JPH08322846A - Trocar tube, trocar tube assembly and implement for insertion into catheter - Google Patents

Abstract

PURPOSE: To make it possible to easily and surely insert a catheter tube with low invasion by forming an aperture communicating with the internal cavity of a tubular member on the flank of this tubular member of a trocar tube consisting of the tubular member and a gripping member existing on the base end side of the tubular member. CONSTITUTION: The expansion type trocar tube 10 is composed of the tubular member 11 and the gripping member 17 connected to the operator side part 13 at the base end of the tubular member 11. The tubular member 11 is formed to an approximately conical shape smaller in the diametral bore and outside diameter of the front end 14 than the diametral bore and outside diameter of the base end 13 in a natural state. The tubular member 11 is formed to a tapered shape gradually degreasing in the outside diameter from the base end 13 toward the front end 14. Further, a slit (first aperture) 16 extending along the longitudinal direction of the tubular member 11 is formed on the flank of the tubular member 11. This slit 16 communicates with the internal cavity 12 and front end opening, respectively, of the tubular member 11. The width of the front end 14 of the slit 16 is made narrower than the width at the base end of the slit 16 in the natural state before the expansion of the tubular member 11.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a trocar tube, a trocar tube assembly and a catheter which are used, for example, when inserting a catheter tube into the body, particularly when inserting and leaving an indwelling catheter in the abdominal cavity in peritoneal dialysis. It relates to an insertion instrument.

[0002]

2. Description of the Related Art In peritoneal dialysis therapy in which dialysis is performed through the peritoneum for a patient with renal failure, continuous injection of fresh dialysate into the abdominal cavity and drainage of dialysate waste fluid are performed to maintain continuous A continuous ambulatory peritoneal dialysis (hereinafter referred to as “CAPD”) capable of performing dialysis has been widely performed recently.

At the start of this CAPD, it is necessary to indwell a catheter tube (indwelling catheter) in the abdominal wall that connects the inside of the abdominal cavity and the outside of the body in order to inject and discharge the dialysate. At this time, for the purpose of securely fixing the catheter tube or preventing infection, the location where the catheter tube penetrates the peritoneum and is inserted into the abdominal cavity and the location where the catheter tube penetrates the skin from outside the body are different. A subcutaneous tunnel is formed between the two.

In order to form this subcutaneous tunnel, the skin at a portion (first incision site) that penetrates the peritoneum is incised by about 5 cm and the catheter tube is inserted into the abdominal cavity, and then the proximal portion (base) of the catheter tube is formed. An end portion) is connected to a guide needle having a sharp tip, and the needle is brought out of the body by puncturing toward the outside of the body at a portion (second incision portion) about 4 to 5 cm away from the first incision portion. As another method, after inserting the catheter tube into the abdominal cavity at the first incision site, an incision is made at a position about 4 to 5 cm away from the first incision site, and forceps is applied from the site toward the first incision site. Etc. are inserted, the catheter tube inserted through the first incision site is grasped, and the proximal portion of the catheter tube is pulled out of the body.

However, in each of the above methods,
Since the incision is large at the puncture site, especially at the first incision site, there is a problem that the invasion and burden on the patient (specifically, postoperative pain, cosmetic problems, and length of hospital stay) increase.

[0006]

SUMMARY OF THE INVENTION An object of the present invention is to provide a trocar tube, a trocar tube assembly, and a trocar tube in which a catheter tube such as an indwelling catheter used for CAPD can be easily and reliably inserted with minimal invasiveness. An object is to provide an instrument for inserting a catheter.

[0007]

The above objects are achieved by the present invention described in (1) to (22) below.

(1) A trocar tube comprising a tubular member and a grip member located on the proximal end side of the tubular member, wherein the trocar pipe has a side surface of the tubular member that communicates with an inner cavity of the tubular member. A trocar tube having an opening formed therein.

(2) A trocar tube comprising a tubular member and a grip member located on the proximal end side of the tubular member, wherein the side surface of the tubular member can communicate with the inner cavity of the tubular member. A trocar tube having an opening forming part for forming an opening of the trocar tube.

(3) The trocar tube according to (2), wherein the opening forming portion is formed by a plate piece capable of opening and closing the first opening portion.

(4) The trocar tube according to (3), wherein the plate piece has higher flexibility than the tubular member.

(5) The trocar according to (3) or (4), wherein the plate piece has a function of blocking at least a part of the inner cavity of the tubular member when the first opening is formed. tube.

(6) The first opening is continuous along the longitudinal direction of the tubular member at least halfway from the tip of the tubular member.
The trocar tube according to any one of 1.

(7) The trocar tube according to any one of (1) to (6) above, wherein the width of the first opening changes along the longitudinal direction of the tubular member.

(8) A trocar tube comprising a tubular member and a grip member connected to the base end of the tubular member, wherein the tubular member and the grip member include a tubular shaft of the tubular member. A trocar tube characterized by being capable of being divided into a plurality of planes or a plane substantially parallel to the tube axis.

(9) The tubular member is formed by connecting a plurality of plate-like members arranged along the circumferential direction by bonding or fusing,
The trocar tube according to any one of (1) to (8) above, which is integrated.

(10) The grip member is provided with a marker indicating the direction of the first opening (1)
A trocar tube according to any one of (1) to (9).

(11) The trocar tube according to any one of the above (1) to (10), wherein the tubular member has a diameter at the tip end portion smaller than that at the base end portion.

(12) The trocar tube according to the above (11), wherein at least the diameter of the distal end portion of the tubular member is expandable.

(13) A trocar tube assembly comprising: the trocar tube according to (12) above; and an expansion tube that is inserted into the inner cavity of the tubular member to expand the diameter of the distal end portion,
A trocar tube assembly, wherein a second opening communicating with an inner cavity of the expansion tube is formed on a side surface of the expansion tube.

(14) The trocar tube assembly according to (13), wherein the expansion tube has a marker indicating the direction of the second opening.

(15) The above-mentioned (13), which is provided with an obturator having a puncture end at its tip, which is used by inserting it into the inner cavity of the tubular member
Alternatively, the trocar tube assembly according to (14).

(16) A trocar tube according to any one of the above (1) to (12), and a plug having a puncture end at the tip, which is used by being inserted into the lumen of the tubular member. Characterized trocar tube assembly.

(17) A catheter insertion device comprising the trocar tube assembly according to any one of (13) to (16) and a puncture needle having a passage therein, wherein one end of the passage is A catheter insertion device having a side opening near the tip of a puncture needle.

(18) The device for inserting a catheter according to the above (17), wherein the puncture needle has a marker indicating a direction in which the passage is opened.

(19) A catheter insertion instrument comprising the trocar tube assembly according to any one of (13) to (16) and a puncture needle assembly, wherein the puncture needle assembly is internally A puncture needle having a passage, and a spacer for holding a constant distance between the tubular body and the puncture needle at a position different from the puncture needle, and one end of the passage is provided laterally near the tip of the puncture needle. A device for inserting a catheter, characterized in that it is opened at a position facing the direction of the tubular body in a state where the spacer is attached.

(20) The catheter insertion device according to the above (19), wherein the spacer has an engaging portion that engages with the tubular body.

(21) The above (19) or (20), which has a distance adjusting means for adjusting a distance between the tubular body and the puncture needle.
The device for inserting a catheter according to [4].

(22) The catheter insertion device according to any one of (17) to (21), which has a puncture depth regulating means for regulating the puncture depth of the puncture needle.

The trocar tube of the present invention comprises a tubular member and a grip member located at the proximal end side thereof, and has a first opening or a first opening communicating with the inner cavity of the tubular member formed on the side surface of the tubular member. It has an opening forming portion for

The first opening is continuous along the longitudinal direction of the tubular member from the tip of the tubular member to at least the middle thereof. In addition, the width of the first opening may be constant or changing along the longitudinal direction of the tubular member. The opening forming portion is configured by, for example, a plate piece capable of opening and closing the first opening, preferably a plate piece having higher flexibility than the tubular member.

Further, the trocar tube of the present invention comprises a tubular member and a grip member located at the base end side thereof, and the tubular member and the grip member are substantially parallel to the surface including the tube axis of the tubular member or the tube axis. The surface may be divided into a plurality of parts.

In such a trocar tube of the present invention, the tubular member may have a constant diameter along the longitudinal direction, or may have a diameter at the tip end smaller than that at the base end. In the latter case, it is preferable that the tubular member has an expandable diameter at least at its tip.

Further, the tubular member may be one in which a plurality of plate-shaped members arranged along the circumferential direction are connected and integrated by adhesion or fusion. Further, in the trocar tube of the present invention, it is preferable that the grip member is provided with a marker indicating the direction of the first opening (or the opening forming portion).

The trocar tube assembly of the present invention comprises the trocar tube as described above and a plug having a puncture end at the tip which is used by inserting it into the inner cavity of the tubular member.
Further, in the trocar tube assembly of the present invention, in the case where the tubular member is such that the diameter of the distal end portion is smaller than that of the proximal end portion and at least the diameter of the distal end portion is expandable, the inner diameter of the tubular member is further increased. And an expansion tube for expanding the diameter of the distal end portion of the tubular member. A second opening communicating with the lumen of the expansion tube is formed on the side surface of the expansion tube. Further, the expansion tube preferably has a marker indicating the direction of the second opening.

Further, when the tubular member and the grip member are dividable into a plurality of parts by a surface including the tube axis of the tubular member or a surface substantially parallel to the tube axis, an opening is formed on the side surface of the tubular member. You don't have to. A puncture needle or puncture needle assembly is preferably used for the trocar tube or trocar tube assembly of the present invention.

The catheter insertion device of the present invention comprises this puncture needle or puncture needle assembly and the above-mentioned trocar tube assembly. The puncture needle has a passage therein, and one end of the passage is opened laterally near the tip of the puncture needle.

On the other hand, the puncture needle assembly is used by being attached to a tubular body such as a trocar tube or an expansion tube, and the puncture needle having a passage therein and the distance between the trocar tube and the puncture needle are arranged. A spacer which holds the spacer constant is provided, and one end of the passage is opened laterally near the tip of the puncture needle and in a position facing the direction of the trocar tube in which the spacer is mounted.

In this case, the spacer has an engaging portion that engages with the trocar tube. Further, it is preferable to provide a distance adjusting means for adjusting the distance between the trocar tube and the puncture needle.

In such a catheter insertion device, the puncture needle preferably has a marker indicating the direction in which the passage opens. Further, it is preferable that a puncture depth regulating means for regulating the puncture depth of the puncture needle is provided.

In the trocar tube assembly including the trocar tube and the obturator, when puncturing a living tissue such as the abdominal wall with the obturator inserted in the trocar tube, as described above, the distal end portion of the tubular member of the trocar tube is If the diameter of is smaller than the diameter of the base end, that is, if it is tapered,
It is possible to puncture and penetrate a predetermined site (first puncture site) on the abdominal wall with less resistance, and there is little invasion.

In such a trocar tube, the effective inner diameter, particularly the inner diameter of the distal end portion, can be expanded by inserting an expansion tube or the like from the proximal end side thereof, whereby the catheter tube or other devices can be expanded. The insertion is facilitated (hereinafter, the trocar tube having such a configuration is referred to as an "expanded trocar tube" if a particular distinction is required).

