JP4260058B2 - Medical tube insert - Google Patents

Description

  This invention makes it possible to easily insert a medical tube called a shunt tube used for reducing bleeding from a bypass anastomosis planned portion when performing a bypass operation on a tubular organ such as a blood vessel. In particular, the present invention relates to a medical tube insertion tool for use in connecting the internal thoracic artery or the like to the distal side of the stenosis of the coronary artery of the heart.

  Oxygen and nutrients are supplied to the heart muscle by blood flowing through the coronary arteries, but the coronary arteries have few collateral circulations, so if the coronary arteries are obstructed for some reason, it will continue from there. There is no blood supply. Therefore, a part of the heart muscle (tissue) is necrotized within tens of minutes. This is a so-called myocardial infarction, and in the worst case, the patient dies.

  In recent years, as a surgical treatment for ischemic heart disease, coronary artery bypass surgery is performed in which the internal thoracic artery is directly anastomosed to the distal side of the stenosis.

  By the way, in coronary artery bypass surgery, there are a method in which the heart is stopped and a method in which the heart is pulsated (moved), but when the heart is stopped, an oxygenator is used. Although separately necessary, from the viewpoint of improving the patient's QOL and the like, a minimally invasive surgery is required as much as possible, and many operations under heart pulsation are performed.

  Since the operation is performed under heartbeat, when the anastomosis part of the coronary artery is incised, bleeding is recognized as a matter of course, which obstructs the surgical field during the operation. For this purpose, many medical tubes called bypass shunts or shunt tubes and their use have been proposed (see, for example, Patent Document 1). As you can see, from the viewpoint of minimally invasive, the opening of the coronary artery for anastomosing bypassed blood vessels can be suppressed to the minimum necessary, so one end of the shunt tube can be grasped with tweezers, bent and inserted, etc. Complex work is required. Therefore, a medical tube insertion tool such as a shunt insertion tool has been proposed as one that can be inserted without using the tweezers described above (see, for example, Patent Document 2).

JP 2002-102260 A (page 3, FIGS. 3 and 4) Japanese Patent Laying-Open No. 2003-038497 (5th page, FIGS. 1 and 7)

  However, the insertion tool found in Patent Document 2 is merely an improvement of a jig for inserting a blood vessel catheter, generally called a sheath, for inserting one into a blood vessel. After inserting all of the coronary artery from the incision into the distal side using an insertion tool, it is necessary to move it to the central side using the attached thread, and the shunt tube can be moved using conventional tweezers. Although simplified than the method of bending and inserting, there is a problem that if the operation is mistaken, it may come out of the incision portion, and it is difficult to insert when inserting into the coronary artery.

  Therefore, an object of the present invention is to solve the conventional problems as described above, and to provide an insertion tool that can more easily insert a medical tube such as a shunt tube.

In order to achieve the above object, an invention according to claim 1 is an insertion tool for inserting a medical tube such as a shunt tube used in a bypass operation in a tubular organ such as a blood vessel. A main body having a hollow cylindrical outer tube having a predetermined length that is open, a push member having a rod inserted into the inside from a proximal end side of the outer tube of the main body, and a predetermined interval from a distal end opening surface of the outer tube. When the tube inserted in a state of being folded in two from the base opening side of the outer tube provided at the front end opening of the outer tube is pushed out by the rod of the extruding member, the tube both bent leading end side of comprises an induction member for inducing to be extruded in the respective opposite directions, the guide member is facing and connected to a connection piece provided on the mantle tube and the distal end opening face of the mantle tube The guide member engages with the connecting piece when the tube is completely pushed out from the distal end portion of the outer tube by the rod of the push-out member. The member that swings from the facing position to the non-facing position protrudes from the notch groove provided in the axial direction of the outer tube and is provided movably along the notch groove .

