JP2001327525A - Nasolacrimal tube and nasolacrimal tube device for lacrimal remodeling surgery - Google Patents

Abstract

(57) [Problem] To perform a nasolacrimal tube insertion operation while directly observing the operation in a dark nasal cavity by illumination or detecting the position of the nasolacrimal tube, Provided is a nasolacrimal tube device which enables easy and reliable insertion of a nasolacrimal tube. SOLUTION: At both ends of a flexible indwelling tube portion 20 having a diameter that can be inserted into the lacrimal canal, a flexible and light-transmitting probe tube portion 21 is formed so as to form an extension of the indwelling tube portion 20. Connected. The distal ends 21 a and 21 b of each probe tube portion 21 are closed, and an opening 23 is formed near the base end of each probe tube portion 21. During the operation, a light emitting element such as an optical fiber element 30 is inserted into the probe tube portion 21 through the opening 23. Thus, the light-transmitting probe tube portion 21 shines in the nasal cavity and illuminates the nasal cavity. Thus, the operator can accurately grasp the probe tube portion 21 in the nasal cavity and pull it out. Probe tube part 2 instead of light emitting element
The position of the nasolacrimal tube can be detected by inserting an ultrasonic probe, an endoscope, or the like into the inside of the tube.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a nasolacrimal tube used in an operation for reforming the lacrimal punctum, lacrimal canaliculus, lacrimal sac, and lacrimal duct of the nasolacrimal duct for the treatment of lacrimation. It relates to a nasolacrimal tube device.

[0002]

2. Description of the Related Art The human eye and nose are shown in FIG. 15, and the inside of an eye E is an upper punctum 1a and a lower punctum, which are small holes which open up and down on the nose side. It communicates with the upper lacrimal canaliculus 2a and the lower lacrimal canaliculus 2b via 1b. The upper lacrimal canaliculus 2a and the lower lacrimal canaliculus 2b pass through the total lacrimal canaliculus 3 and the lacrimal sac 4
It is connected to. The lacrimal sac 4 communicates with a nasolacrimal duct 5 extending downward, and the lower end of the nasolacrimal duct 5 ends in a lower nasal passage 6. Note that reference numeral 7 denotes a middle nasal passage, and reference numeral 8 denotes a middle turbinate.

As a nasolacrimal tube used for performing a reconstructive operation of the lacrimal tract including the puncta, lacrimal canaliculus, lacrimal sac, nasolacrimal duct, etc., an instrument having a silicone tube is known. . The silicone tubing is often used, for example, as a stent for lacrimal ductostomy or lacrimal tubuloplasty, or as an insert for preventing lacrimal passage obstruction, a complication of ocular radiation therapy.

[0004] An instrument having this silicone tube and a method of using the same are as shown in FIGS. 16 and 17. As shown in FIG. 16, a metal rod-shaped probe 10, 10 is attached to both ends of a flexible silicone tube 9 as shown in FIG.
Are connected, and the tip of each rod-shaped probe 10 is enormous as indicated by reference numeral 11. This device is inserted into the lacrimal sac 4 and the nasolacrimal duct 5 from the upper and lower punctum 1a, 1b as shown in FIG. That is, first, the expanding part 11 at the tip of each rod-shaped probe 10 is inserted into the upper and lower canaliculi 2a and 2b via the upper and lower teardrops 1a and 1b, respectively. Then, the insertion operation is further advanced, and when the enlarged portion 11 reaches the inside of the nasal cavity, the special hook 12 is hooked on the enlarged portion 11 of each rod-shaped probe 10 and pulled out as shown in FIG. Due to such a guiding action of each rod-shaped probe 10, the silicone tube 9 is passed through the lower nasal passage 6 from the punctum 1a, 1b. After the above insertion work is completed, the rod-shaped probe 10 is removed from the silicone tube 9 as necessary, and the ends of the silicone tube 9 are tied together so that the knot 13 is formed as shown in FIG. The tube 9 is fixed as shown to prevent it from falling off, and is left in the body as a stent to maintain the communication state of the lacrimal passage.

