JP4490872B2 - Medical tube - Google Patents

Description

  The present invention relates to a medical tube used for draining a bodily fluid staying in, for example, a fetal bladder in fetal urinary tract obstruction or a fetal thoracic cavity in fetal pleural effusion.

  For example, when a stenosis occurs in the biliary tract due to a tumor or the like, bile or pancreatic juice (body fluid) does not flow out into the duodenum, and thus treatment is performed to distribute the body fluid through a medical tube (drainage tube) to the site where the stenosis has occurred.

  The medical tube used for such treatment has a malecot type (Patent Document 1) and a pick tail type as having a tube removal prevention (movement regulation) means for regulating the movement of the tube in the body cavity. (Patent Literature 2), side flap type (Patent Literature 3), and teacup shape type (Patent Literature 4) drainage tubes are known.

  In the medical field, fetal urinary tract-amniotic fluid shunt surgery, which is one of fetal surgical treatments, is well known as being performed for fetal obstructive urinary tract diseases.

  Also in such an operation, a drainage tube is used to drain the body fluid (urine) staying in the bladder into the mother's uterus. In this case, the drainage tube is used by placing one end of the tube in the fetal urinary bladder through the mother while observing with an ultrasonic device and fixing the other end of the tube to the fetal body surface.

  Conventionally, as this type of medical tube, a drainage tube (malecot type) has been proposed as an internal catheter double basket as shown in FIG.

  This medical tube will be described with reference to FIG. 2. In FIG. 2, the medical tube denoted by reference numeral 21 includes an inflow side end portion 22 having an opening 22a through which a body fluid flows, and a straight tube portion through which an attachment target is inserted. And an outflow side end 24 having an opening 24a through which bodily fluid flows out. In the inflow side end portion 22 and the outflow side end portion 24, a plurality of strip portions are formed along the tube axis line at positions in the tube circumferential direction, and the plurality of strip portions are further bent outward. By forming, elastic portions (tube movement restricting portions) 22A and 24A are provided, respectively.

The fetal urinary tract-amniotic fluid shunt operation (use of the medical tube 21) using the medical tube 21 is performed as shown in FIG. That is, under observation by the ultrasonic device 31, the guide needle 34 (inner needle 34 A and outer needle 34 B) is first inserted into the bladder 33 A of the fetus 33 through the amniotic fluid cavity 32 A of the mother body 32, and then the inner needle of the guide needle 34. After pulling out 34A, medical treatment is performed while the elastic portions 22A and 24A are straightened in the outer needle 34B of the guide needle 34 by the insertion sheath 35 previously covered with the outflow side end 24 (shown in FIG. 2). The tube 21 for insertion is inserted and the inflow side end part 22 is detained in the bladder 33A.
Japanese Utility Model Publication No. 61-42615 Japanese Utility Model Publication 4-51805 JP-A-9-56809 Japanese Utility Model Publication No. 3-36365

  By the way, in the fetal urinary tract-amniotic fluid shunt operation, the membrane (skin) thickness of the bladder 33A as an affected part that is large at the beginning of the operation changes to a normal thickness as the drainage progresses. There is a case to go. In this case, in the conventional medical tube 21, the tube length protruding (exposed) from the body surface of the fetus 33 into the amniotic fluid cavity 32A, that is, the tube exposure length into the amniotic fluid cavity 32A of the tube intermediate portion 23 as a straight tube portion. The elastic portion 24A functions as a gripping portion for the fetus 33, and the risk that the fetus 33 is gripped by the fetal fluid cavity 32A increases. .

  For this reason, in the tube mounting state with respect to the mounting target, it is possible to prevent the tube intermediate portion from protruding toward the body surface, and to prevent the occurrence of a tube pulling accident by the fetus in the above-described amniotic fluid shunt operation or the like. There has been a demand for the appearance of tubes.

  Accordingly, the object of the present invention is to prevent the tube intermediate portion from projecting toward the body surface when the tube is attached to the attachment target, thereby preventing the occurrence of a tube withdrawal accident by the fetus in an amniotic fluid shunt operation or the like. It is to provide a medical tube that can be used.

