JP6704257B2 - Insertion aid for small intestine indwelling tube - Google Patents

Description

TECHNICAL FIELD The present invention relates to an insertion assisting tool used when inserting a small intestine indwelling tube into a stomach.

In recent years, for patients who cannot ingest food orally, a gastrostomy penetrating from outside the body into the stomach is formed in the patient's abdomen, and a gastrostomy tube is inserted into the gastrostomy to supply nutrients directly into the stomach. Is being done. As the gastrostomy tube, for example, a tube main body, a flexible bumper portion provided at the tip of the tube main body and locked to the inner wall of the stomach, and provided at the proximal end of the tube main body to engage the body surface. A body surface locking portion that is stopped is known. Further, a rod-shaped insertion assisting tool used when inserting the gastrostomy tube into the gastrostomy is known (for example, refer to Patent Document 1).

When inserting the gastrostomy tube into the gastrostomy using the rod-shaped insertion assisting tool, first insert the insertion assisting tool into the tube main body and form a smaller diameter than the inner diameter of the tube main body at the tip of the bumper portion. It engages with the locked part. Then, by further pushing, the bumper portion is deformed in a slender shape along the axis thereof toward the distal end, and in this state, the gastrostomy tube is inserted into the gastrostomy. Then, when the bumper part inserted into the gastrostomy reaches the inside of the stomach, the insertion assisting tool can be removed from the tube body to restore the bumper part to its original state and lock it on the inner wall of the stomach.

On the other hand, a small intestine indwelling tube is used to directly administer a drug, nutrition or the like to a part of the small intestine continuing from the duodenum, for example, the jejunum. The small intestine indwelling tube has a shape obtained by further extending the tube body to the tip of the bumper portion in the gastrostomy tube.

JP, 2004-261566, A

From the shape of the small intestine indwelling tube, it can be considered to be inserted into the gastrostomy in the same manner as the gastrostomy tube. However, when a locking portion for locking the tip of the insertion assisting tool is formed in the small intestine indwelling tube, after removing the insertion assisting tool, a drug by the locking section when administering a drug, nutrition, or the like, There is a problem that the flow of nutrition is disturbed.

In order to solve the above problem, it is conceivable that the small intestine indwelling tube is not provided with the locking portion, and the inner diameter of the tube body is the same before and after the bumper portion. However, if the inner diameter of the tube body is the same before and after the bumper portion, the insertion assisting tool cannot engage with the bumper portion, and there is a disadvantage that the small intestine indwelling tube cannot be inserted into the gastrostomy.

The present invention solves this inconvenience, and provides an insertion aid for a small intestine indwelling tube that can easily insert a small intestine indwelling tube including a tube body having the same inner diameter before and after a bumper portion into a gastrostomy. With the goal.

In order to achieve such an object, an insertion assisting tool for a small intestine indwelling tube of the present invention is provided with a tube main body placed in the small intestine through a gastrostomy and an inner wall of the stomach provided in the middle of the outer peripheral surface of the tube main body. A flexible bumper portion that is locked and a body surface locking portion that is provided at the base end portion of the tube body and locked to the body surface are provided, and the tube body is the same before and after the bumper portion. A small intestine indwelling tube insertion aid used when inserting a small intestine indwelling tube having an inner diameter into a gastrostoma, which is a hollow cylindrical gripping portion and a hollow protruding from the tip of the gripping portion and inserted into the tube body. A cylindrical insertion portion, the insertion portion having a length that reaches at least a portion beyond the bumper portion when inserted into the tube body, and is deformable outward at the tip end portion. It is characterized in that it is provided with a pressure contact portion that pressure contacts the inner wall of the tube body.

