JP2011206179A - Gastrostomy instrument and gastrostomy method - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a gastrostomy instrument and a gastrostomy method which are safe, quickly and easily detain a gastrostomy catheter of large diameter without using a guide wire or the like, prevents aeroperitonia, are easy to punctuate with without damaging blood vessels of abdomen or stomach walls, and prevents a distal end opening part of a sheath from being turned up.SOLUTION: The gastrostomy instrument includes: a trocar needle 2 having a needle body which has a sharp end, is of a small diameter, and has prescribed length; an expansion dilator 3; and a peel away sheath 4. In the trocar needle, the dilator, and the sheath, a small diameter part of the dilator 3 protrudes from the distal end opening part of the sheath without level difference, a tip of the trocar needle 2 protrudes from the distal end opening part of a small diameter part of the dilator without level difference, and a thin groove 46 as a means for dividing the sheath body into a plurality of parts in the axis direction is provided on a sheath body-surrounding wall of the sheath 4 in the state that grip parts 22, 34, 44 provided for respective back end parts are abutted and assembled.

Description

  TECHNICAL FIELD The present invention relates to a gastrostomy device and a gastrostomy method, and more specifically, a technique that enables a gastrostomy operation of placing a gastrostomy catheter in the stomach quickly and easily without using a guide wire or the like. It is related to.

  Conventionally, what has been performed as a so-called gastrostomy is an open gastrostomy that forms a fistula by laparotomy under general anesthesia. However, because patients who are candidates for gastrostomy are elderly or bedridden and often have some kind of disease, general anesthesia is extremely risky.

  Therefore, recently, a percutaneous endoscopic gastrostomy (hereinafter referred to as “PEG”) in which a gastrostoma is constructed using an endoscope is performed, and gastrostomy using PEG is performed. Widely used as the current tube feeding method. In PEG, first, an endoscope is inserted from the oral cavity, air is sent from the air supply channel, the stomach is inflated, and the abdominal wall and stomach wall are brought into close contact with each other. Next, tube-shaped gastrostomy catheters are inserted. There are several methods for this, including the pull / push method in which a gastrostomy catheter is inserted from the oral cavity using a guide wire, and the abdomen using a sheath. There is an “introducer method” in which a gastrostomy catheter is inserted, and a “direct method” in which a gastrostomy catheter is inserted into the abdomen using a guide wire or a dilator.

  However, each of the above methods has drawbacks, and the “pull / push method” inserts a gastrostomy catheter through the oral cavity, so that bacteria on the pharynx may adhere to the gastrostomy catheter and become infected at the stomach construction site. is there. The “Introducer method” uses a sheath and a metal trocar needle to form a fistula, but puncturing a thick trocar needle may damage the abdominal blood vessels and stomach wall, which is dangerous. Only a small gastrostomy catheter that fits the trocar needle can be inserted. On the other hand, in the “direct method”, a puncture needle of about 18 G (1.0 mm) is punctured in the abdomen, a guide wire is inserted from the puncture needle, and the fistula is expanded along the guide wire with a dilator. Although a sputum catheter can be inserted, the dilator must be removed when the gastrostomy catheter is inserted, and at that time, air is trapped in the abdominal cavity, causing a pneumoperitoneum.

  Therefore, the present inventors can place a gastrostomy catheter that is safer and has a larger outer diameter than before by using a thin trocar needle, assembling the dilator and sheath, and puncturing and inserting it into the abdomen. As a result of earnest research on the problem of whether to prevent pneumoperitoneum, the present inventors have found a method that can improve both the “introducer method” and the “direct method”, and have completed the present invention.

