Apparatus for treating intestinal disorder

Abstract

To provide an apparatus for treating a patient suffering from a disorder related to the passageway of the patient's intestines, such as constipation or incontinence.SOLUTION: An apparatus for treatment includes a pump to be implanted in a patient, where the pump is operable on at least one selected portion of the intestines to pump intestinal contents through the passageway of the intestines. The pump includes a constriction device adapted to alternately constrict the selected portion to at least substantially reduce the volume of the passageway of the intestines along the selected portion and release the selected portion to increase the volume of the passageway of the intestines along the selected portion, so that the intestinal contents are displaced through the passageway of the intestines.SELECTED DRAWING: Figure 2A

Description

[Technical Field]

[0001] The present invention treats patients with disorders related to their intestinal passages, such as constipation and incontinence. Regarding the device. [Background technology]

[0002] Faecal incontinence is a widespread problem. Many different solutions to this problem have been attempted, Currently, several types of sphincter surgery are used to relieve fecal incontinence. A pressure artificial anal sphincter and a balloon connected to the anal sphincter and placed in the patient's scrotum. A manually operable implantation system is used that includes a reservoir. The point is that stiff fibers that form around the reservoir over time can cause the pumping component of the system to Therefore, the formed fibers eventually become a hard fiber layer. This can make it difficult to pump from the balloon reservoir. The point is that hydraulic fluid is used in the system, so there is always a risk of fluid leaking from the system. Furthermore, manually emptying the reservoir when a bowel movement is required is a hassle. It's quite a complicated task.

[0003] U.S. Patent No. 5,593,443 describes an artificial hydraulic anal sphincter capable of reflex and voluntary control. The paper discloses an inflatable artificial sphincter with a pump system inside the patient's scrotum. This is disclosed in Japanese Patent No. 4222377.

[0004] Artificial and special forms of fecal incontinence are ileostomy, jejunostomy, colostomy, and rectostomy, which can result in the small intestine (jejunum or ileum) or large intestine The intestine (colon or rectum) is cut and the open end of the intestine is passed through the patient's abdominal wall. This is called a "stoma." Reasons for this type of surgery include colorectal cancer, perforation, diverticulitis, or various types of intestinal diseases such as ulcerative colitis and Crohn's disease Typically, patients with a fistula have a continuous collection of bowel contents that are expelled through the fistula. A plastic bag is worn. For this bag configuration to be liquid-tight, the patient must Requires an adhesive plate attached to the skin, which is inconvenient for the patient The patient may have a bowel movement that contains feces and is often accompanied by redness and inflammation of the skin. Also, it is inconvenient to have to wear the bag all the time, which is usually placed on the patient's abdomen.

[0005] U.S. Patent No. 6,752,754 discloses an artificial rectum that replaces a diseased portion of a patient's rectum. The entrance of the artificial rectum is operatively connected to the distal end of the patient's large intestine and is connected to the patient's anus. The feces are communicated to a macerator-type pump, which expels the feces through the outlet of the connected artificial rectum. As the pump rotates, it creates a shearing effect on the feces, forcing it into the screw-in. Helical screw type catheter that moves down along the screw of the prosthesis and discharges through the patient's anus. Includes Impella. [Prior art documents] [Patent documents]

[0006] [Patent Document 1] U.S. Patent No. 5,593,443 [Patent Document 2] U.S. Patent No. 4,222,377 [Patent Document 3] U.S. Patent No. 6,752,754 Summary of the Invention [Problem to be solved by the invention]

[0007] It is an object of the present invention to provide an advantageous device for treating a patient having a disorder related to the patient's intestinal passage. The purpose is to provide.

[0008] Another object of the present invention is to provide a method for treating a patient having a disorder related to the patient's intestinal passage. To do this. [Means for solving the problem]

[0009] Therefore, according to a first aspect of the present invention, a patient having a disease relating to the patient's intestinal passage a device for treating a bowel disease, the device being implanted in a patient and directed to at least one selected portion of the bowel; a pump operable to pump intestinal contents through the intestinal passage, the pump comprising: constricting the selected portion to at least significantly reduce the volume of the intestinal passage along the selected portion. Reducing and releasing the selected portion to reduce the volume of the intestinal passage along the selected portion. Alternately increasing the amount of intestinal fluid in the intestinal passage, thus increasing the displacement of intestinal contents through the intestinal passage. An apparatus is provided that includes a constriction device configured as follows:

[0010] For patients in whom the selected portion of the intestine ends at the patient's anus, the pump may be used to pump the intestinal contents into the anus. This solution allows the pump of the present invention to pump the patient's body through the The pump acts on the intestine, i.e., the constriction device of the pump constricts the intestine and displaces the intestinal contents. This differs from the prior art of the above-mentioned US Pat. No. 6,752,754 in that it

[0011] A patient's bowel is surgically modified to end at a fistula, an ileostomy, or a jejunostomy For patients with a stoma, colostomy, or rectostomy, the pump filters the intestinal contents. It is configured to be pumped out of the patient's body through the perforation.

[0012] The device of the present invention is surgically attached to the patient's intestine, forming a portion of the intestine and acting as a constriction device. configured to form at least a portion of the selected portion of the intestine that is constricted by The constriction device may act only on the artificial intestinal member and not damage the intestine. When the pump is not in operation, the constriction device The intestinal element can be tightly constricted to completely close the intestinal passage, or When the pump is not in operation, the artificial intestinal member is engaged to close the intestinal passageway or to close the selected portion. and upon actuation of the pump, releasing a selected portion. at least one implantable and removable closure configured to open the intestinal passageway; A member can be provided.

[0013] The artificial intestine member is integrated with the patient's intestine between both ends of the patient's intestine. The pump can be directly or indirectly connected to the patient's anus, thereby allowing the pump to The contents can be pumped out of the patient's body through the anus. The pump acts on the artificial intestinal member, i.e., the constriction device of the pump constricts the artificial intestinal member. The invention differs from the above-mentioned US Pat. No. 6,752,754 in that it displaces the intestinal contents therein by using a catheter. Alternatively, the artificial intestinal member can be configured to terminate at the fistula, thereby The pump can pump the intestinal contents out of the patient's body through the fistula.

[0014] To maintain the pump in the desired position on the patient's abdomen, the patient's abdominal wall or other The pump is fitted with an engagement device configured to attach the pump to tissue associated with the abdominal cavity. It can be attached.

[0015] To protect the intestine from external influences, an elastic protective tube is provided which at least partially covers the selected portion of the intestine. A tube can be provided, whereby the constriction device of the pump can be selected from the protective tube. Narrows both selected parts.

[0016] Supporting the selected portion of the intestine as the constriction device constricts the selected portion of the intestine Alternatively, the constriction device may comprise an implantable support for the selected The portion can be configured to contact and constrict tissue or bone in the patient's body.

[0017] The apparatus operates a constriction device to alternately constrict and release selected segments. The control device controls the pump so that the intestinal contents move through the intestinal passage. The control device may be suitably operated by the patient and is preferably or a wireless remote control.

[0018] Electrical stimulation of the intestine Electrically stimulates muscle or nerve tissue in selected areas of the intestine to An electrical stimulation device may be provided to at least partially contract the inflated portion. Such stimulation devices, when used as an adjunct to a constriction device, allow the patient's bowel to be especially carefully and therefore, as will be apparent from the embodiments of the present invention described below, This minimizes the chance of damaging the intestine.

[0019] The stimulation device stimulates muscle or nerve tissue in selected areas of the intestinal tissue with electrical pulses. The stimulation device may include at least one electrode configured for stimulation. The device may be a plurality of electrodes that are separate from the constriction device or integrated with the constriction device. The electrodes form a series of electrodes along a selected portion of the intestine. and / or negative, preferably a combination of positive and negative pulses. The stimulation effect varies depending on the pulse amplitude, the off-time period between successive pulses, the pulse duration, and the pulse This is achieved by varying various pulse parameters such as pulse repetition frequency. A pulse amplitude of 5 mA and a pulse duration of approximately 300 μs are suitable for nerve stimulation. On the other hand, a pulse amplitude of approximately 20 mA and a pulse duration of approximately 30 μs are suitable for muscle stimulation. The pulse repetition frequency is preferably about 10 Hz.

[0020] Advantageously, the control device may variably apply the electrodes along the selected portion, e.g. The current is applied according to a previously set method, and the position of the electrodes on the selected area is changed over time. This causes the currently unstimulated portion of the intestine to contract partially. , so that the stimulation device can restore nearly normal blood circulation before being stimulated again. Several electrodes or groups of electrodes are gradually moved in the upstream or downstream direction of the intestine. Alternatively, the electrodes can be energized one at a time sequentially or in groups. The electrodes can be energized randomly or sequentially according to a predetermined pattern.

[0021] Pump Configurations Embodiments of the present invention, including various possible configurations of the pump, are described below. explain.

[0022] According to a simple embodiment of the invention, the constriction device of the pump is configured to restrict the selected portion to its a first constriction member that constricts and releases the selected portion at the upstream end; a second constriction member that constricts and releases between its upstream and downstream ends; In this embodiment, the control device controls the constriction and release of the selected portion independently of one another. The first and second constriction members are controlled to alternately move in a vertical direction.

[0023] With respect to the operation of the pump, the control device Constricting the selected segment to close the intestinal passage at the upstream end of the selected segment. and controlling the first constriction member on the upstream side so that Narrowing the selected portion between its upstream and downstream ends to The intestinal contents contained in the intestinal passage are configured to control downstream movement through the intestinal passage. The control device further comprises: The selected portion is released to select the intestinal contents in the intestinal passage upstream of the selected portion. and a second constriction member for controlling the first and second constriction members to allow the first and second constriction members to enter the constricted portion. It is composed.

[0024] When the pump is not in operation, the stimulation device described above may be used in conjunction with any constriction member to restrict the passage of the intestine. Therefore, the first and second constriction members are at least one constriction member. A procedure that involves gently constricting a selected segment of the intestine to at least significantly reduce the cross-sectional area of ​​the intestinal passage. The control device is configured to maintain the constriction member in a locked position, and the control device controls the constriction member to constrict the selected portion. When the patient is in a diarrhoea state, the stimulation device is controlled to stimulate the selected area and close the intestinal passage. The phrase "mildly constricting the selected portion" refers to restricting blood circulation within the intestinal tissue. This should be understood as narrowing this part of the intestine while leaving it almost intact. This allows for sufficient blood circulation in the blood vessels of the selected portion of the intestine, thus The intestinal tissue of the selected section is then exposed to the constriction element for an extended period of time, causing the constriction of the selected section. Maintain the integrity of the

[0025] The stimulation device may also cooperate with any constriction member during operation of the pump. In this case, the stimulation device includes at least one electrode. A plurality of electrodes forming a series of electrodes along the surface of at least one constriction member of the constriction device. The electrode has a surface that contacts the selected portion of the intestine. The electrode is connected to the first constriction member and the second constriction member. When one of the two constriction members constricts the selected area, the muscles or stimulates nerve tissue with electrical pulses.

[0026] With respect to the operation of the pump in which the constriction member and the stimulation device cooperate, the control device i. gently constrict the selected segment and close the intestinal passage at the upstream end of the selected segment; controlling the upstream first constriction member to at least significantly reduce the cross-sectional area of ​​the ii. Stimulating the selected portion when the first constriction member constricts the selected portion. to contract the selected segment and close the intestinal passage at the upstream end of the selected segment. Control the stimulation device so that iii. constricting the selected portion between its upstream and downstream ends to form a selected The second constriction member is positioned so that the intestinal contents contained in the constricted portion move downstream within the intestinal passage. Control. Optionally, the stimulation device is configured to select when the second constriction member constricts the selected portion. The second narrowing is achieved by electrically stimulating the selected area to reduce the volume of the intestinal passage. Specifically, the control device may be configured to control the second constriction device. When the selected portion is constricted, the selected portion is continuously stimulated, thus The stimulation device is configured to gradually contract the selected portion constricted by the constriction member. As a result, the intestinal contents are displaced through the intestinal passage in a peristaltic manner. Alternatively, the constriction device may include only a single elongated constriction member, in which case the restriction The control device is configured to continuously control the selected portion when the constriction member constricts the selected portion. The selected portion constricted by the constriction member is then gradually contracted. This causes peristaltic displacement of the intestinal contents within the intestinal passage.