The insertion aid for a small intestine indwelling tube of the present invention (hereinafter abbreviated as insertion aid) inserts a small intestine indwelling tube having the tube body, the bumper portion, and the body surface locking portion into a gastrostomy. Used when

In the insertion assisting tool of the present invention, a distal end portion of the insertion portion protruding from the distal end of the grip portion is provided with a pressure contact portion that is deformable outward. Therefore, the insertion assisting tool of the present invention inserts the insertion portion into the tube body of the small intestine indwelling tube, and when the tip portion reaches at least a portion exceeding the bumper portion, the pressure contact portion is outward. The pressure contact portion is pressed against the inner wall of the tube main body by deforming toward the inner wall.

According to the insertion assisting tool of the present invention, it is possible to deform the bumper portion along the axis thereof toward the distal end in a slender shape by pressing the pressure contact portion against the inner wall of the tube body and further pushing. it can. Therefore, according to the insertion assisting tool of the present invention, the small intestine indwelling tube can be easily inserted into the gastrostomy even if the inner diameter of the tube body is the same before and after the bumper portion.

Therefore, according to the insertion assisting tool of the present invention, the small intestine indwelling tube is inserted into the gastrostomy in a state where the bumper portion is elongated and deformed, and the bumper portion returns to its original state by reaching the inside of the stomach. It can be locked to the inner wall of the stomach. After that, the insertion assisting tool of the present invention can be removed from the tube body by restoring the deformation of the pressure contact portion to the original state and releasing the pressure contact with the inner wall of the tube body.

The insertion assisting tool of the present invention includes, for example, a rod that is provided in the inside of the grip portion and the insertion portion so as to be able to move forward and backward, and a large diameter portion provided at the tip of the rod, and the insertion portion is elastic. The body comprises a plurality of petaloid portions, the pressing portion being divided by a plurality of slits provided at the tip of the insertion portion and being deformed outward by the large diameter portion when the rod retracts. It may be configured by parts.

According to the configuration, the insertion portion is inserted into the tube body of the small intestine indwelling tube, and when the tip portion reaches at least a portion beyond the bumper portion, the rod is retracted with respect to the grip portion. .. With this configuration, the large diameter portion provided at the tip of the rod enters the inside of the petal-shaped portion, so that the petal-shaped portion can be expanded outward, and the petal-shaped portion can be expanded. It can act as a pressure contact portion.

Further, according to the above configuration, when the rod is advanced with respect to the grip portion, the petal-shaped portion returns to its original state due to its elasticity, so that the pressure contact with the inner wall of the tube body can be released. ..

The perspective view which shows one structural example of the small intestine indwelling tube and the insertion assistance tool of the small intestine indwelling tube of this invention. A is a sectional view of the insertion assisting tool of the present invention shown in FIG. 1, and B is a sectional view showing a state in which a petal-shaped portion is enlarged. A is sectional drawing which shows the state which inserted the insertion assistance tool of this invention in a tube main body, B is sectional drawing which shows the state which pressed the petal-shaped part of the insertion assistance tool of this invention to the inner wall of a tube main body. The method of inserting a small intestine indwelling tube into a gastrostomy using the insertion aid of the present invention is shown, A is a schematic sectional view of an initial state, and B is a schematic sectional view showing a state of inserting a small intestine indwelling tube into a gastrostomy. , C are schematic cross-sectional views showing a state in which insertion of the small intestine indwelling tube is completed.

Next, embodiments of the present invention will be described in more detail with reference to the accompanying drawings.

The obturator (insertion aid) 1 of this embodiment shown in FIG. 1 is used when inserting the small intestine indwelling tube 10 into a gastrostomy (not shown).

The obturator 1 has a hollow cylindrical grip portion 2, a hollow cylindrical insert portion 3 that is continuously provided at the tip of the grip portion 2 and projects from the tip, and moves back and forth inside the grip portion 2 and the insert portion 3. And a freely provided rod 4. The insertion portion 3 is made of an elastic material such as metal or synthetic resin, and a plurality of (four in this embodiment) petals divided by a plurality of (four in this embodiment) slits 5 at the tip of the insertion portion 3 Formed portion 6 is formed. An operation unit 7 for moving the rod 4 back and forth is provided at the base end of the rod 4.

