen 190 communicates with an airtight space surrounded by the outer balloon 120 and the inner balloon 130.

  The outer balloon 120 has, for example, a length along the central axis of 30 to 100 mm and an outer diameter when expanded of about 30 mm. The outer balloon 120 is a non-rupture type balloon that does not rupture even when penetrated by the puncture needle 700. As a material therefor, a synthetic resin satisfying hardness JISA 20 to 80 degrees, tensile strength 8 to 25 MPa, tear strength 20 to 60 kg / cm, 100% modulus 3 to 6 MPa, elongation 300 to 460%, balloon internal pressure 2.8 to 75 psi. Can be selected. For example, soft vinyl chloride resin, polyurethane resin, and silicone rubber can be suitably selected. In addition, polyethylene, polyester, natural rubber latex, and the like can be candidates as long as they are devised so as not to burst even by puncture. When these materials are employed, for example, bursting can be avoided by coating the surface with a synthetic resin or adjusting the expansion rate, thickness, and internal pressure. The outer balloon 120 is formed into a desired shape by blow molding, dip molding, extrusion molding, compression molding, or the like.

  For the inner balloon 130, a sheet material covering the puncture opening 113 can be used. The material of the inner balloon 130 may be the same as that of the outer balloon 120, or a material that is easier to expand than the outer balloon 120 may be employed. In particular, from the viewpoint of confirming the entry of the puncture needle 700 with the endoscope 600, a transparent material is preferable. A specific shape will be described later.

  When fluid is injected into the airtight space surrounded by the outer balloon 120 and the inner balloon 130 via the balloon lumen 190, the outer balloon 120 is directed toward the outer periphery of the body tube 110 and the inner balloon 130 is directed toward the through-hole, as shown in the figure. Expand together. Conversely, when the injected fluid is discharged through the balloon lumen 190, the expanded outer balloon 120 and the inner balloon 130 are both deflated.

  When the puncture needle 700 is inserted through the inner balloon 130 to reach the through hole, the tip of the puncture needle 700 cannot be retained in the through hole, and the inner wall surface facing the puncture opening 113 may be pierced. Furthermore, it may break through the main body tube 110 and penetrate the outer balloon 120 as well. In this case, the subject's esophagus is damaged. In order to prevent such a situation, the guide tube 100 includes a reinforcing sheet 140 as a reinforcing portion that reinforces the main body tube 110 at a position facing the puncture opening 113 with the central axis of the through hole interposed therebetween.

  The reinforcing sheet 140 is, for example, a stainless steel mesh sheet disposed along the inner wall surface of the main body tube 110. The puncture needle 700 cannot penetrate the reinforcing sheet 140 at a normal insertion pressure in the procedure. The material of the reinforcing sheet 140 is not limited to a metal material such as stainless steel, and may be a synthetic resin such as a hard vinyl chloride resin, a polycarbonate resin, or an ABS resin as long as it has rigidity sufficient to prevent the puncture needle 700 from penetrating. good. Moreover, it is good not only as arrange | positioning as a reinforcement sheet | seat, but the said location of the main body tube 110 is hardened, and it is good also as a reinforcement part.

  FIG. 3 is a side view orthogonal to the distal end side view of the guide tube 100. The figure on the left side is a side view observed from a direction orthogonal to the central axis of the main body tube 110. In particular, it is a side view observed so that the first major axis end 1121, which is the point located on the most distal end side, of the distal end side opening 112 having an elliptical opening surface is directly above. At this time, the second long diameter end 1122 which is the point located closest to the base end side is directly below.

  The drawing on the right side is a cross-sectional view taken along a plane orthogonal to the central axis at a position where the outer balloon 120 reaches its maximum diameter when inflated. However, the figure shows a state during contraction. Also, it is drawn corresponding to the vertical relationship of the left side view.

  An opening center 1130 of the puncture opening 113 formed in the main body tube 110 is disposed on a ridge line passing through the first major diameter end 1121 in the distal end side opening 112. That is, the opening center 1130 exists on a straight line extending rightward from the first long-diameter end 1121 in the left side view, and is located at the highest point of the main body tube 110 in the right sectional view.

