JP3216882U - Catheter, auxiliary tool for mounting, urinary tract bypass device provided with catheter - Google Patents

Abstract

The positioning member can be smoothly moved by hand with respect to the catheter body without applying a large force, and the positioning member is stably held at a predetermined position after the positioning member is positioned. Provided are a catheter, a mounting aid, and a ureteral bypass device. A renal catheter 3 of a ureteral bypass device 1 includes a renal catheter body 11 and a positioning member 13. The positioning member 13 includes a flanged tubular member 16 and a tightening member 17. The rod-shaped tubular member 16 includes a collar portion 16a that can be fixed to the kidney, and a cylinder portion 16b that is bound to the collar portion 16a. The tightening member 17 is fitted to the outer peripheral portion of the cylindrical portion 16b. When the tightening member 17 is fitted and the tube portion 16b is tightened, the inner peripheral surface of the tube portion 16b and the outer peripheral surface of the renal catheter body 11 are pressed against each other, and the frictional force caused by the contact between the inner peripheral surface and the outer peripheral surface is brought about. Thus, the relative movement between the renal catheter body 11 and the flanged tubular member 16 is restricted. [Selection] Figure 1

Description

  The present invention relates to a catheter for indwelling in a kidney or a bladder, a mounting aid for smoothly performing a procedure using the catheter, and a urinary tract bypass device including the catheter.

  Patent Document 1 describes a ureteral bypass device that is used to secure 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. ing. This ureteral bypass device includes a kidney catheter having one end indwelled in the renal pelvic cavity of the kidney, a relay adapter to which the other end of the kidney catheter is connected, and one end connected to the relay adapter and the other end And a bladder catheter that is placed in the bladder.

  Patent Document 2 discloses that the internal urethral orifice of the bladder in animals such as dogs and cats or the urinary tract downstream from the internal urethral orifice is obstructed due to cancer or other urinary tract disease. A urination bypass device provided for securing the urinary tract is described. This urination bypass device includes a kidney catheter having one end indwelled in the renal pelvic cavity of the kidney, a relay adapter to which the other end of the kidney catheter is connected, and one end connected to the relay adapter and the other end being A urinary catheter placed between the penis and the foreskin.

  The renal catheter described in Patent Document 1 and Patent Document 2 includes a renal catheter body formed of a hollow tube, and a positioning member that can be fitted to an outer peripheral portion of a longitudinal middle portion of the renal catheter body, The positioning member includes a collar part that can be fixed to the kidney and a cylindrical part integrated with the collar part. The relative movement of the positioning member in the longitudinal direction with respect to the renal catheter main body is regulated by a frictional force caused by contact between the outer peripheral surface of the renal catheter main body and the inner peripheral surface of the cylindrical portion of the positioning member.

Utility model registration No. 3209522 Utility Model Registration No. 3211050

  However, after the kidney catheter is indwelled in the kidney, it may be desired to change the position of the positioning member relative to the kidney catheter body to an appropriate position. In such a case, compared to before the kidney catheter is indwelled in the kidney. Because the space where you can put your hands is narrow, you can't apply great force by hand. In such a case, in the renal catheter shown in Patent Document 1, depending on the magnitude of the frictional force acting between the outer peripheral surface of the renal catheter main body and the inner peripheral surface of the cylindrical portion of the positioning member, the renal catheter main body However, there has been a problem that the positioning member cannot be easily moved relatively.

  The present invention has been made to solve the above-described problems, and can smoothly move the positioning member with respect to the catheter body by hand without applying a large force. An object of the present invention is to provide a technique capable of stably holding the positioning member at a predetermined position of the catheter body after positioning the positioning member.

  In order to achieve this object, a catheter according to the present invention includes a distal end portion that can be placed in either an organ of the kidney or the bladder, and the distal end portion that is connected to the distal end portion and placed in the organ. A catheter main body comprising a hollow tube having an intermediate portion that can communicate with the inside of the organ through the intermediate portion, and a rear end portion that can communicate with the distal end portion through the intermediate portion, and an outer peripheral portion of the intermediate portion. A catheter having a fitting member that can be fitted, wherein the positioning member includes a collar part that can be fixed to the organ, and a tubular member with a collar that includes a tubular part integrated with the collar part, and the tube A tightening member that can be fitted to the outer peripheral portion of the portion, and the tightening member is fitted to the outer peripheral portion of the tubular portion of the hooked tubular member that is fitted to the outer peripheral portion of the intermediate portion of the catheter body. By tightening the tube portion, the inner peripheral surface of the tube portion and the intermediate portion The outer peripheral surface is in pressure contact, and the relative movement between the intermediate portion and the flanged tubular member in the direction along the axis of the intermediate portion is restricted by the frictional force generated by the contact between the inner peripheral surface and the outer peripheral surface. It is characterized by this.

  A catheter according to a second aspect of the present invention is the catheter according to the first aspect, wherein the catheter is made of a disc-like cloth that can be fitted to the outer peripheral portion of the intermediate portion of the catheter body and can be fixed to the surface of the kidney. A cuff is further provided, and the collar portion of the tubular member with the collar and the cuff are characterized in that their side surfaces are bonded to each other.

  The catheter according to a third aspect of the present invention is the catheter according to the first or second aspect, wherein the tightening member is a circular elastic member in which a slit is formed along the axial direction thereof. The tightening member when fitted to the outer peripheral portion of the tubular portion of the flanged tubular member has a cross-sectional shape orthogonal to the axial direction deformed into a C-shape. It is.

