WO2019111847A1 - Cathéter de gastrostomie, ensemble de gabarit d'insertion, gabarit d'insertion et ensemble de cathéter de gastrostomie - Google Patents

Cathéter de gastrostomie, ensemble de gabarit d'insertion, gabarit d'insertion et ensemble de cathéter de gastrostomie Download PDF

Info

Publication number
WO2019111847A1
WO2019111847A1 PCT/JP2018/044360 JP2018044360W WO2019111847A1 WO 2019111847 A1 WO2019111847 A1 WO 2019111847A1 JP 2018044360 W JP2018044360 W JP 2018044360W WO 2019111847 A1 WO2019111847 A1 WO 2019111847A1
Authority
WO
WIPO (PCT)
Prior art keywords
bumper
gastrostomy catheter
cap
locking
proximal end
Prior art date
Application number
PCT/JP2018/044360
Other languages
English (en)
Japanese (ja)
Inventor
鈴木　裕
浩之 福田
有川　清貴
鈴木　稔
Original Assignee
住友ベークライト株式会社
鈴木　裕
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from JP2018145805A external-priority patent/JP7316029B2/ja
Priority claimed from JP2018154832A external-priority patent/JP7114402B2/ja
Application filed by 住友ベークライト株式会社, 鈴木　裕 filed Critical 住友ベークライト株式会社
Priority to KR1020207019093A priority Critical patent/KR102543294B1/ko
Priority to US16/768,788 priority patent/US20210177704A1/en
Priority to CN201880078047.6A priority patent/CN111655219B/zh
Priority to EP18886918.4A priority patent/EP3721856A4/fr
Publication of WO2019111847A1 publication Critical patent/WO2019111847A1/fr

Links

Images

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61J—CONTAINERS SPECIALLY ADAPTED FOR MEDICAL OR PHARMACEUTICAL PURPOSES; DEVICES OR METHODS SPECIALLY ADAPTED FOR BRINGING PHARMACEUTICAL PRODUCTS INTO PARTICULAR PHYSICAL OR ADMINISTERING FORMS; DEVICES FOR ADMINISTERING FOOD OR MEDICINES ORALLY; BABY COMFORTERS; DEVICES FOR RECEIVING SPITTLE
    • A61J15/00—Feeding-tubes for therapeutic purposes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/02—Holding devices, e.g. on the body
    • A61M25/04—Holding devices, e.g. on the body in the body, e.g. expansible