When the tubular member of the trocar tube is formed by connecting and integrating a plurality of plate-like bodies, it is necessary to install a covering tube or the like on the outer periphery in order to fix the separated plate-like bodies. Therefore, the diameter can be sufficiently reduced, the puncture resistance at the time of puncturing the living body is reduced, and the invasion is reduced. Since the adjacent plate-like bodies are bonded to each other at the side surface by adhesion or fusion, the tubular member can be easily and surely expanded by inserting an expansion tube or the like.

On the side surface of the trocar tube of the present invention, a slit (first opening), in particular, a slit which is continuous along the longitudinal direction of the tubular member from the tip of the tubular member to at least the middle thereof is formed. Further, in the case of the trocar tube having the opening forming portion, for example, the plate piece is opened to the inside of the tubular member to form the slit (first opening portion).

From the site (second puncture site) separated by a predetermined distance from the first puncture site where the trocar tube is punctured,
Long instruments such as guide wires, sheaths, catheter tubes such as indwelling catheters are inserted, and these
It reaches the inside of the slit through the subcutaneous tissue and is further inserted into the target site in the abdominal cavity through the lumen of the trocar tube.
After inserting the catheter into the target site in this manner, the trocar tube is removed from the abdominal wall, and only the catheter tube is left indwelling.

A slit (second opening) is also formed on the side surface of the expansion tube for expanding the expansion trocar tube. The slit overlaps with the slit formed in the expansion type trocar tube when the expansion tube is inserted into the trocar tube. Therefore, in a state where the trocar tube is expanded, as in the above, a catheter tube or the like that has passed through the subcutaneous tissue is sequentially passed through the slits formed in the expansion tube and the trocar tube and the lumen of the expansion tube, and the target site in the abdominal cavity. Can be inserted into.

When a divisible trocar tube (hereinafter, a trocar tube having such a structure is referred to as a "divided trocar tube" if a distinction is required) is punctured at the first puncture site, The trocar tube can be divided and removed, improving operability.

When the split trocar tube is applied to the expanded trocar tube, when the trocar tube is punctured at the first puncture site and expanded by the expansion tube with the slit, the expansion tube is left on the abdominal wall. The trocar tube can be divided and removed. Also in this case, as described above,
A catheter tube or the like that has passed through the subcutaneous tissue can be inserted into a target site in the abdominal cavity sequentially through the slit formed in the expansion tube and the lumen of the expansion tube. No slit may be formed on the side surface of such a split trocar tube.

The catheter insertion device of the present invention is used, for example, as follows. A trocar tube (or an expanded trocar tube in which an obturator and an expansion tube are inserted) is inserted from the first puncture site, and the trocar tube is inserted into the abdominal cavity. Next, a puncture needle or the like is punctured at the second puncture site, the first guide wire is inserted through a passage (lumen) formed inside the puncture needle, and is inserted through the subcutaneous tissue to form a side surface of the trocar tube. The slit and the trocar tube lumen formed in 1 are sequentially passed to reach the abdominal cavity. Then, only the puncture needle is removed.

A sheath with a dilator (tube insertion aid) inserted in its inner cavity is advanced along this first guide wire, and the sheath is guided into the abdominal cavity by the same route as described above. After removing the first guide wire and dilator, insert the endoscope into the sheath, observe the inside of the abdominal cavity on the monitor screen imaged by the endoscope, and insert the sheath tip into the target site such as inside the small pelvic cavity. Proceed to. At this time, the distal end portion of the sheath is curved in a desired manner in advance, and the sheath is reinforced by a reinforcing member such as a braid, so that the sheath distal end portion cannot be rotated or pushed on the proximal side of the sheath. To the target site easily.

After inserting the sheath into the small pelvic cavity, the endoscope is removed and the second guide wire is inserted into the sheath,
This is allowed to reach the small pelvic cavity. Further, the sheath is removed while leaving the second guide wire, and then the indwelling catheter is advanced along the second guide wire. As a result, the indwelling catheter can be guided by the same route as described above, that is, through the subcutaneous tunnel, and its tip can be easily and surely inserted into the small pelvic cavity.

After that, if the second guide wire and the trocar tube are removed, only the indwelling catheter is left indwelling. At this time, if the middle part of the indwelling catheter is previously curved or bent into a shape conforming to the subcutaneous tunnel formed in the abdominal wall by the above method, it becomes difficult to move in the abdominal wall after placement.

In such a method of use, prior to the insertion of the first guide wire, the tubular member of the trocar tube punctured at the first puncture site may be expanded by inserting the expansion tube into the expandable trocar tube. . Further, in the case of the expansion type trocar tube having the opening forming portion, the distal end side of the tubular member expands and the slit (first opening) is formed by inserting the expansion tube. It is also possible to expand the dividable expandable trocar tube with the expansion tube, and then divide and remove the trocar tube to leave only the expansion tube at the first puncture site.

The puncture needle that is punctured at the second puncture site has a passage inside, and one end of the passage is opened laterally near the tip of the puncture needle. Therefore, the first guide wire inserted into the passage from the other end side of the passage protrudes toward the side of the puncture needle from the opening and can be easily and surely inserted into the subcutaneous tissue.

Instead of the puncture needle, a puncture needle having a passage therein, and a spacer for keeping a constant distance between the puncture needle and a tubular body (trocar tube, expansion tube, etc.) at a position different from the puncture needle. It is also possible to use a puncture needle assembly provided with. In this case, since the puncture needle is punctured in the abdominal wall while engaging the engaging portion formed at the end of the spacer with the trocar tube or the expansion tube punctured at the first puncture site, the second puncture needle is used. The puncture site is always at a constant distance from the first puncture site.

Further, one end of the passage formed inside the puncture needle is laterally near the tip of the puncture needle, and in the direction of those tubes with the spacer attached to the trocar tube or the expansion tube. Since it is opened at the position facing, the first guide wire inserted into the passage from the other end side of the passage protrudes toward the side of the puncture needle from the opening, and the trocar tube and / Alternatively, it can easily and surely proceed toward the slit formed in the expansion tube and can surely reach the inside of the slit.

When the puncture depth regulating means is provided, since the puncture depth of the puncture needle is regulated to an appropriate depth, the puncture is too shallow to approach the skin or the puncture is too deep. As a result, there is no inconvenience that the tip of the puncture needle reaches the muscle layer, and the guide wire or the indwelling catheter can be inserted into the subcutaneous tissue between the skin and the anterior rectus abdominis muscle at an appropriate depth.

According to the present invention as described above, for example, CA
When an indwelling catheter used for PD is inserted into the abdominal cavity and placed, the trocar tube assembly is punctured in the abdominal wall, and a puncture needle is punctured in a different place, so that it is not necessary to make a large incision in the abdominal wall. In addition, a subcutaneous tunnel can be easily and surely formed to insert and indwell the catheter tube in the abdominal cavity, so that the operability of inserting the catheter tube is improved and the invasion is greatly reduced.

[0059]

BEST MODE FOR CARRYING OUT THE INVENTION A trocar tube, a trocar tube assembly and a catheter insertion device according to the present invention will be described below in detail with reference to the preferred embodiments shown in the accompanying drawings.

FIG. 1 is a perspective view showing a first embodiment of a trocar tube of the present invention, FIG. 2 is a perspective view of an obturator, and FIG. 3 is a perspective view showing a state in which the obturator is inserted in the trocar tube. Is. 4 is a perspective view showing a configuration example of an expansion tube for expanding the trocar tube, and FIG. 5 is a perspective view showing a state where the trocar tube is expanded by the expansion tube shown in FIG.

The trocar tube assembly of the present invention comprises a trocar tube 10 shown in FIG. 1, an obturator (intratrocar tube needle) 20 shown in FIG. 2, and an expansion tube 30 shown in FIG. Hereinafter, these configurations will be sequentially described.

As shown in FIG. 1, a trocar tube (expansion type trocar tube) 10 of the present invention includes a tubular member 11 and a grip member 17 connected to a proximal end portion (hand side portion) 13 of the tubular member 11. It consists of and.

The tubular member 11 has a base end portion 13 and a tip end portion 14, and in a natural state, the diameter (inner diameter, outer diameter) of the tip end portion 14 is larger than the diameter (inner diameter, outer diameter) of the base end portion 13. The smaller one has a substantially conical shape. In this embodiment, the tubular member 11 has a taper shape in which the outer diameter gradually decreases from the base end portion 13 toward the tip end portion 14. Here, the "natural state" means a state in which an external force is not applied to the tubular member 11.

The tip portion 14 of the tubular member 11 is constructed so as to expand in accordance with its outer diameter by inserting an expansion tube 30 described later. Hereinafter, a structure for expanding the tubular member 11 will be described.

The tubular member 11 is composed of a plurality of elongated plate-like members 15 arranged in an annular shape along the circumferential direction of the tubular member 11. Each plate-shaped body 15 has a trapezoidal shape in which the width on the base end side is larger than the width on the front end side. Then, the side surfaces of the adjacent plate-like bodies 15 are bonded or fused to each other, whereby the plate-like bodies 15 are connected and integrated to form the tubular member 11. In this case, each plate 1
It is preferable that the tip portions of 5 are separated (have no binding force).

The plate-like body 15 can be adhered to various adhesives such as acrylic adhesives, epoxy adhesives, rubber adhesives, silicone adhesives, polyurethane adhesives, polyester adhesives and polyamide adhesives. Adhesives or various solvents can be used.

When the plate-like body 15 is fused, heat fusion, high frequency fusion, ultrasonic fusion, or the like can be performed. Such adhesion or fusion of the plate-shaped body 15 is performed by the expansion tube 3 described later.
It is preferable that the bonding strength is such that the plate members 15 can be easily separated by inserting 0 or the like. Note that such adhesion and fusion of the plate-shaped body 15 can be similarly applied to the case of adhering and fusion-bonding plate pieces 151, 152, 161, 191 described later.

The material forming the plate-like body 15 is preferably a material having a strength sufficient to withstand the impact when puncturing the abdominal cavity or the pressure received from the body wall, and examples thereof include stainless steel and aluminum. Or various metal materials such as aluminum alloy, super elastic alloy, shape memory alloy, polyamide, polyvinyl chloride, polycarbonate, ABS resin, polyethylene, polypropylene, polystyrene, polytetrafluoroethylene, acrylic resin, polyester, polyimide, polyarylate, Polyacetal, polyphenylene sulfide (PPS), liquid crystal polymer, polyether ether ketone (PEEK)
Various synthetic resin materials such as In addition,
The materials mentioned here can also be used for the tubular member 111 and the like that are not formed of a plate-like body to be described later.

The tip portion 14 of the plate member 15 is made of a softer material such as a super elastic alloy, soft polyvinyl chloride, ethylene-vinyl acetate copolymer, silicone rubber, polyurethane, or thermoplastic elastomer. It can also be configured, and thereby, damage such as scratching when contacting a living tissue such as an organ is prevented, and safety is further enhanced.

Further, in order to further reduce the puncture resistance of the trocar tube 10, the outer surface of the plate member 15 is preferably smoothed. The total number of such plate-like members 15 depends on the material and thickness thereof, but is preferably about 4 to 50, more preferably about 5 to 12, and even more preferably about 6 to 8. .