  When the fitting member according to the invention described in claim 4 is fitted to the outer peripheral portion of the tubular portion of the tubular member with a hook in the catheter according to claim 3, the fitting aid is fitted. A cylindrical mounting assisting tool capable of assisting, wherein the mounting assisting tool includes a small diameter portion on one end side in the direction along the axis, and a large diameter portion on the other end side in the same direction, An outer diameter of the small-diameter portion, comprising a slope portion connecting the small-diameter portion and the large-diameter portion so that the thickness thereof smoothly changes, and a through-hole penetrating from the one end side to the other end side. Is formed to have a dimension equal to or smaller than the inner diameter of the tightening member before being fitted to the outer periphery of the tubular portion of the flanged tubular member, and the outer diameter of the large diameter portion is the tubular portion of the tubular member with the flange The through-hole can be inserted through the catheter body. It is.

  The urinary tract bypass device according to the invention described in claim 5 includes a renal catheter having a renal catheter body including a hollow tube whose tip can be placed in the kidney, and a hollow tube whose tip can be placed in the bladder. Urinary tract bypass device comprising: a bladder catheter having a bladder catheter body comprising: a rear end portion of the kidney catheter body; and a relay adapter capable of connecting one end portion and the other end portion to the rear end portion of the bladder catheter body. Then, at least one of the renal catheter and the bladder catheter is the catheter according to any one of claims 1 to 3.

  A urinary tract bypass device according to the invention described in claim 6 is the catheter according to any one of claims 1 to 3, wherein the distal end portion can be placed in a kidney, and the catheter When a catheter having a main body is defined as a renal catheter main body and a renal catheter, respectively, the renal catheter, and a urinary catheter main body including a hollow tube having a distal end portion and a rear end portion opposite to the distal end portion are provided. A urinary bypass device comprising: a urinary catheter; a relay adapter capable of connecting one end and the other end to the rear end of the kidney catheter body and the rear end of the urine catheter body, wherein the relay adapter One end and the other end of the catheter are respectively connected to the rear end of the kidney catheter body and the rear end of the urination catheter body. In which it characterized in that it is configured to communicate from the tip of the renal catheter body to the tip of the urinary catheter body through the relay adapter.

According to the present invention, the tightening member is fitted to the outer peripheral portion of the tubular portion of the flanged tubular member that is fitted to the outer peripheral portion of the intermediate portion of the catheter body, and the cylindrical portion is tightened so that the inner portion of the cylindrical portion is tightened. The peripheral surface and the outer peripheral surface of the intermediate portion are pressed against each other, and the frictional force generated by the contact between the inner peripheral surface and the outer peripheral surface causes relative movement between the intermediate portion and the flanged cylindrical member in the direction along the axis of the intermediate portion. Be regulated. Therefore, before the tightening member is fitted to the outer peripheral portion of the tubular portion of the barbed tubular member, the outer peripheral surface of the intermediate portion of the catheter body and the inner peripheral surface of the tubular portion of the barbed tubular member are tightening members. Therefore, the flanged cylindrical member can be smoothly moved by hand with respect to the intermediate portion without applying a large force. As a result, it is possible to easily perform the positioning operation of the hooked tubular member with respect to the intermediate portion of the catheter body.
On the other hand, after the tightening member is fitted to the outer peripheral portion of the tubular portion of the flanged tubular member positioned with respect to the intermediate portion of the catheter body, the inner peripheral surface of the tubular portion and the intermediate portion are tightened by the tightening force of the tightening member. Since the relative movement between the intermediate portion and the flanged tubular member is restricted by the frictional force caused by the contact between the inner peripheral surface and the outer peripheral surface, the flanged tube is placed at a predetermined position in the intermediate portion. The shaped member can be stably held.

  According to the second aspect of the present invention, since the side surface of the collar portion of the tubular member with the collar and the cuff made of the disk-like cloth are bound to each other, the cuff is easy to fix to the surface of the organ. By interposing, the tubular member with a flange can be easily fixed to an organ.

  According to the invention described in claim 3, the tightening member is made of a cylindrical elastic member having a slit formed along the axial direction thereof, and is fitted to the outer peripheral portion of the tubular portion of the flanged tubular member. The tightening member is elastically deformed into a C-shaped cross section. For this reason, the fastening member for fitting to the outer peripheral part of the cylinder part of a cylindrical member with a hook and fastening a cylinder part can be comprised with a simple structure.

  According to the fourth aspect of the present invention, the mounting aid includes a through-hole through which the catheter body can be inserted, and the small-diameter portion and the large-diameter through the slope portion so that the thickness changes smoothly. The outer diameter of the small-diameter portion is formed to be smaller than the inner diameter of the tightening member, and the outer diameter of the large-diameter portion is formed to be larger than the outer diameter of the tubular portion of the flanged tubular member. . For this reason, it is possible to easily expand the tightening member to the inner diameter that can be inserted into the cylindrical portion of the flanged tubular member by inserting the tightening member into the mounting aid from the small diameter portion side and moving it to the large diameter portion. Can do. Also, by inserting the catheter body into the mounting aid with the tightening member fitted to the large-diameter portion of the mounting aid, the diameter can be increased to the vicinity of the tube portion of the tubular member with a hook. Since the tightening member can be positioned, the operation of fitting the tightening member to the cylindrical portion can be easily performed.

  According to the invention described in claim 5, since the catheter according to any one of claims 1 to 3 is provided in the urinary tract bypass device, at least the same effect as the effect of the invention described in claim 1 is provided. Can be played. Therefore, description of the effect of this device is omitted to avoid redundant description.

  According to the sixth aspect of the present invention, since the catheter according to any one of the first to third aspects is provided with a catheter that can be placed in the kidney, at least the first aspect of the present invention. The same effect as that of the invention can be produced. Therefore, the description of the effect of this invention is also omitted to avoid redundant description.

