JP4573825B2 - Insertion aid for gastrostomy tube - Google Patents

Description

  The present invention relates to a gastrostomy tube insertion aid used when a gastrostomy tube is inserted into the stomach through a fistula.

  Conventionally, for patients who cannot take food orally, a hole (fistula) penetrating into the stomach from outside the body is drilled in the patient, and a gastrostomy tube is inserted into the stomach through the fistula, and through the gastrostomy tube Nutrition is directly supplied to the stomach.

  The gastrostomy tube has a flexible tube body whose tip is inserted into the stomach through a fistula and a flexibility that regulates the extraction of the tube body from the stomach provided at the tip of the tube body. And a substantially rod-shaped intragastric fixation portion. Conventionally, according to Patent Document 1, a protrusion projecting radially inward is provided at one position in the circumferential direction of the peripheral wall of the intragastric fixation part, and a bag hole-like engagement opening radially inward is provided at this protrusion. A gastrostomy tube in which a fistula is formed is known.

  When inserting this gastrostomy tube into the stomach, use an insertion assisting tool provided with a rod-shaped member, insert the tip of the rod-shaped member into the engagement hole, and then place the tube body along the rod-shaped member. Pull the main body axially toward the rod-shaped member. According to this, the distal end of the rod-shaped member comes into contact with the bottom of the engagement hole, the intragastric fixing portion is elongated elongated starting from the formation position of the engagement hole, and the gastrostomy tube is easily inserted into the fistula. be able to.

However, if the tube body is pulled too strongly in the axial direction, the rod-shaped member may penetrate through the bottom of the engagement hole. When this happens, the gastric fixation part cannot be stretched, and the gastrostomy tube becomes unusable. Therefore, it is necessary to pull the tube body carefully, and the operability is deteriorated.
JP 2006-102195 A

  In view of the above points, the present invention has an object to provide a gastrostomy tube insertion aid having good operability that does not cause any problems even if the tube body of the gastrostomy tube is pulled strongly in the axial direction. .

  In order to solve the above-mentioned problems, the present invention provides a flexible tube main body whose tip is inserted into the stomach through a fistula, and the tube main body that is provided at the tip of the tube main body from the stomach. A gastrointestinal fixing portion having a substantially rod-like shape that has flexibility to regulate, and opens radially inward to a protruding portion that protrudes inward in the radial direction provided at one circumferential direction of the peripheral wall portion of the intragastric fixing portion. An insertion assisting tool for a gastrostomy tube for inserting a gastrostomy tube in which an engaging hole is formed into the stomach, comprising a rod-shaped member whose tip is inserted into the engaging hole. A step portion having an outer diameter larger than the inner diameter of the engagement hole is provided on the outer periphery of the portion of the rod-shaped member that is separated from the tip in the axial direction by a predetermined length.

In order to solve the above-mentioned problems, the present invention provides a flexible tube main body whose distal end is inserted into the stomach through a fistula, and an extraction of the tube main body from the stomach provided at the distal end of the tube main body. A gastrointestinal fixing portion having a flexible shape that regulates the inner wall of the stomach, and radially inwardly projecting in a radially inward projecting portion provided at one circumferential direction of the peripheral wall portion of the intragastric fixing portion. A gastrostomy tube insertion assisting tool for inserting a gastrostomy tube having a pouch hole-like engagement hole to be opened into the stomach, comprising a rod-like member whose tip is inserted into the engagement hole in the outer peripheral portion of a predetermined length apart rod-like member from the distal end of the rod-like member axially caudal, large stepped portion outer diameter than the inner diameter of the engaging hole is provided, the hole of the predetermined length engaging hole It is characterized by being set to a length less than the depth .

In addition, although the engagement hole formed in the gastrostomy tube is a bag hole shape, in this invention, the length (above-mentioned predetermined length) from a step part to the front-end | tip of a rod-shaped member is below the hole depth of an engagement hole. to be set to the length, without the tip of the rod abuts strongly hole bottom of the engaging hole, it is possible to prevent the hole bottom is pierced by the rod-like member.

  In the present invention, it is desirable that the outer diameter of the step portion is set to be equal to or less than the circumferential width of the protrusion. According to this, it can prevent that the insertion resistance of the gastrostomy tube to a fistula increases by presence of a step part. That is, no matter how much the intragastric fixation portion is stretched, its width does not narrow below the circumferential width of the projection, and if the outer diameter of the step portion is less than or equal to the circumferential width of the projection, the intragastric fixation portion is The width when stretched is the same as in the case where no step is provided on the rod-shaped member.

