JP4451269B2 - Overtube for gastrostomy - Google Patents

Description

  The present invention relates to an overtube for gastrostomy construction that is used by being inserted into the oral cavity during gastrostomy construction.

For patients who have health problems and are unable to ingest nutrition spontaneously, a fistula (gastric fistula) is constructed in the patient's abdomen, and a gastrostomy catheter is attached to the fistula, and nutrition is provided through the gastrostomy catheter. Is known to ingest.
When constructing a gastrostomy, insert an endoscope into the stomach, select the site for gastrostomy, and then pierce the stomach wall from the outside of the body to form a fistula, from which a guide wire is inserted into the stomach insert. The tip of the guide wire is hooked on a snare inserted through the endoscope, and then the endoscope is removed. As a result, the distal end portion of the guide wire is pulled out from the oral cavity, and the gastrostomy catheter is inserted into the stomach from the oral cavity side using this guide wire and attached to the fistula. As a gastrostomy catheter used at the time of gastrostomy construction, a catheter body in which a lumen is formed, which is generally called a Ponsky type catheter, is often used.

In such a procedure, when the gastrostomy catheter is inserted, the gastrostomy overtube is inserted into the patient's oral cavity so that bacteria in the oral cavity do not adhere to the stopper or the like. A gastrostomy catheter may be inserted through the inside. Furthermore, even when a gastrostomy overtube is used, bacteria may adhere to the inner peripheral surface of the tube when the endoscope is removed. Therefore, there is one in which a soft cover that covers the inner wall of the tube is attached so that the stopper is not contaminated with such bacteria (see, for example, Patent Document 1). The distal end of the soft cover is folded back from the inner side to the outer side at the distal end on the tube insertion side, and the proximal end side of the tube protrudes from the tube. In such an overtube for gastrostomy, after pulling out the endoscope while holding the guide wire, the soft cover is pulled out from the proximal end of the tube. When the soft cover is removed, a clean inner surface of the tube appears, and the gastrostomy catheter is inserted into the stomach through such a tube.
JP 2003-275324 A

However, the soft cover is folded outward in the oral cavity of the patient, and such a soft cover is difficult to pull out from the outside, and the workability is poor. Further, when pulling out the soft cover, there is a possibility that the inner surface of the soft cover, that is, the surface on which bacteria may adhere may come into contact with the inner peripheral surface of the tube.
The present invention has been made in view of such circumstances, and an object thereof is to provide a gastrostomy catheter when the gastrostomy catheter is inserted into a patient's body using an overtube for gastrostomy. It is to be able to perform a procedure efficiently while preventing bacteria and the like from attaching.

  The invention according to claim 1 of the present invention for solving the above-mentioned problems is used for inserting a gastrostomy catheter having a catheter body provided with a stopper through a mouth of a patient at the time of gastrostomy construction, A tube body capable of being inserted through the catheter and inserted into the patient's oral cavity from the distal end side; and an inner sheath provided along the inner peripheral wall of the tube body, wherein the distal end portion of the inner sheath In the overtube for gastrostomy construction which is folded from the inner peripheral surface of the tube main body to the outer peripheral surface at the distal end of the tube main body inserted into the tube body, the distal end portion of the inner sheath is detachable from the tube main body. An elastic member is provided, and an operation member is attached to the elastic member, and the operation member passes through the inner periphery of the inner sheath and passes through the inner tube. It was gastrostomy overtube, characterized in that is drawn to the outside from the proximal end of the body.

  In the gastrostomy overtube, the operating member is pulled from the outside of the body when the endoscope is removed. Since the operating member pulls the distal end portion of the inner sheath from the inside of the tube main body, the inner sheath is pulled into the tube main body while being peeled from the tube main body, and finally from the proximal end side of the tube main body to the outside of the body. Pulled out. Further, the distal end portion of the inner sheath drawn into the tube main body is deformed so as to be narrowed toward the center by the elastic member.