[0005]

By the way, when performing the insertion operation of the instrument with the silicone tube as described above, since the lacrimal sac 4 and the nasolacrimal duct 5 are particularly dark, the intranasal operation is groped. It is necessary to perform the procedure, and in many cases, a temporary path that deviates from the path that should be passed through is formed in the tissue, and operations such as damaging the nasal mucosa and causing a large amount of bleeding are extremely difficult.
In order to avoid this, there have been attempts to perform operations while observing with an endoscope, illuminate with an operating light, etc. Therefore, the operation is not easy, and it is difficult to directly see the inside of the nasal cavity with a surgical light, so that a sufficient effect cannot be obtained.

SUMMARY OF THE INVENTION The present invention has been made to solve the above-mentioned problem, and an object of the present invention is to securely insert a nasolacrimal tube out of the nasal cavity through the nasal cavity when performing the nasolacrimal tube insertion operation as described above. And can be easily pulled out, so that there is no problem such as damaging the mucous membrane and causing bleeding,
It is an object of the present invention to provide a nasolacrimal tube and a nasolacrimal tube device used for lacrimal remodeling surgery.

[0007]

According to the present invention, there is provided, in accordance with the present invention, a flexible tube having a diameter capable of being inserted and placed in a lacrimal canal. An opening is formed at a position at a predetermined distance from at least one of the tubes, and the tip of the tube has a smooth curved shape and is sharpened. . It is desirable that the tube be formed to be bent at an angle near the opening with the opening as a vertex.

The tube comprises a flexible indwelling tube portion, and a flexible probe tube portion connected to each of both ends of the indwelling tube portion so as to form an extension of the indwelling tube portion. The opening may be formed in the probe tube portion.

According to the present invention, there is provided a flexible tube which can be inserted and placed in the lacrimal canal, and an opening is formed at a predetermined distance from at least one of both ends of the tube. And a nasolacrimal tube device for use in lacrimal reconstructive surgery, comprising a light-emitting element that is removably inserted into the tube through the tubule. The light emitting element can be constituted by an optical fiber or a self-luminous body.

Further, according to the present invention, there is provided a flexible tube which can be inserted and placed in the lacrimal canal, and an opening is formed at a predetermined distance from at least one of both ends of the tube. A nasolacrimal tube device for use in lacrimal reconstructive surgery, comprising a tube position detecting means inserted removably into the tube via the tube. The tube position detecting means can be constituted by an ultrasonic probe or an endoscope.

[0011]

Next, an embodiment of the present invention will be described.

As shown in FIG. 1, an embodiment of a nasolacrimal tube and a nasolacrimal tube device used for lacrimal reconstructive surgery according to the present invention has a tube T having a diameter that can be inserted into the lacrimal passage. The tube T comprises a flexible indwelling tube portion 20 and a flexible, light transmissive (transparent) connected to each of the two ends of the indwelling tube portion 20 to form an extension of the indwelling tube portion 20. Or translucent) probe tube portion 21. The flexible indwelling tube portion 20 can be made of silicone as in the conventional example. The probe tube portion 21 can be made of, for example, a material selected from the group consisting of a simple substance or a mixture of polyolefin, polyamide, or polyurethane. Tubes made of these materials, such as polyolefins, are harder than silicone tubes, have better shape retention, and are easier to insert into the lacrimal canal. The inner diameter of the indwelling tube portion 20 is, for example, preferably about 0.05 to 3.5 mm, more preferably about 0.5 to 0.6 mm, and the outer diameter of the probe tube section 21 is about 0.1 to 4.0 mm. It is more preferably, for example, about 1.1 mm. Tip 2 of probe tube portion 21
The length from 1a to the opening 23 is typically about 55 mm. Note that the tube T may have a structure in which the indwelling tube portion 20 and the probe tube portion 21 are all integrally formed of the same material.

