JP2013099519A - Medical tube guiding equipment, medical tube, and medical system - Google Patents

Medical tube guiding equipment, medical tube, and medical system Download PDF

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JP2013099519A
JP2013099519A JP2012223664A JP2012223664A JP2013099519A JP 2013099519 A JP2013099519 A JP 2013099519A JP 2012223664 A JP2012223664 A JP 2012223664A JP 2012223664 A JP2012223664 A JP 2012223664A JP 2013099519 A JP2013099519 A JP 2013099519A
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magnet
medical tube
tube
medical
oral cavity
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JP5424514B2 (en
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Seitaro Watanabe
誠太郎 渡邉
Atsushi Nakajima
淳 中島
Kensuke Kubota
賢輔 窪田
Noritoshi Kobayashi
規俊 小林
Kunihiro Hosono
邦広 細野
Takamitsu Sato
高光 佐藤
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Yokohama National University NUC
Yokohama City University
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Yokohama City University
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Abstract

PROBLEM TO BE SOLVED: To provide a medical tube guiding equipment and a medical tube which do not require skill or a worker in guiding a medical tube inserted through a nasal cavity to the outside of an oral cavity, are unlikely to cause complication, are not affected by a figure of an operator or a patient, do not need to wake up the patient and which therefore do not give the patient pain in guiding the tube with simple, quick, and reliable handling.SOLUTION: The revulsive 2 for a medical tube 1 is used for guiding the medical tube 1 inserted through the nasal cavity N of a living body to the outside of the oral cavity M, and has a second magnet 2b magnetically attached to a first magnet 1a provided on an end side of the medical tube 1. Since magnetic attachment of the first magnet 1a and the second magnet 2a is checked under radioscopy, and the medical tube 1 is extractable outside the oral cavity M, and work reliability is improved.

Description

本発明は医療用チューブの誘導器具及び医療用チューブ並びに医療用システムに関し、特に、鼻腔から挿入された医療用チューブを口腔外に誘導するために用いられる医療用チューブの誘導器具及び医療用チューブ並びに医療用システムに関する。   TECHNICAL FIELD The present invention relates to a medical tube guide device, a medical tube, and a medical system, and more particularly, to a medical tube guide device and a medical tube used for guiding a medical tube inserted from the nasal cavity to the outside of the oral cavity, and The present invention relates to a medical system.

一般に、胆管等の体腔に狭窄部が生じ、胆汁などの体液の排出が困難になった場合、胆汁を排出する治療が行われるが、その治療方法として、内視鏡を使用し、経鼻的にドレナージチューブ（ドレナージカテーテル）を挿入して胆汁を排出する内視鏡的経鼻胆管ドレナージ術（以下、ＥＮＢＤ（endoscopic nasal biliary drainage）という）が知られている（例えば、特許文献１及び特許文献２参照）。   In general, when a stenosis occurs in a body cavity such as a bile duct and it becomes difficult to drain body fluids such as bile, treatment to drain bile is performed. Endoscopic nasal biliary drainage (hereinafter referred to as ENBD (endoscopic nasal biliary drainage)) in which a drainage tube (drainage catheter) is inserted into and drained bile is known (for example, Patent Document 1 and Patent Document) 2).

図３及び図４はＥＮＢＤの作業手順を説明するための説明図である。   3 and 4 are explanatory diagrams for explaining the work procedure of ENBD.

まず、内視鏡等を使用して、胆管等の体腔に発生した狭窄部に留置され、胆汁を排出するためのドレナージチューブ（以下、ＥＮＢＤチューブ１０という）を経口的に誘導する（図３（Ａ）参照）。しかし、この状態では、口を閉じられない、食事を摂れない、歯でチューブを破損するおそれがある等、患者が生活する上で不便である。   First, an endoscope or the like is used to orally guide a drainage tube (hereinafter referred to as an ENBD tube 10) that is placed in a stenotic part generated in a body cavity such as a bile duct and discharges bile (FIG. 3 ( A)). However, in this state, it is inconvenient for the patient to live, such as being unable to close his mouth, not being able to eat, and possibly damaging the tube with his teeth.

そこで、鼻腔Ｎから短いプラスチックチューブ（以下、ネラトンチューブ１１という）を挿入し（図３（Ｂ）参照）、そのネラトンチューブ１１を口腔Ｍ外に引き出す（図４（Ａ）参照）。   Therefore, a short plastic tube (hereinafter referred to as a nelaton tube 11) is inserted from the nasal cavity N (see FIG. 3B), and the nelaton tube 11 is pulled out of the oral cavity M (see FIG. 4A).

