JP3530183B1 - Gastrostomy catheter kit - Google Patents

Abstract

Kind Code: A1 A catheter kit used for constructing a gastrostomy in a living body, which is improved in push method or pull method while reducing bacterial infection in a gastrostomy site in a living body. Provide what can be implemented under. A tube (12) for introducing nutrients from outside the body into the stomach (18) and a tubular sheath (14) covering the tube from the outside thereof are inserted together into the stomach (18) through the oral cavity (54) of a living body. . If the tube is to be advanced alone after the sheath has reached the insertion limit, the distal end 46 of the sheath will be broken by the distal end 28 of the tube, after which the tube will advance alone to approach the gastrostomy site. .
Therefore, until the sheath reaches the insertion limit position, the sheath prevents biological bacteria from adhering to the tube, and therefore, even if the tube reaches and contacts the gastrostomy site, The site does not have to be infected by bacteria.

Description

Detailed Description of the Invention 【Technical field】

[0001] The present invention relates to a catheter kit used for constructing a gastrostomy in a living body, and particularly to a push method or a pull method while reducing bacterial infection at a site of the gastric fistula in the living body. It relates to an improvement of the technology that enables it to be implemented.

[Background technology]

Enteral nutrition is already present as one of the nutritional supplements. This enteral nutrient is generally administered to patients who have difficulty or inability to swallow food. As one method of realizing such administration, there is a method of injecting an enteral nutritional supplement from the outside of the body into the stomach through a tube installed in the gastrostomy of the patient. This is called gastrostomy nutritional management.

In order to carry out this gastrostomy nutritional management, it is necessary to construct a gastrostomy on the abdominal wall and stomach wall of the patient. This gastrostomy can be constructed by laparotomy, but in recent years, percutaneous endoscopic gastrostomy has the advantage of shortening the operation time and early recovery of postoperative patients.
Implementation of aneous Endoscopic Gastrostomy (hereinafter abbreviated as “PEG”) is becoming widespread.

PEG is roughly classified into two types. It is the "pull method" or "push method" in which the tube is orally inserted into the body and set, and the "introducer method" in which the tube is percutaneously inserted and set into the body.

In both the "pull method" and the "push method", first, a guide wire is inserted from the outside of the body into the stomach through a through hole formed in the abdominal wall and the stomach wall of a patient prior to gastrostomy. It The inserted guide wire is grasped by the endoscope inserted from the oral cavity and partially pulled out from the oral cavity to the outside of the body. The tube is inserted from the outside of the body through the oral cavity into the stomach while using the guide wire that is placed in the living body so as to extend through the through hole and the oral cavity, and thereby the tube is placed inside the stomach. .

[0006] In order to prevent the once installed tube from being arbitrarily removed from the patient's stomach, an intragastric fixture for fixing the tube in the stomach is attached to a portion of the tube that is left in the stomach.

As described above, the "pull method" and the "push method"
And are basically common in terms of tube insertion principle, and therefore almost common in both advantages and disadvantages. However, the "pull method" is a method of pulling the tube through the oral cavity into the stomach by applying an axial tensile force to the tube with the guide wire, while the "push method" is the method of pulling the guide wire. It is a method of pushing the tube into the stomach through the oral cavity by applying an axial compressive force to the tube while guiding the tube.
As described above, the “pull method” and the “push method” are different from each other with respect to the type (direction) of the force applied to the tube for inserting the tube.

On the other hand, in the "introducer method", a tube is directly inserted into the stomach from outside the body through a through hole formed in the abdominal wall and stomach wall of the patient. Therefore, according to the "introducer method", the tube does not pass through the oral cavity when it is inserted into the body.

In this "introducer method",
In order to prevent the once-installed tube from being arbitrarily detached from the through hole of the patient, an intragastric fixing device larger than the through hole is attached to a portion of the tube that is left in the stomach. However, the tube and intragastric fixture must pass through a narrow through hole during the tube insertion process.

Therefore, in the "introducer method", the intragastric fixture is constructed so that its shape changes such that it contracts during the tube insertion process and expands during the indwelling state. An example of such an intragastric fixing device is a balloon that changes between a contracted state and an expanded state when a fluid is taken in and out.

The "introducer method" is capable of increasing the radial dimension of the intragastric fixator and the tube because the intragastric fixator and the tube must pass through a narrow through hole formed in the patient. Due to technical difficulties and the like, it has not been established as a general method of PEG.

Therefore, the general method of PEG is:
The “pull method” or “push method” is different from the case of performing the “introducer method” when the “pull method” or the “push method” is performed. It must pass through one oral cavity, pharynx, and esophagus in that order.

Therefore, when the "pull method" or the "push method" is carried out, unlike the case where the "introducer method" is carried out, when the tube passes through the oral cavity, pharynx and esophagus, the tube is infected with bacteria. May be contaminated with. As a result, the bacteria may be transmitted to the gastrostomy site of the patient, that is, the wound, by the tube and become infected.

Patent Document 1 discloses a conventional example of a catheter kit which makes it possible to carry out the "pull method" while preventing infection of the wound. This conventional example is a catheter kit having a structure in which a PEG tube is covered with a sheath to prevent wound infection.

Specifically, in the conventional example, a guide wire installed in a living body so as to extend through a through hole formed in the abdominal wall and stomach wall of a patient and the oral cavity is exposed to the outside of the body. At, it is connected to the connecting wire of the PEG tube. The PEG tube is covered with a contamination-preventing sheath.

The sheath is flexible and extends in the lengthwise direction, and is open at both ends thereof. One of the open ends of the sheath is adapted to be used as the outlet end of the tube. A peripheral portion of the sheath forming the outlet end is folded back to the outside, and the folded peripheral portion is partially adhered to the sheath at its tip. Thereby, a cylindrical space extending in the circumferential direction of the sheath is formed at the outlet end of the sheath.

A closing thread is inserted through the space. On the other hand, a cover extending along the length direction of the sheath is attached to the outside of the sheath. The cover and the sheath form a space extending in the length direction of the sheath. A tightening tube is inserted in the space so as to be relatively movable. The fastening tube extends along the sheath in a direction away from a position near its outlet end.

The closing thread is constructed as a continuous thread and has a loop portion at an intermediate position thereof. The closure thread is wrapped around the sheath at its loop. Of the closing thread, the two portions extending from the loop portion form a bundle, enter one of the ends of the tightening tube near the outlet end of the sheath, pass through it, and eventually reach the opposite side. Is partially exposed from the end of the.

In this conventional example, the exposed portion of the closing thread that is exposed from the tightening tube is pulled in a direction away from the tightening tube, and at the same time, the tightening tube is moved toward the outlet end of the sheath. If pushed in, the loop portion of the closing thread is tightened, and as a result, the outlet end of the sheath is reduced in diameter and closed. Conversely, if the exposed portion of the closing thread is allowed to be drawn in a direction approaching the tightening tube and at the same time the pulling tube is pulled away from the outlet end of the sheath, the loop part of the closing thread is pulled. As a result of the loosening, the outlet end of the sheath is expanded and opened.

As described above, in this conventional example, the opening and closing of the outlet end of the sheath are selectively performed by operating the closing thread and the tightening tube.
Then, in this conventional example, in the process of inserting the PEG tube into the body together with the sheath, the outlet end of the sheath is closed by the operation of the closing thread and the tightening tube, and PE is inserted into the closed sheath.
The G tube is enclosed. As a result, according to this conventional example, bacteria do not adhere to the PEG tube during the insertion process of the PEG tube.

In this conventional example, after the PEG tube is placed in the stomach, the outlet end of the sheath can be opened by the operation of the closing thread and the tightening tube, and the PEG tube is opened from the outlet end of the sheath. It is exposed and the tip of the PEG tube is eventually inserted into the patient's through hole. After that, the sheath is removed from the body through the oral cavity while gradually exposing the outer peripheral surface of the PEG tube in the axial direction.

