[go: up one dir, main page]
More Web Proxy on the site http://driver.im/

JP3639523B2 - Rectal catheter - Google Patents

Rectal catheter Download PDF

Info

Publication number
JP3639523B2
JP3639523B2 JP2000355761A JP2000355761A JP3639523B2 JP 3639523 B2 JP3639523 B2 JP 3639523B2 JP 2000355761 A JP2000355761 A JP 2000355761A JP 2000355761 A JP2000355761 A JP 2000355761A JP 3639523 B2 JP3639523 B2 JP 3639523B2
Authority
JP
Japan
Prior art keywords
intestine
excretion
passage
air
catheter
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired - Fee Related
Application number
JP2000355761A
Other languages
Japanese (ja)
Other versions
JP2002153564A (en
Inventor
重信 高根
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Create Medic Co Ltd
Original Assignee
Create Medic Co Ltd
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Create Medic Co Ltd filed Critical Create Medic Co Ltd
Priority to JP2000355761A priority Critical patent/JP3639523B2/en
Publication of JP2002153564A publication Critical patent/JP2002153564A/en
Application granted granted Critical
Publication of JP3639523B2 publication Critical patent/JP3639523B2/en
Anticipated expiration legal-status Critical
Expired - Fee Related legal-status Critical Current

Links

Images

Landscapes

  • Media Introduction/Drainage Providing Device (AREA)