The small intestine indwelling tube 10 includes a tube main body 11, a flexible silicone rubber bumper portion 12 provided on the outer peripheral surface of the tube main body 11, and a base end of the tube main body 11 extending radially outward. The body surface locking portion 13 is provided. The tube body 11 has the same inner diameter before and after the bumper portion 12. Further, a plug body 15 that blocks a port 14 that communicates with the tube body 11 is connected to the body surface locking portion 13.

With respect to the small intestine indwelling tube 10, the insertion portion 3 of the obturator 1 has a length that reaches at least a portion beyond the bumper portion 12 when inserted into the tube body 11.

In the small intestine indwelling tube 10, the bumper portion 12 includes a dome wall portion 16 that expands in a dome shape in the distal direction, and an annular fixing portion 17 that is fixed to the tube body 11. The dome wall portion 16 is formed in a circular shape in a plan view, and the tube body 11 is inserted into an insertion hole 18 formed in the center thereof. The inner diameter of the insertion hole 18 is formed larger than the outer diameter of the tube body 11, whereby the dome wall portion 16 is allowed to move in the longitudinal direction of the tube body 11.

Further, the dome wall portion 16 and the fixed portion 17 are connected by a plurality of (four in the present embodiment) connecting portions 19 provided at predetermined intervals in the circumferential direction. Each connecting portion 19 is formed in a curved band shape, and integrally connects the dome wall portion 16 and the fixed portion 17. Although the dome wall portion 16 and the connecting portion 19 are formed with the same thickness, the connecting portion 19 is more easily bent than the dome wall portion 16 due to the difference in shape.

Next, the operation of the obturator 1 will be described with reference to FIG.

As shown in FIG. 2A, in the obturator 1, a rod 4 is arranged inside the grip portion 2 and the insertion portion 3, and the rod 4 can be moved back and forth by an operation portion 7 provided at the base end thereof. ing. A large-diameter portion 41 having a diameter larger than the outer diameter of the rod 4 and the inner diameter of the insertion portion 3 is provided at the tip of the rod 4, and the large-diameter portion 41 enters the tip of the petal-shaped portion 6 so as to enter the state. It is installed in. As a result, each petal-shaped portion 6 is slightly deformed outward by the large-diameter portion 41 in advance.

The operating portion 7 is composed of a cylindrical operating portion main body 71 and a pointing portion 72 continuously provided at the proximal end of the operating portion main body 71, and the proximal end of the rod 4 is supported by the distal end of the operating portion main body 71. There is. By manipulating the pointing portion 72, the operation portion main body 71 can be moved back and forth along the inner wall of the hollow cylindrical grip portion 2. On the other hand, the pointing portion 72 is locked to the base end of the grip portion 2 to limit the forward movement of the rod 4.

Next, when the pointing portion 72 is operated to retract the rod 4, the large diameter portion 41 enters inward from the tip of the petal-shaped portion 6 as shown in FIG. 2B. At this time, since the insertion portion 3 is made of an elastic body as described above and the large diameter portion 41 has a diameter larger than the inner diameter of the insertion portion 3, the petal-shaped portion 6 is elastically deformed outward by the large diameter portion 41. To be done.

Therefore, when the small intestine indwelling tube 10 is inserted into the gastrostomy by the obturator 1 of the present embodiment, first, as shown in FIG. 3A, the grip portion 2 is gripped and the body surface locking portion of the small intestine indwelling tube 10 is held. The insertion portion 3 is inserted into the tube main body 11 from the port 14 formed in 13. At this time, the pointing portion 72 of the operating portion 7 is locked to the base end of the grip portion 2, and the large diameter portion 41 of the rod 4 is arranged at the tip portion of the petal-shaped portion 6, and the petal-shaped portion is formed. 6 is not deformed to the extent that it is pressed against the inner wall of the tube body 11.