(1) In order to achieve the above-described object, the present invention uses two tube end portions that are detachably attached to a mounting target and are provided at both ends of the tube intermediate portion, respectively, inside and outside the mounting target. A tube movement restricting means for holding and holding the attachment object and restricting the movement of the tube from the attachment object, respectively. Of the two tube movement restricting means, at least the tube movement restricting means on the outside of the attachment target is a spiral expansion / contraction portion that is wound in a tube axial direction so as to be extendable / contractable following the change in thickness of the attachment target. Thus formed, the tube middle portion is formed in a curved portion toward the expansion portion, the expansion portion has a contact portion in close contact with the mounting object, The abutting portion is wound around the curved portion of the tube middle portion, and an elastic return force acts in a contracting direction in the tube mounting state by the expansion / contraction portion, the abutting portion, and the curved portion. to provide a medical tube, characterized in that cause.

For this reason, according to the medical tube of the present invention, when the thickness of the mounting target changes in the state where the two tube ends are arranged inside and outside the mounting target, the two tubes move following the change. Among the restricting means, at least the expansion / contraction portion ( tube movement restricting means ) outside the mounting target is expanded and contracted . That is, when the thickness of the attachment target increases, at least the tube movement restriction means outside the attachment target of the two tube movement restriction means extends against the elastic force, and the thickness decreases. Among the two tube movement restricting means, at least the tube movement restricting means outside the mounting target contracts due to the elastic force . Thereby, since the protrusion of the tube intermediate portion between the two tube end portions to the outside of the mounting target can be prevented, for example, it is possible to prevent the occurrence of the tube pulling accident by the fetus in the amniotic fluid shunt operation.
Since there is a contact portion in close contact with the mounting target on the mounting target side of the tube movement regulating means outside the mounting target, there is a gap in which a fetal finger or the like can be inserted between the contact portion and the mounting target. Never formed. As a result, it is possible to effectively prevent the occurrence of a tube pulling accident by the fetus.

(2) In the medical tube according to the above (1), the expansion / contraction part and the contact part are arranged to communicate with each of the two tube movement restricting means via the curved part, The stretchable portion is preferably formed by spirally winding the other stretchable portion on the side opposite to the winding direction .

(3) above (1) or in the medical tube according to (2), the dimensions of the intermediate tube straight portion of the curved portion is disposed, the dimension L before the winding cube straight portion 0 ≦ L ≦ 10 mm It is preferable that it is set to.

  Since it is configured in this way, even if the tube intermediate portion is exposed to the outside of the mounting target, the exposed portion does not function as a gripping portion. In this case, if L> 10 mm, the tube intermediate portion functions as a gripping portion.

(4) In the medical tube according to any one of the above (1) to (3), it is preferable that the two tube movement restricting means have shapes different from each other.

  Since it is configured in this manner, a tube movement restricting means inside the attachment target and a tube movement restricting means outside the attachment target each having a shape matched to the shape inside and outside the attachment target are obtained. Thus, for example, when a malecot type tube movement restricting means is selected as the tube movement restricting means on the inner side of the wearing target, the amount of deformation of the tube movement restricting means is small, so that the tube end against a small body cavity such as the fetal bladder It becomes easy to place the part.

(5) In the medical tube according to any one of (1) to (4), it is preferable that the outer sizes of the two tube movement restricting units are different from each other.

  Since it is configured in this manner, a tube movement restricting means inside the attachment target and a tube movement restricting means outside the attachment target each having an outer size matched to the size inside and outside the attachment target are obtained. Thus, for example, when a tube movement restricting means having a small outer size is selected as the tube movement restricting means on the inner side of the attachment target, the detention space occupied by the tube movement restricting means on the inner side of the attachment target is small. In contrast, it becomes easier to place the end of the tube.

(6) In the medical tube according to any one of the above (1) to (5), the spiral diameter of the stretchable portion is set to a dimension such as gradually increases toward the tube middle portion from the tube end It is preferable that

  Since it is configured in this manner, the spiral expansion / contraction part is stably placed on the mounting target in the tube mounting state. Thereby, the mounting force of the medical tube with respect to the mounting target can be ensured.