  As a result of conducting a prior art investigation on the present invention, there is JP-A-2003-38655 (Patent Document 1), which discloses a dilator with a sheath for mounting a gastrostomy catheter. Yes. However, the dilator disclosed here is not formed in a tapered shape because the tip is formed in a flat surface shape orthogonal to the axis, although the outer diameter of the tip of the dilator is formed to be about 1.6 mm. It ’s hard to insert. Moreover, since the tip portion of the dilator protruding from the tip opening portion of the sheath is formed by a transition portion having a plurality of steps, it is not easy to insert the dilator, for example, smooth insertion is interrupted at the transition portion. It was. Further, a step is formed between the distal end opening of the sheath and the outer surface of the dilator, and this step sometimes turns the distal end opening of the sheath from the dilator during insertion.

Japanese Patent Laying-Open No. 2003-38655 (see paragraph 0032 and FIG. 9)

  In view of the conventional problems as described above, the present invention can safely and easily place a gastrostomy catheter having a large outer diameter without using a guide wire or the like, thereby preventing pneumoperitoneum. Furthermore, an object of the present invention is to provide a gastrostomy device and a gastrostomy method that can be easily punctured and do not damage the blood vessel and stomach wall of the abdomen and that the distal end opening of the sheath does not turn over.

  In order to solve the above-mentioned problem, the invention according to claim 1 is an instrument used for a gastrostomy method, having a needle body with a small diameter and a predetermined length with a sharp tip, A trocar having a needle gripping portion at the rear end of the needle body, and a dilator body having an axial hole through which the needle body of the trocar needle is inserted. A dilator for expansion provided with a dilator gripping portion provided with a tapered small diameter portion gradually becoming smaller and a needle gripping portion abutting when the needle body of the trocar needle is inserted into the rear end portion; The sheath has a sheath body provided with an axial hole through which the dilator body of the dilator is inserted, and a sheath grip portion is provided on the rear end portion of the sheath body to which the dilator grip portion abuts when the dilator body of the dilator is inserted. Tapy The trocar needle, the dilator, and the peel-away sheath are assembled with the gripping portions provided at the rear end portions in contact with each other, and the small-diameter portion of the dilator has the tip opening of the peel-away sheath. And the tip of the trocar needle protrudes from the tip opening of the small diameter portion of the dilator without a step, and the sheath body peripheral wall of the sheath is divided into a plurality of the sheath body in the axial direction. Means are provided.

  The invention according to claim 2 is the gastrostomy device according to claim 1, wherein the needle body of the trocar needle has a small diameter.

  According to a third aspect of the present invention, in the gastrostomy device according to the first or second aspect, an outer surface of the distal end of the sheath body is provided between the rear end of the small-diameter portion of the dilator and the distal end of the sheath body of the sheath. By forming the taper surface downward in the distal direction, no step is formed.

  According to a fourth aspect of the present invention, in the gastrostomy device according to any one of the first to third aspects, the means for dividing is a thin groove.

  The invention according to claim 5 punctures the gastrostomy construction device according to any one of claims 1 to 4 into the abdomen in a state where the trocar needle, the dilator and the peel-away sheath are assembled, and the tip of the trocar needle Is inserted until the stomach enters the stomach, and then the trocar needle is removed, and the dilator with the peel-away sheath is pushed into the stomach to expand the fistula, and then the dilator is removed and the peel-away sheath Is divided into a plurality of pieces in the axial direction by means of dividing provided on the peripheral wall of the sheath body, and a gastrostomy catheter is inserted, and then the peel-away sheath is removed and the gastrostomy catheter is placed.

  The present invention is as described above. According to the invention described in any one of claims 1 to 4, the needle body has a small diameter and a predetermined length with a sharp tip, and the rear of the needle body. It has a trocar with a needle gripper at the end and a dilator body with an axial hole through which the needle body of this trocar needle is inserted. The dilator for expansion provided with a dilator gripping portion that is provided with a tapered small diameter portion and a needle gripping portion that comes into contact with the rear end when the needle body of the trocar needle is inserted, and a dilator for the dilator A peel-away sheath having a sheath body provided with an axial hole through which the body is inserted, and having a sheath gripping portion that abuts the dilator gripping portion when the dilator body of the dilator is inserted into the rear end portion of the sheath body The trocar needle, the dilator, and the peel-away sheath are assembled with the grip portions provided at the rear end portions in contact with each other, and the small-diameter portion of the dilator is stepped from the tip opening portion of the peel-away sheath. And the tip of the trocar needle protrudes without a step from the tip opening of the dilator having a small diameter, and the sheath body peripheral wall of the sheath is provided with means for dividing the sheath body into a plurality of parts in the axial direction. Therefore, it is possible to puncture the abdomen while inserting the gastrostomy device. Therefore, a gastrostomy catheter having a larger outer diameter can be placed in a safer manner than before. In addition, since the trocar needle, the dilator, and the peel-away sheath are inserted at a time and then sequentially removed from the innermost trocar needle, the number of operations is reduced. Further, since it is not necessary to use a guide wire or the like as in the prior art, it is easy to use.

