JP4678002B2 - Biological tissue thickness measuring instrument - Google Patents

Description

  The present invention relates to a biological tissue thickness measuring instrument and a biological tissue thickness measuring method.

As a method of administering nutrition to patients who cannot take nutrition orally, enteral nutrition management by percutaneous endoscopic gastrostomy (hereinafter abbreviated as “PEG”) is frequently performed. In order to carry out this PEG, a kit product including a fistula catheter is used.
There are various types of fistula catheters depending on the period of use, and any of these must be replaced with a new catheter after indwelling for a certain period.
On the other hand, there is a fistula button that is used for a long time, but unlike the catheter type, it is generally impossible to adjust the length. When a fistula button shorter than the fistula length from the body surface to the living tissue (for example, in the stomach) is attached, the nutrient channel of the fistula button is not inserted into the living tissue. There is a risk of causing peritonitis because the nutrients and drugs that are used are not accurately injected into the stomach. On the other hand, when a fistula button that is significantly longer than the length of the fistula is attached, there are many portions that protrude from the body surface, which may hinder the patient's life.
Therefore, it is necessary to measure the thickness of the living tissue (the total thickness of the stomach wall and the abdominal wall, that is, the length of the fistula) in advance, and selectively use a fistula button having an appropriate length.
Various instruments for measuring the fistula length of a patient have been proposed (see, for example, Patent Documents 1, 2, and 3).

USP 4972845 USP 5356382 JP 2005-524465 A

An object of the present invention is to provide a biological tissue thickness measuring instrument that can easily and accurately measure the thickness of a biological tissue, is minimally invasive to a patient, and is easy to manufacture.

Such an object is achieved by the present invention described in the following (1) to (6).
(1) A biological tissue thickness measuring instrument that is inserted into a body organ from a body surface portion and measures a body tissue thickness from the body surface portion to the inner surface of the body organ, the first shaft portion and the first shaft portion First in-vivo preventing means attached near the proximal end of the first shaft portion, a notch portion attached near the distal end portion of the first shaft portion, and formed on the distal end side from the position of the notch portion, A first shaft body having a contact portion that contacts an organ;
A second shaft body having a second shaft portion and a second in-vivo preventing means attached near the base end portion of the second shaft portion;
The second shaft main body is opposed to the first shaft main body, and is attached via a hinge portion between the tip of the contact portion and the position of the notch portion, and A living tissue thickness measuring instrument having a guide wire insertion passage in the first shaft portion from the vicinity of the notch portion toward the first shaft portion proximal end side.
(2) The living tissue thickness measuring instrument according to (1), wherein the first shaft portion has at least one first positioning means.
(3) The first positioning means includes a first positioning means A attached to the proximal end side of the first shaft portion and a first positioning means B attached to the distal end side. The biological tissue thickness measuring instrument according to (2), which is provided.
(4) The biological tissue thickness measuring instrument according to (1), wherein the second shaft portion has at least one second positioning means.
(5) The living tissue thickness measuring instrument according to any one of (1) to (3), wherein the contact portion has a groove.
(6) The biological tissue thickness measuring instrument according to any one of (1) to (5), wherein a scale portion is attached to the first shaft portion and / or the second shaft portion.

ADVANTAGE OF THE INVENTION According to this invention, the thickness of a biological tissue can be measured safely and accurately, and the biological tissue thickness measuring instrument which is minimally invasive and easy to manufacture for a patient can be provided.

  The biological tissue thickness measuring instrument of the present invention is a biological tissue thickness measuring instrument that is inserted into the inner surface of a body organ from the body surface part and measures the body tissue thickness from the body surface part to the body organ, comprising the first shaft part and A first in-vivo preventing means attached in the vicinity of the proximal end portion of the first shaft portion, a notch portion attached in the vicinity of the distal end portion of the first shaft portion, and the position of the notch portion. A first shaft body having a contact portion formed on the distal end side, a second shaft portion, and a second in-vivo preventing means attached near the proximal end portion of the second shaft portion. A second shaft main body, the second shaft main body facing the first shaft main body, and a hinge portion between the tip of the abutting portion and the position of the notch portion. It is characterized by being installed.