Description

【0001】
【発明の属する技術分野】
本発明は、検査や治療のために人間の肛門から直腸・大腸・結腸に薬剤や空気を注入し、必要に応じて腸内より注入物及び排泄物を排出するために用いる直腸カテーテルに関する。
【0002】
【従来の技術】
従来において、検査や治療のために人間の肛門から薬剤や空気を注入するには、直腸カテーテルのカテーテル本体を肛門に挿入し、カテーテル本体の基端側からカテーテル本体内の通路を通して薬剤や空気を圧送して腸内に送り込む。送り込んだ薬剤を排泄物とともに排出するには、カテーテル本体の基端側からポンプで吸引して、腸内へ送り込んだ薬剤を排泄物とともに排出する。
吸引のため又は圧送のためのポンプを止めた状態で、ポンプよりもカテーテル本体側の通路に残留した薬剤・空気・排泄物が腸内に流れるのを防ぐ弁は、従来の直腸カテーテルにおいてはカテーテル本体の基端部のポンプに接続するチューブとの接続部分に設けられていた。
この直腸カテーテルでは、通路内に薬剤・空気・排泄物が残留するため腸内圧の変化等によりカテーテル本体内から腸内に流れ込んでしまうことがあった。
特に、回収した排泄物が腸内に戻ると処置される人が非常に不快に感じていた。
また、直腸カテーテルでバリウムを送って直腸を造影して撮影に移ろうとする際、カテーテル本体内に残留したバリウムが、直腸内に流れ込んで造影をくずしてしまうことが再々起こるという問題点があった。
【0003】
【発明が解決しようとする課題】
本発明が解決しようとする課題は、従来のこれらの問題点を解消し、カテーテル本体内に取り込んだ排泄物が腸内に戻らないようにし処置される人が不快に感じないようにして処置される人の負担を減らすことができる直腸カテーテルを提供することにある。
【0004】
【課題を解決するための手段】
かかる課題を解決した本発明の構成は、
1) 腸内に挿入されるカテーテル本体内に腸内から排泄物を排出する排泄路を設け、同排泄路を排泄物吸引装置に接続して強制排出できる直腸カテーテルにおいて、前後に作用する所定の圧力差で変形して排泄物を通過させる抵抗体を前記排泄路の先端部に設け、排泄路内に収容した排泄物が腸内に逆流するのを抑制したことを特徴とする直腸カテーテル
2) 腸内に挿入されるカテーテル本体内に腸内から排泄物を排出する排泄路を設け、同排泄路を排泄物吸引装置に接続して強制排出できる直腸カテーテルにおいて、腸内から排泄路へ向かう方向にのみ排泄物を通す逆止弁を排泄路の先端部に設け、排泄路内に収容した排泄物が腸内に逆流するのを抑制したことを特徴とする直腸カテーテル
3) 腸内に挿入されるカテーテル本体内に腸内から排泄物を排出する排泄路を設け、同排泄路を排泄物吸引装置に接続して強制排出できる直腸カテーテルにおいて、外部の操作で開閉する開閉弁を排泄路の先端部の先端に近い位置の路内に設け、排泄路内に収容した排泄物が腸内に逆流するのを抑制したことを特徴とする直腸カテーテル
4) カテーテル本体内に空気を腸内に送る空気注入路を設け、前後に作用する所定の圧力差で変形して空気を通過させやすくする抵抗体を空気注入路の先端部に設けた前記1)〜3)いずれかに記載の直腸カテーテル
5) カテーテル本体内に空気を腸内に送る空気注入路を設け、所定以上の圧力が負荷されると開いて空気を通過しやすくする閉止弁を空気注入路の先端部に設けた前記1)〜3)いずれかに記載の直腸カテーテ
にある。
【0005】
【作用】
本発明では、肛門から腸内に挿入したカテーテル本体の排泄路を排泄物が通過するようにして、排泄物を排出する。排泄路の先端部には抵抗体を設けているので、排泄路に収容し残留した排泄物が腸内に逆流しようとしても残留した排泄物は大きな圧力を抵抗体に加えないので抵抗体は変形せず排泄物を逆流させない。
排泄路の先端部に逆止弁を設けたものは、逆止弁によって腸内から排泄路内へ向かう方向にのみ排泄物が通るようにし、排泄路内から腸内へ排泄物が流れないようにして逆流しないようにする。
排泄路の先端部の先端に近い位置の路中に開閉弁を設けたものは、排泄物を吸引する際に外部の操作で開閉弁を開き、それ以外では外部の操作で開閉弁を閉じ、排泄路内から腸内へ排泄物が流れないようにする。
カテーテル本体に空気注入路を設け、空気注入路の先端部に抵抗体を設けたものは、空気注入路内に残留した空気の圧力では、抵抗体が変形しないようにして、残留した空気が腸内に流れ出てしまうことを抑制する。
カテーテル本体に空気注入路を設け、空気注入路の先端部に閉止弁を設けたものは、所定の圧力以上で開く閉止弁によって、空気注入路内に残留している空気の圧力では閉止弁が開弁しないようにして残留している空気が腸内に流れ込まないようにする。
カテーテル本体内に排泄路と薬剤注入路と空気注入路を設け、各路の先端部に抵抗体を設けたものは、排泄路に残留した排泄物、薬剤注入路に残留した薬剤、空気注入路に残留した空気が残留した圧力では抵抗体を変形させないようにして腸内に流れ出すことがないようにする。
【0006】
【発明の実施の形態】
本発明において、抵抗体は逆止弁並びに閉止弁によってカテーテル本体内に残留する薬剤又は空気並びに排泄物を漏れ出さないように又は逆流しないようにした状態では、造影による撮影の際に問題にならないようなバリウムや空気の少量の漏れや、処置される人が不快に思わないような少量の排泄物の逆流は発生してもよいものとする。
外部で操作する開閉弁は、空気や水の注入・注出によって開閉するものなどがあり、腸内に漏れ出てしまうようなことがあっても人体に与えないものが好ましい。
本発明において、抵抗体と閉止弁は逆止弁としての機能を有してもよいものとする。
【0007】
【実施例】
本発明の各実施例について図面を参照して具体的に説明する。
実施例1(図1〜4参照)
図1〜4に示す実施例1はカテーテル本体内に薬剤注入路と排泄路と空気注入路を設け、それぞれの先端部分に抵抗体を設けるようにした直腸カテーテルの例である。
図1は実施例1の直腸カテーテルのカテーテル本体の先端部分を示す説明図である。図2は実施例1の直腸カテーテルの説明図である。図3は実施例1の直腸カテーテルの抵抗体の動きを示す説明図である。図4は実施例1の直腸カテーテルの抵抗体の説明図である。
図中、1は直腸カテーテル、2はカテーテル本体、3は薬剤注入路、3aは薬剤注入路の先端部分に設けた抵抗体、4は排泄路、4aは排泄路の先端部分に設けた抵抗体、5は空気注入路、5aは空気注入路の先端部分に設けた抵抗体、7はカテーテル先端部、7aはカテーテル先端部開口、8は薬剤注入路接続部、9は排泄路接続部、10は空気注入路接続部、11はバルーン用空気通路接続部、12は薬剤注入チューブ、13は排泄チューブ、14は空気注入チューブ、15は空気チューブ、16は薬剤注入装置、17は排泄物吸引装置、18は空気注入装置、19はバルーン制御装置、20はバルーンである。
【0008】
実施例1の直腸カテーテル1は、図1〜4に示すように人の肛門から腸内に挿入できる長いかつ適度に軟らかい材質の棒状のカテーテル本体2内部に、カテーテル本体2の長手方向に沿ってカテーテル本体2を貫通するように薬剤注入路3、排泄路4、空気注入路5をそれぞれが分離するように設ける。さらにカテーテル本体2の長手方向に沿ってカテーテル本体2の先端近くの所定の位置から後端まで伸びるように2箇所に図示しないバルーン用空気通路を設ける。
【0009】
次に、図2に示すように薬剤注入路3,排泄路4,空気注入路5の先端部分に抵抗体3a,4a,5aを設ける。抵抗体3a,4a,5aは薬剤注入路3,排泄路4,空気注入路5を先端部で塞ぐ形状のものに直線状の切れ目を設けたものである。この抵抗体3a,4a,5aは受けた力によって変形することにより切れ目部分が開口する。この開口は、抵抗体3a,4a,5aの変形に対応して大きくなるようにする。
【0010】
次にカテーテル本体2の先端にカテーテル先端部7を設ける。カテーテル先端部7は肛門に挿入しやすいように先端に行くに従って縮径する形状になっている。また、カテーテル先端部7には複数のカテーテル先端部開口7aを設けてカテーテル本体2の先端つまり、各抵抗体3a,4a,5aの前方が外部と連通するようにしている。
【0011】
次に薬剤注入路3の後端には、チューブに接続するための薬剤注入路接続部8を設け、排泄路4の後端には、チューブに接続するための排泄路接続部9を設け、空気注入路5の後端には、チューブに接続するための空気注入路接続部10を設け、バルーン用空気通路の後端には、チューブに接続するためのバルーン用空気通路接続部11を設ける。
次に薬剤注入路接続部8に薬剤注入チューブ12の一端を接続し、さらに薬剤注入チューブ12のもう一端を薬剤注入装置16に接続する。次に排泄路接続部9に排泄チューブ13の一端を接続し、さらに排泄チューブ13のもう一端を排泄物吸引装置17に接続する。次に空気注入路接続部10に空気注入チューブ14の一端を接続し、空気注入チューブ14のもう一端を空気注入装置18に接続する。次にバルーン用空気通路接続部11に空気チューブ15の一端を接続し、さらに空気チューブ15のもう一端をバルーン制御装置19に接続する。
次にカテーテル本体2の先端部の所定の間隔で離れた2箇所に内部への空気の注入・注出で膨縮するバルーン20を設け、バルーン20をバルーン用空気通路にそれぞれ接続する。
【0012】
本実施例1の直腸カテーテル1は、カテーテル本体2を肛門より腸内に挿入し、バルーン制御装置19でバルーン20に空気を送ってバルーン20を肛門の内外で膨張させ、カテーテル本体2を人hに固定する。
次に薬剤注入装置16,空気注入装置18によって腸内に空気と薬剤として造影剤であるバリウムを注入する。
バリウムが注入される際には、図3,4に示すようにバリウムに圧力をかけて圧送するので、バリウムがカテーテル本体2の先端まで来るとバリウムが薬剤注入路3の抵抗体3aに圧力をかけることになる。圧力を受けた抵抗体3aは、受けた圧力の分変形して切れ目が開くように開口し、この開口部分を通ってバリウムが腸内に流れ込む。必要に応じて腸内に空気を送る場合にも圧送された空気が空気注入路5の抵抗体5aに圧力をかけ、抵抗体5aを変形させ、切れ目部分を開口させて腸内に空気が流れるようにする。
バリウムを腸内に送るのを停止すると、バリウムはカテーテル本体の薬剤注入路3内に残留するが、残留圧力は低いため抵抗体3aを変形させないため、腸内に流れ込むことはほぼない。
空気についても同様に腸内に送るのを停止すると、空気はカテーテル本体2の空気注入路5内に残留するが、残留圧力は低いため抵抗体5aを変形させないため、腸内に流れ込むことはほとんどない。
よって、このように薬剤注入路3の先端に抵抗体3aを設けることによってバリウムを腸内に送った後に、さらにバリウムや空気がカテーテル本体から腸内に流れ出てしまうようなことがないので、造影をくずしてしまうようなことがなく安定して確実に撮影ができる。さらに、安定して造影による撮影ができることによって、処置・検査がスムーズに行え、やり直しが起こりにくくして処置・検査の時間・検査が増えるのを抑制して処置される人の負担を少なくすることができる。
【0013】
このようにしてバリウムで造影した腸の撮影が終了したならば、排泄物吸引装置17を作動させ、吸引する。吸引されることによって排泄路4の先端の抵抗体4aの吸引側には負圧がかかり、抵抗体4aの先端側には腸内のバリウムと排泄物の圧力がかかる。腸内のバリウムと排泄物の圧力だけでは抵抗体4aの切れ目部分が開口するほど抵抗体4aは変形しないが、反対側に負圧がかかることにより差圧として大きくなるので抵抗体4aが変形し切れ目部分が開口してこの開口部分をバリウムと排泄物が通って排出される(図3(b),図4(b))。よって、排泄物吸引装置17を作動させない状態では、腸内のバリウムと排泄物が排泄路4に流れ込んだり、一度、排泄路4内に取り込んだバリウムと排泄物が腸内に戻ってしまうようなことがなく、処置される人に与える不快感を抑えることができる。
【0014】
実施例2(図5〜9参照)
図5〜9に示すのは、薬剤注入路と空気注入路の先端部に閉止弁を設け、排泄路の先端部に逆止弁を設けた直腸カテーテルの例である。
図5は実施例2の直腸カテーテルのカテーテル本体の先端部分を示す説明図である。図6は実施例2の直腸カテーテルの閉止弁の動きを示す説明図である。図7は実施例2の直腸カテーテルのカテーテル本体の先端部分を示す説明図である。図8は実施例2の直腸カテーテルの逆止弁の動きを示す説明図である。図9は実施例2の直腸カテーテルの逆止弁の説明図である。
図中、21は閉止弁、21aは弁体、21bは支持部、22は逆止弁である。実施例2では、図5に示すように薬剤注入路3及び空気注入路5の先端部分に閉止弁21を設け、排泄路4の先端部分に逆止弁22を設ける。
閉止弁21は、図5〜7に示すように薬剤注入路3及び空気注入路5のそれぞれの先端の開口を覆うように塞ぐことができる弁体21aを支持部21bで薬剤注入路3及び空気注入路5のそれぞれの先端開口に押し付けるようにして設ける。また、弁体21aの薬剤注入路側には薬剤注入路の先端開口部分に挿入でき、所定以上の力が加わると薬剤注入路の先端開口部への挿入が保持できなくなる挿入部を設ける。
逆止弁22は、図5,8,9に示すように排泄路4のカテーテル本体2の基端側に行くに従って内部通路が徐々に偏平状に狭くなるようにし、後端で内部通路が切れ目になる形状にし、かつ内部に物が通過する際には押し拡げられるように切れ目及び内部通路が開くことができるようにしている。
【0015】
本実施例2では、薬剤注入路3内に薬剤を圧送するか空気注入路5内に空気を圧送すると、薬剤注入路3及び空気注入路5それぞれの先端に取り付けた閉止弁21の弁体21aの挿入部分を押すように薬剤又は空気の圧力がかかり、図6(b)に示すように弁体21aが路の先端開口の上方に移動する。これによって先端開口が比較的急激に大きく開口することになり薬剤又は空気が吐出する。
薬剤又は空気の圧送中には、吐出する力が常に弁体21aを開く方向に力が加わるため、弁体21aが路の先端開口を開口させた状態が保持される。薬剤又は空気の圧送が終了したならば、弁体21aに薬剤又は空気の吐出による力が加わらないようになるため、支持部21bによって弁体21aは路の先端開口に押し付けられるようにして先端開口を閉じる。弁体21aは薬剤又は空気が圧送されて所定の力を受けないと開弁しないので、カテーテル本体を肛門に挿入した使用中に、薬剤注入路3内の薬剤又は空気注入路5内の空気がさらに腸内に流れ出してしまうことがない。
さらに、造影による撮影が終了し、腸内に注入した薬剤と排泄物を強制的に排出させる際には、図8(b),図9(b)に示すように逆止弁22の後方を吸引することによって、逆止弁22の前後の圧力差が大きくなり、逆止弁22の内部を押し広げるようにして腸内の薬剤と排泄物が逆止弁22を通過して吸引される。このようにして薬剤と排泄物が吸引されて排泄物吸引装置17を停止した後に、排泄路4内に回収した薬剤と排泄物が残留している状態において、逆流しようとしても、逆流圧は逆止弁22の偏平形状をより偏平にしようと力を加えてしまうため、逆止弁22を開口させることができない。よって逆流して回収した薬剤や排泄物が腸内に戻ってしまうことがなく、処置される人に不快感を与えないようにできる。
その他符号、構成、作用、使い方は実施例1と同じである。
