JP3773951B2 - Translaryngeal tracheostomy device - Google Patents

Description

Description <br/> present invention relates to through laryngotracheal aperture-forming apparatus.
Tracheostomy is usually performed under aseptic conditions in the operating room with the assistance of an assistant, anesthesiologist, and nurse with operating room.
The patient is placed on his back with a cushion under the shoulder and the head in an over-extended state to expose the laryngotracheal region.
To perform a tracheotomy, a skin incision is made that includes skin, subcutaneous cellular tissue, and skin muscle. The incision is approximately 4 cm long and is made along the horizon above the jugular fossa. If desired, an incision may be made vertically from the cricoid cartilage down 3-4 cm along the center line.
Longitudinal incisions have the advantage of not crossing superficial vessels, but leave very noticeable scars.
Therefore, in conventional techniques, in order to perform a tracheotomy, it is necessary to perform an actual operation despite the difficulties and contraindications inherent in this operation.
The intent of the present invention is to allow a tracheostomy tube to be inserted without performing surgery with new techniques, is actually bloodless, and requires little incision in the skin or muscle tissue, and thus scar healing. To provide a device for translaryngeal tracheostomy that eliminates the problems associated with time and scar formation.
Within the scope of the above intention, the object of the present invention is to provide a device capable of mounting a tracheostomy tube from the inside to the outside by fundamentally modifying the technology used so far. is there.
It is another object of the present invention to provide a device that can open a tracheostomy while avoiding surgery and complications such as bleeding, infections, and large ugly scars usually associated with surgery.
Another object of the present invention is to provide a device that allows a tracheostomy tube to be worn in a much shorter time than conventional methods.
Such intent, these purposes, etc. will become apparent below, but can be inserted from the outside inward into the internal annular space of the trachea (trocar); A puller wire that can be moved outside the oral cavity; a tracheostomy tube in which the end is substantially conical and into which the end of the puller wire can be inserted; and the tracheostomy tube in the trachea Expansion means that can be inserted and secured to the end of the puller wire for pulling out of the inner annular portion by pulling means provided on the puller wire from the other end. This is achieved by the translaryngeal tracheal opening forming device of the present invention.
Further features and advantages will become apparent from the description of a preferred embodiment of a translaryngeal tracheostomy device, given as a non-limiting example in the accompanying drawings, which limit the invention is not.
FIG. 1 is a schematic exploded cross-sectional view of a tracheostomy tube and related parts.
FIG. 2 is a view of a tracheostomy tube assembled for insertion in the first embodiment.
FIG. 3 is an illustration of a tracheostomy tube having a rigid penetration cone.
FIG. 4 is a diagram of a tracheostomy tube in which the penetrating member is formed by a plurality of cones.
FIG. 5 is a schematic view showing a first stage of inserting a rigid cannula equipped with a bronchoscope.
FIG. 6 is a schematic view showing a step of inserting a trocar.
FIG. 7 is a schematic view showing a step of inserting a pulling wire.
FIG. 8 is a schematic view showing the insertion of the pulling wire and the delivery of the end portion from the oral cavity.
FIG. 9 is an overview showing the steps of connecting the puller wire to the tracheostomy tube.
FIG. 10 is a schematic view showing the tracheostomy tube delivery from the tracheal internal annular space.
FIG. 11 is a schematic view showing the removal of the penetrating member of the tracheal opening forming tube.
FIG. 12 is a layout diagram of the tracheal opening forming tube in the trachea.
FIG. 13 is a perspective overview of an instrument for pulling a puller wire.
FIG. 14 is a schematic view of the final assembly of the instrument at the stage of pulling out the penetrating member of the tracheal opening forming tube.
As shown in the drawings, the translaryngeal tracheal opening forming device of the present invention comprises a rigid cannula 1 having an inflatable sleeve 2 that can be inserted into the trachea 3. The cannula 1 can be connected to a ventilation unit so that the patient's regular breathing is maintained.
The rigid cannula is provided with an elastic plug 5 in a manner known per se in order to insert the bronchoscope 6 without letting gas escape, thus maintaining the continuity of the patient's breathing.
The bronchoscope 6 is arranged inside the cannula 1 so that an internal annular space generally indicated by reference numeral 10 can be confirmed. Illumination is performed while the cannula 1 is moved forward toward the front wall of the trachea 3, and in this way, the region 10 can be confirmed from the outside by fluoroscopy of the light beam projected by the bronchoscope.
The trocar 11 can be inserted into the inner annular region 10 and is inserted from the outside of the trachea into the region illuminated at a downward angle, from the outside to the inside of the trachea, as shown in FIG. Then, the bronchoscope 6 can be removed.
The trocar 11 acts as a guiding member for the inserted puller wire 20 so that the end of the puller wire can easily exit the oral cavity by passing through the cannula 1.
Once the puller wire is in place, the cannula 1 and trocar 11 are removed, thus reaching the situation shown in FIG.
