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WO2003049800A1 - Trousse catheter pour ulcere gastrique - Google Patents

Trousse catheter pour ulcere gastrique Download PDF

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Publication number
WO2003049800A1
WO2003049800A1 PCT/JP2002/012578 JP0212578W WO03049800A1 WO 2003049800 A1 WO2003049800 A1 WO 2003049800A1 JP 0212578 W JP0212578 W JP 0212578W WO 03049800 A1 WO03049800 A1 WO 03049800A1
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WO
WIPO (PCT)
Prior art keywords
tube
stomach
intragastric
state
fixture
Prior art date
Legal status (The legal status 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 status listed.)
Ceased
Application number
PCT/JP2002/012578
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English (en)
Japanese (ja)
Inventor
Jiro Kanie
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Individual
Original Assignee
Individual
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
Family has litigation
First worldwide family litigation filed litigation Critical https://patents.darts-ip.com/?family=19187253&utm_source=google_patent&utm_medium=platform_link&utm_campaign=public_patent_search&patent=WO2003049800(A1) "Global patent litigation dataset” by Darts-ip is licensed under a Creative Commons Attribution 4.0 International License.
Application filed by Individual filed Critical Individual
Priority to AU2002349670A priority Critical patent/AU2002349670A1/en
Publication of WO2003049800A1 publication Critical patent/WO2003049800A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

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
    • A61J15/0015—Gastrostomy feeding-tubes
    • 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
    • A61J15/0026—Parts, details or accessories for feeding-tubes
    • A61J15/003—Means for fixing the tube inside the body, e.g. balloons, retaining means
    • A61J15/0034—Retainers adjacent to a body opening to prevent that the tube slips through, e.g. bolsters
    • A61J15/0038—Retainers adjacent to a body opening to prevent that the tube slips through, e.g. bolsters expandable, e.g. umbrella type
    • 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
    • A61J15/0003—Nasal or oral feeding-tubes, e.g. tube entering body through nose or mouth
    • A61J15/0007—Nasal or oral feeding-tubes, e.g. tube entering body through nose or mouth inserted by using a guide-wire
    • 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
    • A61M2025/0213—Holding devices, e.g. on the body where the catheter is attached by means specifically adapted to a part of the human body

