JPH0324849B2 - - Google Patents

Description

[Detailed Description of the Invention] [Industrial Application Field] The present invention relates to a ventricular shunt, which is used in daily life during surgery and treatment for hydrocephalus, etc., and in particular can measure pressure in the ventricles (intracranial pressure). Concerning ventricular shunt.

Intracranial pressure refers to the cerebrospinal fluid present in the cranial cavity,
This refers to the pressure exerted on the inside of the skull by the brain parenchyma, ventricles, cerebrovascular bed, etc. When the brain parenchyma, cerebrospinal fluid cavity, cerebrovascular bed, etc. increase in volume due to lesions or various other causes, intracranial pressure increases. Sometimes. Among diseases that increase intracranial pressure, a condition in which cerebrospinal fluid accumulates abnormally within the skull is called hydrocephalus.As a treatment for this hydrocephalus,
Emergency surgery and continuous treatment are performed using ventricular shunts.

[Conventional technology]

In general, a ventricular shunt consists of a tubular ventricular catheter inserted into the ventricle and a tubular peritoneal catheter connected to this via a relay chamber such as a reservoir or pump chamber. Excess fluid, ie, excess cerebrospinal fluid resulting from the difference between cerebrospinal fluid production and absorption, is allowed to drain into the peritoneal cavity through the ventricular catheter, the transit chamber, and the peritoneal catheter. All of this treatment of cerebrospinal fluid is done inside the skin to avoid bacterial infection.

A check valve that can be pushed open by the hydraulic pressure of fluid discharged from the ventricle is provided inside the relay chamber, and the flow rate is regulated by this check valve.

[Problem that the invention seeks to solve]

By the way, when performing surgery for hydrocephalus, etc., it is necessary to know the pressure state in the ventricles of a patient who has a ventricular shunt installed, but generally speaking, the pressure in the ventricles is determined by observing the patient's facial expressions and eye conditions. However, the problem is that the pressure in the ventricles cannot be detected using conventional ventricular shunts, and only a judgment is made as to whether the pressure is significantly higher or slightly higher than in a healthy case.

The present invention aims to solve these problems and provides a pressure sensor that uses a ventricular shunt attached to a patient to detect ventricular pressure with simple operation. The aim is to provide ventricular shunt with a ventricular shunt.

[Means for solving problems]

Therefore, the ventricular shunt with a pressure sensor of the present invention has a ventricular catheter inserted into the ventricle, a relay chamber connected to the ventricular catheter, and a peritoneal catheter connected to the relay chamber. In the shunt, a shutoff valve mechanism capable of blocking communication to the peritoneal catheter is provided inside the relay chamber,
A pressure sensor is provided inside the relay chamber on the upstream side of the shutoff valve mechanism, and the pressure sensor is connected to a pair of rigid discs facing each other and a rigid column member that connects these discs to each other. , an elastic membrane extended in a cylindrical shape between the discs, and the membrane contains a contrast agent, and a gas is introduced into the cylindrical space formed by the membrane and the pair of discs. It is characterized by being enclosed.

[Effect]

In the above-mentioned ventricular shunt with a pressure sensor of the present invention, when detecting the pressure in the ventricle, the flow to the peritoneal catheter is first blocked by the shutoff valve mechanism, and then the diameter of the membrane portion is reduced using external pressure by X-ray imaging. An image of the pressure sensor is required.

Then, the ratio between the diameter of the minimum diameter reduced part of the membrane in the pressure sensor and the diameter of the disc part of the same pressure sensor is determined, and the calibration is performed from data showing the relationship between the external pressure determined in advance and the above ratio. The ventricular pressure can be easily determined by this method.

〔Example〕

Hereinafter, embodiments of the present invention will be explained with reference to the drawings. Figures 1 to 3 show a ventricular shunt equipped with a pressure sensor as an embodiment of the present invention.
The figure is a plan view with the upper wall removed, FIG. 2 is a sectional view taken along the - arrow in FIG. 1, FIG. 3 is an enlarged perspective view of the pressure sensor, and FIG. FIG. 3 is a plan view showing the electromagnetic box used for switching with the top wall removed.

As shown in Figures 1 and 2, a relay chamber 1 made of a soft wall made of silicone resin, etc. is a small chamber-shaped reservoir 1.
A and a valve chamber 1b communicating with the reservoir 1a, and a thin tube-shaped ventricular catheter 2 inserted into the patient's ventricle is connected to the reservoir 1a.

