JP6094262B2 - Gastrostomy catheter - Google Patents

Description

  The present invention relates to a gastrostomy catheter.

  Enteral nutrition management by percutaneous endoscopic gastrostomy (hereinafter abbreviated as “PEG”) is frequently performed as a method for administering nutrition to patients who cannot take nutrition orally. A gastrostomy catheter is used to perform this PEG.

  There are various types of catheters for gastrostoma due to the indwelling technique, patient condition, period of use, operability of caregivers, etc., but in general, liquid substances such as nutrients or chemicals are introduced from outside the body into the stomach. A flexible tube having a lumen and extending along the wall surface of the fistula, and an overhanging indwelling portion attached to the distal end portion of the flexible tube and expanded in the radial direction of the flexible tube ( Bumpers, balloons, etc.).

  The gastrostomy catheter is inserted and placed in a fistula that penetrates the patient's abdominal wall to the stomach wall. In order to pass the indwelling part through the fistula when inserting or removing the gastrostomy catheter from the fistula, the outer diameter is reduced to the same extent as that of the flexible tube by extending the indwelling part. It is desirable to reduce insertion resistance and removal resistance.

  Patent Document 1 discloses a gastrostomy catheter configured with a rubber balloon-like balloon (an in-vivo fixing portion, an intra-gastric fixing portion). In the invention described in Patent Document 1, a rod-shaped insertion assisting member is inserted into the introduction duct (through hole) of the gastrostomy catheter, and the distal end of the insertion assisting member is locked to the peripheral end portion of the balloon. Elongate. Thereby, it deform | transforms into the magnitude | size which can pass a fistula, and the resistance at the time of insertion of the catheter for gastrostoma is reduced.

JP 2008-284389 A

  However, the invention described in Patent Document 1 cannot use the insertion assisting member at the time of removal, and the reproducibility of the folding of the internal fixation part and the reliability of the operation are not sufficient. For this reason, there is a case where the body fixing part is not sufficiently folded and there is still a resistance at the time of removal. Such removal resistance can also reduce a patient's QOL (Quality of Life).

  The present invention has been made in view of the above-described problems, and has high reproducibility and reliable operation even when removed, and can deform the internal fixation part, and can reduce resistance during insertion or removal of the gastrostomy catheter. The present invention provides a gastrostomy catheter that can be reduced as much as possible.

Such an object is achieved by the present invention described in the following (1) to (4).
(1) A gastrostomy catheter comprising a flexible tube having a first lumen and a second lumen, and an inflatable and contractible balloon provided at the distal end of the flexible tube,
A receiving portion provided on the distal end side of the balloon tip and on an extension line of the first lumen shaft, and pressing the receiving portion in the distal direction when the balloon is in a contracted state; A gastric fistula catheter comprising: balloon extending means that includes pulling means that extends the balloon in a distal direction and operates to make the outer diameter of the balloon smaller than a contracted state.
(2) The gastrostomy catheter according to (1), wherein the traction means is at least one traction member extending in a proximal direction from the receiving portion and having a proximal end fixed to the balloon.
(3) The gastrostomy catheter according to (2) , comprising a plurality of the traction members, wherein the plurality of traction members are arranged to extend radially from the receiving portion toward the balloon.
(4) The gastrostomy catheter according to any one of (1) to (3), further including a pressing member that presses the receiving portion.

  According to the present invention, the resistance at the time of insertion or extraction of the gastrostomy catheter is reduced by extending the deflated balloon by the balloon extending means and reducing the diameter to the same extent as the outer diameter of the flexible tube. be able to. Since the deformation of the internal fixation part according to the present invention is highly reproducible and reliable in operation, it is possible to reduce the resistance at the time of insertion or extraction regardless of the skill of the operator or the condition of the patient.

It is a perspective view of the catheter for gastrostoma concerning embodiment of this invention, and is a figure showing the state which expanded the balloon. 1 is an overall view of a gastrostomy catheter according to an embodiment of the present invention, showing a state where a balloon is inflated. It is a longitudinal cross-sectional view of FIG. It is a general view of the catheter for gastrostoma which concerns on embodiment of this invention, and is the figure showing the state before extending a balloon with a press member. It is a longitudinal cross-sectional view of FIG. 1 is an overall view of a gastrostomy catheter according to an embodiment of the present invention, showing a state in which a balloon is extended by a pressing member. It is a longitudinal cross-sectional view of FIG. It is the front view of the obturator among the press members used when using the catheter for gastrostoma which concerns on embodiment of this invention, a side view, and sectional drawing. It is the front view, side view, and sectional drawing of an outer cylinder and a stopper among the press members used when using the gastrostomy catheter which concerns on embodiment of this invention.