The proximal end of the probe tube portion 21 is joined to both ends of the indwelling tube portion 20 at portions indicated by reference numeral 24. In addition, the tip 21a of the probe tube portion 21 has a curved tip for facilitating easy and smooth insertion into a punctum or the like.
For example, it is formed to have a spherically pointed, substantially conical shape and a closed end, and as shown in FIG. 2, in a free state, is formed to have a shape bent in a hook shape. As shown most clearly in FIG.
An opening 23 is formed in the vicinity of the base 1. Through the opening 23, a metal thin wire bougie, an extra-fine light emitting element (for example, an optical fiber element) or a tube position detecting means is removably inserted into the probe tube portion 21 as described later. The periphery of the opening 23 needs to be formed firmly so as not to be severed. The closed distal end 21a of the probe tube portion 21 is formed to have such a hardness that the bougie does not penetrate when pushed by the distal end of the inserted fine wire bougie. The tip 21
Although a is preferably closed, it may be opened to the extent that it does not cause any trouble. The probe tube portion 21 is bent at an angle α near the opening 23. Opening 23
Is provided on the convex side of the apex position of this bent portion. The angle α is, for example, about 5 degrees. In the illustrated embodiment, one opening 23 is provided at a position separated by a certain distance from both ends 21a.
It is possible in some cases to omit the opening on one side.

Next, a description will be given of a metal thin wire bougie and an extra-fine optical fiber element belonging to the device of the present invention. FIG. 3 shows the bougie 26. This boogie 26
Is made of a very fine metal wire having flexibility but shape retention, and has an outer diameter that can be inserted into the inside of the probe tube portion 21 through the opening 23 as shown in FIG. The base of the bougie 26 is provided with a grip 26a (FIG. 5) for gripping the bougie 26 when the bougie 26 is operated, as described later.

On the other hand, FIG.
In the same manner as the bougie 26, the probe has a flexible ultrafine line having an outer diameter that can be inserted into the probe tube portion 21 through the opening 23. This optical fiber element 30
Has a configuration in which when one end receives light from a light source 31 (FIG. 8), the light travels while reflecting inside. Note that any linear light-emitting body other than the optical fiber can be used as the light-emitting element. For example, a self-luminous body that emits light by itself, for example, a luminous pigment, may be used as a light-emitting element instead of an optical fiber that needs to be supplied with light from a light source. In any case, the self-luminous body needs to be in the form of a flexible ultrafine wire having an outer diameter that can be inserted through the opening 23 into the inside of the probe tube portion 21.

Next, a method of using the nasolacrimal tube device of the present invention having the above-described structure will be described.

First, as shown in FIG. 3, a boogie 26 made of a thin metal wire is inserted into one probe tube portion 21 through an opening 23. At this time, since the opening 23 is at the apex of the bent portion of the probe tube portion 21, the insertion of the thin metal wire bougie 26 from the opening 23 into the probe tube portion 21 can be easily performed. Since the boogie 26 made of a thin metal wire has a linear shape, as shown in FIG.
Is inserted, the bent hook-shaped probe tube portion at the distal end 21a of the probe tube portion 21 disappears.
That is, following the linear shape of the thin metal wire bougie 26, the distal end of the probe tube portion 21 becomes linear as shown in FIG. 3, and the bent shape of the bent distal end 21a disappears.

When the state shown in FIG.
The insertion of the probe tube portion 21 is started from the lower punctal point 1b (FIG. 15) with a first. The inserted probe tube portion 21 proceeds through the lacrimal canaliculus 2b, the total lacrimal canalicular 3, and the lacrimal sac 4,
Eventually, it reaches the position shown in FIG. In this position, the tip 21 a of the probe tube portion 21 has reached the position of the nasal floor wall 15. Completion of insertion of the probe tube portion 21 into a predetermined position can be confirmed at a position immediately before the opening 23 enters the lower punctum 1b.

When the state shown in FIG. 5 is confirmed, the thin metal wire bougie 26 is pulled out as shown by an arrow A as shown in FIG. The removal of the bougie 26 is performed by gripping a knob 26a provided at the base thereof. When the bougie 26 is removed, the tip 21a of the probe tube portion 21 loses the function of maintaining the linear shape by the bougie 26, and the tip 21a returns to its original key shape due to its habit as shown in FIG. As a result, the hook-shaped tip 21a hits the nose bottom wall 15 and the probe tube portion 21 is in a stable state in which it is difficult to come off.

Next, as shown in FIG. 7, an optical fiber element 30 as a light emitting element, which is a feature of the present invention, is inserted in the direction of arrow B through the opening 23 into the probe tube portion 21 from which the bougie 26 has been removed. I do. At this time, the opening 2
The bent shape near 3 facilitates insertion of the optical fiber element 30. The optical fiber element 30 is connected to the probe tube portion 2
1 is as shown in FIG. Since the optical fiber element 30 has low shape retention, even if it is inserted up to the distal end in the probe tube portion 21, the distal end portion 21a bent in a hook shape maintains its shape as shown in FIG. The escape of the probe tube portion 21 against the nose bottom wall 15 is continuously prevented.