The end of the puller wire 20 is generally inserted into a tracheal opening forming tube indicated by reference numeral 30, which has a tubular member 31 having an inflatable sleeve 32 at one end and a generalization at the other end. And a penetrating member denoted by reference numeral 35.
The inflatable sleeve 32 is placed inside the tubular member 31 and connected to the air supply tube 32a during the insertion phase, as will be clarified below, and can subsequently be removed and connected to the pump member 32b. .
As shown in FIGS. 1 and 2, the penetrating member 35 is composed of a cone 40 that is arranged and fixed at the end of the tubular member 31, and a flexible cone 41 is bonded thereon, for example, by bonding. It is attached by the agent. The cone has a metal insert 42 at the penetrating tip.
In this way, a loose-taper penetrating member is obtained, which causes a gradual divariation as it enters the inner annular region.
The penetrating member 35 is at the end of the tubular member 31, as shown in FIG. 3, and has a larger taper angle, generally indicated by reference numeral 50, to produce a more dense expansion. It can also be obtained by a single hard cone, optionally made of metal or metallized.
In another embodiment of the penetrating member 35 shown in FIG. 4, there are a plurality of cones 55 having increasing dimensions, which are continuously disposed on the puller wire 20 connecting them.
The pulling wire 20 is inserted at the end where the tracheal opening forming tube 30 is disposed, and the penetrating member 35 gradually widens the inner annular region 10 by pulling the wire, and as a result, is inserted outward from the inside. There is an enlargement means for the purpose of preventing the puller wire from detaching from the tracheostomy tube when the tracheostomy tube is allowed to exit.
The magnifying means can be provided in a variety of ways, directly secured to the end of the wire and can be inserted into the trocar 11 during the first stage, and the wire mounted on the tracheostomy tube It can be constituted by a cup 61 and an elastic ring 62 for preventing it from coming off when inserted.
In this way, the enlargement means is provided at the tip of the pulling wire 20 to enlarge, and as shown in FIGS. 1 to 4, the enlargement portion meshes so that the inner walls of the cones 40 and 55 do not come out as fixing means, The tracheal opening forming tube 30 is fixed to the pulling wire 20.
If desired, a member can be provided that is coupled to the first retainer 60 to increase its size and prevent pull-out.
In addition, if it is desired to use a smaller trocar, a small strip that can be folded into a U shape when inserted into a tracheostomy tube is joined to the wire without providing an extension on the wire, and so on. Thus, it is possible to effectively enlarge the end of the wire and prevent it from being accidentally pulled out even if the puller wire is pulled.
Of course, it is also possible to use other members, such as wire knots, that expand the end of the puller wire after insertion into the tracheostomy tube.
When the penetrating member is pulled out from the inner annular region 10 by the pulling wire, the penetrating member 35 is cut and removed, and the expansion pipe 32a is connected to the pump member 32b. After directing the free end of the tracheostomy tube 30 toward the lung region, the sleeve member 32 is inflated to breathe the patient.
Therefore, in this method, a tracheostomy tube is attached from the inside to the outside, and only a very small hole is formed by the trocar just by gradually expanding the internal annular region with little or no bleeding operation. It is.
In order to facilitate the installation of the tracheostomy tube, an instrument 70 is provided, in particular so that an accurate traction force can be applied to the traction wire 20. This instrument is shown in FIGS. 13 and 14 and consists of a basic body 70 having a plate 72 that can be placed on the outer surface of the trachea in the region where the wire 20 exits. The plate 72 is provided with a passage hole 73 that is larger than the diameter of the tracheostomy tube used.
The plate 72 is connected to a guide rod 75 terminated with a support crossing tool 76 that allows the user to apply the palm.
The slider 80 is slidable on the guide rod 75 and is provided with a grip recess 81 for placing the operator's finger thereon, and further forms a sheet 82 into which the puller wire 20 can be inserted. It can be locked by a locking means constituted by a screw 83.
Therefore, in order to pull the pulling wire 20, the operator fixes the end of the pulling wire protruding from the hole formed in the inner annular region, and then puts the palm on the crossing tool 76 and operates the pulling wire by the action of the slider 80. Thus, the penetrating member can be easily pulled out, and the tracheostomy tube can be pulled out as well.
Furthermore, in this method, the plate 72 provides an abutment element that is in position relative to the outer surface of the trachea and prevents the passage of the penetrating member so that the portion is not torn.
Ultimately, the use of the instrument allows the operator to utilize the traction force in stages, thus avoiding excessive or dangerous forces on the patient.
From the above, it is clear that the present invention achieves its intent and purpose, in particular, that the tracheostomy tube avoids surgery with bleeding and from inside the trachea without damaging muscle and skin tissue. The fact that it is inserted outwardly emphasizes the fact that it gives a device that can form a tracheostomy in a sufficiently innovative way.
Many modifications and variations of this invention are possible and all are considered to be within the scope of the inventive concept.
Moreover, all the details can be replaced by other technically equivalent elements.
Indeed, the materials used and the attendant shapes and dimensions may be as required.