The invention according to claim 2 is the invention according to claim 1, wherein the tube is bent into two by guiding the take-out thread tied to the intermediate portion of the tube and moving it to the proximal end side of the outer tube. A slit that can be inserted into the distal end portion of the outer tube is formed over a predetermined length in the axial direction from the distal end opening of the outer tube . According to a third aspect of the present invention, in the second aspect of the present invention, the length of the slit is substantially the same as the length from the bent base portion to the distal end portion of the tube folded in two.

The invention according to claim 4 is characterized in that, in claim 2 or 3 , a tag is attached to the tip of the take-off thread, and the tag is detachably attached to the outer tube. .

According to a fifth aspect of the present invention, in the fourth aspect , the tag is provided with a mounting hole, and the outer tube is provided with a projection to which the mounting hole is detachably fitted. .

  Since the present invention is configured as described above, when using a medical tube such as a shunt tube in a bypass operation when a coronary artery is occluded, the tube can be inserted with a simple operation. There is an excellent effect that tweezers are not used in the insertion, and that it is not possible to insert the tweezers out of the incision due to an erroneous operation.

  Embodiments of the present invention will be described with reference to the accompanying drawings.

(Embodiment 1)
1 to 6 show the insertion tool of the first embodiment. FIG. 1 is an exploded perspective view of the insertion tool before the pushing member is inserted into the outer tube of the insertion tool body, and FIG. In both figures, 1 is an insertion tool main body, and this main body has the outer tube | pipe 3 in which the full length including the holding part 2 was formed by predetermined length (for example, about 85 mm). The outer tube 3 has a hollow cylindrical shape that is open at both ends. The diameter of the outer tube 3 is a predetermined diameter (for example, about 4 mm), and the grip portion 2 is connected to the proximal end side. In front of the distal end opening of the outer tube 3, a shunt tube, which will be described later, is not straight and spaced apart from the distal end opening, and a guide member 5 for guiding both the left and right sides faces partly in the circumferential direction. The outer tube 3 is provided integrally with the connecting piece 6. A slit 7 for guiding a take-out thread, which will be described later, is formed in the axial direction from the opening of the distal end of the outer tube 3 on the opposite side to the connecting piece 6 in the circumferential direction. The grip portion 2 is formed to have a diameter larger than that of the outer tube 3, and an inner hole thereof is formed to have the same diameter as the inner hole of the outer tube 3 and communicates with each other.

  Reference numeral 11 denotes an extrusion member, and the member has a rod 13 having a total length including the grip portion 12 and a predetermined length (for example, about 80 mm). The rod 13 has a predetermined diameter (for example, about 2 mm), and the grip portion 12 is connected to the rear end side. The grip portion 12 is formed to have a diameter larger than that of the rod 13 and the same diameter and the same size as the grip portion 2 of the main body 1. The push-out member 11 is a medical tube inserted into the outer tube 3 by inserting the rod 13 into the outer tube 3 from the proximal end opening of the inner hole provided in the grip portion 2 of the main body from the distal end side. The shunt tube 15 is pushed out.

  The shunt tube 15 is made of a flexible material such as silicone rubber, and has a predetermined length (for example, about 20 mm) at both ends as shown in FIG. A take-out thread 16 is tied to the middle part of the shunt tube 15, and a tag 17 is attached to the tip of the thread. In addition, about this shunt tube 15, a commercially available thing other than what was illustrated can also be utilized as it is.

  About the material of the insertion tool main body 1 and the extrusion member 11, various metals such as metals such as stainless steel, aluminum, and brass, PTFE, nylon, polyethylene, polyurethane, polyvinyl chloride, polyacetal, and ABS are usually used for medical purposes. Any material can be selected, and different materials can be used in each part.

  When using this insertion tool, first, the shunt tube 15 is inserted into the distal end from the distal end opening of the outer tube 3 in a folded state. That is, the shunt tube 15 is applied to the recess formed by the distal end opening of the outer tube 3 and the connecting piece 6 and the guide member 5 (for example, the state shown in FIG. When the take-out thread 16 is moved along the slit 7 so as to be pulled toward the base end side, the shunt tube 15 is naturally bent into two and inserted into the outer tube 3, and the take-out thread 16 is When the base end of the slit 7 is reached, it is inserted in a state of being completely folded into two. FIG. 2 shows the loaded state (see also FIG. 5 (A)).