The total length of the tubular member 11 is not particularly limited, but is preferably about 30 to 250 mm, more preferably about 50 to 200 mm, and further preferably about 70 to 150 mm.

The tubular member 11 is not limited to the one formed by connecting a plurality of separately formed plate-like bodies as in this embodiment. For example, after forming a tubular member having a diameter gradually reduced toward the tip, a plurality of cuts extending in the tube axis direction are formed on the outer peripheral surface and / or the inner peripheral surface to form a thin wall portion, and the thin wall portion is formed. The plate-shaped bodies adjacent to each other may be connected by a part. In this case, when an expansion tube 30 described later is inserted into the tubular member 11, at least a part of the thin portion is broken, and the plate-shaped body is separated and expanded.

A slit (first opening) 16 extending along the longitudinal direction of the tubular member 11 is formed on the side surface of the tubular member 11.
Are formed. In the case of this embodiment, one plate 15
The slit 16 is formed by cutting the groove from the middle to the tip. The slit 16 communicates with the inner cavity 12 and the tip opening of the tubular member 11, respectively.

The length of the slit 16 is not particularly limited, but it is preferably about 10 to 100% of the total length of the tubular member 11, and more preferably about 30 to 70%. In addition, the slit 16 when the tubular member 11 is expanded
May have the same width or different widths along the longitudinal direction of the tubular member 11. In this case, the width of slit 16 (average)
Is not particularly limited, but is preferably about 1 to 20 mm, more preferably about 3 to 10 mm.

When the first opening is formed by the slit 16 described above, it is easy to form and the width (opening area) of the slit 16 before and after the expansion of the tubular member 11 is increased.
Has the following advantages.

That is, as shown in FIG. 1, the tubular member 1
Before expansion of 1 (natural state), the tip portion 1 of the slit 16
Since the width in 4 is narrower than the base end of the slit 16, there is no problem in puncturing the living tissue with the trocar tube 10, and since the opening area of the slit 16 is small,
At the time of puncturing a biological tissue, it is possible to prevent subcutaneous adipose tissue or the like from entering the tubular member 11 through the slit 16, and when the distal end portion 14 of the tubular member 11 is expanded, Along with this, the width of the slit 16 also increases, and it becomes possible to easily insert a device such as a catheter tube.

In the present invention, the first opening is
Not limited to the slit shape as shown, for example, a polygon such as a circle, an ellipse, a quadrangle, a shape in which a plurality of these are connected, or a shape including a part thereof, such as a guide wire or a catheter tube, Any material may be used as long as it can pass.

The grip member 17 is provided mainly for gripping the grip member 17 to operate the trocar tube 10. The grip member 17 has an outer wall portion 171, and inside thereof, an insertion port for inserting a plug 20, an expansion tube 30, and the like, which will be described later, is formed through the outer wall portion 171. The proximal end portion 13 of the tubular member 11 is fixed to the distal end side of this insertion port.

Examples of the material forming the outer wall portion 171 of the grip member 17 include various metal materials such as stainless steel, aluminum or aluminum alloy, polyamide, polyvinyl chloride, polycarbonate, ABS resin,
Examples include various synthetic resin materials such as polyethylene, polypropylene, polyester, polytetrafluoroethylene, and acrylic resin.

Further, a marker (mark) 172 is attached to the outer wall portion 171 of the grip member 17 at a position corresponding to the slit 16 to indicate the forming position of the slit 16, that is, the forming position in the circumferential direction of the tubular member 11. . Due to the presence of the marker 172, the direction of the slit 16 can be easily grasped in a state where the trocar tube 10 is punctured into the living tissue, and more accurate operation can be performed.

As shown in FIG. 2, the obturator 20 comprises a shaft 21, a grip member 24 connected to the base end 22 of the shaft 21, and a head portion 25 formed at the tip 23 of the shaft 21. To be done. The head portion 25 is formed with a sharp puncture end (blade edge) 26 and a taper portion 27 located on the base end side thereof. A constricted portion 28 is formed at the boundary between the shaft 21 and the head portion 25. It is preferable that the shaft 21 and the head portion 25 are integrally molded. The tip of the puncture end 26 may be rounded, which further enhances the effect of preventing damage to organs and the like in the abdominal cavity during puncture.

The shaft 21 is tapered so that its outer diameter gradually decreases from the base end 22 toward the tip 23. In this case, the shaft 21 has the obturator 20 as shown in FIG.
With the shaft 21 inserted into the trocar tube 10.
It is preferable that the outer peripheral surface of is shaped so as to contact or approach the inner peripheral surface of the tubular member 11.

As the materials for forming the shaft 21, the head portion 25 and the grip member 24, for example, various metal materials such as stainless steel, aluminum or aluminum alloy, titanium or titanium alloy, superelastic alloy, shape memory alloy and the like, and , Polyamide, hard polyvinyl chloride, polycarbonate, ABS resin, polyethylene, polypropylene, polyester, polytetrafluoroethylene, acrylic resin, polyphenylene sulfide (PP
S), polyetherketone (PEK), polyetheretherketone (PEEK), various synthetic resin materials such as liquid crystal polymers, and various ceramic materials are mentioned, and hard materials such as stainless steel and hard resin are particularly preferable.

The length of the shaft 21 is determined in relation to the total length of the tubular member 11 of the trocar tube 10 to be inserted.
That is, as shown in FIG.
0 is inserted into the trocar tube 10 and the head portion 2
The length 5 is set so as to protrude from the tip end opening of the tubular member 11. Specifically, the total length of the shaft 21 is
It is preferably about 40 to 300 mm, more preferably about 60 to 250 mm.

As shown in FIG. 3, the obturator 20 is inserted into the inner cavity 12 of the tubular member 11 through the insertion opening of the grip member 17 of the trocar tube 10, and the tip end surface of the grip member 24 becomes the base end surface of the grip member 17. When approaching or abutting, the head portion 25 is projected from the tip opening of the trocar tube 10. At the tip portion 14 of the trocar tube 10, a plate-like body 15
Is made of a flexible material and is separated from each other, the head portion 25 can easily pass through the tip portion 14, and the obturator 20 can be easily inserted into the trocar tube 10. it can.

The tip portion 14 of the trocar tube 10 has a plug 2
It is located in the constricted part 28 of 0, and at this time, the trocar tube 1
Since the outer diameter of the tip portion 14 of 0 is substantially equal to or smaller than the maximum outer diameter of the head portion 25, puncture resistance when puncturing the abdominal wall (body wall) with the obturator 20 and the trocar tube 10 is small, Easy to puncture and less invasive. After piercing the abdominal wall, only the obturator 20 is removed while leaving the trocar tube 10, but at this time, the tapered tip portion 27 of the obturator 20 expands the flexible tip portion 14 of the trocar tube 10. The obturator 20 can be smoothly removed.

As shown in FIG. 4, the expansion tube 30 is composed of a tubular member 31 and a grip member 36 connected to a base end portion (hand side portion) 32 of the tubular member 31. A slit (second opening) 35 extending along the longitudinal direction of the tubular member 31 is formed on the side surface of the tubular member 31. The slit 35 communicates with the inner cavity 34 and the tip opening of the tubular member 31, respectively.

The length of the slit 35 is not particularly limited, but is preferably about 10 to 100% of the entire length of the tubular member 31, and more preferably about 25 to 65%. The width of the slit 35 may be the same or different along the longitudinal direction of the tubular member 31. In this case, the width (average) of the slits 35 is not particularly limited,
It is preferably about 20 mm, more preferably about 3 to 10 mm.

In the illustrated structural example, the inner diameter and outer diameter of the tubular member 31 are substantially constant over the entire length of the tubular member 31, but the invention is not limited to this, and the inner diameter and outer diameter of the tubular member 31 are It may be gradually decreased in the tip direction.

The second opening is not limited to the slit shape as shown in the drawing, but may be, for example, a polygon such as a circle, an ellipse, or a quadrangle, a shape in which a plurality of these are connected, or a part thereof. Any shape, such as a guide wire or a catheter tube, may be used as long as it can pass therethrough. Then, the shape and size of the second opening,
The installation position and the like may be the same as or different from those of the first opening. The grip member 36 has an outer wall portion 361, and the same insertion opening as that described above is formed inside thereof.

A marker (mark) 362 is attached to the outer wall portion 361 of the grip member 36 at a position corresponding to the slit 35, which indicates the position in which the slit 35 is formed, that is, in the circumferential direction of the tubular member 31. . Due to the presence of the marker 362, the direction of the slit 35 of the expansion tube 30 can be easily grasped when the expansion tube 30 is inserted into the trocar tube 10, and the slit 35 can be aligned with the slit 16 of the trocar tube 10.

As the constituent material of the tubular member 31, the same material as that of the tubular member 11 can be used, and as the constituent material of the grip member 36, the same material as that of the grip member 17 can be used.

The total length of the tubular member 31 of the expansion tube 30 is determined in relation to the total length of the tubular member 11 of the trocar tube 10 to be inserted and is not particularly limited, but is preferably about 40 to 300 mm, more preferably about 60 to 250 mm. preferable. In this case, the total length of the tubular member 31 is preferably equal to or greater than the total length of the tubular member 11.

The inner diameter of the tubular member 31 depends on various conditions such as the size of the catheter tube to be inserted, the outer diameter of the tubular member 11 and the degree of expansion of the tubular member 11, but is 2.0.
It is preferably about 49 mm, more preferably about 3.0 to 30 mm, still more preferably about 3.0 to 20 mm.

The tubular member 31 of the expansion tube 30 as described above is inserted into the lumen 12 of the tubular member 11 from the insertion opening at the proximal end of the grip member 17 of the trocar tube 10, and the distal end surface of the grip member 36 is gripped. When approaching or abutting on the proximal end surface of 17, the tubular member 31 spreads the tubular member 11 to spread the tubular members 11 as shown in FIG.
The bonded or fused portion of 5 is broken, the plate-like bodies 15 are separated from each other, and the trocar tube 10 is expanded. At this time, all or part of the slit 35 of the expansion tube 30 overlaps the slit 16 of the trocar tube 10, and an insertion passage for a device such as a guide wire, a sheath, or an indwelling catheter described later is formed in the overlapped opening portion. .

In such a trocar tube assembly, after the obturator 20 is inserted into the trocar tube 10, these are punctured from the first puncture site on the abdominal wall, and after being inserted into the abdominal cavity through the peritoneum. By removing only the obturator 20 while leaving the trocar tube 10, and then inserting the expansion tube 30 into the trocar tube 10, at least the tip of the tubular member 11 of the trocar tube 10 is expanded.

A subcutaneous tunnel using the trocar tube assembly as described above, a first guide wire 40, a dilator (tube insertion assisting device) 50, a sheath 60 and a flexible endoscope (endoscope) 70 described below. And a catheter tube, such as an indwelling catheter, can be inserted into the abdominal cavity.

FIG. 6 is a perspective view showing a structural example of the first guide wire. First guide wire 4 shown in FIG.
0 is composed of a wire rod having a rigidity that can be advanced by pushing it into the subcutaneous tissue. Specifically, a core wire made of a superelastic alloy or a core wire formed with a coating layer made of polyurethane, for example, on the outer periphery of the core wire may be mentioned.