[Patent Document 1] Japanese Unexamined Patent Application Publication No. 2001-224694

DISCLOSURE OF THE INVENTION [Problems to be Solved by the Invention]

According to the above-mentioned conventional example, when the PEG tube covered with the sheath is placed in the stomach through the oral cavity, when the PEG tube is about to be inserted into the through hole of the living body, the insertion is performed. Prior to
A special separation operation is performed to separate the PEG tube from the sheath.

Specifically, as described above, the closing thread, which is exposed from the tightening tube, is allowed to be drawn in a direction approaching the tightening tube, and at the same time, the tightening tube is removed from the sheath. Pulling away from the exit end is performed. This allows
The loop portion of the closing thread is loosened so that the outlet end of the sheath is expanded and opened.

In this open state, the PEG tube is pulled by the guide wire in the direction projecting from the outlet end of the sheath. By this pulling, the PEG tube is exposed from the sheath and is eventually inserted into the through hole of the living body.

Thus, in this conventional example, PE
In order to insert the G tube into the through hole after separating it from the sheath, it is necessary to perform an operation for separating the PEG tube, which is different from the operation for inserting the PEG tube. Therefore, this conventional example has room for improving the usability of the catheter kit.

Against the background of the circumstances described above, the present invention is a catheter kit used for constructing a gastrostomy of a living body, which is pushed while reducing bacterial infection at the site of the gastrostomy in the living body. It is an object of the invention to provide a method capable of implementing the law or pull method with improved usability.

[Means for Solving the Problems]

The following aspects are obtained by the present invention.
Each mode is divided into sections, each section is given a number, and is described in a format in which the numbers of other sections are cited as necessary. this is,
This is for facilitating the understanding of some of the technical features that can be adopted by the present invention and combinations thereof, and it is understood that the technical features that can be adopted by the present invention and combinations thereof are limited to the following embodiments. Should not be. That is, it should be construed that it is not hindered to appropriately extract and adopt the technical features described in the present specification, which are not described in the following aspects, as the technical features of the present invention.

Further, it is not always necessary to describe each item in a format in which the numbers of other items are cited, and to make the technical features described in each item separate and independent from the technical features described in other items. It does not mean that it interferes, and it should be construed that the technical features described in each section can be appropriately made independent depending on the nature thereof.

(1) A gastrostomy catheter kit for constructing a gastrostomy in a living body, which is used for introducing nutrition into the stomach from outside the body, wherein the nutrition is introduced into the stomach from outside the body. Is a tube having a nutritional passage formed therein, which is inserted into the stomach through the oral cavity of the living body, and then the living body is placed in the planned site of the gastrostomy in the living body prior to the construction of the gastrostomy. Which is inserted and installed in a through hole formed so as to penetrate the abdominal wall and stomach wall of the tube, and a tubular sheath which covers the tube from the outside thereof, together with the tube of the living body. A through-hole that is inserted into the body through the oral cavity and that has a sheath stopper that defines the insertion limit position into the body, and wherein the tube alone has the through hole after the sheath reaches the insertion limit position. Let's approach As a result, an axial relative displacement of the tube with respect to the sheath occurs, and due to the axial relative displacement, a rupture portion that ruptures a portion of the sheath facing the gastric side end portion of the tube is A catheter kit for constructing a gastrostomy that is formed at the end of the stomach.

In this catheter kit, the tube is inserted into the body through the oral cavity of the living body together with the tubular sheath that covers the tube from the outside.

Therefore, according to this catheter kit, the tube is protected from bacterial adhesion by the sheath in the process of being inserted into the body through the oral cavity. Therefore, according to this catheter kit, even if the tube reaches and comes into contact with the through hole formed in the living body, the through hole does not have to be infected with bacteria, and as a result, wound infection is reduced. .

That is, according to this catheter kit, it is possible to construct a gastrostomy in a living body by the "pull method" or "push method" of PEG. On the other hand, when the “pull method” or “push method” is performed, the tube is originally inserted into the body through the oral cavity, pharynx, and esophagus, which are the media of the bacterial flora, so the tube is contaminated with bacteria. May be done. However, according to the catheter kit according to this section, although the tube inserted into the stomach from the oral cavity of the living body through the esophagus passes through the bacterial flora medium, the tube is covered with the sheath during the passage. As a result, the tube can pass through the bacterial flora medium without contact with bacteria.

Furthermore, in this catheter kit, a sheath
The stopper is provided on the sheath, and after the sheath reaches the insertion limit position, the tube alone approaches the through hole. Along with this approach, axial relative displacement of the tube with respect to the sheath occurs. In this catheter kit, the axial relative displacement causes the portion of the sheath facing the gastric side end of the tube to be broken by the breaking portion formed at the gastric side end of the tube.

Therefore, according to this catheter kit, it is not necessary to perform a special operation in order to separate the tube from the sheath so as to break the part of the sheath facing the gastric end of the tube. Become. That is, when the tube is moved in the direction of approaching the through hole of the living body, the sheath is automatically broken in association with it. Therefore, according to this catheter kit, the work of separating the tube from the sheath is simplified and the usability is improved.

Further, in this catheter kit, the opening (opening) of the sheath, which is an operation that allows the tube to approach the through hole independently, is achieved by the phenomenon of the sheath breaking, and the sheath is inserted. In the period until reaching the limit position, the sheath is not broken and forms a continuous body.

Therefore, according to this catheter kit, bacteria pass from the outside of the sheath through the sheath (particularly, the portion to be broken of the sheath), enter the inside, and adhere to the tube. Can be prevented more reliably. Thus, the more reliable sealing function of the sheath protects the tube from bacterial attachment. Therefore, according to this catheter kit, it becomes easy to prevent bacteria from adhering to the tube during the tube insertion process.

In this section, "living body" can be defined to include human beings, but it can also be defined to include animals other than humans.

Furthermore, in this section, "axial relative displacement"
As a principle of “breaking the sheath” by means of, for example, there is a principle of causing a force (for example, an axial force or a radial force) from the tube to act on the sheath along with the axial relative displacement thereof, and breaking the sheath by the force. .

Further, as the method of "breaking the sheath" in this section, for example, a method of piercing the sheath with a tube, a method of pushing and breaking the sheath with a tube, a method of pushing and breaking the sheath with a tube, and a sheath are used. There is a method of tearing the sheath along a pre-formed dividing line (for example, a linear region where stress is easily collected from the periphery of a seam or a sheath, along which a tube is easily broken).

Further, in this section, as a mode of "breaking the sheath", for example, a mode of separating the sheath into a plurality of portions along its length direction, or a mode of separating the sheath along its length direction. There is a mode of partially separating into a plurality of parts.

(2) The tube is inserted into the stomach through the oral cavity of the living body by using the guide wire inserted into the through hole, and the sheath is the guide wire. The gastrostomy catheter kit according to (1), which is inserted into the body through the oral cavity of the living body together with the tube while utilizing the above.

In this catheter kit, the above-mentioned pull method or push method is carried out by using a guide wire inserted into a through hole formed in the living body, whereby the tube together with the sheath is placed in the living body. It is inserted into the stomach through the oral cavity. Therefore, according to this catheter kit, the operation of inserting the tube and the sheath can be performed with the assistance of the guide wire.

(3) In the item (1) or (2), the sheath is a peel-away type in which at least a part in the longitudinal direction of the sheath is torn to the side of the sheath due to the relative displacement in the axial direction. The catheter kit for constructing a gastrostoma according to claim 1.

In this catheter kit, the sheath is a peel-away type, and the sheath is torn to the side of the sheath at least at a part in the lengthwise direction of the sheath due to the axial relative displacement with respect to the tube.

On the other hand, the torn portion of the sheath is
As compared with the state before being torn, the radial dimension of the sheath changes easily. This is because, for example, when a portion of the sheath in the lengthwise direction is torn laterally and divided into a plurality of small portions, each of the plurality of small portions is reduced in size compared to before the division. (Fragmentation) reduces the rigidity of each individual, making it easy to deform, and as a result,
This is because it becomes easy for the small portions to change their mutual positional relationship in the radial direction of the sheath.