  In this manner, by arranging the opening center 1130 on the ridge line passing through the first long-diameter end 1121, the relative positional relationship between the entry direction of the puncture needle 700 and the puncture opening 113 can be satisfactorily determined. That is, as described with reference to FIG. 1, the distal end side opening 112 cut obliquely is entered into the esophagus with its elliptical opening surface facing the palate 903, and therefore the first major axis in the esophagus The end 1121 is located on the ventral side, and the second long diameter end 1122 is located on the dorsal side. Then, the opening center 1130 of the puncture opening 113 is located on the ventral side. In PTEG treatment, the puncture position of the neck is generally on the ventral side. Therefore, when the puncture opening 113 is disposed toward the ventral side, the puncture needle 700 faces the entry direction of the puncture needle 700, so that the operation is easy for the operator.

  The puncture opening 113 has an opening angle around the central axis of θ. As shown, θ is less than 180 degrees. When θ is 180 degrees or more, the inner balloon 130 covers the puncture opening 113 from the through-hole side inside the main body tube 110, and therefore occupies more than half of the through-hole when inflated. Then, depending on the endoscope 600 to be observed from the central axis direction, the entry path of the puncture needle 700 may be difficult to observe. Furthermore, the space for retaining the tip of the puncture needle 700 that has penetrated the inner balloon 130 and the space for pulling out the tip of the guide wire 800 are relatively small.

  Further, when θ is 180 degrees or more, there are portions where two points facing each other across the central axis are both openings. Then, the puncture needle 700 that has entered from one side may pass through the inside without breaking through the inner balloon 130 and may penetrate through to the other. In this case, if the puncture needle 700 further penetrates the outer balloon 120, the subject's esophagus will be damaged.

  Therefore, θ is preferably less than 180 degrees. In particular, it was found that θ is preferably less than 120 degrees in view of the visibility of the inner balloon 130 with respect to inflation.

  On the other hand, if θ is too small, it is difficult for the operator to guide the puncture needle 700 to the puncture opening 113. That is, if θ is a certain size, it is easy to guide the tip of puncture needle 700 to the through hole. From this point of view, it was found that if θ is 90 degrees or more, puncture is sufficiently easy.

  The end portion of the balloon lumen 190 may be disposed anywhere as long as it communicates with the airtight space surrounded by the outer balloon 120 and the inner balloon 130. However, as shown in FIG. It is preferable to arrange them on the opposite side across. By arranging as shown in the drawing, the balloon lumen 190 does not blur the contrast line for X-ray confirmation along the ridge line direction passing through the first major axis end 1121. Further, in this embodiment, an integrated structure in which the balloon lumen 190 is provided as a thin tube in the tube wall of the main body tube 110 is employed, but a configuration in which the balloon lumen 190 is inserted into the through hole of the main body tube 110 as a separate tube is employed. May be.

  As described above, the guide tube 100 according to the present embodiment includes the reinforcing sheet 140 at a position facing the puncture opening 113 with the central axis of the through hole interposed therebetween. As shown in the figure, the reinforcing sheet 140 is attached by bonding along the inner wall surface of the main body tube 110. The reinforcing sheet 140 is preferably set to a size having a central angle slightly larger than θ so that the puncture needle 700 that has passed through the puncture opening 113 can reach the opening angle θ of the puncture opening 113. .

  The inner balloon 130 is hermetically bonded to the outer peripheral surface of the main body tube 110 so as to close the puncture opening 113. The inner balloon 130 does not have to be in the form of a sheet. In the present embodiment, as shown in the figure, the inner balloon 130 is formed in a cylindrical shape that is in close contact with the outer peripheral surface of the body tube 110. Since the inner balloon 130 formed in a cylindrical shape is an elastic material, it has a biasing force that biases the outer peripheral surface of the main body tube 110 in the direction of the through hole.

  Next, a case where the outer balloon 120 and the inner balloon 130 are inflated will be described. FIG. 4 is an orthogonal cross-sectional view taken along a plane orthogonal to the central axis when the outer balloon 120 and the inner balloon 130 are inflated.