  In the present invention, it is desirable that the outer peripheral surface extending in the axial direction from the step portion is formed as a tapered surface that is reduced in diameter toward the axial direction. According to this, when the insertion assisting tool is pulled out after the gastrostomy tube is inserted into the stomach, the stepped portion is smoothly pulled out from the fistula, and the pain experienced by the patient can be alleviated.

  In the present invention, it is preferable that the rod-shaped member is composed of a core rod and a cylindrical body extrapolated to the core rod, and the stepped portion is configured by a tip surface of the cylindrical body. Although it is possible to cut a relatively large-diameter bar to form a stepped portion, if the stepped portion is formed at the end surface of the cylindrical body, troublesome processing becomes unnecessary and cost reduction is achieved. Is advantageous.

  Hereinafter, the insertion aid of the embodiment of the present invention will be described, but before that, the gastrostomy tube 100 will be described with reference to FIGS. 1 and 2. The gastrostomy tube 100 has a tube main body 101 whose tip is inserted into the patient's stomach through a fistula drilled in the patient, and the tube main body 101 provided at the tip of the tube main body 101 from the stomach. It is comprised by the substantially gastric-shaped intragastric fixing part 102 to regulate. The tube main body 101 and the intragastric fixation part 102 are integrally formed of a flexible synthetic resin (silicone resin).

  A protruding portion 103 that protrudes inward in the radial direction is formed at one place in the circumferential direction of the peripheral wall portion of the intragastric fixing portion 102. An engagement hole 104 is formed. A cutout portion 105 is further formed on the peripheral wall portion of the intragastric fixing portion 102 so as to be positioned on the opposite side of the protruding portion 103. Further, a communication port 106 communicating with the tube main body 101 is formed at the bottom of the intragastric fixing portion 102.

  With reference to FIG. 3, the insertion assisting tool 1 of the embodiment includes a gun-shaped handle 2 made of synthetic resin and a rod-shaped member 3 extending from the upper portion of the handle 2 in the axial direction. At the upper end of the handle 2, a groove portion 21 narrower than the outer diameter of the tube main body 101 of the gastrostomy tube 100 is formed. A plurality of protrusions 22 are formed in the groove portion 21 to prevent the tube body 101 from slipping.

  The rod-shaped member 3 includes a stainless steel core rod 31 and a cylindrical body 32 made of synthetic resin (polypropylene) extrapolated to the core rod 31. The core rod 31 includes a first straight rod portion 31a on the axial caudal side (the handle 2 side), a bent portion 31b bent in a crank shape downward from the tip of the first straight rod portion 31a, and an axial direction from the bent portion 31b. It is formed in a shape having a second straight rod portion 31c extending to the front. The distal end portion of the second straight rod portion 31 c can be inserted into the engagement hole 104 of the gastrostomy tube 100.

  The cylindrical body 32 is externally fixed to the second straight bar portion 31 c of the core bar 31. As shown in FIG. 4A, the distal end portion of the second straight rod portion 31c protrudes forward in the axial direction by a predetermined length set to be equal to or less than the depth of the engagement hole 104 from the distal end of the cylindrical body 32. I am doing so. Thus, the step portion 33 constituted by the distal end surface of the cylindrical body 32 is provided on the outer periphery of the portion of the rod-shaped member 3 that is spaced apart from the distal end of the rod-shaped member 3 in the axial direction.

  The outer diameter of the stepped portion 33, that is, the outer diameter of the distal end of the cylindrical body 32 is set to be larger than the inner diameter of the engagement hole 104 and not more than the circumferential width W of the protruding portion 103 of the intragastric fixing portion 102. Further, the outer peripheral surface of the cylindrical body 32 is formed as a tapered surface 32 a that is reduced in diameter from the tip end of the cylindrical body 32 toward the tail in the axial direction. The cylindrical body 32 is further formed with a small diameter portion 32b having the same diameter as the minimum diameter portion of the tapered surface 32a, extending in the axial direction, and reaching the bent portion 31b of the core rod 31.