FIG. 7 is a side view showing a configuration example of the dilator. The dilator 50 shown in the figure is a dilator shaft 51 that is harder than a sheath tube 61 described later.
And the base end portion (hand side portion) of the dilator shaft 51
2 and a dilator housing 54 connected to 2. The dilator 50 is formed with an inner cavity 55 penetrating from the tip end to the base end.

As the material for forming the dilator shaft 51, a material having a certain degree of rigidity is used. For example, polyethylene, polypropylene, polyurethane, polyvinyl chloride, ethylene-vinyl acetate copolymer, polyamide, polytetrafluoroethylene, Examples thereof include ABS resin and polycarbonate.

FIG. 8 is a side view showing a structural example of the sheath. The sheath 60 shown in the figure comprises a flexible sheath tube 61 and a sheath housing 65 connected to a proximal end portion (hand side portion) 62 of the sheath tube 61. The sheath 60 is formed with an inner cavity 64 that penetrates from the distal end to the proximal end. Further, the distal end portion 63 of the sheath tube 61 has a desired curved shape.

In the tube wall of the sheath tube 61,
A reinforcing member (not shown) preferably made of a braid is embedded. Thereby, the rotation operation and the pushing operation of the sheath 60 on the proximal side are surely transmitted to the distal end portion of the sheath,
It is possible to easily guide the distal end portion of the sheath and prevent the collapse of the inner cavity 64.

As the material forming the sheath tube 61, for example, polyethylene, polypropylene, polyurethane, polyvinyl chloride, ethylene-vinyl acetate copolymer, polyamide, polytetrafluoroethylene, silicone or the like, or two or more of them can be used. A combination (such as a laminated body) may be mentioned.

Further, in the sheath housing 65, a drug solution injection line 66 composed of a tube 67 and a mixed injection instrument 68.
Are connected to each other, and a chemical solution or the like can be supplied to the inner cavity 64 of the sheath 60 through the chemical solution injection line 66.

FIG. 9 is a side view when the sheath 60 and the dilator 50 are combined. As shown in the figure, when the dilator 50 is inserted into and combined with the inner cavity 64 of the sheath 60, the distal end portion 63 of the sheath tube 61 becomes substantially straight due to the rigidity of the dilator shaft 51.
Further, in this state, the distal end portion 53 of the dilator shaft 51 projects from the distal end opening of the sheath tube 61 by a predetermined length.

FIG. 10 is a side view showing a structural example of a flexible endoscope. A flexible endoscope 70 shown in the figure has a flexible shaft portion 71 and a proximal end portion (hand side portion) 7 of the shaft portion 71.
2 and an operation unit 74 connected to the control unit 2. A bundle of optical fibers for light transmission and light reception is installed in the shaft portion 71. The proximal side of this optical fiber bundle is
It is connected to a monitor device (not shown) via the operation unit 74. A rotatable handle 75 is installed on the operation portion 74, and the distal end portion 73 of the shaft portion 71 is moved in two directions as indicated by the alternate long and short dash line in FIG. 10 by rotating the handle 75 in a predetermined direction. Bend to.

An example of a method for inserting and leaving the catheter tube in the abdominal cavity using the trocar tube assembly or the like will be described below.

With the obturator 20 inserted into the trocar tube 10, these are punctured from the first puncture site of the abdominal wall, inserted into the abdominal cavity through the peritoneum, and then the obturator is left with the trocar tube 10 left. Only 20 is removed and then the expansion tube 30 is inserted into the trocar tube 10 to expand the tubular member 11.

Next, a small incision is made on the abdominal wall at a position apart from the first puncture site to some extent, and the first guide wire 40 is inserted through the small incision to insert the subcutaneous tissue between the skin and the muscular layer. Toward the direction of the trocar tube 10 punctured at the first puncture site and proceed substantially parallel to the abdominal wall. The first guide wire 40 reaches the inside of the slits 35 and 16, further advances through the inner cavity 34 of the expansion tube 30 toward its distal end side, projects from the distal end opening of the expansion tube 30, and is inserted into the abdominal cavity. .

Next, in the state where the sheath 60 and the dilator 50 are combined, the first cavity 55 of the dilator 50 is inserted into the first cavity 55.
The proximal end side of the guide wire 40 is inserted, and the sheath 60 and the dilator 50 are pushed along the first guide wire 40 and inserted into the abdominal cavity. Then, the first guide wire 40 and the dilator 50 are removed while leaving the sheath 60. When the first guide wire 40 and the dilator 50 are removed, the distal end portion 63 of the sheath tube 61 returns to the original curved shape.

Next, the flexible endoscope 70 is inserted into the inner cavity 64 of the sheath 60 inserted into the abdominal cavity, and the distal end of the flexible endoscope 70 is advanced to the vicinity of the distal end of the sheath tube 61, and the sheath tube 6
Observe the vicinity of the tip of 1. At this time, the sheath tube 6
The tip 63 of No. 1 is curved as desired. In this state,
The sheath housing 65 is grasped on the proximal side of the sheath 60 to perform rotation and pushing operations, and at the same time, the flexible endoscope 7
The distal end portion of the sheath tube 61 is guided to a target position while the distal end portion 73 is bent by the zero operating portion 74.

Thereafter, the flexible endoscope 7 is left with the sheath 60 left.
0 is removed, and a second guide wire (not shown, which has the same structure as the first guide wire) separately prepared is inserted into the inner cavity 64 of the sheath 60. Further, the sheath 60 is removed while leaving the second guide wire, and the proximal end side of the second guide wire is inserted into the lumen of a separately prepared indwelling catheter (not shown), and the indwelling catheter is moved to the second position. Push it along the guide wire and insert it into the abdominal cavity. At this time, the indwelling catheter is inserted into the abdominal cavity through the subcutaneous tissue, the slits 35 and 16 and the lumen 34 of the expansion tube 30 in the same manner as described above.

Next, the trocar tube 10 and the expansion tube 30 that have been punctured on the abdominal wall are removed. At this time, the peritoneum or fascia that has been expanded by the expanded trocar tube 10,
The rectus abdominis muscle, subcutaneous tissue, etc. contract and adhere to the indwelling catheter.

Finally, the second guide wire is removed from the indwelling catheter to complete the indwelling of the indwelling catheter. Thus, peritoneal dialysis can be performed by injecting a fresh dialysate and discharging a waste dialysate through the indwelling catheter placed in the peritoneum.

According to the above method, the subcutaneous tunnel formed between the small incision (corresponding to the second puncture site) and the first puncture site does not expand beyond the outer diameter of the indwelling catheter. , The indwelling catheter and the living tissue are firmly attached. Furthermore, as described above, even at the first puncture site, the living tissue and the indwelling catheter are in close contact with each other, so that the dialysate injected into the peritoneum via the indwelling catheter is unlikely to leak.

The indwelling catheter is not limited to the one formed of a simple tube, and the outer peripheral surface of the indwelling catheter,
In particular, a bio-derived material such as collagen may be placed in a portion in contact with the abdominal wall tissue. With such a configuration, the collagen layer and the biological tissue are fused after the indwelling catheter is inserted, and a fistula is formed in the subcutaneous tunnel portion relatively early. Therefore, skin infection is less likely to occur in the subcutaneous tunnel portion, and the indwelling catheter can be left indwelling for a long period of time. Further, since the indwelling catheter and the living tissue do not cause adhesion, the indwelling catheter can be easily replaced.

In the above description, the case where the present invention is applied to insertion and indwelling of an indwelling catheter used for CAPD has been described. However, the application of the present invention is not limited to this, and for example,
It can also be applied to a gastrostomy that penetrates the abdominal wall and stomach wall.

FIG. 11 is a perspective view showing a second embodiment of the trocar tube of the present invention. Hereinafter, this embodiment will be described, but the description of the same matters as those of the first embodiment will be omitted.

A trocar tube (split type trocar tube) 80 shown in FIG. 11 is a tubular member 81 having an inner cavity 82 and a separable grip connected to a proximal end portion (hand side portion) 83 of the tubular member 81. And a member 88.

As in the above, the tubular member 81 has a substantially conical shape in which the diameter (inner diameter, outer diameter) of the distal end portion 84 is smaller than the diameter (inner diameter, outer diameter) of the base end portion 83 in the natural state. ing. The distal end portion 84 of the tubular member 81 is configured to expand in accordance with its outer diameter by inserting the expansion tube 30.

The tubular member 81 is composed of a plurality of plate-like members 85 arranged in an annular shape along the circumferential direction of the tubular member 81 and similar to the above.
It consists of. The side surfaces of the adjacent plate-like bodies 15 are adhered or fused to each other, whereby the plate-like bodies 85 are connected and integrated to form the tubular member 81. In this case, each plate-shaped member 8 is formed so that the tubular member 81 can be easily divided.
It is preferable that the plate-like bodies 85 are separated (have no binding force) near the base end portion 83 of 5 by forming the notches 86 and the like.

FIG. 12 is a cross sectional view of the grip member 88. As shown in FIGS. 11 and 12, the grip member 88 is composed of a pair of grip halves 88a and 88b. On the joint surface of these grip halves 88a and 88b, a concave and convex fitting portion 881 composed of a removable convex portion and a concave portion is formed, and by fitting the concave and convex fitting portion 881, the grip half bodies 88a and 88b are formed. 88b is joined and integrated,
The grip member 88 is configured.

Further, semicircular grooves are formed in the inner central portions of the grip halves 88a and 88b, respectively. With the grip halves 88a and 88b joined and integrated, the expansion tubing is formed by both grooves. An insertion port 89 for inserting 30 is formed. The proximal end portion 83 of the tubular member 81 is fixed to the distal end side of the insertion port 89.

As described above, the obturator 20 is attached to the trocar tube 8.
In the state of being inserted in 0, these are punctured from the first puncture site of the abdominal wall, penetrated through the peritoneum and inserted into the abdominal cavity, then only the obturator 20 is removed while leaving the trocar tube 80, and thereafter, By inserting the expansion tube 30 into the trocar tube 80, at least the tip of the tubular member 81 of the trocar tube 80 is expanded.

Then, the fitting of the concavo-convex fitting portion 881 is released to divide the grip halves 88a and 88b. Along with this, the tubular member 81 is also divided at the boundary portion 87 (the plate-shaped bodies 85 have already been separated from each other due to the expansion of the tubular member 81). That is, the grip member 88 is the tubular member 81.
It is divided into two by a plane including the tube axis of. The grip member 88 and the tubular member 81 thus divided are respectively removed from the first puncture site, and only the expansion tube 30 remains.

The grip member 88 is a tubular member 81.
It may be divided by a plane substantially parallel to the tube axis, and further divided into three or more. Further, the grip halves 88a, 88b may be joined by a means other than the concave-convex fitting portion 881 as shown, or the inner surfaces of the grip halves 88a, 88b may simply contact or approach (face each other). It may be

FIG. 13 is a perspective view showing a third embodiment of the trocar tube of the present invention, FIG. 14 is a perspective view showing another constitutional example of the obturator, and FIG. 15 is a view showing the inside of the trocar tube shown in FIG. It is a perspective view which shows the state which inserted the obturator shown in FIG. Hereinafter, the embodiment shown in these drawings will be described, but the description of the same matters as those in the first embodiment will be omitted.