Definitions

  • the present invention relates to a catheter 'kit used in connection with a gastrostoma of a living body.
  • Enteral nutrition has already been used for patients who have difficulty or cannot swallow food.
  • a technique for realizing such administration there is a technique for injecting an enteral nutritional agent from outside the body into the stomach through a gastrostomy made in the abdominal wall and stomach wall of the patient. This is called gastrostomy nutritional management.
  • a catheter kit is used to perform this PEG. It is used to create a gastrostomy that penetrates the patient's abdominal wall and stomach wall, and is used to introduce nutrients from outside the body into the stomach when implanted in the stomach .
  • catheter / kit that can be used for nutrient introduction but cannot be used for gastrostomy. Regardless of the intended use, the reality is that tubing is not designed to withstand long-term use. Is being replaced.
  • the catheter kit, including the replacement tube, can be used for nutrient delivery but not for gastrostomy.
  • the type that can be used not only for nutrition introduction but also for gastrostomy is called the gastrostomy catheter 'kit', whereas the type that can be used only for nutrition introduction,
  • the type intended for tube replacement is distinguished by the type of gastrostomy nutritional management catheter, kit and rat.
  • nutrient introduction is feasible in both types, so if it is sufficient to discuss both types assuming the function of nutrient introduction, the meaning of distinguishing both types is important. There is no. Both types are collectively referred to as gastrostomy catheter kits.
  • a gastrostomy catheter kit includes: (a) a tube having a nutrient passage for introducing nutrients from outside the body into the stomach; and (b) the tube in the stomach in the implanted state. And a gastric fixation device for fixing the tube to the stomach wall so that the tube is not removed from the patient.
  • the tube is used not only with intragastric fixation but also with extracorporeal fixation.
  • This extracorporeal fixation device is provided in a portion of the tube that is to be located outside the body in the above-mentioned implanted state, and fixes the tube to the abdominal wall so that the tube is not buried in the stomach.
  • the cooperative action of the extracorporeal fixation device and the intragastric fixation device makes it possible to position the tube relatively to the abdominal wall and the stomach wall.
  • stomach wall and the abdominal wall are mutually connected at the gastrostomy site. It is important that it be maintained in close contact with the object. If the stomach wall and the abdominal wall separate from each other at the site of gastrostomy, for example, acute peritonitis may be caused.
  • the aforementioned PEG is roughly classified into two.
  • the first technique is to introduce a tube into the stomach through the patient's abdominal wall and stomach wall, which is called the introducer method.
  • the second method is the pull method and the push method.
  • a guide wire is inserted into the stomach through the patient's abdominal wall and stomach wall, whether pulled or pushed, and then inserted into the stomach from the oral cavity and then out of the oral cavity into the stomach.
  • the guide wire is pulled by the endoscope pulled out, so that the guide wire is pulled out of the oral cavity together with the endoscope.
  • a tube is inserted into the stomach from the oral cavity using the guide wire.
  • the insertion of the tube into the stomach is performed by pulling the tube into the stomach by the guider in the pull method, whereas the tube is inserted in the stomach by the push method. By pushing it into the stomach.
  • the intragastric fixation tube can be inserted into the stomach from outside the body via a narrow fistula in the gastrostoma. It must be.
  • the gastric fixation device includes a balloon which is formed of a thin shell and can be inflated and deflated, and the fluid is supplied to and discharged from the balloon (eg, sterile distilled water). It was generally configured as a balloon type that selectively realizes inflation and deflation of the stomach ⁇ fixation device.
  • the intragastric fixation device and tube are externally passed through a narrow fistula. It is not necessary to insert it into the stomach Absent. Therefore, in this case, the intragastric fixation device is generally configured as a non-balloon type having a larger size and higher rigidity than the above-mentioned balloon.
  • the intragastric fixation device is of a non-balloon type, the possibility of unintended deformation of the intragastric fixation device is small. Thus, it is unlikely that the stomach wall and abdominal wall will separate from each other at a time when it is important that the stomach wall and the abdominal wall adhere to each other at the site of gastrostomy.
  • the gastric fixation device is of the balloon type, it may collapse unexpectedly due to damage such as rupture. If the intragastric fixation becomes deflated, it will be difficult to keep the stomach wall and abdominal wall in close contact, and complications such as acute peritonitis due to unplanned dissection of the stomach wall and abdominal wall will occur. May be triggered.
  • the tube passes through the mouth and esophagus during gastrostomy. Since the oral cavity and the esophagus are culture media of the bacterial flora, if the pull method or the push method is performed, the tube is likely to be contaminated with bacteria when passing through the oral cavity and the esophagus. As a result, there is a high possibility that the gastrostomy site, or wound, of the patient will become infected with bacteria.
  • the wound does not have to pass through the medium of the oral and esophageal flora, and the wound may be infected with bacteria. small.
  • the wound when performing the introducer method, the wound is susceptible to bacteria.
  • the advantage is that the possibility of dyeing is small.
  • U.S. Pat.Nos. 4,863,438, 4,944,732 and 5,248,302 disclose elastic deformation by external force.
  • a possible non-balloon type intragastric fixation device which is in a free state and protrudes radially outward from the tube, but in an external force acting state where an external force is applied.
  • a projection area obtained by projecting the intragastric fixation coaxially with a tube is smaller than a projected state.
  • a rod-shaped obturator is placed inside or outside the tube.
  • the tube is inserted until it reaches the gastric fixation device located at the distal end of the tube, and the obturator is further pushed in so that the gastric fixation device is coaxial with the tube. It is stretched elastically. Due to this stretching, the projected area of the intragastric fixation device is reduced.
