JP2003320021A - Indwelling tube - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an indwelling tube allowing an operator to clearly grasp the position of the indwelling tube when inserting the indwelling tube into a narrowed part inside a body cavity and indwelling it there while observing through an endoscope. <P>SOLUTION: The indwelling tube 1 to be inserted into the body cavity and indwelled while being confirmed through an endoscope comprises an indwelling tube body 2 with a lumen 29 and at least a pair of flaps 3 longitudinally separately disposed and projecting outward in the radial direction on the outer peripheral surface of the indwelling tube body. The outer surface of one flap 3a on the proximal side of the flaps is colored differently from the indwelling tube body to make the flap clearly discriminated. <P>COPYRIGHT: (C)2004,JPO

Description

Description: BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an indwelling tube which is inserted into a body cavity of a patient while being checked with an endoscope and is indwelled. [0002] For example, as a treatment for discharging bile and the like accumulated in a bile duct, a stent as an indwelling tube is guided endoscopically to a stenotic portion of the bile duct, and the stent is placed in the stenotic portion. 2. Description of the Related Art Bile collected in a bile duct is drained through a lumen of a stent as an indwelling tube. [0003] For example, a stent is disclosed in Japanese Utility Model Laid-Open No. 63-20.
As shown in Japanese Patent Publication No. 854, a relatively flexible pipe-shaped stent body made of a polymer compound such as polyethylene or silicone rubber is used. A pair of flaps facing each other are provided. [0004] A procedure for guiding the stent having the above-described structure into a body cavity endoscopically and placing it in a stenotic part of the bile duct is performed in the following procedure. That is, as shown in FIG. 7, a long guide wire 9 made of a flexible wire is inserted into a forceps channel 8 provided in the insertion portion 7 of the endoscope 6, and the guide wire 9 is viewed through the endoscope 6. It is guided to the bile duct 4 together with the insertion portion 7 of the mirror 6. Next, the guide wire 9 is advanced by the operation on the hand side to pass through the stenosis portion 5, and then the stent 1 is moved to an appropriate position by the pusher tube 10 using the guide wire 9 passing through the stenosis portion 5 as a guide. Push the stent 1 in place. Normally, the distal end of the stent 1 is located at the back of the stenosis 5. In addition, the proximal end is located slightly before the bile duct outlet so that the presence or absence of clogging due to solidification of bile or the like in the stent lumen can be confirmed on an endoscopic image. At this time, the distal flap is located slightly behind the stenosis 5 and the proximal flap is located slightly before the bile duct outlet so that the stent is not easily displaced. The indwelling is performed while confirming the flap with the endoscope image. As shown in FIGS. 8 (a) and 8 (b), the flap is formed by making a V-shaped cut in the stent body 2 and inserting the V-shaped portion into the stent body 2.
By bending outward from the root in the radial direction, the sharp portions 11 are formed so as to face each other. Therefore, the flap 3 and the stent main body 2 have the same color, and FIG.
As shown in (1), it was difficult to confirm whether the stent 1 was inserted into the stenotic part 5 to a predetermined depth under an endoscope. Further, depending on the color of the stent 1, halation may occur under the endoscope, and the visibility may be impaired. Therefore, when the stent 1 is pushed into the stenotic part 5 under an endoscope, the position of the flap 3 cannot be accurately captured, and the stent 1 may be pushed until the flap 3 enters the bile duct. When the flap 3 is located in the bile duct, since there is no portion where the flap 3 is hooked, the position of the stent 1 may be displaced by movement due to biological movement such as respiration. 1
Had to be pulled back to perform the positioning operation, which was very troublesome. Further, since it is difficult to confirm the position of the flap 3, the time required for the principle is long, and the burden on the patient may be increased. An object of the present invention is to provide an indwelling tube that allows the position of a flap to be clearly grasped when the indwelling tube is inserted into a stenosis in a body cavity and is indwelled while looking through an endoscope. According to the first aspect of the present invention, there is provided an indwelling tube inserted into a body cavity and placed therein while confirming with an endoscope. At least one pair of flaps provided on the outer peripheral surface of the tube main body so as to be spaced apart in the longitudinal direction and protrude radially outward, and the outer side surface of the flap provided on the proximal side of the flaps, The indwelling tube is provided with a marking for clarifying the flap. According to the present invention, the flap becomes clear when the indwelling tube is inserted into the body cavity of the patient under the endoscope, so that the position of the flap can be easily captured. An embodiment of the present invention will be described below with reference to the drawings. The indwelling tube 1 shown in FIG. 1 has an indwelling tube main body 2 having a lumen 29. The indwelling tube main body 2 is a relatively flexible hollow pipe made of a biocompatible polymer compound such as polyethylene or silicone rubber, and preferably has an outer peripheral surface coated with a hydrophilic lubricant. A pair of flaps 3 are provided on the outer peripheral portions near both ends in the longitudinal direction of the indwelling tube main body 2 to prevent removal. These flaps 3 are cut into the indwelling tube main body 2 in a V-shape, and the V-shaped portion 4 formed thereby is sharpened by the sharp portion 6 at the tip.