Further, the measurement method using the biological tissue thickness measuring instrument of the present invention includes inserting the biological tissue thickness measuring instrument from the body surface into the internal organ using the biological tissue thickness measuring instrument, and And measuring the living tissue thickness until the contact portion and the first shaft portion are in a substantially linear state and inserted into a body organ from the surface of the body surface, and the contact portion In the procedure 2 in which the device is brought into a substantially vertical state with respect to the first shaft portion, and in the state of the second procedure, the living tissue thickness measuring instrument is pulled up to the surface of the body surface, and the contact portion is moved into the body organ Procedure 3 for making contact with the inner surface, and procedure for reading the scale attached to the first shaft portion and / or the second shaft portion protruding from the body surface portion by locking the contact portion with the internal organ. 4, the thickness of the living tissue is measured.

Hereinafter, each component will be described in detail with reference to the drawings.
1 (a) and 1 (b) are perspective views showing an embodiment of the biological tissue thickness measuring instrument of the present invention.
As shown in FIG. 1 (a), the biological tissue thickness measuring instrument 1 of the present invention includes a first shaft portion 21 and a first in-vivo prevention device attached near the proximal end portion of the first shaft portion 21. A first shaft main body having means 22, a notch 23 provided near the tip of the first shaft 21, and a contact 24 formed on the tip of the notch 23. 2, a second shaft body 31, and a second shaft main body 3 having a second in-vivo preventing means 32 attached in the vicinity of the proximal end portion of the second shaft portion 31, The second shaft main body 3 faces the first shaft main body 2 and is attached via a hinge portion 4 between the tip of the contact portion 24 and the position of the notch portion 23.

The first shaft portion 21 and the second shaft portion 31 are inserted into the internal organ through the fistula of the patient while facing each other. Therefore, it is preferable that the maximum width of the first shaft portion 21 and the second shaft portion 31 is equal to or less than the size of the formed hole.
For example, when an 8 mm fistula is formed, the total width is preferably 1 to 7 mm. By making the total width within the above range, it can be easily inserted without damaging the fistula at the time of insertion.

  The cross section of the first shaft portion 21 and the second shaft portion 31 is circular or plate-like if the maximum width of the first shaft portion 21 and the second shaft 5 is equal to or less than the size of the patient's fistula. The shape is not particularly limited. Preferably, since it is used by being inserted into the fistula of a patient, it is preferable that the first shaft portion 21 and the second shaft portion 31 are each formed in a semicircular shape and become circular when facing each other. Thereby, the biological tissue thickness measuring tool 1 can be inserted into a patient's fistula with low invasion (small burden). In the case of other than a circle, the corner is preferably chamfered or rounded.

  Although the length of the said 1st shaft part 21 and the 2nd shaft part 31 is not specifically limited, 30-130 mm is preferable and 50-110 mm is especially preferable. If the length is within the above range, a length sufficient for measuring the thickness of the living tissue and good operability can be obtained.

In the vicinity of the tip portion of the first shaft portion 21, a contact portion 24 is attached on the tip portion side of the position of the notch portion 23.
As will be described later, by the sliding operation of the second shaft portion 31 facing the first shaft portion 21, the notch portion 23 and the hinge portion 4 described later are deformed as shown in FIG. The state of the contact portion 24 with respect to the shaft portion 21 can be changed between a substantially linear state in FIG. 1A and a substantially vertical state in FIG. The shape of the notch 23 is not particularly limited as long as the state of the contact portion 24 with respect to the first shaft portion 21 can be changed. The notch 23 may be slit, V-shaped, or any other shape, and may be attached to either surface of the first shaft portion 21 (the back surface of the surface shown in FIG. 1). It is preferable that the thickness of the thinnest portion of the notch 23 is 0.1 to 0.5 mm, particularly 0.1 to 0.3 mm. If it is in the said range, the sliding operativity of the 2nd shaft part 31 and the repeatability intensity | strength of the said notch part 23 can be made favorable. More preferably, the notch portion 23 is preferably attached to a surface of the first shaft portion 21 that faces the second shaft portion 31. By being attached at the above-mentioned position, it is possible to prevent the notch 23 from contacting and pinching the patient's fistula wall surface, and it is possible to safely and easily insert the biological tissue thickness measuring instrument 1 into the patient's fistula. Become.

