JP4706013B2 - Endoscopic clip device - Google Patents

Description

  The present invention relates to an endoscope clip device that is passed through a treatment instrument guide tube of an endoscope and used for hemostasis treatment or the like in the body.

In general, an endoscopic clip device is attached to a distal end portion of a sheath in which a cylindrical fastening ring is fitted to a clip formed of a material having a spring property, and these are passed through a treatment instrument guide tube of the endoscope. When the tip of the operation wire that is placed and inserted through the sheath is engaged with the back end of the clip and pulled, the clamping ring comes into contact with the tip of the sheath and is pushed out toward the tip of the clip to forcibly close the clip. Then, by disengaging the operation wire and the clip, the clip with the tightening ring fitted and closed is placed in the body (for example, Patent Document 1, 2).
Japanese Utility Model Publication 4-26091 JP 2002-191609 A

When performing clip treatment in the body under endoscopic observation, close the clip with the tightening ring after the clip in the opened state is brought into close contact with the affected area by remote control. There is a need to do.
However, in a conventional endoscope clip device, a tightening ring is fitted to the rear end portion of the clip, and the tightening ring is loosely engaged with the distal end of the sheath. The stability of the clip posture in the state of protruding forward from the sheath tip is poor, and the posture of the clip with respect to the sheath tip projecting from the endoscope tip into the observation field is easy to wobble by a slight operation, etc. In some cases, it may take time to guide the clip while pinching the affected area.

  The present invention has been made to solve such problems, and the posture of the clip in a state of projecting forward from the distal end of the sheath and being opened is always stable with respect to the distal end of the sheath, so that the affected area can be accurately identified. An object of the present invention is to provide an endoscopic clip device capable of smoothly guiding a clip in a sandwiched state.

  The endoscope clip device of the present invention is formed of a material having a spring property in a shape that expands forward when the rear end is bent back into a loop shape or a half loop shape and no external force is applied. A clip, a cylindrical tightening ring that is fitted in a state of covering the clip and forcibly closing the clip, and the tip portion abuts the tightening ring and pushes the tightening ring toward the tip of the clip And a sheath for forcibly closing the clip, and a distal end portion that is inserted into the sheath so as to be movable in the axial direction relative to the sheath, and the rear end portion of the clip near the distal end of the sheath. In an endoscopic clip device provided with a clip holding member that is detachably connected, the vicinity of the rear end portion of the clip is accommodated to keep the posture of the clip constant. The clip rear holding chamber which is characterized in that provided at the end portion of the sheath.

  The clip rear end holding chamber may be formed in a cylindrical shape that accommodates the vicinity of the rear end portion of the clip, and the ridge line portion of the outer edge of the portion near the rear end of the clip is formed on the inner peripheral surface of the clip rear end holding chamber. The vicinity of the rear end portion of the clip may be accommodated in the clip rear end holding chamber in the contact state. Then, the portion near the rear end of the clip may be able to be retracted into a portion deeper than the clip rear end holding chamber in the sheath by deformation, and the clip is positioned at a position corresponding to the bottom of the clip rear end holding chamber. A clip rear end contact hole that can be passed if the rear end portion of the clip abuts and the rear end portion of the clip is deformed may be formed.

  Further, the sheath may be formed of a flexible member, and the clip rear end holding chamber may be formed of a rigid body so as to be integrally fixed to the distal end of the sheath, and the distal end portion is covered with the clip. Thus, the outer tube that elastically deforms the clip in the closed state may be provided by being fitted to the sheath so that it can be moved in the axial direction relative to both the sheath and the clip holding member. Moreover, the rear end bending return part of a clip may be formed in the width | variety narrower than another part.

  Further, the tightening ring may be disposed so as to surround the clip at a position closer to the front than the portion accommodated in the clip rear end holding chamber, and by pushing the sheath relatively forward with respect to the clip holding member. The part near the rear end of the clip is deformed and pulled into the part behind the clip rear end holding chamber in the sheath, and at the same time, the tightening ring is pushed by the sheath and moves toward the tip of the clip, forcing the clip It may be in a closed state. Then, the portion near the rear end of the clip is deformed and pulled into the portion behind the clip rear end holding chamber in the sheath, and when the clip is forcibly closed by the tightening ring, the portion closer to the rear end of the clip It is good to deform | transform into the state which a part can pass the clip rear end holding chamber loosely.

  Further, the rear end portion of the clip may be bent back into a substantially U-shaped half-loop shape, and the tightening ring is positioned in front of the portion stored in the clip rear end holding chamber near the rear end portion of the clip. The protrusion may be formed on the clip so as to restrict the tightening ring from dropping behind the clip. The protrusion may be formed by deforming the member itself forming the clip.

