JP3209522U

JP3209522U - Kidney catheter and ureteral bypass device provided with the same

Info

Publication number: JP3209522U
Application number: JP2017000036U
Authority: JP
Inventors: 陽介岡田
Original assignee: 有限会社オーキッド
Priority date: 2017-01-11
Filing date: 2017-01-11
Publication date: 2017-03-23
Anticipated expiration: 2027-01-11

Abstract

【課題】縫合糸を腎臓カテーテルから取り除いても、また、腎臓カテーテルの先端部を屈曲形成しなくても、腎臓カテーテルの先端部が腎臓の腎盂腔内から抜け出ないようにすることができる腎臓カテーテルを提供する。【解決手段】腎臓カテーテル３は、腎臓カテーテル本体１１と位置決め部材１５を備える。位置決め部材は、腎臓に固定可能な鍔部１５ａと筒部１５ｂを備える。腎臓カテーテル本体の中間部１１ｂに位置決め部材が嵌合されたときの、中間部と位置決め部材の筒部１５ｂとの接触摩擦力により中間部と位置決め部材との相対移動が規制される。相対移動を規制し得る摩擦力の最大値は、腎臓カテーテルが腎臓に留置されているときに作用して相対移動を生じさせる外力の想定最大値より大きく、かつ、人の手のみにより付与可能な外力の値より小さい値に設定されている。【選択図】図１A renal catheter capable of preventing the distal end portion of the renal catheter from coming out of the renal pleural cavity of the kidney without removing the suture thread from the renal catheter or bending the distal end portion of the renal catheter. I will provide a. A renal catheter includes a renal catheter body and a positioning member. The positioning member includes a collar portion 15a and a cylindrical portion 15b that can be fixed to the kidney. The relative movement between the intermediate portion and the positioning member is restricted by the contact friction force between the intermediate portion and the cylindrical portion 15b of the positioning member when the positioning member is fitted to the intermediate portion 11b of the renal catheter body. The maximum value of the frictional force that can regulate the relative movement is larger than the assumed maximum value of the external force that acts when the renal catheter is placed in the kidney and causes the relative movement, and can be applied only by human hands. It is set to a value smaller than the external force value. [Selection] Figure 1

Description

本考案は、腎臓内に留置され腎臓内の尿が流入する先端部と、該先端部に連なる中間部を介して先端部と連通すると共に先端部から流入した尿を排出可能な後端部とを備えた腎臓カテーテルに関するものである。 The present invention includes a tip portion that is placed in the kidney and into which urine in the kidney flows, and a rear end portion that communicates with the tip portion through an intermediate portion that is continuous with the tip portion and that can discharge urine that has flowed from the tip portion. The present invention relates to a renal catheter equipped with

腎臓カテーテルとしては、特許文献１に示されているものがある。この腎臓カテーテルは、腎臓の腎盂腔内に留置される先端部と、該先端部に連なる中間部を介して先端部と連通すると共に中継アダプタに接続される後端部とを備えている。腎臓カテーテルの先端部には、腎盂腔内の尿が流入し得る複数の側孔が穿設され、これらの側孔から流入した尿は中継アダプタ内に排出されるように構成されている。また、腎臓カテーテルの先端部は円弧状に屈曲形成されており、先端部が腎盂腔内に留置されたとき、先端部の屈曲部が腎盂腔内に位置付けられる。腎臓カテーテル内にはその全域に亘って細い縫合糸が挿通されており、腎臓カテーテルの先端部が腎盂腔内に留置された後、張力を付与した状態で前記縫合糸を保持することで、腎盂腔内に留置された先端部を円弧状に屈曲させた状態を維持するようにしている。
これにより、先端部を腎盂腔内から引き出すような引張力が腎臓カテーテルに付与されたとき、先端部の屈曲部が腎盂腔内で引っ掛かることで腎臓カテーテルの先端部が腎盂腔内から抜け出すことが防止される。 As a renal catheter, there is one disclosed in Patent Document 1. This renal catheter includes a distal end portion that is placed in the renal pelvic cavity of the kidney, and a rear end portion that communicates with the distal end portion through an intermediate portion connected to the distal end portion and is connected to the relay adapter. The distal end portion of the renal catheter is formed with a plurality of side holes through which urine in the renal pelvis can flow, and the urine flowing from these side holes is discharged into the relay adapter. Further, the distal end portion of the renal catheter is bent in an arc shape, and when the distal end portion is placed in the renal pelvis cavity, the bent portion of the distal end portion is positioned in the renal pelvic cavity. A thin suture thread is inserted through the entire area of the renal catheter. After the distal end portion of the renal catheter is placed in the renal pelvic cavity, the suture thread is held in a tensioned state so that the renal pelvis is retained. The state where the tip portion placed in the cavity is bent in an arc shape is maintained.
As a result, when a pulling force is applied to the renal catheter so that the distal end is pulled out from the renal pelvic cavity, the distal end of the renal catheter is pulled out of the renal luminal cavity by the bent portion of the distal end being caught in the renal luminal cavity. Is prevented.

このような腎臓カテーテルの先端部を腎盂腔内に留置するには、屈曲形成された腎臓カテーテルの先端部が留置可能な空間が腎臓の腎盂腔内に存在している必要がある上、幾つもの作業を行う必要がある。その作業の一部を以下に説明する。
まず、腎臓の状態をＸ線撮影により取得した画像で観察し、屈曲形成された腎臓カテーテルの先端部が留置可能な程度に腎盂腔が拡張しているか否かを確認する。泌尿器系疾患等により尿管が閉塞または尿管障害を起こした場合、尿管内の圧力が高くなることで腎盂腔が拡張する症状が出やすい。
Ｘ線撮影による画像観察の結果、腎臓カテーテルの先端部が留置可能であると判断されると、腎臓カテーテルの後端部から腎臓カテーテル内に真っ直ぐな中空管を挿入し先端部まで到達させることで、先端部の屈曲部を真っ直ぐな状態に矯正する。
次に、腎臓を細い針で穿刺して形成された刺入口を介してガイドワイヤの先端を腎盂腔内まで挿入したのち、このガイドワイヤの後端を、腎臓カテーテル内に挿入された前記中空管内に挿入し、ガイドワイヤに沿わせて中空管と共に腎臓カテーテルをその先端部が腎盂腔内に進入するまで挿入する。 In order to place the tip of such a renal catheter in the renal pelvis, a space in which the tip of the bent kidney catheter can be placed must be present in the renal pelvis of the kidney. Need to do work. A part of the work will be described below.
First, the state of the kidney is observed with an image acquired by X-ray imaging, and it is confirmed whether or not the renal pelvis has expanded to such an extent that the distal end portion of the bent kidney catheter can be placed. When the ureter is obstructed or has a ureteral disorder due to a urinary system disease or the like, the pressure in the ureter is increased, and the renal vagina is likely to expand.
As a result of image observation by X-ray photography, when it is determined that the distal end of the renal catheter can be placed, a straight hollow tube is inserted into the renal catheter from the rear end of the renal catheter to reach the distal end. Then, the bent part of the tip part is corrected to a straight state.
Next, after the distal end of the guide wire is inserted into the renal pelvic cavity through the puncture formed by puncturing the kidney with a thin needle, the rear end of the guide wire is inserted into the hollow tube inserted into the renal catheter. The kidney catheter is inserted along with the guide wire until the distal end of the kidney catheter enters the renal pelvis cavity.

次に、腎臓カテーテルの先端部を腎盂腔内に留置したまま、腎臓カテーテルから中空管を引き抜いたのちガイドワイヤも腎臓カテーテルから引き抜く。
次に、腎臓カテーテル内に挿通され腎臓カテーテルの後端部から食み出している縫合糸を手で引っ張り、腎盂腔内に留置された先端部を円弧状に屈曲させる。
次に、中継アダプタのコネクタ部の外周部に腎臓カテーテルの後端部の内周部を嵌合して腎臓カテーテルを中継アダプタに接続する。このときに、腎臓カテーテルの後端部から食み出している縫合糸を、該縫合糸に張力を付与したまま中継アダプタのコネクタ部の外周部と腎臓カテーテルの後端部の内周部とで挟持した状態で腎臓カテーテルを中継アダプタに接続する。これにより、縫合糸による張力が付与されたまま保持されることで、腎盂腔内に留置された腎臓カテーテルの先端部は円弧状に屈曲した状態が維持される。 Next, the hollow wire is pulled out from the renal catheter while the distal end portion of the renal catheter is left in the renal pelvis cavity, and then the guide wire is pulled out from the renal catheter.
Next, the suture thread inserted into the renal catheter and protruding from the rear end portion of the renal catheter is pulled by hand, and the distal end portion placed in the renal pelvic cavity is bent in an arc shape.
Next, the kidney catheter is connected to the relay adapter by fitting the inner periphery of the rear end of the kidney catheter to the outer periphery of the connector portion of the relay adapter. At this time, the suture thread protruding from the rear end portion of the renal catheter is applied between the outer peripheral portion of the connector portion of the relay adapter and the inner peripheral portion of the rear end portion of the renal catheter while applying tension to the suture thread. Connect the renal catheter to the relay adapter in the clamped state. Accordingly, the distal end portion of the renal catheter indwelled in the renal pelvic cavity is maintained in a state of being bent in an arc shape by being held with tension applied by the suture thread.

米国特許第８８０８２６１号明細書US Pat. No. 8,808,261

しかしながら、特許文献１に示された腎臓カテーテルを使用するためには、その先端部が屈曲形成されているため、その先端部が留置可能な空間が腎臓の腎盂腔内に存在している必要があり、そのような空間が無い場合は、屈曲形成された先端部を腎盂腔内に留置することができないため、先端部の屈曲部が腎盂腔内で引っ掛かることで腎盂腔内から抜け出すことを防止するという手段を採用することができない。
また、縫合糸を手で引っ張ることで腎臓カテーテルの先端部を円弧状に屈曲させ、さらに、縫合糸に張力を付与したまま中継アダプタのコネクタ部の外周部と腎臓カテーテルの後端部の内周部とで縫合糸を挟持した状態で腎臓カテーテルを中継アダプタに接続するようにしたので、それらの作業が面倒であった。
また、腎臓カテーテルの内部にその長手方向全域に亘って縫合糸が挿入されたまま残されるので、腎臓カテーテル内を尿が流れる際に縫合糸が障害物となり腎臓カテーテル内が目詰まりしやすくなる。 However, in order to use the renal catheter shown in Patent Document 1, since the distal end portion thereof is bent, it is necessary that a space where the distal end portion can be placed exists in the renal pelvic cavity of the kidney. If there is no such space, the bent tip cannot be placed in the renal pelvis cavity, preventing the bent portion of the tip from being pulled out of the renal pelvis by being caught in the renal pelvis cavity. It is not possible to adopt the means of doing.
In addition, the distal end of the renal catheter is bent in an arc shape by pulling the suture by hand, and further, the outer peripheral portion of the connector portion of the relay adapter and the inner peripheral portion of the rear end portion of the renal catheter while tension is applied to the suture. Since the kidney catheter was connected to the relay adapter in a state where the suture was sandwiched between the two parts, these operations were troublesome.
In addition, since the suture thread is left in the entire length of the kidney catheter, the suture thread becomes an obstacle when urine flows through the kidney catheter, and the kidney catheter is easily clogged.

