JP2006187673A - Ligator and endoscope system - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a ligator which can prevent a grip from being projected from a guide tube. <P>SOLUTION: The ligator is equipped with double sheaths 1, 2 which are insertable into a body cavity, an operating part body 5 set on the proximal end part of the inner sheath 2, a clip 4 set on the proximal end part of the outer sheath 1, an operating wire 14 movably inserted inside the inner sheath 2, a slider 6 fixed to the proximal end part of the operating wire 14 to move the operating wire 14 within a prescribed range, a clip unit 7 detachably set on the distal end part of the operating wire 14, and a spacer 16 detachably set on the distal end part of the operating part body 5 to allow the tip end of the outer sheath 1 to move in a direction away from the operating part body 5 and regulate movement approaching the operating part body 5 and to prevent the distal end part of the clip unit 7 from projecting out from the tip end of the outer sheath 1. <P>COPYRIGHT: (C)2006,JPO&NCIPI

Description

  The present invention relates to a ligation apparatus that performs hemostasis using a clip and an endoscope system.

There exists a thing proposed in patent document 1 in this kind of ligation apparatus. In the conventional ligating apparatus, an operation tube having a clip unit mounting connecting ring attached and fixed at its tip is slidably disposed in the introduction tube, and an operation wire is inserted into the operation tube, and the clip unit connected to the connection ring is connected to the operation wire. It is designed to be detachably connected to a hook member attached to the tip of the head.
JP-A-8-280701

  In the conventional ligation apparatus disclosed in Patent Document 1, the clip unit is detachable from the apparatus main body. For this reason, each time a clip is to be used, the clip unit is attached to the hook member of the apparatus main body. Work is necessary. However, since the clip unit itself is quite small, the mounting operation of the clip unit is troublesome and there is a problem that it takes time to prepare until the ligating apparatus is actually used.

  Further, the connection method between the apparatus main body and the clip has a problem that the clip and the apparatus main body are detached due to vibration / dropping during transportation or the like. For this reason, there is a possibility that an operation such as reattaching the clip may be required when used. In addition, since transportation is normally performed with the clip unit attached at the time of sale, the introduction tube may move toward the hand side with respect to the coil sheath due to vibration or dropping, and the tip of the clip may protrude from the introduction tube. There is.

  The present invention has been made in order to solve such problems. The purpose of the present invention is to enable the user to use it immediately, and to introduce the introduction tube to the proximal side with respect to the sheath before use. An object of the present invention is to provide a ligating apparatus and an endoscope system that can move and prevent a clip from protruding from an introduction tube.

  In order to solve the above-described problem, a ligation apparatus according to an aspect of the present invention includes an introduction tube having a diameter-enlarged portion at a proximal end portion that can be inserted into a living body cavity, and the introduction tube inside the introduction tube. And a distal end portion of the sheath member that is movably inserted along the axial direction of the sheath member and a proximal end portion of the sheath member, and the sheath member moves relative to the introduction tube in accordance with the movement. An operation wire body, an operation wire inserted inside the sheath member so as to be movable along the axial direction of the sheath member, and a movement wire provided on the operation portion body, the proximal end of the operation wire A moving mechanism that is fixed to the operating portion and moves the operating wire within a predetermined range with respect to the operating portion main body and the sheath member in accordance with movement on the operating portion main body; Possible movement of the moving mechanism Therefore, the clip unit having an open clip that is closed as the operation wire is moved in the pulling direction with respect to the sheath member, the distal end portion of the operation portion main body, and the diameter expansion of the introduction tube In the state in which the operation unit body is disposed, the operation unit body comes into contact with the distal end portion and the diameter-enlarged portion, thereby approaching the introduction pipe with respect to the introduction pipe. And a spacer that restricts relative movement of the clip unit and prevents the tip of the clip unit from protruding from the tip of the introduction tube.