  • the projection surface With the volume reduced the tube is inserted into the stomach from outside the body via the gastrostoma together with the intragastric fixation device. After the insertion, the obturator is withdrawn from the tube, and accordingly, the intragastric fixture is restored to the overhang state, and as a result, the tube is prevented from being removed from the gastrostoma.
  • the intragastric fixation device is non-balloon type, after the tube is implanted in the stomach, unlike the case of the balloon type, the intended function, namely, gastrostomy of the tube, is not achieved. There is no great possibility that the removal prevention function of preventing removal from the room will be impaired. Disclosure of the invention
  • a needle or the like is generally inserted into the abdominal wall and stomach wall of the patient at the tube insertion site where the tube should be inserted, at the start of the construction.
  • a through-hole is formed through the abdominal wall and the stomach wall, and the stomach wall is fixed to the abdominal wall so that the stomach wall does not move with respect to the abdominal wall.
  • the tube and the gastric fixation device are inserted into the stomach from outside the body via the above-mentioned through-hole, but it is actually difficult to completely fix the stomach wall to the abdominal wall.
  • the stomach wall may move during surgery.
  • the present invention provides a stomach that can be used to overcome the disadvantages of the conventional introducer method while enjoying the advantages of the conventional introducer method.
  • the task was to provide a fistula catheter kit.
  • a catheter / kit for gastrostoma used to introduce nutrients from outside the body into the stomach in an implanted state embedded in the stomach of a living body, wherein the nutrient passage introduces the nutrients from outside the body into the stomach.
  • An elastically deformable non-balloon type intragastric fixation device which is in a protruding state in which the tube protrudes radially outward from the tube in a free state, but an external force in which an external force is applied.
  • the projection surface area obtained by projecting the gastric fixation device coaxially with the tube is the overhang.
  • the catheter kit can be used for gastrostomy applications. As mentioned above, it is important for the gastrostomy to optimize the insertion path when inserting the tube and the gastric fixation device from outside the body into the stomach. Specifically, it is important that the holes formed in the skin, abdominal wall, and stomach wall of the living body are matched with each other before the tube is inserted, and the tube is inserted in that state.
  • a hollow rod is used to temporarily reduce the projected area of the intragastric fixation device, and a rod is provided inside the hollow rod.
  • An internal passage is provided in connection with this passage in the rod.
  • a communication passage for connecting the passage in the mouth to the space in the stomach when the hollow rod is engaged with the intragastric fixation device is provided in the stomach. It is provided on the fixture.
  • the hollow rod and the intragastric fixture when the hollow rod and the intragastric fixture are engaged, that is, when the projected area of the intragastric fixture is reduced, the hollow rod and the intragastric fixation are used. It is possible to pass a continuous wire through the tool.
  • the wire can be configured as a guide wire.
  • the guide wire is used by passing through a through-hole formed so as to penetrate the abdominal wall and the stomach wall with the start of gastrostoma construction.
  • This guide * wire is used while being passed through the hollow rod and By guiding the empty rod, the tube is guided to be inserted into the stomach from outside the body through the through hole.
  • a force is applied from the guide wire to the abdominal wall and stomach wall in a tangential direction (lateral direction) of the surface of the skin of the living body.
  • the force causes the holes formed in the skin, abdominal wall, and stomach wall of the living body to line up along the guide wire before the tube is introduced into the stomach.
  • the stabilization will be at the same time as the introduction route of the vehicle is optimized.
  • a rod is provided for reducing the projected area of the intragastric fixation device by the operation of an operator located outside the body.
  • a communication passage is provided in the intragastric fixation device, whereby the assembly of the tube, the intragastric fixation device, and the hollow rod is guided. It can be guided by the wire and inserted into the stomach from outside the body.
  • the intragastric fixation device is of a non-balloon type, so that the removal prevention function is not hindered by damage such as rupture. You.
  • the advantage of the conventional mouth-ducer method that is, the possibility that the wound is less likely to be infected with bacteria than the pull method and the push method is obtained.
  • the disadvantage of the conventional introducer method that is, the function of the gastric fixation device that originally prevents removal, is said to be impaired due to damage to the gastric fixation device. It is easier to overcome the disadvantages.
  • the catheter / kit according to this section can be used for the purpose of replacing the tube currently used with a new one after the gastrostoma is completed.
  • the tube currently used is After removal, the tube is inserted into the stomach via a gastrostomy with a new catheter / kit, using a hollow rod to reduce the projected area of the intragastric fixture. At the time of this insertion, the use of the aforementioned guide wire is generally omitted.
  • living body can be defined to include humans, but can also be defined to include animals other than humans.
  • the tube is provided in a portion of the tube that is to be located outside the body in the implanted state, and the tube is fixed to the abdominal wall so that the tube is not buried in the stomach.
  • the gastrostoma according to (1) including a fixing device, and positioning the tube relative to the abdominal wall and the stomach wall by a cooperative action of the extracorporeal fixing device and the intragastric fixing device.
  • Catheter kit including a fixing device, and positioning the tube relative to the abdominal wall and the stomach wall by a cooperative action of the extracorporeal fixing device and the intragastric fixing device.
  • both an intragastric fixation device and an extracorporeal fixation device that cooperate with each other to position the tube with respect to the living body are provided.
  • a guide 'wire used through a through-hole formed so as to penetrate the abdominal wall and stomach wall of the living body with the start of gastrostoma construction in the living body. And is used while being passed through the passage in the rod and the communication passage, and in this state, the assembly of the tube, the gastric fixation device, and the hollow rod is passed through the passage.