また、中継アダプタのコネクタ部の外周部と腎臓カテーテルの後端部の内周部とで縫合糸を挟持すると、その挟持した縫合糸に沿って微小な隙間が生じるため、腎臓カテーテルから中継アダプタに流入しようとする尿の一部が前記隙間から漏洩する虞がある。この漏洩を回避するために、縫合糸を中途部で切断して、中継アダプタのコネクタ部と腎臓カテーテルの後端部との嵌合長さの中途部までしか縫合糸の末端が到達しないようにして腎臓カテーテルを中継アダプタに接続することが行われている。これにより、中継アダプタのコネクタ部と腎臓カテーテルの後端部との嵌合長さのうち中継アダプタ側の嵌合部分に縫合糸が挟持されない領域が形成されるので、尿の漏洩が回避される。しかしながら、このような細かな作業も非常に面倒であった。
本考案は、上述したような様々な問題を解消するためになされたもので、縫合糸を使用して腎臓カテーテルの先端部を屈曲形成する場合は該縫合糸を腎臓カテーテルから取り除いても、腎臓カテーテルの先端部が腎臓の腎盂腔内から抜け出ないようにすることができるだけでなく、腎臓カテーテルの先端部を屈曲形成しなくても、腎臓カテーテルの先端部が腎臓の腎盂腔内から抜け出ないようにすることができる腎臓カテーテルを提供することを目的とする。 In addition, when a suture is sandwiched between the outer peripheral portion of the connector portion of the relay adapter and the inner peripheral portion of the rear end portion of the renal catheter, a minute gap is generated along the sandwiched suture. There is a risk that part of the urine to be introduced will leak from the gap. In order to avoid this leakage, the suture is cut halfway so that the end of the suture reaches only the middle part of the fitting length between the connector part of the relay adapter and the rear end part of the renal catheter. It has been practiced to connect a renal catheter to a relay adapter. As a result, a region in which the suture thread is not clamped is formed in the fitting portion on the relay adapter side in the fitting length between the connector portion of the relay adapter and the rear end portion of the renal catheter, thereby preventing leakage of urine. . However, such detailed work was also very troublesome.
The present invention has been made to solve the various problems as described above. When a distal end portion of a kidney catheter is bent using a suture, the kidney can be removed even if the suture is removed from the kidney catheter. Not only can the tip of the catheter not escape from the renal luminal cavity of the kidney, but the distal end of the renal catheter does not escape from the renal luminal cavity of the kidney without bending the distal end of the renal catheter. It is an object of the present invention to provide a renal catheter that can be used.

この目的を達成するために、本考案に係る腎臓カテーテルは、腎臓内に留置され腎臓内の尿が流入する先端部と、該先端部に連なる中間部を介して前記先端部と連通すると共に前記先端部から流入した尿を排出可能な後端部とを備えた中空の管からなる腎臓カテーテル本体と、前記中間部の外周部に嵌合可能な位置決め部材とを備えた腎臓カテーテルであって、前記位置決め部材は、腎臓に固定可能な鍔部と、該鍔部と一体化された筒部とを備え、前記中間部の外周部に前記位置決め部材が嵌合されたときの、前記中間部の外周部と前記位置決め部材の筒部の内周部との接触による摩擦力により、前記中間部の軸芯に沿う方向における前記中間部と前記位置決め部材との相対移動を規制し、前記相対移動を規制し得る摩擦力の最大値は、前記腎臓カテーテルが腎臓に留置されているときに作用して前記相対移動を生じさせる外力であって想定される最大の外力の値より大きく、かつ、前記相対移動を生じさせる外力であって人の手のみにより付与可能な外力の値より小さい所定の値に設定されていることを特徴とするとするものである。 In order to achieve this object, the renal catheter according to the present invention communicates with the distal end portion via a distal end portion that is placed in the kidney and into which urine in the kidney flows, and an intermediate portion that is continuous with the distal end portion. A renal catheter body comprising a renal catheter body comprising a hollow tube provided with a rear end portion capable of discharging urine flowing from the front end portion, and a positioning member that can be fitted to the outer peripheral portion of the intermediate portion; The positioning member includes a collar part that can be fixed to a kidney, and a cylindrical part integrated with the collar part, and the positioning member is fitted to the outer peripheral part of the intermediate part. The frictional force caused by the contact between the outer peripheral portion and the inner peripheral portion of the cylindrical portion of the positioning member restricts the relative movement between the intermediate portion and the positioning member in the direction along the axis of the intermediate portion, and The maximum frictional force that can be regulated is An external force that acts when the visceral catheter is indwelled in the kidney and causes the relative movement, which is larger than the assumed maximum external force value, and the external force that causes the relative movement and is a human hand. It is characterized in that it is set to a predetermined value smaller than the value of the external force that can be applied only by this.

請求項２に記載した考案に係る腎臓カテーテルは、請求項１に記載の腎臓カテーテルにおいて、前記所定の値は、５ないし１０ニュートン（Ｎ）の範囲に設定されていることを特徴とするものである。
請求項３に記載した考案に係る腎臓カテーテルは、請求項１または請求項２に記載の腎臓カテーテルにおいて、前記中間部の外周部に嵌合可能で、かつ、腎臓の表面に固定可能な盤状の布製のカフをさらに備え、前記位置決め部材の鍔部と前記カフとは、それらの側面同士が互いに結着されていることを特徴とするものである。
請求項４に記載した考案に係る腎臓カテーテルは、請求項１ないし請求項３のうち何れか一つに記載の腎臓カテーテルにおいて、前記腎臓カテーテルが腎臓に留置されたとき、前記位置決め部材の筒部が嵌合された前記中間部における部位は、前記中間部における他の部位より高い剛性を有するように構成されていることを特徴とするものである。
請求項５に記載した考案に係る尿管バイパス装置は、請求項１ないし請求項４のうち何れか一つに記載の腎臓カテーテルと、前記腎臓カテーテルに一端部が接続可能な中継アダプタと、前記中継アダプタの他端部に接続可能な膀胱カテーテルとを備えたものである。 According to a second aspect of the present invention, there is provided a renal catheter according to the first aspect, wherein the predetermined value is set in a range of 5 to 10 Newtons (N). is there.
A renal catheter according to the invention described in claim 3 is a disk-like shape that can be fitted to the outer peripheral portion of the intermediate portion and can be fixed to the surface of the kidney in the renal catheter according to claim 1 or 2. The cloth cuff is further provided, and the collar portion of the positioning member and the cuff are characterized in that their side surfaces are bonded to each other.
A kidney catheter according to the invention described in claim 4 is the kidney catheter according to any one of claims 1 to 3, wherein when the kidney catheter is placed in the kidney, the tubular portion of the positioning member The part in the intermediate part to which is fitted is configured to have higher rigidity than the other part in the intermediate part.
A ureteral bypass device according to the invention described in claim 5 is a kidney catheter according to any one of claims 1 to 4, a relay adapter capable of connecting one end to the kidney catheter, And a bladder catheter connectable to the other end of the relay adapter.

本考案によれば、腎臓カテーテル本体の中間部と位置決め部材の筒部との接触による摩擦力により、中間部と位置決め部材との相対移動を規制するようにした。このため、縫合糸を使用して腎臓カテーテル本体の先端部を屈曲形成する場合は該縫合糸を腎臓カテーテル本体から取り除いても、腎臓カテーテル本体の先端部が腎臓の腎盂腔内から抜け出ないようにすることができるだけでなく、腎臓カテーテル本体の先端部を屈曲形成しなくても、腎臓カテーテル本体の先端部が腎臓の腎盂腔内から抜け出ないようにすることができる。
また、中間部と位置決め部材との相対移動を規制し得る摩擦力の最大値は、腎臓カテーテルが腎臓に留置されているときに作用して前記相対移動を生じさせる外力であって想定される最大の外力の値より大きく、かつ、前記相対移動を生じさせる外力であって人の手のみにより付与可能な外力の値より小さい所定の値に設定されている。このため、腎臓カテーテルが腎臓に留置されているときに該腎臓カテーテルの腎臓カテーテル本体に想定される最大の外力が加わったとしても位置決め部材の筒部と中間部との相対移動が確実に阻止されると共に、人の手の力のみで中間部に対して位置決め部材を無理なく相対移動させ適宜位置決めすることができる。
請求項２に記載の考案によれば、中間部と位置決め部材との相対移動を規制し得る摩擦力の最大値が５ないし１０ニュートン（Ｎ）の範囲に設定されているので、腎臓カテーテルが腎臓に留置されているときに該腎臓カテーテルに想定される最大の外力が加わったとしても位置決め部材の筒部と中間部との相対移動が確実に阻止されると共に、人の手の力のみで中間部に対して位置決め部材を無理なく相対移動させ適宜位置決めすることができる。 According to the present invention, the relative movement between the intermediate portion and the positioning member is restricted by the frictional force caused by the contact between the intermediate portion of the renal catheter body and the cylindrical portion of the positioning member. For this reason, when using a suture to bend the distal end of the renal catheter body, the distal end of the renal catheter body does not come out of the renal pelvic cavity even if the suture is removed from the renal catheter body. In addition, the distal end portion of the renal catheter body can be prevented from slipping out of the renal pleural cavity of the kidney without bending the distal end portion of the renal catheter body.
In addition, the maximum value of the frictional force that can regulate the relative movement between the intermediate portion and the positioning member is an external force that acts when the renal catheter is placed in the kidney and causes the relative movement, and is assumed to be the maximum The external force is set to a predetermined value that is greater than the external force value and smaller than the external force value that causes the relative movement and that can be applied only by a human hand. For this reason, even when the maximum external force assumed on the kidney catheter body of the kidney catheter is applied when the kidney catheter is indwelled in the kidney, the relative movement between the cylindrical portion and the intermediate portion of the positioning member is reliably prevented. In addition, the positioning member can be relatively moved relative to the intermediate portion without difficulty by only the force of the hand of a person and can be appropriately positioned.
According to the second aspect of the present invention, the maximum value of the frictional force that can regulate the relative movement between the intermediate portion and the positioning member is set in the range of 5 to 10 Newton (N). Even if the maximum external force assumed to be applied to the renal catheter is applied to the kidney catheter, the relative movement between the cylindrical portion and the intermediate portion of the positioning member is reliably prevented, and the intermediate force can be obtained only with the force of a human hand. The positioning member can be relatively moved relative to the portion without difficulty and can be positioned appropriately.