Further, the relay chamber 1 is connected to the peritoneal catheter 3, and is provided with a partition wall 1c that partitions the inside of the relay chamber 1 into an upstream compartment A and a downstream compartment B,
The upstream compartment A communicates with the ventricular catheter 2, and the downstream compartment B communicates with the peritoneal catheter 3.

Then, fluid discharged from the patient's ventricle passes through the ventricular catheter 2, passes through the reservoir 1a, and then passes through the valve ventricle 1b.
When the discharge liquid flows into the upstream compartment A, the first
A check valve 4, a second check valve 5, and a third check valve 6 are provided on the partition wall 1c at positions spaced apart in the radial direction from a reference position 7 within the valve chamber 1b.

The first check valve 4 has a larger regulated flow rate than the second check valve 5, and the second check valve 5 has a larger regulated flow rate than the third check valve 6, In this embodiment, each of the check valves 4, 5, and 6 is configured as a single slit type check valve, but these may be of a cross slit type, a spring type, or a membrane type. You may also change it to .

In the upstream compartment A, the partition wall 1c has circular valve seats 4a surrounding each check valve 4, 5, 6, respectively.
5a, 6a are provided, and each valve seat 4a, 5a,
A movable sphere 8 made of a magnetic material that can selectively close each check valve 4, 5, 6 by engaging with one of the check valves 6a is movable by receiving magnetic force from an electromagnet from outside the valve chamber 1b. It is enclosed in the upstream compartment A.

Further, at the reference position 7, a circular seat 9 for seating the movable sphere 8 is formed on the surface of the partition wall 1c in the upstream compartment A.

When the movable sphere 8 is seated on each valve seat 4a, 5a, 6a or the circular seat 9, the position of the movable sphere 8 is held by being held between the soft wall of the valve chamber 1b. ing. In addition, flexible receiving plates 4b, 5b, 6b, and 13 for cushioningly receiving the movable sphere 8 that moves by magnetic force are integrated with the partition wall 1c in the vicinity of each of the valve seats 4a, 5a, and 6a, and the circular seat 9, respectively. It is installed protrudingly.

Further, between the reservoir 1a and the circular seat 9, a sphere holding part 10 is provided as a valve seat of a shutoff valve mechanism formed on the soft wall of the upstream compartment A and the partition wall 1c. By pushing the second movable sphere 11 made of a magnetic material into the holding part 10 with magnetic force, the reservoir 1
The flow of liquid from A to each check valve 4, 5, 6 in the upstream compartment A of the valve chamber 1b is blocked.

Then, when keeping the holding part 10 in the open state, the second
A locking plate 12 for locking the movable sphere 11 of
Near the upstream side of the circular seat 9, it is provided on the partition wall 1c integrally with the receiving plate 13 of the movable sphere 8.

Although a magnetic material such as iron is used as the material for each movable sphere 8, 11, it is desirable that the surface of the metal sphere be coated with silicone resin or the like.

In the ventricular shunt of the present invention, on the upstream side of the sphere holding part 10 as the valve seat of the isolation valve mechanism,
A pressure sensor 14 is provided inside the relay chamber 1, and in this embodiment, the pressure sensor 14 is provided inside the extension chamber of the reservoir 1a.

This pressure sensor 14, as shown in FIG.
A pair of rigid disks 14a, 14a facing each other
and a rigid column member 14b that interconnects these disks 14a, 14a, and an elastic membrane 14c containing a contrast medium is arranged between the pair of disks 14a, 14a. It is stretched in a shape.

Then, the membrane 14c and the pair of discs 14
The cylindrical space formed by a and 14a is filled with dry air at approximately 1 atmosphere.

Note that the pressure sensor 14 has a pair of discs 14
A, 14a is attached to the inner wall of the extension chamber of the reservoir 1a.

As shown in FIG. 4, the electromagnet box 20 is
A plurality of electromagnets 21, 22a, 22b, 23-25 for driving each movable sphere 8, 11 by magnetic force
When using this, the ventricular shunt relay chamber 1 is implanted under the skin of the patient's head.
The electromagnetic box 20 is fixed to the outside of the patient's head via a belt (not shown) along the patient's head.

And each electromagnet 21, 22a, 22b, 23
-25 are each receiving plate 4b, 5b, 6 in relay room 1
b, 13, the locking plate 12, and the holding portion 10, so as to be able to take a relative position as shown in FIG.

In addition, each electromagnet 21, 22a, 22b, 23-2
5 is selectively excited.
A wire harness connected to these electromagnets
It is connected to a DC power source via a switch on an operation panel (not shown).