Hereinafter, preferred embodiments of the gastrostomy catheter of the present invention will be described in detail with reference to the drawings.
FIG. 1 is a perspective view of a gastrostomy catheter 1 according to an embodiment of the present invention, and shows a state in which a balloon 3 is inflated. FIG. 2 is an overall view of the gastrostomy catheter 1 according to the embodiment of the present invention, and shows a state where the balloon 3 is inflated. FIG. 3 is a longitudinal sectional view of FIG.

  The gastrostomy catheter 1 of this embodiment is placed in the gastrostoma and used for administration of nutrients, drugs, etc. from outside the body to the stomach.

  As shown in FIGS. 1 to 7, the gastrostomy catheter 1 of the present embodiment includes a flexible tube 2 having a first lumen 21 and a second lumen 25, and a distal end of the flexible tube 2. And a balloon 3 that can be inflated and deflated, and a body surface fixing part 4 that is provided at the base end of the flexible tube 2. In addition, a cap 5 that seals the proximal-side opening 22 of the first lumen 21 and a balloon extension means 6 that extends the balloon 3 are provided.

  The flexible tube 2 is a main body portion of the gastrostomy catheter 1 and is placed in the fistula to allow communication between the outside of the body and the stomach. The flexible tube 2 has a first lumen 21 through which nutrients, drugs, and the like are administered into the stomach.

  Any material can be used as the flexible tube 2 as long as it is a flexible material. As a material for the flexible tube 2, for example, silicone rubber or polyurethane elastomer is preferable from the viewpoint of enhancing the biocompatibility of the flexible tube 2 and enabling indwelling for a relatively long period of time. These can be used alone or in combination of two or more.

  The first lumen 21 is used to administer nutrients, drugs, etc. into the stomach as described above. The first lumen 21 is provided over the entire length of the flexible tube 2 and communicates with the outside through the proximal end opening 22 and the distal end opening 23.

  A duckbill valve 24 is provided in the vicinity of the proximal end side opening 22 of the first lumen 21. The duckbill valve 24 is formed so as to allow inflow of liquid or the like from the proximal end side to the distal end side of the flexible tube 2 but prevent outflow of liquid or the like from the distal end side to the proximal end side. For this reason, the leakage of the gastric contents to the outside of the body through the gastrostomy catheter 1 is satisfactorily prevented.

  In this embodiment, the duckbill valve 24 is provided in the vicinity of the proximal end side opening 22 of the first lumen 21, but the installation position is not limited to this, and the vicinity of the distal end side opening 23 or the first lumen 21. It may be provided anywhere such as in the center. Further, the shape of the valve is not limited to the duckbill valve, and any shape may be used as long as it has a function of allowing only inflow of liquid or the like in one direction.

  The balloon 3 is provided at the distal end portion of the flexible tube 2. As shown in FIG. 3, the balloon 3 has a donut shape in the inflated state. The central hole 31 of the balloon 3 communicates with the first lumen 21 and forms a flow path for nutrients or the like together with the first lumen 21.

  In order to inflate or deflate the balloon 3, the inside of the balloon 3 communicates with the outside through the second lumen 25 and the fluid inlet 26. The second lumen 25 is provided in the flexible tube 2 and is formed in parallel with the first lumen 21. The distal end of the second lumen 25 communicates with the inside of the balloon 3, and the proximal end communicates with the fluid inlet 26. The fluid inlet 26 is formed in the body surface fixing part 4. The fluid inlet 26 is provided with a check valve (not shown) in order to maintain the balloon 3 in an inflated or deflated state.

  The balloon 3 can be inflated and deflated by the second lumen 25 and the fluid inlet 26. When a syringe or the like is connected to the fluid inlet 26 and the fluid inside the balloon 3 is discharged through the second lumen 25, the balloon 3 contracts, and conversely, if the fluid is supplied into the balloon 3, the balloon 3 expands. .