請求項３に記載の考案によれば、位置決め部材の鍔部と盤状の布製のカフとは、それらの側面同士が互いに結着されているので、腎臓の表面に固定しやすいカフを介することで位置決め部材を腎臓に容易に固定することができる。
請求項４に記載の考案によれば、位置決め部材の筒部が嵌合された中間部における部位は、中間部における他の部位より高い剛性を有するように構成されている。このため、中間部内の流路面積の減少を防止することができるだけでなく、位置決め部材の筒部による中間部への緊締力が減少して中間部と位置決め部材との相対移動を規制し得る摩擦力の最大値が減少する虞を低減することができる。
請求項５に記載の考案によれば、請求項１ないし請求項４のうち何れか一つに記載の腎臓カテーテルを尿管バイパス装置に備えるので、少なくとも請求項１記載の考案の効果と同一の効果を奏することができる。よって、この考案の効果の記載は省略する。 According to the third aspect of the present invention, since the side surface of the collar portion of the positioning member and the disc-shaped cloth cuff are bonded to each other, the cuff is easily fixed to the surface of the kidney. Thus, the positioning member can be easily fixed to the kidney.
According to the fourth aspect of the present invention, the portion of the intermediate portion in which the cylindrical portion of the positioning member is fitted is configured to have higher rigidity than the other portion of the intermediate portion. For this reason, not only can the flow area in the intermediate portion be reduced, but also the friction that can restrict the relative movement between the intermediate portion and the positioning member by reducing the tightening force of the positioning member to the intermediate portion due to the cylindrical portion. The possibility that the maximum value of the force is reduced can be reduced.
According to the invention described in claim 5, since the renal catheter according to any one of claims 1 to 4 is provided in the ureteral bypass device, at least the same effect as that of the invention described in claim 1 is provided. There is an effect. Therefore, description of the effect of this device is omitted.

（１）図は本考案の実施の形態に係る腎臓カテーテルを備えた尿管バイパス装置を示した図であり、（２）図は本考案の実施の形態に係る腎臓カテーテルを示した図である。(1) The figure is the figure which showed the ureteral bypass device provided with the renal catheter which concerns on embodiment of this invention, (2) The figure which showed the renal catheter which concerns on embodiment of this invention . （１）図は本考案の実施の形態に係る腎臓カテーテルに縫合糸が挿入された状態を示した図であり、（２）図は（１）図の矢視Ａ−Ａ線に沿う断面を拡大して示した図である。(1) The figure is the figure which showed the state by which the suture thread was inserted in the renal catheter which concerns on embodiment of this invention, (2) A figure shows the cross section which follows the arrow AA line of (1) figure. It is the figure expanded and shown. （１）図は膀胱カテーテルを示した図であり、（２）図は（１）図の矢視Ｂ−Ｂ線に沿う断面を拡大して示した図である。(1) The figure is the figure which showed the urinary bladder catheter, (2) The figure is the figure which expanded and showed the cross section which follows the arrow BB line of (1) figure. （１）図は膀胱カテーテルと腎臓カテーテルとを接続するための中継アダプタを上方から見た状態を示した平面図であり、（２）図は同中継アダプタを側方から見た状態を示した側面図であり、（３）図は（１）図の矢視Ｃ−Ｃ線に沿う断面を示した図である。(1) The figure is the top view which showed the state which looked at the relay adapter for connecting a urinary bladder catheter and a renal catheter from upper direction, (2) The figure showed the state which looked at the relay adapter from the side It is a side view, (3) The figure is the figure which showed the section which meets the CC line of the figure of (1) figure.

（１）図は腎臓カテーテルの腎臓への挿入および膀胱カテーテルの膀胱への挿入に際して使用されるカニューラを示した図であり、（２）図は同カニューラ内に挿入されるトロッカーを示した図であり、（３）図は同カニューラ内に同トロッカーが挿入されて構成された穿刺針を示した図であり、（４）図はガイドワイヤの腎臓への挿入に際して使用されるシースを示した図であり、（５）図は同ガイドワイヤを示した図である。(1) The figure shows the cannula used when inserting the renal catheter into the kidney and the bladder catheter into the bladder. (2) The figure shows the trocar inserted into the cannula. (3) is a view showing a puncture needle constructed by inserting the same trocar into the cannula, and (4) is a view showing a sheath used for inserting a guide wire into the kidney. (5) is a view showing the guide wire. （１）図および（２）図は、本考案の実施の形態に係る腎臓カテーテルの先端部を変更した変形例を示した図である。FIGS. (1) and (2) are views showing modifications in which the distal end portion of the renal catheter according to the embodiment of the present invention is changed. （１）図は、本考案の実施の形態に係る腎臓カテーテルの中間部の一部を変更した変形例を示した図であり、（２）図は（１）図の矢視Ｄ−Ｄ線に沿う断面を拡大して示した図である。(1) The figure is the figure which showed the modification which changed a part of intermediate part of the renal catheter which concerns on embodiment of this invention, (2) The figure shows the DD line | wire by the arrow of (1) figure It is the figure which expanded and showed the cross section in alignment with. （１）図および（２）図は、本考案の実施の形態に係る腎臓カテーテルの中間部の一部を変更した他の変形例について、該中間部の一部をそれぞれ拡大して示した図である。(1) FIG. And (2) are the figures which expanded and showed a part of this intermediate part about the other modification which changed a part of the intermediate part of the renal catheter which concerns on embodiment of this invention, respectively. It is. （１）図は本考案の実施の形態に係る腎臓カテーテルを一対備えた尿管バイパス装置を示した図であり、（２）図は膀胱カテーテルと一対の腎臓カテーテルとを接続するための中継アダプタを上方から見た状態を示した平面図である。(1) The figure is the figure which showed the ureteral bypass apparatus provided with a pair of kidney catheters concerning embodiment of this invention, (2) The figure is a relay adapter for connecting a bladder catheter and a pair of kidney catheters It is the top view which showed the state which looked at from upper direction.

以下、本考案に係る実施の形態を図１ないし図５を参照して詳細に説明する。図１の（１）図において符号１で示すものは、本実施の形態に係る腎臓カテーテル３を備えた尿管バイパス装置の一例である。この尿管バイパス装置１は、犬および猫等の動物や人間の尿管が泌尿器系疾患等により閉塞または尿管障害を起こした際に尿路の確保のために供されるものである。
なお、作図の都合上、図１ないし図３および図５では、長尺な部材については、その長手方向中途部を省略して示している。尿管バイパス装置１は、腎臓カテーテル３および膀胱カテーテル５と、これらのカテーテル３，５が接続される中継アダプタ７と、各カテーテル３，５が中継アダプタ７に接続される接続部をそれぞれ被覆し緊締する一対の円筒状のブーツ９，９を備えている。 Hereinafter, embodiments of the present invention will be described in detail with reference to FIGS. 1 to 5. What is indicated by reference numeral 1 in FIG. 1A is an example of a ureteral bypass device including the renal catheter 3 according to the present embodiment. This ureteral bypass device 1 is provided for securing a urinary tract when an animal such as a dog or a cat or a human ureter is obstructed or has a ureteral disorder due to a urinary system disease or the like.
For convenience of drawing, in FIGS. 1 to 3 and FIG. 5, the longitudinal members of the long members are not shown. The ureteral bypass device 1 covers the kidney catheter 3 and the bladder catheter 5, the relay adapter 7 to which these catheters 3, 5 are connected, and the connection part to which each catheter 3, 5 is connected to the relay adapter 7. A pair of cylindrical boots 9, 9 to be tightened are provided.

腎臓カテーテル３は、中空の管からなる腎臓カテーテル本体１１と円盤状のカフ１３と位置決め部材１５とを備えている。腎臓カテーテル本体１１は、腎臓の腎盂腔内に留置される先端部１１ａと、該先端部１１ａに連なる中間部１１ｂと、該中間部１１ｂに連なると共に該中間部１１ｂを介して先端部１１ａと連通する後端部１１ｃとからなる。図２の（１）図において一部を拡大して示したように先端部１１ａは、末端部が先細に形成された先細部１７を有している。前記カフ１３および位置決め部材１５には、腎臓カテーテル本体１１の中間部１１ｂの外周部に嵌合可能な貫通孔がそれぞれの軸芯上に形成されている。位置決め部材１５は、カフ１３の外径より小さい外径を有する円盤状の鍔部１５ａと、該鍔部１５ａと一体化された円筒状の筒部１５ｂとを備えている。なお、先端部１１ａの先細部１７の末端部が先細に形成されているので、カフ１３および位置決め部材１５を腎臓カテーテル本体１１に先細部１７側から挿入する際に挿入しやすくなる。 The kidney catheter 3 includes a kidney catheter main body 11 made of a hollow tube, a disk-shaped cuff 13, and a positioning member 15. The renal catheter body 11 includes a distal end portion 11a placed in the renal pelvic cavity of the kidney, an intermediate portion 11b connected to the distal end portion 11a, and connected to the intermediate portion 11b and to the distal end portion 11a via the intermediate portion 11b. And a rear end portion 11c. As shown in a partially enlarged view in FIG. 2A, the distal end portion 11a has a tapered portion 17 whose end portion is tapered. In the cuff 13 and the positioning member 15, through holes that can be fitted to the outer peripheral portion of the intermediate portion 11 b of the renal catheter body 11 are formed on the respective shaft cores. The positioning member 15 includes a disc-shaped flange portion 15a having an outer diameter smaller than the outer diameter of the cuff 13, and a cylindrical tube portion 15b integrated with the flange portion 15a. Since the distal end portion of the tapered portion 17 of the distal end portion 11a is tapered, it becomes easy to insert the cuff 13 and the positioning member 15 into the renal catheter body 11 from the tapered portion 17 side.

位置決め部材１５が中間部１１ｂの外周部に嵌合されたときの、中間部１１ｂの外周部と位置決め部材１５の筒部１５ｂの内周部との接触による摩擦力により、中間部１１ｂの軸芯に沿う方向における中間部１１ｂと位置決め部材１５との相対移動が規制される。そして、相対移動を規制し得る摩擦力の最大値を超える人の手の力が位置決め部材１５に付与されることにより位置決め部材１５が中間部１１ｂを摺動して両者の相対移動が可能となる。前記摩擦力の最大値は、５ないし１０ニュートン（Ｎ）の範囲に設定されている。この範囲内であれば、人の手の力のみで中間部１１ｂに対して位置決め部材１５を無理なく相対移動させ適宜位置決めすることができる。また、前記摩擦力の最大値が前記範囲内であれば、腎臓カテーテル３が腎臓に留置されているときに作用することが想定される最大の外力（腎臓カテーテル本体１１の中間部１１ｂの軸芯に沿う方向に該中間部１１ｂを位置決め部材１５に対して相対移動させる外力）が該腎臓カテーテル３の腎臓カテーテル本体１１に加わったとしても、位置決め部材１５の筒部１５ｂと中間部１１ｂとの接触による摩擦力により両者の相対移動が確実に阻止される。 When the positioning member 15 is fitted to the outer peripheral portion of the intermediate portion 11b, the frictional force caused by the contact between the outer peripheral portion of the intermediate portion 11b and the inner peripheral portion of the cylindrical portion 15b of the positioning member 15 causes the axial center of the intermediate portion 11b. The relative movement between the intermediate portion 11b and the positioning member 15 in the direction along the direction is restricted. The positioning member 15 slides on the intermediate portion 11b by allowing the positioning member 15 to be applied with the force of the human hand that exceeds the maximum value of the frictional force that can regulate the relative movement. . The maximum value of the frictional force is set in the range of 5 to 10 newtons (N). Within this range, the positioning member 15 can be relatively moved relative to the intermediate portion 11b with the help of the hand of a person and positioned appropriately. Further, if the maximum value of the frictional force is within the above range, the maximum external force that is assumed to act when the renal catheter 3 is indwelled on the kidney (the axis of the intermediate portion 11b of the renal catheter body 11). Even if an external force that moves the intermediate portion 11b relative to the positioning member 15 in the direction along the center of the kidney catheter 3 is applied to the kidney catheter body 11, the contact between the cylindrical portion 15b of the positioning member 15 and the intermediate portion 11b. The relative movement between the two is reliably prevented by the frictional force.