  • the fixing device is a non-balloon type, it is easy to properly construct a gastrostoma in a living body by the introducer method.
  • the hollow rod is disposed on the outer side of the tube in the engaged state, and at the same time, applies a compressive force in a direction generally parallel to the gastric fixation device in the gastric space.
  • the intragastric fixation is elastically stretched coaxially by the transmitted compressive force, whereby the projection area is reduced (1) or (3).
  • Catheter kit for gastrostoma according to [1].
  • a catheter kit for gastrostoma according to claim 1.
  • the gastric fixation device has a hollow structure, and in the engaged state, the hollow gasket uses the transmitted compressive force of the gastric fixation device.
  • the intragastric fixation device includes an engaging portion to be engaged with a distal end portion of the hollow rod, and the communication passage is connected to the engaging portion.
  • the gastrostoma catheter 'kit according to any of the above items.
  • the engaging portion includes a bottomed hole that receives the front end of the hollow port in abutting state, and the communication passage has a bottom surface at one end thereof and a bottom end at the other end thereof.
  • a catheter for gastrostoma wherein the catheter kit for gastrostoma according to any one of (1) to (9) is used for the purpose of constructing a gastrostoma in the living body.
  • a method for using a kit comprising: a guide to be passed through a through-hole formed so as to penetrate an abdominal wall and a stomach wall of the living body; A first step of communicating with the gasket, and applying the external force to the intragastric fixture by the hollow rod to reduce the projection area of the intragastric fixture. While the assembly of the tube, the intragastric fixation device, and the hollow rod is guided to the stomach wire, the assembly is inserted into the stomach from outside the body through the through hole, whereby the tube is inserted into the stomach.
  • the drawback of the conventional introducer method is that the gastric fixation device's essential removal protection is impaired due to unexpected deformation of the gastric fixation device. It will be easier to overcome.
  • the combination of tube and intragastric fixation used to perform this method must be sold as a single gastrostomy catheter kit. Is not essential.
  • the catheter for gastrostoma according to any of (1) to (9) A method for using a gastrostomy catheter kit for using the kit for nutritional supplementation to the living body, wherein the hollow force allows the external force to act on the intragastric fixture.
  • the assembly of the tube, the intragastric fixture, and the hollow rod is inserted into the stomach from outside the body, and a gastrostoma previously constructed in the living body is inserted.
  • a second step of elastically restoring the protruded state to the overhang state is
  • the parts of the catheter kit can be easily shared. For some reason, it is possible to replace tubes with a cheap power catheter kit. For the same reason, according to the method according to the above (10), inexpensive power kits can be used because the components of the cat kit can be easily shared. This makes it possible to construct a gastrostoma using
  • FIG. 1 is a perspective view showing an assembled state of a catheter / kit for a gastrostoma according to a first embodiment of the present invention.
  • FIG. 2 is a front sectional view showing a part of the kit for gastrostoma catheter shown in FIG.
  • FIG. 3 is a perspective view for conceptually explaining a method of constructing a gastrostoma using the gastrostoma catheter kit shown in FIG. Figure 4 is a flowchart showing the gastrostomy procedure.
  • FIG. 5 is a front cross-sectional view for explaining how the guide wire 20 is inserted into the stomach during the implementation of the gastrostomy method of FIG.
  • FIG. 6 is a front sectional view showing a part of the gastrostoma catheter 'kit according to the second embodiment of the present invention in an assembled state and in a free state.
  • FIG. 7 is a front sectional view showing the gastrostoma catheter 'kit' in FIG. 6 in an assembled state and in an externally acting state.
  • FIG. 8 is a flow chart showing a method of exchanging the tube 10 using the gastrostomy catheter kit shown in FIG. BEST MODE FOR CARRYING OUT THE INVENTION
  • FIG. 1 shows an assembled state of all the components of a gastrostomy catheter 'kit according to a first embodiment of the present invention, except for the hollow port and the extracorporeal fixing device.
  • This gastrostomy catheter kit can be used to create a gastrostomy with the int-oral transducer in a patient as a living body, and to supply nutrition to the patient directly from outside the body into the stomach. Used for ⁇ applications.
  • the gastrostomy catheter kit includes a tube 10, a non-balloon type intragastric fixture 12, a hollow rod 14 shown in a cross-sectional view in FIG. 2, and an extracorporeal fixture 16. It is configured to include the guide 'wire 20' shown in FIG.
  • the tube 10 is, as is well known, used to introduce nutrients from outside the body into the stomach in an implanted state in the patient's stomach. Therefore, the tube 10 has a nutrition passage 11 therein.
  • the gastric fixation device 12 is provided in a portion of the tube 10 that is to be located in the stomach in the above-mentioned embedded state.
  • the gastric fixation device 12 has the gastric fixation device 12 attached to the tip of the tube 10 c.
  • the gastric fixation device 12 has the tube 10 attached to the stomach wall so that the tube 10 is not removed from the human body. Performs a pull-out prevention function of fixing to
  • the gastric fixation device 12 is made of an elastically deformable material. As a result, the intragastric fixation device 12 is in a protruding state in which the tube 10 protrudes radially outward from the tube 10 in the free state, but is in the stomach in the external force acting state in which an external force is applied. The projected area obtained by projecting the fixture 12 coaxially with the tube 10 is reduced from the overhang state.
  • the intragastric fixture 12 has a hollow structure that is open on the side opposite to the side where the tube 10 is mounted.
  • the intragastric fixation device 12 mainly has a thin-walled structure and a mushroom shape.
  • the intragastric fixation device 12 has a mounting structure with the tube 10, and the distal end portion of the tube 10 is substantially airtight and pulled out from an engagement portion 24 formed coaxially with the gastric fixation device 12. It has a structure that makes it impossible to fit.
  • An external force acting position at which the external force is to be applied is set in a portion of the intragastric fixture 12 facing the outside of the body in the implanted state.
  • the hollow rod 14 is removably engaged with its intragastric fixture 12 therefrom.