  Also, after puncturing and inserting the abdomen, the gastrostomy catheter is inserted with the trocar needle and dilator for dilatation sequentially removed, leaving the peel-away sheath, so air does not leak into the abdominal cavity and pneumoperitoneum occurs. Can also be prevented. Furthermore, since the tip of the trocar needle body is sharp, it is easy to puncture, and does not damage the abdominal blood vessels and stomach wall as before, and the distal end of the sheath opens when expanding the fistula. There is an excellent effect that the part does not turn up from the dilator.

  According to the invention described in claim 5, the gastrostomy catheter can be placed quickly and easily using the gastrostomy device according to any one of claims 1 to 4.

BRIEF DESCRIPTION OF THE DRAWINGS It is a general view of the instrument for gastrostoma construction which shows one embodiment of this invention, (A) is the front view which abbreviate | omitted a part of the axial direction, (B) is a left view, (C) is a right view. FIG. FIG. 2 is a longitudinal front view of FIG. FIG. 3 is an enlarged sectional view taken along line XX in FIG. 2. It is a general view of a trocar needle, (A) is a front view which omitted some axial directions, (B) is a left side view, (C) is a right side view. It is a general view of the dilator for expansion, (A) is a front view which omitted some axial directions, (B) is a left side view, (C) is a right side view. It is a whole view of a peel-away sheath, (A) is a front view in which a part in the axial direction is omitted, (B) is a left side view, and (C) is a right side view. It is principal part sectional drawing which expands and shows the front-end | tip and rear-end vicinity of a small diameter part of a dilator. It is effect | action explanatory drawing which shows an example of use. It is principal part sectional drawing which expands and shows the front-end | tip and rear-end vicinity of the small diameter part of the dilator of another example. It is a whole front view of the instrument for gastrostoma construction method which abbreviate | omitted a part of axial direction which shows another embodiment. The lock mechanism is shown, (A) is a right side view of each state when locked and (B) is when unlocked.

  Hereinafter, a gastrostomy device according to an embodiment of the present invention will be described with reference to the drawings.

  1 to 3, reference numeral 1 denotes a gastrostomy device 1. The gastrostomy device 1 includes a metal trocar needle 2, a synthetic resin dilator 3, and a synthetic resin peel-away sheath 4. It is made up of.

  As shown in FIG. 4, the trocar needle 2 is made of, for example, steel suitable for a living body, and has a thin needle body 21 having an outer diameter of 2 mm. The distal end 21a of the distal end portion of the needle body 21 is formed into a sharp shape with a three-sided cut (the blade angle is 120 ° as shown in FIG. 4B) so that it can be easily punctured. A needle gripping portion 22 is provided at the rear end portion of the needle body 21. The needle gripping portion 22 includes a circular large diameter portion 22a near the rear end to which the rear end portion of the needle body 21 is fitted and fixed, and a circular small diameter portion 22b on the opposite side. The needle gripping portion 22 is composed of a large diameter portion 22a and a small diameter portion 22b so that the large diameter portion 22a can be easily pulled out when the needle gripping portion 22 is pulled out from a state where it is in contact with the holding portion of the dilator described later. This is because. The trocar needle 2 has an axial length of 190 mm for the needle body 21 and 10 mm for the needle gripping portion 22 and a total length of 200 mm. Since the shape of the tip 21a of the needle body 21 is sharp and is dangerous in that state, a cap for tip protection may be provided at the tip when not in use.