  According to the present invention, the tube intermediate portion can be prevented from projecting toward the body surface in the tube attachment state with respect to the attachment target, and the occurrence of tube withdrawal accidents by the fetus in an amniotic fluid shunt operation or the like can be prevented.

[Embodiment]
Hereinafter, a medical tube according to an embodiment of the present invention will be described with reference to FIGS. 1 and 3. FIG. 1 is a plan view for explaining a medical tube according to an embodiment of the present invention. In addition, description of this Embodiment is performed using the same code | symbol as FIG. 3 about members other than a medical tube.

[Overall configuration of medical tube]
In FIG. 1, a medical tube (drainage tube) denoted by reference numeral 1 passes through an inflow side end portion 2 having an opening 2a through which a body fluid flows and a membrane portion of a bladder 33A (shown in FIG. 3) as an attachment target. The tube intermediate portion 3 and an outflow side end portion 4 having an opening 4a for allowing a body fluid to flow out are provided, and are attached to the membrane portion of the bladder 33A in a detachable manner when in use. And the whole is formed with polyolefin resin, such as a polyethylene resin. In the material of the medical tube 1, additives such as bismuth oxide and barium sulfate are mixed in order to make X-rays opaque. In addition to the polyolefin resin, for example, a thermoplastic elastomer resin (particularly a urethane elastomer resin) is used as the material of the medical tube 1.

(Configuration of inflow side end 2)
The inflow side end 2 is disposed at one end of the medical tube 1. The inflow side end portion 2 is provided with a telescopic portion 5 as a tube movement restricting means (tube element) that is wound in a spiral shape in a natural tube state within a virtual plane perpendicular to the tube axis. The expansion / contraction part 5 has an abutting part 5A that is in close contact with the membrane part of the bladder 33A, and is configured to expand and contract following the change in the thickness of the bladder 33A (film part) in the tube-mounted state. The spiral diameter of the expansion / contraction part 5 is set to a dimension that gradually increases from the inflow side end part 2 toward the tube intermediate part 3. Thereby, the expansion-contraction part 5 is arrange | positioned in the state stably in the membrane part of the bladder 33A in the tube mounting state.

(Configuration of tube middle part 3)
The tube intermediate portion 3 communicates with the inflow side end portion 2 and the outflow side end portion 4 and is entirely formed by a curved portion. In the present embodiment, the case where the tube linear portion dimension L in the tube intermediate portion 3 is L = 0 has been described, but it may be within the range of 0 ≦ L ≦ 10 mm. Thereby, even if the tube middle part 3 is exposed outside the bladder 33A, the exposed part does not function as a gripping part. In this case, if L> 10 mm, the tube intermediate portion 3 functions as a gripping portion.

(Configuration of outflow side end 4)
The outflow side end 4 is arranged at the other end of the medical tube 1. The outflow side end 4 is provided with a tube movement restricting means (tube element) that is spirally wound on the side opposite to the winding direction of the inflow side end 2 in a natural tube state in a virtual plane perpendicular to the tube axis. The expansion / contraction part 6 is provided. The expansion / contraction part 6 has an abutting part 6A that is in close contact with the membrane part of the bladder 33A, expands and contracts following the change in thickness of the bladder 33A (film part) in the tube-mounted state, and the membrane of the bladder 33A together with the extension part 5 The part is configured to be pinched and held by an elastic force (elastic restoring force of the telescopic parts 5 and 6). When the contact portion 6A of the extendable portion 6 is in close contact with the membrane portion of the bladder 33A, the tube intermediate portion 3 as a portion that is relatively easy to grasp is not exposed to the outside of the bladder 33A. The spiral diameter of the expansion / contraction part 6 is set to a dimension that gradually increases from the outflow side end part 4 toward the tube intermediate part 3. Thereby, the expansion-contraction part 6 is arrange | positioned in the state stable in the membrane part of the bladder 33A in the tube mounting state.

