JP2020011103A - Rectal drain - Google Patents

Abstract

To provide a rectal drain capable of highly efficiently decompressing in the inside of the rectum and improving quality and safety of the medical care.SOLUTION: The rectal drain includes: a hollow and flexible tube body 11 that extends in the longitudinal direction and the front end 12 or rear end 13 of which is opened; a reinforcement part 20 that is formed halfway of the tube body 11 at a portion coming into contact with the anal sphincter muscle, when it is inserted into the anus from the front end 12 side and placed, and has the hardness and wall thickness more than those of other portions; and a stationary piece 30 that is formed on the rear side of the reinforcement part 20, is spread to the periphery thereof, and is sewn and fixed to a body surface part around the periphery of the anus.SELECTED DRAWING: Figure 1

Description

  The present invention relates to a rectum drain for reducing the pressure in the rectum by inserting it from the anus of a patient and placing it there.

  Conventionally, after rectal resection (low anterior resection) for the treatment of rectal cancer, the probability of suture failure has not been small. That is, if proper decompression in the rectum cannot be performed after surgery, suture failure may occur.

  If the suture fails, reoperation is necessary, and the probability of an artificial anus increases. It has been found that inserting a drain tube in the rectum and placing it in the rectum to prevent such a situation reduces the probability of suture failure.

  However, there is no actual drain tube for the purpose of reducing the pressure of the rectum, and in each facility, for example, other similar drain tubes (eg, Patent Documents 1 to 4) are used as substitutes. It was the fact that there were many cases.

JP-A-63-184015 JP-A-8-735 JP-A-9-173441 JP-A-9-313598

  However, in the substitutes described in Patent Literatures 1 to 4 and the like described above, the drain is crushed when inserted into the anus, and insertion is difficult, or the drain placed in the anus has a drainage of the anal sphincter. When pressed by force and collapsed, the lumen was narrowed, and sufficient decompression could not be performed. Here, if sufficient decompression cannot be performed, there is a problem that the possibility of suture failure after surgery increases. Also, with these substitutes, it is difficult to fix the drain, so that there is a problem that the drain is likely to drop during placement and the tube is easily torn by directly suturing the tube to the skin.

  The present invention has been made in view of the problems of the conventional technology as described above, and by making a special rectal drain instead of a substitute, it is possible to reduce dropout during indwelling and to reduce the number of tubes. To provide a rectal drain capable of reducing crushing and lumen stenosis, efficiently reducing the pressure in the rectum, and improving the quality and safety of medical care by reducing suture failure. Aim.

The gist of the present invention for achieving the above-described object lies in the following inventions.
In a rectal drain (10) for reducing the pressure in the rectum by inserting and indwelling from the patient's anus,
A hollow, flexible tube body (11) extending longitudinally and opening at a front end (12) or a rear end (13);
In the middle of the tube main body (11), a reinforcing part having higher hardness and / or wall thickness than the other part is provided at a part that comes into contact with the anal sphincter when inserted and placed in the anus from the front end (12) side. 20) to form
And a fixing piece (30) provided around the back of the reinforcing portion (20) and fixed to the body surface around the anus.
The reinforcing portion (20) is formed by bonding or fixing a tubular member in a state where the tubular member is externally fitted in the middle of the tube body (11),
The fixing piece (30) is formed integrally with a rear end side of the tubular member, and is formed by dividing a portion extending further rearward from a rear end side of the tubular member into a plurality of pieces in a circumferential direction,
The fixing piece (30) can be temporarily turned from the root to the front end side including the rear end side of the tubular member, and in the turned state, the rear end (13) of the tube body (11) can be turned. ), The cut end on the rear end (13) side of the tube body (11) is concealed by the root of the fixing piece (30) that has been returned to the original state or the rear end side of the tubular member. A rectal drain (10), characterized in that:

Next, an operation based on the above-described solution will be described.
The rectal drain (10) is inserted into the patient's anus from the front end (12) side of the tube body (11) and is placed there. At this time, particularly, a portion in contact with the anal sphincter is compressed in the axial direction, and a reinforcing portion (20) having a higher hardness and / or thickness than other portions is formed in the portion. The reinforcing portion (20) can reduce the collapse of the tube body (11) and the stenosis of the lumen by the anal sphincter, and can efficiently reduce the pressure in the rectum and discharge the contents of the intestinal tract.