一方、図３に示すように膀胱カテーテル５は、中空の管からなる膀胱カテーテル本体１９と、前記カフ１３と同様に構成された円盤状のカフ２１と、該カフ２１の外径より小さい外径を有する円盤状の位置決め部材２３とを備えている。膀胱カテーテル本体１９は、膀胱内に留置される先端部１９ａと、該先端部１９ａに連なる中間部１９ｂと、該中間部１９ｂに連なると共に該中間部１９ｂを介して先端部１９ａと連通する後端部１９ｃとからなり、先端部１９ａは、図３の（１）図において一部を拡大して示したように、末端部が先細に形成された先細部２５を有している。前記カフ２１および位置決め部材２３には、膀胱カテーテル本体１９の中間部１９ｂの外周部に嵌合可能な貫通孔がそれぞれの軸芯上に形成されている。
前記腎臓カテーテル本体１１の先細部１７を除いた先端部１１ａ，中間部１１ｂ，後端部１１ｃと、膀胱カテーテル本体１９の先細部２５を除いた先端部１９ａ，中間部１９ｂ，後端部１９ｃとの内径および外径は同一の寸法に形成されている。腎臓カテーテル本体１１および膀胱カテーテル本体１９は可撓性を有する部材からなり、それらの材質としては、例えば、ポリウレタン等の樹脂を挙げることができる。 On the other hand, as shown in FIG. 3, the bladder catheter 5 includes a bladder catheter body 19 formed of a hollow tube, a disc-shaped cuff 21 configured in the same manner as the cuff 13, and an outer diameter smaller than the outer diameter of the cuff 21. And a disk-shaped positioning member 23. The urinary bladder catheter body 19 includes a distal end portion 19a placed in the bladder, an intermediate portion 19b connected to the distal end portion 19a, and a rear end connected to the intermediate portion 19b and to the distal end portion 19a via the intermediate portion 19b. The tip portion 19a has a tapered portion 25 having a tapered end portion, as shown in a partially enlarged view in FIG. 3 (1). In the cuff 21 and the positioning member 23, through holes that can be fitted to the outer peripheral portion of the intermediate portion 19b of the bladder catheter main body 19 are formed on the respective shaft cores.
The distal end portion 11a, the intermediate portion 11b, and the rear end portion 11c of the kidney catheter body 11 except for the tapered portion 17; and the distal end portion 19a, the intermediate portion 19b, and the rear end portion 19c of the bladder catheter body 19 excluding the tapered portion 25; The inner diameter and the outer diameter of are formed to the same dimension. The kidney catheter body 11 and the bladder catheter body 19 are made of a flexible member, and examples of the material thereof include resins such as polyurethane.

腎臓カテーテル本体１１の先端部１１ａにおける中間部１１ｂ側の端部には、Ｘ線を透過しないマーカー部２７を備えており、該マーカー部２７は、硫酸バリウムまたはタングステン等のＸ線を透過しない物質の粉末がポリウレタン等の樹脂に添加されて形成された管からなる。
腎臓カテーテル３の位置決め部材１５の鍔部１５ａ，筒部１５ｂおよび膀胱カテーテル５の位置決め部材２３の材質としては、例えば、ポリウレタンまたはシリコンゴム等の樹脂を挙げることができる。腎臓カテーテル３の位置決め部材１５の鍔部１５ａと筒部１５ｂとは、熱を加えて互いに溶着することで一体化している。なお、熱を加えて溶着する方法に替えて、接着剤により接着することで一体化するか、または、成形型に樹脂材料を注入して一体成形により形成してもよい。 The end portion of the distal end portion 11a of the renal catheter body 11 is provided with a marker portion 27 that does not transmit X-rays at the end portion on the intermediate portion 11b side, and the marker portion 27 is a substance that does not transmit X-rays such as barium sulfate or tungsten. The tube is formed by adding a powder of polyurethane to a resin such as polyurethane.
Examples of the material of the collar portion 15a and the cylindrical portion 15b of the positioning member 15 of the renal catheter 3 and the positioning member 23 of the bladder catheter 5 include resins such as polyurethane and silicone rubber. The collar portion 15a and the cylindrical portion 15b of the positioning member 15 of the renal catheter 3 are integrated by applying heat and welding each other. In addition, it replaces with the method of applying heat and welding, and it may integrate by adhere | attaching with an adhesive agent, or you may inject | pour the resin material into a shaping | molding die and may form by integral molding.

また、腎臓カテーテル３のカフ１３および膀胱カテーテル５のカフ２１は不織布からなり、それらの材質としては、例えば、ポリエステル繊維，ナイロン繊維またはアクリル繊維等を挙げることができる。
腎臓カテーテル３の位置決め部材１５の鍔部１５ａとカフ１３との対向する側面同士および膀胱カテーテル５の位置決め部材２３とカフ２１との対向する側面同士は結着されており、それらの結着の方法としては、結着する部位を加熱して溶着する方法や接着剤により結着する方法が挙げられる。各位置決め部材１５，２３にカフ１３，２１がそれぞれ結着されているので、腎臓や膀胱の表面に固定しやすいカフ１３，２１を介することで各位置決め部材１５，２３を腎臓や膀胱にそれぞれ容易に固定することができる。
腎臓カテーテル本体１１の先端部１１ａは、円弧状に屈曲形成されており、その屈曲部の円弧状の内周面に、その内周方向に一定の間隔を隔てて穿設された４個の側孔３１…と、先端部１１ａの先細部１７に形成された開口１７ａとを備えている。また、腎臓カテーテル本体１１の先端部１１ａには、前記側孔３１より小さい小孔３３がマーカー部２７の近傍に穿設されている。該小孔３３には、後述する縫合糸４７が挿通される。 Further, the cuff 13 of the renal catheter 3 and the cuff 21 of the bladder catheter 5 are made of non-woven fabric, and examples of materials thereof include polyester fiber, nylon fiber, and acrylic fiber.
The opposing side surfaces of the buttocks 15a and the cuff 13 of the positioning member 15 of the renal catheter 3 and the opposing side surfaces of the positioning member 23 and the cuff 21 of the bladder catheter 5 are bound to each other. Examples of the method include a method in which a part to be bound is heated and welded, and a method in which a part is bound with an adhesive. Since the cuffs 13 and 21 are respectively attached to the positioning members 15 and 23, the positioning members 15 and 23 can be easily attached to the kidney and the bladder through the cuffs 13 and 21 that are easily fixed to the surface of the kidney and the bladder. Can be fixed to.
The distal end portion 11a of the renal catheter main body 11 is bent and formed in an arc shape, and four sides are formed on the arc-shaped inner peripheral surface of the bent portion at regular intervals in the inner peripheral direction. Are provided with holes 31... And an opening 17 a formed in the tip 17 of the tip end portion 11 a. Further, a small hole 33 smaller than the side hole 31 is formed in the distal end portion 11 a of the renal catheter body 11 in the vicinity of the marker portion 27. A suture thread 47 (described later) is inserted into the small hole 33.

一方、膀胱カテーテル本体１９の先端部１９ａは、その長手方向に一定の間隔を隔てて２個ずつ穿設された合計４個の側孔３５…と、先端部１９ａの先細部２５に形成された開口２５ａとを備えている。先端部１９ａの長手方向で同じ位置に穿設された２個の側孔３５，３５同士は先端部１９ａの軸芯に沿う方向から見て該軸芯回りに１８０度の等角度間隔で穿設されていると共に、先端部１９ａの長手方向で一方の位置に穿設された２個の側孔３５，３５と他方の位置に穿設された２個の側孔３５，３５とは前記軸芯回りに互いに９０度だけ角度がずれた位置に穿設されている。
而して、尿管バイパス装置１における腎臓カテーテル本体１１の先端部１１ａが腎臓の腎盂腔内に留置されることで、腎盂腔内の尿が各側孔３１および開口１７ａを介して先端部１１ａ内に流入したのち、中間部１１ｂ内および後端部１１ｃ内を通過して中継アダプタ７内に排出される。また、尿管バイパス装置１における膀胱カテーテル本体１９の先端部１９ａが膀胱内に留置されることで、腎臓カテーテル本体１１内から中継アダプタ７内に排出された尿が膀胱カテーテル本体１９の後端部１９ｃ内，中間部１９ｂ内および先端部１９ａ内を通過し、先端部１９ａの各側孔３５および先細部２５の開口２５ａを介して膀胱内に流入する。 On the other hand, the distal end portion 19a of the urinary bladder catheter body 19 is formed in a total of four side holes 35 formed by two at a predetermined interval in the longitudinal direction and the tapered portion 25 of the distal end portion 19a. And an opening 25a. Two side holes 35, 35 drilled at the same position in the longitudinal direction of the tip 19a are drilled at equal angular intervals of 180 degrees around the axis as viewed from the direction along the axis of the tip 19a. The two side holes 35 and 35 drilled at one position in the longitudinal direction of the distal end portion 19a and the two side holes 35 and 35 drilled at the other position are the axis. It is perforated at a position where the angle is shifted by 90 degrees.
Thus, the distal end portion 11a of the renal catheter main body 11 in the ureteral bypass device 1 is placed in the renal pelvic cavity of the kidney, so that urine in the renal pelvic cavity can be passed through the side holes 31 and the openings 17a. After flowing in, it passes through the intermediate part 11 b and the rear end part 11 c and is discharged into the relay adapter 7. Further, the distal end portion 19a of the bladder catheter main body 19 in the ureteral bypass device 1 is placed in the bladder so that the urine discharged from the kidney catheter main body 11 into the relay adapter 7 is the rear end portion of the bladder catheter main body 19 It passes through 19c, the intermediate portion 19b, and the distal end portion 19a, and flows into the bladder through the side holes 35 of the distal end portion 19a and the opening 25a of the tapered portion 25.