A trocar tube 110 shown in FIG. 13 has a tubular member 111 having an inner cavity 112 and a grip member 1 connected to a proximal end portion (hand side portion) 113 of the tubular member 111.
It is composed of 17 and.

The tubular member 111 has a substantially constant outer diameter and inner diameter from the proximal end to the distal end, and the side surface of the tubular member 111 extends along the longitudinal direction of the tubular member 111 from the distal end to the middle of the tubular member 111. An elongated slit (first opening) 115 is formed.

The slit 115 communicates with the inner cavity 112 and the tip opening of the tubular member 111, respectively. In the case of this embodiment, the width of the slit 115 is constant along the longitudinal direction thereof.

The grip member 117 has the same structure as that of the grip member 17, and a marker (mark) 119 indicating the forming direction of the slit 115 is attached to the outer wall portion 118 at a position corresponding to the slit 115. There is.

As shown in FIG. 14, the obturator 120 is composed of a shaft 121 and a grip member 124 connected to a base end 122 of the shaft 121. The shaft 121 has a substantially constant outer diameter over the entire length, and a puncture end (blade edge) 125 is formed at a tip 123 thereof. The tip of the puncture end 125 may be rounded, which further enhances the effect of preventing damage to organs and the like in the abdominal cavity during puncture.

As shown in FIG. 15, the shaft 121 is
With the obturator 120 inserted in the trocar tube 110,
The length is set to such an extent that the puncture end 125 projects from the tip end opening of the tubular member 111.

16 and 17 are perspective views showing a fourth embodiment and a fifth embodiment of the trocar tube of the present invention, respectively. Hereinafter, each embodiment shown in these drawings will be described, but the description of the same matters as those in the third embodiment will be omitted.

Each trocar tube 110 shown in FIGS. 16 and 17 has a tubular member 111 having an inner cavity 112 and a proximal end portion (hand side portion) 113 of the tubular member 111, as in the third embodiment. However, the width of the slit (first opening) 130 formed on the side surface of the tubular member 111 changes along the longitudinal direction thereof. This is different from the third embodiment.

That is, the trocar tube 11 shown in FIG.
At 0, the slit 130 has a certain narrow width for a predetermined length from the tip thereof, that is, a narrow width through which a device such as a guide wire or a catheter tube can pass, but the proximal side ( On the grip member 117 side), a circular opening 131 having a diameter larger than the narrow width is presented, and the opening area of the entire slit 130 is set smaller than the opening area of the slit 115 in the third embodiment. Has been done.

A device such as a guide wire or a catheter tube has a circular opening 13 having a sufficiently large opening area.
Since it is inserted into the tubular member 11 after passing through the inside of the trocar 1, the operation can be performed smoothly and surely, while the opening area of the entire slit 130 can be made smaller, so that the trocar tube 110 has a smaller opening area. When puncturing living tissue,
Subcutaneous adipose tissue and the like can be prevented from entering the tubular member 111 via the slit 130.

In the trocar tube 110 shown in FIG. 17, the slit 130 has a circular opening 131 similar to that described above.
Further, at the tip of the slit 130, the width of the taper portion 132 gradually increases in the tip direction.
Are formed. In such a slit 130, the same action and effect as described above are exhibited, and the tapered portion 1
With 32, since there is no acute-angled portion at the tip portion of the slit, there is an advantage that the tip portion is less likely to damage the tissue.

FIG. 18 is a perspective view showing a sixth embodiment of the trocar tube of the present invention, and FIG. 19 is a sectional view taken along the line AA in FIG. Hereinafter, the embodiment shown in these drawings will be described, but the description of the same matters as those in the third embodiment will be omitted.

A trocar tube 140 shown in FIG. 18 has a tubular member 141 having an inner cavity 142 and a marker 149 connected to a proximal end portion (hand side portion) 143 of the tubular member 141.
And a grip member 147 having

The tubular member 141 has a substantially constant outer diameter and inner diameter from the proximal end to the distal end, and on the side surface of the tubular member 141, along the longitudinal direction of the tubular member 141, from the distal end to the middle of the tubular member 141. An opening forming portion 150 for forming the slit (first opening) 115 and the like as described above is formed at the position.

The opening forming portion 150 has a slit (first
A pair of narrow plate pieces 151, 15 that can be opened and closed)
It is composed of two. The plate pieces 151 and 152 are rotatably or curved with respect to the tubular member 141 at the portions that are divided by the boundary portion 153 and that are the opposite edge portions 154 and 155 of the slit (first opening portion). It is supported so that it can be (bent) deformed, and thereby has a function as a door for opening and closing the slit (first opening).

The plate pieces 151, 152 are preferably more flexible than the tubular member 141 in order to open and close them smoothly. As an example, the plate pieces 151, 15
When 2 is made of the same material as the tubular member 141 (may be a different material), its thickness may be smaller than that of the tubular member 141. That is, as shown in FIG. 19, the thicknesses of the plate pieces 151 and 152 are
An example is a configuration that gradually decreases toward the boundary portion 153.

Further, the constituent materials of the plate pieces 151 and 152 themselves may be composed of a material having higher flexibility. Examples of such materials include polyvinyl chloride, polyamide, polyurethane, various soft resins such as ethylene-vinyl acetate copolymer (EVA), natural rubber, isoprene rubber, butyl rubber, butadiene rubber, styrene-butadiene rubber, silicone. Various rubbers such as rubber and urethane rubber,
Examples include various elastomers such as polyamide elastomer and polyester elastomer.

The plate pieces 151 and 152 are the tubular members 1.
Even if it is integrally formed with 41, as shown in FIG. 20, for example, another member may be attached to the tubular member 141 by adhesion, fusion, or the like. In the example of FIG. 20, the plate pieces 151 and 152 are attached to the inner surface of the tubular member 141, but may be the outer surface of the tubular member 141 or the edge portions 154 and 155 of the slit.

The plate pieces 151 and 152 may be in contact with each other or may be separated by a slight distance at the boundary portion 153. When the plate pieces 151 and 152 are in contact with each other at the boundary portion 153, they have no bonding force (adhesive force). That is, in the boundary portion 153, a notch is formed, and the ends of the plate pieces 151 and 152 contact (compress) with each other through the notch, but due to the action of external force, as shown by the dotted line in FIG. When the plate pieces 151, 152 are bent (bent) and deformed, the contact (compression) portions are easily separated from each other.

Further, as shown in FIG. 20, the plate pieces 151,
The ends of 152 may be in contact with each other (compression bonding) in a state where they overlap with each other to some extent. Also in this case, as in the above, the contact (compression) portions can be easily separated.

Further, the plate pieces 151 and 152 have the boundary portion 15
3 may have a bonding force (adhesive force). For example, in the boundary portion 153, the ends of the plate pieces 151 and 152 are lightly adhered or lightly fused with an adhesive, and the adhesive portion or the fused portion is broken / separated at the time of use. May be

Further, as shown in FIG. 21, plate pieces 151,
The structure may be such that 152 is connected at the boundary portion 153 via the thin portion 156. In this case, at the time of use, the thin portion 156 can be easily broken and separated,
Open the plate pieces 151, 152 and slit (first opening)
Can be formed.

22 and 23 are perspective views respectively showing a seventh embodiment of the trocar tube of the present invention. Hereinafter, the embodiment shown in this figure will be described.
The description of the same matters as those of the embodiment and the like will be omitted.

A trocar tube 180 shown in FIG. 22 has a tubular member 181 having an inner cavity 182 and a marker 189 connected to a proximal end portion (hand side portion) 183 of the tubular member 181.
And a grip member 187 having

The tubular member 181 has a substantially constant outer diameter and inner diameter from the proximal end to the distal end, and the side surface of the tubular member 181 extends along the longitudinal direction of the tubular member 181 from the distal end to the middle of the tubular member 111. An opening forming portion 160 for forming a slit (first opening portion) 166 similar to the above is formed at the position.

The opening forming portion 160 has a slit (first
It is composed of one plate piece 161 capable of opening and closing the opening). The plate piece 161 has a strip shape corresponding to the shape of the slit (first opening), and has appropriate flexibility by being made of the above-mentioned material, for example. .

This plate piece 161 is fixedly or integrally formed with the tubular member 181 at the base end 162 thereof, and all or some of the opposite edge portions 163, 164 are the edges of the slit (first opening portion). It is bonded to the part to be a part with a bonding force (adhesive force), preferably by adhesive bonding, fusion bonding, interposition of a thin part, or the like.

As shown in FIG. 23, at the time of use, both edge portions 163 and 164 are broken and separated, and at least the tip end side of the plate piece 161 is pushed into the inner cavity 182 of the tubular member 181, and in particular, the opening forming portion 160 and The slit (first opening) 166 is formed by moving to the vicinity of the inner surface of the tubular member 181 on the opposite side.

In this embodiment, when the slit 166 is formed, the base end of the plate piece 161 is curved, and the curved portion 16 is formed.
5 functions as a guide surface for guiding an instrument such as a guide wire or a catheter tube into the inner cavity 182 of the tubular member 181. That is, the device is tubular member 18
Even when approaching from the direction substantially perpendicular to the axis of No. 1, the tip of the instrument is bent along the curved portion 165 in the direction perpendicular to the axis of the tubular member 181. Therefore, the instrument can be easily and smoothly guided into the lumen 182 and inserted therethrough, and the operability is further improved.

When the slit 166 is formed, the curved portion 165 shields most of the inner cavity 182 and divides the inner cavity 182 into the distal end side and the proximal end side of the slit 166. Prevention of). Furthermore, even when the trocar tube 180 is removed with the indwelling catheter in place, the operation can be smoothly performed without increasing the removal resistance.

FIG. 24 is a perspective view showing an eighth embodiment of the trocar tube of the present invention. Hereinafter, the embodiment shown in this figure will be described, but the description of the same matters as those of the seventh embodiment will be omitted.

The trocar tube 180 shown in FIG. 24 is the same as the seventh embodiment except that the shape of the plate piece 191 in the opening forming portion is different from that of the plate piece 161. That is, the plate piece 191 that constitutes the opening forming portion 190 is composed of a narrow strip portion 192 and an elliptical portion (may be circular) 193 on the base end side thereof, and its width changes along the longitudinal direction. A slit (first opening) 195 is formed.

In this case, the plate piece 191 has the elliptical portion 19
The base end 194 of No. 3 is fixed to or integrally formed with the tubular member 181. The minor axis of the elliptical portion 193 is preferably set equal to or slightly larger than the inner diameter of the tubular member 181. Also, the band-shaped portion 1
The tip end of 92 is located closer to the base end side than the tip end of the tubular member 181.

In this embodiment, when at least the strip portion 192 of the plate piece 191 is pushed into the inner cavity 182 of the tubular member 181, and the slit (first opening) 195 is formed,
Since the elliptical portion 193 of the plate piece 191 functions as the guide surface and shields the lumen 182 almost completely,
The infection prevention effect mentioned above is higher.

Furthermore, when the trocar tube 180 is removed while the indwelling catheter is indwelling, the same procedure as described above is performed.
The operation can be smoothly performed without increasing the withdrawal resistance.