  The gastrostomy tube 100 is inserted into the stomach through the fistula with the insertion aid 1 attached thereto. When the insertion assisting tool 1 is attached to the gastrostomy tube 100, first, as shown in FIG. 4A, the small-diameter portion 32b of the cylindrical body 32 is formed in the notch portion 105 of the intragastric fixing portion 102 of the gastrostomy tube 100. In the inserted state, the distal end portion of the second straight rod portion 31 c protruding from the distal end of the cylindrical body 32 is inserted into the engagement hole 104 formed in the protruding portion 103 of the intragastric fixing portion 102. Here, the outer diameter of the distal end of the cylindrical body 32 is larger than the inner diameter of the engaging hole 104, and the length of the distal end portion of the second straight rod portion 31 c protruding from the distal end of the cylindrical body 32 is the hole of the engaging hole 104. Since the depth is less than or equal to the depth, the stepped portion 33 constituted by the distal end surface of the cylindrical body 32 comes into contact with the protrusion 103. Next, as shown in FIG. 4 (b), the tube body 101 of the gastrostomy tube 100 is placed along the second straight rod portion 31 c, and in this state, the tube body 101 is pulled axially toward the rod-shaped member 3.

  According to this, the step 33 is pressed against the protrusion 103, and the intragastric fixation section 102 is elongated with the protrusion 103 at the head, as shown in FIG. 4C. Here, since the protrusion 103 has high strength, the stepped portion 33 does not penetrate the protrusion 103 even if the tube body 101 is pulled strongly in the axial direction. Further, since the length of the distal end portion of the second straight rod portion 31 c protruding from the distal end of the cylindrical body 32 is equal to or less than the hole depth of the engagement hole 104, the distal end of the second straight rod portion 31 c is the hole of the engagement hole 104. It does not abut against the bottom strongly, and the hole bottom is prevented from being broken by the rod-shaped member 3. Therefore, it is not necessary to carefully adjust the tensile force of the tube body 101, and the operability is improved.

  When the tube main body 101 is pulled as described above to stretch the intragastric fixation portion 102, the tube main body 101 is pushed into the groove 21 at the upper end of the handle 2 in this state. According to this, the tube main body 101 is clamped by the groove part 21 in the tensioned state, and the intragastric fixation part 102 is held in the stretched state.

  After the insertion assisting tool 1 is thus attached to the gastrostomy tube 100, the handle 2 is grasped and the rod-shaped member 3 is inserted into the fistula together with the gastrostomy tube 100, and the gastrostomy tube 100 is inserted into the stomach through the fistula. insert. And after insertion, the tube main body 101 is removed from the groove part 21 of the handle 2, and the rod-shaped member 3 is pulled out from a fistula in this state. At this time, the intragastric fixation portion 102 is restored to a substantially bowl-like shape, the extraction of the gastrostomy tube 100 from the stomach is restricted, and the gastrostomy tube 100 remains in the body.

  Here, no matter how much the intragastric fixation portion 102 is stretched, its width does not become smaller than the circumferential width W of the protrusion 103. If the outer diameter of the stepped portion 33 is equal to or smaller than the circumferential width of the protruding portion 103 as in this embodiment, the width when the intragastric fixation portion 102 is stretched is not provided with the stepped portion 33 on the rod-shaped member 3. Same as the case. Therefore, the insertion resistance to the fistula does not increase by providing the step portion 33 on the rod-shaped member 3.

  Moreover, in this embodiment, since the outer peripheral surface of the cylindrical body 32, that is, the outer peripheral surface of the rod-shaped member 3 extending in the axial direction from the step portion 33, is formed as a tapered surface 32a whose diameter decreases toward the axial direction. When the rod-shaped member 3 is pulled out from the hole, the stepped portion 33 is smoothly pulled out from the hole without causing a catch on the inner wall surface of the hole. Thus, the pain experienced by the patient can be alleviated.

  As mentioned above, although embodiment of this invention was described with reference to drawings, this invention is not limited to this. For example, in the above-described embodiment, the rod-shaped member 3 is constituted by the core rod 31 and the cylindrical body 32 extrapolated thereto, and the step portion 33 is constituted by the distal end surface of the cylindrical body 32. It is also possible to form the stepped portion 33 by cutting a rod having a diameter or larger. However, forming the step portion 33 using the cylindrical body 32 as in the above embodiment eliminates the need for troublesome processing and is advantageous in terms of cost.