  As shown in FIG. 5, the expansion dilator 3 is made of, for example, a thermoplastic resin suitable for a living body, and has a dilator body 31 provided with an axial hole 32 through which the needle body 21 of the trocar needle 2 is inserted. ing. A tip portion of the dilator main body 31 is provided with a small-diameter portion 33 having a tapered cone shape that gradually decreases in the tip direction. The outer surface of the distal end of the small-diameter portion 33 and the outer surface of the needle body 21 of the trocar needle 2 are in a smoothly connected state, and no step is formed between the distal end of the small-diameter portion and the outer surface of the needle body 21. ing. Further, a dilator gripping portion 34 is provided at the rear end portion of the dilator main body 31 with which the needle gripping portion 22 contacts when the needle main body 21 of the trocar needle 2 is inserted. The dilator gripping portion 34 includes a circular large diameter portion 34a near the rear end with which the circular small diameter portion 22b of the needle gripping portion 22 abuts and a circular small diameter portion 34b on the opposite side. The reason why the dilator gripping portion 34 is composed of the large diameter portion 34a and the small diameter portion 34b is the same reason as in the case of the needle gripping portion 22, and the dilator gripping portion 34 is in contact with the holding portion of the sheath described later. This is because the large-diameter portion 34a is picked up so that it can be easily pulled out. The extension dilator 3 has an axial length of 153 mm for the dilator body 31, 20 mm for the small diameter portion 33, and 9 mm for the dilator grip portion 34, and a total length of 182 mm.

  As shown in FIG. 6, the peel-away sheath 4 is made of, for example, a thermoplastic resin suitable for a living body, and includes a sheath body 41 provided with an axial hole 42 through which the dilator body 31 of the dilator 3 is inserted. Yes. As shown in FIG. 7, a tapered surface 43 is formed on the outer surface of the distal end of the sheath body 41. The outer surface of the tapered surface is flush with the outer surface of the rear end of the small diameter portion 33 of the dilator 3. Thus, no step is formed between the distal end of the sheath body 41 and the rear end of the small diameter portion 33 of the dilator 3. In this embodiment, the tapered surface 43 is formed to be flush with the outer surface of the rear end of the small-diameter portion 33 in order to prevent the formation of a step, but such a configuration is not necessarily required. You may make it connect as a curved surface which became convex in the direction. In addition, a pair of sheath gripping portions 44 against which the dilator gripping portion 34 abuts when the dilator main body 31 of the dilator 3 is attached to the rear end portion of the sheath main body 41 so that the sheath main body 41 is sandwiched, but the sheath is sandwiched between both side edges. The main body 41 is provided symmetrically so that a part of the outer surface appears. The sheath gripping portion 44 includes a large collar portion 44a near the rear end with which the small diameter portion 34b of the dilator gripping portion 34 abuts and a small collar portion 44b on the opposite side.

  The sheath body 41 is a peripheral wall in which a part of the outer surface appears, and a thin groove 46 as a means for tearing the main body in the axial direction and dividing it into a plurality of parts is formed in a portion along the axial direction. It is provided as shown by a broken line. In this embodiment, two grooves 46 are provided at positions where the positions are shifted by 180 ° in the circumferential direction. In addition, the groove | channel 46 is an example, for example, many small holes, for example, may be formed at a predetermined interval to facilitate tearing. The peel-away sheath 4 has an axial length of 143 mm for the sheath body 41 and 7 mm for the sheath grip 44, and a total length of 150 mm. In order to grasp the insertion depth, a scale may be provided on the outer peripheral surface of the sheath body 41 of the peel-away sheath 4.