  In order to solve the above problems, an endoscope system according to another aspect of the present invention includes an ligation apparatus and an endoscope including an elongated insertion portion having a treatment instrument insertion channel through which the introduction tube is inserted. A ligation device having a diameter-enlarged portion at a proximal end portion, and capable of being moved along the axial direction of the introduction tube inside the introduction tube. An inserted sheath member, an operation portion main body in which a distal end portion thereof is connected to a proximal end portion of the sheath member and the sheath member moves relative to the introduction tube in accordance with the movement, and the sheath member An operation wire that is movably inserted along the axial direction of the sheath member, and is movably provided on the operation portion main body, and is fixed to a proximal end portion of the operation wire. The operation wire is moved in accordance with the movement on the operation unit. A moving mechanism for moving the body and the sheath member within a predetermined range, and a detachable portion provided at a distal end portion of the operation wire, and the operation wire is drawn into the sheath member by the movement of the movement mechanism A clip unit having an open clip, which is closed as it moves in the direction, and is detachably disposed between the distal end portion of the operation portion main body and the enlarged diameter portion of the introduction tube, The clip unit is configured to restrict relative movement of the operation portion main body in the proximity direction with respect to the introduction pipe by abutting against a distal end portion and the diameter-expanding portion of the operation portion main body in a state where the clip unit is disposed. And a spacer for preventing the tip of the tube from protruding from the tip of the introduction tube.

  According to the present invention, a ligation apparatus that can be used immediately by a user and that can prevent a clip from protruding from the introduction tube by moving the introduction tube toward the proximal side with respect to the sheath before use, and An endoscope system can be provided.

[First Embodiment]
An endoscope ligation apparatus according to a first embodiment of the present invention will be described with reference to FIGS.
(Constitution)
As shown in FIG. 1, an endoscope ligation apparatus according to this embodiment includes an introduction tube 1 having an inner / outer diameter of about φ2.1 mm / 2.5 mm made of a high-density polyethylene tube or the like. A coil sheath (sheath member) 2 inserted in the introduction tube 1 so as to be able to advance and retreat; an operation wire 3 which is inserted in the coil sheath 2 so as to be able to advance and retract; and a base end of the introduction tube 1 A silicone grip (first operation means) 4 for performing the advance / retreat operation of the introduction tube 1 with respect to the coil sheath 2 by being press-fitted in the vicinity, and an operation portion main body attached to the proximal end of the coil sheath 2 5, a slider (second operation means) 6 that is attached to the base end of the operation wire 3 via a pipe 14 and is slidable with the operation unit body 5, and a clip (unit) attached to the distal end of the operation wire 3 7 The is configured as a main member.

  Silicone oil is applied to the operation wire 3 in order to improve the sliding performance with the coil sheath 2.

  The clip 7 includes a claw 8, a holding tube 9, and a connecting plate (connecting member) 10. The nail 8 is bent in the shape of α in the middle and both ends thereof are formed in a nail shape. In the released natural state, the arm portion of the nail 8 as shown in FIG. 19 is opened small.

  The connecting plate 10 is provided with a hole 11 at the proximal end, and a hook portion 12 is formed at the distal end. The hook portion 12 is hooked on the proximal end side loop portion of the claw 8 in the presser tube 9 and filled with silicone 13 in the presser tube 9 so that the clip 7 is not separated. At this time, the α portion 18 of the claw 8 is not drawn deeply into the holding tube 9, and the arm portion 19 of the claw 8 can be opened small as shown in FIG.

  The operation wire 3 is passed through the hole 11 of the connecting plate 10 and the midway portion is folded back. The portions on both sides of the two operation wires 3 that are folded back by the midway portion are inserted into the coil sheath 2 so as to be movable back and forth while being parallel. The operation wire 3 is fixed to the slider 6 at the base end portions on both sides. Pipes 14 are fitted on both side base ends of the operation wire 3. The folded portion of the operation wire 3 is bent very tightly, and the connecting plate 10 is sandwiched and fixed completely by the bending force.

  The outer surface of the introduction tube 1 is embossed (small unevenness), which reduces the contact area between the introduction tube 1 and the channel of the endoscope and improves the insertion property of the endoscope into the channel. Similarly, the inner surface of the introduction tube 1 is also embossed, thereby reducing the sliding resistance between the introduction tube 1 and the coil sheath 2.

  In a region located between the operation unit main body 5 and the slider 6, a compressed spring 15 is disposed on the outer periphery of the pipe 14 in a loosely wound state. Then, the elastic force of the spring 15 urges the slider 6 toward the hand side, so that the distal end of the coil sheath 2 and the proximal end surface of the holding tube 9 are separated during use and transportation, and at the separated portion. Deformation and the like are prevented from occurring.