The invention according to claim 2 is the gastrostomy overtube according to claim 1, wherein a cover is bonded to the inner peripheral surface of the inner sheath, and the inner sheath and the cover The operation member is inserted.
In this gastrostomy overtube, since the operation member is not exposed on the inner surface of the inner sheath, the operation member is not caught when an endoscope or the like is inserted.

The invention according to claim 3 is the gastrostomy overtube according to claim 1 or 2, wherein the tube main body is provided with an introduction part for introducing the gastrostomy catheter at the proximal end of the tube main body. The sheath is folded back at the proximal end portion of the introduction portion and engaged with the outer peripheral portion of the introduction portion, and the operation member is folded back at the proximal end portion of the introduction portion and can be detached from the introduction portion. It is attached to the tab for use.
In this gastrostomy overtube, when the stripping tab is pulled away from the introduction portion, the operation member is pulled while it is fixed to the introduction portion side of the inner sheath, so the inner sheath is gradually peeled off from the distal end side. Is done.

The invention according to claim 4 is the overtube for gastrostoma construction according to claim 3, wherein the peeling tab is extended from the tab main body to be mounted on the outer periphery of the introduction portion, the tab main body, A tab fixing portion that is detachably engageable with the groove formed in the introduction portion, and the tab fixing portion is detached from the groove when an operator grips the peeling tab. It is supported by.
In this gastrostomy overtube, when the endoscope is inserted, the peeling tab can be engaged with the introducing portion by the tab fixing portion, so that the inner sheath does not peel off. Since the tab fixing portion is disengaged when the peeling tab is gripped, the inner sheath can be easily peeled by grasping and pulling the peeling tab.

According to a fifth aspect of the present invention, in the gastrostomy overtube according to the third aspect of the present invention, the outer peripheral portion of the introduction portion is provided with a warping portion that protrudes so as to prevent the inner sheath from being detached. It is characterized by being.
In this gastrostomy overtube, when the operation member is pulled, the warped portion prevents the inner sheath from falling off the introduction portion.

The invention according to claim 6 is provided with an insertion port having an inner diameter into which a gastrostomy catheter can be inserted at the proximal end, a tube main body into which the distal end is inserted into the body, and the tube main body disposed in the tube main body. An inner sheath extending from the distal end to the proximal end of the tube main body, the inner sheath extending from the distal end to the proximal end of the tube main body, and the engagement of the inner sheath A gastrostomy device comprising: an operation member having one end fixed to the proximal end side of the stopper portion, passing through the inner peripheral side of the inner sheath, and the other end extending from the proximal end portion of the tube body. Overtube for use.
In this gastrostomy overtube, the locking portion at the tip of the inner sheath is locked to the tip of the tube body. When the operating member is pulled, the engaging portion is disengaged from the tube main body so that the inner sheath can be recovered.

  According to the present invention, since the operation member attached to the distal end portion of the inner sheath and pulled out of the body through the inner peripheral side of the inner sheath is provided, the operation member can be pulled when the endoscope is removed. The inner sheath can be pulled out from the distal end side. Therefore, the inner sheath can be reliably and smoothly pulled out, and the efficiency of the procedure can be improved. Furthermore, since the inner sheath is deformed so as to squeeze toward the center by the elastic member, the inner sheath once peeled does not come into contact with the inner peripheral surface of the tube body again. Therefore, even when bacteria or the like are attached to the inner peripheral surface of the inner sheath, such bacteria are not attached to the inner peripheral surface of the tube body.

(First embodiment)
FIG. 1 shows the configuration of a Ponsky-type gastrostomy catheter used in this embodiment. FIG. 2 shows the configuration of the gastrostomy overtube.
As shown in FIG. 1, the gastrostomy catheter 1 has a flexible catheter body 2 having a lumen formed therein. One end of the catheter body 2 is provided with a loop 3 to which the distal end portion of the guide wire is locked, and the other end of the catheter body 2 is provided with a stopper 4 for preventing removal. The stopper 4 has a continuous wall portion extending in diameter from the proximal end that forms a boundary with the catheter body 2, and an opening 5 having a diameter larger than that of the catheter body 2 is formed in a circular shape at the distal end thereof. As a hollow dome shape. In addition, the gastrostomy catheter applied to this Embodiment is not limited to the shape shown in FIG.