  Moreover, in the said embodiment, although the crank-shaped bending part 31b was formed in the middle of the rod-shaped member 3, it is also possible to form the rod-shaped member 3 in a straight shape over the full length. However, in this case, even if the tube main body 101 of the gastrostomy tube 100 is pulled axially toward the rod-shaped member 3, the portion of the tube main body 101 near the intragastric fixing portion 102 has the thickness of the intragastric fixing portion 102. Due to the influence, the rod-shaped member 3 is separated, and the insertion resistance into the fistula increases. On the other hand, in the above-described embodiment, the first straight rod portion 31a on the tail end side of the rod-shaped member 3 is decentered by the bent portion 31b with respect to the second straight rod portion 31c on the distal end side. Thus, the tube body 101 is in close contact with the first straight rod portion 31a over the portion near the intragastric fixation portion 102 (see FIG. 4B). Therefore, the above embodiment is more advantageous because it can reduce the insertion resistance into the fistula. Furthermore, in the said embodiment, since the tail end of the cylinder 32 has reached the bending part 31b, the bending part 31b serves as a stopper part which mechanically prevents the axial displacement of the cylinder 32 with respect to the core rod 31. Also works. Therefore, even if the cylinder body 32 is not firmly fixed to the core rod 31, it is possible to reliably prevent the cylinder body 32 from being displaced in the axial direction due to the pulling force in the axial direction with respect to the rod-shaped member 3 of the tube body 101.

  Further, the insertion assisting tool of the above embodiment extends the intragastric fixation portion 102 by bringing the step portion 33 of the rod-like member 3 into contact with the protrusion 103 formed on the intragastric fixation portion 102 of the gastrostomy tube 100. Therefore, this insertion assisting tool can also be applied to a gastrostomy tube in which the engagement hole 104 is a through hole that reaches the outer surface of the intragastric fixation portion 102. In this case, the length between the distal end of the rod-shaped member 3 and the stepped portion 33 is not limited in bringing the stepped portion 33 into contact with the projection 103, but the distal end of the rod-shaped member 3 is stretched. Protruding forward is not preferable in terms of treatment. Therefore, the length should be less than the length of the engagement hole.

The perspective view which shows the gastrostomy tube used as the operation target of the insertion assistance tool of embodiment of this invention. Sectional drawing of the gastrostomy tube of FIG. The perspective view of the insertion auxiliary tool of embodiment of this invention. (A) Sectional view showing the initial state of attachment of the insertion aid to the gastrostomy tube, (b) Side view showing the completed state of attachment of the insertion aid to the gastrostomy tube, (c) Insertion assistance to the gastrostomy tube The bottom view of the principal part of the mounting completion state of a tool.

Explanation of symbols

  DESCRIPTION OF SYMBOLS 1 ... Insertion aid, 3 ... Rod-shaped member, 31 ... Core rod, 32 ... Cylindrical body, 32a ... Tapered surface, 33 ... Step part, 100 ... Gastrostomy tube, 101 ... Tube main body, 102 ... Intragastric fixation part, 103 ... projection, 104 ... engagement hole.

Claims (4)

A flexible tube body whose distal end is inserted into the stomach through a fistula, and a substantially bowl-shaped flexible member that is provided at the distal end of the tube body and regulates the extraction of the tube body from the stomach A pouch hole-like engagement hole that opens radially inward is formed in a radially inward projecting protrusion provided at one place in the circumferential direction of the peripheral wall portion of the stomach fixing portion. A gastrostomy tube insertion aid for inserting the gastrostomy tube into the stomach, comprising a rod-like member whose tip is inserted into the engagement hole,
On the outer periphery of the portion of the rod-shaped member that is a predetermined length away from the tip of the rod-shaped member in the axial direction, a step portion having an outer diameter larger than the inner diameter of the engagement hole is provided ,
The gastrostomy tube insertion aid, wherein the predetermined length is set to a length equal to or less than the depth of the engagement hole . Outer diameter insertion aid for claim 1 Symbol placement of gastrostomy tubes, characterized in that it is set below the circumferential width of the projection of the stepped portion. The gastrostomy tube insertion assisting device according to claim 1 or 2, wherein an outer peripheral surface extending in the axial caudal direction from the step portion is formed as a tapered surface having a diameter reduced toward the axial caudal direction. The rod-like member is composed of a extrapolated tubular body mandrel and mandrel, to any one of claim 1 to 3, characterized in that the step portion is constituted by the distal end surface of the cylindrical body The gastrostomy tube insertion aid as described.

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