図４に示すように中継アダプタ７は、中継アダプタ本体３７と、該中継アダプタ本体３７に組み付けられた封止部材３９および一対のコネクタ４１，４１とを備えている。各コネクタ４１はそれぞれ中空の部材からなる。中継アダプタ本体３７は、椀状の第一アダプタ片３７ａと、該第一アダプタ片３７ａの開口部に圧入嵌合された第二アダプタ片３７ｂとを備えている。第二アダプタ片３７ｂの外周部には、周方向に互いに間隔を隔てて４個の貫通孔４３…が穿設されている。封止部材３９は、シリコンゴム材からなり、第一アダプタ片３７ａの中央部の貫通孔に嵌合圧入されている。各コネクタ４１は、中空の管からなり、それらの一端部に刻設された雄ねじ部が第二アダプタ片３７ｂに刻設された一対の雌ねじ孔にそれぞれ螺着されている。各コネクタ４１の他端部には、腎臓カテーテル本体１１の後端部１１ｃと膀胱カテーテル本体１９の後端部１９ｃとがそれぞれ嵌合接続される接続部４１ａが形成されている。中継アダプタ本体３７の内部には、第一アダプタ片３７ａ，第二アダプタ片３７ｂ，封止部材３９および一対のコネクタ４１，４１により囲繞された空洞４５が形成されている。第一アダプタ片３７ａと第二アダプタ片３７ｂとの圧入嵌合部、第一アダプタ片３７ａと封止部材３９との圧入嵌合部および第二アダプタ片３７ｂへの各コネクタ４１の螺着部は、それぞれ液密にシールされている。 As shown in FIG. 4, the relay adapter 7 includes a relay adapter main body 37, a sealing member 39 and a pair of connectors 41, 41 assembled to the relay adapter main body 37. Each connector 41 is made of a hollow member. The relay adapter main body 37 includes a bowl-shaped first adapter piece 37a and a second adapter piece 37b press-fitted into the opening of the first adapter piece 37a. Four through holes 43 are formed in the outer peripheral portion of the second adapter piece 37b at intervals in the circumferential direction. The sealing member 39 is made of a silicon rubber material, and is fitted and press-fitted into the through hole at the center of the first adapter piece 37a. Each connector 41 is formed of a hollow tube, and a male threaded portion engraved at one end thereof is screwed into a pair of female threaded holes engraved in the second adapter piece 37b. At the other end of each connector 41, a connecting portion 41a is formed in which the rear end portion 11c of the renal catheter main body 11 and the rear end portion 19c of the bladder catheter main body 19 are fitted and connected. Inside the relay adapter main body 37, a cavity 45 surrounded by a first adapter piece 37 a, a second adapter piece 37 b, a sealing member 39 and a pair of connectors 41, 41 is formed. A press-fit fitting portion between the first adapter piece 37a and the second adapter piece 37b, a press-fit fitting portion between the first adapter piece 37a and the sealing member 39, and a screwed portion of each connector 41 to the second adapter piece 37b are as follows. , Each is liquid tightly sealed.

＜尿管バイパス装置を留置する作業手順＞
次に、尿管が泌尿器系疾患などにより閉塞または尿管障害を起こした犬および猫等の動物や人間の腹部に、上述した尿管バイパス装置１を留置して尿路を確保するために行う外科的治療の作業手順の一例について図５も参照して詳細に説明する。
まず、腎臓の状態をＸ線撮影により取得した画像で観察し、腎臓カテーテル本体１１の屈曲形成された先端部１１ａが留置可能な程度に腎盂腔が拡張しているか否かを確認する。
腎臓カテーテル本体１１の先端部１１ａが留置可能であると判断されると、ナイロン製の１本の細い縫合糸４７（図２参照）が予め挿入された腎臓カテーテル本体１１の後端部１１ｃから腎臓カテーテル本体１１内に、図５の（１）図に示すような真っ直ぐな中空の管からなる金属製のカニューラ５１ａを挿入し腎臓カテーテル本体１１の先端部１１ａまで到達させて、先端部１１ａの屈曲部を真っ直ぐな状態に矯正しておく。なお、前記縫合糸４７は、その一端部が外部に存置されたまま他端部が腎臓カテーテル本体１１の後端部１１ｃから先端部１１ａまで挿通され先細部１７の開口１７ａから外部に延出されたのち小孔３３から再び腎臓カテーテル本体１１内に挿通されて後端部１１ｃから外部に延出されている。 <Working procedure for placing the ureteral bypass device>
Next, the above-described ureteral bypass device 1 is placed in the abdomen of animals and humans such as dogs and cats whose ureters are obstructed or have ureteral disorders due to urinary tract diseases or the like to secure a urinary tract An example of the surgical treatment procedure will be described in detail with reference to FIG.
First, the state of the kidney is observed with an image acquired by X-ray imaging, and it is confirmed whether or not the renal pelvic cavity is expanded to such an extent that the bent distal end portion 11a of the renal catheter body 11 can be placed.
When it is determined that the distal end portion 11a of the renal catheter body 11 can be placed, a single thin suture 47 (see FIG. 2) made of nylon is inserted into the kidney from the rear end portion 11c into which the renal catheter body 11 has been inserted in advance. A metal cannula 51a made of a straight hollow tube as shown in FIG. 5 (1) is inserted into the catheter body 11 to reach the distal end portion 11a of the renal catheter body 11, and the distal end portion 11a is bent. Straighten the part straight. The other end of the suture thread 47 is inserted from the rear end portion 11c of the renal catheter body 11 to the distal end portion 11a with one end portion of the suture thread 47 remaining outside. After that, it is again inserted into the renal catheter body 11 from the small hole 33 and extends to the outside from the rear end portion 11c.

次に、図５の（１）図に示すカニューラ５１ａと同一の構成を有する別個のカニューラ５１ａ内に、図５の（２）図に示すような真っ直ぐな先端が尖った金属製の針金状のトロッカー５１ｂが挿入されて構成された穿刺針５１（図５の（３）図参照）を膀胱カテーテル本体１９内にその後端部１９ｃ側から挿入しておく。
次に、腹部の中央をメスにより縦に切開して膀胱および腎臓を外部に露出させたのち、膀胱カテーテル本体１９およびカニューラ５１ａから突出したトロッカー５１ｂの先端により膀胱を穿刺して形成した刺入口を介して膀胱カテーテル５の先端部１９ａを膀胱内に挿入する。
次に、膀胱カテーテル本体１９の先端部１９ａを膀胱に挿入したまま膀胱カテーテル５内から穿刺針５１を抜き出す。 Next, in a separate cannula 51a having the same configuration as the cannula 51a shown in FIG. 5 (1), a metal wire-like shape with a sharp tip as shown in FIG. 5 (2) is used. A puncture needle 51 (see FIG. 5 (3)) configured with the trocar 51b inserted is inserted into the bladder catheter body 19 from the rear end 19c side.
Next, a longitudinal incision is made with a scalpel at the center of the abdomen to expose the bladder and kidney to the outside, and then the puncture port formed by puncturing the bladder with the tip of the trocar 51b protruding from the bladder catheter body 19 and the cannula 51a The distal end portion 19a of the bladder catheter 5 is inserted into the bladder.
Next, the puncture needle 51 is extracted from the bladder catheter 5 while the distal end portion 19a of the bladder catheter body 19 is inserted into the bladder.

次に、膀胱カテーテル本体１９の先端部１９ａを挿入した部位の膀胱の漿膜を、巾着の紐を引っ張ることで巾着の開口を窄めるようにする所謂、巾着縫合によりナイロン製の縫合糸で縫合する。これにより、膀胱カテーテル本体１９の外周部が膀胱の漿膜により緊締され、膀胱カテーテル本体１９の膀胱に対する相対移動は阻止される。
次に、一方の手で膀胱カテーテル本体１９の中間部１９ｂを把持した状態で他方の手で位置決め部材２３を把持して膀胱カテーテル本体１９に対して位置決め部材２３をカフ２１と共に膀胱の漿膜面の近傍まで相対移動させたのち、膀胱の漿膜面とカフ２１の側面とに医療用接着剤を塗布して膀胱の漿膜面とカフ２１とを接着すると共に膀胱の漿膜面とカフ２１とを縫合糸で縫合する。これにより、カフ２１および位置決め部材２３の膀胱に対する相対移動は阻止される。なお、膀胱の漿膜面とカフ２１とを縫合糸で縫合することで両者は強固に結着されるので、膀胱の漿膜面とカフ２１への医療用接着剤の塗布は省略してもよい。
次に、図５の（４）図に示すような真っ直ぐな中空の管からなる金属製のシース５３内に挿入された注射針（図示せず）を該シース５３と共に腎臓に穿刺して形成した刺入口を介してシース５３を腎盂腔内に挿入する。
次に、シース５３を腎臓に挿入したままシース５３内から前記注射針を抜き出したのち、図５の（５）図に示すようなガイドワイヤ５５をシース５３内に挿入し、ガイドワイヤ５５をその先端部が腎盂腔内に進入するまで挿入する。ガイドワイヤ５５は、柔軟性を有し自由に撓むことができる金属製の部材からなる。 Next, the serosa of the bladder where the distal end portion 19a of the bladder catheter body 19 is inserted is sutured with a nylon suture thread by so-called purse string suture, in which the purse string opening is narrowed by pulling the string of the purse string. To do. Thereby, the outer peripheral part of the bladder catheter body 19 is tightened by the serosa of the bladder, and the relative movement of the bladder catheter body 19 with respect to the bladder is prevented.
Next, in a state where the middle portion 19b of the bladder catheter body 19 is grasped with one hand, the positioning member 23 is grasped with the other hand, and the positioning member 23 is attached to the bladder catheter body 19 together with the cuff 21 on the serosal surface of the bladder. After the relative movement to the vicinity, a medical adhesive is applied to the serosal surface of the bladder and the side surface of the cuff 21 to adhere the serosal surface of the bladder and the cuff 21, and the serosal surface of the bladder and the cuff 21 are sutured. Suture with. Thereby, the relative movement with respect to the bladder of the cuff 21 and the positioning member 23 is prevented. Since the serosal surface of the bladder and the cuff 21 are sutured together by a suture thread, the application of the medical adhesive to the serosal surface of the bladder and the cuff 21 may be omitted.
Next, an injection needle (not shown) inserted into a metal sheath 53 made of a straight hollow tube as shown in FIG. 5 (4) is punctured with the sheath 53 into the kidney. The sheath 53 is inserted into the renal pelvic cavity through the puncture opening.
Next, after the sheath needle 53 is inserted into the kidney and the injection needle is extracted from the sheath 53, a guide wire 55 as shown in FIG. 5 (5) is inserted into the sheath 53, and the guide wire 55 is inserted into the sheath 53. Insert until the tip enters the renal pelvis. The guide wire 55 is made of a metal member that is flexible and can be freely bent.