As shown in FIG. 2, the gastrostomy overtube (hereinafter referred to as “overtube”) 10 includes a tube main body 11 inserted into the oral cavity from the distal end side, and a catheter introduction portion attached to the proximal end of the tube main body 11. 12.
The tube body 11 is long and flexible, and is graduated so that the amount of insertion into the oral cavity of the patient can be confirmed. An annular groove 11 a is formed on the outer periphery of the distal end portion of the tube main body 11. Such a tube body 11 is made of, for example, silicone rubber, vinyl chloride, vinyl chloride-vinyl acetate copolymer, polyurethane, fluororesin, polyamide, polypropylene, polyacetal, polyethylene, or other polymer resin, natural rubber, or synthetic rubber. Manufactured from rubber.

The catheter introduction part 12 has an elongated shape, and extends from the distal end side joining part 13 attached to the tube body 11 so that the introduction part body 14 gradually expands in a taper shape along the longitudinal direction. The proximal end portion 15 of the introducing portion main body 14 has an annular shape with a constant diameter, and an opening portion 16 is formed as an insertion port opened to the outside. A flange 17 projects from the outer peripheral surface of the base end portion 15, and an annular groove 17 a is formed on the outer peripheral surface of the flange 17. Further, in the base end portion 15, a flap 18 that is a folded portion is formed on the opening 16 side of the flange 17. The flap 18 has a starting point on the flange 17 side, and rises from here to open to the opening 16 side. The maximum inner diameter of the introducing portion main body 14, that is, the inner diameter of the proximal end portion 15 is larger than the maximum outer diameter of the stopper 4 of the gastrostomy catheter 1 as shown in FIG. Is smaller than the maximum outer diameter of the stopper 4.
Such a catheter introduction part 12 is manufactured from general-purpose plastics such as polycarbonate, polyacetal, acrylonitrile / butadiene / styrene copolymer (ABS), and the like. Further, the catheter introduction part 12 and the tube body 11 are joined using, for example, ultrasonic fusion, thermal fusion, solvent adhesive, or the like.

Here, the inner tube 20 is provided in the overtube 10 in a substantially cylindrical shape along the inner peripheral surfaces of the tube main body 11 and the catheter introduction part 12.
The inner sheath 20 has its distal end folded back outward at the distal end of the tube body 11. The distal end portion of the inner sheath 20 is fused in a folded state in a bag shape, and a ring-shaped elastic member 21 is accommodated therein. The elastic member 21 is a locking portion that can be removed from the groove 11 a of the tube body 11. Further, the proximal end portion of the inner sheath 20 extends along the inside of the catheter introduction portion 12, is folded back from the inside to the outside at the proximal end portion 15, rides over the flap 18, and is disposed in the vicinity of the flange 17. Here, an inner sheath fixing portion 22 is formed. The inner sheath fixing portion 22 is configured by folding the inner sheath 20 into a bag shape and fusing it, and accommodating a ring-shaped elastic member 23 inside the bag body. Such an inner sheath 20 is made of silicone rubber, vinyl chloride, vinyl chloride-vinyl acetate copolymer, polyurethane, fluororesin, polyamide, polypropylene, polyacetal, polyethylene, or other polymer resin, or natural rubber or synthetic rubber. It is manufactured.