(A) The figure is the figure which showed the ureteral bypass apparatus provided with the renal catheter which concerns on embodiment of this invention, (b) The figure is the figure which expanded and showed the renal catheter. (A) The figure is the figure which showed the state in which the suture thread was inserted in the renal catheter which concerns on embodiment of this invention, (b) A figure follows the arrow AA line of (a) figure. It is the figure which expanded and showed the cross section. It is the longitudinal cross-sectional view which fractured | ruptured and showed the auxiliary tool for mounting which concerns on embodiment of this invention in the direction in alignment with the axial center. (A) The figure is the figure which showed the bladder catheter, (b) The figure is the figure which expanded and showed the cross section which follows the arrow BB line of (a) figure. (A) The figure is the top view which showed the state which looked at the relay adapter for connecting a bladder catheter and a renal catheter from upper direction, (b) The figure shows the state which looked at the relay adapter from the side. It is the side view shown, (c) figure is the figure which showed the cross section which follows the arrow CC line of figure (a) figure.

(A) The figure which showed the cannula used at the time of insertion to the kidney of a renal catheter and the insertion of a bladder catheter into the bladder, (b) The figure showed the trocar inserted in the cannula (C) is a diagram showing a puncture needle constructed by inserting the same trocar into the cannula, and (d) is a sheath used for inserting a guide wire into the kidney. (E) The figure is the figure which showed the same guide wire. (A) The figure thru | or (d) figure is a figure for demonstrating the operation | work procedure at the time of fitting a fastening member to the auxiliary tool for mounting. (E) FIG. Thru | or (i) figure is a figure for demonstrating the operation | work procedure at the time of mounting | wearing a fastening member to a renal catheter using the auxiliary tool for mounting | wearing. (A) The figure is the figure which showed the ureteral bypass device provided with the urinary bladder catheter and a pair of kidney catheter, (b) The figure shows the relay adapter for connecting a urinary bladder catheter and a pair of kidney catheters It is the top view which showed the state seen from upper direction. (A) The figure is the figure which showed the ureteral bypass apparatus which concerns on the modification which changed the bladder catheter of the ureteral bypass apparatus shown in FIG. 1, (b) The figure expands and shows the bladder catheter It is a figure.

Hereinafter, embodiments of the present invention will be described in detail with reference to FIGS. What is shown by the code | symbol 1 in Fig.1 (a) figure is an example of the ureteral bypass apparatus provided with the renal catheter 3 which concerns on this Embodiment. The renal catheter 3 constitutes a “catheter” according to the present invention, and the ureteral bypass device 1 constitutes a “urinary tract bypass device” according to the present invention. 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 FIG. 1, FIG. 2, FIG. 4, FIG. 6, and FIG. In FIG. 2 and FIG. 6C, since the member is long, if it is difficult to understand that two portions drawn apart from each other are made of the same member, the same member is used. For the sake of clarity, one part is marked with the same symbol in parentheses.
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 mounts 9 and 9 to be tightened are provided.

  As shown in FIG. 1B, the renal catheter 3 includes a renal catheter main body 11 made of a hollow circular tube, a positioning member 13, and a disc-shaped cuff 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. The renal catheter body 11 constitutes a “catheter body” as referred to in the present invention. As shown in FIG. 2 (a), a part of the tip portion 11a has a tapered portion 19 having a tapered end portion. The positioning member 13 includes a flanged cylindrical member 16 and a cylindrical tightening member 17, and the flanged cylindrical member 16 includes a disk-shaped flange 16 a having an outer diameter smaller than the outer diameter of the cuff 15; A cylindrical tube portion 16b integrated with the flange portion 16a is provided. A through-hole that is fitted to the outer peripheral portion of the intermediate portion 11b of the renal catheter body 11 is formed on each shaft core in the flange portion 16a, the tube portion 16b, and the cuff 15 of the tubular member 16 with the flange.

  The tightening member 17 is fitted to the outer peripheral portion of the cylindrical portion 16 b of the flanged cylindrical member 16. The tightening member 17 is cut in a direction along its axis to form one slit 17a (see FIG. 2), and is fitted to the outer peripheral portion of the tubular portion 16b of the flanged tubular member 16. The front tightening member 17 is set so that its inner diameter is smaller than the outer diameter of the cylindrical portion 16b, and the gap of the slit 17a is zero or substantially zero. Therefore, the tightening member 17 is fitted to the outer peripheral portion of the tubular portion 16b of the flanged tubular member 16 to expand the diameter, whereby the gap of the slit 17a is increased to the state shown in FIG. Is in a state of being elastically deformed into a C-shape. For this reason, the fastening member 17 for fitting to the outer peripheral part of the cylindrical part 16b of the flanged cylindrical member 16 and fastening the cylindrical part 16b can be configured with a simple structure.

  When the fastening member 17 is fitted to the outer peripheral portion of the cylindrical portion 16b of the flanged cylindrical member 16 fitted to the outer peripheral portion of the intermediate portion 11b of the renal catheter main body 11, the cylindrical attachment shown in FIG. When the auxiliary tool 21 is used, it can be easily fitted. The wearing auxiliary tool 21 includes a cylindrical auxiliary tool main body 23 and a cylindrical small-diameter cylindrical body 25 that is bonded to the auxiliary tool main body 23 and integrated with the auxiliary tool main body 23. The tightening member 17 and the auxiliary tool main body 23 and the small-diameter cylindrical body 25 of the auxiliary tool main body 23 are made of an elastic member, and the material thereof is slid as compared with the material of the cylindrical portion 16b of the flanged cylindrical member 16. Synthetic resins such as nylon, polycarbonate, polypropylene, and high-density polyethylene that have low resistance and high rigidity and toughness can be mentioned. Among them, polypropylene or high-density polyethylene with low sliding resistance is particularly suitable.