The optical fiber element 30 is inserted into the probe tube section 21 as described above, and the light is input from the light source 31 to the optical fiber element 30 as shown in FIG. The optical fiber element 30 shines. Therefore, the probe tube portion 21 shines as a whole in a dark nasal cavity and illuminates the inside of the nasal cavity from the inside because the probe tube portion 21 is light-transmissive (transparent or translucent). For this reason, the surgeon can directly look inside the nasal cavity. Therefore, the operator securely grasps the distal end 21a of the probe tube portion 21 shining in the nasal cavity with, for example, otolaryngological forceps or the hook 33 as shown in FIG. To pull it out of the nasal cavity in the direction of arrow C.

As a result, the indwelling tube portion 20 following the probe tube portion 21 has the lower puncta 1b and the lower canaliculus 2
b, it is drawn into the tear sac 4 and the like. FIG. 10 shows the state.
Shown in In this state, the opening 23 is in the nasal cavity. Next, as shown by an arrow D in FIG.
0 is removed from the probe tube portion 21. As a result, the probe tube portion 21 does not shine.

Subsequently, as shown in FIG. 11, the probe tube portion 21 is further pulled out as shown by an arrow E, and a part of the indwelling tube portion 20 is also exposed. Thereby, the retraction of the indwelling tube portion 20 via the lower punctum 1b is completed.

Next, the insertion operation of the probe tube portion 21 and the indwelling tube portion 20 on the other side is started via the upper punctum 1a. The procedure is basically the same as the above-described procedure via the lower punctal point 1b.
With reference to FIG.

First, as shown in FIG.
After 3, the fine metal wire bougie 26 is inserted into the remaining probe tube portion 21 in the direction indicated by the arrow F. The tip of the remaining probe tube portion 21 is indicated by reference numeral 21b. Then, the probe tube portion 2 is formed by the leading action of the bougie 26 having shape retaining properties in the same manner as described above.
1 is inserted until its tip 21b hits the nose bottom wall 15. When the bougie 26 is removed, the tip 21b bends due to its habit and hits the nose bottom wall 15, and the probe tube portion 21 cannot easily come off as shown in FIG.

Next, the optical fiber element 3 is inserted into the probe tube portion 21 from which the bougie 26 has been removed in the same manner as described above.
When 0 is inserted (not shown), the probe tube portion 21 shines in the nasal cavity, so that the operator can easily grasp the distal end 21b of the probe tube portion 21 with a hook and pull it out. Next, after removing the optical fiber element 30 in exactly the same manner as described above, the probe tube portion 21 on that side is further pulled out to obtain the state shown in FIG. In this state, both ends of the indwelling tube portion 20 have been completely inserted into the lacrimal passage from the upper punctum 1a and the lower punctum 1b, and have been led out of the nasal cavity. And finally,
The probe tube portion 21 is detached from the indwelling tube portion 20, and a knot 13 is formed in the indwelling tube portion 20 in the same manner as in the conventional case shown in FIG. .

The procedure described above is based on the optical fiber element 3
The same applies when a linear self-luminous body is used instead of 0.

In the embodiment described above, a light emitting element having a lighting effect such as the optical fiber element 30 or a self-luminous body is used. Instead of the light emitting element, a probe tube in the lacrimal passage or the nasal cavity is used. "Tube position detecting means" that can detect the position of the portion 21 can also be used. Examples of the tube position detecting means include an ultrasonic probe and an endoscope. The ultrasonic probe to be used is formed in a thin line shape because it is put into and taken out of the probe tube portion 21 through the opening 23. The same applies to the endoscope. The ultrasonic probe emits an ultrasonic wave in the probe tube portion, and detects whether or not the probe tube portion is out of the path that should be originally passed, based on the reflection state of the ultrasonic wave. The operator can see the reflection state of the ultrasonic wave and know the path through which the probe tube is passed. When an ultrasonic probe is used, the probe tube does not necessarily need to be light-transmissive. When an endoscope is used, it is necessary to see the outside of the probe tube portion through the wall of the probe tube portion, so that the probe tube portion needs to be light-transmissive.

