JP2008018007A - Catheter for peritoneal dialysis - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a catheter provided with a means capable of observing intraperitoneal conditions by an endoscope periodically in a low invasion manner. <P>SOLUTION: The catheter for peritoneal dialysis, which is opened at both ends, comprises: an intraperitoneal detention part to be placed inside the abdominal cavity; an external projection part projected to the outside of the body; and an abdominal wall fixing part positioned in the middle of the intraperitoneal detention part and the external projection, wherein a slit for communicating the outer side and inner side of the catheter is provided between the distal end of the intraperitoneal detention part and the abdominal wall fixing part, and a projection part is provided on a position crossing the slit on the inner surface of the catheter. <P>COPYRIGHT: (C)2008,JPO&INPIT

Description

The present invention relates to a catheter. More specifically, the present invention relates to a catheter that is placed in the body when performing peritoneal dialysis therapy (hereinafter also referred to as peritoneal dialysis, PD), and injects and drains dialysate into the abdominal cavity.

Peritoneal dialysis (also referred to as PD) is a flexible catheter placed in the abdominal cavity of a patient with renal failure, and the dialysate is stored in the abdominal cavity through the catheter. The function of the kidneys is complemented by exchanging water several times a day and exchanging it multiple times a day to discharge toxins and excess water from the body. Compared with hemodialysis, this treatment is useful in that it has less influence on the circulatory system because dialysis is performed over a long period of time in vivo, and that the restraint time during dialysis is short.

Examples of complications particularly problematic when peritoneal dialysis are performed include peritonitis and encapsulating peritoneal sclerosis (also referred to as EPS). Peritonitis is caused by invasion of bacteria into the abdominal cavity via a catheter, and EPS is caused by long-term peritoneal dialysis, composition of dialysate, peritoneal function deterioration due to peritonitis and the like. Both of these are diseases that require the peritoneal dialysis to be temporarily interrupted, and in severe cases, are related to the life of the patient. Therefore, it is important to detect lesions and treat them at an early stage of onset.

Current methods for testing and diagnosing peritoneal conditions and peritoneal function include examination of dialysate discharged after storage, and peritoneal equilibrium test (also called PET) that predicts peritoneal function from the amount of water removed and the amount of solute removed. ), Patient interviews. However, since either method is a method of estimating the function / state of the peritoneum from the test results, it is difficult to determine the onset of peritonitis / EPS only by these tests. In general, after performing these examinations, if you suspect the onset of peritonitis or EPS due to symptoms or signs, perform image diagnosis, endoscopy, tissue biopsy, etc., and then diagnose It is used. For this reason, even if peritonitis or EPS develops, it often takes time to find it, and there are cases where the symptoms have already progressed when the onset is observed. Then, it becomes difficult to treat peritonitis and EPS, and it becomes difficult to perform peritoneal dialysis.

In order to detect the onset of peritonitis and EPS at an early stage, it is effective to regularly observe the intraperitoneal state with an endoscope. However, as referred to in Non-Patent Document 1, in order to introduce an endoscope into the abdominal cavity, the abdomen must be incised, which is painful and burdensome for the patient. In peritoneal dialysis therapy in which fluid is stored in the abdominal cavity, it is not desirable to repeat the incision in the abdomen, and regular observation cannot be performed. Therefore, a method for introducing an endoscope into the abdominal cavity using a catheter used for peritoneal dialysis was examined.

When a general catheter for peritoneal dialysis is used, an endoscope is inserted through the dialysate flow path. Normally, a peritoneal dialysis catheter has a flow path that connects the outside and the inside of the tube only at the opening at both ends and the side hole at the distal end of the intraperitoneal indwelling portion. Therefore, when an endoscope is inserted from the dialysate flow path, the endoscope is inserted into the abdominal cavity from a deepened portion in the abdominal cavity called a Douglas fossa as shown in FIG. For this reason, the field of view of the endoscope is limited within a narrow range, which is not preferable for observation in the abdominal cavity.

In addition, when a catheter having a plurality of channels as shown in Patent Document 1 is used in the same manner, the endoscope can be exposed to the abdominal cavity before reaching the Douglas fossa. It can be said that it is suitable. However, since the catheter is used on the premise that dialysate is always passed through any of the passages, it does not have a mechanism for preventing liquid from entering when the passage is not used. Therefore, since the passage is opened even when the endoscope is not used, the liquid stays in the endoscope passage, the waste in the body is not sufficiently discharged, and there is an error in the amount of drainage. Various problems are expected to occur when performing peritoneal dialysis.