  When a fluid such as physiological saline is injected into an airtight space surrounded by the outer balloon 120 and the inner balloon 130, the outer balloon 120 expands in the outer peripheral direction to expand the esophagus, and the inner balloon 130 expands in the direction of the through hole. Then, the guidance of the puncture needle 700 is visualized. The puncture needle 700 first penetrates the outer balloon 120 and enters an airtight space filled with fluid. Since the outer balloon 120 is a non-rupture type balloon, it does not rupture with respect to the penetration of the puncture needle 700. When the distal end of the puncture needle 700 passes through the puncture opening 113, the operator can confirm the state with the endoscope 600 through the inner balloon 130 which is a transparent material.

  When the surgeon visually recognizes that the puncture needle 700 has passed through the puncture opening 113 and has reached the inside of the inner balloon 130, the surgeon further pushes it to penetrate the inner balloon 130, and the tip of the puncture needle 700 reaches the through hole of the main body tube 110. Proceed. In addition, since the reinforcing sheet 140 is installed at the tip in the entry direction, there is no possibility that the puncture needle 700 breaks through the main body tube 110.

  Subsequently, the guide wire 800 is inserted into the lumen of the puncture needle 700, and the tip thereof is protruded from the tip of the puncture needle 700. The reinforcing sheet 140 also protects the main body tube 110 against the guide wire 800. In addition, it is preferable that the front end of the guide wire 800 is brazed so as to be curved after protruding from the front end of the puncture needle 700, as illustrated. Since the curved tip is easily hooked on the inner balloon 130, the possibility that the guide wire 800 is pulled out together with the puncture needle 700 is reduced, and it can be expected to stay in the through hole.

  Next, variations of the opening center 1130 will be described. FIG. 5 is a diagram for explaining the relationship between the distal end side opening 112 and the puncture opening 113 of the guide tube 100 having an opening center 1130 different from the above example. 5 (a) and 5 (b) are respectively represented by a tip side view and an orthogonal sectional view, and these correspond to the viewpoints of the tip side view and the orthogonal sectional view of FIG.

  FIG. 5A shows that the opening center 1130 is rotated by α degrees (α <180 degrees) clockwise with respect to the central axis from the highest point corresponding to the first major axis end 1121 in the orthogonal sectional view. The guide tube 100 is shown. In other words, when the main body tube 110 is observed from the distal end side, the opening center 1130 is the first proximal end positioned clockwise from the first major axis end 1121 positioned closest to the distal end of the distal end opening 112. It is arrange | positioned on the ridgeline which passes through the point between 2 long diameter ends 1122.

  In the majority of subjects, the puncture position of the puncture needle 700 is selected slightly to the left with respect to the spine from the positional relationship of the thyroid gland, trachea, carotid artery, jugular vein, etc. in the neck. Therefore, for a large number of subjects, it is easier for the operator to puncture the puncture needle 700 when the opening center 1130 exists at a position shifted clockwise as described above. For a larger number of subjects, α is preferably less than 90 degrees. Further, it is preferable that the installation position of the reinforcing sheet 140 is appropriately corrected so as to face the offset opening center 1130 as illustrated.

  In the example of the figure, the balloon lumen 190 is disposed on the opposite side across the opening center 1130 and the central axis, but may be disposed on a ridge line passing through the second major axis end 1122. In particular, if it is arranged on the tube wall protected by the reinforcing sheet 140, the risk of being damaged by the puncture needle 700 is reduced.

  FIG. 5B shows the position where the opening center 1130 is rotated by β degrees (α <180 degrees) counterclockwise from the uppermost point corresponding to the first major axis end 1121 in the orthogonal sectional view. The guide tube 100 arrange | positioned is shown. In other words, the opening center 1130 is located on the most proximal side in the counterclockwise direction from the first long diameter end 1121 located on the most distal side of the distal side opening 112 when the main body tube 110 is observed from the distal side. It arrange | positions on the ridgeline which passes along the point in the middle until it reaches the 2nd long diameter end 1122.

  As described above, the majority of the subjects are selected such that the puncture position of the puncture needle 700 is slightly leftward with respect to the spine. However, some subjects are selected slightly rightward with respect to the spine. The However, if only the left-side guide tube 100 is prepared, it is difficult to perform a procedure for some of these subjects. Therefore, it is preferable to prepare the guide tube 100 in which the opening center 1130 exists at a position shifted counterclockwise as described above. In this case, in order to deal with as many subjects as possible among some subjects, β is preferably less than 90 degrees.

