JPH028740B2 - - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION [Field of Industrial Application] The present invention relates to a ventricular-peritoneal shunt or a ventricular-atrial shunt (hereinafter referred to as "ventricular shunt") that is surgically implanted in the body of a patient with hydrocephalus. ), and particularly relates to a ventricular shunt that can switch the flow rate.

[Conventional technology]

In general, a ventricular shunt consists of a thin tube-shaped ventricular catheter that is inserted into the ventricle, a shunt body (relay chamber) that is connected to this ventricular catheter and consists of a reservoir and a pump chamber, and a shunt body that is connected to the shunt body. It consists of a tube-shaped peritoneal catheter or an atrial catheter that is inserted into the abdominal cavity or atrium.

The shunt body is buried under the scalp on the skull, and inside the shunt body is a relief valve, such as a miter valve, that can be pushed open by the pressure of cerebrospinal fluid, which is fluid discharged from the ventricles. The relief valve functions as a flow rate regulator to regulate the flow rate, and also functions as a check valve.

Examples of such conventional ventricular shunts include the "Plug Valve for Physiological Flow Diversion Mechanism" disclosed in Japanese Patent Application Laid-open No. 117280/1980, which claims priority based on U.S. Patent Application No. 302181, and U.S. Patent Application No. 183463
``Suction control device for physiological drainage'' disclosed in Japanese Patent Application Laid-Open No. 48-41588 with a priority claim based on No.
is proposed.

[Problem that the invention seeks to solve]

By the way, after implantation of a ventricular shunt, it may be necessary to adjust the regulated flow rate using the aforementioned check valve, but in conventional ventricular shunts, the regulated flow rate is fixed by a single relief valve, so the patient's The main body of the shunt, which is to be implanted in the head, etc., is surgically removed.
There is a problem in that the relief valve must be replaced with a relief valve having an adjusted flow rate of another standard.

The present invention is an attempt to solve these problems, and is designed to enable the flow rate to be changed by a simple operation using a driving force from outside the patient's body, without having to replace the shunt body implanted inside the patient's body. The purpose of the present invention is to provide a flow-switchable ventricular shunt.

[Means for solving problems]

For this reason, the flow rate switching type ventricular shunt of the present invention is
A ventricular catheter whose tip is inserted into the ventricle of the brain to drain cerebrospinal fluid from the same ventricle, and a peritoneal catheter whose tip is inserted into the peritoneal cavity or atrium to discharge the cerebrospinal fluid to the peritoneal cavity or atrium. or a ventricular shunt comprising an atrial catheter and a shunt body that is connected to the proximal end of the ventricular catheter and the proximal end of the peritoneal catheter or the atrial catheter, respectively, to communicate the catheters, the peritoneal catheter as described above; Alternatively, the shunt body is provided with a check valve capable of preventing backflow of cerebrospinal fluid from the atrial catheter to the ventricular catheter, and the flow rate of the cerebrospinal fluid sent from the ventricular catheter to the peritoneal catheter or the atrial catheter is switched. A flow rate switching mechanism is provided for, and the flow rate switching mechanism is
a main passage for cerebrospinal fluid formed in the shunt body;
A plurality of flow channels are connected in parallel from a branch part of the main passage toward a peritoneal catheter or an atrial catheter, and each flow channel is inserted into each of the plurality of flow channels and the flow rate in the communicating state of each flow channel is set to a predetermined flow rate. and a plurality of on-off valves that are inserted in each of the plurality of flow paths and can individually shut off each flow path by receiving a driving force from the outside, The valve bodies of the plurality of on-off valves are formed as movable spherical valve bodies that can be moved within the valve chamber and aligned with the valve seats in order to close each on-off valve. The present invention is characterized in that an open position holding circular seat that can be held in an open state is disposed at an end of the valve chamber that branches from the flow path and extends in a direction opposite to the valve seat.

[Effect]

In the above-described flow rate switching type ventricular shunt of the present invention,
By opening and closing the on-off valves inserted in each of the multiple flow paths using a driving force from the outside, the multiple on-off valves in the shunt body are individually controlled to open and close, thereby cutting off communication between the multiple flow paths. The state is controlled, the flow rate is switched, and the flow rate of the cerebrospinal fluid becomes the sum of the flow rates regulated by the flow rate regulator inserted in the flow path in the communicating state.

In addition, since the circular seats for holding the open position are arranged at the ends of the valve chambers that branch from each flow path in the opposite direction to the valve seat, the spherical valve body is held in the circular seat. This is assisted by the hydraulic pressure of the cerebrospinal fluid and is carried out reliably.

[Example] Hereinafter, embodiments of the present invention will be explained with reference to the drawings. Figures 1 to 6 show a flow rate switching type ventricular shunt as a first embodiment of the present invention, and Figure 1 shows the upper wall of the ventricular shunt. FIG. 2 is a longitudinal sectional view (cross-sectional view along arrows in FIG. 1), and FIG. 3a is a cross-sectional view along arrows in FIG. 1. A cross-sectional view taken in the direction of arrows, and FIG.
FIG. 5 is a sectional view taken along the arrow - in FIGS. 1 and 7, FIG. 6 is a plan view showing an enlarged portion of FIG. 1, and FIGS. 7 to 11 are views showing a second embodiment of the present invention. This shows a flow-switchable ventricular shunt as the seventh
The figure shows a plan cross-sectional view with the upper wall removed (cross-sectional view taken along the - arrow in Figure 8), a vertical cross-sectional view (cross-sectional view taken along the - arrow in Figure 7), and Figure 9 shows the 7 is a cross-sectional view taken along arrows in FIG. 7, FIG. 10 is a cross-sectional view taken along arrows XI--XI in FIG. It is a schematic diagram for explaining the effect at the time of burial.

As shown in Figures 1 to 6, the flow-switchable ventricular shunt according to the first embodiment of the present invention has a tubular shape that can be inserted into a patient's ventricle to drain cerebrospinal fluid from the ventricle. a ventricular catheter 2, a peritoneal catheter or an atrial catheter (hereinafter referred to as "peritoneal catheter") 3 whose tip can be inserted into the peritoneal cavity or atrium to send out the cerebrospinal fluid to the peritoneal cavity or atrium;
A shunt made of a soft wall made of silicone resin or the like, which is connected to the proximal end 2a of the ventricular catheter 2 and the proximal end 3a of the peritoneal catheter 3, and has a main passage 10 that allows the catheters 2 and 3 to communicate with each other. The main body (relay room) 1 is comprised of a main body (relay room) 1.

In addition, the shunt main body 1, the ventricular catheter 2, and the peritoneal catheter 3 are provided with a check valve 4 that can prevent backflow of cerebrospinal fluid from the peritoneal catheter 3 to the ventricular catheter 2. valve 4
In this embodiment, slit type relief valves 6 and 7 serving as flow rate adjusting sections of a flow rate switching mechanism 5, which will be described later, also serve this function.

The shunt main body 1 can be attached to the scalp 16 by suturing a suture or the like passing through the suture through hole 15 to the scalp 16.
A main passage 10 is fixed on the skull 17 at the bottom of the main passage 10 and connects to the ventricular catheter 2 and the peritoneal catheter 3, and a small chamber-shaped reservoir 11 is formed on the side of the ventricular catheter 2 of the main passage 10. , main passage 1
A small chamber 12 formed on the peritoneal catheter 3 side of 0
The main passage 10 downstream of the reservoir 11 has a first passage 13 and a second passage 14 that connect the branch passage 10a and the small chamber 12 in parallel.

As shown in FIG. 6, the first flow path 13 has a slit _6a with a predetermined depth D1 that can adjust the flow rate in the communicating state of the first flow path 13 to a predetermined flow rate _Q1 .
a slit-type relief valve 6 as a first flow rate adjusting section formed with a slit-type relief valve 6, and a ball as a first opening/closing valve that can shut off the first flow path 13 by receiving a driving force from the outside of the shunt body 1. A type on-off valve 8 is inserted.

The ball type on-off valve 8 includes a circular valve seat 8a formed on the wall surface of the shunt main body 1, a valve chamber 8b formed in a first flow path 13 on the upstream side opposite to the circular valve seat 8a, and a valve chamber 8b formed in a first flow path 13 on the upstream side opposite to the circular valve seat 8a. A movable spherical valve body 8c is enclosed in the chamber 8b and can be moved by receiving a driving force from a finger 18 from the outside of the soft upper wall 1a and front wall 1b of the valve chamber 8b and the scalp 16, and the valve body 8c is seated. The on-off valve 8 is held between the soft upper wall 1a and the valve body 8c in a position where the valve body 8c is aligned with the valve seat 8a.
between the closed position holding circular seat 8d that closes the first flow path 13 and the soft upper wall 1a at a position where the valve body 8c is separated from the valve seat 8a by seating the valve body 8c. It is composed of a circular seat 8e for holding the open position which is held between the opening and closing valves 8 to open the on-off valve 8 and communicate the first flow path 13. And Enza 8e
is disposed at an end of a valve chamber 8b that branches from the first flow path 13 and extends in a direction opposite to the valve seat 8a.

As shown in FIG. 6, the second flow path 14 has a predetermined depth that can adjust the flow rate in the communicating state of the second flow path 14 to a predetermined flow rate Q ₂ (here, = 1/2Q ₁ ). a slit-type relief valve 7 as a second flow rate adjustment section formed with a slit 7a of size D ₂ (<D ₁ );
The second shaft receives the driving force from the outside of the shunt body 1.
A ball type on-off valve 9 as a second on-off valve capable of blocking the flow path 14 is inserted.

The ball type on-off valve 9 includes a circular valve seat 9a formed on the wall surface of the shunt main body 1, a valve chamber 9b formed in a second flow path 14 on the upstream side opposite to the circular valve seat 9a, and a valve chamber 9b formed in a second flow path 14 on the upstream side opposite to the circular valve seat 9a. A movable spherical valve body 9c that is enclosed in the chamber 9b and can be moved by receiving a driving force from a finger 18 or the like from the outside of the soft upper wall 1a and the soft front wall 1c of the valve chamber 9b and the scalp 16, and the valve body 9c. When the valve body 9c is seated, it is held between the soft upper wall 1a and the open/close valve 9 at a position where the valve body 9c is aligned with the valve seat 9a.
between the closed position holding circular seat 9d that closes the second flow path 14 and the soft upper wall 1a at a position where the valve body 9c is separated from the valve seat 9a by seating the valve body 9c. It is composed of a circular seat 9e for holding the open position which is held between the opening and closing valves 9 to open the opening and closing valve 9 and communicate with the second flow path 14, and is constructed almost in the same way as the ball type opening and closing valve 8 described above. Also in this case, the circular seat 9e is connected from the second flow path 14 to the valve seat 9.
It is disposed at the end of the valve chamber 9b that branches and extends in the opposite direction to a.

The first relief valve 6 has a larger regulated flow rate than the second relief valve 7, and in this embodiment, each of the relief valves 6 and 7 is configured as a single-slit check valve. However, these may be changed to a cross-slit type, a spring-equipped type, or a membrane type.

The movable spherical valve bodies 8c, 9c may be made of plastic or metal, but metal balls coated with silicone resin may also be used.
In the case of movable spherical valve bodies made of plastic, it is desirable to mix a contrast medium into the plastic material so that the position of the movable spherical valve bodies 8c, 9c can be confirmed by X-ray photography as in the case of metal. .

As mentioned above, the flow rate switching mechanism 5 controls the predetermined flow rate.
A _first flow rate switching section 5a includes a slit type relief valve 6 and a ball type on-off valve 8 inserted in a flow path 13 to control the flow of Q1, and a predetermined flow rate Q2 _.
(=1/2Q ₁ ) is composed of a second flow rate switching section 5ab equipped with a slit type relief valve 7 inserted in the flow path 14 and a ball type on-off valve 9, The moving directions F ₁ and F ₂ of the valve bodies 8c and 9c in these on-off valves 8 and 9 are parallel to each other and parallel to the center line L of the shunt body 1.

Since the flow rate switching type ventricular shunt as the first embodiment of the present invention is configured as described above, FIG.
As shown in FIG. 2, when the movable spherical valve bodies 8c and 9c are seated on the open position holding seats 8e and 9e, respectively, the cerebrospinal fluid flowing from the patient's ventricle through the ventricular catheter 2 into the reservoir 11 is released. , passes through the main passage 10 and the first and second flow paths 13, 14, enters the valve chambers 8b, 9b, passes through the two open valves 8, 9, and flows upstream of the relief valves 6, 7. Get on the side.

At this time, if the difference between the pressure of the cerebrospinal fluid upstream of the relief valves 6 and 7 and the pressure of the cerebrospinal fluid downstream of the relief valves 6 and 7 is equal to or greater than a predetermined value, the relief valves 6 and 7 become open, and the small chamber 1
The cerebrospinal fluid flows into the small chamber 12, and the cerebrospinal fluid in the small chamber 12 further flows into the patient's abdominal cavity and atrium through the peritoneal catheter 3.

In this way, the cerebrospinal fluid from the ventricle flows at the maximum flow rate as the sum (Q ₁ +Q ₂ ) of the respective regulated flow rates of the two relief valves 6 and 7.

In this case, the circular seats 8e and 9e for maintaining the open position are both arranged at the ends of the valve chambers 8b and 9b, which branch from the respective flow paths 13 and 14 in the direction opposite to the valve seats 8a and 9a. Therefore, the spherical valve bodies 8c, 9c are reliably held in the conical seats 8e, 9e, assisted by the hydraulic pressure of the cerebrospinal fluid.

Next, if you want the flow rate to be medium _Q1 , as shown by the chain line in FIG. It is sufficient to seat the movable spherical valve body 9c on the circular seat 9d and close the second on-off valve 9, thereby allowing the cerebrospinal fluid to flow only through the first relief valve 6, which has a relatively large regulated flow rate. Can be done.

If you want to make the flow rate even smaller, _Q2 , as shown by the solid line in FIG. It is sufficient to seat the body 9c on the circular seat 9e and close the second on-off valve 9, thereby allowing the cerebrospinal fluid to flow only through the second relief valve 7, which has a relatively small regulated flow rate.

As mentioned above, in this embodiment, the first relief valve 6 and the second relief valve 7 have different regulated flow rates, so the two relief valves 6 and 7 can switch the flow rate in three stages. However, even if both relief valves 6 and 7 have the same regulated flow rate, the flow rate can be switched in two stages: when the flow is allowed to flow to only one of them, and when the flow is allowed to flow to both.

When it is desired to stop the outflow of cerebrospinal fluid via this ventricular shunt, the movable spherical valve bodies 8c and 9c are guided to the closed position holding seats 8d and 9d, respectively, and the first
Then, both the second on-off valves 8 and 9 are closed to block the flow of cerebrospinal fluid from the reservoir 11 to the relief valves 6 and 7 through the main passage 10 and the first and second flow passages 13 and 14. Bye.

In addition, in this first embodiment, as shown in FIGS. 3a to 3d, the valve bodies 8c and 9c are moved from the closed position holding seats 8d and 9d to the open position holding seats 8e and 9e. At this time, the soft upper wall 1a is attached to the scalp 16.
All you have to do is press it with your finger 18.

Further, when moving the valve bodies 8c, 9c from the open position holding seats 8e, 9e to the closed position holding seats 8d, 9d, the soft upper wall 1a and the soft front wall 1b, 1c are moved from the scalp 16. All you have to do is press it with your finger 18.

According to this embodiment, the moving direction of the valve bodies 8c, 9c
Since F ₁ and F ₂ are configured to be parallel to each other, it is easy to see or touch the open/close states of the on-off valves 8 and 9.

A flow rate switching type ventricular shunt as a second embodiment of the present invention is configured as shown in FIGS. 7 to 11, and differs from the first embodiment in the following points.

The orientation of the valve seats 8a, 9a facing the valve chambers 8b, 9b of the ball type on-off valves 8, 9 is set to be inclined toward the center from the moving direction F ₁ , F ₂ of the valve bodies 8c, 9c. .

That is, the center of the small chamber 12' and the circular seats 8d, 9
The first
Flow paths 13 and 14 are formed, and the circular seats 8d,
The circular seat 8 moves from 9d to the moving direction of the valve bodies 8c and 9c.
When tracing in the opposite direction from e and 9e, soft rear walls 1d and 1e forming the outer wall of the shunt body 1 are immediately located.

The rest of the structure is similar to that of the first embodiment, and in FIGS. 7 to 11, the same reference numerals as in FIGS. 1 to 6 indicate substantially the same components.

Therefore, in this second embodiment, FIG.
As shown in ~d, the valve bodies 8c and 9c are moved from the circular seats 8d and 9d for holding the closed position to the circular seat 8 for holding the open position.
When moving toward e, 9e, the soft upper wall 1a
and the soft posterior walls 1d and 1e with fingers 1 through the scalp 16.
8, and it is possible to apply a larger lateral driving force to the valve bodies 8c and 9c than in the first embodiment.

Further, three or more such flow rate switching units may be provided and set to different regulated flow rates. For example, regarding the minimum flow rate Q sequentially, let n be a natural number.
If the regulated flow rate is set to 2 ⁿ times, (2 ⁿ −
1) Step-by-step flow rate switching can be performed.

In addition, in each of the above-mentioned embodiments, orifices with different flow rates may be provided in place of the relief valves 6 and 7, and in this case, the first and second flow paths 1
3 and 14, respectively, or a single check valve is inserted in the main passage 10.

Further, the first and second flow rate switching sections 5a and 5b may be configured such that the moving directions F ₁ and F ₂ of the valve bodies 8c and 9c are orthogonal to the center line L of the shunt body 1.

Furthermore, the valve chambers 8b, 9b and the small chambers 12, 12' may be arranged vertically.

〔Effect of the invention〕

As detailed above, the flow rate switching type ventricular shunt of the present invention includes a ventricular catheter whose tip is inserted into the ventricle and can drain cerebrospinal fluid from the ventricle;
A peritoneal catheter or an atrial catheter whose distal end can be inserted into the peritoneal cavity or the atrium to send the cerebrospinal fluid to the peritoneal cavity or the atrium, a proximal end of the ventricular catheter, and a proximal end of the peritoneal catheter or atrial catheter. The ventricular shunt is provided with a shunt body that is connected to a shunt body that connects each catheter to the ventricular catheter, and is provided with a check valve capable of preventing backflow of cerebrospinal fluid from the peritoneal catheter or the atrial catheter to the ventricular catheter, and The shunt body is provided with a flow rate switching mechanism for switching the flow rate of cerebrospinal fluid sent from the ventricular catheter to the peritoneal catheter or the atrial catheter, and the flow rate switching mechanism is connected to a plurality of flow channels connected in parallel to each other. , a plurality of flow rate adjusting parts inserted in each of the plurality of flow channels and capable of adjusting the flow rate in the communicating state of each flow channel to a predetermined flow rate, and a plurality of flow rate adjusting parts inserted in each of the plurality of flow channels and capable of adjusting the flow rate in the communicating state of each flow channel from the outside. The structure includes a plurality of on-off valves that can individually shut off each flow path in response to the driving force of The simple structure of being disposed on the valve has the advantage that the flow rate switching operation, which has conventionally been considered difficult, can be performed extremely easily and safely, and the flow rate adjustment position can be accurately determined.

In addition, in particular, the circular seats for holding the open position are arranged at the ends of the valve chambers that branch from each flow path in the opposite direction from the valve seat, so that the spherical valve body is held in the open position. There is also the advantage that retention in the conical seat is assisted by the hydraulic pressure of the cerebrospinal fluid and is carried out reliably.

[Brief explanation of drawings]

1 to 6 show a flow rate switching type ventricular shunt as a first embodiment of the present invention, and FIG. 1 is a plan sectional view with the upper wall removed (the
Fig. 2 is a longitudinal sectional view (a sectional view taken in the direction of the arrow in Fig. 1), and Fig. 3a is a - sectional view in Fig. 1.
A cross-sectional view taken in the direction of the arrows, and FIGS. 3b to 3d are schematic diagrams for explaining the action during burial, FIG. 1 and 7 - arrow sectional view, No. 6
The figure is an enlarged plan view of the part shown in FIG.
Figures 7 to 11 show a flow rate switching type ventricular shunt as a second embodiment of the present invention, and Figure 7 is a plan cross-sectional view with the upper wall removed (-
8 is a longitudinal sectional view (cross-sectional view in the direction of the arrow in FIG. 7), FIG. 9 is a sectional view in the direction of the arrow in FIG. 7, and FIG. 10 is a cross-sectional view in the direction of the arrow in FIG. 11a is a sectional view taken along the line XI--XI in FIG. 7, and FIGS. 11b to 11d are schematic diagrams for explaining the operation when buried. 1... Shunt main body (relay room), 1a... Soft upper wall,
1b, 1c...soft front wall, 1d, 1e...soft back wall,
2... Ventricular catheter, 2a... Proximal end, 3... Peritoneal catheter, 3a... Proximal end, 4... Check valve, 5... Flow rate switching mechanism, 5a... First flow rate switching unit, 5b... Second
Flow rate switching part, 6... slit type relief valve as a first flow rate adjustment part, 6a... slit, 7... second
Slit type relief valve as a flow rate adjustment part, 7
a...Slit, 8...Ball type on-off valve as the first on-off valve, 8a...Circular valve seat, 8b...Valve chamber (upstream compartment), 8c...Movable spherical valve body, 8d...Circular seat for maintaining closed position , 8e...Circular seat for holding the open position, 9...Ball type on-off valve as a second on-off valve, 9a...Circular valve seat, 9b...Valve chamber (upstream compartment), 9c...Movable spherical valve body, 9d... Closed position holding circular seat, 9e... Open position holding circular seat, 10... Main passage, 10a... Branch part, 11... Reservoir, 12, 12'... Small chamber (downstream compartment), 13... First flow path , 14... Second channel, 15... Suture through hole, 16... Scalp, 17... Skull, 18... Finger, L... Center line.

Claims (1)

[Scope of Claims] 1. A ventricular catheter whose distal end is inserted into the ventricle of the brain to drain cerebrospinal fluid from the ventricle, and a catheter whose distal end is inserted into the abdominal cavity or atrium to drain the cerebrospinal fluid from the same ventricle. a ventricle comprising a peritoneal catheter or an atrial catheter capable of delivering fluid; and a shunt body connected to the proximal end of the ventricular catheter and the proximal end of the peritoneal catheter or the atrial catheter, respectively, to communicate the catheters; The shunt is provided with a check valve capable of preventing backflow of cerebrospinal fluid from the peritoneal catheter or the atrial catheter to the ventricular catheter, and the shunt body is provided with a check valve for preventing backflow of cerebrospinal fluid from the ventricular catheter to the peritoneal catheter or the atrial catheter. A flow rate switching mechanism for switching the flow rate of cerebrospinal fluid is provided, and the flow rate switching mechanism connects the cerebrospinal fluid main passage formed in the shunt body and the branch part of the main passage to the peritoneal catheter or the atrium. a plurality of flow channels connected in parallel toward the catheter; a plurality of flow rate adjustment sections that are inserted in each of the plurality of flow channels and can adjust the flow rate in a communicating state of each flow channel to a predetermined flow rate; The structure includes a plurality of on-off valves that are inserted into each of the plurality of flow paths and can individually shut off each flow path by receiving a driving force from the outside, and the valve body of the plurality of on-off valves is connected to each of the plurality of on-off valves. an open position holding circle that is formed as a movable spherical valve element that can move within the valve chamber and align with the valve seat to close the on-off valve, and that can hold the movable spherical valve element and hold the on-off valve in an open state; A flow rate switching type ventricular shunt, characterized in that a seat is disposed at an end of the valve chamber branching from the flow path and extending in a direction opposite to the valve seat. 2. The flow rate switching type ventricular shunt according to claim 1, wherein the plurality of flow rate adjustment units are configured to have mutually different regulated flow rates. 3. The flow rate switching type ventricular shunt according to claim 2, wherein each regulated flow rate of the plurality of flow rate adjustment units is sequentially set to 2 ⁿ times the minimum flow rate Q, where n is a natural number. 4 At least one of the plurality of flow rate adjusting parts
is configured as a slit-type relief valve that is pushed open when the pressure of the cerebrospinal fluid on the upstream side of the flow rate adjustment section becomes higher than the pressure of the cerebrospinal fluid on the downstream side by a predetermined pressure or more. The flow-switchable ventricular shunt according to any one of items up to 3. 5. The flow rate switching type ventricular shunt according to claim 4, wherein all of the plurality of flow rate adjustment units are configured as the slit type relief valves and also serve as the check valves.