  The contact portion 24 can be inserted into the fistula of the patient in a substantially straight state with respect to the first shaft portion 21. When the diameter of the patient's fistula is 8 mm, the length of the longest portion of the cross section of the contact portion 24 is preferably 8 mm or less. If it is the said dimension, it will not specifically limit even circular, plate shape, or other shapes. Since it is preferably used by being inserted into a patient's fistula, it is preferably circular. Thereby, the biological tissue thickness measuring instrument 1 can be inserted into a patient's fistula with low invasion. In the case of other than a circle, the corner is preferably chamfered or rounded.

  The contact portion 24 is in contact with the inner surface of the internal organ (for example, the inner surface of the stomach wall) in a substantially vertical state with respect to the first shaft 2. Thereby, the biological tissue thickness measuring tool 1 can be reliably brought into contact with the inner surface of the internal organ and can be hooked. The protruding length of the contact portion 24 (the size of the protruding piece) is not particularly limited as long as it can be reliably contacted, but is preferably 5 to 25 mm. More preferably, it is 10-20 mm. If it is in the said range, operativity is favorable and it can contact | abut on the patient's internal organ inner surface safely and reliably.

  The second shaft portion 31 is attached to the contact portion 24 via the hinge portion 4 between the tip of the contact portion 24 and the position of the notch portion 23. Thereby, the notch part 23 and the hinge part 4 are deform | transformed by sliding operation (up-down direction in FIG. 1) of the 2nd shaft part 31 facing the 1st shaft part 21, and the 1st shaft part 21 is deform | transformed. It is possible to change the state of the contact portion 24 with respect to the substantially linear state and the substantially vertical state.

A state change of the contact portion 24 with respect to the first shaft portion 21 will be briefly described.
By sliding the second shaft portion 31 facing the first shaft portion 21 toward the tip end side of the first shaft portion 21 (downward direction in FIG. 1A), the hinge portion 4 is interposed. Thus, a force is applied to the abutting portion 24 attached in the distal direction. The notch 23 is deformed by this force, and the contact portion 24 can be brought into a substantially linear state with respect to the first shaft portion 21. In this state, the biological tissue thickness measuring instrument 1 is inserted into the patient's fistula safely and easily.

  By sliding the second shaft portion 31 facing the first shaft portion 21 toward the base end side of the first shaft portion 21 (upward in FIG. 1B), the hinge portion A force for pulling up in the direction of the base end portion is applied to the contact portion 24 attached via 4. The notch 23 is deformed by this force, and the contact portion 24 can be brought into a substantially vertical state with respect to the first shaft portion 21. In this state, the contact portion 24 comes into contact with and is locked against the inner surface of the internal organ (for example, the inner surface of the stomach wall).

  As described above, the purpose of the hinge portion 4 is to transmit the force for changing the state of the contact portion 24 with respect to the first shaft portion 21 from the second shaft portion 31 to the contact portion 24. If is achieved, the shape is not particularly limited. Preferably, the thickness of the hinge part 4 is 0.1 to 0.5 mm, particularly 0.1 to 0.3 mm. If the thickness of the hinge portion 4 is within the above range, the sliding operability of the second shaft portion 31, the strength of the hinge portion 4 itself, and the repeatability strength can be improved, and the flowable resin at the time of molding Therefore, there is a possibility that the die manufacturing cost can be reduced.

  The first shaft portion 21 and the second shaft portion 31 have at least one positioning means for defining the substantially straight state and the substantially vertical state of the contact portion 24 with respect to the first shaft portion 21 described above. It is preferable to have one. Thereby, the operator can know the state with respect to the 1st shaft part 21 of the contact part 24 which exists in a patient's internal organ (for example, stomach) from the patient's body outside.

An example of the positioning means is shown in FIGS. 2 (a) and 2 (b).
A first positioning means A211 and a first positioning means B212 are attached to the first shaft portion 21 on the surface where the first shaft portion 21 and the second shaft portion 31 which face each other face each other, and the second shaft portion. By attaching the second positioning means 311 to 31, the above-described function is achieved.
When the second positioning means 311 located between the first positioning means A211 and the first positioning means B212 is in contact with the first positioning means B212, as shown in FIG. In the internal organs of the patient (for example, in the stomach), the abutting portion 24 indicates a substantially straight state with respect to the first shaft portion 21, and when abutting on the first positioning means A211 side, As shown in FIG. 2B, the contact portion 24 is in a substantially vertical state with respect to the first shaft portion 21 in the internal organs of the patient (for example, in the stomach).