Is formed by bending at the root portion 5 so as to face each other on the radial outside. The outer surface of the flap 3a on the proximal side of the flaps 3 is colored in a different color from the indwelling tube main body 2 as a marking. Laser marking may be used for coloring. As the indwelling tube 1, a flap 3 may be formed by another member and added to the outer peripheral portion of the indwelling tube main body 2. An indwelling tube guide device 20 shown in FIG. 2 is used to guide the indwelling tube 1 configured as described above into a body cavity endoscopically and indwell in a stenotic part of a bile duct. In FIG. 2, (a) indwelling tube guide device 20
, A partially cutaway side view, (b) is a cross-sectional view taken along line AA,
(C) is a sectional view along the line BB, and (d) is a side view of the indwelling tube guide device 20. The indwelling tube guide device 20 is a long guide catheter 2 that can be inserted into a forceps channel of an endoscope.
One. The guide catheter 21 is formed of a flexible synthetic resin material, for example, a fluorine-based resin or a nylon-based resin. The guide catheter 21 has a lumen 22 formed over its entire length, and a guide catheter cock 23 is provided at a proximal end of the guide catheter 21. The indwelling tube 1 is fitted to the distal end of the guide catheter 21. A guide wire 24 is inserted through a lumen 22 of the guide catheter 21. The guide wire 24 is formed of an elongated metal stranded wire, and its distal end is tapered, and its proximal end extends from the guide catheter cock 23. A pusher tube 25 made of a flexible synthetic resin is fitted to the guide catheter 21 on the proximal side of the fitted indwelling tube 1 so as to be able to advance and retreat in the axial direction. A pusher tube cock 26 is provided at a proximal end of the pusher tube 25. A flexible wire 27 is inserted between the outer peripheral surface of the guide catheter 21 and the inner peripheral surface of the pusher tube 25 so as to be able to advance and retreat in the axial direction. The distal end of the flexible wire 27 is pressed and engaged between the inner peripheral surface of the indwelling tube 1 and the outer peripheral surface of the guide catheter 21. An operating ring 28 provided at the proximal end of the flexible wire 27 extends out of the pusher tube cock 26. When the indwelling tube 1 is introduced endoscopically into a body cavity using the indwelling tube guide device 20 having the above-described configuration and is indwelled in a stenosis of a bile duct, first, a guide catheter 21 and a pusher tube are inserted. 25, the indwelling tube 1 is fitted to the distal end of the guide catheter 21, and the flexible wire 27 is inserted between the indwelling tube 1 and the guide catheter 21. Press in the distal end. On the other hand, the insertion portion of the endoscope is inserted into the body cavity, and the distal end component is guided to the vicinity of the bile duct. Indwelling tube 1
Has its proximal end abutted against the distal end of pusher tube 25. Next, guide wire 2 is inserted into the forceps channel of the endoscope.
4, the guide wire 24 is advanced under the endoscope, and the distal end of the guide wire 24 is guided to the stenosis of the bile duct. Next, the indwelling tube guide device 20 in which the indwelling tube 1 is set is inserted through the guide wire 24 from the proximal end of the guide wire 24, and the indwelling tube guide device 20 is inserted into the forceps channel using the guide wire 24 as a guide. . Then, the guide wire 24 is advanced by the operation of the hand side and passed through the stenosis,
Thereafter, the indwelling tube guide device 20 is advanced by using the guide wire 24 that has passed through the stenosis to push the indwelling tube 1 until the flap 3a provided on the proximal side is located slightly before the bile duct outlet,
The indwelling tube 1 is indwelled. At this time, since the indwelling tube 1 is fitted to the guide catheter 21,
Even if 4 is bent at a large bending angle, it does not buckle,
The indwelling tube 1 advances integrally with the indwelling tube guide device 20 and can be guided to a target site. When the indwelling tube 1 is inserted into the stenosis by the indwelling tube guide device 20, it is confirmed that the indwelling tube 1 has been pushed too deeply under the endoscope, that is, the flap 3a has entered the bile duct. Then, the indwelling tube 1 is pulled back by pulling back the indwelling tube guide device 20 to the proximal side. At this time, since the flap 3a is colored in a color different from that of the indwelling tube main body 2, the flap 3a becomes clear under the endoscope, and the flap 3a of the indwelling tube 1 is located slightly before the bile duct outlet. In this way, positioning and placement can be reliably performed. So flap 3
Since a can be firmly hooked on the bile duct outlet, the indwelling tube 1 is fixed so as not to move in the body. Further, the flap 3a becomes clear,
Since the time required for the procedure can be reduced, the burden on the patient can be reduced. Next, while holding the guide catheter 21 and the pusher tube 25, the operator puts his / her finger on the operation ring 28 and pulls the flexible wire 27 to the proximal side, and the distal end of the flexible wire 27 becomes a guide. The flexible wire 27 and the indwelling tube 1 are separated from the catheter 21 and the indwelling tube 1 and separated from each other. Thereby, the indwelling tube 1 is indwelled in the stenosis. At this time, since the distal end of the guide wire 24 is located at the stenosis, and the guide wire 24 is inserted through the guide catheter 21, the next treatment is performed using the guide wire 24 as a guide. It is also possible to do. In addition, since the guide catheter 21 has the lumen 22, the liquid is sent from the guide catheter cock 23,