[0027] In more advanced embodiments of the present invention, the constriction device of the pump may be configured to constrict the selected portion of the pump. a first constriction member at the upstream end that constricts and releases the selected portion; a second constriction member at the downstream end for constricting and releasing the selected portion; a third constriction member that constricts and releases between the upstream end and the downstream end. In this embodiment, the control device controls the constriction and release of the selected portion independently of each other. The first, second, and third constriction members are controlled to alternately move in a direction perpendicular to the axis of the constriction member.

[0028] With respect to the operation of the pump, the control device Constricting the selected segment to close the intestinal passage at the upstream end of the selected segment. and controlling the first constriction member on the upstream side so that controlling a downstream second constriction member to release the selected portion; Narrowing the selected portion between its upstream and downstream ends to and controlling the third constriction member so that the intestinal contents contained in the third constriction member move downstream within the intestinal passage. It is configured as follows.

[0029] The control device Constricting the selected segment to close the intestinal passage at the downstream end of the selected segment. and controlling the downstream second constriction member so that controlling the upstream first constriction member to release the selected portion; Releasing the selected portion between its upstream end and downstream end, A third narrowing is provided to allow the intestinal contents in the downstream intestinal passage to enter the selected portion. It is also configured to control the fence member.

[0030] When the pump is not in operation, the above-mentioned The stimulation device described above may be used in conjunction with any constriction device to close the intestinal passageway. The first, second, and third constriction members are arranged such that at least one constriction member is selected. It is maintained in a resting position that gently constricts the intestinal passageway to at least significantly reduce its cross-sectional area. and the control device controls the constriction member to constrict the selected portion. The stimulation device is controlled to stimulate the selected portion to close the intestinal passage.

[0031] The stimulation device may be configured to act as one of the first, second, and third constriction members during operation of the pump. In this case, the stimulation device may be coupled to at least one of the constriction devices. The constriction member includes a plurality of electrodes forming a series of electrodes along the surface thereof, the surface being adapted to selectively connect the intestine to the constriction member. The electrode contacts one of the first constriction member and the second constriction member and / or Or, when the third constriction member constricts the selected portion, the muscle or or stimulates nerve tissue with electrical pulses.

[0032] With respect to the operation of the pump in which the constriction member and the stimulation device cooperate, the control device The selected segment is gently constricted to create a severance of the intestinal passage at the upstream end of the selected segment. controlling the upstream first constriction member to at least substantially reduce the area; When the first constriction member constricts the selected portion, the selected portion is electrically stimulated. activating the selected segment to contract and close the intestinal passage at the upstream end of the selected segment. and controlling the stimulation device to controlling a downstream second constriction member to release the selected portion; Narrowing the selected portion between its upstream and downstream ends to and controlling the third constriction member so that the intestinal contents contained in the third constriction member move downstream within the intestinal passage. .

[0033] Optionally, the stimulation device is selected when the third constriction member constricts the selected portion. The third narrowing is achieved by electrically stimulating the selected area to reduce the volume of the intestinal passage. Specifically, the control device may be configured to control the third constriction device. When the selected portion is constricted, the selected portion is continuously stimulated, thus The stimulation device is configured to gradually contract the selected portion constricted by the constriction member. As a result, the intestinal contents are displaced through the intestinal passage in a peristaltic manner.

[0034] Furthermore, the control device The selected segment is gently constricted to create a severance of the intestinal passage at the upstream end of the selected segment. controlling the downstream second constriction member to at least substantially reduce the area; Stimulating the selected portion when the second constriction member constricts the selected portion; The selected segment is contracted to close the intestinal passage at the upstream end of the selected segment. Control the stimulation device to controlling the upstream first constriction member to release the selected portion; Releasing the selected portion between its upstream end and downstream end, A third narrowing is provided to allow the intestinal contents in the downstream intestinal passage to enter the selected portion. Control the fence components.

[0035] According to another embodiment of the present invention including a stimulation device, the constriction device a first constriction member for constricting and releasing the portion at its upstream end; and a second constriction member for constricting and releasing the constricted portion at its downstream end. The control device is adapted to alternately constrict and release selected portions independently of one another. In this embodiment, the stimulation device controls the first and second constriction members. The selected portion is electrically stimulated between its upstream end and downstream end to stimulate the selected portion. It is configured to contract and reduce the volume of the intestinal passage.

[0036] With respect to the operation of the pump, the control device Constricting the selected segment to close the intestinal passage at the upstream end of the selected segment. and controlling the first constriction member on the upstream side so that controlling a downstream second constriction member to release the selected portion; The selected portion is continuously stimulated between its upstream and downstream ends to stimulate the selected portion. The intestinal contents are gradually displaced through the intestinal passage in a peristaltic manner. to control the stimulation device.

[0037] Optionally, the control device gently constricts the selected portion to reduce the pressure upstream of the selected portion. a first upstream narrowing to at least significantly reduce the cross-sectional area of ​​the intestinal passage at the lateral end; a first constriction member for controlling the first constriction member and a second constriction member for controlling the second constriction member; Stimulating the selected segment to contract the selected segment and induce contraction of the intestine at the upstream end of the selected segment. The stimulation device is controlled to close the passageway.

[0038] Furthermore, the control device Constricting the selected segment to close the intestinal passage at the downstream end of the selected segment. and controlling the downstream second constriction member so as to controlling the upstream first constriction member to release the selected portion; Stopping stimulation of the selected portion between its upstream and downstream ends and to allow intestinal contents in the intestinal passage upstream of the selected segment to enter the selected segment. to control the stimulation device.

[0039] Optionally, the control device may be configured to gently constrict the selected portion to provide a flow path downstream of the selected portion. a downstream second narrowing to at least significantly reduce the cross-sectional area of ​​the intestinal passage at the lateral end; a second constriction member that controls the second constriction member and that is selected when the second constriction member constricts the selected portion; Stimulating the selected segment to contract the selected segment and induce contraction of the intestine at the downstream end of the selected segment. The stimulation device is controlled to close the passageway.

[0040] According to another embodiment of the present invention, the constriction device is adapted to extend through a series of selected portions of the intestine. The control device is configured to constrict any portion of the intestinal passageway to close the intestinal passageway. by sequentially constricting selected portions of the intestinal passageway to force the intestinal contents through the intestinal passageway. The constriction device is controlled so that it moves in a peristaltic motion downstream within the narrowing. The device is such that each constriction member sequentially restricts a selected portion of a series of selected portions. a control device; cyclically moving each constriction member in turn along a selected portion of the series of selected portions (Alternatively, the constriction device may be a single constriction device.) Preferably, the constriction device includes a locking mechanism for holding the constriction member. The control device rotates the rotor so that each constriction member is rotated through a series of selected The selected portions are controlled to be cyclically constricted. The member preferably includes a roller that rolls over the intestine to constrict a selected portion of the intestine.

[0041] Optionally, the stimulation device described above may be used in conjunction with a constriction device to induce a series of selected portions of the sac. The selected portion of the stenosis can be successively constricted and contracted. The device narrows any of a series of selected sections to narrow the cross section of the intestinal passage. The product is at least significantly reduced, and the stimulation device is constricted by the constriction device. The control device electrically stimulates selected areas to close the intestinal passage. The intestinal contents are then forced through the intestinal passage by successively constricting selected portions of the intestinal passage. Control the constriction device to move while continuously stimulating the selected area. and select the constriction device to achieve continuous constriction of the selected area. The stimulation device is controlled to continuously contract the stimulated portion. The chair is positioned over the constriction element of the constriction device and stimulates the intestinal tissue with electrical pulses. A plurality of such electrodes are attached to each of the constriction members. The constriction member may be distributed along a surface of the selected portion. The control device contacts the intestine when one of the constriction members is constricted. cyclically moving the constriction member along selected portions of the series of selected portions one after the other; Controlling the constriction device to energize the electrodes, while controlling the stimulation device to energize the electrodes. do.

[0042] According to another embodiment of the present invention, the constriction device comprises an elongated at least The intestine further comprises a constriction member, preferably two elongated members extending along the intestine on either side of the intestine. The control device allows the elongated constriction members to cooperate with each other to gradually constrict the selected portion. The constriction device is controlled to move the intestinal contents through the intestinal passage. The member is sized to contact a selected portion of the intestine on either side for a length thereof. The contact surface is provided with a contact hole.

[0043] The contact surface is preferably convex, and the control device is adapted to control the convex contact surface of the constriction member to contact the intestine. The constriction device is rolled over the selected portion of the intestine to gradually constrict the selected portion of the intestine. Each constriction member has a convex surface that rolls along a selected portion of the intestine to restrict the intestine. A constriction that narrows the selected portion and a convex surface that relieves the selected portion of the intestine. The latch is configured to transition between a released state and a locked state.

[0044] Optionally, the stimulation device described above can cooperate with an elongated constriction member. Thus, the control device controls the elongated constriction member to gradually constrict the selected portion. The stimulation device can be controlled to stimulate selected areas. The electrodes are preferably arranged longitudinally on the surface of the elongated constriction member that contacts the selected portion of the intestine. The control device energizes the electrodes sequentially along the elongated constriction member to target selected areas of the intestine. The stimulation device is controlled to gradually narrow the affected area.

[0045] According to another embodiment of the present invention, the constriction device is adapted to restrict at least a portion of a selected portion of the intestine. and radially expanding one section of the intestinal passageway along the selected portion to expand the expansion chamber. and narrowing the expansion section in the axial direction in selected portions to reduce the volume of the chamber. and thus significantly reducing the displacement of intestinal contents through the intestinal passage. In operation, the control device axially constricts and releases selected portions of the expansion section. and thus controlling the constriction device to displace the intestinal contents through the intestinal passage. The constriction device may have a rest position that does not expand this section of the selected portion, and a Preferably, the constriction device is adjustable between an expanded position, which expands this section of the constriction device. The device then grows fibrous tissue to externally attach the expansion device to the wall of the selected portion of the intestine. material, whereby the inflation device, when in its expanded position, The wall of the section is drawn radially outward to form an expansion section of the selected section.

[0046] Optionally, using the stimulation device described above, when the constriction device is in its expanded position The expansion section of the selected portion is electrically stimulated to cause the expansion section of the selected portion to contract axially. The electrodes of the stimulation device are preferably positioned at the expanded section of the selected portion of the intestine. forming at least a series of electrodes extending around the

[0047] In one embodiment of the present invention, a separate closure member engages a selected portion of the intestine to close the intestinal passage. to close or at least partially constrict the selected portion when the pump is not operating. and configured to release selected portions upon operation of the pump to open the intestinal passage. At least one implantable and removable closure member is provided. The member at least partially constricts the selected portion to prevent bowel movement when the pump is not in operation. The cross-sectional area of ​​the tract is at least significantly reduced, and the stimulation device described above is adapted to stimulate the intestinal muscle or nerve tissue. Electrically stimulates the tissue, causing the intestine to contract and completely close the intestinal passage when the closure element constricts the intestine. The electrodes of the stimulation device are separate from the closure member or is integral with the closure member and preferably distributed along the intestine-contacting surface of the closure member. The control device is configured so that the occlusion element and the stimulation device work together to circulate blood through the narrowed intestinal blood vessels. Allow sufficient circulation so that the intestinal tissue is not exposed to the closure member for extended periods when the pump is not in operation. The pump controls the closure member and stimulation device to maintain their integrity after the pump is inserted. , including an elongated constriction member with electrodes of the stimulation device as described above, a control device When the pump is operating, the electrodes are energized variably to move blood through the narrowed intestinal vessels. It can always be circulated sufficiently.