  The positioning means described above is an example, and the means is not particularly limited as long as it can define a substantially linear state and a substantially vertical state with respect to the first shaft portion 21 of the contact portion 24. This can be achieved by simply marking the first shaft portion 21 and / or the second shaft portion 31, and is equivalent to the second positioning means for the first shaft portion 21 opposite to the above-described configuration. This is achieved even if the second shaft portion 31 is provided with one corresponding to the first positioning means A and the first positioning means B. Further, a first in-vivo preventing means 22 provided near the base end of the first shaft portion 21 and a second in-vivo preventing means 32 provided near the base end of the second shaft portion 31 described later. It is also possible to use the contact as it is as a positioning means.

As described above, the first in-vivo preventing means 22 and the second in-vivo preventing in the vicinity of the base end portions of the first shaft portion 21 and the second shaft portion 31 (upper side in FIG. 1A). Each means 32 is provided to prevent the biological tissue thickness measuring instrument 1 from accidentally entering the patient's fistula.
If the shape of the first body intrusion prevention means 22 and the second body intrusion prevention means 32 is larger than the diameter of the patient's fistula, the purpose is achieved, and it is substantially perpendicular to the surface in the vicinity of the base end portion of each shaft portion. It may be formed in a direction or may be wider than each shaft, and its shape is not particularly limited.

  The first in-vivo preventing means 22 and the second in-vivo preventing means 32 are also used as gripping portions for sliding the second shaft portion 31 facing the first shaft portion 21 described above. it can. As an anti-slip in this operation, protrusions may be provided, respectively, so that the operation can be performed while the biological tissue thickness measuring instrument 1 is securely grasped. The shape of the non-slip is not particularly limited, and it can function as a non-slip even if it is formed in a concave shape as well as a protrusion.

  As shown in FIG. 3A, the first shaft portion 21 is formed with a guide wire insertion passage 5 for inserting a guide wire and a groove 6 into which the guide wire can be inserted in the contact portion 24. be able to. Thereby, it becomes possible to operate the biological tissue thickness measuring instrument 1 along the already placed guide wire, and the biological tissue thickness measuring instrument 1 can be accurately and safely inserted into the fistula of the patient. .

  Further, in the state where the guide wire is inserted into the living tissue thickness measuring instrument 1 through the guide wire insertion passage 5 and the groove 6, the contact portion 24 described above is substantially perpendicular to the first shaft 2 and substantially perpendicular. Even if the state is changed, since the guide wire path of the contact portion 24 is formed by the groove 6, the guide wire is not bent and the subsequent button exchange operation is not affected at all.

  Furthermore, even if the guide wire is accidentally pulled out of the patient's fistula after inserting the biological tissue thickness measuring instrument 1 into the fistula, the guide wire is inserted into the patient's fistula along the guide wire insertion path 5. It can be reinserted through the fistula into the target site in the body organ.

  The shape of the guide wire insertion passage 5 is not particularly limited, such as a groove or a hole. Preferably, the width, depth, diameter, or the like is preferably 0.9 to 1.5 mm, and particularly preferably 0.9 to 1.2 mm. By making it within the above-mentioned dimension range, the insertion property of the guide wire of 0.035 'inch is particularly excellent. Furthermore, it is more preferable to include a hole 51 on the path of the guide wire insertion path 5 even if it is partial. Thereby, the supplementary function of the guide wire by the biological tissue thickness measuring instrument 1 is improved, and the biological tissue thickness measuring instrument 1 can be inserted into the fistula of the patient more safely and reliably.

 As another embodiment, as shown in FIG. 3B, when the guide wire insertion passage 5 is formed only by a groove, the opening of the groove 6 formed in the contact portion 24 is not formed in the guide wire insertion passage 5. If it is formed so as to be opposed to the opening, it is possible to exhibit the same guide wire supplementing function as the embodiment including the hole 51 even partially in the above-described guide wire insertion path 5.