  The outer diameter of the small-diameter cylindrical body 25 is preferably set to a size smaller than the inner diameter of the tightening member 17 when not fitted to the outer peripheral portion of the intermediate portion 11b of the renal catheter body 11, but the same dimension as the inner diameter. May be set. In short, it is sufficient that the tightening member 17 is set to a dimension that allows the tightening member 17 to be easily fitted to the outer peripheral portion of the small-diameter cylindrical body 25. The auxiliary tool body 23 has a fitting portion 23a formed at one end thereof (see the enlarged view of the portion surrounded by the two-dot chain line ellipse in FIG. 3) and the fitting portion. A frustoconical inclined surface portion 23b that is continuous with the outer peripheral surface of the fitting portion 23a and has an outer diameter larger than the outer diameter of the engaging portion 23a. And a large-diameter portion 23c.

  The outer diameter of the large-diameter portion 23c is set to be larger than the outer diameter of the cylindrical portion 16b of the flanged cylindrical member 16. One end portion of the small-diameter cylindrical body 25 is fitted and bonded to the outer peripheral portion of the fitting portion 23 a of the auxiliary tool body 23. The binding between the auxiliary tool body 23 and the small-diameter cylindrical body 25 may be performed by heat fusion using a mold, or may be performed by an adhesive. When the mounting aid 21 is composed of the auxiliary tool body 23 and the small-diameter cylindrical body 25, it is desirable to make the colors of the two different from each other. By doing so, both can be easily distinguished visually, so that the workability when inserting the fastening member 17 into the mounting aid 21 from the small-diameter cylindrical body 25 side is improved. In addition, the auxiliary tool 21 for mounting may be comprised by the single member by integral molding instead of the structure which binds and integrates the auxiliary tool main body 23 and the small diameter cylindrical body 25. FIG.

As shown in FIG. 3, the attachment auxiliary tool 21 is configured by integrating the auxiliary tool main body 23 and the small-diameter cylindrical body 25, so that the small-diameter portion 26 and the small-diameter portion 26 are connected in the longitudinal direction. A slope portion 23b that is gradually expanded to an outer diameter larger than the outer diameter of the small diameter portion 26 and a large diameter portion 23c that is continuous with the slope portion 23b and has an outer diameter larger than the outer diameter of the small diameter portion 26 are coaxial in this order. It is composed of the above. The inner diameters of the auxiliary tool main body 23 and the small-diameter cylindrical body 25 are formed to be slightly larger than the outer peripheral portions of the intermediate portion 11b and the rear end portion 11c of the kidney catheter main body 11, so that the intermediate portion 11b and the rear end portion are formed. A through hole 21 a into which 11 c can be inserted is formed along the axial center of the mounting aid 21.
A procedure for fitting the tightening member 17 to the outer peripheral portion of the tubular portion 16b of the flanged tubular member 16 fitted to the outer peripheral portion of the intermediate portion 11b of the renal catheter body 11 will be described later.

  When the tightening member 17 is further fitted to the outer peripheral portion of the tubular portion 16b of the flanged tubular member 16 fitted to the outer peripheral portion of the intermediate portion 11b of the renal catheter body 11, the tubular portion 16b is moved by the tightening member 17. Tightened from the outer periphery. As a result, the inner peripheral part of the cylindrical part 16b and the outer peripheral part of the intermediate part 11b are pressed against each other, and a large frictional force is generated between them. Thereby, the relative movement of the intermediate part 11b and the positioning member 13 in the direction along the axis of the intermediate part 11b is restricted. At this time, the diameter of the intermediate portion 11b is slightly reduced and the flow path area in the intermediate portion 11b is slightly reduced. However, there is no functional problem for the renal catheter 3.

  On the other hand, as shown in FIG. 4, the bladder catheter 5 includes a bladder catheter main body 27 formed of a hollow circular tube, a disk-shaped cuff 29 configured similarly to the cuff 15, and an outer diameter smaller than the outer diameter of the cuff 29. And a disk-shaped positioning member 31 having a diameter. The urinary bladder catheter body 27 includes a distal end portion 27a placed in the bladder, an intermediate portion 27b connected to the distal end portion 27a, and a rear end connected to the intermediate portion 27b and to the distal end portion 27a via the intermediate portion 27b. The distal end portion 27a has a tapered portion 33 having a tapered end portion as shown in FIG. 4 (a). . In the cuff 29 and the positioning member 31, through holes that can be fitted to the outer peripheral portion of the intermediate portion 27 b of the bladder catheter main body 27 are formed on the respective shaft cores.

  The distal end portion 11a, the intermediate portion 11b, and the rear end portion 11c of the renal catheter body 11 except for the tapered portion 19; and the distal end portion 27a, the intermediate portion 27b, and the rear end portion 27c of the bladder catheter body 27 that exclude the tapered portion 33; The inner diameter and the outer diameter of each are formed in the same dimension. The renal catheter body 11 and the bladder catheter body 27 are made of a flexible member, and examples of the material thereof include resins such as polyurethane.