  After the shunt tube 15 is inserted, it is confirmed whether the shunt tube is not kinked at the bent portion.

  Next, as shown in FIG. 4, an insertion in which a shunt tube 15 is inserted is made by making an incision of about 5 mm in the planned anastomosis portion (the peripheral side of the occlusion) of the coronary artery 21 by a predetermined technique of coronary artery bypass surgery. The instrument 1 is inserted into the coronary artery from the incision 22 and the shunt tube 15 is pushed out by the rod 13 of the push-out member 11 to be inserted and placed.

  At this time, as shown in FIG. 5, the shunt tube 15 is guided by the guide member 5 in the directions in which both distal ends are opposite in the coronary artery 21. In other words, the shunt tube 15 to be pushed out once strikes the guide member 5 from the both ends, but is gradually guided in the opposite directions of the left and right sides by the pushing force (FIG. 5 (A) → ( B)), when the gripping portion 12 of the pushing member 11 comes into contact with the gripping portion 2 of the main body 1 and the rod 13 reaches the vicinity of the distal end opening of the outer tube 3, the extruded member 11 is completely pushed out (see FIG. 5C). )reference). When the shunt tube 15 is completely pushed out, the insertion tool 1 is taken out. At this time, the shunt tube 15 is left in place without shifting the position of the shunt tube 15 or performing other operations as in the prior art. .

  After the placement of the shunt tube 15 is completed, the operation after removing the insertion tool 1 is the same as the internal thoracic artery 23 bypass operation using the conventional shunt tube as shown in FIG. When the anastomosis 23 is about to end, the tag 17 of the shunt tube 15 is held and removed via the take-out thread 16 to complete the anastomosis.

(Embodiment 2)
7 and 8 show the insertion tool of the second embodiment. FIG. 7 is an overall front view of the insertion tool, and FIG. In both figures, the basic constituent members and the sizes of the respective parts are the same as those in the first embodiment, and therefore, the same reference numerals are given to the same components to simplify the description, and different configurations and the like will be described below. The explanation will be focused on.

  The second embodiment is greatly different from the first embodiment in that the guide member 25 is movable. That is, the connection piece 26 formed in a substantially L-shaped bridge shape at a position slightly rearward from the distal end of the outer tube 3 and the base end of the slit 7 extends its distal end to the vicinity of the distal end opening of the outer tube 3 and shakes. The guide member 25 is attached to the extended tip so as to be able to swing at a position facing the distal end opening surface of the outer tube 3 and a position not facing the tracking member 26. ing. In addition, a member 27 for pushing up and swinging the connecting piece 26 in conjunction with the pushing operation of the rod 13 is provided at the tip of the rod 13 of the pushing member 11. Reference numeral 28 denotes a notch groove provided in the axial direction of the outer tube 3 in order to make it possible to swing it upward. It is free.

  In the second embodiment, the tag 31 is detachably attached to the outer tube 3. That is, a small fitting hole 32 is formed in the tag 31, and a projection 33 to which the fitting hole is detachably fitted and attached is provided on the side opposite to the connection piece 26 of the outer tube 3. With this configuration, it is possible to prevent the tag 31 and the removal thread 16 from interfering until the insertion tool 1 is inserted from the incision portion 22 into the coronary artery.

  In the second embodiment, the same effects as those in the first embodiment can be expected. Furthermore, in the second embodiment, the guide member 25 is mounted via the connection piece 26, and the member 27 is attached to the tip end portion of the rod 13 of the push member 11. As the shunt tube 15 is pushed out, the member 27 swings the connection piece 26. As a result, the guide member 25 swings away from the position facing the distal end opening surface of the outer tube 3 to the position not facing the shunt tube 25. There is an advantage that the position of the shunt tube 15 is not shifted when the insertion tool 1 is taken out after the tube 15 has been inserted and placed.