次に、カニューラ５１ａが挿入された腎臓カテーテル本体１１の先端部１１ａ側からカニューラ５１ａ内にガイドワイヤ５５の後端を挿入し、腎臓カテーテル本体１１の先端部１１ａが腎臓の腎盂腔内に進入するまで腎臓カテーテル３をガイドワイヤ５５に沿わせて挿入する。
次に、腎臓カテーテル本体１１の先端部１１ａを腎盂腔内に留置したまま腎臓カテーテル本体１１からガイドワイヤ５５を引き抜いたのちカニューラ５１ａも腎臓カテーテル本体１１から引き抜く。このとき、ガイドワイヤ５５とカニューラ５１ａとを同時に引き抜いてもよい。
先端部１１ａが腎臓の腎盂腔内に位置付けられて４個の側孔３１…の全てが腎盂腔内に位置付けられていることが確認されると、腎臓カテーテル本体１１内に挿通され腎臓カテーテル本体１１の後端部１１ｃから外部に食み出している２本の縫合糸４７を同時に手で引っ張り、腎盂腔内に留置された腎臓カテーテル本体１１の先端部１１ａを円弧状に屈曲させる。なお、腎臓カテーテル本体１１の先端部１１ａが４個の側孔３１…を全て含めて腎臓の腎盂腔内に確実に位置付けられているか否かは、腎盂腔内に造影剤が注入された腎臓をＸ線撮影してその撮影により取得した画像中に写し出された先端部１１ａのマーカー部２７と腎盂腔の外形との相対的な位置関係から確認することができる。 Next, the rear end of the guide wire 55 is inserted into the cannula 51a from the distal end portion 11a side of the renal catheter body 11 into which the cannula 51a has been inserted, and the distal end portion 11a of the renal catheter body 11 enters the renal fistula of the kidney. Until the kidney catheter 3 is inserted along the guide wire 55.
Next, after the guide wire 55 is pulled out from the renal catheter body 11 while the distal end portion 11a of the renal catheter body 11 is left in the renal pelvic cavity, the cannula 51a is also pulled out from the renal catheter body 11. At this time, the guide wire 55 and the cannula 51a may be pulled out simultaneously.
When the distal end portion 11a is positioned in the renal pelvic cavity of the kidney and it is confirmed that all of the four side holes 31 are positioned in the renal pelvic cavity, the distal end portion 11a is inserted into the renal catheter main body 11 to be inserted. The two suture threads 47 protruding from the rear end portion 11c to the outside are simultaneously pulled by hand, and the distal end portion 11a of the renal catheter body 11 placed in the renal pelvic cavity is bent in an arc shape. Whether or not the distal end portion 11a of the renal catheter body 11 is surely positioned in the renal pelvic cavity including all four side holes 31 is determined based on whether the kidney into which the contrast medium has been injected into the renal pelvic cavity or not. It can be confirmed from the relative positional relationship between the marker portion 27 of the distal end portion 11a and the external shape of the renal pelvic cavity, which is captured in an image obtained by X-ray imaging.

次に、腎臓カテーテル本体１１の後端部１１ｃから外部に食み出している２本の縫合糸４７のうち何れか一方の縫合糸４７のみを手で引っ張り、腎臓カテーテル本体１１内から縫合糸４７を完全に抜き出す。なお、縫合糸４７を抜き出しても、腎臓カテーテル本体１１の先端部１１ａの円弧状に屈曲した形状は、該先端部１１ａ自体の剛性により残存し、その屈曲部の円弧状の内周面に各側孔３１が穿設されていることで、各側孔３１が腎盂腔の内壁に当接し難いので該内壁により各側孔３１が閉塞される虞は低減される。
次に、一方の手で腎臓カテーテル本体１１の中間部１１ｂを把持した状態で他方の手で位置決め部材１５を把持して腎臓カテーテル本体１１に対して位置決め部材１５をカフ１３と共に腎臓の腎被膜の近傍まで相対移動させる。このとき、中間部１１ｂと位置決め部材１５の筒部１５ｂとの接触による摩擦力の最大値を超える力を付与することで位置決め部材１５等を相対移動させることができる。摩擦力の最大値が５ないし１０ニュートン（Ｎ）の範囲に設定されているので、人の手の力のみで中間部１１ｂに対して位置決め部材１５を無理なく相対移動させ適宜位置決めすることができる。 Next, only one of the two sutures 47 protruding from the rear end portion 11c of the renal catheter body 11 to the outside is pulled by hand, and the suture 47 from the kidney catheter body 11 is pulled. Is completely extracted. Even when the suture thread 47 is extracted, the arcuate shape of the distal end portion 11a of the renal catheter body 11 remains due to the rigidity of the distal end portion 11a itself, and the arcuate inner peripheral surface of the bent portion Since the side holes 31 are perforated, it is difficult for the side holes 31 to come into contact with the inner wall of the renal pelvis cavity, so that the possibility of the side holes 31 being blocked by the inner wall is reduced.
Next, in a state where the intermediate portion 11b of the renal catheter body 11 is gripped by one hand, the positioning member 15 is gripped by the other hand, and the positioning member 15 is attached to the kidney catheter body 11 together with the cuff 13 together with the kidney capsule of the kidney. Move relative to the vicinity. At this time, the positioning member 15 and the like can be relatively moved by applying a force exceeding the maximum value of the frictional force due to the contact between the intermediate portion 11b and the cylindrical portion 15b of the positioning member 15. Since the maximum value of the frictional force is set in a range of 5 to 10 Newtons (N), the positioning member 15 can be relatively moved relative to the intermediate portion 11b by using only the force of a human hand and can be appropriately positioned. .

次に、腎被膜の表面とカフ１３の側面とに医療用接着剤を塗布して腎被膜の表面とカフ１３とを接着する。なお、腎被膜は膀胱に比べて非常に柔らかく脆いので、上述した巾着縫合を行うことができないため、腎被膜とカフ１３とを縫合糸で仮止めする。而して、腎被膜の表面にカフ１３が固定されることで、該カフ１３に結着された位置決め部材１５の腎臓に対する相対移動は阻止される。
次に、腹膜の外側に延出された腎臓カテーテル本体１１の後端部１１ｃと膀胱カテーテル本体１９の後端部１９ｃとにブーツ９をそれぞれ挿入したのち、中継アダプタ７の一方のコネクタ４１の外周部に腎臓カテーテル本体１１の後端部１１ｃの内周部を嵌合して腎臓カテーテル３を中継アダプタ７に接続すると共に、中継アダプタ７の他方のコネクタ４１の外周部に膀胱カテーテル本体１９の後端部１９ｃの内周部を嵌合して膀胱カテーテル５も中継アダプタ７に接続する。 Next, a medical adhesive is applied to the surface of the kidney capsule and the side surface of the cuff 13 to adhere the surface of the kidney capsule and the cuff 13. Since the kidney capsule is very soft and fragile compared to the bladder, the above described purse-string suture cannot be performed. Therefore, the kidney capsule and the cuff 13 are temporarily fixed with a suture thread. Thus, when the cuff 13 is fixed to the surface of the kidney capsule, the relative movement of the positioning member 15 attached to the cuff 13 with respect to the kidney is prevented.
Next, after inserting the boots 9 into the rear end portion 11c of the kidney catheter body 11 and the rear end portion 19c of the bladder catheter body 19 extending outside the peritoneum, the outer periphery of one connector 41 of the relay adapter 7 is inserted. The kidney catheter 3 is connected to the relay adapter 7 by fitting the inner peripheral portion of the rear end portion 11c of the kidney catheter body 11 to the portion, and the rear end of the bladder catheter body 19 is connected to the outer periphery of the other connector 41 of the relay adapter 7. The bladder catheter 5 is also connected to the relay adapter 7 by fitting the inner peripheral portion of the end 19c.

次に、腎臓カテーテル本体１１と膀胱カテーテル本体１９とに挿入された各ブーツ９を中継アダプタ７に向かって両カテーテル本体１１，１９に沿ってそれぞれ移動させ、両カテーテル本体１１，１９の各後端部１１ｃ，１９ｃと中継アダプタ７の各コネクタ４１との各接続部をそれぞれブーツ９により被覆して緊締する。
次に、腎臓カテーテル３と膀胱カテーテル５とが接続された中継アダプタ７を腹膜の外表面に縫合糸で縫合する。このとき、中継アダプタ７の第二アダプタ片３７ｂの平坦な外側面を腹膜の外表面に当接させた状態で第二アダプタ片３７ｂの４個の貫通孔４３…に縫合糸を挿通しながら縫合することで中継アダプタ７が腹膜の外表面に安定的に固定される。また、中継アダプタ７は、最初に腹部の中央を切開した部分以外の部位に位置する腹壁の下方に位置付けられ、該腹壁に対向する中継アダプタ７の封止部材３９の先端により該腹壁が押圧されることでその部位の腹部の皮膚が若干隆起する。この腹部の隆起により、中継アダプタ７の封止部材３９の腹部に対する位置を目視により容易に特定することができる。 Next, the boots 9 inserted in the renal catheter body 11 and the bladder catheter body 19 are moved along the catheter bodies 11 and 19 toward the relay adapter 7, respectively. Each connection portion between the portions 11c and 19c and each connector 41 of the relay adapter 7 is covered with the boot 9 and tightened.
Next, the relay adapter 7 to which the renal catheter 3 and the bladder catheter 5 are connected is sutured to the outer surface of the peritoneum with a suture thread. At this time, with the flat outer surface of the second adapter piece 37b of the relay adapter 7 in contact with the outer surface of the peritoneum, the suture is inserted through the four through holes 43 of the second adapter piece 37b. By doing so, the relay adapter 7 is stably fixed to the outer surface of the peritoneum. The relay adapter 7 is positioned below the abdominal wall located at a portion other than the part where the center of the abdomen is cut out first, and the abdominal wall is pressed by the tip of the sealing member 39 of the relay adapter 7 facing the abdominal wall. As a result, the skin of the abdomen of the part slightly rises. Due to the protrusion of the abdomen, the position of the relay adapter 7 relative to the abdomen of the sealing member 39 can be easily identified visually.

最後に、閉塞または尿管障害を起こした尿管の長手方向中途部の外周部を縫合糸で緊締して尿管内の尿路を閉塞したのち、メスにより切開した腹部の閉腹手術を行い、尿管バイパス装置１を腹部に留置する作業を終了する。
なお、上述した作業手順の順番については、上述した順番に限らず、本考案の目的から逸脱しない範囲で適宜変更してもよい。
また、上述した作業では、腎臓カテーテル３の腎臓カテーテル本体１１を腎臓の腎盂腔内に挿入する際に、シース５３やガイドワイヤ５５を使用する方法を採用したが、これに替えて、膀胱カテーテル５の膀胱カテーテル本体１９を膀胱内に挿入する方法と同様の方法を採用してもよい。すなわち、カニューラ５１ａ内にトロッカー５１ｂが挿入された穿刺針５１を腎臓カテーテル本体１１内に挿入し、腎臓カテーテル本体１１およびカニューラ５１ａから突出したトロッカー５１ｂの先端により腎臓を穿刺して形成した刺入口を介して腎臓カテーテル本体１１の先端部１１ａを腎盂腔内に挿入するようにしてもよい。 Finally, after closing the urinary tract in the ureter by tightening the outer periphery of the middle part in the longitudinal direction of the ureter where obstruction or ureteral disorder has occurred with the suture, perform abdominal abdominal surgery incised with a scalpel, The operation of placing the ureteral bypass device 1 in the abdomen is completed.
In addition, about the order of the work procedure mentioned above, you may change suitably in the range which is not restricted to the order mentioned above, and does not deviate from the objective of this invention.
Further, in the above-described operation, a method of using the sheath 53 and the guide wire 55 is employed when the renal catheter body 11 of the renal catheter 3 is inserted into the renal pelvic cavity of the kidney, but instead, the bladder catheter 5 A method similar to the method of inserting the bladder catheter body 19 into the bladder may be adopted. That is, a puncture needle formed by inserting a puncture needle 51 having a trocar 51b inserted into a cannula 51a into the renal catheter body 11 and puncturing the kidney with the tip of the trocar 51b protruding from the kidney catheter body 11 and the cannula 51a. The distal end portion 11a of the renal catheter body 11 may be inserted into the renal pelvis cavity.