【0016】
実施例3(図10,11参照)
図10,11に示すのは、薬剤注入路と排泄路の先端部の路中に外部で操作する開閉弁を設けた直腸カテーテルの例である。
図10は実施例3の直腸カテーテルの説明図である。図11は実施例3の直腸カテーテルの開閉バルーンの動きを示す説明図である。
図中、27は開閉弁として用いた開閉バルーン、27aは開閉バルーン用空気通路である。
実施例3では、図10,11に示すようにカテーテル本体2内に分離させて設けた薬剤注入路3と排泄路4の先端に近い位置の内周に膨張すると路を塞いで物が通過できなくなるようにできる環状の開閉バルーン27を設け、カテーテル本体内に開閉バルーン27に空気を注入・注出できる開閉バルーン用空気通路27aを設ける。また、開閉バルーン用空気通路27aは後端で図示しないチューブにより図示しない制御装置に接続する。
実施例3の直腸カテーテルの開閉バルーン27は、空気を送ることで内側に向って膨張し、薬剤注入路3及び排泄路4を先端に近い位置で塞いで路を閉じ、空気を注出して開閉バルーン27を収縮させて路を通過可能にする。
このように、小型のバルーンを路内に設けるようにしてもよい。
その他符号、構成、作用、使い方は実施例1と同じである。
【0018】
【発明の効果】
本発明によれば、カテーテル本体内に取り込んだ排泄物が腸内に戻らないようにし処置される人が不快に感じないようにして処置される人の負担を減らす直腸カテーテルにできる。
排泄路の先端部に逆止弁を設けたものは、確実にカテーテル本体内に回収した排泄物が腸内に戻らないようにして処置される人の負担をより確実に軽減する。
排泄路の先端部の先端に近い位置の路内に開閉弁を設けたものは、必要に応じて開閉弁を開閉するように外部で操作して確実にカテーテル本体内に回収した排泄物が腸内に戻らないようにして処置される人の負担をより確実に軽減する。
カテーテル本体に空気注入路を設け、空気注入路の先端部に抵抗体を設けたものと空気注入路の先端部の路中に閉止弁を設けたものは、造影した撮影の際に腸内に空気が流れ出てしまうようなことを防ぎ、安定して造影による撮影がスムーズに行えるようにし、処置される人の負担を少なくできる。
カテーテル本体内に排泄路と薬剤注入路と空気注入路を設け、各路の先端部に抵抗体を設けたものは、造影した撮影の際に腸内に薬剤や空気が流れ出てしまうようなことを防ぎ、さらに安定して造影による撮影がスムーズに行えるようにし、処置される人の負担をさらに少なくできる。
【図面の簡単な説明】
【図1】 実施例1の直腸カテーテルのカテーテル本体の先端部分を示す説明図である。
【図2】 実施例1の直腸カテーテルの説明図である。
【図3】 実施例1の直腸カテーテルの抵抗体の動きを示す説明図である。
【図4】 実施例1の直腸カテーテルの抵抗体の説明図である。
【図5】 実施例2の直腸カテーテルのカテーテル本体の先端部を示す説明図である。
【図6】 実施例2の直腸カテーテルのカテーテル本体の先端部分を示す説明図である。
【図7】 実施例2の直腸カテーテルの閉止弁の動きを示す説明図である。
【図8】 実施例2の直腸カテーテルの逆止弁の動きを示す説明図である。
【図9】 実施例2の直腸カテーテルの逆止弁の説明図である。
【図10】 実施例3の直腸カテーテルの説明図である。
【図11】 実施例3の直腸カテーテルの開閉バルーンの動きを示す説明図である
【符号の説明】
1 直腸カテーテル
2 カテーテル本体
3 薬剤注入路
3a (薬剤注入路の)抵抗体
4 排泄路
4a (排泄路の)抵抗体
5 空気注入路
5a (空気注入路の)抵抗体
7 カテーテル先端部
7a カテーテル先端部開口
8 薬剤注入路接続部
9 排泄路接続部
10 空気注入路接続部
11 バルーン用空気通路接続部
12 薬剤注入チューブ
13 排泄チューブ
14 空気注入チューブ
15 空気チューブ
16 薬剤注入装置
17 排泄物吸引装置
18 空気注入装置
19 バルーン制御装置
20 バルーン
21 閉止弁
21a 弁体
21b 支持部
22 逆止弁
27 開閉バルーン
27a 開閉バルーン用空気通路
h 人
[0001]
BACKGROUND OF THE INVENTION
The present invention relates to a rectal catheter that is used for injecting drugs and air from a human anus into the rectum, large intestine, and colon for examination and treatment, and for discharging injected and excreted substances from the intestine as needed.
[0002]
[Prior art]
Conventionally, in order to inject drugs and air from the human anus for examination and treatment, the catheter body of the rectal catheter is inserted into the anus, and the drug and air are passed from the proximal end of the catheter body through the passage in the catheter body. Pump into the intestines. In order to discharge the sent medicine together with the excrement, the medicine is sucked from the proximal end side of the catheter body by a pump and the sent medicine into the intestine is discharged together with the excrement.
A valve that prevents the flow of medicine, air, or excrement remaining in the passage on the side of the catheter body from the pump while the pump for suction or pumping is stopped is a catheter in conventional rectal catheters. It was provided in the connection part with the tube connected to the pump of the base end part of a main body.
In this rectal catheter, since medicine, air, and excrement remain in the passage, it may flow into the intestine from the catheter body due to a change in intestinal pressure or the like.
In particular, when the collected excreta returns to the intestines, the person being treated felt very uncomfortable.
In addition, when barium was sent with a rectal catheter to contrast an image of the rectum, there was a problem that barium remaining in the catheter body would flow into the rectum and destroy the contrast again. .
[0003]
[Problems to be solved by the invention]
The problem to be solved by the present invention is to solve these conventional problems and prevent the excrement taken in the catheter body from returning to the intestine so that the person to be treated does not feel uncomfortable. An object of the present invention is to provide a rectal catheter that can reduce the burden on an individual.
[0004]
[Means for Solving the Problems]
The configuration of the present invention that solves this problem is as follows.
1) In a rectal catheter that is provided with an excretory passage for discharging excrement from the intestine in the catheter body that is inserted into the intestine and can be forcibly discharged by connecting the excretion passage to a excretion suction device, A rectal catheter 2) characterized in that a resistor that deforms due to a pressure difference and passes excrement is provided at the distal end of the excretory passage to prevent the excrement accommodated in the excretory passage from flowing back into the intestine. In a rectal catheter that can be forcibly discharged by connecting the excretory passage to the excretion suction device in the body of the catheter that is inserted into the intestine, and excreting excrement from the intestine, the direction from the intestine to the excretion route A rectal catheter 3) which is inserted into the intestine, and is provided with a check valve at the distal end of the excretory passage to prevent the excrement contained in the excretory passage from flowing back into the intestine. In the intestine in the catheter body Excretion path provided for discharging et excrement in rectal catheter that may be forced out by connecting the excretion path excrement suction device, a position near the opening and closing valve for opening and closing by an external operation on the tip of the distal end portion of the excretory passage provided in the road, the air injection passage to send air into the intestine provided excrement accommodated in excretory passage rectal catheter 4) catheter body, characterized in that it has prevented from flowing back into the intestine, in the longitudinal The rectal catheter 5 according to any one of 1) to 3) above, wherein a resistor that is deformed by a predetermined pressure difference that acts to facilitate the passage of air is provided at the distal end of the air injection path. The rectum according to any one of the above 1) to 3), wherein an air injecting passage is provided to the inside, and a closing valve is provided at the distal end of the air injecting passage that opens when a predetermined pressure or more is applied and facilitates passage of air. in catheters <br/>.
[0005]
[Action]
In the present invention, the excrement is discharged so that the excrement passes through the excretion path of the catheter body inserted into the intestine from the anus. Since the tip portion of the excretory passage is provided with resistor, the resistor deformed because excrement which contains excretion path and residual excrement remaining even if to flow back into the intestine not apply large pressure to the resistor Do not let the excrement flow backward.