  The trocar needle 2, dilator 3 and peel-away sheath 4 are assembled as follows. That is, first, the dilator 3 is inserted from the distal end side of the small-diameter portion 33 into the rear end opening portion where the grip portion 44 of the sheath 4 is located, and the small-diameter portion 34 b of the grip portion 34 is inserted into the large collar portion 44 a of the grip portion 44 of the sheath 4. Abut. Due to this contact, the small-diameter portion 33 of the dilator 3 is in a state of protruding from the distal end opening of the sheath 4. Next, the trocar needle 2 is inserted into the rear end opening portion where the grip portion 34 of the dilator 3 with the sheath 4 is attached from the front end side, and the small diameter portion 22 b of the grip portion 22 is inserted into the large diameter portion of the grip portion 34 of the dilator 3. It abuts on 34a. By this contact, the tip portion of the trocar needle 2 is in a state of protruding from the tip opening of the small diameter portion 33 of the dilator 3. As a result, the trocar needle 2, the dilator 3 and the peel-away sheath 4 are assembled, and there is no step in the tip direction. That is, there are steps between the needle body 21 of the trocar needle 2 and the distal end of the small diameter portion 33 of the dilator 3 and between the rear end of the small diameter portion 33 of the dilator 3 and the distal end of the sheath body 41 of the sheath 4. It will not be formed.

  The gastrostomy procedure performed using the gastrostomy device 1 with the trocar needle 2, dilator 3 and peel-away sheath 4 assembled as described above will be described with reference to FIG.

  First, although not shown, the following pre-procedure is performed. That is, an endoscope is inserted from the oral cavity, and a fistula site is determined while confirming with a finger sign and an illumination sign. After determining the fistula site, disinfect the skin, perform local anesthesia and test puncture, and determine the size of the gastrostomy catheter to be placed. Then, according to the procedure of the gastric wall fixing tool, the gastric wall is fixed, and then a skin incision is performed with a scalpel to about 10 mm to the dermis.

  This procedure is performed after the previous procedure is completed. First, as shown in FIG. 8A, the gastrostomy device 1 assembled with the trocar needle 2, the dilator 3 and the peel-away sheath 4 is punctured and inserted into the abdomen. At this time, the tip of the trocar needle 2 is inserted until it enters the stomach. By combining the small-diameter trocar needle 2 and the dilator 3, damage to abdominal blood vessels and stomach walls can be prevented.

  Next, the trocar needle 2 is removed. Although not particularly illustrated, the dilator 3 with the sheath 4 attached is further pushed into the stomach to expand the fistula. By pushing and expanding the dilator 3, a fistula can be formed more safely and a gastrostomy catheter having a large outer diameter can be inserted. After expanding the fistula, the dilator 3 is removed. FIG. 8B shows this state. Next, as shown in FIG. 8C, a gastrostoma feeding tube 51 is inserted into the sheath 4 left by the removal of the dilator. After the insertion, as indicated by an arrow, the gripping portion 44 of the sheath 4 is picked and pulled away in the opposite direction, so that the portion of the sheath 4 protruding on the body surface is torn along the thin groove 46. Further, the entire sheath 4 is removed by pulling out the lower portion of the sheath body 41 whose upper portion is torn. By performing these operations, it is possible to prevent a pneumoperitoneum caused by the accumulation of air in the abdominal cavity. Thereafter, as shown in FIG. 8 (D), in the gastrostoma feeding tube 51, the balloon 52 is inflated inside the stomach, and the stopper 53 for drop-off prevention is attached on the body surface side, and the gastrostoma feeding tube 51 is placed. This completes the construction. After completion of the construction, it becomes possible to put a nutrient through the indwelling gastrostoma feeding tube 51.