Definitions

  • the present invention relates to a gastrostomy catheter, an insertion jig set used for attaching a gastrostomy catheter into a stomach, an insertion jig, and a gastrostomy catheter set.
  • the present application is related to Japanese Patent Application No. 2017-232868 filed on Dec. 4, 2017, Japanese Patent Application No. 2018-145805 filed on Aug. 2, 2018, and August 21, 2018. The priority is claimed based on Japanese Patent Application No. 2018-154832 filed in Japan, the contents of which are incorporated herein by reference.
  • an intragastric fixed part such as an expandable bumper or balloon. It is known to have a configuration in which the part can be indwelled.
  • a balloon provided with a bumper reduced in diameter by a rod, and as disclosed in Patent Document 2, a balloon expanded and contracted by a fluid such as a salt solution There is something that is provided.
  • a cap in the same document, a capsule and the like which can be held in a state in which the intragastric fixed part is folded so as to cover the intragastric fixed part (described in the same document as an internal bolster).
  • An insertion jig set for a gastrostomy catheter (described as an instrument for gastrostomy) is disclosed.
  • the intragastric fixed part is folded by the cap, and the intragastric fixed part can be inserted into the stomach through the fistula, thereby reducing the burden on the subject.
  • the cap is formed with a hole for passing a lip cord (tearing cord).
  • the cap is torn by pulling the rip cord passed through the hole, and from the state of restraining the intragastric fixation portion to a state in which the intragastric fixation portion becomes expandable, the intragastric fixation portion is intragastrically It is described that it is detained.
  • this cap when used for the intragastric fixed part with high elasticity, the cap can be removed unexpectedly from the intragastric fixed part without being able to suppress the elastic restoration of the intragastric fixed part. Is considered. Furthermore, it was difficult for the operator to obtain confirmation that the cap had been removed from the intragastric fixed part only by pulling the rip cord.
  • the present invention has been made in view of the above problems, and has an object to provide a gastrostomy catheter which can be relatively indwelled for a relatively long time while reducing the administrative burden while suppressing the resistance applied to the body low.
  • Another object of the present invention is to provide an insertion jig set, an insertion jig, and a gastrostomy catheter set capable of preferably removing the cap while preventing the cap from being accidentally detached from the gastrostomy catheter.
  • the gastrostomy catheter according to the present invention has a shaft provided with a lumen, a flexible bumper provided at the tip of the shaft, and elasticity to be able to bias the bumper in the radial direction or the bumper And a linear member capable of restricting the deformation in the diameter reduction direction.
  • the insertion jig set of the present invention is an insertion jig set for inserting a gastrostomy catheter having a foldable intragastric fixation portion at its tip into the body, and is advanced into the tubular mantle and the mantle
  • An insertion jig configured to include a retractable insertion portion, the gastrostomy catheter attached around the outer collar, and the distal end side of the outer collar and folded
  • a cap covering at least a part of the intragastric fixation part in a fixed state, and one of the gastrostomy catheter or the mantle and the cap has a locking part for locking to the other,
  • the said insertion part is characterized by releasing the latching by the said latching part, when it passes through in the said outer collar part, and is advanced.
  • the insertion jig of the present invention is for inserting a gastrostomy catheter having a collapsible intragastric fixation part at its tip and a cap covering at least a part of the intragastric fixation part in a folded state into the body.
  • the insertion jig comprising: a tubular mantle through which the gastrostomy catheter can be attached; and an insertion section which is inserted into the mantle.
  • the mantle is the insertion jig.
  • a locking portion for locking to a cap is provided, and the insertion portion is characterized in that the locking by the locking portion is released when the insertion portion is advanced into the outer collar portion.
  • the gastrostomy catheter set of the present invention comprises a gastrostomy catheter having a collapsible intragastric fixation section at its tip, and a cap covering at least a part of the intragastric fixation section in a folded state;
  • the gastrostomy catheter is formed so as to be able to insert a part of an insertion jig for insertion into the stomach, and the cap has a locked portion which is locked to the insertion jig. I assume.
  • the gastrostomy catheter of the present invention by providing a linear member capable of biasing the bumper in the radial direction or restricting the deformation of the bumper in the radial direction, flexibility can be achieved compared to the conventional gastrostomy catheter It becomes possible to use the bumper of the material which it has. Therefore, the resistance applied to the body during insertion and removal of the catheter can be suppressed low. Furthermore, unlike a gastrostomy catheter with a balloon, it does not use fluid, so there is no need to replace fluid. For this reason, compared with what is provided with a balloon, administrative effort is reduced and relatively long-term indwelling becomes possible.
  • the insertion jig set, the insertion jig, and the gastrostomy catheter set of the present invention it is possible to preferably remove the cap while preventing the cap from being accidentally detached from the gastrostomy catheter.
  • FIG. 14 is a perspective view corresponding to FIG.
  • FIG. 14 is a cross-sectional view showing a 1XV-1XV cross section of the bumper and shaft of FIG. 13; It is a perspective view which shows the extracorporeal fixing tool provided with the proximal end holding
  • FIG. 19 is a partial cross-sectional view showing a part of the insertion jig set, and is a view showing a 2II-2II cross section of FIG. 18;
  • FIG. 19 is a partial cross-sectional perspective view showing a cross section of the distal end of the mantle and is a view showing a 2III-2III cross section of FIG. 18;
  • It is a perspective view which shows an insertion jig set, and is a figure which shows the state which the cap released and expanded the bumper.
  • FIG. 1 It is a fragmentary sectional view which shows a part of insertion jig set, and is a figure which shows the 2V-2V cross section of FIG. It is sectional drawing which shows the latching structure of the outer collar part and cap which concerns on a 2nd-1 modification, and is a figure which shows the bending end part of a closed arm state. It is sectional drawing which shows the latching structure of the outer collar part and cap which concerns on a 2nd-1 modification, and is a figure which shows the bending end part of an open arm state. It is sectional drawing which shows the latching structure of the gastrostomy catheter and cap which concern on a 2nd-2 modification. FIG.
  • FIG. 21 is a cross-sectional view showing a locking structure of a gastrostomy catheter and a cap according to a second to third modified example, showing a locked state.
  • FIG. 21 is a cross-sectional view showing a locking structure of a gastrostomy catheter and a cap according to a second to third modified example, showing a locking released state.
  • FIG. 1 is a front view of a gastrostomy catheter 11 according to this embodiment
  • FIG. 2 is a front cross-sectional view of the gastrostomy catheter 11.
  • distal side means the side far from the operator of the gastrostomy catheter 11 in the gastrostomy catheter 11 unless specifically stated otherwise, specifically, the side provided with the bumper 13
  • the distal side may be referred to as the distal side.
  • proximal side refers to the side closer to the operator of the gastrostomy catheter 11, unless otherwise noted.
  • the gastrostomy catheter 11 has a shaft 12 provided with a lumen, a flexible bumper 13 provided at the distal end of the shaft 12, and elasticity so that the bumper 13 can be biased in the radial direction or the bumper 13 And a linear member (wire 14) capable of restricting the deformation in the diameter reduction direction.
  • “capable of biasing the bumper 13 in the diameter expansion direction” means that the wire 14 is elastically deformed to apply a restoring force in the diameter expansion direction of the bumper 13 by contacting in the radial direction of the bumper 13 We say that it is possible.
  • the deformation of the bumper 13 in the diameter reduction direction can be limited means that the wire 14 abuts the bumper 13 when the bumper 13 tries to reduce the diameter by contacting the edge surface of the stomach wall, etc. It means that the deformation in the radial direction of the bumper 13 can be limited. That is, the wire 14 is not limited to one constantly urged in the radial direction with respect to the bumper 13, and may be biased in the radial direction only when an external force is applied to the bumper 13. Further, in the present embodiment, although the restoring force of the wire 14 is applied to the bumper 13 in the diameter expansion direction from the inner side, for example, the diameter expansion from a linear member (not shown) disposed outside the bumper 13 The configuration may be such that a directional restoring force is applied.
  • the gastrostomy catheter 11 is more flexible than the gastrostomy catheter 11 configured not to include the wire 14 capable of biasing the bumper 13 in the radial direction or limiting the deformation of the bumper 13 in the radial direction. It is possible to adopt a material having elasticity to the bumper 13. Therefore, the resistance applied to the body at the time of insertion and removal of the gastrostomy catheter 11 can be suppressed low. Furthermore, the gastrostomy catheter 11 with the bumper 13 and the wire 14 does not use fluid unlike the gastrostomy catheter with the balloon, so there is no need to replace fluid. For this reason, compared with the case where a balloon is used, administrative effort is reduced, and relatively long-term indwelling becomes possible.
  • FIG. 5 is a schematic explanatory view showing the state of the gastrostomy catheter 11 in which the bumper 13 is placed in the stomach 152. As shown in FIG.
  • the gastrostomy catheter 11 includes a shaft 12, a fixed portion (extracorporeal fixture 15) provided at the proximal end of the shaft 12, a bumper 13 provided at the distal end, the extracorporeal fixture 15, the shaft 12 and the bumper 13 And the wire 14 disposed over the inside of each of the
  • the gastrostomy catheter 11 according to the present embodiment is integrally molded of silicone rubber or urethane rubber except for the wire 14.
  • the present invention is not limited to such a configuration, and separate components may be joined and configured. In particular, it is preferable in terms of quality that the same kind of material is used even if another component is joined.
  • the extracorporeal fixture 15 and the shaft 12 are provided with a lumen.
  • the lumen includes a main lumen 18 for injecting a nutrient, and a sub-lumen 19 that accommodates at least a portion (proximal side) of the wire 14.
  • the main lumen 18 communicates with the hollow space of the bumper 13 and a communication hole 13a formed in the bumper 13 to be described later, and forms a flow path penetrating from the proximal end to the distal end in the gastrostomy catheter 11, Nutrients can be infused into the stomach 152 from outside the body.
  • the main lumen 18 is formed to have a D-shaped cross section in the present embodiment, and extends linearly along the axial direction of the shaft 12 on the center side of the shaft 12 and the extracorporeal fixture 15.
  • a communication hole 13 a which is a circular hole is formed at the end of the main lumen 18.
  • the communication hole 13 a is formed to have a large diameter so as to expose the main lumen 18 and the sub lumen 19 and to include the main lumen 18 and the sub lumen 19 in a bottom view of the bumper 13.
  • Nutrients supplied to the stomach 152 (see FIG. 5) through the gastrostomy catheter 11 pass through the external fixation device 15 and the main lumen 18 of the shaft 12 and through the communication holes 13a of the bumper 13 to the stomach 152. It will be supplied.
  • a check valve is provided in the main lumen 18, to prevent backflow of contents such as gastric juice from the inside of the stomach 152 to the outside of the body, but this is omitted and FIG. 2 etc. are illustrated.
  • the sub lumen 19 is formed on the outer peripheral side of the main lumen 18.
  • the main lumen 18 is formed to have a D-shaped cross section at a portion passing through the shaft 12, so that the sub lumen 19 is formed through a portion formed thicker than the other portions.
  • the sub-lumen 19 is formed in a circular shape in cross section, and is formed by being bent along the shaft 12 and the extracorporeal fixture 15 in an L shape.
  • the sub-lumen 19 linearly extends along the axial direction in the shaft 12, and is bent at a right angle at the part reaching the extracorporeal fixture 15, and the extension direction of the extracorporeal fixture 15 Extends linearly along the As a part of the wire 14 is accommodated in the sub-lumen 19, the injection of the nutrient through the main lumen 18 is not inhibited. Also, the wire 14 can be protected within the sublumen 19.
  • a distal end 19 b which is a distal end having a certain length in the sub-lumen 19 linearly extends from the proximal side to the distal side and continues in the bumper 13.
  • that the tip end open portion 19b of the sub-lumen 19 is continued in the bumper 13 means that the tip end open portion 19b of the sub-lumen 19 is provided in a space that is continuous with the space in the bumper 13.
  • the sub lumen 19 is formed, and the proximal end side of the wire 14 is disposed in the sub lumen 19 so that the distal end side of the wire 14 can be guided in the bumper 13.