  Although the base end surface of the coil sheath 2 is configured to be received by the receiving portion 17 of the operation portion main body 5, in order to prevent the coil sheath 2 from penetrating the receiving portion 17 when a large force is applied, FIG. As shown, a metal washer 20 is inserted between the base end surface of the coil sheath 2 and the receiving portion 17 of the operation portion main body 5.

  When this ligation apparatus is packaged as a product, the entire ligation apparatus is rolled and sealed in a sterilization pack (not shown), and sterilized. At this time, as shown in FIG. 2, the tip of the clip 7 is loaded into the sterilization pack in a state where the tip of the clip 7 is retracted about 5 to 15 mm from the tip of the introduction tube 1 and stored. Furthermore, the entire ligation apparatus is loaded into a sterilization pack, and then placed in a carton (not shown) for use in a sales route. However, the introduction tube 1 is close to the coil sheath 2 due to vibration and dropping during transportation at the time of sale. In order to prevent the clip 7 from protruding from the introduction tube 1 by moving to the side, as shown in FIG. 2, a spacer 16 is disposed between the grip 4 and the distal end of the operation portion main body 5, and the grip 4 And the operation unit main body 5 are kept from becoming shorter than a certain distance.

  The spacer 16 is formed with locking tongue pieces 16a and 16b that mesh with each other in the central region of the bendable plate-like member. The plate member 16 is made of, for example, a resin member (polypropylene or the like). The locking tongue pieces 16a and 16b are mounted on the outer periphery of the introduction tube 1, and are detachably attached.

As shown in FIG. 2, the spacer 4 is press-fitted and fixed to the grip 4 at a position about 30 mm away from the distal end of the operation section body 5 with the clip 7 stored in a predetermined position in the introduction tube 1. The distance from the base end face of the grip 4 to the base end face of the introduction tube 1 is set to be about 35 to 40 mm. That is, the proximal end of the introduction tube 1 is inserted into the space 22 with the coil sheath 2 of the operation unit body 5 by 5 to 10 mm.
In addition, the said dimension is one aspect | mode and can be suitably changed according to the kind etc. of a ligation apparatus, and is not limited to the said dimension.

(Function)
When using the endoscope ligation apparatus, as shown in FIG. 2, the endoscope in which the introduction tube 1 is inserted in the body cavity in advance while the clip 7 is housed in the introduction tube 1. Insert into the channel. After the leading end of the introduction tube 1 protrudes into the body cavity, the spacer 16 is bent into a U shape as shown in FIG.

  Next, the introduction pipe 1 is pulled toward the hand side by the grip 4 and the clip 7 is protruded from the tip of the introduction pipe 1 (state of FIG. 1). At this time, the proximal end of the introduction tube 1 is accommodated in the operation portion main body 5. That is, since the coil sheath 2 is not exposed, the clip 7 can be pushed out very smoothly. If the coil sheath 2 is exposed to the outside, the coil sheath 2 is bent at this portion, and the smooth clip 7 cannot be projected, but this can be avoided.

  Next, by pulling the slider 6 to the hand side with a light force, the α portion 18 of the claw 8 is drawn into the holding tube 9 as shown in FIG. In this state, the introduction tube 1 coming out on the proximal side of the endoscope is pushed into the endoscope, and the open claw 8 is pushed onto the target bleeding site in the body cavity.

  In this state, the slider 6 is pulled strongly toward the hand side. Then, the proximal end portion of the arm portion 19 of the nail 8 is drawn into the holding tube 9, the nail 8 is closed, and the tissue at the bleeding site is grasped. When the slider 6 is pulled further strongly, the hook portion 12 of the connecting plate 10 extends, and the clip 7 (only the claw 8 and the holding tube 9) grips the tissue, and the clip 7 is separated from the apparatus main body. It becomes a state. Then, the clip 7 is left in the body cavity with the bleeding part closed for about one week to stop bleeding.

  In addition, in order to implement | achieve the said effect | action, the intensity | strength of the hook part 12 is set so that the hook part 12 may be extended after the nail | claw 8 is drawn in in the holding | suppressing pipe | tube 9, and it will be in the state which can fully hold | grip a structure | tissue now. ing.