次いで、ＥＮＢＤチューブ１０をネラトンチューブ１１の先端孔に挿入して接続し（図４（Ｂ）参照）、ネラトンチューブ１１を鼻腔Ｎ側に引いてＥＮＢＤチューブ１０を鼻腔Ｎから外に出す（図４（Ｃ）参照）。   Next, the ENBD tube 10 is inserted into and connected to the tip hole of the nelaton tube 11 (see FIG. 4B), and the nelaton tube 11 is pulled to the nasal cavity N side to bring the ENBD tube 10 out of the nasal cavity N (FIG. 4). (See (C)).

これによって、胆管内に留置されたＥＮＢＤチューブ１０を用いて、経鼻的に体外に胆汁を排出することが可能となる。   This makes it possible to drain bile out of the body nasally using the ENBD tube 10 placed in the bile duct.

ここで、鼻腔Ｎから挿入したネラトンチューブ１１を口腔Ｍ外に引き出す作業としては、次の３つの方法が提案されている。   Here, the following three methods have been proposed for pulling out the nelaton tube 11 inserted from the nasal cavity N out of the oral cavity M.

（１）まず、患者を覚醒させ背臥位にした後、鼻腔からネラトンチューブを挿入する。次いで、喉頭鏡で開口し、鑷子を用いてネラトンチューブを把持し、口腔外へ引き出す（以下、この方法を従来法という）。   (1) First, the patient is awakened and placed in the supine position, and then a nelaton tube is inserted from the nasal cavity. Next, the laryngoscope is opened, and the nelaton tube is grasped with a lever and pulled out of the oral cavity (hereinafter, this method is referred to as a conventional method).

（２）まず、患者を覚醒させた後、鼻腔からネラトンチューブを挿入する。次いで、患者に開口を指示し、利き手の示指でネラトンチューブを把持し、口腔外へ引き出す（以下、この方法をフィンガー法という）。   (2) First, the patient is awakened, and then a nelaton tube is inserted from the nasal cavity. Next, the patient is instructed to open, and the nelaton tube is grasped with the index finger of the dominant hand and pulled out of the oral cavity (hereinafter, this method is referred to as finger method).

（３）まず、ガイドワイヤーでループ部を作り、患者の咽頭壁に当たるまで挿入する。次いで、鼻腔からネラトンチューブを挿入する。次いで、Ｘ線透視でネラトンチューブがガイドワイヤー内を通過したことを確認した後、ガイドワイヤーを引き、ネラトンチューブを口腔外へ引き出す（以下、この方法をガイドワイヤー誘導法という）。このガイドワイヤー誘導法は、２０１０年に従来法等の問題点を改善した新しい誘導法として報告されている(石塚 泉：ガイドワイヤーを用いたENBDチューブの鼻腔内への誘導. Gastroenterol Endoscopy 52:965, 2010参照)。
実開平５−６５３４９号公報 特開２００３−１３５５９０公報 (3) First, make a loop with a guide wire and insert it until it touches the pharyngeal wall of the patient. Then, the nelaton tube is inserted from the nasal cavity. Next, after confirming that the nelaton tube has passed through the guide wire by X-ray fluoroscopy, the guide wire is pulled and the nelaton tube is pulled out of the oral cavity (hereinafter, this method is referred to as a guide wire guiding method). This guide wire guide method was reported in 2010 as a new guide method that improved the problems of the conventional methods (Izumi Izuka: Guide the ENBD tube into the nasal cavity using a guide wire. Gastroenterol Endoscopy 52: 965 , 2010).
Japanese Utility Model Publication No. 5-65349 JP 2003-135590 A

しかし、上記３つの方法には次のような課題があった。   However, the above three methods have the following problems.

（１）従来法では、術者が喉頭鏡で開口した状態で、鑷子を用いてネラトンチューブを把持する必要があるため、手技が煩雑で熟練を要し、作業に時間がかかるという課題があった。   (1) In the conventional method, it is necessary for the operator to grasp the nelaton tube with a lever while the laryngoscope is open, so that there is a problem that the technique is complicated and requires skill, and the work takes time. It was.

また、作業に人手を要するという課題があった。   In addition, there is a problem that the work requires manpower.

また、患者を覚醒する必要があるため、患者に苦痛を与えるという課題があった。   Moreover, since it was necessary to awaken a patient, there existed the subject of giving a patient a pain.

さらに、合併症のおそれもあるという課題があった。   In addition, there is a problem that there is a risk of complications.

（２）フィンガー法では、術者が利き手の示指でネラトンチューブを把持する必要があるため、手技が煩雑で、手技の習得に時間がかかるという課題があった。   (2) The finger method has a problem that the operator needs to grasp the nelaton tube with a dominant hand, and thus the procedure is complicated and it takes time to acquire the procedure.