[0029]

According to the present invention, as described above, the tube is provided with an opening, so that the light emitting element and the tube position detecting means can be put in and out of the tube through the opening. For this reason, when performing a nasolacrimal tube insertion operation, when a light emitting element is used, the tube itself shines, and the operation of the tube in a dark nasal cavity can be easily and accurately performed while directly viewing the tube with illumination. it can. Then, by forming the distal end of the tube into a curved surface, the insertion of the tube into the lacrimal canal becomes smooth.

When the tube position detecting means is used, the path through which the tube is passed can be known by the detecting means. Therefore, it is possible to avoid problems such as the tube forming a temporary path and damaging the mucous membrane and causing bleeding.

Further, by bending the tube so as to form an angle in the vicinity of the opening, the light emitting element and the tube position detecting means can be easily inserted into and removed from the tube.

Further, the bougie of the wire removably inserted into the tube allows the tube to be reliably introduced into the lacrimal canal.

Also, by giving the distal end of the tube a bend in the shape of a hook in a free state, the distal end of the tube can be brought into contact with the nasal base wall, and the tube can be reliably prevented from returning during the operation. it can.

Furthermore, by forming the probe tube portion of the tube from a material selected from the group consisting of polyolefin, polyamide, or polyurethane alone or a mixture having good shape retention, a sufficient probe effect of the probe tube portion can be obtained. Becomes possible.

[Brief description of the drawings]

FIG. 1 is a perspective view showing an embodiment of a nasolacrimal tube device used for lacrimal reconstructive surgery according to the present invention.

FIG. 2 is an enlarged view showing details of a probe tube portion and an indwelling tube portion of the nasolacrimal tube device shown in FIG.

FIG. 3 is a view similar to FIG. 2, showing a state of inserting a fine metal wire bougie into an opening of a probe tube part shown in FIG. 2;

FIG. 4 is a view similar to FIG. 2, showing a situation where an optical fiber element as a light emitting element is inserted into an opening of a probe tube part shown in FIG. 2;

FIG. 5 is an explanatory diagram showing an initial procedure for performing a lacrimal canal reconstruction operation using the nasolacrimal tube device of the present invention.

FIG. 6 is an explanatory view showing the next procedure for performing a lacrimal canal reconstruction operation using the nasolacrimal tube device of the present invention.

FIG. 7 is an explanatory view showing the next procedure of the lacrimal canal reconstruction operation.

FIG. 8 is an explanatory view showing a further next procedure of the lacrimal canal reconstruction operation.

FIG. 9 is an explanatory diagram showing a procedure that follows the lacrimal remodeling operation.

FIG. 10 is an explanatory view showing a procedure that is further subsequent to the lacrimal canal reconstruction operation.

FIG. 11 is an explanatory view showing a further next procedure of the lacrimal canal reconstruction operation.

FIG. 12 is an explanatory view showing the next procedure of the lacrimal canal reconstruction operation.

FIG. 13 is an explanatory view showing a procedure performed subsequent to the lacrimal canal reconstruction operation.

FIG. 14 is an explanatory view showing a procedure performed after the lacrimal canal reconstruction operation.

FIG. 15 is a medical explanatory diagram of the lacrimal passage and the like.

FIG. 16 is an explanatory view of a conventional nasolacrimal tube.

FIG. 17 is an explanatory view showing a usage mode of a conventional nasolacrimal tube.

FIG. 18 is a view showing a final mounted state of a conventional nasolacrimal tube.