[0048] Closure of the patient's intestinal passage by the pump. Instead of providing a separate closure element as described above, the pump When the pump is not in operation, the constriction device at least partially constricts the selected area. The constriction device can be maintained in a rest position where it remains closed. The pressure is selected so that, when in this resting position, the blood is sufficiently circulated within the narrowed intestinal vessels. The selected portion is constricted, so that the intestinal tissue is protected from prolonged exposure to the constriction device. Furthermore, the constriction device, when in the resting position, constricts the intestine. The stimulation device described above is adapted to narrow the intestinal passageway to at least significantly reduce its cross-sectional area. If the device causes the intestine to narrow, it electrically stimulates the intestine, causing it to contract and close the intestinal passage. Preferably, the control device is configured to select the electrodes of the stimulation device. A variable current is applied along the selected area to change the position of the electrodes on the selected area over time. and controlling the stimulation device to produce partial contractions of the selected portion of the body, Thus, the currently unstimulated part of the intestine will receive approximately normal blood flow before it is stimulated again. Circulation can be restored.

[0049] Artificial Intestine Element In an embodiment of the present invention, an artificial intestine element is surgically attached to the patient's intestine to provide an intestinal a selected portion of the intestine that forms part of the passageway and is constricted by the constriction device. A significant advantage of this embodiment is that it allows for a narrower range of the various pump configurations discussed above. The device can be used to act on the delicate intestine as well as on the artificial intestinal material. That is the thing. When the pump is not in operation, the constriction device constricts the artificial intestinal member to completely close the intestinal passage. Can be chained.

[0050] The artificial intestinal component can replace a patient's intestine and both intestines if, for example, part of the rectum has been removed due to cancer. Alternatively, the artificial intestinal member may be inserted directly or indirectly into the patient's anus. Can be attached to the gate.

[0051] Insertion of an artificial intestinal component into an ileostomy, jejunostomy, colostomy, or rectostomy When implanted in a patient, the constriction device constricts the artificial intestinal member, thereby preventing the artificial intestinal member from The intestinal contents are discharged through a fistula located downstream. It may end at such a fistula.

[0052] Manual Pump A subcutaneously implantable actuator operably connected to the pump's constriction device. An actuator may be provided, in which case the actuator may be adapted to operate the constriction device. It can be manually operated as shown.

[0053] In one embodiment of the invention, the constriction device is hydraulically operable and the actuator comprises: The actuator is hydraulically coupled to a hydraulically actuable constriction device. Preferably, the hydraulic system includes a manually compressible, resilient reservoir for hydraulic fluid used to operate the system. It's nice.

[0054] Preferably, an inverting valve hydraulically interconnects the reservoir and the hydraulically operable constriction device. The term "reverse servo" refers to a force acting on a moving member with a short stroke. A mechanism that converts a large force into a weak force acting on another moving part with a long stroke, i.e. In other words, it should be understood as the reverse function of a normal servo mechanism. A fraction of the amount of fluid in a smaller reservoir that can be hydraulically connected to the elastic reservoir. The small change is hydraulically coupled to the constriction device by the reversing servo. This can translate into a significant change in the volume of fluid in a larger reservoir. The button is particularly suited for manual operation.

[0055] The reservoir is hydraulically coupled to a hydraulically operable constriction device, and thus the reservoir When the bar is manually compressed, the constriction device closes the selected portion between its upstream and downstream ends. The intestinal contents contained in the selected portion are then forced downstream through the intestinal passage. When the elastic reservoir is manually released and resumes its uncompressed shape, the constriction device The nozzle releases the selected portion between its upstream and downstream ends, It allows the intestinal contents in the upstream intestinal passage to enter the selected portion.

[0056] The hydraulically actuable constriction device comprises a constriction member and, upon expansion, a selected portion thereon. A hydraulic bellows device that operates a constriction member to create a constriction between the upstream end and the downstream end. The compressible elastic reservoir is hydraulically coupled to the bellows device, thus The bellows device expands when the reservoir is manually compressed and expands when the reservoir is manually released. When the bellows device recovers its uncompressed state, it is retracted. When inserted, the selected portion is released between the upstream and downstream ends. Operate the component.

[0057] According to certain embodiments of the present invention, the hydraulically operable constriction device comprises a plurality of constriction devices. a hydraulically operable first sub-device for constricting and releasing the valve at its upstream end; and a hydraulically operable valve that constricts or releases the selected portion at its downstream end. a second sub-device capable of narrowing the selected portion between its upstream and downstream ends; and a hydraulically operable third sub-device for opening and closing the reservoir. The first, second and third sub-devices are hydraulically connected, so that the reservoir is manually When compressed by the The intestinal passage is closed at the upstream end of the selected section, and a downstream second sub-device is a third sub-device releases the selected portion and connects the selected portion to its upstream and downstream ends; The intestinal contents contained in the selected section are then moved downstream through the intestinal passage. When the elastic reservoir is manually released and resumes its uncompressed shape, a second downstream The sub-device constricts the selected segment and closes the intestine at the downstream end of the selected segment. The passage is closed, and the upstream second sub-device releases the selected portion, and the third sub-device The vise releases the selected portion between its upstream and downstream ends to release the selected portion. This allows intestinal contents in the intestinal passage upstream of the segment to enter the selected segment.

[0058] The first sub-device of the constriction device includes a first constriction member and, when expanded, a first constriction member that extends to a selected portion of the constriction device. a first hydraulic bellows device that operates a first constriction member to constrict the a second sub-device of the constriction device including a second constriction member and, when expanded, a second constriction member for actuating the second constriction member to release the selected portion at the downstream end; a hydraulic bellows device, and a third sub-device of the constriction apparatus includes a third constriction member; a third valve adapted to constrict the selected portion between the upstream end and the downstream end upon inflation; and a third hydraulic bellows device for operating the constriction member. hydraulically coupled to the first, second, and third bellows devices, and thus The reservoir expands when it is manually compressed and returns to its uncompressed form when it is manually released. Therefore, when the first bellows device is retracted, and operating the first constriction member to release the selected portion at the upstream end. The second bellows device, when retracted, constricts the selected portion at the downstream end. and when the third bellows device is retracted, the second constriction member is operated to a third constriction member to release the selected portion between the upstream end and the downstream end; Optionally, the hydraulic means described above may be used to operate the device disclosed herein. The pump in the illustrated embodiment can be manually operated.

[0059] Powered Pump In one embodiment of the present invention, the pump is powered. The control device A manually operable switch may be included to start and stop the power pump, the switch comprising: Alternatively, the control device may be configured to be subcutaneously implanted in the patient. The pump is controlled, i.e. started and stopped, by the patient who holds the heart control. The device may include a wireless remote control that is operated to

[0060] A wireless energy pump that transmits wireless energy from outside the patient's body into the patient's body. The energy transmitter may be configured to transmit wireless energy. In particular, wireless energy can be transmitted to directly drive the pump when the Wireless energy can be used to directly drive pumps using electric, electromagnetic, or magnetic fields, or a combination of these. For example, the pump may include an electric pump. In this case, wireless energy in the form of a magnetic or electromagnetic field is used to directly drive an electric pump. It is possible.

[0061] Therefore, the electric pump operates directly upon the transmission of wireless energy. The device converts wireless energy into different forms of energy using an energy conversion device implanted in the patient. converting the generated energy into ghee, preferably electrical energy, and using the converted energy to drive a pump; or b) use wirelessly transmitted energy to directly drive the pump. This can be achieved in different ways: using wireless energy in the form of electromagnetic or magnetic fields It is preferable to generate kinetic energy by directly impacting specific components of the pump. Preferably, such components may include a coil packaged within the pump.

[0062] Alternatively, a capacitor that stores the electrical energy generated by the energy transmission device may be used. An accumulator such as a capacitor or a rechargeable battery may be provided, and the control device The accumulator is controlled to release energy to drive the pump. An implantable charge meter may be provided to measure the charge on the charger, and the control device may A display can be generated in response to the charge meter.

[0063] Sensors In one embodiment of the present invention, a patient's physical parameters or a device's functional parameters are measured. An implantable sensor is provided that directly or indirectly senses the physical parameter. In this regard, the control device detects whether the sensor detects a value of a physical parameter that is higher than a threshold value when the pump is not operating. Generating an indication, such as an audio signal or displayed information, in response to detecting a value exceedance. Physical parameters include the volume of intestinal contents in selected segments of the intestine, the dimensions of the intestinal wall, The method may be a technique or pressure in a selected portion of the intestine.

[0064] With respect to the functional parameters of the device, the control device determines whether the sensor detects the functional parameters during operation of the pump. Triggers alarms, audio signals, and visual indicators in response to detecting that a parameter value exceeds a threshold. A display such as display information can be generated.

[0065] Communications In any of the above embodiments of the present invention, a device configured to be located outside the patient's body may be used. and an internal data communicator that is implantable in the patient and communicates with the external communicator. The internal data communicator may transmit patient information to an external data communicator. The external data communicator feeds back data to the internal data communicator, and / or the external data communicator sends data to the internal data communicator.

[0066] Methods of the Invention According to a second aspect of the invention, a method for treating a patient with a disease relating to the intestinal passage is provided. A method is provided, the method comprising: a) constricting a selected portion of the patient's intestine and forming a constricted intestinal passageway along the selected portion; at least significantly reduce the volume of the intestinal contents, thus preventing the intestinal contents from passing through the intestinal passage and moving laterally downstream. a step of displacing in a direction; b) releasing the selected portion to increase the volume of the intestinal passage along the selected portion; and Thus, intestinal contents in the intestinal passage upstream of the selected segment enter the selected segment. Steps and c) repeating step (a) and step (b) any number of times. .

[0067] If the selected portion of the intestine terminates at the patient's anus, the method comprises steps (a) and (b). and performing step (b) to expel the intestinal contents through the anus; or The method comprises surgically modifying the patient's bowel to terminate at a fistula, and performing step (a) and performing step (b) to drain the intestinal contents through the fistula.

[0068] Steps (a) and (b) of this method may be performed in several steps, as described below. Alternative procedures can be followed.

[0069] Alternative Procedure 1. Step (a) first constricts the selected portion and by closing the intestinal passage at the upstream end of the and step (b) first removing the selected portion except at its downstream end. This is done by releasing the entire portion at the downstream end and then releasing a selected portion at the downstream end. can be.

[0070] Alternative Procedure 2. Step (a) is Partially constricting the selected segment to close the intestinal passage at the upstream end of the selected segment. at least significantly reduce the cross-sectional area of electrically stimulating muscle or nerve tissue in the selected constricted area at the upstream end; Contracting the constricted selected segment to close the intestinal passage at the upstream end of the selected segment. Chained, This is then carried out by narrowing the entire selected area.

[0071] Step (b) first completely releases the selected portion except at its downstream end. , and then releasing the selected portion at the downstream end.