If a check valve is provided at the end of the excretory channel, the check valve allows the excrement to pass only in the direction from the intestine to the excretion channel, so that no excrement flows from the excretion channel into the intestine. To avoid backflow.
When the on-off valve is provided in the path close to the tip of the excretory passage, the on-off valve is opened by an external operation when sucking excrement, and the on-off valve is closed by an external operation otherwise. Prevent excrement from flowing into the intestines from the excretory tract.
The air injection passage provided on the catheter body, those having a resistor to the tip of the air injection passage, in the pressure of the air remaining in the air injection passage, as the resistor is not deformed, remaining air intestine It suppresses flowing out.
For the catheter body with an air injection path and a closing valve at the tip of the air injection path , the closing valve opens at a predetermined pressure or higher, and the closing valve does not operate at the air pressure remaining in the air injection path. Do not open the valve so that the remaining air does not flow into the intestines.
The catheter body is provided with an excretion channel, a drug injection channel, and an air injection channel, and a resistor is provided at the tip of each channel. The excrement remaining in the excretion channel, the drug remaining in the drug injection channel, and the air injection channel The pressure remaining in the air prevents the resistor from being deformed so that it does not flow into the intestines.
[0006]
DETAILED DESCRIPTION OF THE INVENTION
In the present invention, the resistor does not cause a problem when imaging by contrast imaging in a state in which the check valve and the stop valve prevent the drug or air remaining in the catheter body from leaking out or flowing back. Such a small amount of barium or air leakage or a small amount of excretory back flow that does not make the person being treated uncomfortable may occur.
Some open / close valves that are operated externally can be opened and closed by injecting or extracting air or water, and those that do not give to the human body even if they leak into the intestines are preferable.
In the present invention, the resistor and the stop valve may have a function as a check valve.
[0007]
【Example】
Embodiments of the present invention will be specifically described with reference to the drawings.
Example 1 (see FIGS. 1 to 4)
1-4 is an example of a rectal catheter in which a drug injection path, excretion path, and air injection path are provided in a catheter body, and a resistor is provided at each distal end portion.
FIG. 1 is an explanatory view showing the distal end portion of the catheter body of the rectal catheter of Example 1. FIG. FIG. 2 is an explanatory diagram of the rectal catheter according to the first embodiment. FIG. 3 is an explanatory view showing the movement of the resistor of the rectal catheter according to the first embodiment. FIG. 4 is an explanatory diagram of a resistor of the rectal catheter according to the first embodiment.
In the figure, 1 is a rectal catheter, 2 is a catheter body, 3 is a drug injection path, 3a is a resistor provided at the tip of the drug injection path, 4 is an excretion path, and 4a is a resistor provided at the tip of the excretion path 5 is an air injection path, 5a is a resistor provided at the tip of the air injection path, 7 is a catheter tip, 7a is a catheter tip opening, 8 is a drug injection path connection, 9 is an excretion path connection, 10 Is an air injection path connection portion, 11 is a balloon air passage connection portion, 12 is a drug injection tube, 13 is an excretion tube, 14 is an air injection tube, 15 is an air tube, 16 is a drug injection device, and 17 is an excretion suction device. , 18 is an air injection device, 19 is a balloon control device, and 20 is a balloon.
[0008]
The rectal catheter 1 according to the first embodiment has a long and moderately soft material rod-like catheter body 2 that can be inserted into the intestine from a human anus along the longitudinal direction of the catheter body 2 as shown in FIGS. The drug injection path 3, the excretion path 4, and the air injection path 5 are provided so as to be separated from each other so as to penetrate the catheter body 2. Further, balloon air passages (not shown) are provided at two locations so as to extend from a predetermined position near the distal end of the catheter body 2 to the rear end along the longitudinal direction of the catheter body 2.
[0009]
Next, as shown in FIG. 2, resistors 3a, 4a and 5a are provided at the tip portions of the drug injection path 3, the excretion path 4 and the air injection path 5. The resistors 3a, 4a, and 5a are formed by closing the drug injection path 3, the excretion path 4, and the air injection path 5 with the distal ends, and providing a linear cut. The resistors 3a, 4a, and 5a are deformed by the received force to open the cut portion. This opening is made larger corresponding to the deformation of the resistors 3a, 4a, 5a.
[0010]
Next, the catheter tip 7 is provided at the tip of the catheter body 2. The distal end portion 7 of the catheter has a shape that decreases in diameter toward the distal end so as to be easily inserted into the anus. The catheter tip 7 is provided with a plurality of catheter tip openings 7a so that the tip of the catheter body 2, that is, the front of each resistor 3a, 4a, 5a communicates with the outside.
[0011]
Next, at the rear end of the drug injection path 3, a drug injection path connection part 8 for connecting to the tube is provided, and at the rear end of the excretion path 4, an excretion path connection part 9 for connecting to the tube is provided, The rear end of the air injection path 5 is provided with an air injection path connection portion 10 for connection to the tube, and the rear end of the balloon air passage is provided with a balloon air passage connection portion 11 for connection to the tube. .
Next, one end of the drug injection tube 12 is connected to the drug injection path connection portion 8, and the other end of the drug injection tube 12 is connected to the drug injection device 16. Next, one end of the excretion tube 13 is connected to the excretion passage connection portion 9, and the other end of the excretion tube 13 is connected to the excretion suction device 17. Next, one end of the air injection tube 14 is connected to the air injection path connecting portion 10, and the other end of the air injection tube 14 is connected to the air injection device 18. Next, one end of the air tube 15 is connected to the balloon air passage connection portion 11, and the other end of the air tube 15 is connected to the balloon control device 19.