  Any material can be used for the balloon 3 as long as the material can be expanded and contracted. Specifically, the material similar to the flexible tube 2 mentioned above is mentioned. In particular, it is preferable to use silicone rubber as the balloon 3 because of good biocompatibility.

  The body surface fixing part 4 is provided at the base end part of the flexible tube 2. As shown in FIG. 2, the body surface fixing portion 4 is formed orthogonal to the axis of the flexible tube 2. The body surface fixing portion 4 may have any shape and size as long as the gastrostomy catheter 1 does not fall into the stomach, but it is preferable to reduce the thickness so that the movement of the patient is not hindered during placement. .

  Any material can be used as the body surface fixing portion 4, and examples thereof include the same material as that of the flexible tube 2 described above. As a material for the body surface fixing part 4, silicone rubber and polyurethane elastomer excellent in biocompatibility are preferable from the viewpoint of suppressing inflammation at the contact portion with the body surface. These can be used alone or in combination of two or more.

  A method for forming the flexible tube 2 and the body surface fixing portion 4 is not particularly limited, but it is preferable to form them integrally. When integrally molded, the strength is higher than that of a commonly used bonding method, and it can be excellent for long-term use. Moreover, since a level | step difference can be eliminated, the discomfort of the patient in detention can be reduced. The molding method for integrally molding is not particularly limited, but for example, insert molding or two-color molding is practical, and it is manufactured at a low cost in a short time compared to those formed with an adhesive. It becomes possible to do.

  Here, typical dimensions of the gastrostomy catheter 1 will be described. First, the flexible tube 2 preferably has a total length of about 20 to 60 mm and an outer diameter of about 5 to 10 mm. The diameter of the first lumen 21 is preferably about 2 to 7 mm. The balloon 3 preferably has an overall length in an inflated state of about 10 to 18 mm and an outer diameter of the maximum portion of about 18 to 26 mm. Furthermore, the body surface fixing part 4 has a long side of about 28 to 40 mm, a short side of about 8 to 20 mm, and a thickness of preferably about 2 to 15 mm. Therefore, the total length of the gastrostomy catheter 1 is about 32 to 93 mm.

  As shown in FIGS. 1 to 7, the gastrostomy catheter 1 of the present embodiment has a balloon extending means 6 at the tip of the balloon 3. The balloon elongating means 6 elongates the balloon 3 in the distal direction when the balloon 3 is in the deflated state, and makes the outer diameter of the balloon 3 smaller than that in the deflated state. In the present embodiment, the balloon extension means 6 has a receiving portion 61 and a pulling means 62.

  The receiving portion 61 is a portion with which a pressing member 7 described later comes into contact. When the receiving portion 61 is pressed toward the distal end by the pressing member 7, the balloon 3 is expanded and reduced in diameter.

  The receiving portion 61 is provided on the distal end side of the distal end of the balloon 3 and on the extension line of the shaft of the first lumen 21. Therefore, when the gastrostomy catheter 1 is viewed from the distal direction, the receiving portion 61 and the first lumen 21 (the distal opening 23) appear to overlap each other. In the present embodiment, the receiving portion 61 has a substantially disk-shaped concave surface on the proximal end side. It is preferable to have a concave surface because the tip of the pressing member 7 to be described later can easily catch the receiving portion 61.

  The receiving part 61 has a through hole 611 into which a guide wire 200 (not shown) can be inserted. This makes it possible to insert or remove the patient from the fistula along the guide wire 200 while the balloon 3 is extended by the pressing member 7.

  The pulling means 62 operates to extend the balloon 3 by pressing the receiving portion 61 in the distal direction when the balloon 3 is in a deflated state, and to make the outer diameter of the balloon 3 smaller than that in the deflated state. In this embodiment, as shown in FIGS. 1 to 3, the traction means 62 includes four belt-like traction members 63 that extend in the proximal direction from the receiving portion 61 and whose end portions are fixed to the balloon. The pulling member 63 is formed to extend radially from the receiving portion 61 toward the vicinity of the maximum outer diameter when the balloon 3 is inflated. That is, the four pulling members 63 connect the receiving portion 61 and the balloon 3 at intervals of 90 degrees. In the present embodiment, the traction means 62 is constituted by four belt-like traction members 63, but if the deflated balloon 3 can be extended by the pressing member 7, the traction means 62 is not limited to four belt-like shapes. It may be composed of one or more plural strip-shaped members.