また、作業の成否が術者の指の長さや患者の体型に左右されやすいという課題があった。   In addition, there is a problem that the success or failure of the operation is easily influenced by the length of the operator's finger and the body shape of the patient.

さらに、患者を覚醒する必要があるため、患者に苦痛を与えるとともに、術者の指が患者に咬まれるおそれがあるという課題があった。   Furthermore, since it is necessary to awaken the patient, there is a problem that the patient is painful and the operator's finger may be bitten by the patient.

（３）ガイドワイヤー誘導法では、従来法やフィンガー法に比べて簡便な方法ではあるが、初回の施行での成功率は高くなく、確実性に劣るという課題があった。   (3) The guide wire induction method is a simpler method than the conventional method and the finger method, but there is a problem that the success rate in the first enforcement is not high and the reliability is inferior.

また、ガイドワイヤーが口の浅い所で引っ掛かり、奥まで挿入できない等、作業の成否が術者の喉の形等の体型に左右されやすいという課題があった。   In addition, there is a problem that the success or failure of the operation is easily influenced by the body shape such as the shape of the operator's throat, such as the guide wire being caught in a shallow place and not being inserted to the back.

さらに、ガイドワイヤーのループ部にネラトンチューブを通す際に、外れないように長めに通す必要があるため、患者に嘔吐反射やむせこみが起こりやすく、患者の苦痛の一因になるという課題があった。   Furthermore, when passing the nelaton tube through the loop part of the guide wire, it is necessary to pass it long so that it does not come off, so there is a problem that the patient is prone to vomiting reflexes and depression and contributes to patient pain. It was.

本発明は上記課題を解決するためになされたものであり、鼻腔から挿入された医療用チューブを口腔外に誘導する際に、熟練や人手を要することがなく、合併症のおそれがなく、術者や患者の体型に左右されることがなく、また患者を覚醒する必要がないので、患者に苦痛を与えることがなく、簡便、迅速かつ確実に行うことができる医療用チューブの誘導器具及び医療用チューブ並びに医療用システムを提供することを目的とする。   The present invention has been made in order to solve the above-mentioned problems. When a medical tube inserted from the nasal cavity is guided out of the oral cavity, no skill or manpower is required, there is no risk of complications, and The medical tube guide device and the medical care can be performed simply, quickly and surely without causing any pain to the patient because it does not depend on the body shape of the person or patient and it is not necessary to awaken the patient. An object is to provide a medical tube and a medical system.

本発明の医療用チューブの誘導器具は、生体の鼻腔から挿入された医療用チューブを口腔外に誘導するために用いられる医療用チューブの誘導器具であって、
前記口腔から挿入され、前記医療用チューブの先端側に設けられた第１の磁石に磁着される第２の磁石を有する、
ことを特徴とするものである。 The medical tube guide device of the present invention is a medical tube guide device used to guide a medical tube inserted from the nasal cavity of a living body to the outside of the oral cavity,
Having a second magnet inserted from the oral cavity and magnetically attached to a first magnet provided on the distal end side of the medical tube;
It is characterized by this.

チューブ状に形成され、先端側に前記第２の磁石が設けられていてもよい。   It may be formed in a tube shape and the second magnet may be provided on the tip side.

本発明の医療用チューブは、前述した医療用チューブの誘導器具によって口腔外に誘導され、先端側に前記第１の磁石が設けられていることを特徴とするものである。   The medical tube of the present invention is characterized in that it is guided out of the oral cavity by the medical tube guide device described above, and the first magnet is provided on the distal end side.

前記生体の体内物質を排出するために用いられる他の医療用チューブが挿入される挿入孔が形成されていてもよい。   An insertion hole into which another medical tube used for discharging the body material of the living body may be formed.

前記第１の磁石及び第２の磁石の少なくとも表面は、Ｘ線透視下で視認可能な材質で作られていてもよい。
本発明の医療用システムは、生体の鼻腔から挿入され、第１の磁石を備えた医療用チューブと、
前記生体の口腔から挿入され、第２の磁石を備えた誘導器具と、
前記生体の対象部位をＸ線透視するためのＸ線透視手段とを有し、
前記Ｘ線透視手段によりＸ線透視下で視認しながら、前記医療用チューブの前記第１の磁石に前記誘導器具の前記第２の磁石を磁力で吸着させながら磁着させ、前記誘導器具を引いて、前記医療用チューブを口腔外へ引き出す、
ことを特徴とするものである。 At least surfaces of the first magnet and the second magnet may be made of a material that is visible under X-ray fluoroscopy.
The medical system of the present invention includes a medical tube inserted from a nasal cavity of a living body and provided with a first magnet;
A guiding device inserted from the oral cavity of the living body and provided with a second magnet;
X-ray fluoroscopic means for X-ray fluoroscopically the target site of the living body,
While visually recognizing under X-ray fluoroscopy with the X-ray fluoroscopy means, the first magnet of the medical tube is magnetically attached to the first magnet while attracting the second magnet of the guidance instrument with a magnetic force, and the guidance instrument is pulled. Pull the medical tube out of the mouth,
It is characterized by this.