In addition, a method is also conceivable in which a check valve as disclosed in Patent Document 2 is attached and a passage not used is blocked to prevent liquid from entering. However, when a part such as a valve is damaged after the catheter is placed in the abdominal cavity, not only the replacement of the catheter but also the damaged part must be removed from the abdominal cavity. This work is very difficult and burdensome for the patient.

Japanese Patent Laid-Open No. 60-2255 Japanese Patent Laid-Open No. 2002-153563 J Nippon Med Sch 2001; 68 (6)

In view of the above-described problems, the present invention includes means for easily allowing the endoscope to reach the abdominal cavity, and can sufficiently observe the state of the abdominal cavity using the endoscope. The present invention provides a catheter for peritoneal dialysis that can be performed as described above.

In order to solve the above problems, the present invention provides an intraperitoneal indwelling part that is placed in the abdominal cavity, an extracorporeal projecting part that projects out of the body, and an abdominal wall fixing part that is positioned between the intraperitoneal indwelling part and the extracorporeal projection. In the peritoneal dialysis catheter having both ends opened, a slit for communicating the outside and inside of the catheter is provided in the intraperitoneal indwelling portion, and a peritoneal dialysis catheter provided with a convex portion at a position intersecting the slit is provided on the inner surface of the catheter. provide.

In the catheter of the present invention, it is desirable that the slit is provided within a range of 40 mm to 70 mm from the boundary between the intraperitoneal indwelling portion and the abdominal wall fixing portion toward the distal end on the intraperitoneal indwelling portion side.

In the catheter of the present invention, it is desirable that the slit extends in the longitudinal direction of the catheter.

In the catheter of the present invention, it is desirable that the convex portion is provided so as to cross the slit obliquely.

In the catheter of the present invention, it is desirable that the slit and the convex portion are provided so as to intersect at the midpoint of the slit.

In the catheter of the present invention, the endoscope can be inserted into the abdominal cavity from a location other than the distal end of the abdominal cavity by providing a slit that communicates the outside and the inside of the catheter between both ends. As a result, the state of the peritoneum can be easily and sufficiently observed.

In addition, by making the exit of the endoscope into a slit and sharing the dialysate flow path and the endoscope passage, the dialysate is prevented from staying in the catheter and is dialyzed even during daily CAPD. The liquid perfusion was not affected. Furthermore, by making the exit of the endoscope into a slit, there is no need to install parts that prevent the entry and exit of liquid from the exit of the endoscope, and it is possible to suppress an increase in manufacturing procedures and cost. In addition, the phenomenon that parts are damaged after placement and drift into the abdominal cavity does not occur.

Further, by providing a convex portion on the inner surface of the catheter at a position intersecting with the slit, the endoscope can be guided to the slit by applying the endoscope to the convex portion. Therefore, the endoscope can be easily passed through the slit.

In addition, by providing a slit within a range of 40 mm to 70 mm from the boundary between the abdominal cavity indwelling portion and the abdominal wall fixing portion toward the distal end on the abdominal cavity indwelling portion side, insertion of the endoscope in a portion where a wide field of view can be secured Is possible. As a result, the state of the peritoneum can be grasped more accurately and in detail.

Further, by providing the slit in a shape extending in the longitudinal direction of the catheter, the strength of the catheter can be maintained even when the catheter is bent in the abdominal cavity after placement. When the slit is provided so as to extend in the short direction of the catheter, when the catheter is bent, a crack spreads from the slit portion, and in the worst case, the slit may break.

Further, by providing the convex portion intersecting with the slit so as to intersect obliquely with the slit, the endoscope can be guided to the slit while being advanced to the back. Therefore, it becomes easier to expose the endoscope from the slit into the abdominal cavity.

In addition, by providing the slit and the convex portion so as to intersect at the middle point of the slit, the endoscope can be guided to a position where the slit is most likely to open. Therefore, when the endoscope passes through the slit, the slit is prevented from spreading in the longitudinal direction of the catheter, and it becomes easier to insert the endoscope from the slit into the abdominal cavity.

The present invention will be described below with reference to the drawings.