In the above-described trocar tube having the opening forming portion shown in FIGS. 18 to 24, the slit (first opening portion) is shielded when the living tissue is punctured by the trocar tube. The effect of suppressing the entry of subcutaneous fatty tissue into the tubular member is extremely high.

In each of the trocar tubes shown in FIGS. 13 to 24, the inner diameter and the outer diameter of the tubular member are constant along the longitudinal direction, but the present invention is not limited to this, and the tubular member is not limited to this. The inner and / or outer diameter of the member may vary along its length. For example, the inner diameter and / or the outer diameter of the tubular member may be gradually reduced toward the distal end or have such a portion (tapered portion). The trocar tube assembly of the present invention may include any of the trocar tubes described above.

Further, the catheter insertion device of the present invention is
It is composed of any one of the trocar tube assemblies described above and a puncture needle. FIG. 25 is a perspective view showing a configuration example of a puncture needle. As shown in the figure, the puncture needle 91 has a preferably sharp puncture end 92 at its tip, and inside the puncture needle 91 is formed a passage 93 through which a guide wire 100 described later can be inserted. There is. The tip of the puncture end 92 may be slightly rounded.

The base end of the passage 93 is opened at the base end face (upper end face in FIG. 25) of the puncture needle 91 to form an opening 94a,
The tip of the passage 93 opens to the side surface near the tip of the puncture needle 91 to form an opening 94b. On the proximal end surface of the puncture needle 91, a marker 911 indicating the direction in which the opening 94b faces
Is attached.

The constituent material of the puncture needle 91 is, for example,
Stainless steel, aluminum or aluminum alloy,
Various metal materials such as titanium or titanium alloy, super elastic alloy, shape memory alloy, polyamide, hard polyvinyl chloride, polycarbonate, ABS resin, polyethylene, polypropylene, polytetrafluoroethylene, acrylic resin,
Polyphenylene sulfide (PPS), polyetherketone (PEK), polyetheretherketone (PEE)
Various hard resin materials such as K) and various ceramics such as alumina, silica, aluminum nitride, and silicon carbide.

FIG. 26 is a side view showing a configuration example of a guide wire used for the puncture needle 91. The guide wire 100 shown in FIG.
It is made of a wire material having the same flexibility as 0, and the tip end portion 101 is formed with a taper such that the outer diameter gradually decreases toward the tip end. As a result, the guide wire 100 can be smoothly advanced in the subcutaneous tissue, and the subcutaneous tissue is hardly damaged. In addition, the guide wire 100
The tip may be slightly rounded as shown, or may be sharp and sharp like a needle.

The guide wire 100 having such a structure
Can also be used as the above-mentioned first guide wire and second guide wire.

The method of using the puncture needle 91 is as follows. In the method of inserting and leaving the catheter tube in the abdominal cavity as described above, instead of making a small incision on the abdominal wall at a position different from the first puncture site, the puncture needle 91 is punctured at the second puncture site on the abdominal wall. At this time, the puncture depth is adjusted so that the opening 94b is located between the skin and the muscle layer. Further, while visually confirming the marker 911, the puncture needle 91 is rotated as desired so that the opening 94b faces the direction of the first puncture site. The puncture of the puncture needle 91 to the second puncture site is
It is preferable to puncture the opening 94b at an angle such that the direction in which the opening 94b faces is substantially parallel to the abdominal wall.

Next, from the opening 94a of the puncture needle 91 to the passage 9
A guide wire 100 corresponding to the first guide wire is inserted into the guide wire 3. The tip portion 101 of the guide wire 100 has an opening 94 facing the direction of the first puncture site.
The trocar tube 10, 80, 110 protruding from b and punctured in the subcutaneous tissue between the skin and the muscular layer at the first puncture site.
Proceed in the direction of 140 or 180 (hereinafter, typically described as the trocar tube 10). Then, the guide wire 100 reaches the inside of the slits 35 and 16, and is further inserted into the abdominal cavity through the inner cavity 34 of the expansion tube 30.
After the insertion of the guide wire 100 is completed, the puncture needle 91
And the indwelling catheter is placed in the same manner as described above.

According to such a puncture needle 91, since it is not necessary to make an incision at the second puncture site, the invasion is further reduced. In addition, by providing the marker 911,
The direction of the opening 94b can be easily confirmed from outside the body, and the tip of the guide wire 100 can easily reach the slits 35 and 16.

The puncture needle 91 has, as a puncture depth restricting means for restricting the puncture depth, for example, a flange-shaped flange (rib) projectingly formed on the outer peripheral surface at a predetermined position in the longitudinal direction of the puncture needle 91. May have. When the puncture needle 91 is punctured, if the skin is punctured until it abuts on this flange, a certain depth, that is, below the flange (tip side)
The length will be punctured.

Further, the catheter insertion device of the present invention is
It is composed of any one of the trocar tube assemblies and a puncture needle assembly. FIG. 27 is a perspective view showing a configuration example of a puncture needle assembly. The puncture needle assembly 90 shown in the figure includes a puncture needle 91 and a spacer (side arm) 95. The puncture needle 91 in the puncture needle assembly 90 is
The structure is the same as that of the puncture needle 91 except that the marker 911 is not provided.

The spacer 95 is a rod-shaped member having a predetermined rigidity, and one end 96 thereof is fixed to the side surface of the puncture needle 91 at the middle portion in the longitudinal direction. Further, an engaging portion 98 having a U-shaped groove 981 is formed at the other end 97 of the spacer 95. In the groove 981 of the engaging portion 98,
The proximal end portion 13 of the tubular member 11 of the trocar tube 10 punctured at the first puncture site or the proximal end portion 32 of the tubular member 31 of the expansion tube 30 punctured at the first puncture site is engaged, whereby the tube The distance between 10 or 30 and the puncture needle 91, that is, the distance between the first puncture site and the second puncture site is kept constant.

The opening 94b of the puncture needle 91 is formed in such a position as to face the direction in which the groove 981 of the engaging portion 98 is present, that is, the direction of the trocar tube 10 or the expansion tube 30 fitted into the engaging portion 98. . In addition, the opening 94b is the opening 94b.
It is preferable that the guide wire 100 immediately after protruding from b is formed in a direction substantially parallel to the spacer 95 (including an error of about ± 15 ° with respect to the parallel).

The connection angle of the puncture needle 91 to the spacer 95 is not particularly limited, but the angle (acute angle side) between the axis of the puncture needle 91 and the center line of the spacer 95 is 30 to 30.
The angle is preferably about 90 °, more preferably about 45 to 70 °.

In addition, the spacer 95 in this embodiment is
Constitutes a puncture depth regulating means for regulating the puncture depth of the puncture needle 91. That is, the puncture needle 91 and the spacer 9
Position of the fixed portion 99 with 5 (longitudinal position of the puncture needle 91)
By setting, the puncture depth of the puncture needle 91 can be regulated to a constant depth. In this case, the fixing portion 99 and the opening 94
When the lower surface near one end 96 of the spacer 95 comes into contact with or adheres to the skin when the puncture needle 91 is punctured into the abdominal wall (the deepest puncture state), the opening 94b is located between the skin and the muscle layer. It is preferable that the distance between the fixed portion 99 and the tip of the puncture needle 91 is such that the tip of the puncture needle 91 does not reach the rectus abdominis muscle in the deepest puncture state. It is preferable to set the distance.

In such a puncture needle assembly 90, the engaging portion 98 of the spacer 95 is pierced at the first puncture site and the proximal end portion 13 or 3 of the trocar tube 10 or the expansion tube 30 is pierced.
The puncture needle 91 is punctured at the second puncture site on the abdominal wall in the state of being engaged with 2. At this time, it is sufficient to insert the spacer 95 until the vicinity of one end 96 of the spacer 95 comes into contact with or adheres to the skin.
4b will be located at the proper depth, ie in the subcutaneous tissue between the skin and the anterior rectus abdominis muscle and towards the first puncture site.

Thereafter, similarly to the above, the guide wire 100 is inserted through the passage 93 of the puncture needle 91, inserted into the abdominal cavity through the slits 35, 16 and the lumen 34 of the expansion tube 30, and then the engaging portion 98. And the puncture needle 91 is removed, and the indwelling catheter is indwelled in the same manner as described above.

As described above, since the opening 94b is set to have an appropriate depth and direction, the guide wire 100
The indwelling catheter and the indwelling catheter can easily and surely reach the slits 35 and 16, and the action of the spacer 95 makes the distance between the first puncture site and the second puncture site, that is, the length of the subcutaneous tunnel always constant. Can be set.

Although not shown, in the puncture needle assembly 90, in order to change the distance between the first puncture site and the second puncture site, the distance between the puncture needle 91 and the engaging portion 98 (of the spacer 95). It is also possible to provide an adjusting means for variably adjusting the length. This is preferable because the distance between the first puncture site and the second puncture site (length of subcutaneous tunnel) can be adjusted appropriately according to the case.

As the adjusting means, for example, the spacer 95 is composed of the first arm and the second arm, and the connecting positions of both arms are appropriately changed so that the protruding length of the second arm with respect to the first arm. There is a configuration for adjusting the height. Further, as another adjusting means, a plurality of spacers 95 having different lengths may be prepared, and these may be appropriately selected and attached to the puncture needle 91.

Further, the engaging portion 98 has a gripping mechanism such as a chuck or a clip capable of gripping the base end portion of the trocar tube 10 or the expansion tube 30 or the like, and a connecting mechanism having any other structure. It may be. Also, the fixed portion 99
The position of the puncture needle 91 in the longitudinal direction can be changed, and the puncture needle 9
The configuration may be such that the puncture depth of 1 can be adjusted.

[0185]

EXAMPLES The present invention will now be described in more detail with reference to specific examples.

Example 1 A trocar tube assembly, a first and a second guide wire, a dilator, a sheath, a flexible endoscope and an indwelling catheter having the configurations shown in FIGS. 1 to 10 were manufactured. The conditions of these instruments are as follows.