  As described above, when the position of the puncture opening 113 is changed in accordance with the characteristics of the subject, it is preferable to prepare a plurality of types of guide tubes 100. However, preparing a plurality of types of guide tubes 100 may involve various difficulties. Therefore, the guide tube 100 provided with a plurality of puncture openings 113 will be described.

  FIG. 6 is a diagram illustrating a variation of the guide tube 100 provided with a plurality of puncture openings 113. Note that FIG. 6 is also represented by a front end side view and an orthogonal sectional view, as in FIG. 5, and these correspond to the viewpoints of the front end side view and the orthogonal sectional view of FIG. 3.

  FIG. 6A shows an example in which two puncture openings 113 are provided as a puncture opening 113, a first puncture opening 1131 and a second puncture opening 1132. The center of the opening of the first puncture opening 1131 is deviated clockwise from the highest point corresponding to the first major axis end 1121 in the orthogonal sectional view. The center of the second puncture opening 1132 is deviated counterclockwise from the uppermost point corresponding to the first major axis end 1121 in the orthogonal sectional view. As described above, the guide tube 100 having the puncture opening 113 displaced to the opposite side can correspond to many subjects. In addition, when providing a some puncture opening, not only two but three or more may be sufficient. Moreover, you may provide many puncture openings in mesh shape.

  Here, if the puncture opening 113 exists at a position facing each other, even if the puncture needle 700 that has entered from one of the puncture openings 113 breaks through the inner balloon 130 and reaches the through-hole once, the puncture opening 113 faces the penetration direction. There is a case where the inner balloon 130 of the puncture opening 113 exists and penetrates therethrough. Further, when the puncture needle 700 penetrates the outer balloon 120, the esophagus of the subject is injured. Therefore, when providing a plurality of puncture openings 113 in the main body tube 110, the puncture openings 113 should be arranged so as not to face each other across the central axis in the through hole of the main body tube 110.

  Moreover, when providing the some puncture opening 113, it is preferable that each opening center is unevenly distributed to the uppermost point side corresponding to the 1st long diameter end 1121 rather than the horizontal line in an orthogonal cross section. By providing in such a position, the operator can easily puncture the puncture needle 700 with respect to a larger number of subjects.

  As shown in FIG. 6A, in this embodiment, a configuration is adopted in which a sheet-like inner balloon 230 is bonded from the inner wall surface side of the main body tube 110 instead of the cylindrical inner balloon 130. The sheet-like inner balloon 230 is bonded to the inner wall of the main body tube 110 so as to close both the first puncture opening 1131 and the second puncture opening 1132. The inner balloon 230 mounted in this way includes a first inner balloon 2301 that expands corresponding to the first puncture opening 1131 and a second inner balloon 2302 that expands corresponding to the second puncture opening 1132. Each puncture opening 113 may be closed with an independent sheet to form an inner balloon, or the puncture opening 113 may be closed with a cylindrical inner balloon 130.

  Further, as shown in the figure, the guide tube 100 includes a first reinforcing sheet 2401 at a position facing the first puncture opening 1131 with the central axis of the through hole interposed therebetween, and the guide tube 100 has a through hole with respect to the second puncture opening 1132. A second reinforcing sheet 2402 is provided at an opposing position across the central axis. These reinforcing sheets 240 have a function of preventing the puncture needle 700 from penetrating in the same manner as the above-described reinforcing sheet 140.

  FIG. 6B shows an example in which partial outer balloons 220 are provided corresponding to a plurality of inner balloons 230. The first puncture opening 1131 and the second puncture opening 1132 are provided as the puncture openings 113, and the first inner balloon 2301 and the second inner balloon 2302 are provided corresponding to these, as shown in FIG. It is the same. However, the balloon lumen 190 is arranged so that the outer balloon 220, the outer peripheral surface covered with the outer balloon 220, and the space surrounded by the inner balloon 230 communicate with the airtight space. In the illustrated example, the end of the balloon lumen 190 communicates toward the first puncture opening 1131.