In this Kuteteru kit, the tube has an enlarged portion (a rigid body or an elastic body, which is described later) having a radial dimension larger than the radial dimension of the sheath. It is useful when it has, and its enlarged portion must also pass through the sheath.

That is, according to this catheter kit, even if the radial dimension of the sheath before being torn is smaller than the radial dimension of the enlarged portion of the tube, the sheath is torn as the enlarged portion advances. . As a result, the diameter dimension of the sheath is enlarged, so that the sheath can be passed through the tube including the enlarged portion.

By the way, the radial dimension of the sheath over the entire length is defined as the radial dimension of the enlarged portion that should pass through the sheath (if the enlarged portion is elastically deformable, the diameter after elastic deformation). If the sheath is configured in advance so as to be larger than the (direction dimension), the enlarged portion can pass through the sheath without tearing the sheath. However, in this case, the entire sheath is thickened from the beginning.
On the other hand, the thicker the sheath, the more pain and discomfort the body experiences when the sheath passes through a narrow tubular organ of the body.

On the other hand, according to the catheter kit of this item, the sheath locally expands as the expanded portion passes through the inside of the sheath. The position of the expanded portion of the sheath that is expanded by the expanded portion moves in the length direction of the sheath as the expanded portion advances, and when the passage of the expanded portion is completed, the expanded portion returns to its original position. Restoration to radial dimensions is allowed.

Therefore, according to this catheter kit, the tube is covered with a sheath to suppress the bacterial adhesion of the tube, while the pain or discomfort imposed on the living body is alleviated. It is possible to pass the enlarged portion through the sheath.

Furthermore, according to this catheter kit, when the sheath is removed from the tube, it becomes easier to reduce the size of the sheath in the radial direction, as compared with the case where the sheath is not separated at all. Therefore, according to this catheter kit, when the sheath is removed from the body via the oral cavity, the contact force between the sheath and the living body is reduced, and the force required to act on the sheath to remove the sheath is also reduced. To be done. As a result, according to this catheter kit, the pain or discomfort that is given to the living body when the sheath is removed from the living body is alleviated.

In addition, the "tearing of the sheath" in this section is performed, for example, in a portion of the sheath excluding the portion to be broken by the breaking portion.
Further, the “tearing of the sheath” is performed, for example, after the rupture by the rupture portion is completed.

(4) The tube has an enlarged portion larger than the other portions at a position closer to the mouth end than the stomach side end of the tube, and the enlarged part becomes larger due to the axial relative displacement. The catheter kit for gastrostomy according to the item (3), wherein the sheath is torn by moving inside the sheath from the mouth end toward the stomach end.

In this catheter kit, an enlarged portion of the tube larger than the other portions is passed through the sheath, so that a radial compressive force for tearing the sheath laterally is applied to the sheath.

Therefore, according to this catheter kit, it is not essential to perform a special operation for tearing the sheath. That is, it is possible to automatically tear the sheath by axial relative displacement between the tube and the sheath.

(5) The expanded portion is positioned with respect to the tube such that the expanded portion comes into contact with the sheath after the sheath is broken by the breaking portion. Catheter kit for gastrostomy.

According to this catheter kit, before the sheath is broken by the broken portion of the tube, the enlarged portion comes into contact with the sheath so that the sheath cannot be further advanced, and as a result, the breaking of the sheath is not completed. It is easy to avoid.

(6) The gastrostomy catheter kit according to (5), wherein the enlarged portion is an intragastric fixing tool for fixing the tube in the stomach.

According to this catheter kit, the same portion of the tube can fulfill both the function of tearing the sheath and the function of preventing the tube from being arbitrarily removed from the living body. .

(7) The gastrostomy catheter kit according to any one of (1) to (6), wherein the sheath covers the tube prior to insertion into the body.

According to this catheter kit, it becomes easier to reduce bacterial adhesion to the tube as compared with the case where the tube is covered with a sheath after being inserted into the body.

(8) The broken portion has a taper shape in which the diameter increases from the stomach side end of the tube toward the mouth side end thereof, according to any one of (1) to (7). Catheter kit for gastrostomy.

According to this catheter kit, the force is easily concentrated on the broken portion of the tube, and it becomes easy to locally generate a large force on the sheath by the broken portion. Therefore, according to this catheter kit,
In the process of approaching the tube to the through hole of the living body in the body, it becomes easy to reduce the increase in the operation force of the tube necessary for breaking the sheath.

(9) The gastrostomy according to the item (8), wherein the fractured portion functions as a dilator for enlarging the diameter of the fractured hole in the process of inserting the fractured portion into the through hole from the stomach. Installation catheter kit.

According to this catheter kit, the same part of the tube can fulfill both the function of breaking the sheath and the function of constructing a gastrostomy by enlarging the through hole of the living body. Becomes

BEST MODE FOR CARRYING OUT THE INVENTION

Hereinafter, some of more specific embodiments of the present invention will be described in detail with reference to the drawings.

FIG. 1 shows a catheter kit 10 for constructing a gastrostoma according to the first embodiment of the present invention (hereinafter, simply referred to as “catheter kit”) in an assembled state, and FIG. Are shown in a pre-assembled state. The catheter kit 10 is used for constructing a gastrostomy in a patient as a living body by the pull method.

The catheter kit 10 is constructed so as to include the tube 12 and the sheath 14 shown in FIG. 2 and the guide wire 16 shown in FIG.

As shown in FIG. 2, the tube 12 is used for introducing nutrients from outside the body into the stomach 18 in an embedded state in which the tube 12 is embedded in the stomach 18 of the patient (see FIG. 5).
Therefore, as shown in FIG. 2, the tube 12 has a nutrient passage 20 therein. In this embodiment, the tube 12 is configured as a tube 12 commonly used in the medical industry, and has an outer diameter of about 4 mm to about 9.33 mm (about 12 Fr to about 28 Fr). The tube 12 is made of an elastically deformable material such as silicon or urethane,
Thereby, it is given flexibility.

As shown in FIG. 2, the tube 12 has a hollow main body portion 22 extending in the same circular cross section. One of both end portions of the main body portion 22 is a stomach side end portion 24 located on the stomach 18 side when the tube 12 is inserted into the body, and the other is a mouth side end portion 26 located on the mouth side.

To the stomach side end 24 of the main body portion 22, there is integrally connected a tapered tip end portion 28 whose diameter decreases as the distance from the stomach side end 24 increases. This tip 2
8 is made of the same material as that of the main body portion 22, but the tip portion 28 has higher rigidity than the main body portion 22 due to differences in shape, wall thickness, easiness of generation of bending moment, and the like.

On the other hand, a hollow intragastric fixing device 30 is integrally connected to the mouth end 26 of the main body 22. An example of the intragastric fixing device 30 is a mushroom-type intragastric fixing device that is opened on the side opposite to the side connected to the main body 22. The intragastric fixing device 30 is designed to be elastically deformable at least in the radial direction.

FIG. 12 shows the intragastric fixture 30 in use. The intragastric fixing device 30 is used so that the tube 12 of the tube 12 is located in the stomach 18 in an embedded state in which the tube 12 is embedded in the stomach 18. The outer diameter of the intragastric fixing device 30 is set to be larger than the outer diameter of the tube 12. The intragastric fixture 30 serves to secure the tube 12 within the stomach 18 so that the tube 12 does not disengage from the patient.

As shown in FIG. 1, the tube 12 is
It is used by being inserted into the sheath 14 which will be described in detail later. To break through and tear the sheath 14, the tube 1
The second tip 28 is pressed against the sheath 14. In order to perform this piercing function, the tip portion 28 of the tube 12 is
Is formed so as to have a tapered shape as described above. To enhance this piercing function, the tube 12 can be configured, for example, such that the tip portion 28 of the tube 12 is more rigid than the rest of the tube 12.