[0072] Alternative Procedure 3. Step (a) is Partially constricting the selected segment to close the intestinal passage at the upstream end of the selected segment. at least significantly reduce the cross-sectional area of electrically stimulating muscle or nerve tissue in the selected constricted area at the upstream end; Contracting the constricted selected segment to close the intestinal passage at the upstream end of the selected segment. Chained, causing at least partial constriction of the entire selected portion; The selected portion is then stimulated successively from its upstream end to its downstream end to produce the selected The intestinal contents are then gradually contracted, thus displacing them through the intestinal passage in a peristaltic manner. This is done by:

[0073] Step (b) first stops stimulating the selected portion and then completely released except at its downstream end, and then released a selected portion at the downstream end. This is done by releasing the

[0074] Alternative Procedure 4. Step (a) is A cross section of the intestinal passage along the entire selected portion is obtained by partially constricting the selected portion. Make the product at least fairly small, The constricted area is stimulated continuously from its upstream end to its downstream end to stimulate the selected area. The intestinal contents are gradually contracted, thus displacing them through the intestinal passage in a peristaltic manner. and is performed by.

[0075] Alternative Procedure 5. Step (a) involves sequentially constricting portions of a series of selected segments of the intestine. and thus displacing the intestinal contents downstream in a peristaltic manner within the intestinal passage. is executed.

[0076] Alternative Procedure 6. Step (a) is A series of selected portions of the intestine are successively constricted, so that at each constriction, at least significantly reducing the cross-sectional area of ​​the intestinal passageway; Each narrowed area is electrically stimulated, causing the narrowed part of the intestine to contract and close the intestinal passage. This is achieved by displacing the intestinal contents downstream through the intestinal passage. It will be carried out.

[0077] Alternative Procedure 7. Step (a) gradually narrows the selected portion, thus narrowing the intestine. This is done by displacing the contents peristally downstream through the intestinal passage.

[0078] Alternative Procedure 8. Step (a) is electrically stimulating the selected area to cause contraction of the selected area; The contracted selected section is gradually narrowed, thus forcing the intestinal contents down the intestinal passage. This is done by displacing the fluid in a peristaltic motion.

[0079] The present invention also provides another method of treating a patient with a disorder involving the intestinal passage. The law is A constrictor that engages a selected portion of the intestine to constrict or release the selected portion. providing a pump containing the device; The selected portion is constricted to reduce the volume of the intestinal passage along the selected portion by at least The intestinal passageway is then freed along the selected portion by reducing the This alternately increases the volume of the intestinal fluid, thus displacing the intestinal contents through the intestinal passage. and controlling the pump to operate the constriction device as follows:

[0080] The method includes providing at least one removable closure member that engages the patient's intestine. and a closure member is used to at least substantially close the intestinal passage when the pump is not in operation, and releasing the intestine upon actuation of the closure member. The passage can be closed.

[0081] Alternatively, a closure element may be used to constrict the intestine, reducing the cross-sectional area of ​​the intestinal passage by at least a significant amount. This method involves electrically stimulating the muscle or nerve tissue of the intestine, causing the blockage. If the material constricts the intestine, it may further include contracting the intestine to close the intestinal passage. In this case, the method preferably allows sufficient circulation of blood within the narrowed intestinal vessels, thus When the pump is not in operation, the intestinal tissue maintains its integrity after prolonged exposure to the closure member. This includes coordinating the operation of the closure member with electrical stimulation of the intestine so as to

[0082] The present invention also provides a method for treating patients with diseases related to the intestinal passage using the above-described device. This method (I) also provides: providing the apparatus described above; inserting a tubular needle into the abdominal part of a patient's body; Gas is delivered through a tube to fill the abdomen, thereby inflating it Steps and placing at least two laparoscopic trocars within the patient; inserting a camera into the abdomen through one of the trocars; selecting a portion of the patient's intestine; A cutting instrument is inserted through one of the trocars to cut an area in the selected region. and The pump of the device is positioned in the incised area so as to operatively engage the selected portion of the intestine. and and pumping the intestinal contents through the intestinal passage using the pump. The procedure involves cutting an opening in the patient's skin and abdominal wall, and then inserting the patient's intestines into the opening that forms the fistula. selecting a portion of the patient's intestine near the fistula through A pump is used to drain the intestinal contents through the fistula.

[0083] The present invention relates to other methods of treating patients with disorders related to the intestinal passage using the above-described devices. The present invention provides a method (II), which comprises the steps of: providing the apparatus described above; incising the patient's skin and abdominal wall to create an opening; selecting a portion of the patient's intestine; Inserting a cutting instrument through the opening and cutting an area in the selected portion. Pu and, The pump of the device is positioned in the incised area so as to operatively engage the selected portion of the intestine. and and pumping the intestinal contents through the intestinal passage using the pump.

[0084] The present invention relates to other methods of treating patients with disorders related to the intestinal passage using the above-described devices. The present invention provides a method (III), which comprises the steps of: An opening is made in the patient's skin and abdominal wall, and the patient's intestine is inserted into the opening to form the fistula. A step of passing a part, The intestine is cut open to separate the short section of intestine that will form the fistula from the rest of the intestine, while Maintaining the mesenteric vessels connected to the short segment of intestine to ensure blood supply to the short segment of intestine and incising an area at a short portion of the intestine; Place the artificial intestinal component within the incised area and insert the short section of intestine and the artificial intestinal component into the remaining section of intestine. The intestinal connection is made by surgically joining the remaining intestine, the artificial intestinal element, and the short section of intestine. forming a continuous passageway such that the artificial intestinal element forms a selected portion of the patient's intestine; providing the apparatus described above; placing a pump of the device in operative engagement with the artificial intestinal member; and using the pump to pump the intestinal contents through the intestinal passageway and out the fistula.

[0085] The above methods (I), (II) and (III) are manual methods for starting and stopping the pump. The method may further include subcutaneously implanting the operable switch.

[0086] According to the above method (I), method (II), and method (III), the pump constriction device The pump is operatively engaged with a selected portion of the intestine, causing the selected portion to be constricted. and at least significantly reducing the volume of the intestinal passage along the selected portion. Alternately releasing the closed section to increase the volume of the intestinal passage along the selected section. Therefore, the constriction device is operated to displace the intestinal contents through the intestinal passage. It is controlled so that

[0087] Methods (I), (II), and (III) each include at least one removable closure. implanting the member so as to operatively engage the selected portion of the intestine; and A closure member is used to close the intestinal passage when the pump is not operating and to release the intestine when the pump is operating. The method further includes:

[0088] Methods (I), (II), and (III) operate a removable closure member. , further including implanting a driving operating device such as an electric motor. The chair includes a hydraulic actuation device.

[0089] Methods (I), (II), and (III) are wireless energy sources for driving an operating device. and when it is desired to pump the intestinal contents through the intestinal passage, The energy delivered to the device drives a manipulation device to release a selected portion of the intestine. The method further includes operating the closure member.

[0090] Methods (I), (II), and (III) involve implanting an energy source into a patient. providing an external energy source; and controlling the external energy source to emit wireless energy. and converting wireless energy into storable energy. Non-invasively filling the converted energy source with pumps and / or or a removable closure member. The method further includes controlling the implanted energy source from outside the patient's body. It can be surgically modified to terminate at a foramen, allowing the bowel contents to leave the patient's body. The implanted energy source temporarily releases selected portions of the intestine when desired. and Using a pump, the contents of the intestinal passage are pumped out of the body through the fistula. Energy is a storable energy like electrical energy, which is different from wireless energy. The convertible and storable energy can be pumped and / or removed from the closed circuit. It is used to operate the chain members.

[0091] Alternatively, the method (I), the method (II), and the method (III) may be performed by providing an energy source outside the patient's body. and controlling an external energy source from outside the patient's body to emit wireless energy. Control and pump using emitted wireless energy and / or removable For example, the external energy source may be a pump or and / or to emit wireless energy that directly operates the removable closure member. The external energy source can be controlled to emit non-magnetic radio energy. The emitted non-magnetic wireless energy can be controlled by pumping and / or removing It is used to operate a possible closure member or emit electromagnetic wireless energy. The external energy source can be controlled in this way, and the emitted electromagnetic wireless energy can be It is used to operate the cap and / or removable closure member.

[0092] Wireless energy is generated by an implanted energy conversion device that converts electrical energy into radioactive material within the patient's body. The electrical energy can be converted into energy, and the electrical energy can be used to operate the pump and the removable closure member. Electrical energy is used in connection with the operation of the pump and / or the removable It can be used directly in connection with the operation of a closure member, e.g., a pump and / or The removable closure member is adapted to receive the electric energy converted from the wireless energy by the energy conversion device. It can be operated directly by energy.

[0093] Method (I), Method (II), and Method (III) are At least partially restricting the passage of intestinal contents in selected segments to prevent passage of intestinal contents. Prevent the bowel from opening or release the bowel and use a pump to remove the bowel contents. and controlling the removable closure member to allow the removable closure member to be opened.

[0094] Step (a) comprises at least partially restricting the passage of the intestine in the selected portion. and electrically stimulating a selected portion of the intestine, thereby controlling the removable closure member. contracting the affected area to further restrict the passage of intestinal contents and prevent them from passing is executed by

[0095] The present invention provides another method of treating patients with disorders related to the intestinal passage using the above-described device. The method further provides a method comprising: Provide a wireless remote control configured to control the pump from outside the patient's body. And, When the patient desires to have a bowel movement, the pump is operated by the patient using a wireless remote control. and stopping the pump when the patient has finished defecating. [Brief explanation of the drawings]