Next, balloons 20 that are inflated and inflated by injecting and extracting air into the interior are provided at two points apart from the distal end of the catheter body 2 at predetermined intervals, and the balloons 20 are respectively connected to the balloon air passages.
[0012]
In the rectal catheter 1 of the first embodiment, the catheter body 2 is inserted into the intestine from the anus, and air is sent to the balloon 20 by the balloon control device 19 to inflate the balloon 20 in and out of the anus. Secure to.
Next, the drug injection device 16 and the air injection device 18 inject air and barium, which is a contrast agent, into the intestine as a drug.
When barium is injected, pressure is applied to the barium as shown in FIGS. 3 and 4, so that when barium reaches the tip of the catheter body 2, the barium applies pressure to the resistor 3a of the drug injection path 3. It will be over. The resistor 3a that has received the pressure opens so as to be deformed by the received pressure and open a cut, and barium flows into the intestines through the opening. Even when air is sent into the intestine as necessary, the pressure-fed air applies pressure to the resistor 5a of the air injection path 5, deforms the resistor 5a, opens the cut portion, and air flows into the intestine. Like that.
When the supply of barium to the intestine is stopped, barium remains in the drug injection path 3 of the catheter body. However, since the residual pressure is low, the resistor 3a is not deformed and therefore hardly flows into the intestine.
Similarly, when air is stopped from being sent into the intestine, the air remains in the air injection path 5 of the catheter body 2, but the residual pressure is low so that the resistor 5a is not deformed, so that it hardly flows into the intestine. Absent.
Therefore, since barium is sent into the intestine by providing the resistor 3a at the tip of the drug injection path 3 in this way, no further barium or air flows from the catheter body into the intestine. You can shoot stably and reliably without damaging the image. In addition, stable imaging enables smooth treatment / inspection, reduces the burden on the person being treated by suppressing the increase in treatment / inspection time / inspection due to the difficulty of redoing. Can do.
[0013]
When the intestine imaging contrasted with barium is completed in this way, the excreta suction device 17 is operated and sucked. By being sucked, negative pressure is applied to the suction side of the resistor 4a at the tip of the excretory passage 4, and barium and excrement pressure in the intestine is applied to the tip of the resistor 4a. The pressure of the barium and excrement in the intestine alone does not deform the resistor 4a so that the cut portion of the resistor 4a opens, but the resistance 4a is deformed because a negative pressure is applied to the opposite side to increase the differential pressure. The cut portion is opened, and barium and excrement are discharged through this opening portion (FIGS. 3B and 4B). Therefore, in a state where the excretion suction device 17 is not operated, barium and excrement in the intestine flow into the excretion passage 4, or once the barium and excrement taken into the excretion passage 4 return to the intestine. The discomfort given to the person being treated can be suppressed.
[0014]
Example 2 (see FIGS. 5 to 9)
FIGS. 5 to 9 show an example of a rectal catheter in which a closing valve is provided at the distal ends of the drug injection path and the air injection path, and a check valve is provided at the distal end of the excretory path.
FIG. 5 is an explanatory view showing the distal end portion of the catheter body of the rectal catheter according to the second embodiment. FIG. 6 is an explanatory view showing the movement of the closing valve of the rectal catheter according to the second embodiment. FIG. 7 is an explanatory view showing the distal end portion of the catheter body of the rectal catheter according to the second embodiment. FIG. 8 is an explanatory view showing the movement of the check valve of the rectal catheter according to the second embodiment. FIG. 9 is an explanatory view of a check valve of the rectal catheter according to the second embodiment.
In the figure, 21 is a closing valve, 21a is a valve body, 21b is a support part, and 22 is a check valve. In the second embodiment, as shown in FIG. 5, a closing valve 21 is provided at the tip portion of the drug injection path 3 and the air injection path 5, and a check valve 22 is provided at the tip portion of the excretory path 4.
As shown in FIGS. 5 to 7, the shut-off valve 21 supports a valve body 21 a that can cover the opening at the tip of each of the drug injection path 3 and the air injection path 5 with the support portion 21 b and the drug injection path 3 and the air. It is provided so as to be pressed against each opening of the injection path 5. Further, an insertion portion is provided on the side of the drug injection path of the valve body 21a, which can be inserted into the tip opening portion of the drug injection path and cannot be held inserted into the tip opening of the drug injection path when a predetermined force or more is applied.
As shown in FIGS. 5, 8, and 9, the check valve 22 gradually narrows the inner passage gradually toward the proximal end of the catheter body 2 in the excretory passage 4, and the inner passage is cut at the rear end. The cut and the internal passage can be opened so as to be expanded when an object passes through.
[0015]
In the second embodiment, when the drug is pumped into the drug injection path 3 or the air is pumped into the air injection path 5, the valve body 21 a of the closing valve 21 attached to the tip of each of the drug injection path 3 and the air injection path 5. The pressure of the medicine or air is applied so as to push the insertion portion of the valve, and the valve element 21a moves above the end opening of the path as shown in FIG. 6 (b). As a result, the tip opening opens relatively rapidly and the medicine or air is discharged.