  In the present embodiment, the pulling member 63 and the receiving portion 61 are integrally formed. As shown in FIGS. 4 to 7, the pulling member 63 forms an angle of about 45 to 80 degrees with respect to the axis of the gastrostomy catheter 1 in a natural state (a state where the receiving portion 61 is not pressed). It is connected. In order to reduce the contact of the receiving portion 61 with the opposite wall of the stomach during the placement of the gastrostomy catheter 1, it is better that the angle is close to 80 degrees. On the other hand, when the receiving portion 61 is pressed, the pulling members 63 approach each other. At this time, the angle between the pulling member 63 and the axis of the gastrostomy catheter 1 is about 0 to 10 degrees. Therefore, it is preferable that the boundary portion between the receiving portion 61 and the pulling member 63 is rotatable within the above-mentioned angle range. This includes, for example, forming a groove at the boundary portion to reduce the thickness.

  The pulling member 63 and the balloon 3 may be fixed by any method. In this embodiment, an adhesive is used as an example. The fixing position on the balloon 3 is not particularly limited as long as it is in the vicinity of the maximum outer diameter when the balloon 3 is inflated, but the above-described fixing position (adhesive portion) and the patient's stomach wall are brought into contact with each other during placement of the gastrostomy catheter 1. From the viewpoint of reducing, it is preferable to fix on the distal end side than the maximum outer diameter portion at the time of expansion.

  As the pulling means 6, any material can be used as long as its own dimension does not change greatly except that it is bent at the boundary portion between the receiving portion 61 and the pulling member 63 by pressing as described above. Examples of the material of the traction means 6 include polyvinyl chloride, polyurethane (PU), polyamide (PA), polyacetal, acrylonitrile-butadiene-styrene copolymer (ABS), hydrogenated styrene-based thermoplastic elastomer (SEBS), and silicone. Examples thereof include resin materials such as rubber and metal materials such as stainless steel. These can be used alone or in combination of two or more.

  The shape of the extending means 6 will be described. The receiving portion 61 is formed to have an outer diameter that is greater than or equal to the outer diameter of the pressing member 7 that abuts and less than or equal to the maximum outer diameter of the flexible tube 2, and the inner diameter of the concave surface of the receiving portion 61 is approximately the same as the outer diameter of the pressing member 7 that abuts. . In addition, the pulling member 63 is preferably formed with a width of about 2 to 8 mm and a thickness of about 0.5 to 3 mm when formed with a quadrangular prism, although it depends on the number of bands constituting the pulling member 63. Note that the cross-sectional shape of the pulling member 63 is not particularly limited as long as the deflated balloon 3 can be extended by the pressing member 7 and may be a quadrangular prism or a cylinder.

  Next, a method for using the gastrostomy catheter 1 will be described. FIG. 4 is an overall view of the gastrostomy catheter 1 according to the present embodiment, and is a diagram showing a state before the balloon is extended by the pressing member, and FIG. 6 is a gastrostomy catheter according to the present embodiment. It is the whole figure of 1, and is a figure showing the state which extended the balloon with the press member. 5 and 7 are longitudinal sectional views of FIGS. 4 and 6, respectively. The pressing member 7 presses the receiving portion 61 in the distal direction and extends the balloon 3 in the distal direction. In the present embodiment, as shown in FIGS. 4 to 7, the pressing member 7 includes an obturator 8, an outer cylinder 9, a stopper 10, and a spring spring 11.

  Since the pressing member 7 is used for extending the balloon 3, the pressing member 7 will be described first. FIG. 8 is a front view, a side view, and a cross-sectional view of the obturator of the pressing member 7 used when using the gastrostomy catheter 1 according to the present embodiment. FIG. 9 is a front view, a side view, and a cross-sectional view of the outer cylinder and the stopper of the pressing member 7 used when the gastrostomy catheter 1 according to the present embodiment is used.