  By using the gastrostomy device 1 as described above, damage to the abdominal blood vessels and stomach wall can be suppressed, pneumoperitoneum can be prevented, and the burden on the patient can be minimized. That is, in the gastrostomy device 1, the trocar needle 2, the dilator 3 and the peel-away sheath 4 inserted in the assembled state are simply inserted and then sequentially removed, so that the number of operations is reduced. Moreover, since it is not necessary to use a guide wire or the like as in the prior art, it is easy to use. In addition, since the trocar needle 2 and dilator 3 with a small diameter can be assembled to prevent damage to the abdominal blood vessels and stomach wall, a fistula can be formed more safely and a gastrostomy catheter with a large outer diameter can be placed. can do. Also, after puncturing and inserting into the abdomen, the trocar needle 2 and the dilator 3 are sequentially removed, and the gastrostomy catheter is inserted with the sheath 4 left, preventing air from leaking into the abdominal cavity and preventing pneumoperitoneum from occurring it can. Moreover, since the front end outer surface of the sheath 4 is tapered to eliminate a step, it can be smoothly inserted into the abdomen. Moreover, the distal end opening of the sheath 4 does not turn up from the dilator 3 during insertion.

  FIG. 9 shows another example for eliminating a step in the distal direction of the gastrostomy device 1. In this example, the outer diameter of the dilator body 31 'of the dilator is formed to be smaller than the outer diameter of the rear end of the small diameter portion 33', and the sheath body 41 'is inserted and attached to the small diameter dilator body 31'. . The outer diameter of the sheath body 41 ′ is formed so that the outer surface of the distal end is flush with the outer surface of the rear end of the small diameter portion 33 ′ of the dilator body 31 ′. Therefore, when the sheath body 41 ′ is inserted and attached to the dilator body 31 ′, the gap between the rear end of the small diameter portion 33 ′ of the dilator and the tip of the sheath body 41 ′ of the sheath is tapered as shown in FIG. As with the surface 43, no step is formed. Therefore, this another example can also provide the above-described effects. In this alternative example, when the dilator main body 31 ′ is extracted from the sheath main body 41 ′, the sheath material is made of thermoplastic resin and has flexibility, so that an extraction load is applied to the distal end opening of the sheath main body 41 ′. The opening is temporarily expanded to allow removal.

  FIG. 10 shows a gastrostomy device according to another embodiment. In the gastrostomy construction device 61 of this embodiment, when the trocar needle 62, the dilator 63, and the peel-away sheath 64 are assembled, they can be locked by a lock mechanism, respectively. This configuration is basically different from the above configuration, and other configurations are substantially the same, although there are some differences in the shape of the gripping portion. FIG. 11 shows a locking mechanism 66 for the dilator 63 and the peel-away sheath 64.

  That is, the lock mechanism 66 is provided on the arcuate vertical engagement claw 71 provided on the rear end surface of the sheath gripping portion 68 of the peel-away sheath 64 and the front end surface of the gripping portion 72 of the dilator 63, and rotates. And an engaging protrusion 73 that can be engaged with and disengaged from the engaging claw. When locking is performed after the trocar needle 62, the dilator 63, and the peel-away sheath 64 are assembled, the dilator 63 is rotated with respect to the peel-away sheath 64 as shown by an arrow in FIG. The protrusion 73 is engaged with the engagement claw 71. As a result, the peel-away sheath 64 and the dilator 63 are locked and are not integrated and separated from each other in the axial direction. On the other hand, in order to release the lock in order to release the assembly, the dilator 63 is rotated with respect to the peel-away sheath 64 from the state shown in FIG. 11A, and the engaging protrusion 73 as shown in FIG. Is detached from the engaging claw 71. Thereby, the lock is released and the dilator 63 can be separated from the peel-away sheath 64 in the axial direction.

  Although not shown in the drawings, the dilator 63 and the trocar needle 62 are also provided with a locking mechanism. That is, a female screw is formed on the inner surface of the rear end opening of the gripping portion 72 of the dilator 63 and a screw is formed on the outer surface of the front end portion of the needle gripping portion 74 of the trocar needle 62. Lock by screwing into. In FIG. 10, reference numeral 75 denotes two thin grooves for division provided at positions where the position of the peripheral wall of the peel-away sheath 64 is shifted by 180 ° in the circumferential direction, and is the same as the groove 46 in the above embodiment. It comes to have a function.