While the medicine or air is being pumped, a force is always applied in the direction of opening the valve body 21a, so that the state in which the valve body 21a opens the end opening of the path is maintained. When the pumping of the medicine or air is finished, no force due to the discharge of the medicine or air is applied to the valve body 21a, so that the valve body 21a is pressed against the tip opening of the road by the support portion 21b. Close. Since the valve body 21a does not open unless the drug or air is pumped and receives a predetermined force, the drug in the drug injection path 3 or the air in the air injection path 5 is not used during insertion of the catheter body into the anus. Furthermore, it does not flow out into the intestines.
Further, when imaging by contrast is completed and the medicine and excrement injected into the intestine are forcibly discharged, the rear of the check valve 22 is moved as shown in FIGS. 8 (b) and 9 (b). By sucking, the pressure difference before and after the check valve 22 becomes large, and the medicine and excrement in the intestine are sucked through the check valve 22 so as to push the inside of the check valve 22. After the medicine and excrement are sucked in this way and the excrement suction device 17 is stopped, the reverse pressure is reversed even if the medicine and excrement collected in the excretion passage 4 remain in the reverse flow. Since force is applied to make the flat shape of the stop valve 22 flatter, the check valve 22 cannot be opened. Therefore, the medicine and excrement collected by backflow do not return to the intestine, and it is possible to prevent the treated person from feeling uncomfortable.
Other symbols, configurations, operations, and usage are the same as those in the first embodiment.
[0016]
Example 3 (see FIGS. 10 and 11)
FIGS. 10 and 11 show an example of a rectal catheter provided with an on-off valve that is operated externally in the path of the drug injection path and the distal end of the excretion path.
FIG. 10 is an explanatory diagram of the rectal catheter of Example 3. FIG. 11 is an explanatory view showing the movement of the open / close balloon of the rectal catheter according to the third embodiment.
In the figure, 27 is an open / close balloon used as an open / close valve, and 27a is an air passage for the open / close balloon.
In the third embodiment, as shown in FIGS. 10 and 11, when the medicine is inflated to the inner periphery at a position close to the distal ends of the drug injection path 3 and the excretion path 4 provided separately in the catheter body 2, the path can be blocked to pass an object. An annular open / close balloon 27 that can be eliminated is provided, and an open / close balloon air passage 27a through which air can be injected and extracted into the open / close balloon 27 is provided in the catheter body. The open / close balloon air passage 27a is connected to a control device (not shown) by a tube (not shown) at the rear end.
The open / close balloon 27 of the rectal catheter of Example 3 is inflated inward by sending air, closes the drug injection path 3 and excretion path 4 at a position close to the tip, closes the path, and pours air to open / close The balloon 27 is deflated so that it can pass through the road.
Thus, a small balloon may be provided in the road.
Other symbols, configurations, operations, and usage are the same as those in the first embodiment.
[0018]
【The invention's effect】
ADVANTAGE OF THE INVENTION According to this invention, it can be set as the rectal catheter which reduces the burden of the person treated so that the excretion taken in the catheter main body may not return in the intestine, and the person treated may not feel uncomfortable.
Those provided with a check valve at the distal end of the excretory passage more reliably reduce the burden on the person to be treated by preventing the excrement collected in the catheter body from returning to the intestine.
If an on-off valve is provided in the path close to the tip of the excretory path, the excrement collected in the catheter body by operating it externally to open and close the on-off valve as needed Reduce the burden on the person being treated by not going back inside.
The catheter body is provided with an air injection path , a resistor is provided at the tip of the air injection path, and a valve is provided in the end of the air injection path. Air can be prevented from flowing out, stable imaging can be performed smoothly, and the burden on the person being treated can be reduced.
If the catheter body is provided with an excretion path, a drug injection path, and an air injection path, and a resistor is provided at the tip of each path, the drug or air will flow into the intestine during contrast imaging This makes it possible to perform stable and smooth imaging with contrast and further reduce the burden on the person being treated.
[Brief description of the drawings]
1 is an explanatory view showing a distal end portion of a catheter body of a rectal catheter of Example 1. FIG.
2 is an explanatory diagram of a rectal catheter of Example 1. FIG.
FIG. 3 is an explanatory view showing the movement of the resistor of the rectal catheter according to the first embodiment.
4 is an explanatory diagram of a rectal catheter resistor of Example 1. FIG.
5 is an explanatory view showing a distal end portion of a catheter main body of a rectal catheter of Example 2. FIG.
6 is an explanatory view showing a distal end portion of a catheter main body of a rectal catheter of Example 2. FIG.
7 is an explanatory view showing the movement of the closing valve of the rectal catheter of Example 2. FIG.
8 is an explanatory view showing the movement of a check valve of the rectal catheter of Example 2. FIG.
9 is an explanatory view of a check valve of the rectal catheter of Example 2. FIG.
10 is an explanatory diagram of a rectal catheter of Example 3. FIG.
11 is an explanatory view showing the movement of the open / close balloon of the rectal catheter of Example 3. FIG .
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 1 Rectal catheter 2 Catheter main body 3 Drug injection path 3a Resistor of drug injection path 4 Excretion path 4a Resistor of excretion path 5 Air injection path 5a Resistor of air injection path 7 Catheter tip 7a Catheter tip Part opening 8 Drug injection path connection part 9 Excretion path connection part 10 Air injection path connection part 11 Balloon air path connection part 12 Drug injection tube 13 Excretion tube 14 Air injection tube 15 Air tube 16 Drug injection apparatus 17 Excretion suction apparatus 18 Air injection device 19 Balloon control device 20 Balloon 21 Stop valve 21a Valve body 21b Support portion 22 Check valve 27 Open / close balloon 27a Open / close balloon air passage h People