(effect)
As described above, the clip 7 is already attached to the apparatus main body 5 and the product is stored in the introduction tube 1 and sterilized, so that the product can be used immediately without complicated mounting work of the clip 7. . In addition, since the operation wire 3 that is folded back into the hole 11 of the connecting plate 10 is securely fixed, problems such as the clip 7 and the device unit body 5 coming off during transportation and handling in the mounted state are solved. .

  However, in the case of this fixing method, both the clip 7 and the apparatus main body 5 are disposable only once, but the complicated connection of the expensive connecting member (hook) and the connecting member (hook) and the wire Since joining such as brazing is unnecessary, it can be provided as an inexpensive one.

  Further, since the work of loading the clip 7 at the time of use is eliminated, the pipe for guiding the clip attached to the tip of the coil sheath provided in the prior art is also abolished (the connection between the pipe and the coil sheath is unnecessary). Can be made cheaper.

  Further, since the connecting member and the pipe are eliminated, the endoscope (including the side view scope and the perspective scope) can be inserted with a small amount of force. In addition, even when used in combination with a side view scope and a perspective scope, the connecting member and the pipe are eliminated, so that no burden is imposed on the apparatus unit body 5.

[Second Embodiment]
An endoscopic ligation apparatus according to a second embodiment of the present invention will be described with reference to FIG.
(Constitution)
In this embodiment, the difference from the first embodiment described above is that a hole formed at the proximal end of the connecting plate 10 is formed as a hook 20. Other configurations are the same as those of the first embodiment described above. The hook 20 has a strength sufficiently higher than the extension strength of the hook portion 12 at the tip of the connecting plate 10. In addition, the width of the opening portion 21 of the hook 20 is slightly narrower than the diameter of the operation wire 3.

(Function)
In this embodiment, the action different from that of the first embodiment is that the clip 7 can be attached and detached. After the clip 7 mounted in the initial state is finished, the slider 6 is pushed until it hits the tip, and the coil sheath 2 is pressed. The connection wire 10 is removed from the operation wire 3 by protruding the folded portion of the operation wire 3 from the tip of the wire and utilizing the elasticity of the hook 20 of the connection plate 10. Thereafter, the clip 7 is attached to the folded portion of the operation wire 3 by using the elasticity of the hook 20 to widen the open portion 21 of the new clip 7.

(effect)
The number of clips 7 required for hemostasis is an average number of three, and the second clip 7 requires a complicated operation of attaching the clip, but by replacing the clip 7 twice, one apparatus unit body 5 can be used. One patient can be hemostatic. That is, by making the hole of the connecting plate 10 of the clip 7 into a hook shape, only the clip can be replaced and the apparatus can be used repeatedly. Other effects are the same as those of the first embodiment described above.

[Third Embodiment]
An endoscopic ligation apparatus according to a third embodiment of the present invention will be described with reference to FIGS.
(Constitution)
The present embodiment is different from the first embodiment only in the connecting plate 10, the operation wire 3, the operation portion main body 5, the slider 6, and the clip 7, and the other configurations are the same as those in the first embodiment. It is.

  In this embodiment, as shown in FIG. 7A, a substantially tubular fixing portion 54 having a slit 53 is provided at the proximal end of the connecting plate 10, and as shown in FIG. The tip portion of the operation wire 3 is fixed to the fixing portion 54 by inserting the tip portion of the operation wire 3 into the fixing portion 54 and crimping the fixing portion 54.

  The operation wire 3 and the fixing portion 54 may be fixed by laser welding, brazing, or the like. In addition, the length of the fixing portion 54 is desirably set to 30 mm or less in consideration of the insertion property to the endoscope.

  The grip 4 is made by molding a resin such as ABS. As shown in FIG. 9A, the operation unit main body is connected with the proximal end portion of the introduction tube 1 connected to the distal end portion of the grip 4. 5 is fitted in such a manner as to be freely advanced and retracted. A protrusion 56 is provided on the inner surface portion of the grip 4 on the hand side. When the grip 4 is pulled toward the hand side, as shown in FIG. The provided slope portion 57 is press-fitted and the grip 4 and the operation portion main body 5 can be fixed. Further, when the grip 4 is pushed forward, the projection 56 is press-fitted into another inclined surface portion 58 provided on the outer periphery of the distal end portion of the operation portion main body 5, and the grip 4 and the operation portion main body 5 can be similarly fixed. . The outer diameter of the operation portion main body 5 located between the slope portion 57 and the slope portion 58 is smaller than the diameters at both ends, and is a small-diameter outer peripheral portion.