[Use of medical tubes]
The use of the medical tube 1 (fetal urinary tract-amniotic fluid shunt operation) is performed in the same manner as the conventional use of the medical tube 21. That is, as shown in FIG. 3, under the observation by the ultrasonic device 31, first, the guide needle 34 (inner needle 34A and outer needle 34B) is inserted into the bladder 33A of the fetus 33 through the amniotic fluid cavity 32A of the mother body 32, and next. After the inner needle 34A of the guide needle 34 is pulled out, the expansion and contraction portions 5 and 6 are made elastic in the outer needle 34B of the guide needle 34 by the insertion sheath 35 previously covered with the outflow side end 24. The medical tube 1 is inserted while being stretched (straight) against the inflow side end 2 (expandable portion 5) thereof and placed in the bladder 33A.

  In this case, when the inflow side end portion 2 of the medical tube 1 is placed in the bladder 33A whose skin thickness is large as an affected part at the beginning of the fetal urinary tract-amniotic fluid shunt operation, the expansion / contraction part 5 , 6 has an elastic restoring force acting in the direction of contraction, so that the membrane portion of the bladder 33A is held between the stretchable portions 5, 6 by pressure. From this state, when the thickness of the bladder 33A (skin thickness) changes (becomes smaller) to the normal thickness as the drainage progresses, the elastic parts 5 and 6 follow the change and the resilience of the elastic parts 5 and 6 increases. Therefore, the holding of the pressure on the membrane portion of the bladder 33A by the both stretchable portions 5 and 6 is maintained.

[Effect of the embodiment]
According to the embodiment described above, the following effects can be obtained.

(1) In the state where the inflow side end 2 and the outflow side end 4 are respectively disposed inside and outside the bladder 33A, when the membrane (skin) thickness of the bladder 33A changes, the expansion and contraction parts 5 and 6 follow this change. Will expand and contract. This prevents the tube intermediate portion 3 from protruding (exposed) to the outside of the bladder 33A between the inflow side end portion 2 and the outflow side end portion 4, so that, for example, the tube is pulled out by the fetus in the amniotic fluid shunt operation Accidents can be prevented from occurring.

(2) Since a contact portion 6A that is in close contact with the membrane portion of the bladder 33A is provided on the bladder side of the stretchable portion 6, the fetus is located between the contact portion 6A of the stretchable portion 6 and the membrane portion of the bladder 33A. A gap into which the fingers of 33 or the like can be inserted is hardly formed, and even if the fingers or the like are inserted into the gap, the expansion / contraction part 6 extends. Can be prevented.

(3) Since the dimension L of the tube linear portion between the both stretchable portions 5 and 6 is set to L = 0, even if the tube intermediate portion 3 is exposed outside the bladder 33A, this exposed portion functions as a gripping portion. There is nothing to do.

(4) Since the spiral diameters of the telescopic parts 5 and 6 are set to dimensions that gradually increase from the tube end part (inflow side end part 2 and outflow side end part 4) toward the tube intermediate part 3, The stretchable parts 5 and 6 are arranged in a stable state on the membrane part of the bladder 33A in a tube-mounted state. Thereby, the mounting force of the medical tube 1 to the membrane part of the bladder 33A can be ensured. In addition, the stretchable portion 6 has a shape that is difficult to grasp, and the occurrence of a tube pulling accident by the fetus 33 can be more effectively prevented.

  As mentioned above, although the medical tube of this invention was demonstrated based on said embodiment, this invention is not limited to said embodiment, It implements in a various aspect in the range which does not deviate from the summary. For example, the following modifications are possible.

(1) In this embodiment, the case where the shapes of the two tube movement restricting means are the same as the spiral stretchable parts 5 and 6 has been described. However, the present invention is not limited to this, and the shapes are different from each other. Also good. In this case, the tube movement restricting means inside the attachment target and the tube movement restricting means outside the attachment target each having a shape matched to the shape inside and outside the attachment target are obtained. Thus, for example, when a malecot type tube movement restricting means is selected as the tube movement restricting means on the inner side of the wearing target, the amount of deformation of the tube movement restricting means is small, so that the tube end against a small body cavity such as the fetal bladder It becomes easy to place the part.