Note that the bottom wall of the electromagnet box 20 is connected to the relay room 1.
A recess corresponding to the height is formed, so that the electromagnetic box 20 can be stably attached to the patient's head.

With the above-described configuration, when measuring the pressure inside the ventricle with the ventricular shunt of the present invention attached to the patient's head, first use the electromagnet box 20 shown in FIG. Holding part 10 for sphere
An operation is performed to fit the movable sphere 11 therein.

That is, by energizing only the electromagnet 21 in the electromagnet box 20, the movable sphere 11 is guided to the sphere holder 10, thereby closing the flow path from the reservoir 1a to the valve chamber 1b.

As a result, the reservoir 1a is filled with drained fluid that has flowed from the ventricle through the ventricular catheter 2.
The pressure within the reservoir 1a becomes equal to the pressure within the ventricles.

Then, the membrane 14c of the pressure sensor 14
is elastically deformed under the pressure in the reservoir 1a,
As shown by the two-dot chain line in FIG. 3, the diameter of the central portion is significantly reduced.

Such a deformed state of the pressure sensor 14 can be easily confirmed by X-ray photography because each disc 14a is made of a rigid material and the membrane 14c contains a contrast agent.

From this X-ray photograph, the ratio between the diameter d of the minimum diameter reduction part of the membrane 14c and the diameter D of the disk 14a can be determined, so from the data showing the relationship between the external pressure determined in advance and the above ratio, the calibration can be performed. The ventricular pressure can be easily determined by this method.

In addition, in the ventricular shunt with a pressure sensor of the present invention, since the ratio of the diameter of the minimum diameter reduced portion due to deformation of the cylindrical membrane 14c and the diameter of the disk 14a is determined, even if X-ray imaging is performed from an oblique direction, , the above ratio does not change and is not affected by the magnification ratio of the radiograph,
The above ratio can be determined accurately.

When switching the flow rate in the ventricular shunt in order to administer appropriate medical care according to the pressure in the ventricle, the following operation is performed.

By energizing only the pair of electromagnets 22a and 22b in the electromagnet box 20 in FIG. As shown in Figures 1 and 2,
When the movable sphere 8 is seated on the circular seat 9 and the second movable sphere 11 is locked to the locking plate 12,
Effluent flowing into the reservoir 1a from the patient's ventricle through the ventricular catheter 2 enters the upstream compartment A of the valve chamber 1b, passes through three check valves 4, 5, and 6, and flows downstream. Enter side compartment B.

The drained fluid in this downstream compartment B further passes through the peritoneal catheter 3 and flows into the patient's peritoneal cavity.

In this way, the fluid discharged from the ventricle can flow at the maximum flow rate as the sum of the regulated flow rates of the three check valves 4, 5, 6.

Next, when it is desired to reduce the flow rate slightly, by energizing only the electromagnet 25, the movable sphere 8 is attracted so as to be driven from the circular seat 9 toward the receiving plate 6b, and the flow to the third check valve 6 is reduced. A movable sphere 8 is attached to the valve seat 6a in the path.
It is sufficient to close the check valve 6 by closing the check valve 6, and as a result, the discharged liquid is discharged from the first valve, which has a large regulated flow rate.
The flow can only flow through the check valve 4 and the second check valve 5, which has the next highest regulated flow rate.

Also, if you want to make the flow rate even smaller, use the electromagnet 2
After the movable sphere 8 is once returned from the valve seat 6a to the circular seat 9 by excitation of only 2a and 22b, the movable sphere 8 is seated on the valve seat 5a leading to the second check valve 5 by excitation of only the electromagnet 24. The check valve 5 may be closed by using the regulated flow rate, so that the discharged liquid flows only through the first check valve 4, which has the largest regulated flow rate, and the third check valve 6, which has the smallest regulated flow rate. be able to.

Additionally, if you want to minimize the flow rate, electromagnet 2
After the movable sphere 8 is once returned from the valve seat 5a to the circular seat 9 by excitation of only 2a and 22b, the movable sphere 8 is seated on the valve seat 4a leading to the first check valve 4 by excitation of only the electromagnet 23. Then, the check valve 4 can be closed, thereby allowing the drained liquid to flow at the minimum flow rate through only the second and minimum check valves 5 and 6 of the regulated flow rate.