本発明によれば、次のような効果を奏する。   The present invention has the following effects.

（１）第１の磁石及び第２の磁石の磁力による吸着を利用して、鼻腔から挿入された医療用チューブを口腔外に誘導するので、作業が簡便になり、熟練を要することがなくなる。その結果、手技の習得に時間を要さないので、初心者でも短時間で迅速に作業を行うことができる。   (1) Since the medical tube inserted from the nasal cavity is guided out of the oral cavity by utilizing the magnetic force of the first magnet and the second magnet, the operation becomes simple and no skill is required. As a result, since it does not take time to acquire a technique, even a beginner can perform work quickly in a short time.

（２）チューブ状の細い部材を利用するので、作業の成否が術者や患者の体型に左右されることがなくなる。   (2) Since a tube-like thin member is used, the success or failure of the work is not affected by the body shape of the operator or patient.

（３）医療用チューブ及び誘導器具を鼻腔及び口腔にそれぞれ入れるだけで済むので、合併症が生じることがなく、また患者を覚醒する必要がないので、患者の苦痛もほとんどない。   (3) Since it is only necessary to put the medical tube and the guide device into the nasal cavity and the oral cavity, there is no complication, and there is no need to awaken the patient, so there is almost no pain for the patient.

（４）Ｘ線透視下で第１の磁石及び第２の磁石の磁着を確認して、医療用チューブを口腔外へ引き出すことができるので、作業の確実性が向上する。   (4) Since the magnetic attachment of the first magnet and the second magnet can be confirmed under X-ray fluoroscopy and the medical tube can be pulled out of the oral cavity, the reliability of the work is improved.

（Ａ）は本発明の実施形態例に係る医療用チューブを示す側面断面図、（Ｂ）は本発明の実施形態例に係る医療用チューブを示す側面図、（Ｃ）は本発明の実施形態例に係る医療用チューブの誘導器具を示す側面断面図である。(A) is side sectional drawing which shows the medical tube which concerns on the embodiment of this invention, (B) is a side view which shows the medical tube which concerns on the embodiment of this invention, (C) is embodiment of this invention It is side surface sectional drawing which shows the guide device of the medical tube which concerns on an example. （Ａ）〜（Ｄ）は、本発明の実施形態例に係る医療用チューブの誘導器具を用いて、生体の鼻腔から挿入された医療用チューブを口腔外に誘導する作業手順を説明するための説明図である。(A)-(D) is for demonstrating the operation | work procedure which guides the medical tube inserted from the nasal cavity of the biological body out of the oral cavity using the medical tube guiding device according to the embodiment of the present invention. It is explanatory drawing. 図（Ａ）及び（Ｂ）はＥＮＢＤの作業手順を説明するための説明図である。FIGS. 4A and 4B are explanatory diagrams for explaining the work procedure of ENBD. 図（Ａ）〜（Ｃ）はＥＮＢＤの作業手順を説明するための説明図である。FIGS. 4A to 4C are explanatory diagrams for explaining the work procedure of ENBD.

以下、本発明の実施の形態について図面を参照して説明する。図１（Ａ）は本発明の実施形態例に係る医療用チューブを示す側面断面図、（Ｂ）は本発明の実施形態例に係る医療用チューブを示す側面図、（Ｃ）は本発明の実施形態例に係る医療用チューブの誘導器具を示す側面断面図である。   Hereinafter, embodiments of the present invention will be described with reference to the drawings. FIG. 1A is a side sectional view showing a medical tube according to an embodiment of the present invention, FIG. 1B is a side view showing a medical tube according to an embodiment of the present invention, and FIG. It is side surface sectional drawing which shows the guide device of the medical tube which concerns on the example of embodiment.

本発明の実施形態例に係る医療用チューブ１は、例えばネラトンチューブのように、生体の鼻腔Ｎから挿入されるものであり、図１（Ａ）及び（Ｂ）に示すように、可撓性のある合成樹脂等で作られた透明又は半透明の第１のチューブ本体１ｂの先端側の内部に第１の磁石１ａが設けられている。   A medical tube 1 according to an embodiment of the present invention is inserted from a nasal cavity N of a living body like a nelaton tube, for example, and is flexible as shown in FIGS. 1 (A) and 1 (B). A first magnet 1a is provided inside the distal end side of a transparent or translucent first tube body 1b made of a synthetic resin or the like.