 The dimension of the groove 6 is not particularly limited, but the diameter is preferably 0.9 to 1.5 mm, and particularly preferably 0.9 to 1.2 mm. When it is within the above dimensional range, the insertion property of a guide wire of 0.035 'inch is particularly excellent.

  The scale 7 can be attached to the first shaft portion 21 and / or the second shaft portion 31 (FIG. 1A). The scale 7 is attached from the upper surface of the contact portion 24 when the contact portion 24 is substantially perpendicular to the first shaft portion 21 toward the base end side (the upper side in FIG. 1A). Is done. That is, the scale 7 indicates the length from the upper surface of the contact portion 24.

  The scale 7 is not particularly limited, but is preferably formed to 5 to 100 mm, and more preferably 10 to 50 mm. Since the length of the formed fistula is generally in the range of 10 to 50 mm, it is practical to form a scale within the above range. The interval between the scales 7 may be formed at any interval as long as the length from the upper surface of the contact portion 24 can be determined, but an interval of 5 mm is particularly preferable. Generally, a commercially available gastrostomy button is a product lineup with an interval of 5 mm, and it is practical to attach a scale 7 at the above interval. Moreover, it is preferable that the shape of the scale 7 can be determined at a glance, and there is no particular limitation even if it is based on numerical description, protrusions, dents, or penetrations.

  Now, examples of the material constituting the living tissue thickness measuring instrument 1 include resin materials such as vinyl chloride resin, polycarbonate resin ABS resin, polyacetal resin, polyamide resin, polypropylene resin, and polyethylene resin. Although not particularly limited, polypropylene resin having high hinge performance is preferable.

  Next, an example of how to use the biological tissue thickness measuring instrument 1 will be described with reference to FIGS. Specifically, a method for measuring the length of the fistula 95 (total thickness of the stomach wall and the abdominal wall) when replacing the fistula button 91 placed in the stomach 96 from the body surface portion 94 will be described.

[1] As shown in FIG. 4, first, the guide wire 92 is inserted into the lumen of the fistula button 91 placed in the patient, and the distal end portion of the guide wire 92 is inserted from the body surface portion 94 into the stomach 96. Detained.

[2] As shown in FIG. 5, the fistula button 91 is pulled out of the body 93 while the guide wire 92 is left in place.

[3] Next, the second shaft portion 31 facing the first shaft portion 21 is slid to the tip end side (the lower side in FIG. 6) of the first shaft portion 21, and the contact portion 24. Is changed to a substantially linear state with respect to the first shaft portion 21. In this state, the end of the guide wire 92 outside the body 93 is inserted into the groove 6 provided in the contact portion 24 of the biological tissue thickness measuring instrument 1 and the guide wire insertion passage 5 provided in the first shaft portion 21. Pass through. The biological tissue thickness measuring instrument 1 is inserted into the fistula 95 along the guide wire 92.
Thus, since the biological tissue thickness measuring instrument 1 is inserted into the patient's fistula 95 along the guide wire 92, the biological tissue thickness measuring instrument 1 is easily guided to an appropriate position, and further, the biological tissue thickness measuring instrument is measured. Since the maximum width of the tool 1 (the total width of the first shaft portion 21 and the second shaft portion 31 or the width of the contact portion 24) is smaller than the size of the hole 95, the hole 95 is damaged. There is no.

[4] After the living tissue thickness measuring instrument 1 is pushed through the fistula 95 and the contact portion 24 is completely inserted into the stomach 96, the second shaft portion 31 facing the first shaft portion 21 is moved to the first. The shaft portion 21 is slid to the base end side (the upper side in FIG. 7), and the contact portion 24 is changed to a substantially vertical state with respect to the first shaft portion 21. In this state, the biological tissue thickness measuring instrument 1 is slowly pulled up, and the upper surface of the contact portion 24 is brought into contact with the stomach wall inner surface 97 to be hooked. Thereafter, the length of the fistula 95 from the stomach wall inner surface 97 to the body surface 94 is read from the scale 7.
At this time, the operator can easily know the state of the contact portion 24 existing in the stomach 96 of the patient with respect to the first shaft portion 21 from the outside 93 of the patient.