  In the middle of the tube body (11), behind the reinforcing portion (20), there is a fixing piece (30) extending around the fixing piece (30), and this fixing piece (30) is fixed to the body surface around the anus. I do. Thereby, it is possible to reduce the possibility that the tube main body (11) falls off during placement.

  The reinforcing portion (20) can be simply configured by bonding or fixing the tubular member in a state of being fitted outside the tube main body (11). According to such a tubular member, the middle of the tube main body (11) can be maintained at a higher hardness than the other parts in the entire circumferential direction. In addition, by making the reinforcing portion (20) thick, it is possible to prevent the sphincter muscle from being crushed due to compression in the axial direction.

  The fixing piece (30) is formed integrally with the rear end side of the tubular member. Thereby, it can be easily manufactured with a reduced number of parts. Here, the cylindrical member includes a similarly cylindrical portion extending further rearward from the rear end side, and the portion is divided into a plurality of pieces in the circumferential direction to form a fixing piece (30).

  Further, the fixing piece (30) allows the tube member to be temporarily turned from the root to the front end side including the rear end side thereof, and in the turned state, to the rear end (13) side of the tube body (11). Disconnect. Here, the location to be cut is the back side (front end side) of the location where the rear end side of the tubular member is turned up so that the cutting opening does not protrude backward as much as possible.

  After cutting, the root of the fixed piece (30) or the rear end side of the tubular member in the flipped state is returned to the original state, and the tube of the fixed piece (30) is returned by the root or the rear end side of the tubular member. It is concealed so as to cover the cut end on the rear end (13) side of the main body (11). This prevents the rear end side of the tube body (11) from projecting rearward from the root of the fixing piece (30) during normal use in which the rectal drain (10) is placed in the rectum, and the tube body ( 11) is no longer pushed from the rear end side, and the front end (12) can be prevented from unnecessarily interfering with the rectum inner wall.

  ADVANTAGE OF THE INVENTION According to the drain for rectum which concerns on this invention, it can reduce the fall-out during indwelling, can reduce crushing of a tube, and stenosis of a lumen, and can reduce the pressure in the rectum efficiently, and reduce suture failure. This can improve the quality and safety of medical care.

It is a front view showing the drain for rectum concerning a 1st embodiment of the present invention. It is a top view showing the drain for rectum concerning a 1st embodiment of the present invention. It is an explanatory view showing a use state of a drain for rectum concerning a 1st embodiment of the present invention. It is a front view showing the drain for rectum concerning a 2nd embodiment of the present invention. It is a front view showing the drain for rectum concerning a 3rd embodiment of the present invention. It is a top view showing the drain for rectum concerning a 3rd embodiment of the present invention. It is a side view showing the drain for rectum concerning a 3rd embodiment of the present invention. It is a front view showing the drain for rectum concerning a 4th embodiment of the present invention. It is explanatory drawing which shows an example of the usage form of the drain for rectum which concerns on the 3rd, 4th embodiment of this invention. It is explanatory drawing which shows an example of the usage form of the drain for rectum which concerns on the 3rd, 4th embodiment of this invention. It is explanatory drawing which shows an example of the usage form of the drain for rectum which concerns on the 3rd, 4th embodiment of this invention.

Hereinafter, various embodiments representing the present invention will be described with reference to the drawings.
1 to 3 show a first embodiment of the present invention.
The rectal drain 10 according to the present embodiment is intended to reduce the pressure in the rectum and discharge the contents of the intestinal tract by inserting the rectum from the anus of the patient and placing the rectum.

  As shown in FIG. 1, the rectal drain 10 includes a hollow and flexible tube main body 11 that extends in a longitudinal direction and has an open front or rear end. The tube body 11 extends substantially linearly with a cylindrical cross section, the front end 12 is open as it is, and the rear end 13 is connected to a connector 14 communicating with the opening. The tube body 11 is inserted into the patient's anus from the front end 12 side.