  • the hollow rod 14 is in its engaged state In the implanted state, it functions to transmit the compressive force from outside the body to the intragastric fixation device 12.
  • the hollow rod 14 is designed so as to be engaged with the intragastric fixation device 12 while being arranged outside the tube 10. Have been. Specifically, the hollow rod 14 is arranged at a position offset from the axis of the intragastric fixation device 12 coaxial with the tube 10 radially outward of the tube.
  • an engagement portion 30 is formed in the intragastric fixture 12 at the position where the external force acts.
  • the gastric fixation device 12 is engaged with the hollow rod 14 at the engagement portion 30.
  • the engaging portion 30 is formed so as to have an engaging hole 32 that opens on the side of the hollow rod 14.
  • the engagement hole 32 has a bottom portion 34.
  • the hollow rod 14 is fitted coaxially into the engagement hole 32 until the tip of the hollow rod 14 abuts against the bottom portion 34, whereby the engagement with the intragastric fixation device 12 is established. Is achieved.
  • a compressive force as an external force is transmitted to the bottom portion 34 of the intragastric fixture 12 via the hollow rod 14, and as a result, as shown in FIG.
  • the intragastric fixture 12 is coaxially stretched.
  • the free state of the intragastric fixture 12 and the projected area reduced state are selectively realized by the elasticity of the intragastric fixture 12 itself.
  • a plurality of structural members having no elasticity, and an elastic connecting mechanism for elastically connecting the plurality of members to each other for example, a mechanism having a connecting function and an elastic force applying function
  • Such an intragastric fixture 12 can be referred to as a mechanical type.
  • the hollow rod 14 has a rod passage 40 therein.
  • the intragastric fixture 12 has a communication passage 44.
  • the communication passage 44 is opened at a surface facing the hollow rod 14 and a surface facing the opposite side of the both surfaces of the bottom portion 34.
  • an operation unit 48 is provided at the rear end of the hollow rod 14.
  • the operation portion 48 is formed as a projecting portion projecting radially outward from the hollow rod 14.
  • the operation unit 48 is provided so that an operator can easily handle the hollow rod 14.
  • the extracorporeal fixing device 16 is provided in a portion of the tube 10 that will be located outside the body in the embedded state.
  • the position of the extracorporeal fixing device 16 in the axial direction with respect to the tube 10 is adjustable.
  • the external fixture 16 serves to fix the tube 10 to the abdominal wall so that the tube 10 is not buried in the stomach.
  • the tube 10 is then moved relative to the patient's abdominal wall 50 and stomach wall 52 (see FIG. 3) by the cooperative action of the extracorporeal fixture 16 and the intragastric fixture 12. The function of positioning is realized.
  • the guide wire 20 is connected with the start of gastrostoma construction. It is used by penetrating through holes 54 formed so as to penetrate abdominal wall 50 and stomach wall 52.
  • This guide wire 20 is used while being passed through the intra-rod passage 40 of the hollow rod 14 and the communication passage 44 of the intragastric fixture 12 together.
  • the tube 10 can be inserted into the stomach from outside the body through the through hole 54. It has the function of guiding the insertion through the plug.
  • gastrostomy catheter / kit The structure of the gastrostomy catheter / kit has been described in detail above. Next, how to use the catheter will be described in detail. This gastrostomy catheter / kit is used for the purpose of gastrostomy in the present embodiment.
  • FIG. 4 is a flow chart showing a method of constructing a gastrostoma using a gastrostoma catheter kit.
  • step S 1 the worker is placed in the supine position.
  • An endoscope is introduced into the stomach through the patient's mouth.
  • the worker sends air through the lumen of the endoscope into the patient's stomach. Due to this air supply, the patient's stomach expands, and the abdominal wall 50 and the stomach wall 52 come into close contact with each other.
  • the worker further observes the transmitted light emitted from the inserted endoscope and transmitted through the stomach wall 52 and the abdominal wall 50, and by palpating the worker. Identify the tube insertion site in the abdominal skin where tube 10 should be inserted.
  • This tube insertion site is a site where a patient's skin is locally incised, and is also a site where a gastrostoma is finally constructed.
  • the worker disinfects the patient's skin, the identified tube insertion site and its surroundings.
  • the operator performs local anesthesia on the tube insertion site.
  • the operator fixes the stomach wall 52 to the abdominal wall 50 in order to prevent the relative position of the stomach wall 52 from the abdominal wall 50 from being shifted due to peristaltic motion of the stomach.
  • This fixation can be performed, for example, by suturing the stomach wall 52 and the abdominal wall 50 with a suture near the tube insertion site. This gastric wall fixation is released when it is no longer needed.
  • a gastrostoma is constructed by an introducer method using a gastrostoma catheter 'kit having a non-balloon-type intragastric fixture 12.
  • a non-balloon type intragastric fixation device 12 is usually larger than a conventional balloon type intragastric fixation device.
  • a gastrostomy catheter having an intragastric fixation device 12 that is not a balloon type is a balloon type when a gastrostomy is to be constructed by the introducer method using a kit.
  • the tube 10 and the gastric fixation device 1 2 are different from the case where the gastrostoma is constructed by the introducer method using a gastrostomy catheter with a conventional gastric fixation device. It is important to be as cautious as possible.
  • the holes formed at the tube insertion site in the patient's skin, abdominal wall 50, and stomach wall 52 were made to coincide with each other, and the tube 10 and intragastric fixation device 1 were passed through the holes. It is important to introduce 2 into the stomach to optimize and stabilize the introduction path of tube 10.
  • the stomach wall 52 in S 4 is It is fixed to the abdominal wall 50.
  • the patient's skin, abdominal wall 50 and stomach wall 52 are connected to the tube.
  • guide wires 20 are passed through the holes formed respectively.
  • a force is applied from the guide * wire 20 to the abdominal wall 50 and the stomach wall 52 in the tangential direction (lateral direction) of the surface of the patient's skin. Due to the force, the holes formed in the patient's skin and the abdominal wall 50 and the stomach wall 52 in line with the guide wire 20 before the tube 10 was introduced into the stomach. The holes are aligned so that the holes are aligned with each other prior to insertion of tube 10 into the stomach.