  Further, the inner sheath 20 is provided with a wire 24 as an operation member attached to the elastic member 21. The wire 24 may be one, or a plurality of wires. Most preferably, three inner sheaths 20 are arranged at each of the positions at which the circumferential direction of the inner sheath 20 is divided into three equal parts. The wire 24 passes through the bag-like portion of the distal end portion of the inner sheath 20, is once drawn outward, is then folded back at the distal end of the tube body 11, and is introduced into the catheter along the inner peripheral surface of the inner sheath 20. After being pulled out to the part 12 side and folded back at the base end part 15, it is attached to the peeling tab 25. The stripping tab 25 has an annular tab body 26 provided on the outer periphery of the proximal end portion 15 of the catheter introducing portion 12, and the tab body 26 is closer to the opening portion 16 than the inner sheath fixing portion 22 and the flap 18. It is arranged so that a part rides on. An operation unit 27 is provided on the outer peripheral surface of the tab body 26. The operation portion 27 includes a support portion 27a connected to the tab body 26, and arm portions 27b and 27c extending from the distal end of the support portion 27a to the proximal end side and the distal end side, respectively, and is substantially T-shaped in a side view. ing. A tab fixing portion 29 having a claw that engages with the groove 17a on the outer peripheral surface of the flange 17 is provided on the arm portion 27c on the distal end side. Such a peeling tab 25 is manufactured from a known plastic.

  A stopper 30 is fitted into the outer peripheral wall of the tube main body 11. The stopper 30 has a flange 32 protruding from the base end side of the annular sleeve 31 and is made of silicon, polyvinyl chloride, polyethylene or the like. The inner diameter of the sleeve 31 is slightly smaller than the outer diameter of the tube body 11 and can be slid by hand force. Such a stopper 30 is provided to adjust the insertion amount of the tube main body 11. When the stopper 30 is on the distal end side of the tube main body 11, the length inserted into the patient's oral cavity is short. Become. Further, like the stopper 30a shown in FIG. 3, a convex portion 33 on the saw blade may be formed on the inner peripheral wall of the sleeve 31 along the length direction. The convex portion 33 is formed so that the stopper 30a is allowed to move in the direction toward the distal end side of the tube body 11, but is not allowed to move toward the catheter introducing portion 12 side. The convex portion 33 is not limited to a saw blade, and may be a protrusion or a spherical shape.

Next, the operation in this embodiment will be described.
First, after injecting the lubricant into the overtube 10, the insertion part of the endoscope is inserted into the overtube 10, the endoscope is inserted into the patient with the mouthpiece, and the safety in the esophagus is confirmed. Then, the tube main body 11 of the overtube 10 is inserted from the distal end side. The guide wire inserted using the route from the percutaneous to the stomach secured by the puncture needle is grasped with a snare under the endoscope, and the endoscope is removed in the grasped state.
As shown in FIG. 4, when the distal end of the insertion portion 41 is pulled back into the tube body 11 with the snare 42 protruding from the insertion portion 41 of the endoscope 40 being gripped, The person grasps the arm portion 27 b on the proximal end side of the operation portion 27 of the peeling tab 25. As a result, the arm portion 27c on the distal end side opens radially and outward from the support portion 27a, and the tab fixing portion 29 is disengaged from the groove 17a of the flange 17. When the peeling tab 25 is pulled together with the endoscope 40 in this state, the distal end portion of the inner sheath 20 connected through the wire 24 is pulled. As shown in FIG. 5, at the distal end portion of the inner sheath 20, the elastic member 21 is detached from the groove 11 a and is drawn inside the tube main body 11. At this time, as shown in FIG. 6, due to the restoring force of the elastic member 21, the distal end portion of the inner sheath 20 enters the tube main body 11 so as to squeeze inward, that is, near the center line. Therefore, as shown in FIG. 8, when the peeling tab 25 is pulled, the inner sheath 20 that is in close contact with the inner peripheral surface of the tube main body 11 with a weak force peels off so as to be peeled inward. Pulled out of the body. With the passage of the endoscope 40, the inner peripheral surface of the inner sheath 20 becomes an unclean area, but the inner sheath 20 is peeled off so that the inner peripheral surface of the tube body 11 covered with the inner sheath 20 is Exposed as a clean area.