Claims (5)

腸内に挿入されるカテーテル本体内に腸内から排泄物を排出する排泄路を設け、同排泄路を排泄物吸引装置に接続して強制排出できる直腸カテーテルにおいて、前後に作用する所定の圧力差で変形して排泄物を通過させる抵抗体を前記排泄路の先端部に設け、排泄路内に収容した排泄物が腸内に逆流するのを抑制したことを特徴とする直腸カテーテル。In the rectal catheter that can be forcibly discharged by connecting the excretory passage to the excrement suction device by providing an excretion passage for discharging excrement from the intestine in the catheter body inserted into the intestine, a predetermined pressure difference acting on the front and back A rectal catheter characterized in that a resistance body that is deformed in order to allow excrement to pass through is provided at the tip of the excretory passage, and the excretion accommodated in the excretory passage is prevented from flowing back into the intestine. 腸内に挿入されるカテーテル本体内に腸内から排泄物を排出する排泄路を設け、同排泄路を排泄物吸引装置に接続して強制排出できる直腸カテーテルにおいて、腸内から排泄路へ向かう方向にのみ排泄物を通す逆止弁を排泄路の先端部に設け、排泄路内に収容した排泄物が腸内に逆流するのを抑制したことを特徴とする直腸カテーテル。In a rectal catheter that can be forcibly discharged by connecting the excretory passage to the excretion suction device in the body of the catheter that is inserted into the intestine, and excreting excrement from the intestine, the direction from the intestine to the excretion route A rectal catheter characterized in that a check valve that allows excretion to pass only through the urinary tract is provided at the distal end of the excretion passage to prevent the excretion accommodated in the excretion passage from flowing back into the intestine. 腸内に挿入されるカテーテル本体内に腸内から排泄物を排出する排泄路を設け、同排泄路を排泄物吸引装置に接続して強制排出できる直腸カテーテルにおいて、外部の操作で開閉する開閉弁を排泄路の先端部の先端に近い位置の路内に設け、排泄路内に収容した排泄物が腸内に逆流するのを抑制したことを特徴とする直腸カテーテル。An open / close valve that opens and closes by an external operation in a rectal catheter that is provided with an excretory passage for discharging excretion from the intestine in the catheter body that is inserted into the intestine and that can be forcibly discharged by connecting the excretion passage to a excretion suction device. A rectal catheter characterized in that is provided in a path close to the distal end of the excretory passage, and the excrement accommodated in the excretory passage is prevented from flowing back into the intestine. カテーテル本体内に空気を腸内に送る空気注入路を設け、前後に作用する所定の圧力差で変形して空気を通過させやすくする抵抗体を空気注入路の先端部に設けた請求項1〜3いずれかに記載の直腸カテーテル。An air injection path for sending air into the intestine is provided in the catheter body, and a resistor that facilitates the passage of air by being deformed by a predetermined pressure difference acting forward and backward is provided at the distal end of the air injection path. 3. A rectal catheter according to any one of 3. カテーテル本体内に空気を腸内に送る空気注入路を設け、所定以上の圧力が負荷されると開いて空気を通過しやすくする閉止弁を空気注入路の先端部に設けた請求項1〜3いずれかに記載の直腸カテーテル An air injection path for sending air into the intestine is provided in the catheter body, and a closing valve is provided at the distal end of the air injection path that opens when a predetermined pressure or more is applied and facilitates passage of air. A rectal catheter according to any one of the above .
JP2000355761A 2000-11-22 2000-11-22 Rectal catheter Expired - Fee Related JP3639523B2 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
JP2000355761A JP3639523B2 (en) 2000-11-22 2000-11-22 Rectal catheter