  • the extracorporeal fixture 15 fixes outside (limits movement to a predetermined position) outside the stomach so that the gastrostomy catheter 11 will not be buried in the fistula 153 by abutting on the abdominal wall 150.
  • the extracorporeal fixture 15 is larger than the shaft 12 in at least one direction perpendicular to the axial direction of the shaft 12 passed through the fistula 153.
  • the extracorporeal fixture 15 in this embodiment is in the form of a small piece linearly extending perpendicularly to the axial center of the shaft 12.
  • the fistula 153 is formed penetrating the abdominal wall 150 and the stomach wall 151, as shown in FIG.
  • the extracorporeal fixture 15 according to the present embodiment is integrally formed with the shaft 12 and the bumper 13.
  • the extracorporeal fixture 15 is formed with an opening 18 a which is a radially central portion of the shaft 12 and is an opening on the proximal side of the main lumen 18 formed in the axial direction. Further, a strap 17 integrally extends from the side surface of the extracorporeal fixture 15, and a cap 16 capable of sealing the opening 18a is formed at the tip of the strap 17.
  • the extracorporeal fixture 15 is provided with a proximal end holding portion 15 c that holds a proximal end portion 14 a of a wire 14 described later.
  • the proximal end holding portion 15 c holds the proximal end portion 14 a by being embedded in the proximal end portion 14 a of the wire 14.
  • the proximal end holding portion 15 c is provided on the extracorporeal fixture 15 so as to be cut away.
  • the configuration of the proximal end holding portion 15 c that holds the proximal end portion 14 a of the wire 14 is not limited to one that is held by embedding the proximal end portion 14 a.
  • a stopper or the like may be provided at the proximal end of the wire 14, and a part of the extracorporeal fixture 15 may be locked to the stopper, or the proximal end 14a of the wire 14 may be fixed by a part of the extracorporeal fixture 15. May be held to hold the wire 14.
  • a linear marker 15b is attached which serves as a reference for the cutout portion.
  • the marker 15b is attached to a position within a virtual plane (vertical plane in the present embodiment) intersecting with the proximal end 19a of the sub-lumen 19 which is a position where the proximal end holding portion 15c can be reliably cut out.
  • the proximal end 19a does not mean the proximal end, but means a portion having a certain length at the proximal end.
  • the position where the marker 15 b is attached may be the upper surface (proximal end surface) of the extracorporeal fixture 15.
  • the marker 15b may be formed of a paint, and may be a groove-like cut. Also, if the positions of the wire 14 and the sub-lumen 19 can be visually recognized, the marker 15 b is not necessarily an essential configuration. Thus, by providing the proximal end holding portion 15 c, the wire 14 can be held at a predetermined position where the distal end portion of the wire 14 is positioned in the bumper 13.
  • the site disposed outside the body may be a so-called button type or a tube type. If there is another site to be placed outside the body, such as in the case of a tube type, the present invention is not limited to the case where the proximal end holding portion 15c is provided to the extracorporeal fixture 15; On the proximal side, there may be a site for holding the proximal end 14 a of the wire 14.
  • the patient inadvertently removes the wire 14 by preventing the wire 14 from being detached from the extracorporeal fixture 15 or the like. You can prevent it from
  • the bumper 13 is integrally formed with the shaft 12 and has a hollow disk shape.
  • the shape of the bumper 13 in the present embodiment is a disk shape having the same appearance (including substantially the same) in a natural state and in a state where the distal end side of the wire 14 is accommodated.
  • the bumper 13 is not limited to such a shape, and may have flexibility to expand radially outward only when the distal end side of the wire 14 is accommodated.
  • the thickness of the shaft 12 (strictly speaking, the distance between the wall surface of the main lumen 18 and the outer surface of the shaft 12 at a portion where the sub-lumen 19 is not formed is set so that the bumper 13 has predetermined flexibility. It is formed thinner than). As described above, since the bumper 13 is thinner than the shaft 12, the bumper 13 can be easily expanded and contracted. As described above, on the distal side of the bumper 13 and on the extension of the main lumen 18, the communication hole 13a is formed to communicate the inside and the outside of the bumper 13.
  • the bumper 13 is biased radially outward by being disposed so that the tip end side of the super elastic alloy wire 14 winds in the bumper 13, and its disk shape (a diameter is slightly reduced in the radial direction). The shape is also maintained in the stomach 152).
  • the wire 14 is not limited to the one that always biases the bumper 13 radially outward, but when the external force is applied to the bumper 13 and the wire 14 is deformed in the radial direction to abut the wire 14, the wire 14 is biased radially outward. It may be configured to limit its deformation.
  • the bumper 13 is not limited to one formed in a disk shape in the natural state, and may be formed in a disk shape only by arranging the tip end of the wire 14.
  • the linear member (wire 14) is at least partially disposed on the front end side in the bumper 13 so that the bumper 13 can be urged radially outward or deformation in the radial direction of the bumper 13 can be limited.
  • the bumper 13 In the first state and the first state, the bumper 13 is biased or not urged radially outward lower than in the first state, or the deformation in the radial direction of the bumper 13 is allowed to be smaller than in the first state It is configured to be variable in two states.
  • the wire 14 In the second state, the wire 14 is disposed on the proximal side of the bumper 13 or pulled out more proximal than the bumper 13 than when the wire 14 is in the first state.
  • the wire 14 is naturally not urged at all against the bumper 13.
  • the bumper 13 is biased with a lower force than before pulling out the bumper 13, or allows the deformation of the bumper 13 in the contraction direction of the bumper 13 which has been restricted. It will be done.
  • the state of the bumper 13 pertaining to both of these is referred to as a "second state".
  • the "radially outward” means an orientation having a component of radially outward, and means all directions except inward in the radial direction (in other words, the orientation in the center of the bumper 13). The same is true for
  • the proximal end portion 14a of the wire 14 is embedded in the proximal end holding portion 15c as described above.
  • At least the front end portion 14b of the wire 14 is movably disposed in the bumper 13 without being supported by other members, and the inside and the outside of the bumper 13 (more specifically, the inside of the bumper 13 , Can be inserted into and removed from the distal side of the bumper 13).
  • the gastrostomy catheter 11 disposed so as to wind the tip end portion 14b of the wire 14 in the bumper 13.
  • the manufacturer first causes the distal end portion 14 b of the wire 14 passing through the sub-lumen 19 to be temporarily pulled out of the communication hole 13 a to the outside of the bumper 13.
  • the proximal end side of the distal end portion 14b of the wire 14 coming out of the bumper 13 is housed in the bumper 13 so as to gradually roll the coil in the bumper 13, and the wire 14 is disposed in the bumper 13 to the distal end. Set up. In this way, it is possible to easily manufacture the gastrostomy catheter 11 having the wire 14 housed so as to wind the tip end side.
  • the wire 14 described above is disposed on the proximal side in the direction of being pulled out from the bumper 13 from the first state to be in the second state, thereby weakening the biasing force to the bumper 13 or deforming the bumper 13 in the radial direction. Can be tolerated.
  • the wire 14 in the second state in this manner, the resistance applied to the body when the gastrostomy catheter 11 is removed can be suppressed to a low level.
  • the gastrostomy catheter 11 is inserted in a state where the bumper 13 is folded by the capsule cover 110.
  • the gastrostomy catheter 11 when inserting the gastrostomy catheter 11 without using the capsule cover 110, after the wire 14 is pulled out from the bumper 13 and the bumper 13 is put into the second state, the gastrostomy catheter 11 is inserted. It is also good. Also in this case, the resistance applied to the body can be suppressed low.
  • the tip end side of the coiled wire 14 is not limited to the one formed with a curvature which always makes the inner surface of the bumper 13 non-biased. That is, the tip end side of the coiled wire 14 has a radius of curvature larger than the outer diameter of the shaft 12, and the bumper 13 can be locked to the edge of the fistula 153 in the stomach 152. It may be disposed apart from the inner surface of the bumper 13 as long as deformation can be suppressed.
  • the present invention is not limited to such a configuration.
  • only a portion of the wire 14 may be pulled out of the bumper 13 to reduce the amount of the portion of the wire 14 in the bumper 13.
  • the biasing force of the bumper 13 outward in the radial direction is weakened or the force for limiting the deformation in the diameter decreasing direction is weakened.
  • the resistance at the time of inserting and removing can be suppressed. According to these configurations, the load of the wire 14 acting on the bumper 13 can be easily adjusted, which is preferable.
  • the present invention is not limited to such a configuration, and is not limited to the configuration in which the wire 14 is drawn to the proximal side of the gastrostomy catheter 11 as long as the load of the wire 14 on the bumper 13 can be adjusted.
  • the rod that hooks the wire 14 may be inserted from the main lumen 18 and the radially outward load on the bumper 13 may be reduced by winding the wire 14 in the bumper 13 to reduce its diameter.
  • At least the tip portion 14b of the wire 14 is covered with a coating portion 14c whose hardness is lower than that of the wire 14, or is formed into a blunt (substantially spherical) shape by electric discharge machining. At least the tip portion 14b of the wire 14 is covered with the coating portion 14c, or is blunted (substantially spherical) by electric discharge machining.
  • the first portion 14x disposed in the sublumen 19 of the wire 14 and the second portion 14y disposed in the bumper 13 are shown in FIG. As shown in 2, it is bent at a bending point 14j and continuously formed. In other words, the wire 14 is bent outward at the bending point 14 j in the bumper 13 in the radial direction of the bumper 13.
  • the bumper 13 can be smoothly urged in the diameter expansion direction or the deformation in the diameter reduction direction of the bumper 13 can be uniformly restricted at the end where the sub-lumen 19 is inserted. Become. For this reason, it is possible to preferably maintain the biased state in the radial direction with respect to the bumper 13 and the state in which the deformation in the radial direction of the bumper 13 is limited. Unexpected withdrawal from 153 can be prevented.
  • bending so as to extend in a direction along the inner peripheral surface of the bumper 13 means bending so that the incident angle 1 ⁇ 2 is larger than the incident angle 1 ⁇ 1.
  • the wire 14 is bent in a direction along the inner peripheral surface of the bumper 13 so that the wire 14 can be made to follow the inner peripheral surface of the bumper 13, and the bumper 14 is provided at each position in the circumferential direction of the bumper 13. It becomes easy to apply uniformly the load which biases 13 in the diameter-expanding direction, or the load which limits a deformation
  • FIG. 6 is a schematic explanatory view showing a state in which the gastrostomy catheter 11 is inserted into the stomach 152 through the fistula 153.
  • FIG. 7 is a diagram showing the capsule cover 110 from the gastrostomy catheter 11 by the insertion jig 111. It is a typical explanatory view showing the state where the bumper 13 was expanded by removing.
  • the gastrostomy catheter 11 includes a cover (capsule cover 110) that holds and accommodates the bumper 13 in a folded state in which the distal end side of the wire 14 is disposed in the bumper 13.
  • the capsule cover 110 can be attached directly or indirectly to the shaft 12, and the bumper 13 may be accommodated while maintaining the folded state of the bumper 13. That is, the term "to contain” includes those that entirely accommodate the bumper 13 and those that accommodate at least a part of the bumper 13.
  • the capsule cover 110 suppresses the resistance applied to the wall surface of the fistula hole 153 while maintaining the bumper 13 in a folded state when the bumper 13 is disposed in the stomach 152 via the fistula hole 153, and enters the body of the bumper 13. To facilitate the insertion of
  • the capsule cover 110 is a hard capsule cover used for food made of cellulose-based or gelatin-based material, or a material which is decomposed in the body such as polylactic acid, and has a bottom on one side and the other end is an open end. It is formed in the shape of a blunt head cap.
  • the shape of the capsule cover 110 is not particularly limited, and may be hemispherical or the like.
  • An insertion jig 111 is used for attaching the gastrostomy catheter 11 to the fistula 153 and removing the capsule cover 110.
  • the insertion jig 111 is connected to the main body cylinder 111a, the pair of claws 111b attached to the main body cylinder 111a, the operation portion 111c, the piston 111d capable of reciprocating with respect to the main body cylinder 111a, and the piston 111d And pushing rod 111e.
  • the operator When inserting the gastrostomy catheter 11 into the fistula 153, the operator folds the bumper 13 and covers the bumper 13 in the folded state with the capsule cover 110, thereby keeping the bumper 13 in a folded state. Further, the operator holds the insertion jig 111 and holds the shaft 12 with the pair of claws 111b to support the lower surface (distal side surface) of the extracorporeal fixture 15 of the gastrostomy catheter 11, as shown in FIG. Hold as shown.