  As shown in FIGS. 11 and 12, the proximal portion of the coil sheath 2 is disposed on the operation portion main body 5, and after fixing the coil sheath 2 and the operation portion main body 5, the proximal portion of the coil sheath 2 is covered with the main body lid 59. I am doing so. The main body lid 59 is provided with a claw portion 60, and the main body lid 59 is fixed by engaging the claw portion 60 with an engagement groove 61 provided in the operation portion main body 5.

  Further, as shown in FIG. 12, the main body lid 59 is provided with a groove 62 having a semicircular cross section, and the groove 62 is formed by the main body lid 59 when the claw portion 60 and the engagement groove 61 are engaged. Serves as a relief for elastic deformation.

  As shown in FIG. 9A and FIG. 13, the slider 6 includes a slider body 63 and a slider lid 64. The slider body 63 is provided with a total of four engaging claws 65. As shown in FIG. 14, the slider lid 64 is provided with an engagement hole 66 at a position that coincides with the interval W between the engagement claws 65 provided in the slider body 63. By inserting into the engagement hole 66 of the slider lid 64, the engagement claw 65 is engaged with and fixed to the engagement hole 66.

  Further, as shown in FIG. 10, the slider 6 is provided with a ratchet claw 67. In the ratchet claw 67, the locking means 68 and the elastic portion 69 are integrally formed of a resin such as ABS, and the locking means 68 is always in pressure contact with the operation portion main body 5 by the elastic portion 69. The operation portion main body 5 is provided with a locking claw 70. The locking claw 70 engages with the locking means 68 and locks the slider 6 from moving to the tip side. Further, the slider 6 is provided with a ratchet release button 71. By pressing the ratchet release button 71, the locking means 68 is pushed away from the locking claw 70, and the slider 6 can be moved to the tip side. become.

  In the above-described first embodiment, the operation wire 3 is folded back at the tip portion and both ends are fixed to the slider 6. However, the operation wire 3 is folded back at the tip portion to become two operation wires. 3 may be fixed to the slider 6 and the other end may be along the operation wire 3 on the side fixed to the slider 6 in the middle as shown in FIG.

(Function)
The operational effects of this embodiment are the same as those of the first embodiment described above.
(effect)
According to the present embodiment, when the grip 4 is operated to move the coil sheath 2 and the introduction tube 1 forward and backward, there is a change in the force due to the press-fitting of the projection 56 and the slope portion 57, so that the operation can be performed sensibly. Furthermore, since the fixing mechanism for the grip 4 and the operation portion main body 5 is constituted by the protrusion 56 and the inclined surface portion 57, no other members are required, and therefore it can be manufactured at low cost. Further, by engaging and fixing the slider 6, there is no adhesive or bonding work, and it can be manufactured at low cost.

  Further, the present invention is not limited to the above-described embodiments.

BRIEF DESCRIPTION OF THE DRAWINGS The ligation apparatus for endoscopes which concerns on 1st Embodiment of this invention is shown, (a) is a top view which expands and shows only a front-end | tip part, (b) is sectional drawing which expands and shows a front-end | tip part. It is a longitudinal cross-sectional view which shows a state when packaging the ligation apparatus for endoscopes which concerns on 1st Embodiment of this invention. It is a longitudinal section in the state where the clip near the tip part of the ligation apparatus for endoscopes concerning a 1st embodiment of the present invention was stored. It is explanatory drawing of the state isolate | separated from the apparatus with the clip at the time of using the ligation apparatus for endoscopes which concerns on 1st Embodiment of this invention in the state which hold | gripped the structure | tissue. It is explanatory drawing when the spacer at the time of using the ligation apparatus for endoscopes which concerns on 1st Embodiment of this invention is removed from the introductory tube. It is a perspective view of the connection board of the ligation apparatus for endoscopes which concerns on 2nd Embodiment of this invention. The coupling plate of the ligation apparatus for endoscopes which concerns on 3rd Embodiment of this invention is shown, (a) is the perspective view, (b) is a top view of the state with which the coupling plate was connected with the operation wire. is there. It is a top view of the operation part of the ligation apparatus for endoscopes which concerns on 3rd Embodiment of this invention. It is a longitudinal cross-sectional view of the operation part of the ligation apparatus for endoscopes which concerns on 3rd Embodiment of this invention. It is a longitudinal cross-sectional view which expands and shows the P section in (a) of FIG. It is a longitudinal cross-sectional view which expands and shows the Q section in (a) of FIG. It is a cross-sectional view which expands and shows along the AA line in FIG. It is a top view which expands and shows the R section in FIG. It is a cross-sectional view which follows the GG line and HH line in FIG. It is sectional drawing which expands and shows the front-end | tip part of the ligation apparatus for endoscopes which concerns on 3rd Embodiment of this invention.