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
JP2000355761A JP3639523B2 (en) 2000-11-22 2000-11-22 Rectal catheter

Publications (2)

Publication Number Publication Date
JP2002153564A JP2002153564A (en) 2002-05-28
JP3639523B2 true JP3639523B2 (en) 2005-04-20

Family

ID=18828120

Family Applications (1)

Application Number Title Priority Date Filing Date
JP2000355761A Expired - Fee Related JP3639523B2 (en) 2000-11-22 2000-11-22 Rectal catheter

Country Status (1)

Country Link
JP (1) JP3639523B2 (en)

Families Citing this family (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7147627B2 (en) 2002-08-21 2006-12-12 Hollister Incorporated Bowel management system
US8016816B2 (en) 2003-09-09 2011-09-13 Convatec Technologies Inc. Fecal management appliance and method and apparatus for introducing same
ES2341086B2 (en) * 2010-01-29 2011-01-03 Nicolas Anthony Costovici CATHETER FOR THE PRACTICE OF COLONOSCOPY BY IMAGE.
CN110559191B (en) * 2019-10-09 2024-06-18 陈一奇 Nasal gastrointestinal tube

Also Published As

Publication number Publication date
JP2002153564A (en) 2002-05-28

Similar Documents

Publication Publication Date Title
KR101456108B1 (en) Catheter
US3331371A (en) Catheter having internal flow valve at distal end thereof
US4772260A (en) Rectal catheter
US20040044307A1 (en) Urinary catheters
EP2224976B1 (en) Diameter-controlled balloon catheter
EP1488821A2 (en) infusion and drainage catheter and control
JP2006528012A (en) Natural or colostomy closure system
JP2011250903A (en) Urethral catheter
EP4035646B1 (en) Catheter with balloon valve
JPS63177853A (en) Incontinent control apparatus
KR102150487B1 (en) Urethral stricture suppression device
WO2010079795A1 (en) Male sex organ substitute
JP3639523B2 (en) Rectal catheter
JP3639522B2 (en) Rectal catheter
CN109044387A (en) A kind of three chamber angiography catheters that can show esophageal lesion
JP2004357846A (en) Enema catheter
JP2003180821A (en) Urethral catheter
KR102190984B1 (en) Urethal Catheter
CN210020589U (en) Enema device
KR102393312B1 (en) Medical catheter
JP5052904B2 (en) Body access port
JP3071301U (en) Catheter for draining feces
JPH08215303A (en) Catheter for intestinal tube
EP4322895B1 (en) Catheter
JPH10179750A (en) Rectal catheter

Legal Events

Date Code Title Description
A977 Report on retrieval

Free format text: JAPANESE INTERMEDIATE CODE: A971007

Effective date: 20040701

A131 Notification of reasons for refusal

Free format text: JAPANESE INTERMEDIATE CODE: A131

Effective date: 20040901

A521 Written amendment

Free format text: JAPANESE INTERMEDIATE CODE: A523

Effective date: 20041018

TRDD Decision of grant or rejection written
A01 Written decision to grant a patent or to grant a registration (utility model)

Free format text: JAPANESE INTERMEDIATE CODE: A01

Effective date: 20041224

A61 First payment of annual fees (during grant procedure)

Free format text: JAPANESE INTERMEDIATE CODE: A61

Effective date: 20050114

R150 Certificate of patent or registration of utility model

Free format text: JAPANESE INTERMEDIATE CODE: R150

FPAY Renewal fee payment (event date is renewal date of database)

Free format text: PAYMENT UNTIL: 20080121

Year of fee payment: 3

FPAY Renewal fee payment (event date is renewal date of database)

Free format text: PAYMENT UNTIL: 20090121

Year of fee payment: 4

FPAY Renewal fee payment (event date is renewal date of database)

Free format text: PAYMENT UNTIL: 20100121

Year of fee payment: 5

FPAY Renewal fee payment (event date is renewal date of database)

Free format text: PAYMENT UNTIL: 20110121

Year of fee payment: 6

FPAY Renewal fee payment (event date is renewal date of database)

Free format text: PAYMENT UNTIL: 20120121

Year of fee payment: 7

FPAY Renewal fee payment (event date is renewal date of database)

Free format text: PAYMENT UNTIL: 20130121

Year of fee payment: 8

FPAY Renewal fee payment (event date is renewal date of database)

Free format text: PAYMENT UNTIL: 20140121

Year of fee payment: 9

LAPS Cancellation because of no payment of annual fees