It is also possible to suck. FIGS. 3 to 6 show modified examples of the marking applied to the flap 3 of the embodiment, wherein FIG. 3A is a side view of the indwelling tube 1 and FIG. (C) is a schematic view showing a proximal portion of the indwelling tube 1 during a procedure as viewed from an endoscope. That is, FIG. 3 shows that the outer surface of the flap 3a provided on the proximal side of the indwelling tube 1 is colored in a color different from that of the indwelling tube main body 2, and further, a fold is formed at the root 5 of the outer surface of the flap 3. Are drawn on the outer surfaces of the indwelling tube main body 2 and the flap 3 in different colors from the respective colors. FIG. 4 shows that instead of coloring the outer surface of the flap 3a provided on the proximal side of the indwelling tube 1 with a color different from that of the indwelling tube main body 1, the peripheral edge of the flap 3a is inflated by the indwelling tube main body 2. It is bordered by a different color. FIG. 5 shows that instead of coloring the outer surface of the flap 3a provided on the proximal side of the indwelling tube 1 with a color different from that of the indwelling tube body 1, the peripheral portion of the flap 3 is inflated. And a plurality of lines drawn along the longitudinal direction of the indwelling tube main body 2 inside the edged portion. FIG. 6 shows that instead of coloring the outer surface of the flap 3a provided on the proximal side of the indwelling tube 1 with a color different from that of the indwelling tube body 1, the outer peripheral edge of the flap 3 is inflated. And a plurality of lines are drawn inside this portion substantially parallel to the fold of the flap 3. According to the above embodiments, the following configuration is obtained. (Supplementary Note 1) In an indwelling tube to be inserted into and indwelled in a body cavity while being checked with an endoscope, an indwelling tube main body having an inner cavity is separated from an outer peripheral surface of the indwelling tube main body in a longitudinal direction, and At least one pair of flaps provided so as to protrude radially outward, and a marking for clarifying the flap is provided on an outer surface of a flap provided on a proximal side of the flaps. An indwelling tube characterized in that: (Supplementary Note 2) The indwelling tube according to Supplementary Note 1, wherein the marking is provided in a color different from that of the indwelling tube main body. (Supplementary note 3) The indwelling tube according to Supplementary note 1, wherein the marking is performed by laser marking. According to the present invention, an indwelling tube can be appropriately placed in a stenosis in a body cavity.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 shows an indwelling tube according to an embodiment of the present invention, wherein (a) is a side view, (b) is a front view, and (c) is a technique viewed from an endoscope. Schematic showing the proximal portion of the indwelling tube inside. 2A and 2B show an indwelling tube guide device, wherein FIG. 2A is a partially cutaway side view of the indwelling tube guide device, and FIG.
-C is a cross-sectional view along the line A, (c) is a cross-sectional view along the AA line,
(D) is a side view. 3A and 3B show a modification of the marking applied to the flap, wherein FIG. 3A is a side view of the indwelling tube, FIG. 3B is a front view of the indwelling tube, and FIG. 3C is indwelling during the procedure as viewed from the endoscope. FIG. 3 is a schematic diagram showing a proximal portion of a tube. 4A and 4B show a modification of the marking applied to the flap, wherein FIG. 4A is a side view of the indwelling tube, FIG. 4B is a front view of the indwelling tube, and FIG. 4C is indwelling during the procedure as viewed from the endoscope. FIG. 3 is a schematic diagram showing a proximal portion of a tube. 5A and 5B show a modification of the marking applied to the flap, wherein FIG. 5A is a side view of the indwelling tube, FIG. 5B is a side view of the indwelling tube, and FIG. 5C is indwelling during the procedure as viewed from the endoscope. FIG. 3 is a schematic diagram showing a proximal portion of a tube. 6A and 6B show a modified example of the marking applied to the flap, wherein FIG. 6A is a side view of the indwelling tube, FIG. 6B is a front view of the indwelling tube, and FIG. FIG. 3 is a schematic diagram showing a proximal portion of a tube. FIGS. 7A and 7B are explanatory views of a procedure for guiding a stent into a body cavity endoscopically and placing the stent in a stenosis of a bile duct. FIG. 8 shows a conventional flap, (a) is a plan view,
(B) is a side view, and (c) is a schematic diagram showing a proximal portion of an indwelling tube during a procedure viewed from an endoscope. [Description of Signs] 1 ... indwelling tube 2 ... indwelling tube body 3, 3 a ... flap 29 ... lumen

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Claims (1)

Claims: 1. An indwelling tube inserted into a body cavity and indwelling while confirming with an endoscope, comprising: an indwelling tube main body having an inner cavity; and an outer peripheral surface of the indwelling tube main body having a longitudinal direction. And at least one pair of flaps provided at a distance from each other and protruding radially outward, and a marking for clarifying the flap is provided on an outer surface of a flap provided on a proximal side of the flaps. An indwelling tube characterized by being provided with: