JPH0675566B2 - Endoscope through hole forming set - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION <Industrial field of application> The present invention relates to an endoscope through-hole forming set. More specifically, in the examination, treatment, etc. of various biliary tract diseases or renal diseases, it is used to form a hole for inserting the endoscope, which enables the use of the endoscope immediately after drainage,
Moreover, the present invention relates to an endoscope through-hole forming set capable of reliably preventing the drainage tube from deviating from the abdominal cavity.

<Prior art> In recent years, the endoscopic type has been improved, and the bile duct, gallbladder, renal pelvis,
Percutaneous treatment using an endoscope has come to be performed for various diseases in the ureter. That is, a drainage tube with a diameter of 5 to 6 mm (1 mm is 3 French) necessary for insertion of an endoscope is percutaneously inserted into a luminal organ such as a bile duct, gallbladder, or renal pelvis that requires treatment. By doing so, fibrosis as a foreign body reaction of the living body occurs around the tube, and a fistula is formed as a result. This treatment is performed by taking an endoscope in and out through the fistula.

By the way, in conventional endoscopic treatment, the drainage tube is gradually replaced with a drainage tube with a large diameter at intervals of several days to one week, and the endoscope can be inserted for about one month. Although a fistula with a large diameter was formed, it took too much time to form the fistula, and the pain to the patient was very serious.

Therefore, the present inventor has already proposed a bile duct drainage expansion set in order to shorten the time required for surgical operation and treatment (Shokai Sho 62-78938). This drainage expansion set includes a small-diameter tube into which a guide wire can be inserted, a medium-diameter tube covering the outer circumference of the small-diameter tube, and an outer diameter larger than that of the medium-diameter tube covering the outer circumference of the small-diameter tube. It is characterized in that it is made of a large-diameter tube, and the outer diameter of the tip of each of the tubes is tapered so as to gradually taper. With the use of such a drainage expansion set, the conventional technique required 4 to 5 catheter exchanges at intervals of several days to one week in the conventional technique, whereas it took only about 3 to 5 minutes. In a short time, the fistula can be expanded and a large diameter drainage tube can be inserted, and subsequent endoscopic treatment is also possible.

<Problems to be Solved by the Invention> However, for treatment using an endoscope such as lithotripsy, excision of polyp, and recovery of excised tissue, it is necessary to repeatedly take out and put in the endoscope while grasping the tissue or stone. There is
For that purpose, the fistula between the chest wall and the surface of the liver or between the posterior abdominal wall and the kidney must be firmly adhered, and
A 16-18 French large diameter drainage tube had to be indwelled for 2 to 3 weeks to wait for the fistula to be completed, which caused great pain to the patient.

The present invention has been made in view of the above circumstances, and is an endoscope penetrator capable of reducing damage to human tissues as much as possible and performing not only dilation of a fistula but also endoscopic treatment in a short time. An object is to provide a set for forming an insertion hole.

<Means for Solving the Problems> In order to solve the above problems, the present invention is made of a metal guide wire and a slightly hard synthetic resin, and has flexibility capable of elastically bending, A small-diameter tube through which the guide wire can be inserted into the hollow portion, made of a slightly hard synthetic resin, a medium-diameter tube that can be externally inserted into the small-diameter tube, and made of a slightly hard synthetic resin, Made of a medium to large diameter tube that has a larger outer diameter than the medium diameter tube and can be externally inserted into the small diameter tube, and is made of a slightly hard synthetic resin. A large diameter tube that can be inserted, and a large diameter drainage tube that is made of soft synthetic resin and has the same outer diameter as the large diameter tube and that can be externally inserted into the small diameter tube. Made to a large diameter drainage It consists of an extra-thick tube that can be externally inserted into the tube, and the small-diameter tube, medium-diameter tube, medium-large-diameter tube, and large-diameter tube all have tapered outer diameters at their tips. The set for forming an endoscope through-hole is used, which is characterized by being formed.

<Operation> In the endoscope through-hole forming set of the present invention, the outer diameters of the small-diameter tube and the medium-diameter tube, the medium-large-diameter tube, and the tip of the large-diameter tube are tapered gradually. Since it is formed, it is inserted into the fistula by inserting it into the fistula by inserting it onto the guide wire, and then inserting it into the small-diameter tube and inserting it into the medium-diameter tube, medium-large-diameter tube, large-diameter tube, and fistula Then, the tube gradually expands the fistula while pressing the liver tissue or subcutaneous tissue with the tapered surface in contact with the inner surface of the fistula. Therefore, the degree of destruction of the tissue is extremely small, and there is a hemostasis effect by inserting the tissue while pressing the tissue with the tapered surface. After removing the large-diameter tube, cover the thin tube with the large-diameter drainage tube that has been inserted into the fistula and insert it into the fistula.The extra-thick tube becomes thin, and the outer diameter of the large-diameter drainage tube is large. The extra-thick tube and the large-diameter drainage tube are smoothly inserted because they have the same outer diameter as the tube and are therefore formed thick.

<Example> Next, the Example of this invention is described based on drawing.

FIG. 1 to FIG. 9 are explanatory views of a tube constituting an endoscope through hole forming set according to an embodiment of the present invention.
The figures are external views of a small-diameter tube, FIGS. 2 and 3 are vertical and horizontal sectional views in which the distal end portion of the tube of FIG. 1 is enlarged, respectively, and FIG. 4 is an external view of a medium-diameter tube, 5 The figure is an enlarged vertical cross-sectional view of the tip portion of the tube in FIG. 4, and FIGS. 6 to 9 are external views of a medium-diameter tube, a large-diameter tube, a large-diameter drainage tube, and an extra-thick tube, respectively. Further, FIG. 10 to FIG. 19 are explanatory views for showing the procedure of the endoscopic penetration surgery.

The endoscope through-hole forming set of the present invention includes a guide wire (8), a small diameter tube (1), a medium diameter tube (2),
It consists of a medium-diameter tube (3), a large-diameter tube (4), a large-diameter drainage tube (5), and an extra-thick tube (6), and a thin guide wire (8) inserted into the endoscope application site. The small diameter tube (1) is externally inserted, and then the medium diameter tube (2), the medium large diameter tube (3), the large diameter tube (4), and the extra large thickness tube (6) are externally inserted into the small diameter tube (1). The endoscope through-hole is formed by going through. The large-diameter drainage tube (5) is inserted into the small-diameter tube (1) after the extra-thick tube (6) is inserted, and drains bile at the site where the endoscope is applied. ) And the guide wire (8) are removed.

Hereinafter, each component will be described in detail.

The guide wire (8) is used for guiding the thin tube (1) externally inserted, that is, covered, to the site to which the endoscope is applied, and is generally made of metal such as stainless steel, and its tip depends on the application site. The shape of the part is different. For example, the one shown in FIG. 11 is referred to as a J guide wire having a habit of elastically bending the tip into a J shape, which is preferably used for introducing and guiding a catheter into the bile duct or the like. sell. The J guide wire is inserted into the tube with its tip straightened, and when the tip projects from the opening at the tip of the tube, the tip bends in a J shape, which may damage the bile duct. Absent. A commercially available guide wire (8) can be used.

The small-diameter tube (1) is generally called a dilator, and its inner diameter is generally 0.038 inch so as to fit the size of the guide wire (8).
The outside diameter is 10 French and the total length is about 50 cm. The thin tube (1) is made to have high elasticity, for example, polytetrafluoroethylene, perfluoroalkoxy fluororesin, tetrafluoroethylene hexafluoropropylene copolymer, ethylene tetrafluoride ethylene copolymer, high density polyethylene. It is made of a slightly hard synthetic resin such as
As shown in the enlarged cross-sectional view of FIG. 2, the outer diameter of the taper taper is gradually tapered.

The inner diameter of the medium-diameter tube (2) is 10 French and the outer diameter is 14 so that it can be externally inserted around the outer circumference of the small-diameter tube (1).
The French length is about 20 cm. Similar to the small-diameter tube (1), the medium-diameter tube (2) is made of a slightly hard synthetic resin and is formed such that the outer diameter of its tip 2'is tapered gradually (see Fig. 5). .

The medium-diameter tube (3) has an inner diameter of 10 French so that the medium-diameter tube (1) can be fitted around the outer circumference of the small-diameter tube (1), and the outer diameter is formed to be 16 French which is thicker than the medium-diameter tube (2). The total length is about 20 cm, which is the same as the medium diameter tube (2).
The material of the medium-diameter tube (3) and the shape of the tip portion 3'are the same as those of the medium-diameter tube (2).

The large-diameter tube (4) has an inner diameter of 10 French so that the outer circumference of the small-diameter tube (1) can be externally inserted, and the outer diameter is 18 French, which is thicker than the medium-diameter tube (3). The total length is about 20 cm, which is the same as the medium diameter tube (2). The material of the large diameter tube (4) and the shape of the tip portion 4'are also the same as those of the medium diameter tube (2).

The large-diameter drainage tube (5) has an inner diameter of 10 French so that it can be externally inserted around the outer circumference of the small-diameter tube (1), and the outer diameter is 18 French, which is the same as that of the large-diameter tube (4). 33 cm. Since this large diameter drainage tube (5) is made of soft synthetic resin such as soft polyvinyl chloride or silicone rubber, it has excellent flexibility and elasticity, and its tip is for drainage. Side hole (5 ')
There are a plurality of holes.

The extra-thick tube (6) has an inner diameter of 18 French so that it can be extrapolated to the outer circumference of the large-diameter drainage tube (5).
The outer diameter is 19 French, and the total length is about 20 cm like the large diameter tube (4). The extra-thick tube (6) is also made of a slightly hard synthetic resin like the tubes (1) to (4), but unlike the tubes (1) to (4), as long as the rigidity can be maintained. Is thinly formed in.

Next, using the thin tube (1), the medium tube (2), the medium-thick tube (3), the large-tube (4), the large-drainage tube (5), and the extra-thick tube (6) The procedure of endoscopic penetration surgery will be described.

10 to 19 show the procedure of endoscopic incision surgery for a case of biliary tract disease, wherein (a) is the liver,
(B) shows a bile duct and (c) shows a gallbladder.

First, the guide wire (8) is inserted into the small diameter drainage tube (7) which is percutaneously inserted into the bile duct (b) as shown in FIG. 10 (FIG. 11). Next, as shown in FIG. 12, the small diameter drainage tube (7) is removed while leaving the guide wire (8). Then, as shown in FIG. 13, a small-diameter tube (1) having an outer diameter of 10 French is externally inserted into the guide wire (8) and the distal end (1 ') thereof is bile duct (b).
Insert it sufficiently. At this stage the fistula is expanded to 10 French. Next, as shown in FIG. 14, the medium-diameter tube (2) is externally inserted into the small-diameter tube (1) and inserted while rotating it to the vicinity of the hilum of the liver, and the fistula is further expanded to 14 French. Then, only the medium-diameter tube (2) is removed while leaving the small-diameter tube (1), and the medium-large-diameter tube (3) is externally inserted into the small-diameter tube (1) and inserted while rotating, and the fistula is 16 French. Extended to (15th
Figure). Then, by removing the medium-diameter tube (3) and inserting the large-diameter tube (4) onto the small-diameter tube (1) while rotating it, the fistula is further expanded to 18 French (Fig. 16). . Next, the large-diameter tube (4) is removed, and the large-diameter drainage tube (5) covered with the extra-thick tube (6) is externally inserted into the small-diameter tube (1) and sufficiently inserted into the bile duct (Fig. 17). . This large diameter drainage tube (5)
Since the outer diameter is the same as that of the large diameter tube (4), it can be inserted without resistance although it is made of a soft synthetic resin. From the tip of the large diameter drainage tube (5)
Adjust so that the tip of the extra-thick tube (6) is positioned in front of cm, and insert while adding rotation. When the extra-thick tube (6) reaches the bile duct lumen, the thin tube (1) and the guide wire (8 ) Is removed (Fig. 18). This allows biliary drainage. Finally, as shown in FIG. 19, when the large diameter drainage tube (5) is removed while leaving the extra thick tube (6), an endoscope with a diameter up to 18 French which is the inner diameter of the extra thick tube (6) is inserted. Therefore, it is possible to smoothly perform not only biopsy but also operation such as excision of polyp, collection of excised tissue and excision of calculus. After the treatment is completed, a large-diameter drainage tube (5) is inserted through the extra-thick tube (6) so that the same state as shown in Fig. 18 is obtained, and percutaneous drainage is performed.

The present inventor has applied the endoscopic incision formation set according to the present invention to cases of various bile duct diseases such as common bile duct stones, bile duct stenosis, gallbladder stones, gallbladder polyps, ureteral stenosis, and ureteral stones, and illustrated. We succeeded in inserting a percutaneous extra-thick tube not only into the isolated bile duct but also into the gallbladder and renal pelvis, but no complications were confirmed at that time.

The lengths and inner and outer diameters of the tubes are not necessarily limited to the dimensions of the embodiment, and appropriate dimensions can be selected according to the case to which they are applied. Further, the medium diameter tube and the medium diameter tube can be appropriately omitted and used as necessary.

<Effects of the Invention> As is apparent from what has been described above, when the endoscopic through-hole forming set of the present invention is used, the degree of tissue destruction is extremely small, and the tissue is formed by the tapered surface of the tube. Since there is also a hemostatic effect due to compression, it is possible to insert the extra-thick tube required for inserting the endoscope very safely and in a short time.

Further, various endoscopic treatments such as polypectomy, which conventionally requires the insertion and removal of an endoscope, required a fistula formation period of about 3 weeks until a fistula between the chest wall and the liver surface was sufficiently formed. However, if the endoscope through-hole forming set of the present invention is used,
Since the extra-thick tube substitutes for the fistula, the endoscope can be immediately taken in and out without requiring a fistula formation period at all.
Further, since the endoscope can be smoothly taken in and out, the time required for treatment can be greatly shortened, and the pain of the patient can be greatly reduced.

Furthermore, conventionally, the drainage tube is sutured to the skin every time endoscopic treatment is performed, which is very painful for the patient. However, in the set of the present invention, since the extra-thick tube is sutured and fixed to the skin at the time of the first drainage, it is sufficient to tie the newly inserted drainage tube and the extra-thick tube with a thread at the end of the endoscopic treatment thereafter. , No need to sew drainage tube to patient's skin after each drainage.

Moreover, since the extra-thick tube was placed together with the drainage tube, the intra-abdominal deviation of the drainage tube, which sometimes occurred due to the bending of the tube on the surface of the liver due to body movement, was almost eliminated. When an abdominal deviation occurs,
Serious complications such as biliary peritonitis, which can be life-threatening for the patient, necessitate emergency drainage.

[Brief description of drawings]

FIG. 1 to FIG. 9 are explanatory views of a tube constituting an endoscope through hole forming set according to an embodiment of the present invention.
The figures are external views of a small-diameter tube, FIGS. 2 and 3 are vertical and horizontal sectional views in which the distal end portion of the tube of FIG. 1 is enlarged, respectively, and FIG. 4 is an external view of a medium-diameter tube, 5 The figure is an enlarged vertical cross-sectional view of the tip portion of the tube in FIG. 4, and FIGS. 6 to 9 are external views of a medium-diameter tube, a large-diameter tube, a large-diameter drainage tube, and an extra-thick tube, respectively. Further, FIG. 10 to FIG. 19 are explanatory views for showing the procedure of the endoscopic penetration surgery. 1 ... Thin tube, 2 ... Medium tube, 3 ... Medium tube, 4 ... Large tube, 5 ... Drainage tube, 6 ... Extreme tube, 8 ... Guide wire.

Claims (2)

[Claims] 1. A guide wire made of a metal, and a thin tube made of a slightly hard synthetic resin, having a flexibility capable of being elastically bent, and having a hollow portion into which the guide wire can be inserted. Made of a slightly hard synthetic resin, and a medium diameter tube that can be extrapolated to the small diameter tube, and made of a slightly hard synthetic resin, the outer diameter is larger than that of the medium diameter tube, and is externally inserted to the small diameter tube. Uru medium and large diameter tube, made of a slightly hard synthetic resin, the outer diameter is larger than the medium large diameter tube, a large diameter tube that can be externally inserted into the small diameter tube, and made of a soft synthetic resin, A large diameter drainage tube that has an outer diameter equivalent to that of the large diameter tube and can be externally inserted into the small diameter tube, and a very thick tube that is thinly made of a slightly hard synthetic resin and can be externally inserted into the large diameter drainage tube. , Consists of The thin tube, the medium diameter tube, the medium large diameter tube, and the large diameter tube are all formed such that the outer diameter of the tip portion thereof is tapered gradually. Insert hole forming set. 2. The slightly hard synthetic resin is selected from the group consisting of polytetrafluoroethylene, perfluoroalkoxy fluororesin, tetrafluoroethylene hexafluoropropylene copolymer, ethylene tetrafluoride ethylene copolymer and high density polyethylene. The endoscope through-hole forming set according to claim 1, which is at least one of the following.