  • the operator inserts the bumper 13 covered by the capsule cover 110 into the fistula hole 153 together with the capsule cover 110, and inserts the bumper 13 to a position where the bumper 13 reaches the stomach 152 (a position where the nail 111b abuts the surface of the abdominal wall 150)
  • the gastrostomy catheter 11 is pushed in by the jig 111.
  • the operator operates the operation portion 111 c so as to push the operation portion 111 c to the distal side, pushes the piston 111 d into the main body cylinder 111 a, and causes the push rod 111 e to protrude.
  • the push rod 111 e pushes out only the capsule cover 110 through the communication hole 13 a of the bumper 13, and as shown in FIG. 7, the capsule cover 110 drops out of the bumper 13.
  • the bumper 13 released from the holding from the capsule cover 110 is expanded in diameter larger than the hole diameter of the fistula 153 by the biasing force of the wire 14, and is placed in the stomach 152. Since the capsule cover 110 dropped into the stomach 152 is a material which is edible or degraded in the body as described above, it is excreted or dissolved together with the stomach contents and there is no impact on the body.
  • FIG. 8 is a schematic explanatory view showing the state of the gastrostomy catheter 11 in a state in which the proximal end holding portion 15 c is removed from the extracorporeal fixture 15.
  • FIG. 9 is a schematic explanatory view showing a state in which the gastrostomy catheter 11 is removed from the stomach 152.
  • the operator first removes the proximal end holding portion 15c of the extracorporeal fixture 15 from the other part of the extracorporeal fixture 15 with scissors or the like so that a cut is made along the marker 15b. At this time, the operator separates the proximal end holding portion 15 c from the other part of the extracorporeal fixture 15 so as not to cut the wire 14. Since the marker 15b is attached to the position included in the virtual plane intersecting the proximal end 19a of the sub-lumen 19 as described above, by separating the proximal end holding portion 15c along the marker 15b, The embedded portion of the proximal end portion 14 a of the wire 14 in the extracorporeal fixture 15 is eliminated.
  • the operator grasps the proximal end 14 a and withdraws the wire 14 from the bumper 13, the shaft 12 and the extracorporeal fixture 15. Finally, the operator grasps the extracorporeal fixture 15 and pulls the gastrostomy catheter 11 out of the fistula 153. At this time, as shown in FIG. 9, the bumper 13 is in the second state due to the wire 14 being pulled out, and when the wall surface of the fistula hole 153 is touched, the bumper 13 is contracted to the body. Resistance will be suppressed low.
  • FIG. 10 is a front cross-sectional view showing an extracorporeal fixture 115 according to a first modification.
  • the proximal end holding portion 115a for holding the proximal end portion 14a of the wire 14 is separate from the fixing portion (extracorporeal fixture 115), and is detachably attached to the fixing portion (extracorporeal fixture 115).
  • the proximal end holding portion 115a is disposed on the extension of the proximal end 19a of the sub-lumen 19, and has a neck with a small diameter and a head with a large diameter and is located downward (distally) It has a locking projection 115b that protrudes at the bottom.
  • a concave groove 115c is formed in a portion of the extracorporeal fixture 115 opposite to the locking protrusion 115b in a shape relative to the locking protrusion 115b.
  • the locking projection 115b is accommodated in the recessed groove 115c and locked by being expanded so as to elastically deform the opening forming the recessed groove 115c.
  • the proximal end holding portion 115a by attaching the proximal end holding portion 115a to the extracorporeal fixture 115, the state in which the distal end portion of the wire 14 is disposed in the bumper 13 can be maintained. Further, by releasing the locking of the locking protrusion 115b to the recessed groove 115c and removing the proximal end holding portion 115a from the extracorporeal fixture 115, the wire 14 together with the proximal end holding portion 115a is the shaft 12, bumper 13 and The extracorporeal fixture 115 can be removed.
  • the locking protrusion 115b may be made of resin rubber harder than the recessed groove 115c. According to such a configuration, the locking projection 115b can be easily fitted into the relatively soft concave groove 115c.
  • the configuration may be such that a recessed groove is provided on the proximal end holding portion 115 a side, and a locking protrusion is provided on the extracorporeal fixation member 115 side.
  • a clip (not shown) may be further provided which holds the proximal end holding portion 115a and the extracorporeal fixture 115. .
  • FIG. 11 is a bottom view showing the communication hole 113a of the bumper 113 according to the 1-2nd modified example.
  • a part of the inner wall of the bumper 113 according to the first to second modifications is located on the extension of the sub-lumen 19.
  • the communication hole 113a in the present example is formed in a D-shaped cross section so as not to expose the sub-lumen 19 while exposing the main lumen 18 and exposing it in a bottom view. According to such a configuration, when the wire 14 is inserted into the sub-lumen 19 and the distal end portion 14 b is disposed in the bumper 113, the distal end portion 14 b abuts a part of the inner wall of the bumper 113. Therefore, the tip end side of the wire 14 is naturally disposed in the radial direction of the bumper 113.
  • the bumper 113 can be inserted into the stomach hole 152 through the fistula 153 while suppressing resistance applied to the body. Thereafter, the distal end side of the wire 14 in which the proximal end portion 14a is embedded in the proximal end holding portion 115a shown in FIG. 10 is fed so as to wind a coil in the bumper 113 via the sublumen 19 to expand the bumper 113. It is possible to facilitate the state in which the radial direction can be biased or the state in which the radial deformation of the bumper 113 can be limited. Therefore, instead of expanding the diameter of the bumper 13 by removing the capsule cover 110 with the insertion jig 111, the bumper 113 can be put in the first state by a simple method of inserting the wire 14 into the sub-lumen 19 .
  • the cross-sectional circular shape or It may be rectangular and is not limited to such a shape.
  • the shape of the communication hole 113a may also be circular or rectangular in cross section as long as a part of the inner wall of the bumper 113 can be positioned on the extension of the sub-lumen 19, and it is not limited to such a shape .
  • FIG. 12 is a front cross-sectional view showing a tip end opening portion 129b of the sub-lumen 129 according to the first to third modifications.
  • the tip end portion (tip end opening portion 129 b) of the sub-lumen 129 passing through the shaft 122 according to the first to third modifications is formed by being bent outward in the radial direction of the bumper 13. Specifically, the tip end opening portion 129 b extends into the bumper 13, and the wall portion defining the tip end opening portion 129 b is bent and extended radially outward of the bumper 13 in the bumper 13. . According to such a configuration, when inserting the wire 14 into the sub-lumen 129 and disposing the tip portion 14 b in the bumper 13, the tip portion 14 b is the tip of the sub-lumen 129 outward in the radial direction of the bumper 13. It is guided by the opening part 129b.
  • the tip end side of the wire 14 is naturally disposed radially outward of the bumper 13.
  • the distal end side of the wire 14 is in the second state in which the distal end side of the wire 14 is not disposed in the bumper 13, and the bumper 13 is inserted into the stomach hole 153 while suppressing resistance applied to the body. Can be placed on Thereafter, the distal end side of the wire 14 in which the proximal end portion 14a is embedded in the proximal end holding portion 115a shown in FIG.
  • the bumper 13 can be easily biased into a state in which the bumper 13 can be biased in the radial direction, or in a state in which deformation in the radial direction can be suppressed. Therefore, instead of expanding the diameter of the bumper 13 by removing the capsule cover 110 with the insertion jig 111, the bumper 13 can be brought into the first state by the simple method of inserting the wire 14 into the sub-lumen 19 .
  • FIGS. 13 to 15 are perspective views showing a bumper 133 according to a first to fourth modification and a shaft 132 to which the bumper 133 is attached.
  • FIG. 14 is a view showing an inner layer 134 of the bumper 133 with the outer layer 135 of the bumper 133 removed. Is a perspective view corresponding to FIG.
  • FIG. 15 is a cross-sectional view showing the 1 ⁇ V-1 ⁇ V cross section of the bumper 133 and the shaft 132 of FIG.
  • the bumper 133 is formed in a star shape as viewed from the axial direction of the bumper 133 and is connected to the tip of the shaft 132.
  • the shaft 132 has a shaft body 132a and a tip (a first tip 132b and a second tip 132c shown in FIG. 15) formed to have a smaller diameter than the other portion (shaft body 132a).
  • a bumper 133 which will be described in detail later, extends from the tip of the shaft 132.
  • the first tip end portion 132b is formed continuously from the shaft main body 132a to the tip end side, and has a smaller diameter than the shaft main body 132a.
  • the second distal end portion 132c is formed continuously from the first distal end portion 132b to the distal end side, and has a smaller diameter than the first distal end portion 132b.
  • a connection cylindrical portion 134 a of an inner layer 134 of the bumper 133 described later is connected to a tip portion (second tip portion 132 c) of the shaft 132, and the inner layer 134 extends.
  • a connection cylindrical portion 135a of an outer layer 135 of the bumper 133 described later is connected to a tip portion (first tip portion 132b) of the shaft 132, and the outer layer 135 extends.
  • the bumper 133 connected to the first end 132b of the shaft 132 is expanded compared to the case where the end (first end 132b) of the shaft 132 is formed to have the same diameter as the shaft body 132a.
  • the maximum amount of radial deformation can be increased. That is, as described later, the inclination of the bumper 133 (the inclined portion 135c thereof) after deformation with respect to the axial direction can be increased by the wire 14 (see FIG. 15) partially provided in the bumper 133. Therefore, the contact area between the bumper 133 after deformation and the inner surface of the stomach wall 151 (see FIG. 5) can be increased, and the bumper 133 can be easily placed in the stomach 152.
  • the bumper 133 includes an inner layer 134 and an outer layer 135, and there is a space 133s between the inner layer 134 and the outer layer 135, and one space on the tip side of the linear member (wire 14) in the space 133s. Department is arranged.
  • the shaft 132 is provided with a single sub-lumen 132d, through which a wire 14 described later is passed, extending in parallel in the axial direction.
  • the sub-lumen 132 d is in communication with the space 133 s between the inner layer 134 and the outer layer 135 of the bumper 133 attached to the tip of the shaft 132 through the tip surface of the first tip 132 b.
  • a space 133 s that accommodates part of the wire 14 can be formed between the inner layer 134 and the outer layer 135.
  • the space 133s is formed and the rigidity is lowered, when the wire 14 is pulled out from the bumper 133, the bumper 133 can be smoothly deformed into a folded state.
  • a plurality of recessed portions 135f which are depressed in the radial direction of the bumper 133 and extends along the axial direction of the bumper 133 are formed in the circumferential direction of the bumper 133.
  • the concave portion 135f is formed on the surface of (the outer layer 135 of) the bumper 133, so that the bumper 133 can be smoothly deformed into the folded state.
  • a load applied from the wall of the hole 153 (see FIG. 5) is locally applied to a portion of the bumper 133 other than the recess 135f, and a folding starting point is generated in the recess 135f.
  • the bumper 133 can be smoothly deformed into the folded state by the recess 135 f being a space for folding.
  • the outer layer 135 of the bumper 133 is provided on the distal end side of the connection cylindrical portion 135a connected to the shaft 132 from the base end side to the distal end side, the large diameter portion 135b having the largest diameter portion 135e, And a small diameter portion 135g.
  • the inner layer 134 of the bumper 133 extends from the proximal end side to the distal end side in a radial direction from the distal end of the connecting cylindrical portion 134a connected to the shaft 132 and the distal end of the distal end portion 134d. And a tip portion 134d provided on the tip side of the slope portion 134b.
  • the connecting cylindrical portion 135a is connected to the first end portion 132b of the shaft 132, and the inner diameter of the connecting cylindrical portion 135a is formed to be substantially equal to the outer diameter of the first front end portion 132b.
  • the large diameter portion 135b is provided with an inclined portion 135c which is inclined so as to expand in diameter toward the tip in a direction parallel to the axial direction of the shaft 132 including the largest diameter portion 135e, the maximum diameter portion 135e, and And an inclined portion 135d inclined so as to decrease in diameter toward the end.
  • the tip portion 14b of the wire 14 is accommodated in a plane space perpendicular to the axial direction of the bumper 133 including the largest diameter portion 135e.
  • the inclined portion 135c and the inclined portion 135d are formed on both sides of the largest diameter portion 135e, so that the distal end portion 14b of the wire 14 inserted in the space 133s is elastically restored in the radial direction. In doing so, it is suitably guided in the above-mentioned plane space containing the largest diameter portion 135e.