The obturator 8 is detachably engaged with the obturator passage 91 of the outer cylinder 9 and has an outer diameter slightly smaller than that of the obturator passage 91. When the reinforcing member 85 is used, the outer diameter of the obturator is further reduced.
The obturator 8 is detachably engaged with the gastrostomy catheter 1 until it contacts the receiving part 61 of the gastrostoma catheter 1, and a guide wire passage 81 for inserting the guide wire 200, and a proximal end part Includes an operating portion 83 for pressing the receiving portion 61, a protrusion 84 above the guide wire passage 81 and below the operating portion 83, and the rear end portion 82 of the guide wire passage 81 and the operating portion 83 are separated from each other. It is arranged in a state. By doing so, the guide wire 200 does not hinder the operation when the operation unit 83 of the obturator 8 is pushed in with a finger. The obturator 8 can be produced by, for example, injection molding.

  Although it does not restrict | limit especially as the guide wire channel | path 81, it is a groove part of the U-shaped cross section which has a depth larger than the diameter of the guide wire 200 in this example. The minimum length of the formation portion of the guide wire passage 81 is not particularly limited, but it is easy to insert the guide wire 200 to be larger than the maximum length of the gastrostomy catheter 1 in a state of being extended by the pressing member 7. The operability is good and preferable.

  The reinforcing member 85 is an optional component, and the obturator 8 is inserted into the hollow portion of the reinforcing member 85 to reinforce the strength of the obturator 8. By using a metal such as stainless steel that is harder than the obturator 8, the rigidity can be increased. An opening 851 through which the guide wire 200 can be inserted is provided in the substantially central portion of the reinforcing member 85, and is arranged at a position that is consistent with the rear end portion 82 of the guide wire passage 81 and can be continuously seen from a lateral hole 93 of the outer cylinder 9 described later. Is done.

  The protrusion 84 is at a position moved 90 degrees in the circumferential direction with respect to the guide wire passage 81 and is biased outward by a spring. The protrusion 84 is configured to engage with one of two lock holes 92a and 92b attached to the outer cylinder 9 described later. The protrusion 84 may be located at any position in the circumferential direction with respect to the guide wire passage 81, but is preferably a position moved 90 degrees in the circumferential direction from the viewpoint of improving moldability.

  The outer cylinder 9 is normally manufactured by injection molding, and an obturator passage 91 in which the obturator 8 to which the obturator 8 or the reinforcing member 85 is attached is slidably engaged, and a lateral hole for taking out the guide wire 200 to the outside. 93, lock holes 92a and 92b provided at two positions above and below the horizontal hole 93 and at a predetermined interval above and below the position moved 90 degrees in the circumferential direction with respect to the horizontal hole 93, and at a predetermined pitch in the axial direction. There are a plurality of fitting portions 94 that are a pair of hooks on both sides, and a finger hook 95 that is located above the fitting portion 94 and projects in the radial direction of the outer cylinder 9. Further, the lateral hole 93 is generally formed in the axial direction with a length from the fitting portion 94 to the finger hook 95. Further, a step 96 in which one end of the spring spring 11 is disposed is formed in the obturator passage 91 of the outer cylinder 9. The positions of the lock holes 92a and 92b may be any position in the circumferential direction with respect to the lateral hole 93, but from the viewpoint of improving formability, a position moved by 90 degrees in the circumferential direction is preferable.

  The lateral hole 93 is disposed so as to be positioned above the gastrostomy catheter 1 and overlap the guide wire passage 81 of the obturator 8 when the pressing member 7 is combined with the gastrostomy catheter 1. As a result, the guide wire passage 81 of the obturator 8 and the lateral hole 93 communicate with each other. Therefore, before and after the gastrostomy catheter 1 is pressed by the pressing member 7, the guide wire 200 is inserted into the through hole 611, the guide wire passage 81 and the lateral hole 93 of the gastrostomy catheter 1 and used. In the inserted state, the assembly of the gastrostomy catheter 1 and the pressing member 7 can be guided through the fistula from outside the body into the stomach and removed.