  • the operator locally incises the skin at the tube insertion site, and as a result, an opening is formed in the skin at the tube insertion site.
  • the worker further inserts a hollow needle into the formed opening so as to penetrate the abdominal wall 50 and the stomach wall 52 in order. Thereby, a through hole 54 penetrating the abdominal wall 50 and the stomach wall 52 is formed.
  • the worker inserts the guide * wire 20 into the stomach via the lumen of the needle inserted into the formed through hole 54.
  • the part of the guide * wire 20 outside the body is passed through the communication passage 44 of the intragastric fixture 12 and the passage 40 of the hollow rod 14. This can be done after the guide wire 20 has been inserted into the stomach or before it can be inserted, or in theory it can be done during the insertion. Noh.
  • the operator removes the needle from the patient while leaving the guide wire 20. Thereafter, in S7, the operator performs a process on the patient to expand the diameter of the formed through hole 54.
  • the dilator is inserted into the through hole 54 to be expanded while the guide wire 20 is inserted through the inner cavity of the dilator.
  • the operator removes the dilator from the patient. At this time, as shown in FIG. 5, the patient is in a state where only the guide wire 20 is passed through the expanded through hole 54.
  • the worker enters the tube 10 into the stomach through the through hole 54 using the hollow rod 14 and the guide wire 20.
  • the hollow mouth 14 is engaged with the intragastric fixture 12, and the compressive force is transmitted to the intragastric fixture 12 via the hollow rod 14.
  • the gastric fixation device 12 is deformed to an elongated shape.
  • the intragastric fixation device 12 is not of a balloon type, the patient is not pressed strongly in the through-hole 54, and the gastric fixation device 12 is not squeezed. It passes through the hole 54 and is inserted into the stomach.
  • the worker prior to the introduction of the tube 10 into the stomach, the worker accidentally pulls the guide wire 20 into the stomach and accidentally pulls the guide wire 20 during the subsequent work. Ensure that it is placed in the stomach long enough to allow it to be withdrawn. Therefore, the guide wire 20 is not inadvertently removed from the patient during a series of operations for gastrostomy, and this prevents the guide wire 20 from being removed. Thus, the guiding function of the tube 10 is guaranteed.
  • the operator removes the guide wire 20 from the patient. Subsequently, in S 10, the worker removes the hollow rod 14 from the tube 10 in the buried state. As a result, the gastric fixation device 12 is restored to the free state, and the gastric fixation device 12 is brought into a state in which the above-described removal prevention function can be exhibited.
  • the operator adjusts the external fixation device 16 on the tube 10 to an appropriate position, thereby connecting the intragastric fixation device 12 and the external fixation device 16 with each other.
  • the joint positions the tube 10 relatively to the abdominal wall 50 and the stomach wall 52.
  • S 6 in FIG. 4 constitutes an example of the “first step” in the above (10), and S9 and S10 cooperate with each other to form an example of the "second step” in the same paragraph.
  • the tube 10 can be pulled out of the patient using elastic deformation.
  • the hollow rod 14 is a tube. Although it is arranged at a position offset with respect to the tube 10, in this embodiment, as shown in FIG. 6, the hollow rod 70 is substantially coaxial with the tube 10. And it is arranged in the nutrition passage 11 of the tube 10.
  • the non-balloon type intragastric fixation device 74 has a hollow structure and has a first and a second It has portions 80 and 82.
  • the first portion 80 is formed with an engaging portion 84 to which the distal end of the tube 10 is irremovably engaged.
  • the engaging portion 84 has a bottomed hole 86 for receiving the front end of the tube 10 in abutting state.
  • a through hole 88 is formed at the bottom of the bottomed hole 86, and a hollow rod 70 is passed through the through hole 88.
  • the second portion 82 has an engaging portion 92 with which the distal end of the hollow rod 70 is removably engaged.
  • the engaging portion 92 has a bottomed hole 94 for accommodating the front end portion of the hollow opening 70 in an abutting state.
  • a through hole 96 is also formed at the bottom of the bottomed hole 94.
  • FIG. 7 shows that the intragastric fixture 74 is stretched, thereby reducing its projected area.
  • the gastric fixation device 74 has a communication passage 100 for allowing the nutrition passage 11 in the tube 10 to communicate with the space in the stomach via the space in the gastric fixation device 74.
  • a gastrostomy can be created in a patient by a new introducer method similar to that in the first embodiment, or the gastrostomy can be prepared in advance. Nutrition from outside the patient through the gastrostomy It is possible to inject into.
  • the intragastric fixture 74 has an introduction portion such as a passage for introducing the enteral nutritional agent from the nutrition passage 11 into the stomach, an opening, and the like.
  • FIG. 8 is a flow chart showing a method of replacing the tube 10 by using the gastrostomy catheter / kit according to the present embodiment.
  • the operator removes the hollow rod 70 from the tube 10 force. Thereby, the intragastric fixture 74 is restored to the overhang state. Thereafter, in S56, the worker attaches the extracorporeal fixation device 16 to the tube 10, thereby fixing the tube 10 in the stomach in cooperation with the intragastric fixation device 74.
  • FIG. S54 forms an example of the “first step” in the above (11), and S55 forms an example of the “second step” in the above section.
  • the operation is performed, for example, in a procedure reverse to the procedure of inserting the tube 10 into the stomach. It is possible to do with.
  • the gastrointestinal fixture 74 of the tube 10 to be replaced will be stretched with the aid of the hollow rod 70, and the tube 10 will be stretched without the support. It is easier to reduce the pain given to the patient than in the case where it is removed.
  • the hollow rod 70 when trying to remove the tube 10 already attached to the gastrostoma, the hollow rod 70 is connected to the intragastric fixture 74 via the lumen of the tube 10. Will be reached. Therefore, unlike the case where the hollow rod 70 is disposed outside the tube 10, it is not necessary to use the annular gap between the gastrostoma and the tube 10.
  • the operation of removing the tube 10 can be easily simplified with the support of the hollow rod 70.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Gastroenterology & Hepatology (AREA)
  • Medical Preparation Storing Or Oral Administration Devices (AREA)
  • Media Introduction/Drainage Providing Device (AREA)
  • Infusion, Injection, And Reservoir Apparatuses (AREA)