  The tube main body 11 is made of a soft and flexible material as a whole to reduce perforation, and is integrally formed of, for example, a silicone resin or a vinyl chloride resin. The tube main body 11 only needs to have a hardness (for example, a hardness of 60 to 70 or the like) that does not buckle when inserted into the anus. The length of the tube main body 11 is, for example, 200 mm in total length, and its effective length (the length from the front end 12 to a fixed piece 30 described later) is appropriately determined to be 170 mm or the like. The diameter of the tube body 11 is appropriately determined, for example, such that the outer diameter is 12 mm, the inner diameter is 9 mm, and the wall thickness is 1.5 mm.

  The front end 12 is provided with a taper whose diameter gradually decreases toward the front end, and the portion is coated with, for example, a liquid silicone resin diluted with xylene or the like. This smoothes the surface on the front end 12 side. On the other hand, the connector 14 that covers the rear end 13 is a cylindrical part having both ends opened, and is integrally formed of, for example, the same material as the tube body 11. The front end side of the connector 14 is coated with a coating to eliminate a step with the outer peripheral surface of the tube body 11.

  The inside of the tube main body 11 is a continuous lumen having no obstruction from its front end 12 to its rear end 13, and its inner peripheral surface is formed so as to be smoothly connected without irregularities. In the tube main body 11, a plurality of side holes 15 communicating with the tube lumen are formed between the front end 12 and the reinforcing portion 20 described below. The side hole 15 can cope with a case where the opening of the front end 12 is clogged with intestinal contents.

  In the tube body 11, a contrast line 16 extending linearly from the front end 12 to the rear end 13 is embedded. The contrast line 16 is made of, for example, barium sulfate or bismuth oxide, and is used for easily confirming the location of the tube body 11 at the time of image diagnosis under X-ray. It should be noted that the contrast line 16 is preferably colored with an appropriate color so that the presence thereof can be visually confirmed even in normal times.

  In the middle of the tube body 11 on the rear end 13 side, a portion that contacts the anal sphincter when inserted and placed in the anus from the front end 12 has a reinforcing portion 20 having higher hardness and thickness than the other portions. Are formed. A fixing piece 30 is provided behind the reinforcing portion 20 and extends around the fixing portion 30 and is fixed to the body surface around the anus by suturing. Here, the fixing piece 30 is provided with a suture insertion hole 32 which is a small hole through which a suture (not shown) is inserted and whose inner peripheral edge is reinforced.

  The reinforcing portion 20 is formed by bonding or fixing a tubular member formed of a material having a higher hardness than the material of the tube main body 11 so as to be fitted outside the tube main body 11. The reinforcing portion 20 is a cylindrical component having both ends opened, and a pair of fixing pieces 30, 30 described later is integrally provided on the rear side. Note that the term “adhesion” mainly refers to fixing with an adhesive so as not to move, and the term “fixing” includes not only fixing with an adhesive but also fixing with molding.

  More specifically, the first half of the tubular member that is the reinforcing portion 20 has a cylindrical shape whose inner diameter substantially matches the outer diameter of the tube main body 11, and whose outer diameter is slightly larger than the outer diameter of the tube main body 11, As a material with high hardness, for example, it is integrally formed of polyurethane or the like. At the front end of the front half, there is provided a taper 21 whose diameter gradually increases from the outer peripheral surface of the tube body 11 toward the tubular member. Here, the taper 21 is not limited to being a part of the front side of the tubular member itself, and may be formed so as to cover the front end surface of the tubular member with an adhesive or the like.

  The fixing piece 30 is formed by dividing a portion extending further from the rear side of the tubular member into a plurality of pieces in the circumferential direction. Here, the number and shape of the fixing pieces 30 are not particularly limited, but in the present embodiment, the pair of fixing pieces 30 are integrally formed so as to extend rearward of the cylindrical member that is the reinforcing portion 20. Have been. Further, each fixing piece 30 is not a part obtained by directly cutting the first half portion of the tubular member, but is thermally deformed so as to be slightly expanded and expanded as shown in the drawing.