Prior to constructing a gastrostomy in a patient, a narrow through hole that penetrates the abdominal wall and the stomach wall of the patient together is formed in the site where the gastrostomy is to be constructed in the patient. On the other hand, the tube is inserted into the stomach through the oral cavity of the patient, and then is brought close to the through hole and inserted into the through hole. In the inserted state, increasing the diameter of the through hole with a tube is suitable for gastrostomy construction. Therefore, in the present embodiment, the tip end portion 28 of the tube 12 is tapered as described above, and as a result, the tip end portion 28 is formed.
Also works as a dilator.

As shown in FIG. 2, a loop-shaped connecting wire 34 extends from the tip of the tip portion 28 of the tube 12. This connecting wire 34 is a guide
A wire 16 is connected to the guide wire 16 for pulling the tube 12 for insertion into the body (guide
An example of a member (captured by the wire 16) is inseparably attached to the tube 12.

In addition, in addition, when the tube 12 is inserted and installed in the through hole, the tip portion 28 is located outside the body, and normally, the tip portion 28 is cut off from the tube 12 as an unnecessary portion. It In FIG. 12, the stomach 18
The tube 12 installed inside has the tip 2 after the installation.
8 is shown excised. Therefore, it is not essential that the distal end portion 28 of the tube 12 constitutes the nutrient passage 20 for introducing nutrients into the stomach 18 from outside the body.

Therefore, the distal end portion 28 of the tube 12 is different from the main body portion 22 and the intragastric fixing device 30 in the tube 1
It is possible to employ a closed structure that shuts off the space inside 2 from the outside air. When it is necessary to eliminate the possibility that the tube 12 is contaminated with living bacteria during the process of inserting the tube 12 into the body, it is desirable to adopt such a sealed structure.

As shown in FIG. 2, the sheath 14, like the tube 12, has a hollow main body 40 extending in the same circular cross section. One of both ends of the main body 40 is a stomach-side end 42 located on the stomach 18 side when the sheath 14 is inserted into the body, and the other is a mouth-side end 44 located on the mouth side.

The sheath 14 has rigidity and a wall thickness of 0.1.
A material having a size of about mm is configured to have a straw shape. Such a material is, for example, a synthetic resin such as PE (polyethylene) or PP (polypropylene). The inner diameter of the sheath 14 is larger than the outer diameter of the tube 12 and smaller than the outer dimension when the intragastric fixture 30 is projected in the axial direction of the tube 12. Therefore, if the intragastric fixing device 30 is inserted into the sheath 14, the intragastric fixing device 30 is compressed by the sheath 14, and as a result, a compressive force acting from the sheath 14 toward the center of the intragastric fixing device 30 acts. As a reaction force, a circumferential force in the direction of expanding the sheath 14 is applied to the sheath 14. The circumferential force causes the sheath 14 to be torn as shown in FIG.

As shown in FIG. 1, at the gastric side end 42 of the main body 40 of the sheath 14, a hollow tapered distal end 4 having a diameter that decreases as the distance from the gastric side end 42 increases.
6 are integrally connected. In this embodiment,
It is designed so that the outer surface of the distal end portion 28 of the tube 12 is fitted to the inner surface of the distal end portion 46 of the sheath 14 when the tube 12 is inserted into the sheath 14.

As shown in FIG. 1, at the mouth side end portion 44 of the main body portion 40, a sheath-shaped sheath having a diameter larger than that of the main body portion 40 is formed.
The stopper 50 is integrally connected. This sheath 1
4 is used in the inserted state in which the tube 12 is inserted into its lumen 52. In the inserted state, the sheath 1
4, the tube 12 is covered from the outside of the tube 12 in the portion from the tip end portion 28 of the tube 12 to the substantially middle portion of the main body portion 22.

As shown in FIG. 2, the distal end portion 4 of the sheath 14 is
An opening communicating with the inner cavity 52 of the sheath 14 is coaxially formed at the tip of the sheath 6. This opening allows the sheath 14
In the inserted state in which the tube 12 is inserted, the connecting wire 34 extending from the distal end portion 28 of the tube 12 is allowed to pass and be exposed. In FIG. 1, in the inserted state, the connecting wire 34 passes through the opening and the sheath 1
4 is shown projecting to the outside.

As shown in FIG. 2, the sheath stopper 50
Are integrally formed with the main body 40 in a form of protruding from the main body 40 in the radial direction thereof. The sheath stopper 50 contacts the mouth 56 (see FIG. 5) of the patient when the tube 12 covered by the sheath 14 is inserted into the stomach 18 through the oral cavity 54 (see FIG. 5) of the patient, It also serves to define an insertion limit that prevents the sheath 14 from proceeding further in the same direction. To fulfill this function,
In the present embodiment, the diameter of the sheath stopper 50 is set to be larger than the diameter of the mouthpiece (not shown) that is inserted and installed in the mouth 56 of the patient.

In the present embodiment, the sheath 14 is inserted over the length from the oral cavity 54 of the patient to the vicinity of the entrance in the stomach 18. Since the length from a human tooth (incision) to the entrance to the stomach (cardia) is generally about 45 cm, the length of the sheath 14 is also set to about 45 cm.

As shown in FIG. 3A, the sheath 14 is formed with two score lines 58 on the outer peripheral surface thereof.
The two score lines 58 extend from the tip of the tip portion 46 of the sheath 14 to the sheath stopper 50 in the length direction of the sheath 14. The two dividing lines 58 are arranged so as to face each other with the center line of the sheath 14 therebetween.
It is located at 4. In FIG. 3A, only one dividing line 58 is shown by a solid line, and the other dividing line 58 is hidden and invisible. However, the present invention can be implemented in a mode in which the number of the dividing lines 58 formed on the sheath 14 is one or more than two.

Each dividing line 58 is formed so that the sheath 14 is locally recessed in the thickness direction thereof to form a stripe shape. Therefore, when tensile stress acts on each part in the length direction of the sheath 14 in the circumferential direction, the stress locally concentrates on the dividing line 58, and as shown in FIG. 3B, along the dividing line 58. The sheath 14 will be torn.
That is, this sheath 14 is a peel-away type.

As shown in FIG. 5, the guide wire 16
Is used by being inserted into a through hole 74 formed in the patient so as to penetrate both the abdominal wall 70 and the stomach wall 72 of the patient.
The inserted guide wire 16 is grasped by the endoscope 76 inserted through the oral cavity 54 in the stomach 18, and then pulled out of the body through the esophagus 78 and the oral cavity 54 in order together with the endoscope 76. . Guide wire 1
The length of 6 is set to be longer than the length from the oral cavity 54 to the through hole 74 through the esophagus 78 and the stomach 18 in order.

As shown in FIG. 6, the guide wire 16
Is ligated to the connecting wire 34 extending from the distal end of the tube 12 at the end 90 exposed from the oral cavity 54 when installed in the patient. Guide wire 16
The tube 12 by being pulled away from the patient at the end 92 exposed from the abdominal wall 70.
Plays a role of guiding the gas from the oral cavity 54 into the stomach 18 through the esophagus 78.

The construction of the catheter kit 10 has been described in detail above. Next, the method of using the catheter kit 10, namely,
A method for constructing a gastrostomy using the catheter kit 10 will be described in detail.

FIG. 4 is a flow chart showing this gastrostomy construction method. In this method, first, in step S1 (hereinafter, simply referred to as “S1”; the same applies to other steps), the operator uses the endoscope 54 through the oral cavity 54 of the patient laid down in the supine position. Insert 76 into stomach 18. The operator then pumps air through the fiber lumen of the endoscope 76 and into the patient's stomach 18. Due to this insufflation, the stomach 18 of the patient swells, and the abdominal wall 70 and the stomach wall 72
And stick to each other.