  Then, after extracting the endoscope 40 and the inner sheath 20 from the overtube 10, the guide wire 43 is engaged with the loop 3 of the gastrostomy catheter 1 shown in FIG. The gastrostomy catheter 1 is inserted into the body while being pulled back. The gastrostomy catheter 1 is inserted into the stomach through the tube body 11 while being deformed so that the outer diameter of the stopper 4 is reduced by the taper of the catheter introduction portion 12. The gastrostomy catheter 1 inserted into the stomach has one end of the catheter body 2 drawn out of the body through the fistula, and the stopper 4 is left in the body. Further, when the one end portion side of the catheter body 2 is cut to an appropriate length, the lumen is opened, so that nutrition or the like can be directly supplied into the stomach. When the gastrostomy catheter 1 is pulled to the outside of the body, the stopper 4 comes into contact with the stomach wall from the inside to prevent it from easily coming out of the fistula.

According to this embodiment, at the time of gastrostomy construction, the inside of the tube main body 11 inserted into the patient's oral cavity and the catheter introduction part 12 in order to perform insertion / extraction of the endoscope 40 and insertion of the gastrostomy catheter 1. Since the inner sheath 20 is provided on the peripheral surface, the wire 24 is attached to the distal end thereof, and the wire 24 is pulled out to the outside of the body, when the endoscope 24 is pulled out, if the wire 24 is pulled at the same time, The inner sheath 20 can be easily peeled off. Therefore, since the workability is good, the procedure becomes easy. Furthermore, since the inner sheath 20 once peeled is deformed so as to be constricted inward by the elastic member 21 in the tube main body 11, adhesion of bacteria to the gastrostomy catheter 1 to be inserted later can be reliably prevented.
Further, since the elastic member 21 is provided at the distal end portion of the inner sheath 20, the inner sheath 20 can be easily detached from the tube body 11 when pulled by the wire 24. Furthermore, since the elastic member 21 urges the inner sheath 20 in the diameter reducing direction, the inner sheath 20 can be gathered inside, so that the inner sheath 20 peeled off from the tube main body 11 contacts the inner peripheral wall of the tube main body 11 again. Can be prevented.
Since the inner sheath fixing portion 22 using the elastic member 23 is provided at the proximal end portion of the inner sheath 20, and the flap 18 is provided at the proximal end portion 15 of the catheter introduction portion 12, the inner sheath 20 is moved from the proximal end portion 15 side. It can be prevented from coming off.
The peeling tab 25 prevents the wire 24 from being pulled unnecessarily by preventing the wire 24 from being pulled unnecessarily by the engagement with the claw (tab fixing portion 29). Since the engagement can be easily released by grasping the portion 27, the operability is good and the inner sheath 20 can be easily peeled off.

Note that the flap 18 may not be provided at the proximal end portion 15 of the catheter introduction portion 12. Alternatively, only the flap 18 may be provided, and the wire 24 may be directly fixed to the inner sheath fixing portion 22 without providing the peeling tab 25. In this case, the inner sheath 20 can be peeled off by pulling the wire 24 directly or by pulling the inner sheath fixing portion 22.
The inner sheath fixing portion 22 may be bonded to the outer peripheral surface of the base end portion 15 without having the elastic member 23. As an adhesion method, ultrasonic fusion or thermal fusion may be used, or a solvent adhesive may be used for adhesion. In this case, it is preferable that the vicinity of the bonded portion is configured to be cut. Examples of such a configuration include perforations formed along the outer periphery of the inner sheath 20.

It is also possible to use a peeling tab 50 as shown in FIG. In the peeling tab 50, an operation portion 52 on which an operator puts a finger extends from the tab main body 51 outward in the radial direction, and the tab fixing portion 53 includes a protrusion that engages with the groove 17 a of the flange 17. Even with such a peeling tab 50, the same operation and effect as described above can be obtained.
Furthermore, a configuration as shown in FIG. 9 is also possible. A groove 15 a is provided on the outer periphery of the proximal end portion 15 of the catheter introducing portion 12, and a tab fixing portion 55 that engages with the groove 15 a is protruded from the inner peripheral surface of the tab main body 57 of the separation tab 56. Further, the tab main body 57 is formed with a crank-shaped gap 58 in a cross-sectional view, and the proximal end portion of the inner sheath 20 is inserted therethrough. At the base end portion of the inner sheath 20 that protrudes from the tab main body 57, a retaining member 59 by fusion or the like is formed. With this configuration, the inner sheath 20 is not sandwiched between the flap 18 and the peeling tab 56.