第１の磁石１ａは、例えばネオジウム磁石で作られており、第１のチューブ本体１ｂ内に嵌まって固定できるように、チューブ本体の内径（例えば３ｍｍ）よりも若干長い直径を備え、全体が円筒形状に形成されている（例えば長さ７ｍｍ）。また、第１の磁石１ａの少なくとも表面は、Ｘ線透視下で視認可能な材質で作られている。これによって、Ｘ線透視下で第１の磁石１ａの位置を容易に視認することができる。   The first magnet 1a is made of, for example, a neodymium magnet and has a diameter slightly longer than the inner diameter (eg, 3 mm) of the tube body so that the first magnet 1a can be fitted and fixed in the first tube body 1b. It is formed in a cylindrical shape (for example, a length of 7 mm). Further, at least the surface of the first magnet 1a is made of a material that is visible under X-ray fluoroscopy. Thereby, the position of the 1st magnet 1a can be easily visually recognized under X-ray fluoroscopy.

第１のチューブ本体１ｂの先端側の側面には、第１の磁石１ａを挿入するための第１の挿入孔１ｃと、生体の体内物質を排出するために用いられる他の医療用チューブ（例えばＥＮＢＤチューブ）が挿入される第２の挿入孔１ｄとが、それぞれ間隔を隔てて形成されている。なお、第１の挿入孔１ｃ及び第２の挿入孔１ｄの大きさ、形及び位置は用途に応じて適宜変更して形成される。   The first tube main body 1b has a first insertion hole 1c for inserting the first magnet 1a, and another medical tube used for discharging a living body substance (for example, on the side surface on the distal end side of the first tube main body 1b). The second insertion holes 1d into which the ENBD tubes are inserted are formed at intervals. The size, shape, and position of the first insertion hole 1c and the second insertion hole 1d are appropriately changed depending on the application.

第１のチューブ本体１ｂの先端部には、第１の磁石１ａが外に飛び出さないようにするために盲端部１ｅが形成されている。この盲端部１ｅは、鼻腔Ｎ内の損傷を防止するために、丸みのある凸形状に形成されているのが好ましい。   A blind end 1e is formed at the tip of the first tube body 1b so that the first magnet 1a does not jump out. In order to prevent damage in the nasal cavity N, the blind end 1e is preferably formed in a rounded convex shape.

本発明の実施形態例に係る医療用チューブ１の誘導器具２は、口腔Ｍから挿入され、医療用チューブ１を口腔Ｍ外に誘導するために用いられるものであり、図１（Ｃ）に示すように、可撓性のある合成樹脂等で作られた透明又は半透明の第２のチューブ本体２ｂの先端側の内部に、医療用チューブ１の第１の磁石１ａに磁着される第２の磁石２ａが設けられている。   The guide device 2 for the medical tube 1 according to the embodiment of the present invention is inserted from the oral cavity M and used to guide the medical tube 1 out of the oral cavity M, and is shown in FIG. As described above, the second magnetized to the first magnet 1a of the medical tube 1 inside the distal end side of the transparent or translucent second tube body 2b made of flexible synthetic resin or the like. The magnet 2a is provided.

第２の磁石２ａは、例えばネオジウム磁石で作られており、全体が円筒形状に形成されている（例えば直径５ｍｍ、長さ１０ｍｍ）。また、第２の磁石２ａの少なくとも表面は、Ｘ線透視下で視認可能な材質で作られている。これによって、Ｘ線透視下で第２の磁石２ａの位置を容易に視認することができる。   The second magnet 2a is made of, for example, a neodymium magnet, and is formed in a cylindrical shape as a whole (for example, a diameter of 5 mm and a length of 10 mm). In addition, at least the surface of the second magnet 2a is made of a material that is visible under X-ray fluoroscopy. Thereby, the position of the 2nd magnet 2a can be easily visually recognized under X-ray fluoroscopy.

第２のチューブ本体２ｂの先端部には、第２の磁石２ａが外に飛び出さないようにするために盲端部２ｃが形成されている。この盲端部２ｃは、口腔Ｍ内の損傷を防止するために、丸みのある凸形状に形成されているのが好ましい。   A blind end 2c is formed at the tip of the second tube main body 2b so that the second magnet 2a does not jump out. In order to prevent damage in the oral cavity M, the blind end 2c is preferably formed in a rounded convex shape.