なお、上述した腎被膜の表面とカフ１３および膀胱の漿膜面とカフ２１のそれぞれの医療用接着剤による接着力は、経時的に低下するものの、各カフ１３，２１に生体組織が浸入することで腎被膜の表面とカフ１３および膀胱の漿膜面とカフ２１はそれぞれ強固に結着する。これにより、カフ１３を介して腎被膜の表面に位置決め部材１５が強固に結着されることとなる。そして、このことと、位置決め部材１５の筒部１５ｂと中間部１１ｂとの接触による摩擦力の最大値が５ないし１０ニュートン（Ｎ）の範囲に設定されていることとで、腎臓カテーテル３が腎臓に留置されているときに作用することが想定される最大の外力（腎臓カテーテル本体１１の中間部１１ｂの軸芯に沿う方向に該中間部１１ｂを位置決め部材１５に対して相対移動させる外力）が腎臓カテーテル本体１１に加わったとしても、位置決め部材１５に対する、延いては腎臓に対する腎臓カテーテル本体１１の相対移動が確実に阻止される。 In addition, although the adhesive force by each medical adhesive of the surface of the kidney capsule and the cuff 13 and the serosal surface of the bladder and the cuff 21 described above decreases with time, living tissue invades each cuff 13 and 21. Thus, the surface of the kidney capsule and the cuff 13 and the serosal surface of the bladder and the cuff 21 are firmly bound to each other. As a result, the positioning member 15 is firmly bound to the surface of the kidney capsule via the cuff 13. And this and the maximum value of the frictional force caused by the contact between the cylindrical portion 15b of the positioning member 15 and the intermediate portion 11b is set in the range of 5 to 10 Newton (N), so that the renal catheter 3 is in the kidney. The maximum external force that is supposed to act when the device is indwelled (an external force that moves the intermediate portion 11b relative to the positioning member 15 in the direction along the axis of the intermediate portion 11b of the renal catheter body 11). Even if it is added to the renal catheter body 11, the relative movement of the renal catheter body 11 with respect to the positioning member 15 and with respect to the kidney is reliably prevented.

また、腎臓カテーテル本体１１内または膀胱カテーテル本体１９内が目詰まりしたときは、生理食塩水等の洗浄液が充填された注射器の注射針により腹部の皮膚および腹壁を貫通して中継アダプタ７の封止部材３９に該注射針を突き刺し、中継アダプタ７の空洞４５を介して腎臓カテーテル本体１１内および膀胱カテーテル本体１９内に洗浄液を注入する。これにより、尿の流通を阻害していた障害物を除去し腎臓カテーテル本体１１内および膀胱カテーテル本体１９内の流通を良好にすることができる。また、これとは逆に、中継アダプタ７の空洞４５を介して注射器により尿を吸引して採取し、その採取した尿を検査することもできる。このような洗浄液の注入や尿の採取は定期的に行われる。
なお、注射器の注射針が突き刺されることでできる封止部材３９の小さい孔は、注射器の注射針が抜き取られれば封止部材３９自体の弾性力により瞬時に復元して閉塞され液密にシールされる。 Further, when the inside of the renal catheter body 11 or the bladder catheter body 19 is clogged, the relay adapter 7 is sealed through the abdominal skin and the abdominal wall with an injection needle of a syringe filled with a cleaning solution such as physiological saline. The injection needle is pierced into the member 39, and a washing solution is injected into the renal catheter main body 11 and the bladder catheter main body 19 through the cavity 45 of the relay adapter 7. Thereby, the obstruction which has inhibited the circulation of urine can be removed, and the circulation in the renal catheter body 11 and the bladder catheter body 19 can be improved. Conversely, urine can be sucked and collected by a syringe through the cavity 45 of the relay adapter 7 and the collected urine can be examined. Such washing liquid injection and urine collection are performed periodically.
It should be noted that the small hole of the sealing member 39 that can be formed by the needle of the syringe being pierced is instantly restored by the elastic force of the sealing member 39 itself when the syringe needle of the syringe is pulled out, and is sealed and liquid-tightly sealed. The

上述したような本考案の実施の形態に係る腎臓カテーテル３によれば、縫合糸４７を利用して腎臓カテーテル３の先端部１１ａを屈曲させた後、該縫合糸４７を腎臓カテーテル本体１１から完全に取り除くようにしたため、縫合糸４７を中途部の所定の位置で切断してその切断した末端を、腎臓カテーテル本体１１の後端部１１ｃと中継アダプタ７のコネクタ４１との嵌合長さの中途部に位置付けるという細かな作業が不要となる。
また、縫合糸４７を腎臓カテーテル本体１１から完全に取り除くようにした結果、腎臓カテーテル本体１１の先端部１１ａ自体の剛性だけでは円弧状に屈曲した形状が好適に維持されず先端部１１ａが腎臓の腎盂腔内から抜け出やすくなったとしても、位置決め部材１５の鍔部１５ａが結着されたカフ１３が腎被膜の表面に固定されると共に、位置決め部材１５の筒部１５ｂと腎臓カテーテル本体１１の中間部１１ｂとの接触による摩擦力が確実に作用するため、腎臓カテーテル本体１１の先端部１１ａが腎盂腔内から抜け出る虞はない。 According to the kidney catheter 3 according to the embodiment of the present invention as described above, after the distal end portion 11a of the kidney catheter 3 is bent using the suture thread 47, the suture thread 47 is completely removed from the kidney catheter body 11. Therefore, the suture thread 47 is cut at a predetermined position in the middle portion, and the cut end is halfway in the fitting length between the rear end portion 11c of the renal catheter body 11 and the connector 41 of the relay adapter 7. The detailed work of positioning to the part becomes unnecessary.
Further, as a result of completely removing the suture thread 47 from the renal catheter main body 11, the shape bent in an arc shape is not suitably maintained only by the rigidity of the distal end portion 11a itself of the renal catheter main body 11, and the distal end portion 11a is not in the kidney. Even if it becomes easy to escape from the renal pelvic cavity, the cuff 13 to which the collar portion 15a of the positioning member 15 is bound is fixed to the surface of the kidney capsule, and the intermediate portion between the cylindrical portion 15b of the positioning member 15 and the renal catheter body 11 is fixed. Since the frictional force due to contact with the portion 11b acts reliably, there is no possibility that the distal end portion 11a of the renal catheter body 11 comes out of the renal pelvis cavity.

上述した実施の形態は本考案を説明するための一例であり、本考案は、前記の実施の形態に限定されるものではなく、実用新案登録請求の範囲と明細書との全体から読み取れる考案の要旨または思想に反しない範囲で適宜変更可能であり、そのような変更後の腎臓カテーテルもまた、本考案の技術的範囲に含まれるものである。
例えば、上述した実施の形態に係る腎臓カテーテル３の腎臓カテーテル本体１１または腎臓カテーテル３を備えた尿管バイパス装置１の構成に替えて、図６ないし図９に示すように構成してもよい。これらの図において、長尺な部材については作図の都合上その長手方向の一部を省略して示すと共に、上述した実施の形態で説明したものと同一または同等の部材および部位等については、同一の符号を付し詳細な説明は省略し、前記実施の形態とは異なる点を主に詳細に説明する。 The above-described embodiment is an example for explaining the present invention, and the present invention is not limited to the above-described embodiment, and the invention can be read from the entire scope of the claims and the specification of the utility model registration. Changes can be made as appropriate without departing from the gist or idea, and such a changed renal catheter is also included in the technical scope of the present invention.
For example, instead of the configuration of the renal catheter main body 11 of the renal catheter 3 or the ureteral bypass device 1 including the renal catheter 3 according to the above-described embodiment, the configuration may be configured as shown in FIGS. In these drawings, for the convenience of drawing, a part in the longitudinal direction is omitted for a long member, and the same or equivalent members and parts as those described in the above embodiment are the same. The detailed description will be omitted, and differences from the above embodiment will be mainly described in detail.

図６の（１）図に示す腎臓カテーテル３の腎臓カテーテル本体１１の先端部１１ａは、前記実施の形態に係る腎臓カテーテル本体１１の先端部１１ａより大きな曲率半径を有する円弧状に形成している。このような円弧状に形成したことで腎臓の腎盂腔の形状に沿わせて挿入しやすくなる。また、図６の（２）図に示す腎臓カテーテル３の腎臓カテーテル本体１１の先端部１１ａは、真っ直ぐな直線状に形成している。
これらのような形状に先端部１１ａを形成した場合でも、位置決め部材１５の鍔部１５ａが結着されたカフ１３が腎被膜の表面に固定されると共に、位置決め部材１５の筒部１５ｂと腎臓カテーテル本体１１の中間部１１ｂとの接触による摩擦力が確実に作用するため、腎臓カテーテル３の先端部１１ａが腎盂腔内から抜け出る虞はない。また、腎臓カテーテル本体１１の先端部１１ａを大きな曲率半径の円弧状または直線状に形成することで、前記実施の形態に係る腎臓カテーテル本体１１のような屈曲部を有する先端部１１ａを留置可能な空間が腎臓の腎盂腔内に存在しない場合でも腎臓カテーテル３を腎臓に適切に留置することができる。 The distal end portion 11a of the renal catheter body 11 of the renal catheter 3 shown in FIG. 6 (1) is formed in an arc shape having a larger radius of curvature than the distal end portion 11a of the renal catheter body 11 according to the embodiment. . By forming in such an arc shape, it becomes easy to insert along the shape of the renal pelvic cavity of the kidney. Further, the distal end portion 11a of the renal catheter body 11 of the renal catheter 3 shown in FIG. 6 (2) is formed in a straight straight line.
Even when the tip portion 11a is formed in such a shape, the cuff 13 to which the collar portion 15a of the positioning member 15 is bound is fixed to the surface of the kidney capsule, and the cylindrical portion 15b of the positioning member 15 and the kidney catheter are fixed. Since the frictional force due to the contact with the intermediate part 11b of the main body 11 acts reliably, there is no possibility that the distal end part 11a of the renal catheter 3 comes out of the renal pelvis cavity. In addition, by forming the distal end portion 11a of the renal catheter body 11 in an arc shape or a linear shape having a large curvature radius, the distal end portion 11a having a bent portion like the renal catheter body 11 according to the embodiment can be placed. Even when there is no space in the renal pelvic cavity of the kidney, the renal catheter 3 can be properly placed in the kidney.