FIG. 1 is a schematic view of a catheter for peritoneal dialysis according to the present invention. As a material constituting the catheter 1 for peritoneal dialysis of the present invention, a material that is compatible with a living body and is flexible, such as silicone rubber, polyurethane, polyethylene, fluorine resin, and the like is desirable. The length of the catheter 1 for peritoneal dialysis of the present invention and the lengths of the intraperitoneal indwelling portion 11, the abdominal wall fixing portion 12, and the extracorporeal protrusion 13 are not particularly specified, but the length is determined according to the physique of the patient to be applied. It is desirable to do. The inner diameter may be any size as long as the liquid can pass with a sufficient margin and the endoscope can pass.

In FIG. 1, it is used as a fixture when placed in the abdominal cavity, and after placement, in order to prevent so-called tunnel infection, in which bacteria enter the abdominal cavity along the catheter from the protruding portion of the catheter toward the abdominal cavity. Cuff 3 is marked. In general, the cuff is often attached to the boundary between the intra-abdominal placement part and the abdominal wall fixing part and the boundary between the abdominal wall fixing part and the extracorporeal protrusion part, respectively. The cuff may not be attached to the peritoneal dialysis catheter of the present invention at the discretion of the operator. Further, a side hole group 4 is marked at the distal end portion of the intraperitoneal placement portion. This is necessary to place the catheter in the abdominal cavity and then smoothly inject and discharge the dialysate, and to ensure the flow of the dialysate even if one hole is clogged at the time of discharge. It is also possible to change the shape of the side hole portion according to the above or not to provide the side hole itself.

In FIG. 1, a slit 2 is provided. This is used as an entrance / exit of an endoscope in the peritoneal dialysis catheter of the present invention. The slit 2 may be provided in the intraperitoneal indwelling portion. However, if the slit 2 is provided at a position too close to the distal end portion of the intraperitoneal indwelling portion, the exit of the endoscope is opened when the present invention is placed in the abdominal cavity. It will be located at the exit in the abdominal cavity. In that case, when observing the abdominal cavity using an endoscope, it is considered that a sufficient visual field cannot be secured and the object of the present invention cannot be achieved. Further, when the slit 2 is provided at a position too close to the abdominal wall fixing part, there is a risk of damaging the peritoneum when the endoscope is inserted into the abdominal cavity. Therefore, the installation position of the slit 2 is within a range of 40 mm to 70 mm from the boundary between the intraperitoneal indwelling portion and the abdominal wall fixing portion toward the distal end on the intraperitoneal indwelling portion side. However, this does not apply as long as the endoscope has a sufficiently large visual field. By making the entrance of the endoscope into a slit, the dialysate in the abdominal cavity can be smoothly exchanged without affecting the flow rate or flow rate when the endoscope is not used, that is, during daily dialysate exchange. Can do.

The slit 2 may have any shape that allows insertion of an endoscope from the inside of the catheter tube to the outside of the tube, but desirably extends in the longitudinal direction of the catheter. Since the peritoneal dialysis catheter continues to bend after indwelling in the body, if the slit is installed in the short direction of the tube, there is a possibility that breakage from the slit part may occur during long-term indwelling.

FIG. 2 is a schematic view showing a state where the catheter of the present invention is placed in the body and the dialysate is actually exchanged. When an endoscope is inserted into a conventional catheter, the endoscope protrudes from the distal end of the abdominal side of the catheter, and the intraperitoneal observation with the endoscope can be performed only at the back part as shown in FIG. However, according to the catheter of the present invention, the endoscope can be inserted into the abdominal cavity from the circled portion C, and the intraperitoneal observation in a wider range is possible as shown in FIG.

5 to 8 are enlarged views of a portion provided with the slit 2 in the catheter 1 for peritoneal dialysis of the present invention. On the inner surface of the catheter where the slit 2 is provided, a convex portion 5 is provided at a position intersecting with the slit. It is sufficient that the slit 2 and the convex portion 5 intersect at least. For example, an orthogonal shape as shown in FIG. 5, a shape where the slit 2 and the convex portion 5 intersect diagonally as shown in FIG. 6, and an end of the slit 2 and the convex portion 5 are in contact as shown in FIG. 7. The slit 2 and the convex part 5 can be installed in a simple shape. The convex portion 5 may be provided on a part of the inner circumference as shown in FIGS. 5 to 7, or may be provided on the entire circumference as shown in FIG.

9 to 11 are sectional views taken along line A-A 'in FIG. These drawings show the positional relationship between the slit and the convex portion more clearly. About the positional relationship of the said slit 2 and the said convex part 5, if the shape mutually intersects and the objective of this invention is achieved, the shape is not restricted to the range shown by a figure.