Further, the operator observes the inside of the stomach 18 with the inserted endoscope 76 and palpates the operator,
The position of the tube insertion site 102 in which the tube 12 is to be inserted is determined on the skin of the abdomen 100. The tube insertion portion 102 is a portion where the skin of the patient is locally incised, and is also a portion where a gastrostomy is finally constructed.

Next, in S2, the operator determines the position of the positioned tube insertion portion 102 of the patient's skin.
And disinfect the surrounding area. Subsequently, in S3, the operator locally anesthetizes the tube insertion site 102.

Thereafter, in S4, the operator punctures the patient with the puncture needle (not shown) and the outer cylinder 104 in which the puncture needle is inserted at the tube 12 insertion site. At this time, the operator attaches the puncture needle and the outer cylinder 104 to the abdominal wall 7.
The patient is punctured to penetrate both the 0 and stomach wall 72. Thereby, a through hole 74 that penetrates both the abdominal wall 70 and the stomach wall 72 is formed. Subsequently, the operator removes only the puncture needle from the through hole 74 while leaving the outer cylinder 104 at the insertion site of the tube 12.

Subsequently, in S5, the operator passes the guide wire 16 through the inner cavity of the outer cylinder 104 left in the patient.
Is inserted into the stomach 18. Then, in S6, the operator captures and holds the inserted guide wire 16 by the endoscope 76 inserted into the stomach 18 through the oral cavity 54 in S1.

The guide wire 16 is shown in FIG.
It is shown to be gripped by 6. The worker pulls the endoscope 76 out of the body through the oral cavity 54 in this gripped state. As a result, the guide wire 16 is inserted into the body longer through the through hole 74, and finally, as shown in FIG. 6, the distal end portion of the guide wire 16 (that is, the guide wire 16 is grasped by the endoscope 76). The exposed portion) is exposed outside the body through the oral cavity 54.

Subsequently, in S7 of FIG. 4, the worker
As shown in FIG. 6, the connecting wire 34 extending from the distal end of the tube 12 previously covered with the sheath 14 and the distal end portion 9 of the guide wire 16 exposed from the oral cavity 54.
0 is ligated. Since the connecting wire 34 is exposed through the sheath 14 from the tip of the tube 12 located inside the sheath 14, if the connecting wire 34 is pulled, the sheath 14 is pulled together with the tube 12. Will be.

Thereafter, in S8 of FIG. 4, the worker
The portion 106 of the guide wire 16 exposed outside the body is pulled from the abdominal wall 70 side in a direction away from the patient. As a result, the tube 12 and the sheath 14 are integrated into the stomach 1 via the oral cavity 54, the pharynx 110 and the esophagus 78.
8 is pulled and inserted. At this time, the tube 12
Passes through the oral cavity 54, the pharynx 110, and the esophagus 78, which are culture media of the bacterial flora, in that order, but is covered with the sheath 14 on the outer side thereof, so that the tube 12
Need not directly contact the inner walls of the oral cavity 54, the pharynx 110, and the esophagus 78.

As shown in FIG. 7, the length of the sheath 14 is
As described above, since the length from the human tooth to the entrance of the stomach 18 is almost the same, the distal end portion 46 of the mating sheath 14 and the distal end portion 28 of the tube 12 are inserted together into the stomach 18 and advanced. Then, first, the sheath stopper 50 provided at the rear end of the sheath 14 comes into contact with the mouth 56 (for example, a mouthpiece) of the patient. After this abutment, the sheath stopper 50 may be configured such that the sheath 14 is further advanced.
Mechanically blocked by.

Subsequently, in S9 of FIG. 4, the worker
The portion 106 of the guide wire 16 exposed from the abdominal wall 70 to the outside of the body is further pulled away from the patient. As described above, the sheath 14 is the sheath stopper 50.
As a result, the guide wire 16 is pulled so that the tube 12 is displaced relative to the sheath 14 in the axial direction. That is, the sheath 1
The tube 12 is independently advanced toward the stomach 18 side, leaving 4 behind.

By pulling the guide wire 16, the distal end portion 28 of the tube 12 is strongly pressed against the distal end portion 46 of the sheath 14, and as a result, as shown in FIG.
Of the sheath 14 is pierced by the tip 28 of the tube 12, and the tip 46 of the sheath 14 is torn along each secant 58 thereof. Thus, in the present embodiment, the tip of the sheath 14 covering the tube 12 is
The tube 12 is broken by the movement of the tube 12 due to the pulling of the guide wire 16. When the guide wire 16 is further pulled, the distal end portion 28 of the tube 12 is moved to
It is exposed from the torn tip 46.

As shown in FIG. 8, the sheath stopper 50
When the patient touches the mouth 56 of the patient, the sheath 1
The tip portion 46 of 4 is downstream of the culture medium of the bacterial flora, for example,
It is adapted to be located in the stomach 18. Therefore, even if the tip portion 46 of the sheath 14 is pierced in this state and the tube 12 is exposed from the sheath 14, there is almost no possibility that bacteria adhere to the tube 12.

Thereafter, in S10 of FIG. 4, the worker further pulls the guide wire 16 in a direction away from the patient. As a result, as shown in FIG.
By being guided by the guide wire 16, the distal end portion 28 of the is advanced toward the through hole 74 and is then inserted into the through hole 74. After insertion, guide wire 1
When 6 is further pulled in the same direction, the distal end portion 28 of the tube 12 is advanced toward the outside of the body while expanding the through hole 74.

Subsequently, in S11 of FIG. 4, the operator pulls the distal end portion 28 of the tube 12 exposed from the through hole 74 in a direction away from the patient. Eventually, the entire main body portion 22 of the tube 12 is inserted into the inner cavity 52 of the sheath 14, and subsequently, the intragastric fixture 30 provided at the rear end portion of the tube 12 is provided at the rear end portion of the sheath 14. It is installed on the sheath stopper 50.

In this state, the operator makes the tube 1
When 2 is pulled away from the patient, the intragastric fixator 30 also attempts to be inserted into the lumen 52 of the sheath 14 as the tube 12 advances. As a result, the intragastric fixing tool 30 is elastically deformed so as to be reduced in diameter, while the intragastric fixing tool 30 and the sheath 14 are brought into contact with each other, so that a circumferential tensile force is applied to the sheath 14. By that action, the sheath 14
The stress concentrates on each of the dividing lines 58 formed on the base, and as a result, the sheath 14 is torn along the dividing lines 58. As shown in FIG. 9 which shows the sheath 14 as a whole and FIG. 10 which shows the sheath 14 partially and in an enlarged manner, the tearing is caused as the tube 12 advances.
It proceeds from 0 toward the distal end portion 46 of the sheath 14.

As shown in FIG. 9, the tearing of the sheath 14 by the intragastric fixture 30 results in the oral cavity 54 and the pharynx 110 of the patient.
And the so-called esophagus 78, a so-called bacterial flora medium. Therefore, the surface of the intragastric fixing device 30 may be exposed from the sheath 14 and contact the inner wall surface of the esophagus 78 or the like. However, the body portion 22 of the tube 12 having a smaller diameter than the intragastric fixing device 30 does not have to come into contact with the inner wall surface of the esophagus 78 or the like despite the tear of the sheath 14. Also, there is a concern that the bacteria may be transmitted and become infected, that is, the through hole 74, that is, the site where the gastrostomy is to be constructed. The tube 12 contacts this site, but the intragastric fixture 30 does not contact.

Therefore, according to the present embodiment, even if the sheath 14 is torn when the intragastric fixing device 30 passes through the sheath 14, the bacteria are not propagated to the gastrostomy site due to the tear. I'm done.

In the present embodiment, the breaking of the sheath 14 by the sheath stopper 50 is performed by inserting the intragastric fixing device 30 into the sheath 14, and does not require the operator's hand directly. However, if it is necessary to consider that the sheath stopper 50 is less likely to be torn than the other parts of the sheath 14, in order to make the insertion of the intragastric fixture 30 into the sheath 14 smoother. Then, the worker attaches the sheath stopper 50 to the sheath stopper 5
The present invention can be implemented in a manner in which the tearing of the sheath stopper 50 is manually promoted by grasping the two portions where 0 is divided by the dividing line 58 with both hands and pulling them apart.