  The cut shape at the boundary where the roots of the fixed pieces 30 are adjacent to each other is not an acute cut as it is, but is made round by punching a punch hole 31. Thereby, concentration of stress at the cut of the boundary of each fixed piece 30 can be avoided. Each fixing piece 30 can be deformed so as to easily spread toward its periphery, starting from the root portion, that is, between the punch holes 31. Here, since the fixing piece 30 directly contacts the buttocks of the patient, a soft material is preferable. As a method of imparting roundness, a method of forming a rounded shape in advance may be used instead of punching the punch hole 31.

  As shown in FIG. 2, the suture insertion hole 32 is provided substantially at the center of each fixing piece 30. The suture insertion hole 32 is a circular small hole, but the inner peripheral edge thereof is reinforced as described above. Although the specific mode of the reinforcement is not particularly limited, in the present embodiment, the annular member 33 is arranged along the inner peripheral edge of the suture insertion hole 32, and the annular member 33 is By being fixed, the inner peripheral edge is reinforced firmly.

  Here, the annular member 33 is formed integrally with, for example, nylon or the like, and may be disposed on only one of the front and back sides of the fixed piece 30 or a total of two on both sides. The eyelet 34 is made of, for example, polycarbonate or the like, and can fix the annular member 33 to the inner peripheral edge of the suture insertion hole 32. In addition, the material of the suture not shown is also preferably nylon or the like.

Next, the operation of the rectal drain 10 according to the first embodiment will be described.
As shown in FIG. 3, the rectal drain 10 is inserted into the anus of the patient from the front end 12 of the tube body 11 and is placed there. As described above, when the rectal drain 10 is placed in the rectum, the portion in contact with the anal sphincter is particularly compressed in the axial direction, but the portion has higher hardness and thickness than other portions. Are formed.

  The reinforcing portion 20 can reduce crushing of the tube body 11 and stenosis of the lumen by the anal sphincter, and can efficiently reduce the pressure in the rectum and discharge the contents of the intestinal tract after proctectomy. Thereby, the possibility of occurrence of suture failure after the operation can be reduced as much as possible, and the quality and safety of medical treatment can be improved. In addition, it is possible to claim insurance, and it is possible to reduce improper use by substitutes on the hospital side.

  In the middle of the tube body 11, a pair of fixing pieces 30, 30 extends laterally from the periphery behind the reinforcing portion 20. The fixing piece 30 also functions as a stopper that abuts around the anus. The fixing piece 30 prevents the insertion of the tube body 11 on the rear end 13 side into the anus, and inserts the tube body 11 at an optimum position. Can be.

  After the rectal drain 10 is inserted, each fixing piece 30 is sutured and fixed to the body surface around the anus. Here, since the fixing piece 30 has the suture insertion hole 32, the suture can be easily sewn through this. By such a fixing piece 30, it is possible to reliably hold the tube main body 11 in a predetermined state where it is indwelled. However, when suturing the fixing piece 30, it is preferable that the suture has play so that it can move to some extent.

  That is, since the patient performs a normal operation such as standing up, sitting, walking, etc. while the rectal drain 10 is kept in the body from the day after the operation, the rectal drain 10 comes and goes to some extent from the anus. . In order to cope with this, it is preferable that the fixing piece 30 has a play to the suture in addition to the flexibility that can be freely deformed.

  In addition, since the inner peripheral edge of the suture insertion hole 32 through which the suture is passed by the fixing pieces 30 is reinforced, there is no possibility that the suture insertion hole 32 is torn even if pulled by the suture. Here, as the reinforcement, in the present embodiment, an annular member 33 is arranged along the inner peripheral edge of the suture insertion hole 32, and the annular member 33 is fixed via an eyelet 34. Such a simple configuration can surely reinforce and prevent the suture insertion hole 32 from being pulled and torn by the suture.

  Further, various configurations are conceivable as the reinforcing portion 20, but in the present embodiment, as described above, a tubular member formed of a material having a higher hardness than the material of the tube body 11 is provided in the middle of the tube body 11. If it is adhered or fixed in a state where it is fitted to the outside, it can be easily configured. According to such a tubular member, the middle of the tube main body 11 can be maintained at a higher hardness than the other parts in the entire circumferential direction. In addition, simply increasing the thickness of the reinforcing portion 20 can prevent the sphincter muscle from being crushed by compression in the axial direction.