12, FIG. 15 and FIG. 16 are cross-sectional views taken along the line B-B ′ in FIG. 5. FIGS. 13 and 14 illustrate a state in which the endoscope 6 is inserted into the tube of the catheter 1 for peritoneal dialysis of the present invention and exposed from the slit portion to the outside of the tube. The endoscope inserted from the extracorporeal protruding portion of the catheter is advanced toward the intraperitoneal indwelling portion and applied to the convex portion 5. And if it hits on a convex part, an endoscope will be moved to the direction of the slit 2, an endoscope will be penetrated into the abdominal cavity from the slit 2, and the intraperitoneal observation will be performed. As for the size and shape of the convex portion, in this specification, the convex portion having a triangular cross section is shown, but the convex portion has a quadrangular shape as shown in FIG. 15, and the convex portion as shown in FIG. Any member may be used as long as it can satisfy the above-described action and does not obstruct the flow of the dialysate, such as a portion whose tip is curved toward the outside-projecting portion.

In addition, when the slit 2 and the convex part 5 cross | intersect diagonally as FIG. 6, FIG. 10 shows, after the endoscope 6 hits the convex part 5, the slit 2 is advanced while the endoscope 6 is advanced. It becomes easy to reach.

Further, when the slit 2 and the convex portion 5 are provided so as to cross each other at their midpoints, the endoscope can be guided to a portion where the slit 2 is most likely to open. That is, when the endoscope is exposed from the end side of the slit, it is possible to avoid the risk that the slit spreads in the longitudinal direction of the catheter depending on the material of the catheter.

The present invention relates to a catheter for peritoneal dialysis, but this principle can be applied to other catheters for blood vessels and gastrointestinal tracts.

It is the schematic of the catheter for peritoneal dialysis of this invention. It is the schematic which actually uses the catheter for peritoneal dialysis of this invention. It is the figure showing a mode that the endoscope was penetrated in the abdominal cavity using the conventional catheter for peritoneal dialysis. It is the figure showing a mode that the endoscope was penetrated in the abdominal cavity using the catheter for peritoneal dialysis of this invention. It is an enlarged view of the slit vicinity in the catheter for peritoneal dialysis of this invention. It is an enlarged view of the slit vicinity in the catheter for peritoneal dialysis of this invention. It is an enlarged view of the slit vicinity in the catheter for peritoneal dialysis of this invention. It is an enlarged view of the slit vicinity in the catheter for peritoneal dialysis of this invention. It is A-A 'sectional drawing of FIG. It is another aspect of sectional drawing in FIG. It is another aspect of sectional drawing in FIG. FIG. 6 is a B-B ′ sectional view of FIG. 5. In FIG. 12, it is the figure which inserted the endoscope in the catheter for peritoneal dialysis of this invention. In FIG. 12, it is the figure which inserted the endoscope in the catheter for peritoneal dialysis of this invention. It is another aspect of sectional drawing in FIG. It is another aspect of sectional drawing in FIG.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Peritoneal dialysis catheter 11 Intraperitoneal indwelling part 12 Abdominal wall fixing | fixed part 13 Extracorporeal protrusion part 2 Slit 3 Cuff 4 Side hole group 5 Convex part 6 Endoscope

Claims (5)

In an intraperitoneal indwelling portion that is placed in the abdominal cavity, an extracorporeal projecting portion that protrudes outside the body, and an abdominal wall fixing portion that is positioned between the intraperitoneal indwelling portion and the extracorporeal protrusion, the peritoneal dialysis catheter is opened at both ends. A peritoneal dialysis catheter in which a slit for communicating the outside and inside of the catheter is provided in the indwelling portion, and a convex portion is provided on the inner surface of the catheter at a position intersecting with the slit. The catheter for peritoneal dialysis according to claim 1, wherein the slit is provided in a range of 40 mm to 70 mm from the boundary between the intraperitoneal indwelling portion and the abdominal wall fixing portion toward the distal end on the intraperitoneal indwelling portion side. The catheter for peritoneal dialysis according to claim 1 or 2, wherein the slit extends in a longitudinal direction of the catheter. The catheter for peritoneal dialysis in any one of Claims 1-3 in which the said convex part is provided in the form which cross | intersects the said slit diagonally. The catheter for peritoneal dialysis according to any one of claims 1 to 4, wherein the slit and the convex portion are provided so as to intersect at a midpoint of the slit.

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