The protrusion 84 of the obturator 8 engages with one of the two lock holes 92a and 92b. By switching this engagement, the tip position of the obturator 8 relative to the tip position of the outer cylinder 9 can be switched. As a result, the balloon 3 of the gastrostomy catheter 1 can be extended by the pressing member 7.
Specifically, as shown in FIG. 4 to FIG. 7, after the pressing member 7 is engaged with the gastrostomy catheter 1 to form an assembly, the stopper 10 is fitted to a fitting portion 94 described later, With the body surface fixing portion 4 of the catheter 1 fixed, the receiving portion 61 of the gastrostoma catheter 1 can be pressed by switching the engagement of the projection 84 of the obturator 8 from the lock holes 92a to 92b. It becomes. That is, the balloon 3 of the gastrostomy catheter 1 can be extended. Furthermore, the extended state can be maintained.
The engagement between the projection 84 of the obturator 8 and the lock holes 92a and 92b of the outer cylinder 9 is made of a flexible material for the gastrostoma catheter 1, so that the reaction force causes the projection 84 to move. It can be switched just by pressing. Moreover, by incorporating the spring spring 11 in the obturator 8, it can be easily switched by its elastic deformation.

  The fitting portion 94 is a member that fits both arm portions 101 of the stopper 10 described later and attaches the stopper 10 to the outer cylinder 9, and is located near the end of the outer cylinder 9. The fitting portion 94 is provided with a pair of flanges 941, and the stoppers 10 are attached to the outer cylinder 9 by fitting both arm portions 101 of the stopper 10 between the flanges. The number of firewood installed is not particularly limited, and a plurality of firewood is provided. Various lengths of the flexible tube 2 of the gastrostomy catheter 1 are set according to the length of the patient's fistula, and in order to cope with these, a plurality of folds are usually provided.

  The stopper 10 controls the positional relationship between the gastrostomy catheter 1 and the outer cylinder 9 by holding the body surface fixing portion 4 of the gastrostomy catheter 1. The stopper 10 includes both arm portions 101 fitted to the fitting portion 94 of the outer cylinder 9, a pair of fork-shaped holding portions 102 for holding the body surface fixing portion 4 of the gastrostomy catheter 1, and a gastrostomy catheter. 1 has a push-in part 103 for holding the body surface fixing part 4 and a releasing part 104 for releasing the holding.

  The interval between the clamping portions 102 formed in the fork shape is configured to be slightly smaller than the outer diameter of the flexible tube 2 of the gastrostomy catheter 1. As a result, the vicinity of the proximal end of the flexible tube 2 can be sandwiched. Further, the positional relationship between the gastrostomy catheter 1 and the outer cylinder 9 is restricted before and after the gastrostoma catheter 1 is extended by the pressing member 7 by being arranged so as to be scooped up from the lower surface of the body surface fixing part 4. Can do. It is more preferable that another pair of sandwiching portions is provided above the sandwiching portion 102 so as to sandwich the body surface fixing portion 4.

  Both arm portions 101 are fitted into the fitting portions 94 of the outer cylinder 9. Various lengths of the flexible tube 2 of the gastrostomy catheter 1 are set according to the length of the patient's fistula, and a plurality of flexible tubes 2 are provided according to the length of the flexible tube 2 of the gastrostomy catheter 1. By fitting and using the both arm portions 101 at the optimum locations from the fitted portion 94, the balloon 3 of the gastrostomy catheter 1 is not excessively stretched and the balloon 3 is not destroyed. . Furthermore, since the balloon 3 of the gastrostomy catheter 1 of various lengths can be extended as set, the balloon 3 can be extended with good reproducibility regardless of the skill of the operator and can be transferred to the patient's fistula. Insertion resistance or extraction resistance can be reduced.

  Any material can be used for the obturator 8, the outer cylinder 9, and the stopper 10 constituting the pressing member 7 as long as they have a certain level of strength. Examples of the material include polyolefins such as polyethylene (PE) and polypropylene (PP), polyvinyl chloride, polyurethane (PU), polyamide (PA), polyacetal, acrylonitrile / butadiene / styrene copolymer (ABS), and polycarbonate. Examples thereof include resin materials such as (PC) and metal materials such as stainless steel. These can be used alone or in combination of two or more.

  As described above, the case where the pressing member 7 is constituted by the obturator 8, the outer cylinder 9, the stopper 10, and the spring spring 11 has been described. However, the configuration of the pressing member 7 is not limited to this, and the extending means 6 of the gastrostomy catheter 1 is not limited to this. Any configuration may be used as long as it can expand the balloon 3 to reduce insertion resistance or withdrawal resistance to the patient's fistula.