[5] When the measurement of the length of the hole 95 is completed, the second shaft 5 portion facing the first shaft portion 21 is slid again to the tip end side of the first shaft portion 21, and the contact portion 24 is changed into a substantially linear shape with respect to the first shaft portion 21 (FIG. 8), and then the living tissue thickness measuring instrument 1 is pulled out of the body 93 with the guide wire 92 in place (FIG. 9).
At this time, the operator can easily know the state of the contact portion 24 existing in the stomach 96 of the patient with respect to the first shaft portion 21 from the outside 93 of the patient.

[6] Finally, a new fistula button 91 suitable for the measured fistula 95 length is inserted along the guide wire 92 in place. After placing the fistula button 91, the guide wire 92 is pulled out of the body 93 (FIG. 10).
As described above, the living tissue thickness measuring instrument 1 of the present invention and the measuring method using the same can be replaced with a new fistula button 91 having an optimum length.

As mentioned above, although the biological tissue thickness measuring tool of this invention was demonstrated based on embodiment of illustration, this invention is not limited to this.
For example, a first shaft part, a notch part, a contact part, a second shaft part, a hinge part, a guide wire insertion path and a groove, a scale, a body intrusion prevention means, a positioning means, etc. The configuration, shape, and the like can be replaced with any configuration that can have the same function.

It is a perspective view which shows the biological tissue thickness measuring tool of this invention. It is a side view of the biological tissue thickness measuring instrument of this invention. It is a perspective view which shows the GW insertion path of the biological tissue thickness measuring tool of this invention. Schematic diagram 1 showing how to use the biological tissue thickness measuring instrument of the present invention Schematic diagram 2 showing how to use the biological tissue thickness measuring instrument of the present invention Schematic diagram showing how to use the biological tissue thickness measuring instrument of the present invention 3 FIG. 4 is a schematic diagram showing a method for using the biological tissue thickness measuring instrument of the present invention. FIG. 5 is a schematic diagram showing how to use the biological tissue thickness measuring instrument of the present invention. FIG. 6 is a schematic diagram showing how to use the biological tissue thickness measuring instrument of the present invention. FIG. 7 is a schematic diagram showing how to use the biological tissue thickness measuring instrument of the present invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Biological tissue thickness measuring tool 2 1st shaft main body 21 1st shaft part 211 1st positioning means A
212 First positioning means B
22 first in-vivo preventing means 23 notch portion 24 abutting portion 3 second shaft body 31 second shaft portion 311 second positioning means 32 second in-vivo preventing means 4 hinge portion 5 guide wire insertion path 51 hole 6 groove 7 scale 91 button for fistula 92 guide wire 93 extracorporeal 94 body surface 95 fistula 96 intragastric 97 stomach inner surface

Claims (6)

A biological tissue thickness measuring instrument that is inserted into a body organ from the body surface part and measures the body tissue thickness from the body surface part to the inner surface of the body organ,
A first shaft portion, a first in-vivo preventing means attached near the proximal end portion of the first shaft portion, a notch portion attached near the distal end portion of the first shaft portion, A first shaft body having a contact portion that is formed on the distal end side from the notch position and contacts a body organ;
A second shaft body having a second shaft portion and a second in-vivo preventing means attached near the base end portion of the second shaft portion;
Consisting of
The second shaft main body is opposed to the first shaft main body, and is attached via a hinge portion between the tip of the contact portion and the position of the notch portion, and the first shaft The living body thickness measuring instrument characterized in that the part has a guide wire insertion path from the vicinity of the notch part toward the base end part side of the first shaft part.  The living tissue thickness measuring instrument according to claim 1, wherein the first shaft portion has at least one first positioning means.  The first positioning means includes a first positioning means A attached to the proximal end side of the first shaft portion and a first positioning means B attached to the distal end side. The biological tissue thickness measuring instrument according to claim 2.    The living tissue thickness measuring instrument according to claim 1, wherein the second shaft portion has at least one second positioning means.    The living tissue thickness measuring tool according to any one of claims 1 to 3, wherein the contact portion has a groove. The biological tissue thickness measuring instrument according to any one of claims 1 to 5, wherein a scale portion is attached to the first shaft portion and / or the second shaft portion.

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