また、図７の（１）図に示す腎臓カテーテル３の腎臓カテーテル本体１１は、その中間部１１ｂにおける長手方向の一定の範囲Ｌが、中間部１１ｂにおける他の部位より剛性が高い管状部材５７で構成されている。管状部材５７の内径および外径の寸法は、管状部材５７の両端にそれぞれ連なる中間部１１ｂや、先細部１７を除いた先端部１１ａおよび後端部１１ｃの内径および外径の寸法と同一に設定されている。管状部材５７と該管状部材５７の両端にそれぞれ連なる中間部１１ｂとを結着する方法としては、結着する部位を加熱して溶着する方法や接着剤により結着する方法が挙げられる。
また、一定の範囲Ｌは、腎臓カテーテル３が腎臓に留置されたとき、その腎臓カテーテル本体１１の中間部１１ｂに嵌合された位置決め部材１５の筒部１５ｂが位置する部位を含む中間部１１ｂの所定の範囲が設定されている。 Further, the renal catheter body 11 of the renal catheter 3 shown in FIG. 7 (1) is a tubular member 57 in which the constant range L in the longitudinal direction in the intermediate part 11b is higher in rigidity than other parts in the intermediate part 11b. It is configured. The inner diameter and the outer diameter of the tubular member 57 are set to be the same as the inner diameter and the outer diameter of the intermediate portion 11b connected to both ends of the tubular member 57 and the front end portion 11a and the rear end portion 11c excluding the tip 17. Has been. Examples of the method for binding the tubular member 57 and the intermediate portion 11b connected to both ends of the tubular member 57 include a method of heating and welding a portion to be bonded, and a method of bonding with an adhesive.
In addition, the certain range L includes a portion of the intermediate portion 11b including a portion where the cylindrical portion 15b of the positioning member 15 fitted to the intermediate portion 11b of the kidney catheter body 11 is located when the kidney catheter 3 is placed in the kidney. A predetermined range is set.

もし、位置決め部材１５の筒部１５ｂが嵌合された中間部１１ｂの剛性が低いと、該中間部１１ｂが筒部１５ｂによる長時間の緊締によりクリープ現象を起こして縮径することで、該中間部１１ｂ内の流路面積が減少するだけでなく筒部１５ｂによる緊締力も減少し、延いては、中間部１１ｂの外周部と位置決め部材１５の筒部１５ｂの内周部との接触による摩擦力が低下する。この摩擦力が低下すると、中間部１１ｂと位置決め部材１５とが小さな外力でも中間部１１ｂの軸芯に沿う方向に相対移動して、腎臓カテーテル本体１１の先端部１１ａが腎盂腔内から抜け出る虞がある。しかし、上述したように中間部１１ｂの剛性を高くすることでクリープ現象に起因する中間部１１ｂ内の流路面積の減少を防止することができると共に、筒部１５ｂによる緊締力の減少を抑制することができ、延いては、中間部１１ｂと位置決め部材１５の筒部１５ｂとの接触による摩擦力の低下を防止することができる。 If the intermediate portion 11b to which the cylindrical portion 15b of the positioning member 15 is fitted has low rigidity, the intermediate portion 11b shrinks due to a creep phenomenon due to long-time tightening by the cylindrical portion 15b. Not only the flow path area in the portion 11b is reduced, but also the tightening force by the cylindrical portion 15b is reduced, so that the frictional force due to the contact between the outer peripheral portion of the intermediate portion 11b and the inner peripheral portion of the cylindrical portion 15b of the positioning member 15 is reduced. Decreases. When this frictional force decreases, the intermediate portion 11b and the positioning member 15 may move relative to each other in the direction along the axis of the intermediate portion 11b even with a small external force, and the distal end portion 11a of the renal catheter body 11 may come out of the renal pelvis cavity. is there. However, as described above, by increasing the rigidity of the intermediate portion 11b, it is possible to prevent a reduction in the flow passage area in the intermediate portion 11b due to the creep phenomenon, and to suppress a reduction in the tightening force by the cylindrical portion 15b. As a result, it is possible to prevent a decrease in frictional force due to contact between the intermediate portion 11b and the cylindrical portion 15b of the positioning member 15.

管状部材５７の剛性が高くなるように構成する例としては、管状部材５７を、それ以外の腎臓カテーテル本体１１の部位より硬質のポリウレタン等の樹脂で構成する構造や、図７の（２）図と、図８の（１）図および（２）図に示す各構造が挙げられる。図７の（２）図に示す構造は、図７の（１）図に示す管状部材５７のみに剛性の高い樹脂もしくは金属からなる網状の部材５９を内部に埋設したものである。
また、図８の（１）図に示す構造は、前記管状部材５７のみに硬質のポリウレタン等の樹脂もしくは金属からなる螺旋状の線部材６１を内部に埋設したもので、同図は管状部材５７の一部を側方から見た状態を拡大して示しており、同図において右側の略半分は管状部材５７の軸芯に沿う方向の縦方向に縦断して見た断面を示している。
また、図８の（２）図に示す構造は、硬質のポリウレタン等の樹脂からなる１本の帯状部材６３と、該帯状部材６３より幅広で軟質のポリウレタン等の樹脂からなる１本の帯状部材６５とを、これらの帯状部材６３，６５の側縁同士が接合するように螺旋状に巻いて互いに結着することで筒状に形成し管状部材５７を構成したものである。同（２）図は、管状部材５７の一部を側方から見た状態を拡大して示しており、同図において右側の略半分は管状部材５７の軸芯に沿う方向の縦方向に縦断して見た断面を示している。前記各帯状部材６３，６５同士を互いに結着する方法としては、結着する部位を加熱して溶着する方法や接着剤により結着する方法が挙げられる。 As an example in which the tubular member 57 is configured to have high rigidity, the tubular member 57 is configured of a resin such as polyurethane that is harder than the other portions of the renal catheter body 11, or FIG. 7 (2). And the structures shown in FIGS. 8A and 8B. The structure shown in FIG. 7 (2) is obtained by embedding a net-like member 59 made of a highly rigid resin or metal only in the tubular member 57 shown in FIG. 7 (1).
Further, in the structure shown in FIG. 8A, a spiral wire member 61 made of a resin such as hard polyurethane or metal is embedded only in the tubular member 57, and the figure shows the tubular member 57. FIG. 2 is an enlarged view of a portion of the tubular member 57 viewed from the side, and in the same figure, the substantially half on the right side shows a cross-section viewed in a longitudinal direction along the axis of the tubular member 57.
Further, the structure shown in FIG. 8B is composed of one belt-like member 63 made of a resin such as hard polyurethane, and one belt-like member made of a resin such as polyurethane that is wider than the belt-like member 63 and soft. 65 is formed in a cylindrical shape by spirally winding the belt-like members 63 and 65 so that the side edges of the belt-like members 63 and 65 are joined to each other, thereby forming a tubular member 57. FIG. 2B shows an enlarged view of a part of the tubular member 57 viewed from the side. In FIG. 2, the right half of the tubular member 57 is longitudinally cut in the longitudinal direction along the axis of the tubular member 57. The cross section seen is shown. Examples of a method for binding the band members 63 and 65 to each other include a method of heating and welding the portions to be bonded and a method of bonding with an adhesive.

なお、上述した実施の形態に係る腎臓カテーテル３を備えた尿管バイパス装置１は、一対の尿管のうち何れか一方の尿管のみが泌尿器系疾患等により閉塞または尿管障害を起こした場合に使用することができるものである。もし、一対の尿管の双方が泌尿器系疾患等により閉塞または尿管障害を起こした場合は、それぞれの腎臓と膀胱とを２個の尿管バイパス装置１，１を介してそれぞれ個別に接続すれば一対の尿路を共に確保することができるが、これに替えて、図８の（１）図に示す尿管バイパス装置１'を使用して一対の尿路を共に確保するようにしてもよい。この尿管バイパス装置１'は、一対の腎臓カテーテル３，３と１つの膀胱カテーテル５とが１つの中継アダプタ７'に接続されている。図８の（２）図に示すように、中継アダプタ７'の一方側には膀胱カテーテル５が接続される１つのコネクタ４１が設けられ、中継アダプタ７'の他方側には一対の腎臓カテーテル３，３が接続される一対のコネクタ４１，４１が並設されている。 In the ureteral bypass device 1 including the kidney catheter 3 according to the above-described embodiment, only one of the pair of ureters is obstructed or has a ureteral disorder due to a urinary system disease or the like. It can be used for. If both of the pair of ureters are obstructed or have a ureteral disorder due to a urinary tract disease or the like, each kidney and bladder should be connected individually via the two ureteral bypass devices 1 and 1. For example, a pair of urinary tracts can be secured together, but instead, a pair of urinary tracts can be secured together using the ureteral bypass device 1 'shown in FIG. 8 (1). Good. In this ureteral bypass device 1 ', a pair of kidney catheters 3, 3 and one bladder catheter 5 are connected to one relay adapter 7'. As shown in FIG. 8 (2), one connector 41 to which the bladder catheter 5 is connected is provided on one side of the relay adapter 7 ′, and a pair of kidney catheters 3 are provided on the other side of the relay adapter 7 ′. , 3 are connected in parallel.

１尿管バイパス装置
１' 尿管バイパス装置
３腎臓カテーテル
５膀胱カテーテル
７中継アダプタ
７' 中継アダプタ
１１腎臓カテーテル本体
１１ａ先端部
１１ｂ中間部
１１ｃ後端部
１３カフ
１５位置決め部材
１５ａ鍔部
１５ｂ筒部 DESCRIPTION OF SYMBOLS 1 Ureteral bypass apparatus 1 'Ureteral bypass apparatus 3 Kidney catheter 5 Bladder catheter 7 Relay adapter 7' Relay adapter 11 Kidney catheter main body 11a Tip part 11b Middle part 11c Rear end part 13 Cuff 15 Positioning member 15a Ridge part 15b Tube part

Claims

A distal end portion that is placed in the kidney and into which the urine in the kidney flows, and a rear end portion that communicates with the distal end portion through an intermediate portion that is continuous with the distal end portion and that can discharge the urine that has flowed from the distal end portion. A renal catheter body comprising a hollow tube,
A renal catheter provided with a positioning member that can be fitted to the outer peripheral portion of the intermediate portion,
The positioning member includes a collar part that can be fixed to the kidney, and a cylindrical part integrated with the collar part,
When the positioning member is fitted to the outer peripheral portion of the intermediate portion, the frictional force caused by the contact between the outer peripheral portion of the intermediate portion and the inner peripheral portion of the cylindrical portion of the positioning member causes the axial center of the intermediate portion to Restricting relative movement between the intermediate portion and the positioning member in the direction along
The maximum value of the frictional force that can regulate the relative movement is an external force that acts when the renal catheter is indwelled in the kidney and causes the relative movement, and is larger than the assumed maximum external force value. The kidney catheter is set to a predetermined value smaller than a value of the external force that causes the relative movement and can be applied only by a human hand.

The renal catheter according to claim 1,
The renal catheter, wherein the predetermined value is set in a range of 5 to 10 Newton (N).

In the renal catheter according to claim 1 or 2,
A cuff made of a disk-shaped cloth that can be fitted to the outer peripheral portion of the intermediate portion and can be fixed to the surface of the kidney,
A kidney catheter characterized in that the side surface of the collar portion of the positioning member and the cuff are bound to each other.

In the renal catheter according to any one of claims 1 to 3,
When the renal catheter is placed in the kidney, a portion of the intermediate portion into which the cylindrical portion of the positioning member is fitted is configured to have higher rigidity than other portions of the intermediate portion. And kidney catheter.

A renal catheter according to any one of claims 1 to 4;
A relay adapter capable of connecting one end to the kidney catheter;
A ureteral bypass device comprising a bladder catheter connectable to the other end of the relay adapter.