A marker portion 35 that does not transmit X-rays is provided at the end of the distal end portion 11a of the renal catheter body 11 on the intermediate portion 11b side. Examples of the material of the heel part 16a and the cylinder part 16b of the tubular member 16 with a flange of the renal catheter 3 and the positioning member 31 of the bladder catheter 5 include resins such as polyurethane or silicone rubber.
Further, the cuff 15 of the kidney catheter 3 and the cuff 29 of the bladder catheter 5 are made of non-woven fabric, and examples of the material thereof include polyester fiber, nylon fiber, acrylic fiber, and the like.
The opposing side surfaces of the tubular portion 16b and the cuff 15 of the flanged cylindrical member 16 of the renal catheter 3 and the opposing side surfaces of the positioning member 31 and the cuff 29 of the bladder catheter 5 are bound to each other. Examples of the attachment method include a method in which the part to be attached is heated and welded, and a method in which the part is attached with an adhesive. Since the cuff 15 and the cuff 29 are bound to the flanged tubular member 16 and the positioning member 31, respectively, the flanged tubular member 16 and the cuff 15 can be secured via the cuff 15 and the cuff 29 that are easily fixed to the surface of the kidney or bladder. The positioning member 31 can be easily fixed to the kidney and the bladder, respectively.

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 37... And an opening 19 a formed in the tip 19 of the tip 11 a. Further, a small hole 39 smaller than the side hole 37 is formed in the distal end portion 11 a of the renal catheter body 11 in the vicinity of the marker portion 35. A suture thread 53 (described later) is inserted into the small hole 39.
On the other hand, the distal end portion 27a of the urinary bladder catheter body 27 is formed in a total of four side holes 41... That are formed by two at a predetermined interval in the longitudinal direction, and the tapered portion 33 of the distal end portion 27a. And an opening 33a.

  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 the urine in the renal pelvic cavity passes through each side hole 37 and the opening 19a and the distal end portion 11a. 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 27a of the bladder catheter main body 27 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 27. 27c, the intermediate portion 27b, and the distal end portion 27a, and flows into the bladder through the side holes 41 of the distal end portion 27a and the opening 33a of the tapered portion 33.

  As shown in FIG. 5, the relay adapter 7 includes a relay adapter main body 43, a sealing member 45 assembled to the relay adapter main body 43, and a pair of connectors 47 and 47. Each connector 47 is made of a hollow member. The relay adapter main body 43 includes a bowl-shaped first adapter piece 43a and a second adapter piece 43b press-fitted into the opening of the first adapter piece 43a. Four through holes 49 are formed in the outer peripheral portion of the second adapter piece 43b at intervals in the circumferential direction. The sealing member 45 is made of a silicon rubber material, and is fitted and press-fitted into the through hole in the center portion of the first adapter piece 43a.

  Each connector 47 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 43b. At the other end of each connector 47, a nipple portion 47a is formed in which the rear end portion 11c of the renal catheter main body 11 and the rear end portion 27c of the bladder catheter main body 27 are fitted and connected. Inside the relay adapter main body 43, a cavity 51 surrounded by a first adapter piece 43a, a second adapter piece 43b, a sealing member 45, and a pair of connectors 47, 47 is formed. A press-fit fitting portion between the first adapter piece 43a and the second adapter piece 43b, a press-fit fitting portion between the first adapter piece 43a and the sealing member 45, and a screwed portion of each connector 47 to the second adapter piece 43b are as follows. , Each is liquid tightly sealed.

<Working procedure for placing the ureteral bypass device 1>
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 FIGS.
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 53 (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 57a made of a straight hollow tube as shown in FIG. 6 (a) 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 53 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 53 remaining outside. After that, it is again inserted into the renal catheter body 11 from the small hole 39 and extends to the outside from the rear end portion 11c. At this time, the tightening member 17 is not yet fitted to the outer peripheral portion of the tubular portion 16b of the flanged tubular member 16.

  Next, as shown in FIG. 7, the fastening member 17 is inserted into the mounting aid 21. First, as shown in FIGS. 7A and 7B, the tightening member 17 is inserted into the small-diameter portion 26 of the mounting aid 21. At this time, since the outer diameter of the small diameter portion 26 is set to be slightly smaller than the inner diameter of the tightening member 17, the tightening member 17 can be easily inserted into the small diameter portion 26.

  Next, as shown in FIG. 7C, the fastening member 17 is moved by hand to the large diameter portion 23c in the direction along the axis of the mounting aid 21. In the middle of the movement, when the tightening member 17 passes through the inclined surface portion 23b of the mounting aid 21, the tightening member 17 is gradually expanded in diameter by the inclined surface of the inclined surface portion 23b, so that a small force is applied by hand. It is possible to easily expand the diameter and move the tightening member 17 to the large diameter portion 23c. Thereby, the fastening member 17 can be easily expanded in diameter to an inner diameter that can be inserted into the outer peripheral portion of the cylindrical portion 16b of the flanged cylindrical member 16. After moving to the large diameter portion 23c, as shown in FIG. 7D, the tightening member 17 is moved until the longitudinal center of the tightening member 17 or the vicinity thereof is located at the end 55 of the large diameter portion 23c. It is good to leave.

Next, in a separate cannula 57a having the same configuration as the cannula 57a shown in FIG. 6 (a), a metal wire-like shape having a sharp tip as shown in FIG. 6 (b) is used. A puncture needle 57 (see FIG. 6C) configured by inserting the trocar 57b is inserted into the bladder catheter main body 27 from the rear end 27c side.
Next, a longitudinal incision is made at the center of the abdomen with a scalpel 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 57b protruding from the bladder catheter body 27 and the cannula 57a is formed. Then, the distal end portion 27a of the bladder catheter 5 is inserted into the bladder.
Next, the puncture needle 57 is extracted from the bladder catheter 5 while the distal end portion 27a of the bladder catheter body 27 is inserted into the bladder.