[0096] [Figure 1A] 1A-1C show schematic diagrams of different stages of operation of a generic device according to the invention, with the pump of the device applied to the patient's intestine; [Figure 1B]1A-1C show schematic diagrams of different stages of operation of a generic device according to the invention, with the pump of the device applied to the patient's intestine; [Figure 2A] 1C and 1D are schematic diagrams illustrating different stages of operation of the general apparatus of FIGS. 1A and 1B, which also includes an electrical stimulation device. [Figure 2B] 1C and 1D are schematic diagrams illustrating different stages of operation of the general apparatus of FIGS. 1A and 1B, which also includes an electrical stimulation device. [Figure 3A] 1A-1C are diagrams illustrating schematically different stages of operation of an embodiment of the present invention in which a peristaltic pump is applied to the intestine of a patient. [Figure 3B] 1A-1C are diagrams illustrating schematically different stages of operation of an embodiment of the present invention in which a peristaltic pump is applied to the intestine of a patient. [Figure 3C] 1A-1C are diagrams illustrating schematically different stages of operation of an embodiment of the present invention in which a peristaltic pump is applied to the intestine of a patient. [Figure 4A] 3A-3C, which also includes an electrical stimulation device. [Figure 4B] 3A-3C, which also includes an electrical stimulation device. [Figure 4C] 3A-3C, which also includes an electrical stimulation device. [Figure 5A] 1A-1C are longitudinal cross-sectional views of an embodiment of the present invention showing different stages of operation in which the pump includes a constriction device that radially constricts the patient's intestine. [Figure 5B] 1A-1C are longitudinal cross-sectional views of an embodiment of the present invention showing different stages of operation in which the pump includes a constriction device that radially constricts the patient's intestine. [Figure 5C] 1A-1C are longitudinal cross-sectional views of an embodiment of the present invention showing different stages of operation in which the pump includes a constriction device that radially constricts the patient's intestine. [Figure 6A] FIG. 5D is a longitudinal cross-sectional view of a variation of the embodiment of FIGS. 5A-5C, including an electrical stimulation device. [Figure 6B]FIG. 5D is a longitudinal cross-sectional view of a variation of the embodiment of FIGS. 5A-5C, including an electrical stimulation device. [Figure 6C] FIG. 5D is a longitudinal cross-sectional view of a variation of the embodiment of FIGS. 5A-5C, including an electrical stimulation device. [Figure 7] FIG. 6D shows the same embodiment as that of FIG. 6C, illustrating modified operation of the stimulation device. [Figure 8] FIG. 6B shows the embodiment of FIG. 6A when the pump is not in operation. [Figure 9A] 6B illustrates the modified operation of the stimulation device of the embodiment according to FIG. 6A when the pump is not in operation. [Figure 9B] 6B illustrates the modified operation of the stimulation device of the embodiment according to FIG. 6A when the pump is not in operation. [Figure 9C] 6B illustrates the modified operation of the stimulation device of the embodiment according to FIG. 6A when the pump is not in operation. [Figure 9D] 6B illustrates the modified operation of the stimulation device of the embodiment according to FIG. 6A when the pump is not in operation. [Figure 10A] 10A-10C are longitudinal cross-sectional views of another embodiment of the present invention including an electrical stimulation device and illustrating different stages of operation. [Figure 10B] 10A-10C are longitudinal cross-sectional views of another embodiment of the present invention including an electrical stimulation device and illustrating different stages of operation. [Figure 10C] 10A-10C are longitudinal cross-sectional views of another embodiment of the present invention including an electrical stimulation device and illustrating different stages of operation. [Figure 11A] 10A-10C are diagrams of another embodiment of the present invention in which a rotary peristaltic pump is applied to a patient's small intestine, showing different stages of operation. [Figure 11B] 10A-10C are diagrams of another embodiment of the present invention in which a rotary peristaltic pump is applied to a patient's small intestine, showing different stages of operation. [Figure 12A] FIG. 11C is a diagram of a variation of the embodiment of FIGS. 11A and 11B that also includes an electrical stimulation device. [Figure 12B] FIG. 11C is a diagram of a variation of the embodiment of FIGS. 11A and 11B that also includes an electrical stimulation device. [Figure 13A] 10A-10C are longitudinal cross-sectional views of another embodiment of the present invention, showing different stages of operation of another type of peristaltic pump applied to the small intestine of a patient. [Figure 13B] 10A-10C are longitudinal cross-sectional views of another embodiment of the present invention, showing different stages of operation of another type of peristaltic pump applied to the small intestine of a patient. [Figure 13C] 10A-10C are longitudinal cross-sectional views of another embodiment of the present invention, showing different stages of operation of another type of peristaltic pump applied to the small intestine of a patient. [Figure 13D] 10A-10C are longitudinal cross-sectional views of another embodiment of the present invention, showing different stages of operation of another type of peristaltic pump applied to the small intestine of a patient. [Figure 14A] 13A-13D, including an electrical stimulation device. FIG. [Figure 14B] 13A-13D, including an electrical stimulation device. FIG. [Figure 14C] 13A-13D, including an electrical stimulation device. FIG. [Figure 14D] 13A-13D, including an electrical stimulation device. FIG. [Figure 15A] 10A-10C illustrate different stages of operation of another embodiment of the present invention including separate intestinal closure members. [Figure 15B] 10A-10C illustrate different stages of operation of another embodiment of the present invention including separate intestinal closure members. [Figure 16A] FIG. 10 shows another embodiment of the invention including an artificial intestinal element implanted in a colostomy patient, with a pump acting on the artificial intestinal element. [Figure 16B] FIG. 16B shows the artificial intestinal member of FIG. 16A attached to the anus of a patient. [Figure 17] FIG. 17 is an enlarged detail view of the embodiment of FIG. 16. [Figure 18] FIG. 18 shows a modification of the embodiment of FIG. [Figure 19A]10A-10C show schematic diagrams of different stages of operation of another embodiment of the invention, in which the pump includes a constriction device that axially constricts the patient's intestine. [Figure 19B] 10A-10C show schematic diagrams of different stages of operation of another embodiment of the invention, in which the pump includes a constriction device that axially constricts the patient's intestine. [Figure 19C] 10A-10C show schematic diagrams of different stages of operation of another embodiment of the invention, in which the pump includes a constriction device that axially constricts the patient's intestine. [Figure 19D] 10A-10C show schematic diagrams of different stages of operation of another embodiment of the invention, in which the pump includes a constriction device that axially constricts the patient's intestine. [Figure 20] FIG. 19D illustrates the embodiment of FIG. 19D, which also includes an electrical stimulation device. [Figure 21] FIG. 10 is a side view of another embodiment of the present invention in which the pump includes a hydraulically actuable constriction device applied to the patient's intestine in a first stage of operation. [Figure 22] 22-XXII and XXIII-XXIII in FIG. 21, respectively. [Figure 23] 22-XXII and XXIII-XXIII in FIG. 21, respectively. [Figure 24] 22 is a side view of the embodiment of FIG. 21 with the constriction device in a second stage of operation. [Figure 25] 25A and 25B are views taken along the section lines XXV-XXV and XXVI-XXVI in FIG. 24, respectively. [Figure 26] 25A and 25B are views taken along the section lines XXV-XXV and XXVI-XXVI in FIG. 24, respectively. [Figure 27A] 27A-27D show different stages of operation of a hydraulic reversing servo suitable for coupling to the hydraulic constriction device of FIGS. 21-26. [Figure 27B] 27A-27D show different stages of operation of a hydraulic reversing servo suitable for coupling to the hydraulic constriction device of FIGS. 21-26. [Figure 28A]1A-1C illustrate different stages of operation of a mechanically driven constriction device suitable for use in some embodiments of the present invention. [Figure 28B] 1A-1C illustrate different stages of operation of a mechanically driven constriction device suitable for use in some embodiments of the present invention. [Figure 28C] FIG. 28C is a view of a variation of the embodiment of FIGS. 28A and 28B. [Figure 29] FIG. 6C shows the pump embodiment of FIGS. 6A and 6B applied to the small intestine of a colostomy patient. [Figure 30] FIG. 6C illustrates the pump of the embodiment of FIGS. 6A and 6B applied to the small intestine of a colostomy patient terminating at the patient's anus. DETAILED DESCRIPTION OF THE INVENTION

[0097] In the drawings, like reference numerals indicate identical or corresponding parts throughout the several views. is doing.

[0098] FIG. 1A illustrates a method for treating a patient with a condition related to the patient's bowel passage, such as constipation or incontinence. 1 shows a schematic representation of a general embodiment of a device according to the invention, which is adapted to treat a portion of the large intestine or The pump 1 is applied externally to a selected portion 2 of the patient's intestine 3. a constriction device for constricting the selected portion 2 and displacing the intestinal contents therein. In operation, the device is operated as shown in FIG. 1A, with the constriction device selected. a first operating stage in which the selected section 2 is unconstricted and filled with intestinal contents; The constriction device constricts the selected segment 2, forming an intestinal passageway along the selected segment 2. 4 at least significantly reduces the volume of the selected portion 2 of the tubular intestine 3, and therefore The intestinal contents are then cyclically changed between a first phase of operation in which the intestine is at least partially flattened. The object is displaced from the selected portion 2 downstream into the intestine 3, as shown in FIG. 1B. The device is then moved from the second operating stage (FIG. 1B) to the first operating stage. (Figure 1B), the constriction device of the pump 1 releases the selected portion 2, allowing the intestine to Allowing the contents to enter the selected portion 2, thereby As the intestinal contents fill, the volume of the intestinal passageway 4 along the selected section 2 increases.

[0099] The device of FIG. 1A electrically stimulates muscle or nerve tissue in selected areas 2 to stimulate the intestinal wall 6. An electrical stimulation device may be provided to cause the intestinal wall 6 to contract and thus thicken. When a device equipped with such a stimulation device is operated, the device goes through a series of three operating stages: As shown in FIG. 1A, the constriction device of the pump 1 constricts the selected portion 2. a first operating phase in which the selected portion 2 is filled with intestinal contents without allowing the intestinal contents to flow through the selected portion 2; As shown, the constriction device constricts the selected portion 2, and thus the selected Part 2 becomes partially flattened, thereby displacing a quantity of intestinal contents downstream within intestine 3. In the second stage of operation, the liquid is discharged through the open end 5, and as can be seen in FIG. 2B, The electrical stimulation device delivers an electrical pulse (indicated by arrow A in Figure 2B) to the selected constricted area 2. (shown in Fig. 1) stimulates the intestinal wall 6 to thicken and completely close the intestinal passage 4, thereby As a result, more intestinal contents are displaced downstream of the intestine 3 and discharged through the open end 5. The operation steps are performed cyclically. The electrical stimulation device is used to completely close the intestinal passage 4. The constriction device of Pump 1 was selected without substantially impeding blood circulation in the intestinal tissue. Portion 2 can be partially constricted.

[0100] FIG. 3A, FIG. 3B, and FIG. 3C schematically show an embodiment of the present invention similar to the general embodiment according to FIGS. 1A and FIG. 1B, except that the device includes a peristaltic pump 7. As can be seen from FIG. 3A, the peristaltic pump 7 includes a constricting device that extends along a part of the selected portion 2 and forms a limited constriction 8 of the selected portion 2. As shown in FIGS. 3 A to FIG. 3C, the constriction 8 is displaced in the downstream direction (from the left side to the right side in FIGS. 3A to 3C) to move the intestinal contents forward in the intestinal passage 4. A control device 9 is provided to control the constricting device of the peristaltic pump 7. When the constriction 8 is displaced to the right side of the selected portion 2 and the intestinal contents enter the selected portion 2 upstream of the constriction 8 and are refilled into the selected portion 2, the control device 9, as shown in FIG. 3a, releases the selected portion 2 at its right end and forms the constriction 8 at the left end of the selected portion 2 by controlling the constricting device of the peristaltic pump 7, thereby allowing the above-described operation to be repeated.

[0101] FIG. 4A, FIG. 4B, and FIG. 4C schematically show an embodiment of the present invention similar to the embodiment according to FIGS. 3A to 3C, except that the device of the embodiment according to FIGS. 3A to 3C also includes an electrical stimulation device having the same purpose as the electrical stimulation device described above in connection with the embodiments according to FIGS. 2A and FIG. 2B. In the embodiment of FIGS. 4A to 4C, a limited constriction 10 of the selected portion 2 is provided by combining two methods. Thus, according to the first method, the constricting device of the peristaltic pump 7 is selected ... ... ... ... The selected portion 2 is partially constricted, so that the selected portion 2 is partially flattened. In the second method, the electrical stimulation device is The constricted portion of the selected portion 2 is subjected to an electric pulse (indicated by arrow B in Figures 3A to 3C). This stimulates the intestinal wall to thicken and completely close the intestinal passage, thereby forming a stricture 10. The control device 9 is configured for the corresponding constriction 8 according to the embodiment of Figures 3A to 3C. In the same manner as described above, the constriction device and the stimulation device are controlled to form the constriction portion 1. Displace 0.

[0102] 5A, 5B, and 5C show a device for constricting a selected portion 2 of a patient's intestine 3. The pump 11 includes a constriction device 12 configured to flatten the 1 illustrates an embodiment of the present invention including a first pair of upstream constriction devices 12. a second pair of downstream short constriction members 13A and 13B; and a second pair of downstream short constriction members 14A and 14B, and a third pair of elongated narrow members located between the first pair of short members and the second pair of short members. The first pair of two short constriction members 13A, 13B includes: The sacs move closer to each other between the retracted position (FIG. 5A) and the constricted position (FIGS. 5B and 5C). a second pair of two short constriction members 14A, which are radially movable apart; 14B alternately moves between a retracted position (FIG. 5C) and a constricted position (FIGS. 5A and 5B). A third pair of two elongated constrictions, each of which is radially movable toward and away from the other. The members 15A, 15B have a retracted position (FIGS. 5A and 5B) and a constricted position (FIG. 5C). The pump 11 is radially movable between Attached to the selected portion 2, the two constriction members of each constriction member pair are thus The short constriction members 13A and 13B are located on both sides of the selected portion 2 and The short constriction members 14A, 14B are located at the upstream end of the selected portion 2. It is located in the department.