  Since the gastrostomy procedure performed using the gastrostomy device 61 is substantially the same as that performed using the gastrostomy device 1, description thereof will be omitted. Since the gastrostomy device 61 of this embodiment includes the lock mechanism 66 as described above, the trocar needle 62, the dilator 63, and the peel-away sheath 64 are provided by locking the lock mechanism. The trocar needle 62 and the dilator 63 can be prevented from coming out from the proximal end side of the peel-away sheath 64. Therefore, in general, when puncturing the gastrostomy device into the abdomen, in addition to the method of pushing the proximal end side of the device and pushing it in, the puncture is performed by holding the middle part of the entire device in a pencil shape. In the latter case, the dilator 3 and the trocar needle 2 may come out of the peel-away sheath 4 and leave in the gastrostomy device 1 of the embodiment shown in FIGS. On the other hand, the dilator 63 and the trocar needle 62 do not come out of the peel-away sheath 64, and a reliable and safe treatment can be performed.

  In each of the above embodiments, only a preferable example is given, and details of design matters such as a tapered surface as a means for eliminating a step are arbitrary within the scope of the claims. Needless to say, it can be changed and modified. In the embodiment, the gastrostomy feeding tube is shown as the gastrostomy catheter, but another gastrostomy catheter may be used instead of the gastrostomy feeding tube.

1,61 Gastrostomy device 2,62 Trocar needle 3,63 Dilator for expansion 4,64 Peel away sheath 21 Needle body 22,74 Needle gripping part 31 Dilator body 32 Axial hole 33 Small diameter part 34,72 Dilator gripping Portion 41 Sheath body 42 Axial hole 43 Tapered surface 44, 68 Sheath gripping portion 46, 75 Thin groove (means for dividing)
51 Gastrostomy feeding tube (gastrostomy catheter)
66 Locking mechanism 71 Engaging claw 73 Engaging protrusion

Claims (5)

An instrument used for gastrostomy,
A trocar needle having a needle body with a small diameter and a predetermined length with a sharp tip, and a needle gripping portion provided at the rear end of the needle body;
A dilator main body provided with an axial hole through which the needle body of the trocar needle is inserted, a tapered small diameter portion gradually decreasing in the front end direction is provided at the front end portion of the dilator main body, and An expansion dilator provided with a dilator gripping portion with which the needle gripping portion comes into contact when the needle body of the trocar needle is inserted into the rear end portion;
The sheath has a sheath body provided with an axial hole through which the dilator body of the dilator is inserted, and a sheath grip portion is provided on the rear end portion of the sheath body to which the dilator grip portion abuts when the dilator body of the dilator is inserted. With a peel-away sheath,
The trocar needle, the dilator, and the peel-away sheath are assembled with the gripping portions provided at the respective rear end portions in contact with each other. Further, the tip of the trocar needle protrudes from the tip opening of the small diameter portion of the dilator without a step, and the sheath body peripheral wall of the sheath is provided with means for dividing the sheath body into a plurality of parts in the axial direction. An instrument for gastrostomy construction.   The gastrostomy device according to claim 1, wherein the needle body of the trocar needle has a small diameter.   The gastrostomy device according to claim 1 or 2, wherein between the rear end of the small-diameter portion of the dilator and the distal end of the sheath body of the sheath, the outer surface of the distal end of the sheath body is a tapered surface downward in the distal direction. A gastrostomy device characterized in that no step is formed.   The gastrostomy device according to any one of claims 1 to 3, wherein the means for dividing is a thin groove.   Puncture the gastrostomy device according to any one of claims 1 to 4 into the abdomen with the trocar needle, dilator and peel-away sheath assembled, and insert until the tip of the trocar needle enters the stomach, After that, the trocar needle is removed and the dilator with the peel-away sheath is pushed into the stomach to expand the fistula, and then the dilator is removed and the peel-away sheath is provided on the sheath body peripheral wall. A gastrostomy construction method comprising: dividing a gastrostomy catheter into a plurality of parts in the axial direction by means for the purpose; then removing the peel-away sheath; and indwelling the gastrostomy catheter.

Images