Next, the serosa of the bladder at the site where the distal end portion 27a of the bladder catheter body 27 is inserted is sutured with a nylon suture thread by so-called purse string suture so that the purse string opening is narrowed. To do. Thereby, the outer peripheral part of the bladder catheter body 27 is tightened by the serosa of the bladder, and the relative movement of the bladder catheter body 27 with respect to the bladder is prevented.
Next, in a state where the middle portion 27b of the bladder catheter body 27 is grasped with one hand, the positioning member 31 is grasped with the other hand, and the positioning member 31 is attached to the bladder catheter body 27 together with the cuff 29 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 29 to adhere the serosal surface of the bladder and the cuff 29, and the serosal surface of the bladder and the cuff 29 are sutured. Suture with. Thereby, the relative movement with respect to the bladder of the cuff 29 and the positioning member 31 is prevented. Since the serosa surface of the bladder and the cuff 29 are stitched together with a suture, the two are firmly bound, so application of the medical adhesive to the serosa surface of the bladder and the cuff 29 may be omitted.

Next, an injection needle (not shown) inserted into a metal sheath 59 made of a straight hollow tube as shown in FIG. 6D is formed by puncturing the kidney together with the sheath 59. The sheath 59 is inserted into the renal pelvis cavity via the puncture opening.
Next, after the injection needle is pulled out from the sheath 59 with the sheath 59 inserted into the kidney, a guide wire 61 as shown in FIG. 6 (e) is inserted into the sheath 59, and the guide wire 61 is inserted into the sheath 59. Insert until the tip enters the renal pelvis. The guide wire 61 is made of a metal member that is flexible and can be bent freely. After the guide wire 61 is inserted into the renal pelvic cavity, the sheath 59 is pulled out from the kidney while the guide wire 61 remains in the renal pelvic cavity and is pulled out from the guide wire 61.

Next, the rear end of the guide wire 61 is inserted into the cannula 57a from the distal end portion 11a side of the renal catheter body 11 into which the cannula 57a has been inserted, and the distal end portion 11a of the renal catheter body 11 enters the renal fistula of the kidney. Until the renal catheter 3 is inserted along the guide wire 61.
Next, after the guide wire 61 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 57a is also pulled out from the renal catheter body 11. At this time, the guide wire 61 and the cannula 57a may be pulled out simultaneously.

  When it is confirmed that the distal end portion 11a is positioned in the renal pelvic cavity of the kidney and all of the four side holes 37 are positioned in the renal pelvic cavity, the distal portion 11a is inserted into the renal catheter main body 11 to be inserted. The two suture threads 53 protruding outward from the rear end portion 11c 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 37 is determined based on whether the kidney in which the contrast medium is injected into the renal pelvic cavity is used. It can be confirmed from the relative positional relationship between the marker portion 35 of the distal end portion 11a and the external shape of the renal pelvic cavity, which are captured in an image obtained by X-ray imaging.

Next, only one of the two sutures 53 protruding from the rear end portion 11c of the kidney catheter body 11 to the outside is pulled by hand, and the suture 53 from the inside of the kidney catheter body 11 is pulled. Is completely extracted.
Next, in a state where the intermediate portion 11b of the renal catheter body 11 is gripped by one hand, the hooked tubular member 16 is gripped by the other hand, and the hooked tubular member 16 is cuffed 15 against the kidney catheter body 11. At the same time, it is relatively moved to the vicinity of the kidney capsule of the kidney. At this time, since the tightening member 17 is not fitted to the outer peripheral portion of the tubular portion 16b of the flanged tubular member 16, the outer peripheral surface of the intermediate portion 11b of the renal catheter body 11 and the tubular portion 16b of the flanged tubular member 16 The inner peripheral surface is not in pressure contact with the tightening member 17. For this reason, it is possible to smoothly move the hooked tubular member 16 with respect to the intermediate portion 11b of the renal catheter body 11 without applying a large force. The positioning operation of the flanged tubular member 16 can be easily performed.

Next, a medical adhesive is applied to the surface of the kidney capsule and the side surface of the cuff 15 to adhere the surface of the kidney capsule and the cuff 15. 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 15 are temporarily fixed with a suture.
Next, the rear end portion 11c of the renal catheter main body 11 is inserted into the through hole 21a of the mounting aid 21 into which the tightening member 17 has been inserted from the end 55 side of the large diameter portion 23c, and the end 55 of the large diameter portion 23c is inserted. Is inserted until the abutment comes into contact with the end face of the tubular portion 16b of the flanged tubular member 16 (see FIGS. 8 (e) and 8 (f)). As a result, about half of the fastening member 17 in the longitudinal direction is inserted into the outer peripheral portion of the end of the tubular portion 16b of the flanged tubular member 16. Thus, the tightening member 17 is expanded in diameter by inserting the renal catheter body 11 through the through hole 21a of the mounting aid 21 with the tightening member 17 fitted to the large diameter portion 23c of the mounting aid 21. Since it can be positioned to the vicinity of the cylindrical portion 16b of the flanged cylindrical member 16 in this state, the work of fitting the tightening member 17 to the cylindrical portion 16b can be performed easily.

  Next, the intermediate part 11b of the renal catheter body 11 protruding from the end of the small diameter part 26 of the wearing aid 21 and the small diameter part 26 of the wearing aid 21 are simultaneously grasped with one hand and the auxiliary for wearing. The distal end 55 of the large-diameter portion 23c of the tool 21 is in contact with the end surface of the cylindrical portion 16b of the flanged cylindrical member 16, and the other hand is fastened to the cylindrical portion 16b from the large-diameter portion 23c of the mounting aid 21 The tightening member 17 is moved so that the entire member 17 is transferred. At this time, as long as at least a part of the tightening member 17 is fitted to the outer peripheral portion of the large-diameter portion 23c of the mounting aid 21, the dimension is larger than the outer diameter of the tubular portion 16b of the flanged tubular member 16. The inner diameter of the tightening member 17 is expanded to a size substantially equal to the outer diameter of the large diameter portion 23c. For this reason, while at least a part of the tightening member 17 is fitted to the outer peripheral portion of the large-diameter portion 23c, the sliding resistance between the two is small, and in addition, the cylindrical portion 16b of the flanged cylindrical member 16 Since the outer peripheral portion is hardly tightened by the tightening member 17, the tightening member 17 can be smoothly moved by hand to the outer peripheral portion of the cylindrical portion 16b without applying a large force.