(2) In the present embodiment, the case where the outer sizes of the two tube movement restricting means (expandable portions 5 and 6) are the same has been described, but the sizes may be different from each other. In this case, the tube movement restricting means inside the attachment target and the tube movement restricting means outside the attachment target each having an outer size matched to the size inside and outside the attachment target are obtained. Thus, for example, when a tube movement restricting means having a small outer size is selected as the tube movement restricting means on the inner side of the attachment target, the detention space occupied by the tube movement restricting means on the inner side of the attachment target is small. In contrast, it becomes easier to place the end of the tube.

(3) In the present embodiment, the case of the medical tube 1 (having the openings 2a and 4a) that opens in the tube axis direction for the discharge (inflow and outflow) of body fluid has been described. The present invention is not limited to this, and there is no problem even if it is a medical tube having small holes that open in the tube radial direction in addition to the openings 2a and 4a at the inflow side end and the outflow side end.

(4) In the present embodiment, an example used to discharge body fluid (urine) staying in the fetal bladder in fetal urinary tract obstruction has been described. However, the present invention is not limited to this example. It can also be used in the same manner as in the embodiment when draining bodily fluids remaining in other occluded sites including the fetal thoracic cavity in pleural effusion.

(5) The outer size and the number of spiral windings of the expansion / contraction part in the present invention are not particularly limited to the above-described embodiment, and can be changed as appropriate according to the tube placement position, the mounting target, and the like.

It is a top view shown in order to demonstrate the medical tube which concerns on embodiment of this invention. It is a top view shown in order to demonstrate the conventional medical tube. It is sectional drawing typically shown in order to demonstrate the usage method of a medical tube.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1, 21 ... Medical tube, 2, 22 ... Inflow side edge part, 2a, 22a ... Opening, 3, 23 ... Tube intermediate part, 4, 24 ... Outflow side edge part, 4a, 24a ... Opening, 5, 6 ... Telescopic part, 5A, 6A ... contact part, 31 ... ultrasonic device, 32 ... mother body, 32A ... amniotic fluid cavity, 33 ... fetus, 33A ... bladder, 34 ... guide needle, 34A ... inner needle, 34B ... outer needle, 35 ... Sheath for insertion

Claims (6)

A medical tube that is detachably attached to a mounting target and is used by arranging two tube end portions provided at both ends of the tube middle portion inside and outside the mounting target,
Tube movement restricting means for holding and holding the attachment object and restricting tube movement from the attachment object are respectively disposed at the two tube end parts,
Of these two tube movement restricting means, at least the tube movement restricting means outside the attachment target is a spiral expansion / contraction part that is wound in a tube axial direction so as to be extendable / contractable following the change in thickness of the attachment target. Thus it is formed in,
The tube intermediate part is formed in a curved part toward the stretchable part,
The expansion / contraction part has a contact part in close contact with the mounting target,
The abutting portion is disposed by being wound from the curved portion of the tube middle portion,
An elastic return force is applied to the contraction direction in the tube mounting state by the expansion / contraction part, the contact part, and the curved part . Each of the two tube movement restricting means is provided with the extendable portion and the contact portion in communication with each other through the curved portion, and one of the extendable portions is opposite to the winding direction of the other extendable portion. The medical tube according to claim 1, wherein the medical tube is spirally wound around the side . A tube straight portion is disposed in the middle of the curved portion,
Before the winding cube straight section dimension L is 0 ≦ L ≦ 10 mm The medical tube according to claim 1 or 2 is set to a dimension of the.   The medical tube according to any one of claims 1 to 3, wherein the two tube movement restricting means have shapes different from each other.   The medical tube according to any one of claims 1 to 4, wherein the two tube movement restricting means have different outer sizes. The spiral diameter of the expansion part, medical tube according to claim 1 from the tube end portion is set to a dimension such that gradually increases toward the tube middle section.