なお、第２のチューブ本体２ｂの代わりに、可撓性があり、かつ口腔Ｍに入れても害にならない材質で作られた部材であれば、どのような形態の部材でも用いることが可能であり、必ずしもチューブ状に形成されている必要はない。
また、第２の磁石２ａは、第２のチューブ本体２ｂの先端側に、医療用テープを巻き付ける等の手段で固定されていてもよい。 Instead of the second tube main body 2b, any member can be used as long as the member is made of a material that is flexible and does not harm even if placed in the oral cavity M. There is no need to be formed in a tube shape.
Moreover, the 2nd magnet 2a may be fixed to the front end side of the 2nd tube main body 2b by means, such as winding a medical tape.

図２（Ａ）〜（Ｄ）は、本発明の実施形態例に係る医療用チューブの誘導器具を用いて、生体の鼻腔から挿入された医療用チューブを口腔外に誘導する作業手順を説明するための説明図である。   2A to 2D illustrate an operation procedure for guiding a medical tube inserted from a nasal cavity of a living body to the outside of the oral cavity using the medical tube guiding device according to the embodiment of the present invention. It is explanatory drawing for.

まず、生体の鼻腔Ｎから医療用チューブ１を挿入する（図２（Ａ）参照）。   First, the medical tube 1 is inserted from the nasal cavity N of the living body (see FIG. 2A).

次いで、医療用チューブ１の誘導器具２を口腔Ｍから挿入する（図２（Ｂ）参照）。   Next, the guide device 2 of the medical tube 1 is inserted from the oral cavity M (see FIG. 2B).

次いで、Ｘ線透視撮影装置（Ｘ線透視手段）を用いて、生体の対象部位の画像を表示部に表示させ、Ｘ線透視下で視認しながら、医療用チューブ１の第１の磁石１ａに誘導器具２の第２の磁石２ａを磁力で吸着させながら磁着する（図２（Ｃ）参照）。   Next, an image of the target region of the living body is displayed on the display unit using an X-ray fluoroscopic imaging apparatus (X-ray fluoroscopy unit), and the first magnet 1a of the medical tube 1 is viewed while being viewed under X-ray fluoroscopy. The second magnet 2a of the guide device 2 is magnetically attached while being attracted by a magnetic force (see FIG. 2C).

次いで、誘導器具２を引き、医療用チューブ１を口腔Ｍ外へ引き出す（図２（Ｄ）参照）。   Next, the guide device 2 is pulled, and the medical tube 1 is pulled out of the oral cavity M (see FIG. 2D).

その後、生体の体内物質を排出するために用いられる他の医療用チューブ（例えばＥＮＢＤチューブ）を医療用チューブ１の第２の挿入孔１ｄに所定の長さ（例えば１５ｃｍ程度）分挿入した後、医療用チューブ１を鼻腔Ｎ側に引いて他の医療用チューブ（例えばＥＮＢＤチューブ）を鼻腔Ｎから外に出す。   Then, after inserting another medical tube (for example, ENBD tube) used for discharging the body material of the living body into the second insertion hole 1d of the medical tube 1 for a predetermined length (for example, about 15 cm), The medical tube 1 is pulled to the nasal cavity N side, and another medical tube (for example, ENBD tube) is taken out from the nasal cavity N.

本発明の実施形態例によれば、第１の磁石１ａ及び第２の磁石２ａの磁力による吸着を利用して、鼻腔Ｎから挿入された医療用チューブ１を口腔Ｍ外に誘導するので、作業が簡易になり、熟練を要することがなくなる。その結果、手技の習得に時間を要さないので、初心者でも短時間で迅速に作業を行うことができる。   According to the embodiment of the present invention, the medical tube 1 inserted from the nasal cavity N is guided out of the oral cavity M by utilizing the magnetic force of the first magnet 1a and the second magnet 2a. Becomes simple and no skill is required. As a result, since it does not take time to acquire a technique, even a beginner can perform work quickly in a short time.

また、チューブ状の細い部材を利用するので、作業の成否が術者や患者の体型に左右されることがなくなる。   In addition, since the tubular thin member is used, the success or failure of the work does not depend on the body shape of the operator or patient.

また、医療用チューブ１及び誘導器具２を鼻腔Ｎ及び口腔Ｍにそれぞれ入れるだけで済むので、合併症が生じることがなく、また患者を覚醒する必要がないので、患者の苦痛もほとんどない。   Further, since it is only necessary to put the medical tube 1 and the guide device 2 in the nasal cavity N and the mouth M, respectively, no complication occurs, and it is not necessary to wake up the patient, so there is almost no pain for the patient.

さらに、Ｘ線透視下で第１の磁石１ａ及び第２の磁石２ａの磁着を確認して、医療用チューブ１を口腔Ｍ外へ引き出すことができるので、作業の確実性が向上する。   Furthermore, since the medical tube 1 can be pulled out of the oral cavity M by confirming the magnetic attachment of the first magnet 1a and the second magnet 2a under X-ray fluoroscopy, the reliability of the work is improved.