[0103] The control device 9 constricts and releases selected portions 2 independently of one another. A pair of short constriction members 13A, 13B, a pair of elongated constriction members 15A, 15B, and a pair of short constriction members 14A, 14B. The gas 9 controls the action of the pump 11 in displacing the intestinal contents in a circulatory direction downstream of the intestinal passage 4. Therefore, in FIG. 5A, the short constriction member 13 A, 13B and the elongated constriction members 15A, 15B are in their retracted positions, while the short The short constriction members 14A, 14B are in their constricted positions. , 13B also moves radially inward to the constriction, thereby causing a certain volume of intestinal contents to , confined within the intestinal passage 4 between the upstream and downstream ends of the selected portion 2. FIG. 5C shows the state in which the short constriction members 14A, 14B first move radially outward. The narrow constriction members 15A and 15B then move radially inward to narrow the constriction. This shows the state where the object has been moved to the right position. As a result of this state, the object moves as shown by the arrow. Intestinal contents in the intestinal passage 4 between the upstream end and the downstream end of the selected portion 2 are The control device 9 then moves downstream in the passage 4. The contents enter the intestinal passage between the upstream end and the downstream end of the selected portion 2 and enter the passage. The constriction device allows the pump to fill, thereby completing the pumping cycle. Controls S12.

[0104] Although FIGS. 5A to 5C show a pair of constriction members, a single short constriction member 13A, a single The constriction device includes only one elongated constriction member 15A, and a single short constriction member 14A. Note that it is possible to construct a stencil 12. In such a case, the selected stencil 3 The selected portion 2 is located on the opposite side of the constriction members 13A, 14A, and 15A of the selected portion 2. The constriction device 12 is supported by a fixed member located at the

[0105] 6A, 6B, and 6C show that the device according to FIGS. 6A-6C is an electrical stimulation device having the same purpose as the electrical stimulation device described above in relation to the embodiment according to 5A, 5B, and 5C, except that the present invention also includes a device 6A-6C show an embodiment of the invention. The stimulation device according to FIGS. 6A-6C includes a constriction member 13A. , 13B, 14A, 14B, 15A, and 15B and selected portions of intestinal tissue. an array of electrodes 16 configured to stimulate muscle or nerve tissue with electrical pulses; In Figures 6A-6C, an inactive electrode 16 is shown as an open circle. In this embodiment, the narrow The device and the stimulation device work together to avoid the obstruction of blood circulation in the intestinal tissue. The two constriction members of each pair of constriction members are selected to substantially close the intestinal passage. The electrode 16 is configured to electrically connect the narrowed selected portion 2 to the It stimulates the intestinal wall by pulsating it, causing it to thicken and completely close the intestinal passage. This results in a complete blockage of the intestinal passage.

[0106] During operation of the apparatus according to FIGS. 6A to 6C, the control device 9 performs the operations according to FIGS. 5A to 5C. The constriction members 13A to 15B are arranged to move in the same order as described above in relation to the configuration. The control device 9 also controls the constriction members 13A to 15A when one of the constriction members 13A to 15A is selected. The electrodes 16 are controlled to electrically stimulate the intestinal tissue causing the constriction of the intestinal segment 2.

[0107] FIG. 7 is a diagram illustrating the modified operation of the electrodes 16 on the elongated constriction members 15A and 15B. 6C. Thus, the control device 9 is connected to the elongated constriction member 1. 5A, 15B continuously stimulate the selected portion 2 when the selected portion 2 is constricted Therefore, the electrode 1 is moved so that the selected narrowed portion gradually contracts in the downstream direction. As a result, the intestinal contents are displaced downstream in the intestinal passage while moving peristally. Alternatively, the electrode 16 may be configured to stimulate the selected portion 2 successively, gradually moving the portion 2 in an upstream direction. can be contracted to

[0108] FIG. 8 shows the pump 11 in an inoperative state and the constriction members 13A to 15B maintained in their rest positions. 6A shows the embodiment of FIG. 6A in which short upstream and downstream constriction members are 13A, 13B, 14A, and 14B are maintained in their retracted positions, while the elongated The constriction members 15A, 15B gently constrict the selected portion, reducing the cross-sectional area of ​​the intestinal passage. The control device 9 electrically controls the narrowed selected portion 2. stimulates the intestinal wall to thicken, thus reducing the narrowing of the intestinal passage to keep it completely closed. Control all electrodes 16 on the members 15A and 15B at once. It can be only part of the constricted area.

[0109] 9A, 9B, 9C, and 9D show the implementation according to FIG. 6A when the pump 11 is not in operation. 9A illustrates the modified operation of the electrode 16 of the embodiment. Eight electrodes arranged in a row along the constriction member 15A and eight electrodes arranged in a row along the constriction member 15B. The control device 9 controls the electrodes in the two electrode rows according to a preset scheme. and actuating the selected portion 2 to change the position of the electrode on the selected portion over time. This causes the currently unstimulated portion of the intestine to contract momentarily before being stimulated again. The electrodes are arranged in a narrow constriction member 15A, 15B, 15C, 15D, 15E, 15F, 15G, 15H, 15I, 15J, 15K ... From the centrally located electrode of 5B, it is gradually activated in the upstream and downstream directions of the intestine.

[0110] The control device 9 controls two pairs of adjacent electrodes 16A and 16B located in the center of the two electrode rows. and 16B to thicken the intestinal wall along a short distance of the selected portion 2, The intestinal passage in the center of the section 2 is closed. Referring to FIG. 9B, after a predetermined period of time, such as a few seconds, After passing through, the next pair of electrodes 16C on the left side of the electrode pair 16A and the next pair of electrodes 16B on the right side of the electrode pair 16B are Paired electrode 16D is activated while electrodes 16A and 16B are deactivated. The intestinal wall thickens at two distinct locations away from the center of the selected segment 2. See Figure 9C. Then, after a further predetermined period of time has elapsed, the next pair of electrodes 16E on the left side of the electrode pair 16C, The next pair of electrodes 16F, to the right of electrode pair 16D, is activated, while electrodes 16C and 16D As a result, the intestinal wall is split into two distinct sections that are further away from the center of the selected section 2. Referring to FIG. 9D, after a further predetermined period of time, the thickness of the electrode pair 16E becomes The next pair of electrodes 16G to the left and the next pair of electrodes 16H to the right of electrode pair 16F are activated. Meanwhile, electrodes 16E and 16F are deactivated. The stimulation operation is repeated cyclically until the pump 11 is activated.

[0111] 10A, 10B, and 10C show movable elongated constriction members 15A and 15B. 6A, 5B except that the elongated constriction members 17A and 17B are replaced by the elongated constriction members 17A and 17B. 6B and 6C show an embodiment of the invention similar to the embodiment according to FIG. The stimulation device in this state is located on the fixation members 17A, 17B and stimulates the intestinal wall of the selected portion 2. to electrically stimulate the intestinal passage 4 between the upstream and downstream ends of the selected portion 2. It includes an array of electrodes 16 configured to reduce the volume. , the short constriction members 14A, 14B move radially outward first to their retracted positions; The electrodes 16 are then activated to contract the intestinal wall, thus contracting the upstream end of the selected segment 2. The volume of the intestinal passage between the distal and downstream ends is reduced, thereby increasing the volume of the intestinal passage between the distal and downstream ends, as indicated by the arrows. 1 shows the intestinal contents moving downstream within the intestinal passage 4. Additionally, the thickness of the intestinal wall that is electrically stimulated by electrode 16 is exaggerated in FIG. 10C.

[0112] 11A and 11B show another embodiment of the present invention, each showing different stages of operation. 1 is a diagram showing a rotating peristaltic port near a fistula in the small intestine of a colostomy patient. The peristaltic pump 18 is mounted equidistant from the axis 23 of the rotor 20. Constriction device 21 in the form of three cylindrical constriction members 22A, 22B, and 22C. The constriction members 22A to 22C are configured as rollers. An elongated fixed support member 24 is spaced from but supports the rotor 20. 20 and has a part-cylindrical surface 25 concentric with the axis 23 of the rotor 20. do.

[0113] The control device 9 controls the constriction members 22A-22C to be part of a series of selected portions of the intestine 19. The rotor 2 is rotated so as to contact the elongated support member 24 and continuously narrow the 11A shows a constriction member 22A constricting the intestine 19 at a first portion 25. The intestinal passage 4 is closed while the constriction member 22B just closes the intestine 19 to the first portion 25. 11B shows the state where the second portion 26 downstream of the The constriction member 22A is advanced approximately midway along the elongated support member 24 to enclose the constriction member 22A within the intestinal passageway. Displacement of bowel contents and therefore the discharge of a certain amount of bowel contents through the fistula Constriction member 22B opens up intestine 19, while constriction member 22C just Therefore, the control device 9 is configured to move the constriction members 22A to 22C are moved cyclically along the elongated support member 24, while the selected portion of the intestine 19 is The intestinal passage 4 is narrowed, so that the intestinal contents in the intestinal passage 4 are displaced by peristalsis. The same constriction principle can be applied to other mechanical constriction devices that do not include a rotor. Therefore, it can also be implemented.

[0114] 12A and 12B show that the device of the embodiment of FIGS. 12A-12B is similar to that of FIGS. 4A-4C. an electrical stimulation device having the same purpose as the electrical stimulation device described above in relation to the embodiment according to 11A and 11B, except that the present invention also includes a device 12A-12B show an embodiment of the stimulation device. 22C. In this embodiment, the rotor 20 is 11A and 11B, the fixed elongated support member 23 is somewhat further away. Therefore, the constriction members 22A to 22C are arranged to penetrate the intestine 1 when the rotor 20 rotates. When constricting the electrode 9, the mechanical action does not completely close the intestinal passage. By activating 6, the intestinal passage 4 is completely closed. may also be performed by other mechanical constriction devices that do not include a rotor.

[0115] Therefore, when any of the constriction members 22A to 22C constricts a part of the intestine 19, An electrode 16 associated with the constriction member electrically stimulates the constriction with an electrical pulse, As a result, the intestinal wall at the constricted portion thickens, closing the intestinal passage 4. 2A has initiated constriction of a portion of the intestine 19, and the intestinal passage 4 is closed by the electric current on the constriction member 22A. The pole 16 is shown in its actuated closed state.

[0116] 13A-13D show longitudinal sections of another embodiment of the invention at different stages of operation. 1 is a cross-sectional view of another type of peristaltic pump 2 inserted into a selected portion of the patient's intestine 19. Pump 27 is attached to the selected section for a length on each side of the selected section. Two narrow constriction members 29A and 29B having convex surfaces 30A and 30B that abut against each other. The control device 9 is provided with a constriction device 28 including a control device 9B. As shown, elongated constriction members 29A, 29B are moved relative to the selected portion. Thus, the selected portion is controlled to be gradually narrowed.

[0117] Therefore, in the initial position of the constriction members 29A, 29B shown in FIG. 13A, The selected portion is not constricted by the constriction members 29A and 29B. From this initial position, the constriction members 29A, 29B are moved as shown in FIG. 13A. Swing the left end of B towards the selected section (indicated by the arrow) of the intestine 19. The constriction members 29A and 29B are controlled to constrict the constricted portion. The passage 4 is shown completely closed by the selected narrowed portion. As shown in FIG. 13B, the control device 9 is connected to the right end of the constriction members 29A and 29B. The sections move towards each other (indicated by the arrows), while, as can be seen in FIG. 13C, Convex surfaces 30A, 30B of constriction members 29A, 29B define a constricted selected portion between them. The constriction members 29A and 29B are controlled so that they sandwich and move in a rolling manner relative to each other. As a result, the contents of the intestine 19 are pushed to the right (indicated by the white arrow). When 29A, 29B roll relative to each other to the position shown in FIG. 13D, the control device The right ends of the 9 are separated from each other (as indicated by the arrows in FIG. 13D) and are shown in FIG. 13A. The constriction members 29A and 29B are controlled so as to move to the initial position where the constriction members 29A and 29B are positioned. The operational steps shown in 3D are intended to displace the desired amount of intestinal contents through the intestinal passage in a peristaltic manner. This embodiment can be repeated cyclically several times until the Therefore, the peristaltic pump 27 is particularly suitable for use in a patient's intestine, near the patient's fistula. Can be attached.