[Explanation of symbols]

T tube 20 indwelling tube portion 21 probe tube portion 21a tip of probe tube portion 21b tip of probe tube portion 23 opening 26 bougie 30 light emitting element (optical fiber element, self-luminous body), tube position detecting means (ultrasonic probe, endoscope) ) 31 Light source 33 Hook α Bending angle

──────────────────────────────────────────────────続 き Continued on the front page (51) Int.Cl. ⁷ Identification symbol FI Theme coat ゛ (Reference) A61L 29/00 A61L 29/00 R A61M 25/00 306D // A61M 25/00 306 314 314 468 468 A61F 9 / 00 590

Claims (20)

[Claims] A flexible tube having a diameter capable of being inserted into the lacrimal passage and placed therein, and an opening formed at a predetermined distance from at least one of both distal ends of the tube; The nasolacrimal tube used for lacrimal canal remodeling surgery, characterized in that the tip of the nose is sharply curved and pointed. 2. The nasolacrimal tube used in lacrimal canal reconstruction surgery according to claim 1, wherein the tube is bent at an angle near the opening with the opening as a vertex. 3. The tube comprises a flexible indwelling tube portion, and a flexible probe tube portion connected to each of both ends of the indwelling tube portion to form an extension of the indwelling tube portion. The nasolacrimal tube used in the lacrimal canal remodeling surgery according to claim 1, wherein the tube is provided. 4. The nasolacrimal tube used in lacrimal canal reconstruction surgery according to claim 3, wherein at least the probe tube portion of the tube is made of a light transmissive material. 5. The nasolacrimal tube used in lacrimal canal reconstruction surgery according to claim 3, wherein the distal end of the probe tube portion has a habit of bending in a hook shape in a free state. 6. The probe tube portion is a polyolefin,
4. The nasolacrimal tube used in lacrimal canal remodeling surgery according to claim 3, wherein the tube is made of a material selected from the group consisting of polyamide and polyurethane alone or in a mixture. 7. A flexible tube having a diameter capable of being inserted and placed in the lacrimal canal, wherein an opening is formed at a predetermined distance from at least one of both ends of the tube. A nasolacrimal tube device for use in lacrimal canal reconstruction surgery, comprising a light emitting element removably inserted into the tube through the opening. 8. A flexible light transmissive probe tube wherein said tube is connected to a flexible indwelling tube portion and to each of both ends of said indwelling tube portion to form an extension of said indwelling tube portion. A nasolacrimal tube device for use in reconstructing lacrimal canal according to claim 7, characterized by comprising: 9. The nasolacrimal tube device for use in reconstructing lacrimal canal according to claim 7, wherein the tube is bent at an angle near the opening with the opening as a vertex. 10. The light emitting device according to claim 1, wherein the light emitting device comprises an optical fiber.
The nasolacrimal tube device used in lacrimal canal reconstruction surgery according to claim 7, wherein a light source is connected to the optical fiber. 11. The nasolacrimal tube device according to claim 7, wherein the light emitting element is made of a self-luminous body. 12. The nasolacrimal tube device used in lacrimal canal remodeling surgery according to claim 7, wherein both ends of the tube are given a habit of bending in a free state in a hook shape. 13. The nasolacrimal duct device for use in reconstructing lacrimal canal according to claim 7, further comprising a wedge made of a wire removably inserted into the tube through the opening. 14. A flexible tube having a diameter capable of being inserted and placed in the lacrimal passage, having an opening formed at a predetermined distance from at least one of both ends of the tube, A nasolacrimal tube device used for lacrimal canal reconstruction surgery, comprising a tube position detecting means inserted removably into the tube through the opening. 15. The tube comprises a flexible indwelling tube portion, and a flexible probe tube portion connected to each of both ends of the indwelling tube portion to form an extension of the indwelling tube portion. 15. The apparatus according to claim 14, wherein the opening is provided in a probe tube portion.
A nasolacrimal tube device for use in the described remodeling surgery. 16. The nasolacrimal tube instrument used in lacrimal canal reconstructive surgery according to claim 14, wherein the tube is bent at an angle near the opening with the opening as a vertex. 17. The nasolacrimal tube device used in lacrimal canal remodeling surgery according to claim 14, wherein said tube position detecting means comprises an ultrasonic probe. 18. The nasolacrimal tube instrument used in lacrimal canal reconstruction surgery according to claim 14, wherein said probe tube portion is made of a light-transmitting material, and said tube position detecting means is made of an endoscope. . 19. The nasolacrimal duct tube device used in lacrimal canal remodeling surgery according to claim 14, wherein both ends of the tube are given a habit of bending in a free state in a hook shape. 20. The nasolacrimal tube device for use in lacrimal canal reconstruction surgery according to claim 14, further comprising a bougie made of a wire that is removably inserted into the tube through the opening.