  Here, a taper 21 is provided on the front end side of the tubular member forming the reinforcing portion 20 so as to gradually increase in diameter from the outer peripheral surface of the tube body 11 toward the front end outer peripheral surface of the tubular member. The taper 21 eliminates a step at the front end of the tubular member due to an end surface perpendicular to the longitudinal direction, enables smooth insertion without fear of damaging the anus or rectum, and can reduce pain for the patient.

  If the fixing piece 30 is configured as a part of the reinforcing portion 20 without preparing a separate component from the reinforcing portion 20, the fixing piece 30 can be easily manufactured with a reduced number of components. That is, as in the present embodiment, the tubular member forming the reinforcing portion 20 includes a tubular portion extending further rearward from the rear end side, and divides the portion into a plurality in the circumferential direction. To form a fixing piece 30.

  In particular, the portion of the boundary where the roots of the fixing pieces 30 are adjacent to each other is not formed into an acute cut shape as it is, but a punch hole 31 is opened at the top to give it a round shape. Thereby, it is possible to avoid concentration of stress in the cut at the root of each fixing piece 30, and it is possible to prevent tearing from the root of each fixing piece 30. Note that it is sufficient that each fixing piece 30 is normally a pair facing each other at 180 degrees.

  When the rectal drain 10 is placed in the rectum of a patient, the connector 14 at the rear end 13 of the rectal drain 10 may be filled with gauze to prevent leakage of excrement or the like. It is advisable to cover it with a body plug. Here, by temporarily closing with the stopper, the patient can easily take a shower, for example. Further, depending on the pre-operative treatment or the like, it is conceivable to connect the drain bag to the connector 14 and use it.

FIG. 4 shows a second embodiment of the present invention.
The rectal drain 10A according to the present embodiment has the same basic configuration as the rectal drain 10 according to the above-described first embodiment, but the tube main body 11A is curved in advance from the front end 12 to the rear end 13 thereof. It is formed so as to extend. In this case, the tube body 11A integrally formed in a linear shape having a predetermined length may be wound around a drum or the like immediately after molding, or may be integrally formed into a curved shape from the beginning.

  In the case of the tube body 11 extending straight as described above, it may be rare that the tube body 11 is rarely inserted when inserted from the anus. It is possible to orient. Therefore, it can be inserted more easily from the anus. The same parts as those in the first embodiment are denoted by the same reference numerals, and redundant description will be omitted.

5 to 7 show a third embodiment of the present invention.
The rectal drain 10B according to the present embodiment has the same basic configuration as the rectal drain 10 according to the above-described first embodiment, but a pair of fixing pieces 30B, 30B form a tube forming the reinforcing portion 20. It is bent from the base at an angle which spreads in advance from the rear side to the periphery.

  According to such a rectal drain 10B, the fixing pieces 30B can be easily sewn along the body surface around the anus. The same parts as those in the first embodiment are denoted by the same reference numerals, and redundant description will be omitted.

FIG. 8 shows a fourth embodiment of the present invention.
The rectal drain 10C according to the present embodiment has the same basic configuration as the rectal drain 10B according to the third embodiment described above, but the tube main body 11C includes the tube according to the second embodiment described above. Like the main body 11A, it is formed so as to be curved and extend from the front end 12 to the rear end 13 in advance.

  According to such a rectal drain 10C, the tube body 11C can be more easily inserted from the anus, and the fixing pieces 30C can be easily sewn along the body surface around the anus. . The same parts as those in the first embodiment are denoted by the same reference numerals, and redundant description will be omitted.

  Subsequently, another embodiment when the rectal drains 10B and 10C according to the third and fourth embodiments are used will be described. FIG. 9 to FIG. 11 are explanatory views showing an example of usage of the rectal drains 10B and 10C. FIG. 9 shows each fixing piece 30B (30C) as a rear end of a tubular member forming the reinforcing portion 20. It shows a state where the front end side including the side is temporarily turned from the root to the front end side.

  As described above, the rear end side of the tubular member has a portion that is not adhered or fixed to the outer periphery of the tube body 11 over a predetermined length, and the portion is separated from the outer periphery of the tube body 11 as a groove and fixed. It is possible to temporarily turn from the base of the piece 30B (near the punch hole 31) to the front end side including the rear end side of the tubular member. Such an operation is easier for the fixing pieces 30B and 30C that are open from the beginning, but is also possible for the fixing pieces 30 according to the first and second embodiments.

