JPH0632655B2 - Medical guide tube - Google Patents

Description

Detailed Description of the Invention

[0001]

FIELD OF THE INVENTION The present invention is used for sclerotherapy, which is one of the treatment methods for esophageal varices caused by liver disease, in which a drug is injected into a varicose vein to block the inside of a blood vessel to hemostasis / treat it. ,
The present invention relates to a tool that can be used more easily, and that safely and reliably punctures a drug injection needle at a predetermined site.

[0002]

2. Description of the Related Art As a method for treating esophageal varices associated with liver cirrhosis, surgical operations such as esophageal transection have been the mainstream. However, surgical operation cannot be indicated in many cases due to severe liver dysfunction and severe complications, so recently
Surgical practice, August 1985, pages 48-53; Nikkei Medical, July 16, 1984, pages 89-90; End
oscopy, Vol. 15, pp. 136-140 (1983)
As described in the above, it is applicable to most cases of esophageal varices, and the procedure is simpler and safer than surgical operation. The number of cases treated with sclerotherapy) has increased significantly.

There are roughly two types of sclerotherapy.
The first is an endoscopic embolization in which a drug is injected into the esophageal varices to cause blood clots in the esophageal varices themselves and in the blood vessels that are the exclusive blood supply channels of the varices to "harden" and stop bleeding. The second is therapy, in which a drug is first injected around the esophageal varices (extravascular) to harden the esophageal wall by cell fibrosis to prevent variceal bleeding and at the same time to bulge to block blood flow as much as possible. After that, it is an endoscopic sclerotherapy in which a drug is injected into the varicose vein and “hardened” by a thrombus to stop the bleeding. From the point of view of operation, these two methods are different only in the site for injecting the drug, and have the same process for injecting the drug by puncturing a predetermined site in the esophagus with a drug injection needle.

Next, Nikkei Medical, July 1, 1984.
From the 6th issue, pages 89-90, etc., the basic operation of endoscopic embolization therapy will be outlined. As shown in FIG. 4, first, an air tube (2
6) is inserted into the esophagus (20), and the anus balloon (27) is inflated and compressed from the esophageal varix (23) formed in the esophageal wall (22) to the anus or the stomach, and the inflowing blood flow. To reduce blood loss and stop bleeding. Then, the esophageal fiberscope (endoscope) (25) attached with a balloon is inserted into the esophagus (20), and the esophagus fiberscope (25) is inserted.
Align the puncture needle (medicine injection needle) (12) with the position of the esophageal varix (23). Therefore, esophageal varices (23)
After inflating the oral balloon (28) on the more oral side to stop the blood flow and fix the positions of the puncture needle (12) and the esophageal fiberscope (25), the esophageal varices (2)
A puncture needle (12) is inserted into 3) and a curing agent (medicine) is injected. After that, the esophageal fiberscope is removed, a compression hemostatic balloon is inserted, and pressure bonding is performed for 30 minutes to 3 hours when the thrombosis is completed.

At present, the sclerotherapy as described above is becoming the main role in the treatment of esophageal varices, but in these procedures, the esophageal varices are constantly moving due to respiratory movements, etc. Accurate puncture and treatment of varicose veins requires considerable skill, and many points remain to be improved in terms of safety, efficacy, and ease of operation.

[0006]

DISCLOSURE OF THE INVENTION The present invention provides a varicose vein without being affected by respiratory movement in the conventional sclerotherapy procedure which requires skill and cannot fully utilize the effectiveness of the present therapy. It is an object of the present invention to provide a guide tube for an esophageal varices puncture needle, which accurately captures the .

[0007]

That is, the present invention comprises a main lumen and two or more sub-lumens provided on a side wall, and a medical tube for use with an endoscope mounted in the inner lumen of the main lumen. In the above, the tube has one or more side hole portions for accommodating esophageal varices near the distal end portion, and one expandable and contractible outer side tube portion and the tube outer surface near the rear end portion side. It has the above balloons,
The same number of sub-lumens as the number of side holes provided on the side wall of the tube are opened at each side hole, and the same number of balloon sub-lumens as the number of balloons are opened at the inside of each balloon, and A puncture needle guide tube for esophageal varices sclerotherapy, which has branch tubes in the vicinity of the rear end of the tube in the same number as the number of balloons connected to the balloon sublumen.

In the method of using the guide tube according to the present invention, first, the endoscope is attached to an endoscope and inserted into the esophagus, and the esophageal varices are caught in the side hole under direct observation of the endoscope, and then the balloon is inflated. Pressure hemostasis, puncture the esophageal varices caught in the side hole with a puncture needle equipped in the sublumen, inject a drug through the puncture needle to clot and harden the varicose vein, then deflate the balloon and puncture After removing the needle, remove the guide tube.