As mentioned above, in this embodiment, three check valves 4-
Since 6 have mutually different regulated flow rates, 3
Four-stage flow rate switching is performed using the check valves 4, 5, and 6, but if two check valves are used and each has different regulated flow rates, three-stage flow rate switching can be performed. .

In addition, even if there are two check valves and each check valve has the same regulated flow rate, there are two cases: when the flow is allowed to flow to only one of them, and when it is allowed to flow to both.
Stepwise flow rate switching can be performed.

Further, in this embodiment, circular valve seats 4a, 5a, 6 for selectively closing each check valve 4, 5, 6 are provided.
a are provided to surround the check valves 4, 5, and 6, respectively, but these circular valve seats 4a, 5
Instead of a, 6a, each check valve 4,
A circular valve seat may be provided midway along the path of the movable sphere 8 toward the spheres 5 and 6 to form a sphere holding portion.

〔Effect of the invention〕

As described in detail above, according to the ventricular shunt with a pressure sensor of the present invention, a shutoff valve mechanism capable of blocking communication to the peritoneal catheter is provided inside the relay chamber that connects the ventricular catheter and the peritoneal catheter. In addition, a pressure sensor is provided inside the relay chamber on the upstream side of the shutoff valve mechanism, and the pressure sensor is connected to a pair of rigid discs facing each other and a rigid column that connects these discs to each other. A cylindrical space comprising a member and an elastic membrane extending in a cylindrical shape between the discs, the membrane containing a contrast agent, and the membrane and the pair of discs. It has a simple structure in which gas is sealed in the chamber, and has the advantage that the pressure in the ventricle, which has been difficult to detect in the past, can be detected extremely easily and safely using a pressure sensor in the relay chamber.

In particular, in the present invention, the deformed state of the pressure sensor can be clearly detected by X-ray photography using the rigid disk and the membrane containing the contrast agent, and the diameter d of the minimum diameter reduction part and the diameter D of the disk Since the ratio can be accurately determined even by taking X-rays from an oblique direction, the calibration means has the effect of accurately determining the pressure in the ventricle.

[Brief explanation of drawings]

1 to 3 show a ventricular shunt equipped with a pressure sensor as an embodiment of the present invention. FIG. 1 is a plan view with the upper wall removed, and FIG. 3 is an enlarged perspective view of the pressure sensor, and FIG. 4 is a plan view with the upper wall of the electromagnetic box used for switching the flow rate of the ventricular shunt removed. 1... Relay chamber, 1a... Reservoir, 1b... Valve chamber, 1c... Septum, 2... Ventricular catheter, 3...
...peritoneal catheter, 4...first check valve, 5...
Second check valve, 6...Third check valve, 4a, 5
a, 6a... circular valve seat, 4b, 5b, 6b... receiving plate, 7... reference position, 8... movable sphere, 9... circular seat, 10... holding part, 11... second movable sphere,
12... Locking plate, 13... Receiving plate, 14... Pressure sensor, 14a... Rigid disk, 14b... Rigid column member, 14c... Elastic membrane, 20... Electromagnetic box, 21, 22a, 22b , 23-25...
...Electromagnet, A...upstream compartment, B...downstream compartment.

Claims (1)

[Scope of Claims] 1. In a ventricular shunt comprising a ventricular catheter inserted into the ventricle, a relay chamber connected to the ventricular catheter, and a peritoneal catheter connected to the relay chamber, the relay chamber A cutoff valve mechanism capable of blocking communication to the peritoneal catheter is provided inside the peritoneal catheter,
A pressure sensor is provided inside the relay chamber on the upstream side of the shutoff valve mechanism, and the pressure sensor is connected to a pair of rigid discs facing each other and a rigid column member that connects these discs to each other. , an elastic membrane extended in a cylindrical shape between the discs, and the membrane contains a contrast agent, and a gas is introduced into the cylindrical space formed by the membrane and the pair of discs. A ventricular shunt with a pressure sensor, characterized in that it is encapsulated with. 2. The ventricular shunt with a pressure sensor according to claim 1, wherein the gas sealed in the cylindrical space of the pressure sensor is dry air. 3. Claim 1, wherein the relay chamber is formed of a reservoir communicating with the peritoneal catheter and a valve chamber communicating with the reservoir.
The ventricular shunt with a pressure sensor according to item 1 or 2. 4. The invention according to claim 3, wherein the shutoff valve mechanism is provided at a connection portion of the valve chamber with the reservoir, and the pressure sensor is provided in an extension chamber of the reservoir. Ventricular shunt with pressure sensor as described.