1. Trocar tube assembly <Trocar tube> [Tubular member] Plate material: ABS resin Number of plates: 6 Plate joining method: Adhesive adhesive Inner diameter of tip: 2 mm Inner diameter of base: 8 mm Total length: 100 mm Width of slit (before expanding tubular member): 2.5 mm (average) Width of slit (when expanding tubular member): 5 mm (average) Length of slit: 60 mm from tip of tubular member

[Grip member] Constituent material: Polycarbonate

<Observer> [Shaft] Constituent material: ABS resin Outer diameter of the tip (constriction): 2 mm Outer diameter of the base: 8 mm Total length: 140 mm

[Head] Constituent material: Stainless steel (SUS304) Overall length: 8 mm Maximum outer diameter: 3.2 mm

[Grip member] Constituent material: Polycarbonate

<Expansion pipe> [Tubular member] Constituent material: Stainless steel (SUS304) Outer diameter: 8 mm Inner diameter: 7 mm Total length: 140 mm Slit width: 4 mm Slit length: 60 mm from the end of the tubular member

[Grip member] Constituent material: Polycarbonate

2. First guide wire Constituting material: Super elastic alloy (core wire) and thermoplastic polyurethane (outer layer) Tip shape: A taper is formed with the outer diameter gradually decreasing toward the tip Outer diameter: Approx. 1 mm

3. Dilator [Dilator shaft] Material: Polyethylene (containing barium sulfate) Outer diameter: 3 mm Inner diameter: 1.1 mm

4. Sheath [Sheath tube] Constituent material: Polyethylene (containing barium sulfate) Braid: φ50 μm, stainless steel (SUS304),
16 strands Outer diameter: 3.5 mm Inner diameter: 3.0 mm Length of curved tip: 30 mm

5. Flexible endoscope (endoscope) Structure: Built-in optical fiber (for light projection and light reception) Outer diameter: 2.8 mm Effective insertion part length: 700 mm Tip bending part length: 40 mm Tip bending angle: UP100 °, DOWN100 ° (Bend in two directions)

6. Second guide wire Component material: Super elastic alloy (core wire) and thermoplastic polyurethane (outer layer) Tip shape: A taper is formed with the outer diameter gradually decreasing toward the tip Outer diameter: Approx. 1.2 mm

7. Indwelling catheter Constituent material: Fluorine elastomer Outer diameter: 4.5 mm Inner diameter: 2.5 mm Total length: 500 mm

<Experiment 1> Using each device of the above Example 1,
The abdominal wall of an experimental animal (pig) was inserted and placed through the subcutaneous tunnel of the indwelling catheter by the method described above.

Penetration of the trocar tube with the plug inserted into the abdominal wall was small in penetration resistance and could be performed smoothly and with minimal invasion. Further, the expansion of the tubular member of the trocar tube by the expansion tube could be performed easily and surely with a slight force.

Further, both the guide wire and the indwelling catheter could be smoothly and accurately inserted into the target site, and the scars left on the abdominal wall were not conspicuous.

After the indwelling catheter was inserted and left for a predetermined time, the dialysate 5 was put into the abdominal cavity through the indwelling catheter.
When 00 ml was injected, no leakage of dialysate was observed. After that, it was possible to drain the dialysate waste liquid. In addition, no bacterial infection was observed at the subcutaneous tunnel site.

Example 2 The same devices as in Example 1 were produced except that the outer peripheral surface of the indwelling catheter was coated with a collagen layer. The various conditions of the collagen layer are as follows.

[Collagen Layer] Constituent material: Calf-derived heat-crosslinked atelocollagen Properties: Porous (sponge) thickness: Approximately 1 mm (when dry) Place of installation: From a position about 160 mm from the tip of the indwelling catheter to a position about 230 mm The entire circumference of the outer peripheral surface.

Using the devices of Example 2 above, the above Experiment 1 was performed.
When the same experiment was performed, the same result was obtained.
In particular, compared to Example 1, the indwelling catheter could be placed for a long period of time.

(Example 3) [0207] A device for inserting a catheter, which is composed of each device of the above Example 1 and the puncture needle shown in Fig. 25, was manufactured. The conditions of the puncture needle are as follows.

8. Puncture needle Constituent material: Polyphenylene sulfide (PPS) Outer diameter: 3 mm Total length: 40 mm Passage inner diameter: 1.1 mm Passage opening: The lower end of the passage is open to the side of the puncture needle Distance between the tip of the puncture needle and the passage opening: 3 mm Passage opening direction and puncture Angle with needle axis: about 120 °

When the same experiment as the above Experiment 1 was conducted using the catheter insertion device of the above Example 3, the same result was obtained. In particular, the operation of allowing the guide wire or the like to reach the slit under the skin could be performed more easily and reliably than in Example 1.

(Embodiment 4) A trocar tube assembly using a trocar tube having the structure shown in FIGS. 11 and 12, and FIG.
A catheter insertion device similar to that in Example 3 was manufactured except that the puncture needle assembly shown in FIG. The conditions of the trocar tube assembly and the puncture needle assembly are as follows.

9. Trocar tube assembly <Trocar tube> [Tubular member] Plate material: ABS resin Number of plates: 6 Plate joining method: Adhesive bonding (base end not bonded) Tip inner diameter: 2 mm Base end Internal diameter: 8 mm Total length: 100 mm

[Grip member] Construction: A pair of grip halves (removable by a concave and convex fitting portion) Construction material: Polycarbonate

<Obstacle> Same as in Example 1

<Expansion pipe> The same as in Example 1.

10. Puncture needle assembly <Spacer> [Arm] Material: Stainless steel (SUS304) Thickness: 0.8mm Width: 2mm Effective length: 50mm

[Engagement part] Constituent material: Stainless steel (SUS304) Shape: Horseshoe shape (having U-shaped groove) Inner dimension of groove: 7.1 mm

<Puncture needle> Constituent material: ABS resin Outer diameter: 3 mm Total length: 40 mm Passage inner diameter: 1.1 mm Distance between the fixing part of the spacer and the tip of the puncture needle: 25 mm Passage opening: The lower end of the passage is opened on the side of the puncture needle Distance between tip of puncture needle and passage opening: 3 mm Angle between passage opening direction and puncture needle axis: about 120 ° Angle between proximal side of puncture needle and spacer: about 120 °

When the same experiment as in Experiment 1 was conducted using the catheter insertion device of Example 4 above, similar results were obtained. In particular, the operation of reaching the slit via the subcutaneous route of the guide wire or the like could be performed more easily and reliably than in Example 3.

Example 5 The same experiment as in Experiment 1 was carried out by using the puncture needle assembly in Example 4 except that the spacer having an effective length of 42 mm (the other conditions were the same) was replaced. Similar results to Example 4 were obtained.

Example 6 A trocar tube assembly is shown in FIG.
~ Each device similar to that of Example 1 was manufactured except that the configuration shown in Fig. 15 was used. The conditions of the trocar tube assembly are as follows.

11. Trocar tube assembly <Trocar tube> [Tubular member] Material: Stainless steel (SUS304) Outer diameter: 9 mm Inner diameter: 8 mm Total length: 100 mm Slit width (constant): 4 mm Slit length: 60 mm from the end of the tubular member

[Grip member] Constituent material: Polycarbonate Others: With a marker indicating the direction of the slit

<Observer> [Shaft] Constituent material: Stainless steel (SUS304) Outer diameter: 7.9 mm Total length: 140 mm

[Tip] Constituent material: Stainless steel (SUS304) Total length: 10 mm

[Grip member] Constituent material: Polycarbonate

Using the respective devices of Example 6 above, Experiment 1
When the same experiment was performed, the same result was obtained.

(Embodiment 7) The same as embodiment 6 except that the trocar tube is replaced by the one shown in FIG. The trocar conditions are as follows.

<Trocar tube> [Tubular member] Constituent material: Stainless steel (SUS304) Outer diameter: 9 mm Inner diameter: 8 mm Total length: 100 mm Slit width (belt portion): 3 mm Slit width (base circular portion): Diameter 5mm Slit width (tapered part at the tip): Maximum 5mm Slit length: 60mm from tubular member tip

[Grip member] Constituent material: Polycarbonate Others: With a marker indicating the direction of the slit

Using the devices of Example 7 above, Experiment 1
When the same experiment was performed, the same result was obtained.
In addition, in Example 7, when the abdominal wall of the trocar tube was punctured, invasion of subcutaneous adipose tissue into the trocar tube was suppressed, and the operation of inserting the guide wire and the indwelling catheter was easy.

(Embodiment 8) The same as Embodiment 6 except that the trocar tube is replaced by the one shown in FIG. The trocar conditions are as follows.

<Trocar tube> [Tubular member] Constituent material: ABS resin Outer diameter: 9 mm Inner diameter: 8 mm Total length: 100 mm Slit width (constant): 4.5 mm Slit length: 60 mm from the end of the tubular member

[Aperture forming part] Number of plate pieces: 2 Plate shape: narrow strip plate material: Silicone rubber Plate thickness: 1 mm (maximum value) to 0.4 mm (minimum value) Method of fixing plate pieces: Adhesive bonded to the edge of the slit Border between plate pieces: contact state (no adhesive strength)

[Grip member] Constituent material: Polycarbonate Others: With a marker indicating the direction of the slit

Using the devices of Example 8 above, Experiment 1
When the same experiment was performed, the same result was obtained.
Further, in Example 8, when the trocar tube was punctured into the abdominal wall, invasion of subcutaneous adipose tissue into the trocar tube was suppressed, and the operation of inserting the guide wire and the indwelling catheter was easy.

(Embodiment 9) A trocar tube is shown in FIGS.
Same as Example 6 except that the structure shown in FIG. The trocar conditions are as follows.

<Trocar tube> [Tubular member] Constituent material: ABS resin Outer diameter: 9 mm Inner diameter: 8 mm Total length: 100 mm Slit width (constant): 5 mm Slit length: 65 mm from the tip of the tubular member

[Aperture Forming Section] Number of Plate Pieces: 1 Plate Piece Shape: Strip (Strip) Plate Piece Material: Polyester Elastomer Plate Piece Thickness: 0.7 mm Plate Piece Fixing Method: Plate Piece Base End to Tubular Member For fusion. Partially adhesively attach both edges of the plate piece to the edge of the slit (removable)

[Grip member] Constituent material: Polycarbonate Others: With a marker indicating the direction of the slit

Using the devices of Example 9 above, Experiment 1
When the same experiment was performed, the same result was obtained.
Further, in Example 9, the subcutaneous fat tissue hardly penetrated into the trocar tube at the time of puncturing the abdominal wall of the trocar tube, and the insertion operation of the guide wire and the indwelling catheter was easy.

Example 10 Example 10 was the same as Example 6 except that the trocar tube was replaced by the one shown in FIG.
The trocar conditions are as follows.

<Trocar tube> [Tubular member] Constituent material: polyethylene Outer diameter: 9 mm Inner diameter: 8 mm Total length: 100 mm Slit width: 3 to 8 mm Slit length: 65 mm from the tip of the tubular member

[Aperture forming part] Number of plate pieces: 1 Plate shape: strip + elliptical plate Material: polyethylene Plate width (strip): 3 mm Plate width (ov): 8 mm Overall length: 55 mm Elliptical section length: 18 mm Plate piece thickness: 0.5 mm Plate piece fixing method: Plate piece base end is integrally formed with tubular member. Both edges of the plate piece are lightly and partially welded to the edge of the slit.

[Grip member] Constituent material: Polycarbonate Others: With a marker indicating the direction of the slit

When the same experiment as in Experiment 1 was carried out using each of the instruments of Example 10 above, similar results were obtained. Further, in Example 10, the subcutaneous fat tissue hardly penetrated into the trocar tube at the time of puncturing the abdominal wall of the trocar tube, and the insertion operation of the guide wire and the indwelling catheter was easy.

[0246]

As described above, the trocar tube, the trocar tube assembly and the catheter insertion device of the present invention have the following effects.

1. For example, when an indwelling catheter used for CAPD is inserted and placed in the abdominal cavity, a subcutaneous tunnel can be easily and surely formed and placed without making a large incision in the abdominal wall, and invasion is reduced.

2. In the case of having an opening forming portion for forming the first opening, the first opening is formed when necessary, so that, for example, adipose tissue and the like enter the trocar tube when the trocar tube is punctured into living tissue. It is possible to suppress or prevent the above.