Abstract

L'invention concerne une trousse cathéter pour ulcère gastrique permettant de bénéficier d'un avantage classique offert par un procédé d'introduction selon lequel la possibilité de contagion d'un plaie par des bactéries est faible, et de supprimer simultanément le problème généré par la dégradation d'une fonction de prévention d'extraction qui doit être effectuée par un dispositif de mise en place dans l'estomac, la dégradation résultant des dégâts occasionnés au dispositif de mise en place dans l'estomac. Une tige (14) permettant de déployer un dispositif de mise en place dans l'estomac (12) qui n'est pas un dispositif à ballonnet et est fixé à un tube (10) est conçue creuse, et le dispositif de mise en place dans l'estomac comporte un passage (44) permettant à un passage (40) de la tige de communiquer avec un espace de l'estomac, ladite tige étant accouplée au dispositif de mise en place dans l'estomac. Un guide fil continu (20) peut être inséré dans la tige et dans le dispositif de mise en place dans l'estomac, et lorsque l'ensemble constitué du tube, du dispositif de mise en place dans l'estomac et de la tige est inséré dans l'estomac conformément au procédé d'introduction, ledit ensemble peut être guidé de manière précise à l'intérieur de l'estomac par le fil guide.
PCT/JP2002/012578 2001-12-13 2002-12-02 Trousse catheter pour ulcere gastrique Ceased WO2003049800A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU2002349670A AU2002349670A1 (en) 2001-12-13 2002-12-02 Catheter kit for gastric ulcer