In the present embodiment, one dividing line 58 of the sheath 14 is provided on each side of the sheath 14 with the center line of the sheath 14 separated, but the actual breaking of the sheath 14 occurs only on the dividing line 58 on one side. It may be performed along the dividing lines 58 on both sides. Even if the rupture is on one side, the passage area of the intragastric fixator 30 inside the sheath 14 increases, so that the intragastric fixator 30 can advance in the lumen 52 of the sheath 14.

Then, in S12 of FIG. 4, the worker further pulls out the tube 12 from the abdominal wall 70 side. Along with this, the intragastric fixture 30 advances in the lumen 52 of the sheath 14 toward the stomach 18, and eventually passes through the distal end portion 46 of the sheath 14 as shown in FIG. 11. As a result, the tube 12 is separated from the sheath 14.

As shown in FIG. 11, when the intragastric fixing tool 30 passes through the distal end portion 46 of the sheath 14, the tear generated by the intragastric fixing tool 30 starting from the sheath stopper 50 is preceded by the tear. The tip 2 of the tube 12
Due to the continuity of each dividing line 58, the tear generated by the distal end portion 46 of the sheath 14 may be made continuous with each other along both of the two dividing lines 58. When placed in series with each other, when the intragastric fixator 30 passes completely through the sheath 14, the sheath 14 will be completely divided into two parts.

Then, in S13 of FIG. 4, the operator pulls out the tube 12 until the intragastric fixing device 30 contacts the stomach wall 72, as shown in FIG.
Is fixed in the stomach.

Thereafter, in S14 of FIG. 4, the operator removes the sheath 14 inserted from the oral cavity 54 of the patient to the entrance of the stomach 18 to the outside of the body through the oral cavity 54, as shown in FIG. Prior to the removal, the sheath 14 is completely or partially divided as shown in FIG. 12, so that the operator can easily remove the sheath 14 from the patient with a small force. It becomes possible to do it while reducing the burden of.

With the above, the implementation of the gastrostomy construction method shown in FIG. 4 is completed.

As is clear from the above description, in the present embodiment, the distal end portion 28 of the tube 12 is an example of "the gastric side end portion of the tube" in the above item (1), (4) or (8). Intragastric fixture 3 of tube 12
0 constitutes one example of the "mouth end of the tube" in the item (4) or (8). Further, the distal end portion 46 of the sheath 14 constitutes an example of the "stomach side end portion of the sheath" in the above item (4), and the sheath stopper 50 constitutes an example of the "sheath mouth side end portion" in the above item. -ing

Further, in the present embodiment, the distal end portion 28 of the tube 12 constitutes an example of the “breaking portion” in the above item (1), and the distal end portion 46 of the sheath 14 in the above item “of the tube of the sheath. That is, it constitutes an example of "a portion facing the stomach side end". Further, the tube 12 constitutes an example of the "tube" in the item (1) or (2), and the sheath 14 constitutes an example of the "sheath" in any of the items (1) to (3). Of.

Furthermore, in the present embodiment, the intragastric fixing device 30 constitutes an example of the “enlarged portion” in the above (4) or (5), and the intragastric fixing device 30 in the above (6). An example of the "intragastric fixing tool", the sheath 14 constitutes an example of the "sheath" in the item (7), and the distal end portion 28 of the tube 12 is the "broken part" in the item (8) or (9). It constitutes one example.

In addition, according to the present embodiment, the distal end portion 46 of the sheath 14 has a tapered shape and is pointed. Therefore, in the process of inserting the sheath 14 covering the distal end portion 28 of the tube 12 into the narrow tubular organ in the body through the oral cavity 54, the distal end surface of the sheath 14 is more perpendicular to the traveling direction than the case. Sheath 14
The resistance received by the tubular organ from the tubular organ is reduced. This is due to the effect of the slope of the distal end portion 46, and as a result, the work for inserting the sheath 14 becomes easy.

In addition, in the present embodiment, since the distal end portion 28 of the tube 12 is tapered and pointed similarly to the distal end portion 46 of the sheath 14, the narrow through hole 74 is formed. Is facilitated, and after the entry, the tube 12 is further deeply inserted into the through hole 74 while expanding the through hole 74. Therefore,
According to the present embodiment, since the distal end portion 28 of the tube 12 is sharp, the distal end portion 46 of the sheath 14 is easily pierced, and the narrow through hole 74 is easily inserted to enlarge the through hole 74. Effectively used for both.

Further, according to the present embodiment,
The intragastric fixture 30 of the tube 12 performs its original function, ie, preventing the tube 12 from unintentionally leaving the patient after placement in the stomach 18, as well as tearing and breaking the sheath 14. .

By the way, in the conventional example described in Patent Document 1, after the PEG tube covered with the sheath is inserted into the body through the oral cavity, the outlet end of the sheath is opened and the PEG tube is withdrawn from the sheath. A work process is required to determine the opening timing (or the position at which the opening should be performed) to be performed. The opening timing is, for example, the timing at which the gastric side end of the PEG tube covered with the sheath comes into contact with the gastric side end of the puncture needle penetrating the through hole formed in the patient.

This opening timing can be determined, for example, by visually observing the positional relationship between the PEG tube and the puncture needle using an endoscope. However, in this case, the insertion of the endoscope into the patient is performed in the state where the PEG tube is previously installed in the body. As a result, the PEG tube covered by the sheath and the fiber of the endoscope are present together in the thin tubular organs of the patient's pharynx and esophagus.

As a result, when the opening timing is determined using the endoscope, the patient may suffer a great deal of pain, a strong pharyngeal reflex may occur, and a sheath with a tight fiber may be used. The contact may damage the sheath and impair the sealing function.

On the other hand, in the present embodiment, the tamping for tearing the sheath 14 by the distal end portion 28 of the tube 12 is predetermined by the size of the sheath 14, and the operator can determine the timing (position) by himself. Is unnecessary.

Therefore, according to this embodiment, it is possible to omit the work step of deciding the timing at which the sheath 14 is torn and the tube 12 is exposed from the sheath 14, and this also improves the usability of the catheter kit 10. .

Next, a second embodiment of this embodiment will be described. However, since the present embodiment has elements common to the first embodiment, common elements are referred to by using the same reference numerals to omit detailed description, and only different elements will be described in detail. .

In the first embodiment, as shown in FIG. 9, the shape of the sheath 14 is determined so that the sheath stopper 50 is reliably torn when the intragastric fixing device 30 is inserted into the sheath 14. ing. On the other hand, in the present embodiment, tearing of the sheath stopper is not prevented, but tearing is not actively performed.

Specifically, as shown in FIG. 13, in the gastrostomy catheter kit 130 of this embodiment, the diameter of the sheath stopper 132 is continuously increased as it approaches the main body 136 of the sheath 134. Designed to decrease. Furthermore, in this embodiment,
When the intragastric fixator 30 first comes into contact with the sheath stopper 132, the inner diameter of the sheath stopper 132 at the contact position becomes larger than the outer diameter of the intragastric fixator 30 at that time, and there is a gap between the two. The dimensional relationship between the sheath stopper 132 and the intragastric fixing device 30 is set so that the above-mentioned remains.

Therefore, in this embodiment, when the intragastric fixing device 30 first contacts the sheath stopper 132, unlike the first embodiment, the sheath stopper 132 contacts the intragastric fixing device 30 to cause the sheath to move.・ Stopper 132
Moreover, no circumferential tensile stress is generated in the direction of expanding the diameter.