本発明は、上記実施の形態に限定されることはなく、特許請求の範囲に記載された技術的事項の範囲内において、種々の変更が可能である。   The present invention is not limited to the above-described embodiments, and various modifications can be made within the scope of the technical matters described in the claims.

例えば、第１の磁石１ａ及び第２の磁石２ａは、酸化鉄、酸化クロム、コバルト、フェライト等のように磁性を帯びることが可能な物質に代用することも可能である。   For example, the first magnet 1a and the second magnet 2a can be substituted with a material capable of being magnetized, such as iron oxide, chromium oxide, cobalt, and ferrite.

また、第２の磁石１ａ及び第２の磁石２ａは、永久磁石だけでなく、電磁石を用いることも可能である。   Further, the second magnet 1a and the second magnet 2a can use not only permanent magnets but also electromagnets.

さらに、医療用チューブ１、誘導器具２のサイズ、材質及び形状は明細書及び図面に開示されているものに限定されず、適宜変更できる。   Furthermore, the size, material, and shape of the medical tube 1 and the guide device 2 are not limited to those disclosed in the specification and drawings, and can be changed as appropriate.

本発明者らは、本願発明の実施形態例（磁石法）、フィンガー法（finger法）、ガイドワイヤー誘導法（ＧＷ誘導法）について、簡便性や安全性を比較検討するための施術を行った。この施術では、２０１１年１２月から２０１２年２月までの期間に横浜市立大学附属病院において上記各方法２０例の計６０例について前向きランダム化比較試験を行った。   The present inventors performed a treatment for comparing and examining convenience and safety of the embodiment example (magnet method), finger method (finger method), and guide wire guidance method (GW guidance method) of the present invention. . In this treatment, a prospective randomized comparative test was conducted for 60 cases in total 20 cases in the Yokohama City University Hospital during the period from December 2011 to February 2012.

本願発明の実施形態例では、第１の磁石１ａ及び第２の磁石２ａとしてネオジウム磁石が用いられており、第１の磁石１ａ(直径３ｍｍ、長さ７ｍｍ、磁界４５０ｍＴ)をネラトンチューブ内先端に入れて鼻孔から挿入する。第２の磁石２ａ(直径５ｍｍ、長さ１０ｍｍ、磁界５３０ｍＴ)は吸引チューブ先端に固定し、口腔内から挿入し、第１の磁石１ａと吸着させる。ＥＮＢＤはガテックス（Cathex）社製のものを使用した。ペースメーカー症例を除外し、鼻腔内誘導は研修医が施行した。ネラトンチューブの鼻孔挿入から口外への誘導までの時間、さらに透視被曝時間と嘔吐反射回数を計測した。３分間で施行不能であった場合には、上級医に術者を変更した。   In the embodiment of the present invention, neodymium magnets are used as the first magnet 1a and the second magnet 2a, and the first magnet 1a (diameter 3 mm, length 7 mm, magnetic field 450 mT) is placed at the inner end of the nelaton tube. Insert and insert through nostril. The second magnet 2a (diameter 5mm, length 10mm, magnetic field 530mT) is fixed to the tip of the suction tube, inserted from the oral cavity, and adsorbed with the first magnet 1a. ENBD manufactured by Catex was used. Excluding pacemaker cases, intranasal guidance was performed by the resident. The time from the insertion of the noraton tube into the nostril until the induction to the outside of the mouth, the fluoroscopic exposure time and the number of vomiting reflections were measured. If the operation was not possible in 3 minutes, the surgeon was changed to a senior doctor.

以下、上記の施術結果を表１に示す。

Figure 2013099519
The results of the above treatment are shown in Table 1.
Figure 2013099519

表１から、本願発明の実施形態例では、簡便性や安全性の点で、フィンガー法やガイドワイヤー誘導法よりも優れていることがわかる。
従って、本願発明によれば、初心者でも安全で確実に施行可能であり、透視下での視認性も良好であり、容易に、短時間、低侵襲で施行可能であり、装置の作成も安価で簡便であるので、今後のＥＮＢＤ誘導法において第１の選択となり得るものである。 From Table 1, it can be seen that the embodiment of the present invention is superior to the finger method and the guide wire guiding method in terms of simplicity and safety.
Therefore, according to the present invention, even beginners can safely and surely perform, have good visibility under fluoroscopy, can be easily performed in a short time, in a minimally invasive manner, and are inexpensive to create a device. Since it is simple, it can be the first choice in future ENBD guidance methods.