The embodiment will be described below in detail with reference to the drawings. FIG. 1 is a view showing the entire structure of a guide tube according to an embodiment of the present invention, (c) is a sectional view taken along line AA ′, and FIG. 2 is a view showing another embodiment, (c). FIG. 6 is a sectional view taken along line BB ′. And FIG. 3 is a schematic diagram showing a state in which the esophageal varices are caught in the lateral holes using the guide tube shown in FIG. 2, the balloons are inflated, the mutual positions are compressed and fixed, and the puncture needle is punctured. b) is a CC ′ cross-sectional view.

First, in the embodiment shown in FIG. 1, the tube body (1) comprises a main lumen (2), a sublumen (4) for a puncture needle which is provided in a side wall and is opened at a side hole (3), and It comprises a balloon sub-lumen (6) through which air for inflating a balloon (5) provided near the rear end of the side hole (3) is passed. In the present embodiment, the main lumen (2) is open at the tip of the tube body (1), but it is not always necessary to open it. A side hole for accommodating the esophageal varices is provided near the tip of the tube, and the side hole (3) surrounds the outer surface of the tube at a position adjacent to the tube rear end side and expands. Equipped with a retractable balloon (5),
As described above, the sublumen (4) for the puncture needle is opened in the side hole portion (3), and the sublumen (6) for the balloon is opened in the balloon (5).

On the other hand, at the rear end of the tube body (1), there is provided an adapter (7) which communicates with the sublumen (4) for the puncture needle and which can not only insert the puncture needle but also inject the cleaning liquid. The structure is not particularly limited, but one that can be fitted with a luer is preferable. Further, a branch pipe (8) branched from a balloon sublumen (6) for inflating the balloon (5) is provided near the rear end of the tube body (1), and an air inlet ( 9) is attached, the structure of the air inlet (9) is not particularly limited, but it is preferable that it can be fitted with a lure, and it is convenient to use a one-way valve with a holding opening.

The method of use thereof is basically the same as the example shown in FIG. 3. First, the endoscope (10) is mounted in the main lumen (2) of the guide tube of the present invention, and the esophagus is attached to the endoscope. After inserting into the inside and capturing the esophageal varices (21) in the side hole (3) under direct endoscopic view, the balloon (5) is inflated to more sufficiently capture the esophageal varices (21), A drug is injected by puncturing a puncture needle (12) provided in the lumen (4). At this time, the balloon (5) compresses the adjacent part of the esophageal varix (21) to stop bleeding, and the drug causing a thrombus flows in the blood vessel and scatters, which may cause side effects such as pulmonary complications. Along with the removal, the effect of causing more effective closure is exhibited.

Next, another embodiment shown in FIG. 2 will be described. In many cases, there are usually multiple esophageal varices. On the other hand, when the guide tube has only one side hole (3) as shown in the example of FIG. It is necessary to rotate in the esophagus according to the above, but it is quite difficult to rotate and there is a risk of causing esophageal varices. Therefore, the tube body (1) and the endoscope ( It is necessary to remove and reinsert 10), which not only complicates the operation itself, but also causes a great burden on the patient.

This embodiment is adapted to a case with a plurality of such esophageal varices, so that by providing a plurality of side hole portions in advance, it is possible to rotate the guide tube slightly and either The esophageal varices can be captured at the side hole of the.

A plurality of side hole portions I, II, ... (13, 16, ...) At the same distance from the tip of the tube body (1).
As a result, the balloon (5) is provided at a position adjacent to the rear end side of the balloon (5) while avoiding the position of the side hole.
In addition, a sublumen for a puncture needle (4, 1
4, ...) are provided for each side hole. In addition, the adapter (7) communicating with each sub-lumen, the branch pipe (8) branched from the balloon sub-lumen (6), the air inlet (9) and the like are the same as in the embodiment of FIG. is there.
In this embodiment, a plurality of side holes are arranged on the outer peripheral surface of the tube at the same distance from the tip of the tube body (1), but the longitudinal direction of the tube or a combination of the longitudinal direction and the outer peripheral direction is arranged. You may.

The basic usage thereof is the same as that of the embodiment shown in FIG. 1, except that a plurality of esophageal varices are
The point is that the treatment can be performed sequentially one by one. For example, after injecting a drug into the first esophageal varix (21) using the side hole part I (13), the tube body (1) is slightly rotated under the direct view of the endoscope or is slid in the longitudinal direction. The second side hole II (16)
The esophageal varices are captured and the drug is injected according to a predetermined procedure.
Thereafter, a plurality of esophageal varices are sequentially treated by a similar procedure.