  When the outer balloon 220 is partially formed in this way, pressure can be applied in a specific direction of the esophagus, which may make it easier to secure a puncture route. In addition, since the expansion rate can be increased with respect to a specific direction, the puncture needle 700 can be punctured easily.

  As described with reference to FIG. 1, in PTEG treatment, the guide wire 800 is inserted through the lumen of the puncture needle 700 to reach the through hole of the main body tube 110, and then the puncture needle 700 is removed. Since the guide wire 800 is pinched by the puncture route, when the surgeon pushes the guide tube 100 to the stomach side or rotates it around the central axis, the distal end portion of the guide wire 800 comes out of the outer balloon 120 and becomes the esophagus 902. Kept in. However, since the guide tube 100 is inserted into the esophagus 902 while being curved, the guide tube 100 has a large resistance to pushing movement and rotational movement. In addition, it may be uncomfortable for the subject to push the entire guide tube 100. Therefore, another embodiment in which the guide wire 800 is pulled out with almost no movement of the main body tube 110 will be described next.

FIG. 7 is a side sectional view of the distal end portion of the guide tube 100 in another embodiment. The guide tube 100 according to the present embodiment includes an extension tube 310 provided on the distal end side of the main body tube 210 so as to be rotatable relative to the main body tube 210.
The main body tube 210 has a through hole through which the endoscope 600 is inserted in the same manner as the main body tube 110 described above. The main body tube 210 is formed of a synthetic resin such as a soft vinyl chloride resin, polyurethane resin, or silicone rubber having moderate flexibility and elasticity at normal room temperature and body temperature. The main body tube 210 is provided with an outer flange 211 having a groove on the entire inner circumference side at the distal end side opening.

  The extension tube 310 includes an inner flange 311 having a protruding portion that protrudes toward the outer peripheral side and the inner peripheral side at the connection portion with the main body tube 210. The extension tube 310 can rotate relative to the main body tube 210 by loosely fitting the groove portion of the outer flange 211 and the raised portion of the inner flange 311. The extension tube 310 may be made of the same material as that of the main body tube 210, but it is preferable that a hard material is used for the inner flange 311 and its vicinity by two-color molding or the like.

  Similarly, the main body tube 210 is preferably made of a hard material for the outer flange 211 and the vicinity thereof. According to the main body tube 210 and the extension tube 310 configured as described above, the operator presses the endoscope 600 by pressing the distal end of the endoscope 600 against a protruding portion that protrudes toward the inner peripheral side of the inner flange 311, for example. If rotated, the extension tube 310 can be rotated. At this time, the body tube 210 does not rotate within the esophagus 902 of the subject.

  The distal end of the extension tube 310 has a distal end side opening 312 that obliquely intersects with the central axis of the through hole of the extension tube 310, similarly to the distal end of the main body tube 110 described above. An outer balloon 120 is provided on the base end side of several tens of mm from the distal end side opening 312 so as to cover the outer peripheral surface of the extension tube 310.

  A puncture opening 313 is formed on the outer peripheral surface of the extension tube 310 covered with the outer balloon 120. In this embodiment, the puncture opening 313 is airtightly closed by the inner balloon 130 from the inner wall surface side (through hole side) of the extension tube 310. That is, a space surrounded by the outer balloon 120 and the inner balloon 130 with the puncture opening 313 interposed therebetween is formed as an airtight space.

  The balloon lumen 390 in the present embodiment is inserted into the main body tube 210 as a tube separate from the main body tube 210 and extends from the proximal end side to the puncture opening 313 of the extension tube 310. The end of the balloon lumen 390 is inserted between the inner wall surface of the extension tube 310 and the inner balloon 130 and communicates with an airtight space surrounded by the outer balloon 120 and the inner balloon 130. The balloon lumen 390 has a slack according to the assumed amount of rotation of the extension tube 310 in the vicinity of the outer flange 211 and the inner flange 311 that are loosely fitted to each other. In the slack portion, neither the inner wall of the main body tube 210 nor the inner wall of the extension tube 310 is bonded. By giving slack to the balloon lumen 390 in this way, communication between the balloon lumen 390 and the airtight space can be maintained even when the extension tube 310 is rotated. Note that the surgeon may sandwich the balloon lumen 390, which is an elastic member, when pressing the endoscope 600 against the raised portion. Further, the balloon lumen 390 may be configured to communicate with the airtight space from the reinforcing sheet 140 side.