  Next, as shown in FIG. 10, the rear end 13 side of the tube main body 11 (a broken line portion in FIG. 10) is cut in a state where the fixing pieces 30B (including 30C) are turned up. Here, the location to be cut is the back side (front end side) of the location where the rear end side of the tubular member is turned up so that the cutting opening does not protrude backward as much as possible. After the cutting, as shown in FIG. 11, the root of the fixed piece 30B (30C) in the turned up state or the rear end side of the tubular member is returned to the original state.

  Then, the fixed pieces 30B (30C) and the like, which have been returned to the original state, cover the cutting opening on the rear end 13 side of the tube body 11, and the cutting opening is concealed so as to be hidden inside. This prevents the rear end side of the tube body 11 from projecting rearward from the base of the fixing piece 30 during normal use in which the rectal drains 10B and 10C are placed in the rectum.

  Therefore, a feeling of discomfort at the time of indwelling in the patient is alleviated and the feeling of wearing is improved, and the tube main body 11 is not pushed from the rear end 13 side, and the front end 12 unnecessarily interferes with or perforates the rectum inner wall. Can be prevented. In addition, although the connector 14 is not provided at the cut rear end 13, a gauze or a plug may be directly packed into the cut end, or a drainage bag may be temporarily connected and used.

  As described above, the embodiments of the present invention have been described with reference to the drawings. However, the specific configuration is not limited to the above-described embodiments, and even if there are changes and additions without departing from the gist of the present invention. Included in the invention. For example, the length of the tube main body 11 and the like and the specific shapes of the reinforcing portion 20 and the fixing piece 30 and the like in each of the above embodiments are not limited to those illustrated. In addition, the number of the fixing pieces 30 may be usually one pair, but one or three or more fixing pieces may be provided.

  In addition, the reinforcing portion 20 is formed of a material having a higher hardness than the tube main body 11, but may be formed of the same material to have a large thickness, or without partially increasing the thickness. It may be formed of a material having the same thickness and high hardness as other parts.

  Further, the fixing piece 30 is provided with the suture insertion hole 32 in which the inner peripheral edge is reinforced, but it is not always necessary to reinforce it, and the fixing piece 30 may be simply provided as the small hole 32. Further, the fixing piece 30 may be attached and fixed with a tape or the like in a state where the fixing piece 30 is in close contact with the buttocks without providing the small holes 32.

  The rectal drain according to the present invention can be widely applied as a means for appropriately reducing the pressure in the rectum and discharging the contents of the intestinal tract without being limited to the treatment after the rectal resection operation.

DESCRIPTION OF SYMBOLS 10 ... Rectal drain 11 ... Tube main body 12 ... Front end 13 ... Rear end 14 ... Connector 15 ... Side hole 16 ... Contrast line 20 ... Reinforcement part 21 ... Taper 30 ... Fixed piece 31 ... Punch hole 32 ... Suture thread insertion hole 33 ... Annular member 34: Eyelet

Claims (1)

In the rectum drain to reduce the pressure in the rectum by inserting and placing from the patient's anus,
A hollow, flexible tube body that extends longitudinally and has an open front or rear end,
In the middle of the tube main body, a portion that contacts the anal sphincter when inserted and placed in the anus from the front end side, a reinforcing portion having higher hardness and / or wall thickness than other portions is formed,
And, provided behind the reinforcing portion, a fixing piece that extends around and is fixed to the body surface around the anus,
The reinforcing portion is formed by bonding or fixing a tubular member in a state where the tubular member is externally fitted in the middle of the tube main body,
The fixing piece is formed integrally with a rear end side of the tubular member, and is divided into a plurality of parts extending rearward from a rear end side of the cylindrical member in a circumferential direction,
The fixing piece can be temporarily turned from the root to the front end including the rear end of the tubular member, and after cutting the rear end of the tube main body in the turned state, the original A rectal drain, wherein a cut end on a rear end side of the tube main body is concealed by a root of the fixed piece returned to the state or a rear end side of the tubular member.

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