After the tightening member 17 is completely fitted to the outer peripheral portion of the tubular portion 16b of the flanged tubular member 16, the outer peripheral portion of the tubular portion 16b is tightened by the tightening member 17, and the inner peripheral surface of the tubular portion 16b and the kidney are tightened. The outer peripheral surface of the catheter main body 11 is brought into pressure contact, and a large frictional force is generated between the inner peripheral surface and the outer peripheral surface, and the relative movement between the positioning member 13 and the renal catheter main body 11 is restricted by this frictional force.
After the tightening member 17 is fitted to the outer peripheral portion of the tubular portion 16b of the flanged tubular member 16, the mounting aid 21 is extracted from the renal catheter body 11. Since the relative movement between the intermediate portion 11b of the renal catheter body 11 and the hooked tubular member 16 is restricted by the tightening force of the tightening member 17, the hooked tubular member 16 is stably placed at a predetermined position in the intermediate portion 11b. Can be held.
Thus, the relative movement between the positioning member 13 and the renal catheter body 11 is restricted, and the cuff 15 bound to the tubular portion 16b of the flanged tubular member 16 is fixed to the surface of the renal capsule. The relative movement of the renal catheter body 11 with respect to the kidney is prevented.

Next, after the mounts 9 are inserted into the rear end portion 11c of the kidney catheter body 11 and the rear end portion 27c of the bladder catheter body 27 extending outside the peritoneum, the outer periphery of one connector 47 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 27 is connected to the outer periphery of the other connector 47 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 portion 27c.
Next, the mounts 9 inserted into the renal catheter body 11 and the bladder catheter body 27 are moved along the catheter bodies 11 and 19 toward the relay adapter 7, and the rear ends of the catheter bodies 11 and 19 are moved. Each connection portion between the portions 11c and 19c and each connector 47 of the relay adapter 7 is covered with the mount 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 43b of the relay adapter 7 in contact with the outer surface of the peritoneum, the suture is passed through the four through holes 49 of the second adapter piece 43b. 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 45 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 45 can be easily identified visually.

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.

  In the above-described operation, the method of using the sheath 59 and the guide wire 61 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 main body 27 into the bladder may be adopted. That is, a puncture needle formed by inserting a puncture needle 57 into which a trocar 57b is inserted into a cannula 57a into the renal catheter body 11 and puncturing the kidney with the tip of the trocar 57b protruding from the renal catheter body 11 and the cannula 57a. The distal end portion 11a of the renal catheter body 11 may be inserted into the renal pelvis cavity.

  The above-described embodiment is an example for explaining the present invention. The present invention is not limited to the above-described embodiment, and can be read from the scope of the claims of the utility model registration and the entire specification. The catheter and the urinary tract bypass device including the catheter after the change are also included in the technical scope of the present invention.

  For example, the ureteral bypass device 1 according to the above-described embodiment can be used when only one of the pair of ureters is obstructed or has a ureteral disorder due to a urinary system disease or the like. Is. 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. Good. In this ureteral bypass device 1 ′, a pair of kidney catheters 3 and 3 and one bladder catheter 5 are connected to one relay adapter 7 ′, which constitutes the “urinary tract bypass device” in the present invention. The relay adapter 7 'has the same basic configuration except that the relay adapter 7 has only one connector 47, so the same or equivalent member as described for the relay adapter 7 is used. Alternatively, the same reference numerals are given to the portions, and detailed description is omitted.

  Further, in the ureteral bypass device 1 according to the above-described embodiment, the positioning member 31 of the bladder catheter 5 has a structure that does not include the tightening member 17, but instead includes a cylindrical tube portion 16b. Even if the positioning member of the urinary bladder catheter 5 is changed to the same configuration as the positioning member 13 of the renal catheter 3 provided with the cylindrical member 16 with the hook and the cylindrical tightening member 17 fitted to the cylindrical portion 16b. Good. A ureteral bypass device 1 "according to the modification is shown in FIG. 10. The ureteral bypass device 1" constitutes a "urinary tract bypass device" according to the present invention. In FIG. 10, the same or equivalent members or portions as those described for the ureteral bypass device 1 described above are denoted by the same reference numerals including the positioning member 13, and detailed description thereof is omitted. Further, in FIG. 10, for the convenience of drawing, a long member in the longitudinal direction is omitted for a long member. Also in this modification, it is needless to say that the same operations and effects can be achieved with the same or equivalent configurations as those described in the above embodiment.

  As shown in Fig. 10, the ureteral bypass device 1 "includes a kidney catheter 3 and a bladder catheter 5 ', and these catheters 3 and 5' are connected via a relay adapter 7. 'Constitutes a “catheter” in the present invention, and includes a bladder catheter main body 27 ′ formed of a hollow circular tube and a positioning member 13. The bladder catheter body 27 ′ includes a distal end portion 27a ′ placed in the bladder, an intermediate portion 27b ′ continuous with the distal end portion 27a ′, a distal end portion connected to the intermediate portion 27b ′ and via the intermediate portion 27b ′. The rear end portion 27c 'communicates with 27a'. The bladder catheter body 27 'constitutes the "catheter body" as used in the present invention. Since the bladder catheter main body 27 ′ is configured in the same manner as the renal catheter main body 11 including the distal end portion 27a ′, a detailed description of the configuration is omitted. The operation procedure for placing the distal end portion 27a ′ of the bladder catheter body 27 ′ in the bladder is the above-described operation procedure for placing the distal end portion 27a of the bladder catheter body 27 in the bladder or the distal end portion 11a of the kidney catheter body 11. May be carried out in the same manner as the work procedure of placing the mouse in the kidney.