  When the extension tube 310 is rotated, the portion of the guide wire 800 that has entered the through hole is constrained by the portion inserted through the puncture path, so that the tip portion that has entered the through hole is being dragged by rotational movement. Soon, it will be detached from the outer balloon 120. The distal end portion of the pulled guide wire 800 is sandwiched between the esophageal wall 9022 and the outer balloon 120 (illustrated by a dotted line). When the balloon is deflated and the guide tube 100 is pulled out, the distal end portion of the guide wire 800 can be retained in the esophagus 902.

  FIG. 8 is a side sectional view of the distal end portion of the guide tube 100 in still another embodiment. In the guide tube 100 according to the present embodiment, a portion of the distal end portion of the main body tube 110 that is covered with the outer balloon 120 is formed by a hard reinforcing cylinder 115. A hard rotating cylinder 410 is attached in a nested manner on the outer peripheral side of the reinforcing cylinder 115.

  Specifically, a guide slit 116 is provided in the reinforcing cylinder 115 so as to be orthogonal to the central axis of the through hole. The rotating cylinder 410 is provided with a locking claw 415 that is inserted into the guide slit 116 and serves as a guide pin. Since the locking claw 415 is inserted into the guide slit 116 by snap fitting, once it is inserted, it will not easily come out of the guide slit 116. However, since the guide slit 116 is a slit orthogonal to the central axis of the through hole, the locking claw 415 can move along the slit. That is, the rotating cylinder 410 can rotate relative to the reinforcing cylinder 115 within a range corresponding to the length of the guide slit 116.

  The reinforcing cylinder 115 has a puncture opening 113 as a puncture opening on the main body tube 110 side. In this embodiment, the puncture opening 113 is airtightly closed by the inner balloon 130 from the inner wall surface side (through hole side) of the reinforcing cylinder 115. The rotary cylinder 410 has a puncture opening 413 as a puncture opening on the rotary cylinder 410 side. The outer balloon 120 is provided on the outer peripheral surface side of the rotary cylinder 410 so as to cover the puncture opening 413. The puncture opening 113 and the puncture opening 413 are provided so that the openings coincide with each other at the initial position. Therefore, a space surrounded by the outer balloon 120 and the inner balloon 130 with the puncture opening 113 and the puncture opening 413 interposed therebetween is formed as an airtight space.

  The balloon lumen 490 in the present embodiment is inserted into the main body tube 110 as a separate tube from the main body tube 110 and extends from the proximal end side to the puncture opening 113 of the reinforcing cylinder 115. The end of the balloon lumen 490 is inserted between the inner wall surface of the reinforcing cylinder 115 and the inner balloon 130 and communicates with an airtight space surrounded by the outer balloon 120 and the inner balloon 130.

  In this embodiment, the balloon lumen 490 also functions as a guide path for guiding the operation wire 500 that rotates the rotating cylinder 410, in addition to the flow path for flowing the fluid that expands and contracts the balloon. The distal end of the operation wire 500 introduced into the balloon lumen 490 from the proximal end side is pulled out on the distal end side, passes through the puncture opening 113 and the puncture opening 413, and the outer peripheral surface of the rotating cylinder 410 is spirally wound about a half circumference. It is fixed at a fixed point 501. When the operation wire 500 wound and fixed in this manner is pulled from the proximal end side, the operator can rotate the rotating cylinder 410 with respect to the reinforcing cylinder 115.

  When the rotary cylinder 410 is rotated, the guide wire 800 that has entered the through hole is constrained at the portion inserted through the puncture path, so that the tip portion that has entered the through hole is being dragged by the rotational movement. Soon, it will be detached from the outer balloon 120. The distal end portion of the pulled guide wire 800 is sandwiched between the esophageal wall 9022 and the outer balloon 120 (illustrated by a dotted line). When the balloon is deflated and the guide tube 100 is pulled out, the distal end portion of the guide wire 800 can be retained in the esophagus 902. In the present embodiment, since the reinforcing cylinder 115 is made of a hard material, the reinforcing sheet 140 may be omitted.