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
JP2001-380766 2001-12-13
JP2001380766A JP3347315B1 (ja) 2001-12-13 2001-12-13 胃瘻用カテーテル・キット

Publications (1)

Publication Number Publication Date
WO2003049800A1 true WO2003049800A1 (fr) 2003-06-19

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ID=19187253

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/JP2002/012578 Ceased WO2003049800A1 (fr) 2001-12-13 2002-12-02 Trousse catheter pour ulcere gastrique

Country Status (3)

Country Link
JP (1) JP3347315B1 (fr)
AU (1) AU2002349670A1 (fr)
WO (1) WO2003049800A1 (fr)

Families Citing this family (15)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP4524243B2 (ja) * 2003-04-28 2010-08-11 裕 鈴木 瘻孔用カテーテルキット
ATE426388T1 (de) * 2003-04-28 2009-04-15 Sumitomo Bakelite Co Katheterkit fur ein loch
CN101574306B (zh) * 2003-04-28 2012-12-26 住友电木株式会社 瘘孔用导管用具
JP4664848B2 (ja) * 2006-03-30 2011-04-06 裕 鈴木 瘻孔用カテーテルキット
JP4573825B2 (ja) * 2006-10-31 2010-11-04 株式会社トップ 胃瘻チューブ用挿入補助具
JP5008990B2 (ja) * 2007-01-23 2012-08-22 株式会社トップ ボタン型胃瘻チューブ
JP5057573B2 (ja) * 2007-11-22 2012-10-24 クリエートメディック株式会社 カテーテルおよびカテーテルキット
JP5018522B2 (ja) * 2008-02-06 2012-09-05 住友ベークライト株式会社 瘻孔用留置カテーテルキット及び瘻孔用留置カテーテルキットの挿入準備方法
JP2009254578A (ja) * 2008-04-16 2009-11-05 Top:Kk 留置カテーテル
JP2009254579A (ja) * 2008-04-16 2009-11-05 Top:Kk 留置カテーテル用挿入補助具
JP2008284389A (ja) * 2008-08-11 2008-11-27 Top:Kk 瘻孔チューブ
JP5226748B2 (ja) * 2010-08-23 2013-07-03 クリエートメディック株式会社 挿入補助具
JP6660682B2 (ja) * 2015-07-15 2020-03-11 株式会社トップ 胃瘻チューブ
WO2019111847A1 (fr) 2017-12-04 2019-06-13 住友ベークライト株式会社 Cathéter de gastrostomie, ensemble de gabarit d'insertion, gabarit d'insertion et ensemble de cathéter de gastrostomie
KR102543294B1 (ko) 2017-12-04 2023-06-13 스미또모 베이크라이트 가부시키가이샤 위루 카테터, 삽입 지그 세트, 삽입 지그 및 위루 카테터 세트

Citations (5)

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Publication number Priority date Publication date Assignee Title
US4863438A (en) * 1985-11-29 1989-09-05 Applied Medical Technology, Inc. Low profile gastrostomy device
US4944732A (en) * 1988-08-15 1990-07-31 Sandoz Nutrition Corporation Gastrostomy feeding port
US5248302A (en) * 1992-08-05 1993-09-28 Biosearch Medical Products Inc. Percutaneous obturatable internal anchoring device
GB2337204A (en) * 1998-05-12 1999-11-17 Novartis Nutrition Ag Collapsible retention bolster for an ostomy tube
EP1005877A2 (fr) * 1998-12-03 2000-06-07 Smiths Industries Public Limited Company Tube avec manchon

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4863438A (en) * 1985-11-29 1989-09-05 Applied Medical Technology, Inc. Low profile gastrostomy device
US4863438B1 (fr) * 1985-11-29 1992-01-28 Applied Med Tech Inc
US4944732A (en) * 1988-08-15 1990-07-31 Sandoz Nutrition Corporation Gastrostomy feeding port
US5248302A (en) * 1992-08-05 1993-09-28 Biosearch Medical Products Inc. Percutaneous obturatable internal anchoring device
GB2337204A (en) * 1998-05-12 1999-11-17 Novartis Nutrition Ag Collapsible retention bolster for an ostomy tube
EP1005877A2 (fr) * 1998-12-03 2000-06-07 Smiths Industries Public Limited Company Tube avec manchon

Also Published As

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JP3347315B1 (ja) 2002-11-20
JP2003180841A (ja) 2003-07-02
AU2002349670A1 (en) 2003-06-23

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