Claims (14)

Be inserted into the trachea, and can tow wire out by moving the end portion into the oral cavity outward, and the ends of the substantially conical capable of inserting the end of the pulling wire in the oral cavity outward into its tracheostomy forming tube having; a a including via laryngotracheal aperture-forming apparatus includes expansion means for preventing from the tracheostomy forming tube of the traction wire is out, the enlarged section, said pull wire the end portion is intended to be fixed to said end of said traction wire after moving to insert oral outside the gas tube opening formed tube, whereby, from the other end of the gas tube opening formed tube the traction means is applied to said traction wire, is obtained so as to go outside the said gas tube opening formed tube from the inside of the inner annular space of the further the gas pipe pulling into the trachea, characterized in that it comprises a, equipment. A trocar (trocar) that can be inserted inwardly from the outside into the internal annular space of the trachea, wherein the trocar allows the end of the puller wire to be inserted therein. The device according to item. Further comprising a rigid cannula may be inserted into the trachea, said cannula, inserting a bronchoscope into that its free end by the perspective of the light beam projected by said bronchoscope shows finger internal annular space area Ri placeable der in so that, expandable to providing sleeve Oh characterized Rukoto apparatus according to paragraph 1 or claim 2. The tracheostomy forming tube has an inflatable sleeve at one end, characterized in that it further comprises a tubular member having the other of the substantially conical end portion into the through member, the scope of the claims 4. The apparatus according to any one of items 1 to 3 . Can be installed on the inside of the tubular member includes penetrating end of the tubular member further air supply pipe which can be connected to the pump member by pulling when going out from the trachea, to the air supply pipe, said expandable sleeve Device according to claim 4 , characterized in that it is connected. Through-member is a conical object placed fixed to the end of the tubular member, further comprising a flexible conical product mounted on the fixed conical thereof, the end of the flexible conical object is a metal insert characterized that you have a configured penetrating tip apparatus according to claim 4. Device according to claim 4 , characterized in that the penetrating member consists of a single hard cone arranged at the end of the tubular member. Through-member is constituted by a plurality of tapered material you have the dimensions gradually increasing, characterized in that the said traction wire connecting them are continuously arranged, the claims 4 The device according to item. Wherein the enlarged section has a first retainer capable of being inserted directly fixed or One trocar end of the pulling wire, that is composed of a cup-like member attachable to said first retainer The apparatus according to claim 2 . Characterized in further comprising become pinching which may be elastic ring between the first holder and the cup-like member, apparatus according to claim 9, wherein. The enlarged means, after inserting the pulling wire into the tracheostomy forming pipe, characterized in that it is constituted by a this folding into a U-shape so as not withdrawn, claim 1, wherein to paragraph 10 The apparatus of any one of these. The enlarged large unit, characterized in that it consists of a knot formed on the pull wire, apparatus according to any one of claims paragraph 1 to paragraph 11. A further comprises apparatus an instrument for pulling the pulling wire, containing the basic body provided with a plate which instrument can placed on the outer surface of the trachea, passage holes for the through member to the plate, extending from the plate, the induction rod terminated with a supporting cross member, said induction are arranged in a sliding state on the bars, the Oh isosamples provided the slider having a locking means to said pull wire 9. A device according to any one of claims 4 to 8 , characterized in that it is characterized in that: And grip recess is provided for applying a surgeon's finger into the slider, characterized in that the transverse cross member is adapted to shed palm when applying traction to said traction wire, according The apparatus of claim 13 .

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