Explanation of symbols

  DESCRIPTION OF SYMBOLS 1 ... Introduction tube, 2 ... Coil sheath (sheath member), 3 ... Operation wire, 4 ... Grip (1st operation means), 5 ... Operation part main body, 6 ... Slider (2nd operation means), 7 ... Clip ( Unit), 8 ... claw, 9 ... holding tube, 10 ... connecting plate (connecting member), 11 ... hole in connecting plate, 12 ... hook portion of connecting plate, 14 ... operating wire, 15 ... spring, 16 ... spacer, 16a , 16b ... locking tongue piece, 17 ... receiving part, 18 ... alpha part, 19 ... arm part, 20 ... hook, 22 ... space.

Claims (9)

An introduction tube having a diameter-expanded portion at the proximal end portion and insertable into a living body cavity;
A sheath member inserted inside the introduction tube so as to be movable along the axial direction of the introduction tube;
The distal end portion is connected to the proximal end portion of the sheath member, and the sheath member moves relative to the introduction tube in response to the movement,
An operation wire inserted inside the sheath member so as to be movable along the axial direction of the sheath member;
The operation wire is movably provided on the operation unit main body in a state of being fixed to a proximal end portion of the operation wire, and the operation wire is moved with respect to the operation unit main body and the sheath member according to the movement on the operation unit main body. Moving mechanism for moving within a predetermined range,
A clip having an open clip that is detachably provided at a distal end portion of the operation wire, and is closed when the operation wire is pulled in the sheath member by movement of the moving mechanism. Unit,
It is detachably disposed between the distal end portion of the operation portion main body and the enlarged diameter portion of the introduction tube, and in the state in which it is disposed, with respect to the distal end portion and the enlarged diameter portion of the operation portion main body. A spacer that restricts relative movement of the operation unit main body in the proximity direction with respect to the introduction pipe by abutting and prevents the tip of the clip unit from protruding from the tip of the introduction pipe. A ligation device characterized by.   The ligation apparatus according to claim 1, wherein the spacer is detachably disposed by engaging with at least one of a proximal end portion of the introduction tube and the sheath member.   The spacer includes a plurality of tongue portions arranged alternately along the axial direction of the introduction tube and the sheath member in order to sandwich at least one of the proximal end portion of the introduction tube and the sheath member. The ligation apparatus according to claim 2, wherein   The ligation apparatus according to claim 3, wherein the spacer includes a plate-like member that supports a base portion of the tongue portion.   The ligation apparatus according to any one of claims 1 to 4, wherein the spacer is made of a deformable resin material.   The spacer has a length between the distal end of the introduction tube and the distal end of the clip unit in a state where the spacer is disposed between the distal end of the operation portion main body and the diameter-expanded portion of the introduction tube. The ligation apparatus according to claim 1, wherein the ligation apparatus is formed longer than a length between them.   The length of the introduction tube is such that the distal end portion of the introduction tube is more distal than the clip unit in a state in which the spacer is disposed between the distal end portion of the operation portion main body and the enlarged diameter portion of the introduction tube. The ligation apparatus according to claim 1, wherein the ligation apparatus is set so as to be positioned on a side.   The ligation apparatus according to claim 1, wherein the enlarged diameter portion of the introduction pipe is formed of a member different from the introduction pipe. A ligation apparatus according to any one of claims 1 to 8,
An endoscope system comprising an elongated insertion portion having a treatment instrument insertion channel through which the introduction tube is inserted.

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