  Next, a modified example of the outer balloon 120 will be described. As described with reference to FIG. 1, the distal opening 112 is pushed through the esophagus entrance portion 9021 to the vicinity of the neck of the esophagus 902. Then, the outer balloon 120 is inflated. Since the guide tube 100 according to the present embodiment is inserted orally, the guide tube 100 is thicker than the guide tube inserted transnasally. Therefore, the rate at which the outer balloon 120 can be inflated in the esophagus 902 is smaller than the rate in the outer balloon provided in the guide tube inserted transnasally. In general, the esophageal entrance portion 9021 is narrower than the surroundings. Therefore, if an outer balloon that is greatly inflated with respect to a small-diameter guide tube is provided, the outer balloon is caught at the esophageal entrance portion 9021, and the distal end portion of the guide tube is unlikely to easily escape from the esophagus 902.

  On the other hand, in the guide tube 100 according to this embodiment that is inserted orally, the main body tube 110 spreads the esophagus entrance portion 9021 and the expansion rate of the outer balloon 120 is relatively small. The tip of the guide tube 100 may come out. Therefore, in each of the embodiments described below, the outer balloon is inflated so that a hook portion that inhibits movement in the pulling direction is formed.

  FIG. 9 is a side sectional view of a part of the outer balloon 121. When the outer balloon 121 is inflated, the base end side is inclined upright from the outer peripheral surface of the main body tube 110. That is, the rising angle γ on the base end side with respect to the outer peripheral surface is less than 90. When the outer balloon 121 is inflated at such an angle, the proximal end side functions as a hook portion that hooks into the esophagus entrance portion 9021, so that easy disconnection can be prevented.

  Thus, the proximal end side adhesive portion 1211 of the outer balloon 121 has a shape in which the rising portion is brazed to the proximal end side so that the proximal end side is inclined and standing. For example, as shown in the figure, the rising portion is formed to be inclined from the vicinity of the center of the bonding surface to the base end side.

  Further similar modifications will be described. FIG. 10 is a side sectional view for explaining a variation of the hanging portion of the outer balloon. In any example, the rising angle γ on the base end side with respect to the outer peripheral surface is less than 90.

  The hook portion of the outer balloon 122 shown in FIG. 10A is formed by folding the rear end side of the outer balloon 122 and bonding it to the outer peripheral surface of the main body tube 110. That is, the rising portion is brazed to the proximal end side by providing the folded portion 1221 that is folded and adhered to the rear end side of the outer balloon 122.

  The hanging portion of the outer balloon 123 shown in FIG. 10B is formed by a thick portion 1231 provided on the rear end side of the outer balloon 123. The thick portion 1231 has a smaller deformation amount than other portions even when the outer balloon 123 is inflated. Therefore, if it is tilted and bonded to the base end side with respect to the outer peripheral surface, the tilt is maintained even during expansion, and the function as a hanging portion is exhibited.

  The hook portion of the outer balloon 124 shown in FIG. 10C is formed by a bent portion 1241 provided on the rear end side of the outer balloon 124. The bent portion 1241 is formed by bending a part of the proximal end side of the outer balloon 124. The proximal end side of the outer balloon 124 brazed by the bent portion 1241 is inclined during inflation and exhibits a function as a hanging portion.

  The hooking portion of the outer balloon 125 shown in FIG. 10D is formed by adhering the end portion along the inclined surface of the guide ring 180 fitted and attached to the outer peripheral surface of the main body tube 110. Specifically, the guide ring 180 includes a ring portion 1801 that fits on the outer peripheral surface of the main body tube 110 and an adhesion assisting portion 1802 that is erected from the ring portion 1801 at a rising angle γ. If the end of the outer balloon 125 on the proximal end side is adhered along the adhesion assisting portion 1802 and is adhered to the outer peripheral surface of the main body tube 110, the inclination is maintained even when inflated, and the function as a hanging portion is achieved. Demonstrate.