As shown in FIG. 14A, in this embodiment, as the elastically deformable intragastric fixing device 30 is deeply inserted into the sheath 134 which is more rigid, the sheath stopper 132 of the sheath stopper 132 is inserted. The outer diameter decreases and the force with which the sheath stopper 132 compresses the intragastric fixator 30 toward it increases. with this,
The circumferential tensile stress in the direction of expanding the diameter of the sheath stopper 132 increases, and the stress concentrates on each secant 138 formed on the sheath 134. When the stress exceeds the limit,
As shown in (b) of FIG.
It will be torn laterally along 38.

The circumferential tensile stress of the sheath 134 is small in the sheath stopper 132, and then the main body 13
It increases as it approaches 6. Therefore, in the present embodiment, as shown in FIG.
Of these, the tear will occur only in the portion except the whole or part of the sheath stopper 132.

In the present embodiment, typically, the sheath 134 is torn along each dividing line 138 in the portion excluding the sheath stopper 132,
As shown in FIG. 15, the sheath 134 is typically removed from the body through the oral cavity 54 with the two parts that are torn and divided being joined to the sheath stopper 132 that is not torn. become.

Since the sheath stopper 132 is used so as to be located outside the body during the entire series of operations, it is easy to remove the sheath 134 from the body immediately because the sheath stopper 132 is not torn. It will not be exacerbated or will increase the distress or discomfort the patient experiences during its removal.

Next, a third embodiment of the present invention will be described.
However, since the present embodiment has elements common to the first embodiment, common elements are referred to by using the same reference numerals to omit detailed description, and only different elements will be described in detail. .

In the first and second embodiments, the catheter kit for constructing a gastrostoma is used for constructing a gastrostomy in a patient as a living body by the “pull method”. On the other hand, in the present embodiment, the gastrostomy catheter kit is used for the purpose of constructing a gastrostomy by the “push method”.

As described above, the "pull method" uses a guide wire as a pull wire to pull the tube, and pulls the guide wire out of the body to insert the tube into the body through the oral cavity. Is the way.
On the other hand, the “push method” is a method in which a guide wire is used to guide the course of the tube and the tube is pushed (pushed) into the body through the oral cavity.

FIG. 16 shows the sheath 14 and the tube 15 of the gastrostomy catheter kit 150 according to the present embodiment.
2 and 2 are shown before assembly. As shown in FIG. 16, the sheath 14 is configured similarly to the first embodiment. On the other hand, the tube 152 has a distal end portion 154.
And a gastric fixing device 156, and the tip portion 15 thereof.
4 and the intragastric fixture 156 are common to the first embodiment in that they are connected to each other by the main body portion, but the rigidity of the distal end portion 154 and the configuration of the main body portion 160 are different from those in the first embodiment.

Specifically, in this embodiment, the tip portion 154 is made of a rigid material such as PE (polyethylene) or PP (polypropylene). The shape retention of the tip portion 154 is improved as compared with the tip portion 28 in the first embodiment.

Further, in this embodiment, the main body 1
60 is composed of a first portion 162 having rigidity and a second portion 164 having elasticity. First part 1
62 is made of a material having rigidity similar to the tip portion 154. On the other hand, the second portion 164 is
Like the intragastric fixture 30 in the first embodiment, it is made of an elastically deformable material such as silicon or urethane. The second portion 164 has an intragastric fixture 156.
It is elastically deformable by the same material as.
As a result, the second portion 164 is more flexible than the first portion 162.

In the present embodiment, the tube 152 is not inserted into the body through the oral cavity 54 by the pulling of the tube 152, that is, the axial pulling of the tube 152, but the pushing of the tube 152, that is, the axis of the tube 152. The tube 152 moves the oral cavity 5
It is inserted into the body through 4. As a result, in the present embodiment, unlike the first embodiment, the connecting wire 34 is not attached to the tip of the tube 152, but instead, as described above, the shape-retaining property of the tube 152, that is, the self-supporting property. Has been improved.

Specifically, in the present embodiment, the distal end portion 1 of the tube 152, which is located on the leading side when inserted, is used.
54 and the first portion 162, the second portion 164 located on the rear side and the twist in the intragastric fixing device 156,
Independence is improved. In particular, by utilizing the rigidity of the first portion 162, the tube 152 is pushed into the body through the oral cavity 54. The first portion 162 is the oral cavity 54
It has a length equal to or longer than the length from to the through hole 74 through the esophagus 78 and the stomach 18. On the other hand, the second portion 164 is the tube 152 of the tubes 152.
Is a part that is placed in the stomach 18 and then placed in the body.

Along with the tube 152 constructed as described above, the sheath 14 common to the first embodiment is used so as to cover the distal end portion 154 of the tube 152 and the substantially front half portion of the first portion 162. Since the guide wire 170 is commonly inserted through the tube 152 and the sheath 14, the distal end of the distal end portion 154 of the tube 152 has an opening communicating with the nutrient passage 166, which is the lumen thereof. Similarly, the sheath 14 has an opening formed therein.

FIG. 17 is a flowchart showing a gastrostomy construction method for constructing a gastrostomy in a patient by the push method using the catheter kit 150 for gastrostoma construction according to the present embodiment. Hereinafter, the method for constructing a gastrostoma will be specifically described, but detailed description of steps common to the first embodiment will be omitted.

In this gastrostomy construction method, S51 to S56 are sequentially performed, and S1 to S6 in the first embodiment are sequentially performed.
It is executed in the same manner as. Through this, the through hole 74
The guide wire 170 inserted into the stomach 18 via
Similarly to the first embodiment, the endoscope 76 inserted into the stomach 18 via the oral cavity 54 is passed through the esophagus 78 to the oral cavity 54.
Be pulled out.

After that, in S57, the operator inserts the portion of the guide wire 170 exposed from the oral cavity 54 into the lumen of the tube 152 previously covered with the sheath 14 and length of the tube 152. Insert so as to penetrate the entire direction. Further, the operator pulls one end of the guide wire 170 out of the intragastric fixture 156 of the tube 152.

Subsequently, in S58, the operator at least exposes the guide wire 170 penetrating the patient from the through hole 74 and the tube 152.
Tension is applied to the portion between the intragastric fixture 156 and the exposed portion 178. Further, the operator inserts the assembly of the tube 152 and the sheath 14 in the tensioned state toward the stomach 18 through the oral cavity 54 while being guided by the guide wire 170 passing through the assembly. As described above, since the distal end portion 154 and the first portion 162 of the tube 152 are rigid, the distal end portion 154 of the tube 152 is guided when the operator grips these portions and pushes them into the oral cavity 54 of the patient. • Will be advanced along the wire 170 towards the stomach.

As shown in FIG. 18, when the distal end of the assembly of the tube 152 and the sheath 14 reaches the vicinity of the entrance in the stomach 18, the sheath provided on the mouth-side end 44 of the main body 40 of the sheath 14. The stopper 50 contacts the mouth 56 of the patient. After the contact, the sheath 14 is prevented from further advancing.

Thereafter, in S59 of FIG. 17, the operator applies tension to the guide wire 170 while
Only the tube 152 is pushed into the body through the oral cavity 54.
Due to the pushing, the tube 152 tries to advance by itself with the sheath 14 left behind, and eventually the distal end portion 154 of the tube 152 pierces the distal end portion 46 of the sheath 14 and tears the sheath 14. When the sheath 14 is torn, the distal end portion 154 of the tube 152 is exposed from the sheath 14 and independently advances to approach the through hole 74.

Subsequently, in S60, the operator pushes the tube 152 deeper. As a result, the distal end portion 154 of the tube 152 reaches the through hole 74 while being guided by the guide wire 170. The outer cylinder 104 is inserted into the through hole 74 in advance, and the outer cylinder 104 is pushed out of the body by the tip portion 154 of the tube 152. Eventually, the tip portion 154 of the tube 152 is also pushed out of the body.

Then, in S61, the operator releases the tension of the guide wire 170, and the distal end portion 154 of the tube 152 pushed out of the body through the through hole 74.
Pull out. The withdrawal pulls out the distal end portion 154 and the first portion 162 of the tube 152, and then the second portion 164 enters the stomach 18. Almost in synchronization with this, the intragastric fixing device 156 provided on the tube 152 abuts on the sheath stopper 50.