  The material in the second embodiment can be selected as long as it is a material used for medical purposes, as in the first embodiment, but the connection piece 26 is a material having spring elasticity. It is desirable that

  The first and second embodiments are merely preferred examples, and the diameter and length of the outer tube 3 of the main body 1 are the thickness and length of the shunt tube 15 to be used, or the ease of use by the operator. The cross-sectional shape is not a circle, but a rectangle or a polygon such as a hexagon.

  Furthermore, the protrusion process etc. which are seen conventionally may be given so that the extrusion member 11 may not remove | deviate during preparation, and each corner | angular part may be R processed. Further, the present insertion tool can be applied not only to the coronary artery but also to a bypass operation in other blood vessels or an operation such as a lymphatic vessel at the site of use. Furthermore, although the shunt tube 15 has been shown as an example of a medical tube, the present invention is not limited to this and can be applied to, for example, a lacrimal duct reconstruction tube.

FIG. 3 is an exploded perspective view showing the insertion tool of Embodiment 1 according to the present invention, and before inserting the pushing member into the outer tube of the insertion tool body. It is a perspective view of the inserted state same as the above. It is a front view which shows the state which attached the tag to the shunt tube with the taking-out thread. It is action explanatory drawing which shows the state immediately before inserting the insertion tool by which the shunt tube was inserted in the coronary artery bypass surgery from the incision part of a coronary artery. (A)-(C) are principal part top views explaining each effect | action of the same as the above. It is drawing which shows the state which inserted and detained the shunt tube in the predetermined position from the incision part of a coronary artery. FIG. 10 is a front view showing an insertion tool of a second embodiment. (A), (B) is a principal part front view explaining each effect | action of the same as the above.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Inserting tool main body 2 Gripping part 3 Outer tube 5 Guiding member 6 Connecting piece 7 Slit 11 Extruding member 12 Gripping part 13 Rod 15 Shunt tube (medical tube)
16 Extraction thread 17 Tag 21 Coronary artery 22 Incision portion 23 Internal thoracic artery 25 Guide member 26 Connection piece 27 Member 28 Notch groove 31 Tag 32 Fitting hole (attachment hole) 33 Projection

Claims (5)

An insertion tool for inserting a medical tube such as a shunt tube used in a bypass operation in a tubular organ such as a blood vessel,
A main body having a hollow tubular outer tube of a predetermined length opened at both ends;
An extrusion member having a rod inserted into the inside from the proximal end side of the outer tube of the main body ;
The tube, which is provided at a position facing the distal end opening surface of the outer tube at a predetermined interval, is inserted into the distal end portion from the distal end opening of the outer tube and is bent in two from the base side, and is inserted into the tube. When extruding with the rod of the extruding member, it comprises a guiding member that guides the tube so that the two bent front ends of the tube are extruded in opposite directions ,
The guide member is connected to a connecting piece provided on the outer tube and can swing between a position facing the distal end opening surface of the outer tube and a position not facing the outer tube, and the rod of the pushing member A notch groove provided in the axial direction of the outer tube is a member that engages with the connecting piece and swings the guide member from the facing position to the non-facing position when the tube is completely pushed out from the distal end portion of the outer tube. An insertion tool for a medical tube, characterized in that it protrudes from the center and is provided so as to be movable along the notch groove . A slit that can be inserted into the distal end portion of the outer tube in a state where the tube is bent in two by guiding the take-out thread tied to the middle portion of the tube and moving it to the proximal end side of the outer tube, The medical tube insertion tool according to claim 1, wherein the medical tube insertion tool is formed over a predetermined length in the axial direction from the distal end opening of the outer tube .   The medical tube insertion tool according to claim 2, wherein a length of the slit is substantially the same as a length from a bent base portion to a distal end portion of the tube folded in two. The medical tube insertion tool according to claim 2 or 3 , wherein a tag is attached to a distal end portion of the take-out thread, and the tag is detachably attached to the outer tube. The medical tube insertion tool according to claim 4, wherein a mounting hole is formed in the tag, and a projection is provided on the outer tube so that the mounting hole is detachably fitted.

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