  FIG. 11 is a side sectional view for explaining still another variation of the outer balloon. The outer balloon 126 shown in FIG. 11 does not process the end as shown in each example of FIG. 10, but changes the balloon shape itself. The hanging portion of the outer balloon 126 is formed by the bulge of the proximal end side from the distal end side. That is, the balloon shape is determined so that the diameter on the base end side is larger than the diameter on the front end side so that the base end side is larger than the distal end side. If the base end side swells greatly, the guide tube 100 can be prevented from easily coming off.

  As mentioned above, although this invention was demonstrated using embodiment, the technical scope of this invention is not limited to the range as described in the said embodiment. It will be apparent to those skilled in the art that various modifications or improvements can be added to the above-described embodiment. It is apparent from the scope of the claims that the embodiments added with such changes or improvements can be included in the technical scope of the present invention. In particular, various modified examples have been described for each part. However, it is possible to combine the characteristic parts with each other as a whole, and it is said that forms by these combinations can be included in the technical scope of the present invention. Not too long.

100 guide tube, 110 body tube, 111 proximal end opening, 112 distal opening, 1121 first long diameter end, 1122 second long diameter end, 113 puncture opening, 1130 opening center, 1131 first puncture opening, 1132 second puncture opening , 115 Reinforcement cylinder, 116 Guide slit, 120, 121, 122, 123, 124, 125, 126 Outer balloon, 1211 Adhesion part, 1221 Folding part, 1231 Thick part, 1241 Bending part, 130 Inner balloon, 140 Reinforcement Sheet, 180 guide ring, 1801 ring part, 1802 adhesion auxiliary part, 190 balloon lumen, 191 connector, 210 body tube, 211 outer flange, 220 outer balloon, 230 inner balloon, 2301 first inner balloon, 2302 second inner balloon, 240 reinforcement 2401, first reinforcement sheet, 2402 second reinforcement sheet, 390 balloon lumen, 310 extension tube, 311 inner flange, 312 distal end opening, 313 puncture opening, 410 rotating cylinder, 413 puncture opening, 415 locking claw, 490 Balloon lumen, 500 operation wire, 501 fixation point, 600 endoscope, 700 puncture needle, 800 guide wire, 901 oral cavity, 902 esophagus, 9021 esophageal entrance, 9022 esophageal wall, 903 palate

Claims (8)

Out of both ends of the through-hole through which the endoscope is inserted, the tip side inserted into the esophagus passes through the tip side opening that is oblique to the central axis of the through hole and the puncture needle provided on the wall surface on the tip side A body tube having a puncture opening to allow
An outer balloon that covers the puncture opening and is provided on the outer peripheral surface of the main body tube, and is inflated in the outer peripheral direction of the main body tube;
An inner balloon provided to close the puncture opening and inflated toward the through-hole in accordance with the expansion of the outer balloon;
The puncture opening is an endoscope guide tube whose opening angle around the central axis is less than 180 degrees.   The endoscope guide tube according to claim 1, wherein the puncture opening has an opening angle around the central axis of 90 degrees or more.   The guide tube for an endoscope according to claim 1, wherein the puncture opening has an opening angle around the central axis of less than 150 degrees.   The endoscope guide tube according to any one of claims 1 to 3, wherein a center of the puncture opening is disposed on a ridge line passing through a point located closest to the distal end side of the distal end side opening.   The center of the puncture opening is the distance from the point positioned closest to the distal end to the point positioned closest to the proximal end in the clockwise direction when the body tube is observed from the distal end side. The guide tube for endoscopes of any one of Claim 1 to 3 arrange | positioned on the ridgeline which passes this point.   When the body tube is observed from the distal end side, the center of the puncture opening extends from a point located closest to the distal end side of the distal end side opening to a point located most proximally counterclockwise. The endoscope guide tube according to any one of claims 1 to 3, wherein the endoscope guide tube is disposed on a ridge line passing through a point therebetween.   The endoscope guide tube according to any one of claims 1 to 6, further comprising a reinforcing portion that reinforces the main body tube at a position opposed to the puncture opening with the central axis interposed therebetween.   The endoscope guide tube according to claim 7, wherein the reinforcing portion is a sheet material attached to an inner wall surface of the through hole.