Next, the insertion procedure of the gastrostomy catheter 1 of this embodiment will be described.
First, a fistula formation position is determined by palpation from the abdominal wall side while observing the stomach with an endoscope. Next, the abdominal wall and stomach wall are fixed by a known method. Thereafter, a puncture needle is inserted into the fistula formation position, and a guide wire is placed in the stomach through this needle tube. Subsequently, the fistula is expanded and formed using a known dilator through the guide wire. Thereafter, the dilator is removed.

  Next, the pressing member 7 is inserted into the first lumen 21 of the gastrostomy catheter 1 in which the balloon 3 is in a contracted state. The obturator 8 is inserted until it comes into contact with the receiving portion 61. When the obturator 8 is pushed further in the distal direction after the contact, the receiving portion 61 moves in the distal direction, and then the pulling member 63 moves in the distal direction. As a result, as shown in FIG. 8, the balloon 3 fixed to the pulling member 63 is also pulled and extended in the distal direction. Thus, when the balloon 3 is extended, the outer diameter can be reduced.

With the balloon 3 extended as described above, the gastrostomy catheter 1 is inserted into the fistula. Since the deflated balloon 3 is elongated as described above and has a smaller outer diameter than the natural state, insertion resistance to the fistula during insertion can be kept small.
After the insertion, the pressing member 7 is pulled out from the gastrostomy catheter 1 to release the extension of the balloon 3, and the balloon 3 is inflated by injecting fluid into the balloon 3 from the fluid injection port 26 using a syringe or the like. As the balloon 3 expands, the gastrostomy catheter 1 is prevented from falling off, and the gastrostomy catheter can be placed for a long period of time.

  Next, a procedure for removing the gastrostomy catheter 1 will be described. The extraction is performed by extending the balloon 3 in the reverse procedure at the time of insertion. First, a syringe or the like is connected to the fluid inlet 26 and the balloon 3 is contracted by sucking the fluid in the balloon 3. Next, by inserting the pressing member 7 into the first lumen 21 of the gastrostomy catheter 1 and pressing the obturator 8, the outer diameter of the balloon 3 can be made smaller than the natural contracted state as described above. . Therefore, the removal resistance of the balloon 3 can be sufficiently reduced, and the gastrostomy catheter 1 can be easily pulled out and removed from the fistula.

DESCRIPTION OF SYMBOLS 1 Gastric fistula catheter 2 Flexible tube 21 1st lumen | bore 22 Base end side opening 23 Front end side opening 24 Duck bill valve 25 2nd lumen | bore 26 Fluid injection port 3 Balloon 31 Center hole 4 Body surface fixing | fixed part 5 Cap 6 Balloon elongating means 61 Receiving portion 611 Through hole 62 Pulling means 63 Pulling member 7 Pressing member 8 Obturator 81 Guide wire passage 82 Rear end portion of guide wire passage 83 Operation portion 84 Projection portion 85 Reinforcement member 851 Opening 9 Outer cylinder 91 Obturator Passage 92a Lock hole 92b Lock hole 93 Horizontal hole 94 Fitting part 941 ９５ 95 Finger hook 96 Step 10 Stopper 101 Both arms 102 Holding part 103 Pushing part 104 Release part 11 Spring spring 200 Guide wire

Claims (4)

A gastrostomy catheter comprising a flexible tube having a first lumen and a second lumen, and an inflatable and contractible balloon provided at the distal end of the flexible tube,
A receiving portion provided on the distal side of the balloon tip and on an extension line of the shaft of the first lumen;
Pulling means that operates to extend the balloon in the distal direction by pressing the receiving portion in the distal direction when the balloon is in a deflated state, and to make the outer diameter of the balloon smaller than in the deflated state;
A gastrostomy catheter comprising a balloon extending means having   The gastrostomy catheter according to claim 1, wherein the traction means is at least one traction member extending in a proximal direction from the receiving portion and having a proximal end fixed to the balloon. The gastrostomy catheter according to claim 2 , comprising a plurality of the pulling members, wherein the plurality of pulling members are arranged to extend radially from the receiving portion toward the balloon.   The catheter for gastrostoma as described in any one of Claim 1 thru | or 3 further equipped with the press member which presses the said receiving part.