(Second Embodiment)
FIG. 10 shows the structure of the inner tube in the present embodiment. In addition, the same code | symbol is attached | subjected to the same component as 1st Embodiment, and description is abbreviate | omitted.
As shown in FIG. 10, the inner sheath 60 is folded outward at the distal end side and bonded in a bag shape, and the ring-shaped elastic member 21 is accommodated therein. An inner sheath fixing portion 22 as shown in FIG. 2 is formed at the proximal end portion. The wire 24 is provided at each position where the circumferential direction is divided into three parts, and is disposed so as to pass through the inner peripheral surface of the inner sheath 60.

  Here, the inner sheath 60 has a substantially cylindrical sheath body 61 and three wire guide covers 62 attached to the inner peripheral surface of the sheath body 61 so as to cover each wire 24. The wire guide cover 62 has an elongated shape, and a side edge thereof in the longitudinal direction is attached to the sheath body 61 by adhesion. A laminated structure is formed by such a wire guide cover 62 and the sheath body 61, and the wire 24 is inserted so as to be sandwiched therebetween. The sheath body 61 and the wire guide cover 62 are manufactured from the same material as the inner sheath 20. In addition, the wire guide cover 62 may be bonded by ultrasonic fusion, thermal fusion, adhesion with a solvent, or the like, as described above.

When such an inner sheath 60 is peeled off, the sheath main body 61 is peeled away along with the wire guide cover 62 so as to be directed inward, and is recovered outside the body.
In this embodiment, since the wire 24 is not exposed to the inner peripheral surface by the wire guide cover 62, the wire 24 may be caught when the endoscope 40 (see FIG. 4) or other insert is inserted. Thus, the endoscope 40 and the like can be protected. Other effects are the same as described above.

  Note that, as in the inner sheath 70 shown in FIG. 11, the elastic member 21 may be directly bonded to the distal end portion of the sheath main body 61, and the wire 24 may be attached to the elastic member 21. In this case, manufacture becomes easy. Further, the elastic member 21 may be directly bonded to the inner sheath 20 as shown in FIG.

(Third embodiment)
FIG. 12 shows the structure of a gastrostomy overtube. In addition, the same code | symbol is attached | subjected to the same component as 1st Embodiment, and description is abbreviate | omitted.
The inner sheath 80 has its distal end pulled out to the distal end of the tube main body 11 and is locked to the distal end surface of the tube main body 11. In the vicinity of the locking portion 81, a weakened portion 82 is formed along the circumferential direction of the inner sheath 80 at a portion pulled out from the tube body 11. Although the perforation is illustrated as the fragile portion 82, it may be formed by making the thickness thinner than other portions. The wire 24 as an operation member is fixed to the proximal end side (inside) of the fragile portion 82. Other configurations are the same as those of the inner sheath 20.
When peeling the inner sheath 80, the peeling tab 25 is pulled toward the front side. The proximal end side of the fragile portion 82 is pulled by the wire 24 fixed to the peeling tab 25, but since the distal end side of the fragile portion 82, that is, the locking portion 81 is locked to the tube body 11, the fragile portion 82. Is broken, and the distal end portion of the inner sheath 80 is peeled off from the tube main body 11 leaving the locking portion 81 and pulled out of the body.
In this embodiment, since the distal end portion of the inner sheath 80 is locked to the tube main body 11 in the initial state, even if the outer surface of the tube main body 11 rubs against the surface of the body lumen, Misalignment is prevented. Other effects are the same as those of the first embodiment.