  Further, the ureteral bypass device 1, the ureteral bypass device 1 ′ and the ureteral bypass device 1 ″ provided with the positioning member 13 described above include a renal catheter 3 placed in the kidney and a bladder catheter 5 placed in the bladder or 5 'is connected via the relay adapter 7 or 7', but is not limited to this, and is not limited to the kidney catheter (the same catheter as the kidney catheter 3 and the positioning member 13). And a urinary bypass device connected via a relay adapter between the penis and a foreskin covering the penis or in the vagina. In the animals such as dogs and cats, the internal urethral orifice of the bladder or the urinary tract downstream from the internal urethral orifice is obstructed by cancer or other urinary tract disease In this case, the urinary bypass device constitutes a “urinary tract bypass device” according to the present invention.

1 Ureteral bypass device (urinary tract bypass device)
1 'Ureteral bypass device (urinary tract bypass device)
1 "ureteral bypass device (urinary tract bypass device)
3 renal catheter (catheter)
5 Bladder catheter 5 'Bladder catheter (catheter)
7 relay adapter 7 'relay adapter 11 kidney catheter body (catheter body)
11a Front end portion 11b Intermediate portion 11c Rear end portion 13 Positioning member 15 Cuff 16 Ribbed tubular member 16a Rift portion 16b Tube portion 17 Tightening member 17a Slit 21 Mounting aid 21a Through hole 23b Slope portion 23c Large diameter portion 26 Small diameter portion 27 'bladder catheter body (catheter body)
27a ′ front end portion 27b ′ intermediate portion 27c ′ rear end portion

Claims (6)

A tip portion that can be placed in one of the organs of the kidney or bladder, an intermediate portion that is connected to the tip portion, and can communicate with the inside of the organ through the tip portion placed in the organ, A catheter body composed of a hollow tube provided with a rear end portion capable of communicating with the distal end portion via an intermediate portion;
A catheter provided with a positioning member that can be fitted to the outer peripheral part of the intermediate part,
The positioning member includes a collar part that can be fixed to the organ and a tubular member with a collar that is integrated with the collar part, and a fastening member that can be fitted to the outer peripheral part of the cylinder part,
The inner periphery of the tubular portion is obtained by fitting the tightening member to the outer peripheral portion of the tubular portion of the flanged tubular member fitted to the outer peripheral portion of the intermediate portion of the catheter body and tightening the tubular portion. A surface and the outer peripheral surface of the intermediate portion are pressed against each other, and friction between the inner peripheral surface and the outer peripheral surface causes friction between the intermediate portion and the flanged tubular member in the direction along the axis of the intermediate portion. A catheter characterized in that relative movement is restricted. The catheter of claim 1,
A cuff made of a cloth-like cloth that can be fitted to the outer peripheral portion of the intermediate portion of the catheter body and can be fixed to the surface of the kidney;
The catheter, wherein the side surface of the collar portion of the tubular member with the collar and the cuff are bound to each other. The catheter according to claim 1 or claim 2,
The tightening member is composed of a circular elastic member having a slit formed along the axial direction thereof,
The tightening member when fitted to the outer peripheral portion of the tubular portion of the flanged tubular member has a C-shaped deformed cross section perpendicular to the axial direction. . A tubular mounting aid that can assist in fitting the fastening member when the fastening member is fitted to the outer peripheral portion of the tubular portion of the flanged tubular member in the catheter according to claim 3. And
The wearing auxiliary tool has a small diameter portion on one end side in the direction along the axis, a large diameter portion on the other end side in the same direction, and the small diameter portion and the large diameter portion with a smooth thickness. A sloped portion connected to change, and a through-hole penetrating from the one end side to the other end side,
The outer diameter of the small-diameter portion is formed to have a dimension equal to or smaller than the inner diameter of the tightening member before being fitted to the outer peripheral portion of the cylindrical portion of the flanged cylindrical member,
The outer diameter of the large diameter portion is formed to be larger than the outer diameter of the cylindrical portion of the flanged cylindrical member,
The through-hole can be inserted through the catheter body. A renal catheter having a renal catheter body consisting of a hollow tube whose tip can be placed in the kidney;
A bladder catheter having a bladder catheter body composed of a hollow tube whose tip can be placed in the bladder;
A urinary bypass device including a relay adapter to which one end and the other end can be connected to the rear end of the kidney catheter body and the rear end of the bladder catheter body,
The urinary tract bypass device according to any one of claims 1 to 3, wherein at least one of the renal catheter and the bladder catheter is the catheter according to any one of claims 1 to 3. The catheter according to any one of claims 1 to 3, wherein a catheter body whose distal end portion can be placed in a kidney and a catheter having the catheter body are defined as a kidney catheter body and a kidney catheter, respectively. When
The renal catheter;
A urinary catheter having a urinary catheter body composed of a hollow tube having a distal end and a rear end opposite to the distal end; and
A urinary bypass device including a relay adapter to which one end and the other end can be connected to the rear end of the kidney catheter body and the rear end of the urinary catheter body,
One end portion and the other end portion of the relay adapter are connected to a rear end portion of the renal catheter body and a rear end portion of the urinary catheter body, respectively, so that the distal end portion of the kidney catheter body is connected via the relay adapter. A urinary tract bypass device configured to communicate with a distal end portion of a urinary catheter main body.

Images