Next, as shown in FIG. 3B, if the petal-shaped portion 6 at the tip of the insertion portion 3 is inserted into the tube body 11 beyond the portion beyond the bumper portion 12, that is, the portion where the bumper portion 12 is provided. For example, the rod 4 is retracted by pulling the pointing portion 72. By doing so, the large-diameter portion 41 of the rod 4 enters inward from the tip of the petal-shaped portion 6, and the petal-shaped portion 6 is elastically deformed outward by the large-diameter portion 41 and the tube body 11 Is pressed against the inner wall of the.

As a result, the obturator 1 can operate the small intestine indwelling tube 10 via the petal-shaped portion 6 pressed against the inner wall of the tube body 11.

Next, a method of inserting the small intestine indwelling tube 10 into the gastrostomy using the obturator 1 will be described with reference to FIG.

When inserting the small intestine indwelling tube 10 into the gastrostomy using the obturator 1, first, as shown in FIG. 4A, the petaloid portion 6 elastically deformed outward is pressed against the inner wall of the tube body 11. In this state (see FIG. 3B), the distal end side of the tube body 11 is inserted into the gastrostomy G, and the bumper portion 12 is brought into contact with the opening of the gastrostomy G on the body surface B side.

Next, as shown in FIG. 4B, when the tube main body 11 is pressed toward the stomach wall S side by the obturator 1, the flexible bumper portion 12 made of silicone rubber is pressed against the body surface B to form the insertion hole 18. The bumper portion 12 is slenderly deformed by moving upward along the tube body 11. Then, by further pressing the tube body 11 toward the stomach wall S side by the obturator 1, the elongated and deformed bumper portion 12 is pushed into the stomach wall S, that is, the stomach from the gastrostomy G.

Next, when the bumper portion 12 is pushed into the stomach wall S, the bumper portion 12 returns to its original state by its elasticity and is locked to the inner wall of the stomach wall S, and the insertion of the small intestine indwelling tube 10 into the gastrostomy G is completed. Therefore, as shown in FIG. 4C, the pointing portion 72 is pushed to advance the rod 4 and the petal-shaped portion 6 is returned to its original state by its elasticity, thereby releasing the pressure contact with the inner wall of the tube body 11. Then, the obturator 1 is removed from the tube body 11 as shown by the arrow in FIG. 4C.

The obturator 1 of the present embodiment can be used not only for the small intestine indwelling tube 10 but also when inserting the gastrostomy tube into the gastrostomy.

DESCRIPTION OF SYMBOLS 1... Obturator (insertion aid), 2... Gripping part, 3... Insertion part, 4... Rod, 5... Slit, 6... Petal-shaped part (pressing contact part), 10... Small intestine indwelling tube, 11... Tube body, 12... Bumper part, 13... Body surface locking part, 41... Large diameter part.

Claims (2)

A tube body that is placed in the small intestine through a gastrostomy, and body surface engaging portions to be engaged in the provided body to the proximal end of the tubing body,
Small intestine indwelling used when inserting a small intestine indwelling tube having a flexible bumper portion provided on the outer peripheral surface midway between the proximal end and the distal end of the tube body and locked to the inner wall of the stomach A tube insertion aid,
A hollow cylindrical grip portion, and a hollow cylindrical insertion portion that projects from the tip of the grip portion and is inserted into the tube body from the base end side of the tube body,
The distal end of the insertion portion is provided with a pressure contact portion that presses against the inner wall of the tube body by being deformable outwardly while the insertion portion is inserted into the tube body .
The insert, when inserted into the tube body, the insertion aid of the small intestine indwelling tube, characterized in that it comprises a length which at least partially reaches the distal end side of the bumper portion of the pressure contact portion. The insertion aid for a small intestine indwelling tube according to claim 1, further comprising: a rod that is provided inside the grasping portion and the insertion portion so as to be able to advance and retract, and a large diameter portion that is provided at a tip of the rod. The insertion portion is made of an elastic body, and the pressure contact portion is divided by a plurality of slits provided at the tip of the insertion portion and is deformed outward by the large diameter portion when the rod retracts. An insertion aid for a small intestine indwelling tube, which is composed of a plurality of petaloid parts.