[0118] Alternatively, only one of the constriction members 29A, 29B may be provided with a convex surface. In this case, the other constriction member has a flat surface that abuts the selected portion of the intestine 19. Use of a single constriction element having a convex surface that presses the selected portion against the patient's bone. is also possible.

[0119] 14A to 14D show that the device of the embodiment of FIGS. 14A to 14D is An electrical stimulation device having the same purpose as the electrical stimulation device described above in connection with the embodiment 13A-13D, except that it also includes a chair. The stimulation device includes electrodes 16 located on convex surfaces 30A, 30B. In the embodiment of FIGS. 14A to 14D, the constriction members 29A and 29B are 3A to 13D, are arranged somewhat further from each other, but Therefore, when the constriction members 29A and 29B operate to constrict the intestine 19, they are mechanically actuated. Therefore, the intestinal passage 4 is not completely closed. Tract 4 is completely closed.

[0120] Thus, the constriction members 29A, 29B are in the initial position shown in FIG. 14A. In this state, the control device 9 controls the left ends of the constriction members 29A and 29B to contact the selected portion of the intestine 19. The constriction members 29A, 29B are controlled to swing (indicated by arrows) toward the Meanwhile, the electrodes 16 are controlled to electrically stimulate the intestine 19 and cause the intestinal wall to contract and thicken. FIG. 14B shows the intestinal passageway 4 after mechanical constriction of the intestine 19 by constriction members 29A, 29B and electrical constriction. A complete closure is shown in combination with electrical stimulation of the intestine 19 by the poles 16. 14C and 14D show operational stages corresponding to those of FIGS. 13C and 13D described above. Shows the floor.

[0121] In the embodiment according to FIGS. 14A to 14D, the control device 9 is The constriction members 29A and 29B are gradually stimulated so that the convex surfaces 30A and 30B of the constriction members 29A and 29B roll against each other. When the electrodes are inserted, they are gradually contracted in accordance with the movement of the elongated narrowing members 29A and 29B. Control 16.

[0122] 15A and 15B show different stages of operation of another embodiment of the present invention. In this case, the device is a separate pump attached to a selected portion of the patient's intestine 19. The pump 31 includes a separate, removable closure member 32. The pump 31 is of the type described above. , which alternately constricts and releases selected portions of the intestine 19, thus The closure member 32 includes a constriction device for displacing an object through the intestinal passageway 4. The stencil includes two elongated constriction members 33A and 33B located on either side of the closed portion. The constriction members 33A, 33B are configured to release selected portions of the intestine 19 upon operation of the pump 31. and a retracted position (FIG. 15A) in which the constriction members 33A and 33B are selected when the pump is not in operation. The intestinal passage is closed by narrowing the intestinal passage (Fig. 5C). The axially extending members are radially movable in and out of alignment.

[0123] The muscle or nerve tissue in selected portions of the intestine 19 is stimulated with electrical pulses to contract the intestinal wall. A series of electrodes 16 are positioned on the constriction members 33A and 33B. Electrodes 16 are shown as open circles indicating electrodes in the activated state, and FIG. 15B shows electrodes in the activated state. The electrode 16 is indicated by a black round dot. cooperate to prevent the obstruction of blood circulation in the intestinal tissue when the closure member 32 closes the intestinal passageway 4. Therefore, the constriction members 33A and 33B are arranged to prevent the pump 31 from moving when the pump 31 is not in operation (FIG. 15B). and at least partially constricting the selected portion, reducing the cross-sectional area of ​​the intestinal passageway 4 by at least The electrodes are quite small and electrically stimulate the muscle or nerve tissue in the intestine, causing the intestine to contract. Therefore, the intestinal wall thickens and the intestinal passage 4 is completely closed. Follow the pre-set regimen described above in relation to the form or vary the intestinal stimulation. The device may be operated according to any other predetermined pattern or scheme.

[0124] FIG. 16A shows an artificial intestinal element 34 implanted in a colostomy patient with a fistula 35. 1 shows another embodiment of the present invention, including a small intestine 19 surgically cut and its upstream opening. a downstream open end 37 of a short separated section 39 of the small intestine 19 forming a fistula 35; A short section 39 of the intestine 19 is inserted through a surgically created opening in the patient's abdominal wall 39A. The artificial intestine member 34 is inserted between an upstream end 36 and a downstream end 37 of the patient. The small intestine 19 is surgically joined and integrated with the patient's small intestine 19. The artificial intestine member 34 supplies blood to the separated portion 39 that forms the fistula 35. The pump 40 includes a constriction device that acts only on the stenosis valve 4. The holder 40A is fixed to the abdominal wall 39A at the opening. The stenosis device alternately constricts and releases the artificial intestinal member 34, which may comprise an elastic tube. Thus, the intestinal contents are discharged through the patient's fistula 35. The constriction device may be any of the various constriction devices described in the embodiments of this application. In the embodiment of FIG. 16A, the constriction device is a pump. When the artificial intestine member 34 is not in operation, the artificial intestine member 34 is constricted and the passage of the artificial intestine member 34 is normally closed. Furthermore, in the embodiment of FIG. 16A, the small intestine can be narrowed. Any type of pump capable of this may be used.

[0125] The artificial intestinal member 34 or 43 described above is alternately inserted into the patient's anus as shown in FIG. 16B. It can be directly or indirectly attached to the phylum.

[0126] FIG. 17 is an enlarged view of the artificial intestinal member 34 and the pump 40. 1 shows the material 34 sealed to the intestine 19 at its upstream and downstream ends 36, 37. That is, a woven tubular net 41 is attached to the intestine 19 at its upstream end 36. and attached to the pump 40. Another woven tubular net 42 is The tubular net 42 is attached to the separation portion 39 and to the pump 40. It is not completely attached to the separation portion 39, and the net 42 is rolled up on the portion 39. Initially, the woven nets 41 and 42 are typically made of absorbable sutures. The tubular nets 41, 42 seal the intestine 19 to the artificial intestine member 34. Promotes fibrous tissue ingrowth. Other materials such as PTFE, silicone, and polyurethane The material can be attached to the outside of the tubular nets 41 and 42.

[0127] FIG. 18 shows a pump 40 having a tubular portion 44 extending downstream from the pump 40 and forming a fenestration 45. 17, which includes an artificial intestine member 43. The tubular portion 44A extends from the upstream side of the pump 40. In this modification, the artificial intestine member 43 The tubular portion 44A simply needs to be joined and sealed to the patient's small intestine 19.

[0128] 19A, 19B, 19C, and 19D are diagrams illustrating other embodiments of the present invention. 1 shows diagrammatically different stages of operation of a pump 46, which pumps the patient's intestine 19 axially. 19A, the constriction device 47 The chair 47 includes a first pair of constriction members 48A and 48B that are hinged to each other. and a second pair of hinged constriction members 49A and 49B. The members 48A, 48B and 49A, 49B are made of a material 50 that allows fibrous tissue ingrowth. 19B shows a first pair of constrictions, each of which is attached to a selected portion of the intestine 19 on either side thereof. The members 48A, 48B and the second pair of constriction members 49A, 49B move away from each other. 5 to radially expand a selected portion of the intestine 19 to form an expanded chamber 51 of the intestinal passageway 4. FIG. 19C shows the state in which the constriction members 48A and 49B are radially spaced apart from each other. The intestine 19 is then rotated in a circular fashion and axially constricts the selected portion of the intestine 19, thereby forming a chamber. 51 has reduced in volume, displacing intestinal contents from the intestine 19 through the intestinal passage. FIG. 19D also shows the second pair of constriction members 48B and 49B pivoting toward each other. and axially constricting the expanded selected portion to further reduce the volume of chamber 51. This allows more intestinal contents to be displaced from the intestine 19 through the intestinal passage 4. It shows.

[0129] FIG. 20 illustrates the electrical stimulation device described above in connection with the embodiment according to FIGS. 4A-4C. 19D also includes an electrical stimulation device having the same purpose as that of FIG. The stimulation device includes electrodes 11 located on the constriction members 48A, 48B, 49A, and 49B. Electrode 16 includes constriction members 48A, 48B, 49A, and 49B. At the same time as narrowing the intestine 9 in the axial direction, the intestine 19 is electrically stimulated to contract and thicken the intestinal wall. do.

[0130] 21 to 26 show another embodiment of the present invention, in which the manual pump 52 is a hydraulically operated constriction device (53) attached to a selected portion of the patient's intestine (19). The constriction device 53 constricts or releases the selected portion at its upstream end. a first sub-device 54 for constricting the selected portion at its downstream end; a second sub-device 55 for releasing and releasing the selected portion at its upstream end and and a third sub-device 56 that constricts and releases between the flow end and the flow end. The first sub-device 54 comprises a frame 57 and a narrowing element movable relative to the frame 57. and a hydraulic bellows member 59 connected between the frame 57 and the constriction member 58. The support surface 60 of the frame 57 supports the intestine 19, and therefore, as shown in FIG. As can be seen, constriction member 58 constricts intestine 19 against support surface 60. The second sub-device 55 can be inserted into both sides of the intestine 19 as can be seen in FIG. Two constriction members 61A and 61B are located on either side of the intestine 19, and The constriction members 61A and 61B are connected to each other by two bellows members 62A and 62B. The third sub-device 56 is configured similarly to the first sub-device 54 and includes a frame. a frame 63; an elongated narrowing member 64 movable relative to the frame 63; and The hydraulic bellows member 65A and the hydraulic bellows member 65B are connected between the elongated narrow member 64. The support surface 66 of the frame 63 supports the intestine 19. The bellows members 59, 65A , 65B, 62A, 62B, when fully expanded, the volume of bellows member 59 is the volume of two bellows members The volume of the two bellows members 65A and 65B is equal to the volume of the two bellows members 62A and 62B. The area is greater than the volume of the bellows member 59 and greater than the volume of the bellows members 62A and 62B. It has dimensions such that

[0131] an actuator in the form of a manually compressible elastic reservoir 67 containing a volume of hydraulic fluid; The actuator is subcutaneously implantable within the patient's body and includes hydraulic conduits 68A, 68B, 68C, 68D, and 68E, respectively, through bellows members 59, 65A, 65B, 62 A, and 62B. Conduit 68C is hydraulically connected to a single conduit 68E. The supplied hydraulic fluid is branched into two bellows members 65A and 65B. , the reservoir 67 is not compressed, thereby allowing all the bellows members 59, 65A, 65B, 62A, and 62B show the pump 52 in a retracted, non-operating state. As a result of this condition, the sub-device 55 constricts the intestine 19 downstream of the selected portion (FIG. 2). 3), while sub-devices 54 and 56 release intestine 19.