本発明は、例えば、内視鏡的経鼻胆管ドレナージ術（ＥＮＢＤ：endoscopic nasal biliary drainage）、内視鏡的経鼻すい管ドレナージ術（ＥＮＰＤ：endoscopic nasal pancreatic drainage）、超音波内視鏡−嚢胞ドレナージ術（ＥＵＳ−ＣＤ：Endoscopic ultrasonography-cyst drainage）等の治療方法を行う際に利用することができる。   The present invention includes, for example, endoscopic nasal biliary drainage (ENBD), endoscopic nasal pancreatic drainage (ENPD), ultrasound endoscopic nasal pancreatic drainage (ENPD) It can be used when performing treatment methods such as drainage (EUS-CD: Endoscopic ultrasonography-cyst drainage).

１：医療用チューブ
１ａ：第１の磁石
１ｂ：第１のチューブ本体
１ｃ：第１の挿入孔
１ｄ：第２の挿入孔
１ｅ：盲端部
２：誘導器具
２ａ：第２の磁石
２ｂ：第２のチューブ本体
２ｃ：盲端部
Ｎ：鼻腔
Ｍ：口腔 1: Medical tube 1a: 1st magnet 1b: 1st tube main body 1c: 1st insertion hole 1d: 2nd insertion hole 1e: Blind end part 2: Guidance device 2a: 2nd magnet 2b: 2nd 2 tube body 2c: blind end N: nasal cavity M: oral cavity

Claims (7)

生体の鼻腔から挿入された医療用チューブを口腔外に誘導するために用いられる医療用チューブの誘導器具であって、
前記口腔から挿入され、前記医療用チューブの先端側に設けられた第１の磁石に磁着される第２の磁石を有する、
ことを特徴とする医療用チューブの誘導器具。 A medical tube guiding device used for guiding a medical tube inserted from the nasal cavity of a living body to the outside of the oral cavity,
Having a second magnet inserted from the oral cavity and magnetically attached to a first magnet provided on the distal end side of the medical tube;
A medical tube guiding device characterized by that. チューブ状に形成され、先端側に前記第２の磁石が設けられていることを特徴とする請求項１に記載の医療用チューブの誘導器具。   2. The medical tube guiding device according to claim 1, wherein the second tube is formed in a tube shape, and the second magnet is provided on a distal end side. 請求項１又は２に記載の医療用チューブの誘導器具によって口腔外に誘導され、先端側に前記第１の磁石が設けられていることを特徴とする医療用チューブ。   A medical tube that is guided to the outside of the oral cavity by the medical tube guiding device according to claim 1 or 2, and the first magnet is provided on a distal end side. 前記生体の体内物質を排出するために用いられる他の医療用チューブが挿入される挿入孔が形成されている、
ことを特徴とする請求項３に記載の医療用チューブ。 An insertion hole into which another medical tube used for discharging the body material of the living body is inserted is formed.
The medical tube according to claim 3. 前記第１の磁石及び第２の磁石の少なくとも表面は、Ｘ線透視下で視認可能な材質で作られていることを特徴とする請求項１又は２に記載の医療用チューブの誘導器具。   The medical tube guiding device according to claim 1 or 2, wherein at least surfaces of the first magnet and the second magnet are made of a material that is visible under X-ray fluoroscopy. 前記第１の磁石及び第２の磁石の少なくとも表面は、Ｘ線透視下で視認可能な材質で作られていることを特徴とする請求項３又は４に記載の医療用チューブ。   The medical tube according to claim 3 or 4, wherein at least surfaces of the first magnet and the second magnet are made of a material that is visible under X-ray fluoroscopy. 生体の鼻腔から挿入され、第１の磁石を備えた医療用チューブと、
前記生体の口腔から挿入され、第２の磁石を備えた誘導器具と、
前記生体の対象部位をＸ線透視するためのＸ線透視手段とを有し、
前記Ｘ線透視手段によりＸ線透視下で視認しながら、前記医療用チューブの前記第１の磁石に前記誘導器具の前記第２の磁石を磁力で吸着させながら磁着させ、前記誘導器具を引いて、前記医療用チューブを口腔外へ引き出す、
ことを特徴とする医療用システム。 A medical tube inserted from the nasal cavity of a living body and provided with a first magnet;
A guiding device inserted from the oral cavity of the living body and provided with a second magnet;
X-ray fluoroscopic means for X-ray fluoroscopically the target site of the living body,
While visually recognizing under X-ray fluoroscopy with the X-ray fluoroscopy means, the first magnet of the medical tube is magnetically attached to the first magnet while attracting the second magnet of the guidance instrument with a magnetic force, and the guidance instrument is pulled. Pull the medical tube out of the mouth,
A medical system characterized by that.
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