The present invention can be widely applied without being limited to the above-described embodiments.
For example, the combination of the peeling tabs 25, 50, and 56 and the inner sheaths 20, 60, 70, and 80 is not limited to the form of each embodiment.
Further, the operation member is not limited to the wire 24 and may be a band-shaped member. The flap 18 may be provided so as to open toward the flange 17 side, that is, toward the tip.
In the third embodiment, the locking portion 81 may also serve as the fragile portion 82.

It is a figure which shows the gastrostomy catheter used in embodiment of this invention. It is sectional drawing which shows the structure of an overtube. It is sectional drawing which shows an example of a stopper. It is a figure explaining the effect | action of an overtube. It is a figure which shows the state by which engagement by the elastic member was cancelled | released. It is a figure which shows the state by which the front-end | tip part of the inner sheath was drawn in in the tube main body. It is a figure which shows the state by which an inner sheath is gradually taken out. It is a figure which shows an example of the tab for peeling of an overtube. It is a figure which shows an example of the tab for peeling of an overtube. It is a perspective view which shows an inner sheath. It is a perspective view which shows an inner sheath. It is sectional drawing which shows the structure of an overtube.

Explanation of symbols

1 Gastrostomy catheter 2 Catheter body 4 Stopper 10 Overtube (overtube for gastrostomy construction)
11 Tube body 12 Catheter introduction part (introduction part)
15 Base end 16 Opening (insertion slot)
17a Groove 18 Flap (curved part)
20, 60, 70, 80 Inner sheath 21 Elastic member (locking portion)
24 wire (operation member)
25, 50, 56 Peeling tab 26 Tab body 29 Tab fixing part 62 Wire guide cover (cover)
81 Locking part 82 Fragile part

Claims (6)

It is used to insert a gastrostomy catheter with a stopper attached to the catheter body through the patient's oral cavity at the time of gastrostomy construction. The gastrostomy catheter can be inserted inside and inserted into the patient's oral cavity from the distal end side. A tube main body and an inner sheath provided along an inner peripheral wall of the tube main body, and a distal end portion of the inner sheath is a front end of the tube main body inserted into the body, and an inner periphery of the tube main body In the gastrostomy overtube that is folded from the surface to the outer peripheral surface,
An elastic member that can be freely engaged with and disengaged from the tube main body is provided at a distal end portion of the inner sheath, and an operation member is attached to the elastic member, and the operation member passes through an inner periphery of the inner sheath. The gastrostomy overtube is drawn out of the body from the proximal end side of the tube body.   The gastrostomy according to claim 1, wherein a cover is bonded to an inner peripheral surface of the inner sheath, and the operation member is inserted between the inner sheath and the cover. For overtube.   The proximal end portion of the tube body is provided with an introduction portion for introducing the gastrostomy catheter, the inner sheath is folded at the proximal end portion of the introduction portion, is engaged with the outer peripheral portion of the introduction portion, and 3. The gastrostomy construction device according to claim 1, wherein the operation member is folded at a proximal end portion of the introduction portion and attached to a peeling tab that is detachable from the introduction portion. Overtube.   The stripping tab includes a tab main body mounted on the outer periphery of the introducing portion, and a tab fixing portion extending from the tab main body and freely detachable from a groove formed in the introducing portion. 4. The gastrostomy overtube according to claim 3, wherein the fixing portion is supported by the tab main body so as to be detached from the groove when an operator grips the peeling tab. 5. .   The overtube for gastrostoma construction according to claim 3, wherein a warping portion protruding so as to prevent the inner sheath from being detached is provided on an outer peripheral portion of the introduction portion. A tube body having an insertion port having an inner diameter into which a gastrostomy catheter can be inserted at the proximal end, and a distal end inserted into the body;
The distal end of the tube main body has a locking portion that is detachable from the distal end of the tube main body, and extends from the distal end to the proximal end of the tube main body through the tube main body. An inner sheath to
One end is fixed to the proximal end side of the locking portion of the inner sheath, the operation member is passed through the inner sheath inner peripheral side, and the other end is extended from the proximal end portion of the tube body,
A gastrostomy overtube characterized by comprising:

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