Pressing and stopping the blood vessel near the esophageal varices
The number of balloons for fixing the guide tube is
In the above embodiments, there is only one, but it may be divided into two or more and arranged in the outer peripheral direction of the tube. Depending on the case, any one of the balloons divided into two or more is provided. It is also effective to use one or two or more balloons by changing the degree of inflation of each balloon in order to properly recognize the esophageal varices in the lateral hole. Also, if necessary,
Another balloon may be provided at a position closer to the stomach than the side hole, that is, closer to the tip of the tube. When two or more balloons are provided, it goes without saying that a balloon sub-lumen for introducing air, a branch pipe, and an air inlet are provided for each balloon.

The size of the side hole for accommodating the esophageal varices provided in the tube body (1) is not particularly limited, but the width is 5 to 10 m in relation to the size of the esophageal varices.
m, the length is 15 to 60 mm, preferably 15 to 30 mm.

The tube body (1) of the guide tube in the present invention is formed by using soft plastic, rubber or the like, but is preferably formed by a thermoplastic resin having good transparency. It has a good visibility and is suitable for use. The outer diameter of the tube body (1) is usually 14-22
mm, the side wall has a wall thickness of 1.2 to 2.0 mm, and as can be seen from FIGS. 1 to 3, the side wall where the sub-lumen is provided bulges like a rib to reinforce the tube. Plays the role of. As a result, the guide tube of the present invention has rigidity to the extent that it is not affected by respiratory movement of the esophagus and the like, and further, of the side lumen for capturing the esophageal varices and the sublumen from which the puncture needle is projected. The fact that the positional relationship between the tip open holes is fixed makes it possible to easily and accurately insert the puncture needle into the target esophageal varices.

In the above embodiment, the sublumen (4) for the puncture needle and the sublumen (5) for the balloon are provided in the side wall of the tube body (1), but the main lumen (2).
Other tubes may be combined with each other, and they may be integrally molded without any problem. In addition, a line made of a material capable of X-ray contrast may be included in the entire length direction. As the material of the balloon (5), latex rubber, silicone rubber, soft resin or the like can be used.

Further, a handle-like member may be provided at the rear end of the end of the tube body (1) so that the guide tube can be easily rotated and controlled.

[0022]

INDUSTRIAL APPLICABILITY By using the guide tube according to the present invention in the sclerotherapy of esophageal varices, the tube has an appropriate rigidity, and the side hole for capturing the esophageal varices and the puncture needle are used. Since the mutual positional relationship is constant, only the target esophageal varices can be accurately captured by the side hole without being affected by respiratory movement of the esophagus.
It is also easy to select the puncture site, and since the sublumen for the puncture needle is provided in the side wall of the tube body, the tip of the puncture needle is located at the base of the esophageal varices trapped in the side hole, Since it is possible to insert the puncture needle into the esophageal varix quickly and reliably under direct endoscopic view, the sclerotherapy procedure should be simple, safe, and reliable from the practitioner's perspective. In addition, the use of this tube eliminates the need for a needle channel in the endoscope, so a thinner endoscope can be used, which is less pain and burden for the patient, and is safe. The present invention is epoch-making and useful in terms of medical treatment because effective treatment can be carried out.

[Brief description of drawings]

FIG. 1 is a diagram showing an entire structure of a guide tube according to an embodiment of the present invention, (a) and (b) are schematic diagrams of an upper surface and a side surface, and (c) is a sectional view taken along line AA ′. .

2A and 2B are views showing the overall structure of a guide tube according to another embodiment of the present invention, in which FIGS. 2A and 2B are schematic top and side views, and FIG. 2C is a sectional view taken along line BB ′. is there.

FIG. 3 is a schematic view showing a usage state of the guide tube shown in FIG. 2, and FIG. 3 (b) is a sectional view taken along line CC ′.

FIG. 4 is a diagram for explaining a conventional sclerotherapy procedure.

[Explanation of symbols]

 1, 11 Tube body 2 Main lumen 3, 13, 16 Side hole 4, 14 Subrumen 5 Balloon 6 Sublumen for balloon 8 Branch tube 10 Endoscope 12 Puncture needle

Claims (1)

[Claims] 1. A medical device comprising a main lumen (2) and two or more sub-lumens (4, 6, 14) provided on a side wall, wherein an endoscope is attached to an inner cavity of the main lumen for use. In the tube, the tube has one or more side holes (3,1) for accommodating the esophageal varices near the tip.
3, 16) and one or more balloons (5) that can be inflated and deflated on the outer surface of the tube near the rear end side of the side hole, and the side provided on the side wall of the tube. The same number of sub-lumens (4, 14) as the number of holes are opened at the side holes (3, 13, 16), and the same number of balloon sub-lumens (6) as the number of balloons are provided for each balloon (5). The esophagus is characterized in that it has an opening inside and has as many branch tubes (8) as there are balloons connected to the balloon sub-lumen (6) near the rear end of the tube. A puncture needle guide tube for varicose vein sclerotherapy.