  • the largest diameter portion 135 e of the outer layer 135 of the bumper 133 is formed at a position spaced apart from the tip of the shaft 132 toward the tip. As described above, the largest diameter portion 135e is formed at a position spaced apart from the tip end of the shaft 132 toward the tip end side, whereby the bumper 133 covers and overlaps the shaft 132 when the maximum diameter portion 135e is contracted.
  • the folding shape of the bumper 133 can be made compact by restraining.
  • a plurality of recesses 135f are formed in the large diameter portion 135b of the outer layer 135, and a plurality of recesses 135h are formed in the small diameter portion 135g in the circumferential direction.
  • Recesses 135 f and 135 h in the large diameter portion 135 b and the small diameter portion 135 g are formed at corresponding positions in the circumferential direction of the bumper 133.
  • a plurality of concave portions 135f and 135h formed in the large diameter portion 135b and the small diameter portion 135g are formed at corresponding positions in the circumferential direction, so that the portion serving as the starting point of folding of the large diameter portion 135b and the small diameter portion 135g is large.
  • the “corresponding position in the circumferential direction” specifically means that the bumper 133 is at the same angle with the axis of the bumper 133 as a center when viewed from the axial direction.
  • a plurality of recesses 134c are formed in the inclined portion 134b of the inner layer 134, and a plurality of recesses 134e are formed in the tip portion 134d in the circumferential direction.
  • Recesses 134 c and 134 e in each of the inclined portion 134 b and the tip end portion 134 d are formed at corresponding positions in the circumferential direction of the bumper 133.
  • a plurality of concave portions 134c and 134e formed in the inclined portion 134b and the distal end portion 134d are formed at corresponding positions in the circumferential direction, so that a portion serving as a starting point of folding of the inclined portion 134b and the distal end portion 134d is the inclined portion 134b. And the tip portion 134d. For this reason, the inner layer 134 of the bumper 133 can be smoothly deformed in the folded state.
  • the recess 135 f of the outer layer 135 and the recess 134 c of the inner layer 134, and the recess 135 h of the outer layer 135 and the recess 134 e of the inner layer 134 are provided at overlapping positions in the radial direction of the bumper 133.
  • a straight line extending in the radial direction of the bumper 133 by connecting the concaved portions of the concave portion 135f and the concave portion 134c, and the concave portion 135h and the concave portion 134e is in a positional relationship intersecting the axis of the bumper 133. According to such a configuration, interference between the inner layer 134 and the outer layer 135 can be suppressed, and the bumper 133 can be smoothly deformed into a folded state.
  • the inner layer 134 and the outer layer 135 are separated, and in the small diameter portion 135g, the inner layer 134 (strictly, the tip portion 134d) is in contact with the outer layer 135.
  • the rigidity is reduced and the structure is easily shrunk because the inner layer 134 and the outer layer 135 are separated in the large diameter portion 135 b.
  • the rigidity can be enhanced and the configuration can be excellent in the shape retention.
  • FIG. 16 is a perspective view showing an extracorporeal fixture 145 including a proximal end holding portion 148 and a support portion 146 for supporting the proximal end holding portion 148 according to the first to fifth modifications.
  • FIG. 17A is a plan view showing the extracorporeal fixture 145 in the initial state
  • FIG. 17B is a plan view showing a state in which the limiting piece 147 is removed from the extracorporeal fixture 145
  • FIG. 17C shows the support 146 on both sides.
  • the proximal end holding portion 148 is pushed out of the extracorporeal fixture 145.
  • FIG. In FIGS. 16 and 17, the illustration of the cap 16 and the strap 17 shown in FIG. 1 is omitted.
  • the fixing portion (extracorporeal fixing tool 145) limits the movement of the proximal end holding portion 148 and the detachment from the supporting portion 146, which supports the proximal end holding portion 148 movably. And a restriction unit (restriction unit 147).
  • the proximal end holding portion 148 according to the present embodiment is a plate piece having a trapezoidal thickness in a plan view, and the proximal end portion of the wire 14 is embedded inside.
  • the proximal end holding portion 148 has a reverse tapered portion 148 a formed so as to spread outward of the fixing portion (extracorporeal fixture 145).
  • the support portion 146 has a bottom wall 146 c supporting the proximal end holding portion 148 from below and a connecting wall 146 b provided on both sides of the bottom wall 146 c and standing.
  • the bottom wall 146 c and the connection wall 146 b protrude outward in the extension direction of the extracorporeal fixture 145 more than other portions of the support portion 146.
  • a planar-view trapezoidal opening 146 d for exposing at least a part of the proximal end holding portion 148 is formed on the proximal side of the support portion 146.
  • the operator touches the proximal end holding portion 148 with a finger to grasp the proximal end holding portion 148 as an extracorporeal fixing tool, in addition to pinching the support portion 146 from both sides as described later. It is also possible to separate it from 145.
  • the limiting piece 147 is connected to the connection wall 146b and the bottom wall 146c of the support portion 146, and is in the direction in which the proximal end holding portion 148 separates from the support portion 146, and its thickness direction with respect to the proximal end holding portion 148.
  • Provided in a size and position overlapping the The proximal end holding portion 148 is configured to be separable from the support portion 146 by the restriction piece 147 being separated from the support portion 146 as shown in FIG. 17B.
  • the extracorporeal fixture 145 includes the support 146 and the limiting piece 147, the limitation piece 147 can be supported as compared to the case where the entire proximal end holding part 148 is connected to the extracorporeal fixture 145. It is possible to easily separate the proximal end holding portion 148 from the support portion 146 only by separating it from the 146.
  • the support portion 146 is not provided on the path obtained by projecting the proximal end holding portion 148 onto the limiting piece 147, as shown in FIGS. 17A and 17B. A through hole 146e shown is formed. With such a configuration, the movement of the proximal end holding portion 148 in the direction toward the limiting piece 147 is not limited by the support portion 146, and the movement is limited only by the limiting piece 147.
  • the support portion 146 has an opposing portion 146 a extending along the reverse tapered portion 148 a of the proximal end holding portion 148 in a state of being attached to the extracorporeal fixture 145.
  • the opposing portion 146a abuts against the reverse taper portion 148a, and the proximal end holding portion 148 is the outer side of the fixing portion (extracorporeal fixture 145) It is configured to be deformable so that it can be pushed into the
  • the operator pinches the support portion 146 from both sides in the direction (in the direction of the thick arrow) sandwiching the proximal end holding portion 148, and the opposing portion 146a of the support portion 146 is Transform it. Then, a force component (in the direction of the thin arrow) of the load applied from the facing portion 146a to the reverse tapered portion 148a toward the outer side in the extension direction of the extracorporeal fixation device 145 is generated. It will be easily removed to the outside of the tool 145.
  • the “outside of the extracorporeal fixture 145” is not limited to the direction in which the extracorporeal fixture 145 extends away from the shaft 12 (see FIG.
  • the shape of the proximal end holding portion 148 is not limited to a trapezoidal shape including the reverse taper portion 148a in a plan view, and for example, is formed in a pair of arcs instead of the linear reverse taper portion 148a. It may be That is, the shape of the proximal end holding portion 148 may be a shape that is enlarged as it goes outward (in the removal direction of the proximal end holding portion 148) of the extracorporeal fixture 145.
  • FIG. 18 is a perspective view showing the insertion jig set 2S according to the embodiment of the present invention, showing a state in which the cap 25 restrains the bumper 24a to be in the folded state
  • FIG. 19 is a partial cross-sectional view showing a part of a tool set 2S, and is a view showing a 2II-2II cross section of FIG. 18;
  • FIG. 20 is a partial cross-sectional perspective view showing a cross section of the distal end of the mantle 22 and is a view showing a 2III-2III cross section of FIG. 18;
  • FIG. 21 is a perspective view showing the insertion jig set 2S, showing the cap 25 releasing and expanding the bumper 24a.
  • FIG. 22 is a partial cross-sectional view showing a part of the insertion jig set 2S, and is a view showing a 2V-2V cross section of FIG.
  • distal side refers to the side of the insertion jig set 2S and the obturator 21 far from the operator of the insertion jig set 2S and the obturator 21 unless specifically stated otherwise, specifically It refers to the side attached or covered by the cap 25.
  • distal side may be referred to as the distal side.
  • proximal side means the side closer to the operator of the insertion jig set 2S and the obturator 21 unless otherwise noted.
  • proximal side may be referred to as the proximal side.
  • movement of the components of the insertion jig set 2S in the distal direction may be referred to as advancing, and conversely, movement in the proximal direction may be referred to as retraction.
  • An insertion jig set 2S is an insertion jig set 2S for inserting a gastrostomy catheter 24 having a foldable intragastric fixation portion (bumper 24a) at its tip into the body (inside the stomach). is there.
  • the insertion jig set 2S includes an insertion jig (obturator 21) configured to include a cylindrical outer collar 22 and an inserter 23 that can be advanced and retracted inside the outer collar 22; A gastrostomy catheter 24 attached around the circumference 22 and a cap 25 disposed on the distal end side of the mantle 22 and covering at least a part of the intragastric fixation part (bumper 24a) in a folded state.
  • One of the gastrostomy catheter 24 or the mantle 22 and the cap 25 has a locking portion (locking claw 22b) for locking to the other, and the insertion portion 23 is passed through the mantle 22 It is characterized in that when it advances, the locking by the locking claw 22b is released.
  • the gastrostomy catheter 24 or the mantle 22 and the cap 25 are engaged, and the insertion is configured to be capable of releasing the anchor by the intercalated portion 23. It is possible to prevent the cap 25 from being accidentally detached from the mantle 22.
  • “locking” refers to a state in which movement is temporarily held and fixed to limit movement, and in addition to the state of structural locking described below, physical properties may be obtained by using an adhesive or the like. It adheres to and includes the removable state.
  • the insertion portion 23 advanced to the member provided with the locking portion is directly connected
  • the locking force of the locking portion is weakened to release the locking by deforming the member by abutting on or indirectly.
  • the advanced insertion portion 23 directly or indirectly presses against the member provided with the locking portion or the locking target member and presses the member provided with the locking portion or the locking.
  • An insertion jig (obturator 21) includes a gastrostomy catheter 24 having a foldable intragastric fixation part (bumper 24a) at its tip, and at least a part of the intragastric fixation part in a folded state. And a cap 25 covering the inside of the body.
  • the insertion jig (obturator 21) is configured to include a tubular mantle 22 around which the gastrostomy catheter 24 can be attached, and an insertion section 23 which is inserted into the mantle 22. .
  • the outer collar 22 has a locking portion (locking claw 22 b) that locks to the cap 25.
  • the insertion portion 23 releases the locking by the locking claw 22 b when the insertion portion 23 is advanced into the outer collar portion 22. According to the above-described configuration, the outer collar portion 22 and the cap 25 are engaged, and the insertion portion 23 is configured to be able to release the engagement so that the cap 25 is unexpectedly detached from the outer collar portion 22. Can be prevented.
  • a gastrostomy catheter 24 having a foldable intragastric fixation portion (bumper 24a) at its tip and a cap covering at least a part of the bumper 24a in a folded state. And 25 are configured.
  • the gastrostomy catheter 24 is formed so as to be able to insert a part of an insertion jig (obturator 21) for insertion into the stomach, and the cap 25 is engaged with the engagement claw 22b of the obturator 21. It has a stop (locking block 25c).
  • the cap 25 having the locked portion locked to the obturator 21 can prevent the cap 25 from being unintentionally detached from the gastrostomy catheter 24.
  • the configurations of the insertion jig set 2S and the insertion jig (obturator 21) will be described with reference to FIGS.
  • the insertion jig set 2S is disposed on the distal end side of the gastrostomy catheter 24 for inserting the gastrostomy catheter 24 into the body, the gastrostomy catheter 24 attached around the mantle 22 and And a cap 25 covering at least a part of the intragastric fixed part in the folded state.
  • the obturator 21 is configured to include the mantle 22 and the interpolator 23.
  • a holding portion 22 d for holding the extracorporeal fixation portion 24 b on the proximal side of the gastrostomy catheter 24 is provided at the central portion of the mantle 22.
  • the holding portion 22 d has a bifurcated portion extending in a direction intersecting the axial direction of the obturator 21 and holds the extracorporeal fixation portion 24 b of the gastrostomy catheter 24 at the bifurcated portion.
  • Attached to the outer periphery of the distal end of the mantle 22 is a gastrostomy catheter 24 passed from the distal end of the mantle 22.
  • the proximal end of the obturator 21 is provided with a control unit 23 b continuous with the insertion unit 23, and the operator reciprocates the control unit 23 b in the axial direction with respect to the mantle 22 to obtain an insertion unit. It is possible to make 23 reciprocate.
  • slits 22 c are formed at the tip of the outer collar 22, and the slits 22 c extend in the axial direction of the outer ridge 22 up to the tip of the outer ridge 22.
  • the front end of the outer collar 22 is divided into four pieces by four slits 22c.
  • the term "axially extending" means extending including an axial component, and includes not only a direction parallel to the axial direction but also one extending obliquely with respect to the axial direction.
  • the slit 22 c is formed at the tip of the outer collar 22, so that the tip of the outer ridge 22 can be easily expanded. Therefore, when the operator advances the insertion portion 23 and releases the locking by the locking claw 22b as described later, the cap 25 can be smoothly detached from the mantle 22.
  • the distal end of the mantle 22 can be divided into four pieces, and the two opposing pieces can be bent and deformed in a balanced manner. Therefore, the locking and releasing of the cap 25 with respect to the locked block 25c by the locking claws 22b described later can be stably performed, which is preferable.
  • the present invention is not limited to such a configuration, and the number of slits 22c is arbitrary as long as it is possible to expand the diameter of the distal end of the mantle 22 and release the lock of the cap 25. is there.
  • the slit 22c may not be provided.
  • the outer collar portion 22 is provided with a locking portion (locking claw 22 b) for locking a part of the cap 25.
  • the locking claws 22 b are provided on the inner wall surface of the outer collar portion 22 and configured to be able to be locked to a constricted portion of a locked block 25 c of a cap 25 described later. More specifically, of the four pieces divided at the front end of the outer collar portion 22, two opposing pieces are provided.
  • the locking claws 22 b are not limited to those provided on the two opposing pieces divided at the tip of the outer collar 22, the number of the locking claws 22 b is arbitrary, and the division at the tip of the outer collar 22 is It may be provided on all of the four pieces.
  • each of the locking claws 22 b arranged at four positions at every 90 degrees in the circumferential direction of the outer collar portion 22 is a locked block 25 c of the cap 25. It will be locked in the neck part. For this reason, it becomes possible to maintain the locking state with respect to the cap 25 more suitably.
  • the locking claws may be formed on any plurality of pieces. 22b may be provided.
  • the cross section of the locking claw 22b according to the present embodiment in the radial direction with respect to the axial center of the outer collar portion 22 is formed in a trapezoidal shape whose upper side is the axial center side.
  • the acute angle between the distal side and the other nearby inner wall is smaller than the acute angle between the proximal side and the other nearby inner wall It is formed as. That is, the surface formed including the distal side of the trapezoid is an inclined surface that is more inclined than the surface formed including the proximal side of the trapezoid.
  • the proximal side is formed at right angles to the other nearby inner wall surface.
  • the surface on the proximal side of the locking claw 22 b is a surface orthogonal to the axial direction of the mantle 22.
  • the distal surface of the locked block 25 c provided on the cap 25, which is the target of locking of the locking claw 22 b, is also inserted into the distal end of the outer collar 22. It is formed in the direction orthogonal to the axial direction.
  • the diameter is naturally expanded by the abutment of the proximal end face 25a with the inclined surface.
  • a force is applied in the direction, and the distal end of the mantle 22 can be easily expanded.
  • the proximal surface of the locking claw 22b and the distal surface of the locked block 25c are surfaces orthogonal to the axial direction of the mantle 22. Therefore, when the locked block 25c of the cap 25 is inserted to the proximal side beyond the locking claw 22b, even if the cap 25 moves in the axial direction of the mantle 22, the distance of the mantle 22 is increased. A force is less likely to be applied in the direction of expanding the lateral end, and the locking by the locking claw 22 b is less likely to be released.
  • protruding portions 22a protruding inward in the radial direction are formed.
  • the outer circumferential surface of the insertion portion 23 is By abutting on the protrusion 22 a, it has a function of expanding (bending and deforming radially outward) the distal side of the two pieces of the mantle 22.
  • the projecting portion 22a is formed in a circular arc shape in cross section, extends in the circumferential direction, and is disposed on the proximal side of the locking portion (locking claw 22b).
  • the engagement between the cap 25 and the outer collar portion 22 can be suitably released by causing the insertion portion 23 to abut on the projecting portion 22 a and expand the outer collar portion 22.
  • the protruding portions 22 a are formed in a circular arc shape in cross section, so that the distal side of the two pieces of the outer collar 22 is not in the outer direction, without obstructing the axial movement of the outer collar 22 with respect to the insertion portion 23. Can be deformed smoothly to the outside of the
  • the shape of the protrusion according to the present invention is not limited to the one formed in a circular arc shape in cross section, and the surface on the proximal side that abuts the outer surface of the insertion portion 23 inclines gently with respect to the axial direction. As long as it is an inclined surface, it may be triangular in cross section or trapezoidal in cross section.
  • the gastrostomy catheter 24 communicates the outside with the inside of the stomach through the fistula, is attached to the outer periphery of the mantle 22 and is held by the holding portion 22d of the obturator 21 so as to hold and fix the extracorporeal fixation portion 24b. It is done.
  • the gastrostomy catheter 24 includes a radially expandable and contractible bumper 24a which is placed in the stomach, an extracorporeal fixation portion 24b disposed outside the body surface, and a shaft 24c which communicates these. It is done.
  • the bumper 24a is formed in an umbrella shape, extends in a radial direction perpendicular to the axial direction in a natural state, and is housed in a space 25s of a cap 25 described later in a state of being folded and elastically deformed. It is configured to be possible.
  • the bumper 24a is not limited to the umbrella shape as long as the bumper 24a can be expanded and contracted in the radial direction, and may be formed of only a plurality of bendable rod-like members.
  • the cap 25 suppresses the resistance applied to the wall surface of the fistula while holding the folded state of the bumper 24a when the bumper 24a is disposed in the stomach via the fistula (not shown), thereby the bumper 24a being introduced into the body. Make insertion easy.
  • the cap 25 is formed of a hard capsule cover used for food made of cellulose-based or gelatin-based material, or a material that is degraded in the body such as polylactic acid, and has a cap on the distal end side with a blunt head. It is formed.
  • the cap 25 includes a locked block 25c, an axial center 25b continuously extending from the locked block 25c in the radial center, and a distal end of the axial center 25b.
  • a circular deep moat-shaped space 25s capable of accommodating the folded bumper 24a is formed by the outer peripheral portion of the axial center portion 25b and the inner peripheral portion of the peripheral wall 25d.
  • At least a portion of the intragastric fixation portion (bumper 24a) is a locking portion (locking claw 22b) of the cap 25 in a state shown in FIG. ) Is accommodated in a part of the space 25s except for the portion (locked block 25c) to be locked to the. According to such a configuration, it is possible to accommodate at least a part of the bumper 24a in a state where the cap 25 is locked to the mantle 22.
  • the space 25s is formed in a size that can accommodate the bumper 24a.
  • the outer diameter of the axial center portion 25b is smaller than the inner diameter of the shaft 24c of the gastrostomy catheter 24, and the inner diameter of the proximal end face of the peripheral wall 25d is formed larger than the outer diameter of the shaft 24c.
  • a through hole 25 e is formed to extend in the axial direction from the axial center portion 25 b to the locked block 25 c. The through hole 25 e allows a guide wire (not shown) to pass therethrough.
  • the insertion operation of the gastrostomy catheter 24 into the body by the insertion jig set 2S will be described with reference to FIG. 18 to FIG.
  • the operator passes the gastrostomy catheter 24 oriented with the extracorporeal fixation part 24b on the proximal side to the distal end of the mantle 22 and places the holding part 22d on the extracorporeal fixation part 24b.
  • the catheter 24 is attached to the mantle 22.
  • the operator inserts the cap 25 into the mantle 22 while attaching the cap 25 to the gastrostomy catheter 24 so that the bumper 24a of the gastrostomy catheter 24 fits within the space 25s of the cap 25, and the locking claw 22b Lock it.
  • the locking position of the cap 25 by the locking claw 22 b is a position where the locked block 25 c exceeds the locking claw 22 b of the outer collar portion 22.
  • the operator passes the bumper 24a covered by the cap 25 through the stoma together with the cap 25, and the stomach of the obturator 21 until the position where the bumper 24a reaches the inside of the stomach (the position where the holding portion 22d abuts the surface of the abdominal wall) Push in the fistula catheter 24.
  • the operator operates the operation portion 23 b so as to push the insertion portion 23 to the distal side, and pushes the insertion portion 23 to the distal side of the mantle 22.
  • the insertion portion 23 abuts on the projection 22a when it is advanced into the mantle 22 by passing it, and a bending load is applied to the two pieces provided with the projection 22a at the distal end of the mantle 22.
  • the two pieces at the distal end of the mantle 22 are expanded.
  • the locking with respect to the locked block 25c by the locking claws 22b provided at the distal ends of the two sides of the mantle 22 is released, and the cap 25 can be dropped into the stomach by its own weight. Since the cap 25 which has fallen into the stomach is a material which is edible or degraded in the body as described above, there is no influence on the body by being excreted or dissolved together with the stomach contents. In this manner, the bumper 24a released from restraint by the cap 25 can be expanded in the radial direction to place the bumper 24a of the gastrostomy catheter 24 in the stomach.
  • the configuration has been described in which the outer collar portion 22 is expanded to release the locking of the locking claw 22 b and the cap 25 is detached from the outer collar portion 22 by its own weight. Furthermore, as shown in FIGS. 21 and 22, the insertion portion 23 abuts on the proximal end (proximal end face 25a) of the cap 25 to separate the cap 25 from the gastrostomy catheter 24 and the mantle 22. Preferably, it is configured to be able to be advanced to a position where it can be
  • the insertion portion 23 is in the vicinity of the cap 25.
  • the cap 25 can be reliably released by coming into contact with the end face 25a.
  • the extracorporeal fixation portion 24 b is held by the holding portion 22 d of the obturator 21. Since it does not move, it is possible to easily move the cap 25 relative to one another.
  • FIG. 23 is a cross-sectional view showing the locking structure between the outer collar portion 212 and the cap 25 according to the 2-1st modification, showing the bending end 212 a in the closed arm state
  • FIG. It is a sectional view showing a locking structure with cap 25, and is a figure showing bent end 212a in the open arm state.
  • a gastrostomy catheter set 2S2 includes a gastrostomy catheter 24 having a foldable intragastric fixation portion (bumper 24a) at its tip, and a cap 25 covering at least a part of the bumper 24a in a folded state. Is composed including.
  • the gastrostomy catheter 24 is formed so as to be able to insert a part (outer cap 212) of an insertion jig (obturator 21) for insertion into the stomach, and the cap 25 is engaged with the locking claw 212b of the obturator 21. It is characterized by having a locked portion (locked block 25c) to be stopped.
  • the cap 25 having the locked block 25 c locked to the locking claw 212 b of the obturator 21 can prevent the cap 25 from being unintentionally detached from the gastrostomy catheter 24.
  • the two opposing pieces of the distal end of the mantle 212 form a bent end 212a which is bent toward the axial center toward the distal end in the natural state.
  • the distal end of the bending end 212 a is formed to be located on the axial center side of the size between the outer surfaces of the insertion portion 23, and the distal end of the bending end 212 a extends in the axial direction from the distal end of the bending end 212 a.
  • a locking claw 212b is formed protrudingly for locking at the distal end of the locking block 25c.
  • the insertion portion 23 pushed to the distal side with respect to the mantle portion 212 abuts on the bending end portion 212 a which is a part of the inner wall surface of the mantle portion 212 and By expanding the bent end 212a of the portion 212, the locking by the locking portion (locking claw 212b) can be released.
  • the two opposing distal end portions of the mantle 212 do not protrude radially outward from the other portions of the mantle 212, and therefore the stomach
  • the inner wall of the hemorrhoid catheter 24 does not inhibit the deformation. Therefore, the locked state between the outer collar portion 212 and the cap 25 can be released more smoothly than the outer collar portion 22.
  • the bent ends 212 a are not limited to those provided on the two opposing pieces of the distal end of the mantle 212, and the number of the bent ends 212 a is arbitrary, and at the distal end of the mantle 212. It may be provided on all four divided pieces. If the bent end 212 a is provided in all the four pieces, each of the bent ends 212 a arranged at four places at every 90 degrees in the circumferential direction of the outer collar 212 is the locked block 25 c of the cap 25. It will be locked in the neck part. For this reason, it becomes possible to maintain the locking state with respect to the cap 25 more suitably.
  • the tip end portion of the outer collar portion 212 is further configured with a plurality of pieces, the bending is performed to any plurality of pieces.
  • An end 212a may be provided.
  • FIG. 25 is a cross-sectional view showing a locking structure of the gastrostomy catheter 24 and the cap 225 according to the second-2 modification.
  • a gastrostomy catheter set 2S3 includes a gastrostomy catheter 24 having a foldable intragastric fixation portion (bumper 24a) at its tip, and a cap 225 covering at least a part of the bumper 24a in a folded state. Is composed including.
  • the gastrostomy catheter 24 is formed so as to be able to insert a part (capsule 222) of an insertion jig (obturator 21) for insertion into the stomach.
  • the cap 225 according to the present modification has a locking portion (locking protrusion 225 b) that locks to the bumper 24 a of the gastrostomy catheter 24.
  • the locking projection 225b is made of an elastic material
  • the bumper 24a is accommodated in the space 225s of the cap 225 so as to be compressed and deformed radially outward from the outer peripheral surface of the bumper 24a.
  • the cap 225 is locked to the bumper 24a by the frictional force due to the elastic restoring force of the locking projection 225b.
  • the cap 225 being locked to the gastrostomy catheter 24 can prevent the cap 225 from being accidentally detached from the gastrostomy catheter 24.
  • the distal end surface 23a of the insertion portion 23 is brought into contact with the proximal end surface 225a of the cap 225 as in the embodiment described above, and the locking projection 225b is a bumper.
  • the insertion portion 23 may be pushed distally to a position where it is separated from 24a.
  • a locking portion (not shown) for locking on the inner surface of the peripheral wall 225d of the cap 225 is provided on the bumper 24a of the gastrostomy catheter 24 without providing the locking projection 225b. You may
  • FIG. 26 is a cross-sectional view showing the locking structure of the gastrostomy catheter 234 and the cap 235 according to the second to third modifications
  • FIG. 26 and FIG. FIG. 10 is a cross-sectional view showing a locking structure of the embodiment of the present invention, showing a locking released state.
  • a gastrostomy catheter set 2S4 includes a gastrostomy catheter 234 having a foldable intragastric fixation portion (bumper 234a) at its tip, and a cap 235 covering at least a part of the bumper 234a in a folded state. Is composed including.
  • the gastrostomy catheter 234 is formed so as to be able to insert a part (outer cap 222) of an insertion jig for insertion into the stomach, and the cap 235 is a locking portion (engaging part) It has a locking projection 235b).
  • the bumper 234a comprises a wire 234b wound so as to wind a coil inside.
  • the bumper 234 a is accommodated in the space 235 s of the cap 235 in a state where the wire 234 b is contracted toward the axial center side of the bumper 234 a than in the natural state.
  • the cap 235 locks to the gastrostomy catheter 234.
  • the insertion portion 23 is passed through the mantle 222 to a position where it can abut the proximal end (proximal end face 235a) of the cap 235 to release the cap 235 from the gastrostomy catheter 234 and the mantle 222. Is configured to be able to move forward. Specifically, the distal end of the cap 235 is inserted by the insertion portion 23 until the distal end surface 23a of the insertion portion 23 abuts on the proximal end surface 235a of the cap 235 and the locking projection 235b passes over the wire 234b. Pushed into. By pushing the cap 235 in this manner, the cap 235 can be detached from the gastrostomy catheter 234 as shown in FIG.
  • the operator can expand the diameter of the bumper 234a by urging when restoring the wire 234b in the diameter expansion direction.
  • the diameter larger than the hole diameter of the stoma (not shown) of the bumper 234a By enlarging the diameter larger than the hole diameter of the stoma (not shown) of the bumper 234a, the distal end of the gastrostomy catheter 234 is indwelled in the stomach.
  • the present invention is limited to such a configuration It may be configured to be locked to the shaft portion.
  • the insertion portion 23 is described as releasing the locking by the locking portion by directly contacting and pressing the member provided with the locking portion or the locking target member.
  • the above-described member may be indirectly pressed via the third member to release the lock.
  • the present embodiment includes the following technical ideas. (1) a shaft provided with a lumen, A flexible bumper provided at the tip of the shaft; A linear member having elasticity and capable of biasing the bumper in a radial direction or restricting deformation of the bumper in a radial direction; (2) The linear member is A first state, at least a part of which is disposed in the bumper to be capable of biasing the bumper radially outward or restricting the deformation of the bumper in the radial direction; It is disposed proximal to the bumper or pulled out more proximal than the bumper in the first state to lower the bumper radially outward than in the first state.
  • the stomach according to (1) wherein the stomach described in (1) is configured to be variable or not be biased or biased, or a second state that allows the bumper to be deformed in a diameter reduction direction than in the first state.
  • the proximal end of the shaft is provided with a fixing portion for holding the gastrostomy catheter at a predetermined position,
  • the proximal end holding portion holds the proximal end portion by the proximal end portion of the linear member being embedded in the proximal end holding portion, and the proximal end holding portion is provided so as to be cut away at the fixing portion
  • the lumen includes a main lumen for injecting a nutrient and a sub-lumen accommodating at least a part of the linear member, The gastrostomy catheter according to any one of (1) to (5), wherein the distal end open portion of the sub-lumen is connected in the bumper.
  • the gastrostomy catheter according to (6) wherein a part of the inner wall of the bumper is located on the extension of the sub-lumen.
  • a portion of the linear member disposed in the sub-lumen and a portion disposed in the bumper include: The gastrostomy catheter according to any one of (6) to (8), which is bent and continuously formed.
  • the gastrostomy catheter as described in. (13) The vehicle further comprises a cover for holding and accommodating the bumper in the folded state, The gastrostomy catheter according to any one of (1) to (12), wherein the cover holds and accommodates the bumper in a state where at least a part of the linear member is disposed in the bumper. (14) The gastrostomy catheter according to any one of (1) to (13), wherein the largest diameter portion of the bumper is formed at a position spaced farther to the tip side than the tip of the shaft. (15) The surface of the bumper is recessed in the radial direction of the bumper, and a recess extending along the axial direction of the bumper is formed in any one of (1) to (14). Gastrostomy catheter.
  • the bumper includes a large diameter portion having a maximum diameter portion, and a small diameter portion provided on the tip side of the large diameter portion, A plurality of the concave portions are formed in each of the large diameter portion and the small diameter portion,
  • the bumper includes an inner layer and an outer layer, and there is a space between the inner layer and the outer layer, and a part of the linear member is disposed in the space (1) to (16)
  • the gastric fistula catheter according to any one of the preceding claims.
  • the bumper includes a large diameter portion having a largest diameter portion, and a small diameter portion provided on the tip end side of the large diameter portion, In the large diameter portion, the inner layer and the outer layer are separated, The gastrostomy catheter according to (17), wherein in the small diameter portion, the inner layer and the outer layer are in contact with each other.
  • the shaft has a tip portion formed smaller in diameter than other portions, The gastrostomy catheter according to (1) or (2), wherein the bumper extends from the tip of the shaft.
  • the fixing portion is provided on a supporting portion for movably supporting the proximal end holding portion, and on the direction in which the proximal end holding portion is connected to the supporting portion and the proximal end holding portion is separated from the supporting portion.
  • the proximal end holding unit is The gastrostomy catheter according to (3), wherein the restriction portion is configured to be separable from the support portion by being separated from the support portion.
  • the proximal end holding portion has a reverse taper portion formed so as to spread as it goes outward of the fixing portion,
  • the support portion is An opposite portion extending along the reverse tapered portion; After the limiting portion is separated from the supporting portion, the opposing portion abuts against the reverse tapered portion so that the proximal end holding portion can be deformed so as to be pushed outward of the fixing portion.
  • the gastric fistula catheter according to (20) which is configured.
  • An insertion jig set for inserting a gastrostomy catheter having a foldable intragastric fixed portion at its tip into the body An insertion jig including a cylindrical outer collar portion and an insertion portion which can be advanced and retracted through the outer collar portion; The gastrostomy catheter attached around the mantle; A cap disposed on the distal end side of the mantle and covering at least a part of the intragastric fixation part in a folded state; One of the gastrostomy catheter or the mantle and the cap has a locking portion for locking to the other, The insertion jig set which the said insertion part cancels
  • the locking portion is provided on the inner wall surface of the outer collar portion and configured to be lockable to the cap,
  • a protruding portion that protrudes radially inward is formed on the inner wall surface of the outer collar portion, The protrusion is disposed proximal to the locking portion,
  • the insertion jig set according to (23) wherein when the insertion portion is passed through the inside of the outer collar portion and advances, the insertion portion abuts on the projecting portion to expand the outer collar portion.
  • a slit is formed at the tip of the outer collar, The insertion jig set according to (23) or (24), wherein the slit extends in the axial direction of the outer collar portion to the tip of the outer collar portion.
  • the insertion portion is configured to be able to advance to a position where it can be separated from the gastrostomy catheter and the mantle by contacting the proximal end of the cap (22) (25) The insertion jig set according to any one of (25).
  • At least a portion of the intragastric fixed portion is accommodated in a part of the space excluding the locking portion in the cap or a portion locked to the locking portion (22) to (26) The insertion jig set according to any one of the above.
  • the outer collar portion has a locking portion for locking to the cap, The insertion part releases the locking by the locking part when the insertion part is advanced through the inside of the outer collar part.
  • a gastrostomy catheter having a foldable intragastric fixation at its tip, A cap covering at least a part of the intragastric fixation part in a folded state;
  • the gastrostomy catheter is configured to be insertable with a part of an insertion jig for insertion into the stomach,
  • the said cap is a gastrostomy catheter set which has a to-be-locked part latched by the said insertion jig.
  • a gastrostomy catheter having a foldable intragastric fixed portion at its tip, A cap covering at least a part of the intragastric fixation part in a folded state;
  • the gastrostomy catheter is configured to be insertable with a part of an insertion jig for insertion into the stomach,
  • a gastrostomy catheter set having a locking portion for locking one of the gastrostomy catheter and the cap to the other.
  • a gastrostomy catheter that can be relatively indwelled with less administrative effort while keeping resistance applied to the body low.
  • an insertion jig set, an insertion jig, and a gastrostomy catheter set capable of preferably removing the cap while preventing the cap from being accidentally detached from the gastrostomy catheter.
  • stomachstomy catheter 12 shaft 13 bumper 13a communicating hole 14 wire (linear member) 14a proximal end 14b distal end 14c coating 14j, 14k bending point 14x first portion 14y second portion 15 extracorporeal fixture (fixing portion) 15a distal end 15b marker 15c proximal end holding portion 16 cap 17 strap 18 main lumen 18a opening 19 sub-lumens 19a base end 19b tip open part 110 capsule cover 111 insertion jig 111a main body cylinder 111b claw 111c operation part 111d piston 111e push rod 113 bumper 113a communicating hole 115 extracorporeal fixing member (fixed part) 115a proximal end holding portion 115b locking projection 115c recessed groove 122 shaft 129 sub-lumens 129b tip open part 132 shaft 132a shaft main body 132b first tip (tip) 132c second tip (tip) 132d sub-lumens 133 bumpers 133s space 134 inner tube 134a connecting tube 134b slope 134

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • General Health & Medical Sciences (AREA)
  • Pulmonology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Hematology (AREA)
  • Biomedical Technology (AREA)
  • Anesthesiology (AREA)
  • Engineering & Computer Science (AREA)
  • Biophysics (AREA)
  • Media Introduction/Drainage Providing Device (AREA)

Abstract

Ce cathéter de gastrostomie comprend : une tige ayant une lumière; un butoir flexible disposé au niveau d'une extrémité distale de la tige; et un fil ayant une élasticité et configuré pour pousser le butoir dans une direction augmentant le diamètre ou pour limiter la déformation du butoir dans une direction diminuant le diamètre. Au moins une partie du côté d'extrémité distale du fil, lorsqu'elle est agencée dans le butoir, utilise l'élasticité du fil pour pousser le butoir dans la direction augmentant le diamètre ou pour limiter la déformation du butoir dans la direction diminuant le diamètre.
PCT/JP2018/044360 2017-12-04 2018-12-03 Cathéter de gastrostomie, ensemble de gabarit d'insertion, gabarit d'insertion et ensemble de cathéter de gastrostomie WO2019111847A1 (fr)

Priority Applications (4)

Application Number Priority Date Filing Date Title
KR1020207019093A KR102543294B1 (ko) 2017-12-04 2018-12-03 위루 카테터, 삽입 지그 세트, 삽입 지그 및 위루 카테터 세트
US16/768,788 US20210177704A1 (en) 2017-12-04 2018-12-03 Gastrostomy catheter, insertion jig set, insertion jig and gastrostomy catheter set
CN201880078047.6A CN111655219B (zh) 2017-12-04 2018-12-03 胃瘘导管、插入夹具组、插入夹具及胃瘘导管组
EP18886918.4A EP3721856A4 (fr) 2017-12-04 2018-12-03 Cathéter de gastrostomie, ensemble de gabarit d'insertion, gabarit d'insertion et ensemble de cathéter de gastrostomie

Applications Claiming Priority (6)

Application Number Priority Date Filing Date Title
JP2017232868 2017-12-04
JP2017-232868 2017-12-04
JP2018145805A JP7316029B2 (ja) 2018-08-02 2018-08-02 挿入治具セット、挿入治具及び胃瘻カテーテルセット
JP2018-145805 2018-08-02
JP2018154832A JP7114402B2 (ja) 2017-12-04 2018-08-21 胃瘻カテーテル
JP2018-154832 2018-08-21

Publications (1)

Publication Number Publication Date
WO2019111847A1 true WO2019111847A1 (fr) 2019-06-13

Family

ID=66751614

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/JP2018/044360 WO2019111847A1 (fr) 2017-12-04 2018-12-03 Cathéter de gastrostomie, ensemble de gabarit d'insertion, gabarit d'insertion et ensemble de cathéter de gastrostomie

Country Status (1)

Country Link
WO (1) WO2019111847A1 (fr)

Citations (9)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2002534168A (ja) 1999-01-07 2002-10-15 バラード・メディカル・プロダクツ 改良されたバルーン配置をもつ胃のバルーンカテーテル
JP2003180841A (ja) 2001-12-13 2003-07-02 Jiro Kanie 胃瘻用カテーテル・キット
JP2005511206A (ja) 2001-12-10 2005-04-28 アプライド メデイカル リサーチ ガストロストミー用器具パッケイジおよび組立て方法
US20080097392A1 (en) * 2006-08-03 2008-04-24 Delegge Rebecca Catheter assembly including foldable internal bolster
JP2013059560A (ja) * 2011-09-14 2013-04-04 Nihon Covidien Kk 瘻孔カテーテル
JP2014068654A (ja) * 2012-09-27 2014-04-21 Nihon Covidien Kk 胃瘻カテーテル挿入補助キット
JP2014121451A (ja) * 2012-12-21 2014-07-03 Sumitomo Bakelite Co Ltd 胃瘻用カテーテル
JP2018145805A (ja) 2017-03-01 2018-09-20 トヨタ自動車株式会社 車両の制御装置
JP2018154832A (ja) 2017-03-16 2018-10-04 積水化学工業株式会社 粘着テープ

Patent Citations (9)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2002534168A (ja) 1999-01-07 2002-10-15 バラード・メディカル・プロダクツ 改良されたバルーン配置をもつ胃のバルーンカテーテル
JP2005511206A (ja) 2001-12-10 2005-04-28 アプライド メデイカル リサーチ ガストロストミー用器具パッケイジおよび組立て方法
JP2003180841A (ja) 2001-12-13 2003-07-02 Jiro Kanie 胃瘻用カテーテル・キット
US20080097392A1 (en) * 2006-08-03 2008-04-24 Delegge Rebecca Catheter assembly including foldable internal bolster
JP2013059560A (ja) * 2011-09-14 2013-04-04 Nihon Covidien Kk 瘻孔カテーテル
JP2014068654A (ja) * 2012-09-27 2014-04-21 Nihon Covidien Kk 胃瘻カテーテル挿入補助キット
JP2014121451A (ja) * 2012-12-21 2014-07-03 Sumitomo Bakelite Co Ltd 胃瘻用カテーテル
JP2018145805A (ja) 2017-03-01 2018-09-20 トヨタ自動車株式会社 車両の制御装置
JP2018154832A (ja) 2017-03-16 2018-10-04 積水化学工業株式会社 粘着テープ

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
See also references of EP3721856A4 *

Similar Documents

Publication Publication Date Title
JP4287114B2 (ja) 医療装置の管状要素間の動きを軸方向に抑止する保持装置
JP5377944B2 (ja) 胃瘻用シース、シース付きダイレータ、挿入補助具付き胃瘻用シース、胃瘻カテーテルキット
JP6208729B2 (ja) シール部材を備えたカテーテルアセンブリ
US7798998B2 (en) Elastically deformable surgical access device
EP2136721B1 (fr) Dispositif d'accès chirurgical élastiquement déformable présentant un tube de guidage télescopique
ES2907286T3 (es) Capuchones para agujas y catéteres y procedimiento de uso relacionado
US5207644A (en) Device with implantable infusion chamber and a catheter extending therefrom
US20070255219A1 (en) Instrument access device
JP4524243B2 (ja) 瘻孔用カテーテルキット
US10980980B2 (en) Catheter assembly
US20060270989A1 (en) Gastric fastening system
JP6506180B2 (ja) カテーテル組立体
BR112017009834B1 (pt) Sistema de fechamento para uso com uma bainha processual usada na realização de uma arteriotomia
US20090318867A1 (en) Removable Adapter for a Splittable Introducer and Method of Use Thereof
EP3049144B1 (fr) Ensemble de clamp à couvercle coulissant de positionnement de cathéter
JP2010167285A (ja) 解放自在のかえしアンカーを備えたガイドワイヤ
US11051849B2 (en) Cannula assembly with collapsible fixation device
WO2017209304A1 (fr) Dispositif de protection de pointe d'aiguille pour une aiguille à demeure et ensemble aiguille à demeure
JP2022552707A (ja) 血管アクセス装置および方法
WO2019111847A1 (fr) Cathéter de gastrostomie, ensemble de gabarit d'insertion, gabarit d'insertion et ensemble de cathéter de gastrostomie
US20210154439A1 (en) User Selectable Guidewire Advancement Orientation and Catheter Advancement Orientation
KR102543294B1 (ko) 위루 카테터, 삽입 지그 세트, 삽입 지그 및 위루 카테터 세트
US11383031B2 (en) Catheter assembly
AU2019286662A1 (en) Graft securing system, applicator and method
JP7114402B2 (ja) 胃瘻カテーテル

Legal Events

Date Code Title Description
121 Ep: the epo has been informed by wipo that ep was designated in this application

Ref document number: 18886918

Country of ref document: EP

Kind code of ref document: A1

NENP Non-entry into the national phase

Ref country code: DE

ENP Entry into the national phase

Ref document number: 20207019093

Country of ref document: KR

Kind code of ref document: A

ENP Entry into the national phase

Ref document number: 2018886918

Country of ref document: EP

Effective date: 20200706