[0132] 24 to 26 show how the patient can manually compress the reservoir 67 to release hydraulic fluid from the reservoir 67. 5 shows pump 52 in an operational state distributing air from bellows members 59, 65A, 65B, 62A, and 62B. This condition results in the bellows member 59 expanding, and therefore the short constriction member 58 , constricting the intestine 19 and closing the intestinal passage 4 at the upstream end of the selected portion (FIG. 25), the two bellows members 62A, 62B expand, thus shortening the constriction member 61 A, 61B releases the intestine 19 and opens the intestinal passage 4 at the downstream end of the selected portion. 26, the two bellows members 65A, 65B expand, thus forming an elongated narrow A member 64 constricts the selected portion between its upstream and downstream ends, thereby Thus, the intestinal contents are displaced within the intestinal passage 4. The bellows member 59 has a volume that is two bellows when expanded. The volume of the body members 65A and 65B is less than the sum of the volumes of the body members 65A and 65B, and the hydraulic fluid flows through a single conduit 68E. bellows 59 is supplied to bellows 65A, 65B via the reservoir 67. The expansion rate of the bellows members 65A and 65B is sometimes higher than that of the bellows members 65A and 65B. A bellows member 59 having a volume smaller than the volumes of A and B, This is achieved by connecting member 65A to conduit 68B and bellows member 65B to conduit 68D. (It can also be seen that the constriction member 58 is not a constriction member.) Therefore, the constriction member 64 is not a constriction member that can completely enclose the intestine. Closing the intestinal passageway 4 at the upstream end of the selected portion of the intestine 19 well before complete constriction. When the constriction member 64 constricts the intestine 19, the selected portion of the intestine 19 is blocked. A significant amount of the intestinal contents in the intestinal passage is expelled downstream. When compression of bellows members 59, 65A, 67 is stopped, the reservoir resumes its uncompressed state and 65B, 62A, 62B, thereby drawing hydraulic fluid from the bellows members 59, 65A, 65B, 62A, and 62B retract, and pump 52 is in the inoperative state shown in FIG. return.

[0133] The hydraulic operating means of the constriction device according to the above-mentioned FIGS. 21 to 23 may be the same as that according to the FIGS. 1 to 10C. The embodiment of the constriction device and the embodiment of the closure member according to FIGS. 15A and 15B are implemented. It is possible.

[0134] 27A and 27B show hydraulic inversion suitable for use in the embodiment of FIGS. 21-26. The inverted servo 69 is shown with two long side walls 71A and 71B parallel to each other. 1B and two parallel short side walls 72A and 72B. The movable wall 73 is parallel to the long side walls 71A and 71B and is short between the long side walls 71A and 71B. A relatively large, generally cylindrical bellows rib forms a chamber 75 that slides over side walls 72A, 72B. A reservoir 74 extends between the movable intermediate wall 73 and the long side wall 71B and is connected to the movable intermediate wall 73 and the long side wall 71B. The chamber 75 of the large reservoir 74 is joined to the side wall 71B. A relatively small, generally cylindrical bellows reservoir 76 forming a chamber 77 is disposed between the movable wall 73 and the long side. The small bellows extends between the movable wall 73 and the long side wall 71A and is joined to the movable wall 73 and the long side wall 71A. Reservoir 76 is connected to fluid supply tube 78A which is connected to compressible reservoir 67 through conduit 68A. 8, and large bellows reservoir 74 includes bellows members 59, 65A, 65B, 62A, 62B has a fluid supply pipe 79 connected through conduits 68B to 68D.

[0135] Referring to FIG. 27A, when the patient compresses the reservoir 67, a small amount of hydraulic fluid enters the reservoir. 67 through a supply tube 78 into a chamber 77 of a small bellows reservoir 76, This causes the small bellows reservoir 76 to expand and push the movable intermediate wall 73 towards the long side wall 71B. As a result, the large bellows reservoir 74 is pressed against the long side wall 71B by the intermediate wall 73. As can be seen in Figure 27B, a large amount of hydraulic fluid is released. , through a supply pipe 79 from the chamber 75 of the large bellows reservoir 74, and further through a conduit 68B-6 8D and pushed into bellows 59, 65A, 65B, 62A, and 62B of pump 52. .

[0136] 28A and 28B show the embodiments according to FIGS. 1 to 10C and 15A and 15B. 1 shows a manual constriction device 80 that can be implemented in the following manner. an open-ended tubular housing 81 attached to a selected portion of the patient's intestine 19; 28A and the release position shown in FIG. 28B, the constriction member 82 is inserted into the selected portion of the intestine 19. 28B, which causes the intestine 19 to narrow. and a constriction member 82 that is radially movable within the tubular housing 81 so as to The mechanical operating means for mechanically operating the constriction member 82 is attached to the housing 81. an electric motor 83 connected to the constriction member 82; and a constriction member 82 driven by the electric motor 83 and operable to When power is supplied to the motor 83, the motor 8 3 expands the stretching device 30, thus reducing the narrowing, as can be seen in FIG. 28B. The constriction member 82 constricts the intestine 19, closing the intestinal passageway 4. When releasing, the electric motor 83 is reversed, so that the telescopic device 84 moves in the direction of the arrow in FIG. Retracting the constriction member 82 to the position shown in A, thereby releasing the intestine 19; The intestinal passage 4 is opened.

[0137] Alternatively, the mechanical operating means may act on the clamping member 82 as shown in FIG. 28C. The actuator may include a subcutaneously implanted actuator operably coupled to the patient. Therefore, the motor 83 expands the telescopic device 84. and a spring 84a which acts to press the clamping member 82 against the intestine 19. The actuator is a lever operatively connected to the telescoping device 84. The patient pushes lever mechanism 83a through the skin, which is shown in dotted lines. As shown in the figure, the telescopic device 84 is retracted against the action of the spring 84a. When the patient releases the lever mechanism 83a, the spring 84a pulls the telescopic device 84 , thereby again forcing the clamping member 82 against the intestine 19.

[0138] The mechanical operating means described above in connection with Figures 28A, 28B, and 28C are similar to those shown in Figure 1. 10C and 15A to 18.

[0139] FIG. 29 shows the pump 1 of the embodiment of FIGS. 6A and 6B attached to the intestine of a fistula patient. 1, in which constriction members 15A, 15B of constriction device 12 enclose intestine 19. The electrodes 16 are energized to close the intestinal passageway 4. The control device is a wireless remote control. The external control unit in the form of a 85A controller and a microprocessor and an implanted internal control unit 86 that controls the pump 11. The control 85A is operable by the patient to turn the pump 11 on and off. The separate wireless energy transmitter 85B controls the internal control unit 86 to It can also be integrated with the Remote Control 85A, which transmits wireless energy from outside the patient's body. The device is an implanted energy conversion device that converts the transmitted wireless energy into electrical energy. 16. The pump 11 is configured to supply power to the electrode 16. An implanted rechargeable battery 88 energizes the energy generated by the energy conversion device 87. The control unit 86, the energy conversion device 87, and the generated electrical energy are stored. and battery 88 is implanted as a package within the fat layer between the skin and abdominal wall of the patient. The pump 11 is configured such that the wireless energy conversion device 87 is connected to the wireless energy transmitter 85B. It can also be driven directly by electrical energy converted from wireless energy transmitted via The wireless energy is electromagnetic waves emitted by the coil of the energy transmitter 85B. In this case, the corresponding coil of the energy transforming device 87 transforms the electromagnetic wave into a current Convert to.

[0140] The implanted sensor 89 measures the volume of intestinal contents in a selected portion of the intestine and the distension of the intestine 19. Senses a patient's physical parameters, such as tonicity or pressure in the intestines. The Troll 85A detects that a physical parameter exceeded a threshold value when the pump 11 was not operating. configured to generate an indication, such as an audio signal or display information, in response to the sensor detecting the This sign should alert the patient that it is time to have a bowel movement.

[0141] FIG. 30 shows a colostomy tube surgically connected to the patient's anus and attached to the patient's small intestine 19. 6A and 6B show the pump 11 of the embodiment of FIG. 6B.

[0142] The present invention will be described in connection with what are presently considered to be the most practical and preferred embodiments. However, the invention is not limited to the disclosed embodiments, but on the contrary, the invention is not limited to the disclosed embodiments, but on the contrary, the invention is limited to the disclosed embodiments, Covering various modifications and equivalent structures that fall within the spirit and scope of the claims Please understand that this is the case. [Explanation of symbols]

[0143] 1. Pump; 2. (Selected) section of intestine; 3. (Patient's) intestine; 4. (Intestinal) passageway 5. open end; 6. intestinal wall; 7. pump; 8. constriction; 9. control device; 10 Constricted area.

Claims

1. 1. An apparatus for treating a patient having a disorder associated with the patient's intestinal passage, the apparatus comprising: a pump implanted in the patient's body, the pump configured to pump at least part of the patient's intestine a catheter that is operable outside one selected portion and that directs the contents of the intestine through the intestinal passage; and the device is configured to pump blood through an artificial stoma and and configured to expel the contents from at least one of the patient's anus, The pump is The patient is placed in a position such that the intestine is partially flattened but does not close the intestinal passage. configured to partially constrict the at least one selected portion of the intestine. a constriction device formed thereon; When the at least one selected portion of the intestine is partially constricted, and stimulating one or more portions of said at least one selected portion of said intestinal wall to thicken said intestinal wall. and further narrowing said at least one portion of said intestine by applying said stimulation to said at least one portion of said intestine. along at least one selected portion to move the intestinal contents within the passage of the intestine. a stimulation device for moving the The constriction device and the stimulation device are independently controlled to achieve partial constriction. and applying the stimulation along the at least one selected portion in a peristaltic manner. a restriction configured to be moved to pump contents through the passageway of the intestine; Control your device An apparatus comprising:

2. The intestine is surgically modified with an artificial stoma or anus; and and / or ileostomy, jejunostomy, colostomy, or rectostomy 10. The apparatus of claim 1, comprising or consisting of:

3. The patient's intestines are surgically modified to terminate in an artificial stoma or anus. the pump is configured to expel intestinal contents through the fistula or anus.

10. The apparatus of claim 1 .

4. The selected portion of the intestine terminates at the patient's anus, and the pump pumps the intestinal contents. The device of claim 1 configured to expel the anus.

5. The control device includes a wireless remote control for controlling the pump. The device according to any one of claims 1 to 4.

6. The control device controls the patient's blood pressure to directly or indirectly drive the pump. and a wireless energy transmitter configured to transmit wireless energy from outside the body. The device according to any one of claims 1 to 5, comprising:

7. an implantable energy source for converting the transmitted wireless energy into electrical energy; The apparatus of claim 6 further comprising a conversion device.

8. The energy transforming device transforms the transmitted wireless energy into electrical energy.

8. The method of claim 7, wherein the pump is directly driven by the electrical energy. Device.

9. an external data communicator configured to be located outside the patient's body; an internal data communicator implantable in the patient, in communication with the external data communicator; The apparatus of claim 1 further comprising:

10. The internal data communicator feeds data related to the patient to the external data communicator. or the external data communicator supplies data to the internal data communicator.

10. The device according to claim 9.

11. The stimulation device electrically stimulates muscle or nerve tissue in the selected portion of the intestine. stimulating the selected portion to cause partial contraction of the selected portion.

1. The device described in 1.

12. The stimulation device stimulates muscle or nerve tissue in the selected portion of the intestine with electrical pulses.

12. The device of claim 11, comprising at least one electrode configured to stimulate tissue. 。

13. The stimulation device is separate from the constriction device or 12. The device of claim 11, further comprising a plurality of electrodes integrated with the device.

14. 14. The electrodes form a series of electrodes along the selected portion of the intestine. The device described in

15. and further comprising an implanted sensor for sensing a physical parameter of the patient.

15. The device of any one of claims 1 to 14.

16. The sensor measures the volume of bowel contents or the distension of the bowel in the selected portion of the bowel.

16. The device of claim 15, configured to sense tension or pressure within the intestine.

17. The control device detects when the sensor detects that the value of the physical parameter exceeds a threshold value. configured to generate an indication, such as an audio signal or displayed information, in response to detecting the 16. The device of claim 15,

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