3. Also, the opening forming portion is configured by a plate piece,
When the plate piece has a function of blocking the inner cavity of the trocar tube when forming the first opening, the infection prevention effect is further improved.

4. When the distal end of the tubular member of the trocar tube has a smaller diameter than the proximal end when puncturing a living tissue,
The diameter of the tubular member can be reduced, the puncture resistance is small, the trocar tube can be easily inserted, and the invasion is small.

5. If the trocar tube can be expanded by inserting an expansion tube, etc., after puncturing in a state of low puncture resistance before expansion, expand the effective inner diameter of the tip etc., and use a catheter tube such as an indwelling catheter or other Can be easily and surely inserted.

6. If the tubular member of the trocar tube is formed by connecting and integrating multiple plate-shaped bodies by adhesion or fusion, the plate-shaped bodies can be easily and reliably separated from each other when the tubular member is expanded or removed. Therefore, it can be expanded with a slight force, and the first opening can be easily formed.

7. When a trocar tube that can be divided is used, the trocar tube can be divided and removed while leaving the instrument such as the expansion tube inserted in the trocar tube.
In addition to the above-mentioned effects, operability is improved and the variety of procedures is expanded.

8. The catheter insertion device of the present invention is
Since the puncture needle punctures a site different from the puncture site of the trocar tube without making a large incision, invasion is reduced, and a long instrument such as a guide wire or catheter tube can be placed in the subcutaneous tissue in the proper direction. And it can be inserted at a depth, and its operation is easy.

9. When a puncture needle assembly having a spacer is used, the distance between different puncture sites can be kept constant, and in particular, the subcutaneous tunnel can be set to an appropriate length and its operation is simple.

10. When the spacer has the engaging portion, the trocar tube, the expansion tube, and the like can be reliably positioned with respect to the tubular body.

11. If a distance adjusting means is provided,
The distance between different puncture sites can be appropriately set according to the case.

12. When the puncture depth regulating means is provided, the puncture depth of the puncture needle can be made appropriate by a simple operation, and particularly when puncturing the abdominal wall, excessive puncture also penetrates the muscle layer. Inconvenience can be prevented, invasion can be reduced, and safety can be improved.

13. Since the adhesion of the biological tissue at the puncture site after removal of the trocar tube, the puncture needle, etc. is improved,
Leakage of dialysate does not occur and the effect of preventing infection is high.

From the above, the burden on the patient is reduced,
The effect of preventing infection is improved, and the hospital stay can be shortened.

[Brief description of drawings]

FIG. 1 is a perspective view showing an embodiment of a trocar tube of the present invention.

FIG. 2 is a perspective view showing a configuration example of an obturator that constitutes the trocar tube assembly of the present invention.

3 is a perspective view showing a state in which the obturator shown in FIG. 2 is inserted into the trocar tube shown in FIG.

FIG. 4 is a perspective view showing a configuration example of an expansion tube forming the trocar tube assembly of the present invention.

FIG. 5 is a perspective view showing a state in which the expansion tube shown in FIG. 4 is inserted into the trocar tube shown in FIG. 1 to expand the trocar tube.

FIG. 6 is a first part of the catheter insertion device of the present invention.
3 is a perspective view showing a configuration example of the guide wire of FIG.

FIG. 7 is a side view showing a configuration example of a dilator that constitutes the catheter insertion device of the present invention.

FIG. 8 is a side view showing a configuration example of a sheath which constitutes the catheter insertion device of the present invention.

9 is a side view showing a state in which the dilator shown in FIG. 7 is inserted into the sheath shown in FIG.

FIG. 10 is a side view showing a configuration example of a flexible endoscope (endoscope) constituting the catheter insertion device of the present invention.

FIG. 11 is a perspective view showing another embodiment of the trocar tube of the present invention.

12 is a cross-sectional view of a grip member in the trocar tube shown in FIG.

FIG. 13 is a perspective view showing another embodiment of the trocar tube of the present invention.

FIG. 14 is a perspective view showing another configuration example of the obturator that constitutes the trocar tube assembly of the present invention.

15 is a perspective view showing a state in which the obturator shown in FIG. 14 is inserted into the trocar tube shown in FIG.

FIG. 16 is a perspective view showing another embodiment of the trocar tube of the present invention.

FIG. 17 is a perspective view showing another embodiment of the trocar tube of the present invention.

FIG. 18 is a perspective view showing another embodiment of the trocar tube of the present invention.

19 is a cross-sectional view taken along the line AA in FIG.

FIG. 20 is a cross-sectional view of a tubular member in another embodiment of the trocar tube of the present invention.

FIG. 21 is a cross-sectional view of a tubular member in another embodiment of the trocar tube of the present invention.

FIG. 22 is a perspective view showing another embodiment of the trocar tube of the present invention.

23 is a perspective view showing a state in which a first opening is formed in the trocar tube shown in FIG.

FIG. 24 is a perspective view showing another embodiment of the trocar tube of the present invention.

FIG. 25 is a perspective view showing a configuration example of a puncture needle that constitutes the catheter insertion device of the present invention.

FIG. 26 is a side view showing a configuration example of a guide wire constituting the catheter insertion device of the present invention.

FIG. 27 is a perspective view showing a configuration example of a puncture needle assembly that constitutes the catheter insertion device of the present invention.

[Explanation of symbols]

 10 Trocar tube 11 Tubular member 12 Lumen 13 Base end 14 Tip part 15 Plate-like body 16 Slit 17 Grip member 171 Outer wall part 172 Marker 20 Plug 21 Shaft 22 Base end 23 Tip 24 Grip member 25 Head part 26 Puncture end 27 Tapered portion 28 Constriction portion 30 Expansion tube 31 Tubular member 32 Base end portion 33 Side surface 34 Lumen 35 Slit 36 Grip member 361 Outer wall portion 362 Marker 40 First guide wire 50 Dilator 51 Dilator shaft 52 Base end portion 52 Base end portion 54 Dilator housing 55 Lumen 60 Sheath 61 Sheath tube 62 Base end 63 Tip portion 64 Lumen 65 Sheath housing 66 Chemical injection line 67 Tube 68 Mixed injection instrument 70 Flexible scope (endoscope) 71 Shaft portion 72 Base end portion 73 Tip portion 4 Operation part 75 Handle 80 Trocar tube 81 Tubular member 82 Lumen 83 Base end part 84 Tip part 85 Plate-like body 86 Notch 87 Boundary part 88 Grip member 88a, 88b Grip half body 881 Concavo-convex fitting part 89 Insertion port 90 Puncture needle Assembly 91 Puncture needle 911 Marker 92 Puncture end 93 Lumen 94a, 94b Opening 95 Spacer 96 One end 97 Other end 98 Engagement part 981 Groove 99 Fixing part 100 Guide wire 101 Tip part 110 Trocar tube 111 Tubular member 112 Lumen 113 bases End portion 115 Slit 117 Grip member 118 Outer wall portion 119 Marker 120 Obturator 121 Shaft 122 Base end 123 Tip 124 Grip member 125 Puncture end 130 Slit 131 Circular opening 132 Tapered portion 140 Trocar tube 141 Tubular portion 142 lumen 143 base end part 147 grip member 149 marker 150 opening formation part 151, 152 plate piece 153 boundary part 154, 155 edge part 156 thin part 160 opening formation part 161 plate piece 162 base end 163, 164 edge part 165 curved part 166 Slit 180 Trocar tube 181 Tubular member 182 Lumen 183 Base end part 187 Grip member 189 Marker 190 Opening formation part 191 Plate piece 192 Strip part 193 Elliptical part 194 Base end 195 Slit

Claims (22)

[Claims] 1. A trocar tube comprising a tubular member and a grip member located at a proximal end side of the tubular member, wherein a side surface of the tubular member has a first opening communicating with an inner cavity of the tubular member. Trocar tube characterized in that a portion is formed. 2. A trocar tube comprising a tubular member and a grip member located on the proximal end side of the tubular member, wherein the trocar pipe has a side surface of the tubular member that can communicate with an inner cavity of the tubular member. A trocar tube having an opening forming portion for forming an opening. 3. The trocar tube according to claim 2, wherein the opening forming portion is constituted by a plate piece capable of opening and closing the first opening portion. 4. The trocar tube according to claim 3, wherein the plate piece has higher flexibility than the tubular member. 5. The trocar tube according to claim 3, wherein the plate piece has a function of blocking at least a part of an inner cavity of the tubular member when the first opening is formed. 6. The trocar tube according to claim 1, wherein the first opening is continuous along the longitudinal direction of the tubular member from the distal end of the tubular member to at least the middle thereof. 7. The trocar tube according to claim 1, wherein the width of the first opening changes along the longitudinal direction of the tubular member. 8. A trocar tube comprising a tubular member and a grip member connected to the base end portion of the tubular member, wherein the tubular member and the grip member include a surface including a tube axis of the tubular member. Alternatively, the trocar tube can be divided into a plurality of pieces by a plane substantially parallel to the tube axis. 9. The trocar tube according to claim 1, wherein the tubular member is formed by connecting and integrating a plurality of plate-like bodies arranged along the circumferential direction by adhesion or fusion. . 10. The trocar tube according to claim 1, wherein the grip member is provided with a marker that indicates the direction of the first opening. 11. The trocar tube according to claim 1, wherein the tubular member has a diameter at a tip portion smaller than that at a base end portion. 12. The trocar tube according to claim 11, wherein at least the diameter of the distal end portion of the tubular member is expandable. 13. A trocar tube according to claim 12,
A trocar tube assembly comprising: an expansion tube that is inserted into the lumen of the tubular member and expands the diameter of the tip portion, wherein the side surface of the expansion tube is in communication with the lumen of the expansion tube A trocar tube assembly having an opening formed therein. 14. The trocar tube assembly according to claim 13, wherein the expansion tube has a marker indicating a direction of the second opening. 15. The trocar tube assembly according to claim 13 or 14, further comprising a plug having a piercing end at a distal end, which is inserted into the lumen of the tubular member. 16. A trocar comprising the trocar tube according to any one of claims 1 to 12, and an obturator which is used by being inserted into an inner cavity of the tubular member and has a puncture end at a tip thereof. Tube assembly. 17. A catheter insertion instrument comprising the trocar tube assembly according to claim 13 and a puncture needle having a passage therein, wherein one end of the passage has a tip of the puncture needle. An instrument for inserting a catheter, which is opened laterally in the vicinity. 18. The catheter insertion device according to claim 17, wherein the puncture needle has a marker indicating a direction in which the passage is opened. 19. A catheter insertion device comprising the trocar tube assembly according to any one of claims 13 to 16 and a puncture needle assembly, wherein the puncture needle assembly has a passage therein. A needle, a spacer at a position different from the puncture needle and a spacer for holding a constant distance between the puncture needle, and one end of the passage is a side near the tip of the puncture needle, An apparatus for inserting a catheter, which is opened at a position facing the direction of the tubular body in a state where the spacer is attached. 20. The catheter insertion device according to claim 19, wherein the spacer has an engagement portion that engages with the tubular body. 21. The catheter insertion device according to claim 19 or 20, further comprising distance adjusting means for adjusting a distance between the tubular body and the puncture needle. 22. The catheter insertion device according to claim 17, further comprising a puncture depth regulating means for regulating the puncture depth of the puncture needle.