When the operator further draws out the tube 152, the intragastric fixture 156 comes into contact with the sheath stopper 50 and tries to insert it into the lumen 52 of the sheath 14. The contact causes the sheath stopper 50 to be torn according to the same principle as in the first embodiment.

Subsequently, in S62, the operator further pulls out the tube 152. As a result, the intragastric fixing device 1
56 is advanced within the lumen 52 of the sheath 14 toward the stomach,
At the same time, the tearing of the sheath 14 also progresses along the sheath 14. When the intragastric fixture 156 passes through the distal end portion 46 of the sheath 14 and reaches the stomach, the separation of the tube 152 from the sheath 14 is completed.

After that, in S63, the operator uses the tube 152 until the intragastric fixture 156 contacts the stomach wall 72.
Is pulled out, and the intragastric fixing device 156 is fixed to the stomach wall 72 of the patient. A portion (mainly the first portion 162) of the tube 152 pulled out of the body through the through hole 74 is cut off from a portion (mainly the second portion 164) existing in the body. This will place the tube 152 within the stomach 18.

Subsequently, in S64, the operator removes the already torn sheath 14 out of the body.

This is the end of the implementation of this gastrostomy construction method.

As is clear from the above description, in the present embodiment, the distal end portion 154 of the tube 152 is an example of "the gastric side end portion of the tube" in the above (1), (4) or (8). That is, the intragastric fixing device 156 of the tube 152 constitutes an example of the "mouth end of the tube" in the item (4) or (8).

Incidentally, in addition, in the present embodiment,
Although the sheath 14 common to the first embodiment is used, the sheath 134 common to the second embodiment may be used.

Although some of the embodiments of the present invention have been described in detail with reference to the drawings, these are examples.
The present invention can be carried out in other modes in which various modifications and improvements are made based on the knowledge of those skilled in the art, including the modes described in the section of [Means for Solving the Problems].

[Brief description of drawings]

[0159]

FIG. 1 is a perspective view showing a main part of a catheter kit for gastrostoma construction 10 according to a first embodiment of the present invention before being assembled.

FIG. 2 is a catheter kit 10 for constructing a gastrostomy shown in FIG.
FIG. 3 is a perspective view showing a main part of the above in a state before assembly.

FIG. 3 is a catheter kit 10 for constructing a gastrostomy shown in FIG.
FIG. 4 is a perspective view showing the sheath 14 in the state before tearing and in the state after tearing.

FIG. 4 is a catheter kit 10 for constructing a gastrostomy shown in FIG.
6 is a flowchart showing a gastrostomy construction method using the method of FIG.

5 is a side cross-sectional view for explaining the content of implementation of S6 in FIG. 4. FIG.

FIG. 6 is a side sectional view for explaining the contents of implementation of S7 in FIG.

FIG. 7 is a side cross-sectional view for explaining the content of implementation of S8 in FIG.

FIG. 8 is a side sectional view for explaining the content of implementation of S9 in FIG.

9 is a side cross-sectional view for explaining the content of implementation of S11 in FIG.

10 is a perspective view for explaining how the sheath 12 is locally torn and enlarged by the tube 12 during execution of the method for constructing a gastrostomy in FIG. 4. FIG.

FIG. 11 is a perspective view for explaining the content of implementation of S12 in FIG.

FIG. 12 is a front cross-sectional view for explaining an implementation content of S13 and S14 in FIG.

FIG. 13 is a perspective view showing a sheath 134 of the gastrostomy catheter kit 130 according to the second embodiment of the present invention.

FIG. 14 shows the tube 12 in the sheath 134 shown in FIG.
FIG. 8 is a perspective view for explaining a state in which the is inserted over time.

FIG. 15 is a side sectional view for explaining how the tube kit 12 is inserted into the stomach 18 and the sheath 134 is removed from the body using the catheter kit for constructing a gastrostoma shown in FIG. Is.

FIG. 16 is a perspective view showing a main part of a catheter kit for gastrostoma construction 150 according to the third embodiment of the present invention before being assembled.

FIG. 17 is a flowchart showing a gastrostomy construction method using the gastrostomy construction catheter kit 150 shown in FIG. 16 over time.

FIG. 18 is a view showing that the tube 152 and the sheath 14 covering the tube 152 together with the oral cavity 5 during the gastrostomy method shown in FIG.
FIG. 4 is a side cross-sectional view for explaining a state of being inserted into the stomach 18 via 4;

[Explanation of symbols]

[0160] 12,152 tubes 14,134 sheath 16,170 guide wire 18 stomach 28 Tube tip 30,156 Gastric fixation device 46 Tip of sheath 50,132 sheath stopper 54 oral cavity 70 Abdominal wall 72 stomach wall 74 Through hole

─────────────────────────────────────────────────── ─── Continuation of the front page (56) Reference JP-A-4-226676 (JP, A) JP-A-2000-126302 (JP, A) JP-A-2001-224694 (JP, A) JP-A-2003-180840 (JP , A) JP 2003-275324 (JP, A) US Patent 5807314 (US, A) European Patent Application Publication 744185 (EP, A 1) (58) Fields investigated (Int.Cl. ⁷ , DB name) A61J 15 / 00 A61M 25/00-25/18

Claims (9)

(57) [Claims] 1. A catheter kit for constructing a gastrostoma, which is used for introducing nutrients into the stomach from outside the body, wherein the nutrient is introduced into the stomach from outside the body. A tube having a nutrient passage formed therein, which is inserted into the stomach through the oral cavity of the living body, and prior to the construction of the gastrostomy, the body of the living body is placed at the planned site of the gastrostomy in the living body. What is inserted and installed in a through hole formed so as to penetrate the abdominal wall and stomach wall together, and a tubular sheath that covers the tube from the outside thereof, and together with the tube, the oral cavity of the living body. And having a sheath stopper that defines the insertion limit position into the body through the tube, and the tube alone in the through hole after the sheath reaches the insertion limit position. Approached As a result, axial relative displacement of the tube with respect to the sheath occurs, and the axial relative displacement causes a fracture portion that ruptures a portion of the sheath facing the gastric side end of the tube to be a stomach of the tube. Catheter kit for gastrostomy construction formed on the side end. 2. The tube is inserted into the stomach through the oral cavity of the living body by using the guide wire inserted into the through hole, and the sheath is
The gastrostomy catheter kit according to claim 1, which is inserted into the body through the oral cavity of the living body together with the tube while using the guide wire. 3. The gastrostomy according to claim 1, wherein the sheath is a peel-away type in which at least a part in the length direction of the sheath is torn to the side of the sheath due to the relative displacement in the axial direction. Installation catheter kit. 4. The tube has an enlarged portion that is larger than other portions at a position closer to the mouth side end than the stomach side end of the tube, and the enlarged part is the sheath along with the axial relative displacement. The gastrostomy catheter kit according to claim 3, wherein the sheath is torn by moving the inside from the mouth end toward the stomach end. 5. The gastrostomy according to claim 4, wherein the enlarged portion is positioned with respect to the tube such that the enlarged portion abuts on the sheath after the sheath is broken by the breaking portion. Installation catheter kit. 6. The catheter kit for gastrostomy according to claim 5, wherein the enlarged portion is an intragastric fixing tool for fixing the tube in the stomach. 7. The sheath prior to insertion into the body
The gastrostomy catheter kit according to any one of claims 1 to 6, which is in a state of covering the tube. 8. The gastrostomy apparatus according to claim 1, wherein the fractured portion has a tapered shape in which a diameter increases from a gastric end of the tube toward an oral end thereof. Catheter kit. 9. The gastrostomy apparatus according to claim 8, wherein the fractured portion functions as a dilator for increasing the diameter of the fractured hole in the process of inserting the fractured portion into the through hole from the stomach. Catheter kit.