  Further, the rear end portion of the clip may be bent back into a loop shape that intersects in a substantially α shape, and the fastening ring is arranged at a position surrounding the portion that intersects the approximately α shape of the clip and is behind The movement of the clamping ring may be restricted so that the clip does not fall out behind the clip by the portion where the clip at the position swells in a loop shape.

  Further, the clip holding member is provided with a clip connecting member formed of a springy material in a shape that expands forward when no external force is applied. In this case, it may be elastically deformed in a constricted state, and when it protrudes from the distal end of the sheath, it may expand and disengage from the clip. A cylindrical member for constricting the clip connecting member may be disposed adjacent to the side so as to be rotatable around the axis.

  According to the clip device for an endoscope of the present invention, the distal end of the sheath is provided with the clip rear end holding chamber for storing the vicinity of the rear end portion of the clip and holding the posture of the clip constant at the distal end portion of the sheath. The posture of the clip in a state of protruding forward from the tip is always stable with respect to the distal end of the sheath, and the clip can be smoothly guided to the state where the affected part is accurately pinched.

Embodiments of the present invention will be specifically described below with reference to the drawings.
FIG. 4 shows an overall configuration of the endoscope clip device.
Reference numeral 1 denotes a clip that maintains a state in which a living tissue is picked to perform hemostasis and the like, and a tightening ring 2 for maintaining the clip 1 in a closed state is located at a portion slightly behind the intermediate portion of the clip 1. It is attached to cover.

  3 is a flexible sheath for pushing the tightening ring 2 toward the distal end of the clip 1 so that the distal end abuts the rear end of the tightening ring 2 and forcibly closes the clip 1. A clip holding wire 4 (clip holding member) detachably connected to the rear end portion of 1 is inserted into the flexible sheath 3 so as to be slidable in the axial direction, and the flexible sheath 3 and the clip holding wire 4 are inserted. Each of the hand side end portions reaches the operation unit 5.

  The operation handle body 6 of the operation section 5 has a proximal end of the clip holding wire 4 connected and fixed thereto, and is attached to the operation section body 6 so as to be slidable and rotatable about 90 ° to 180 ° around the axis. 7, the base end of the flexible sheath 3 is fixed. Therefore, the operation handle 7 can slide the flexible sheath 3 in the axial direction with respect to the clip holding wire 4 and can be rotated to some extent around the axis. Holes for engaging the operator's fingers are formed in the proximal end of the operation unit body 6 and the operation handle 7.

  Reference numeral 8 denotes a flexible outer tube made of, for example, a fluororesin tube or the like loosely fitted on the flexible sheath 3. A slide operation ring 9 is attached to the proximal end portion of the outer tube 8 positioned at the operation unit 5, and the outer tube 8 is slid in the axial direction with respect to both the flexible sheath 3 and the clip holding wire 4. can do. The distal end of the outer tube 8 is usually at a position slightly retracted from the distal end of the flexible sheath 3, but when the outer tube 8 is pushed forward, the distal end portion of the outer tube 8 covers the clip 1. Thus, the clip 1 can be elastically deformed in a closed state.

  FIG. 5 shows a state in which an operation of changing the clip 1 (or attaching a new clip 1) is performed in the endoscope clip device configured as described above, and the operation handle 7 is pulled toward the hand side. By operating and retracting the distal end of the flexible sheath 3 to the proximal side, the clip connecting member 4A provided at the distal end of the clip holding wire 4 is exposed, and the clip 1 is attached to the clip connecting member 4A. It can be engaged with and disengaged.

  When passing the clip device through a treatment instrument guide tube of an endoscope (not shown), as shown in FIG. 6, the outer tube 8 is pushed forward to the position where it covers the clip 1 and the clip 1 is closed. When the outer tube 8 is pushed into the treatment instrument guide tube with the clip 1 and the flexible sheath 3 completely covered with the clip 1 and the flexible sheath 3 and the distal end protrudes from the distal end of the treatment instrument guide tube toward the body, By retracting the tube 8 to the hand side, as shown in FIG. 4, the clip 1 returns to its natural state due to its own elasticity, and expands toward the front at the tip of the flexible sheath 3.

  When the clip 1 in the expanded state is brought close to the affected part by remote operation so that the affected part is sandwiched by the clip 1, the flexible sheath 3 is pushed forward as shown in FIG. Then, the clip 1 is forcibly closed by pushing the tightening ring 2 forward so as to cover the clip 1, and the bleeding part of the mucous membrane can be clipped. Then, as shown in FIG. 8, if the operation of pulling the flexible sheath 3 to the hand side is performed again, the tip of the flexible sheath 3 is retracted rearward and the clip connecting member 4A is exposed. 1 can be disengaged and the clip 1 in a state of being forcibly closed by the tightening ring 2 can be placed in the body.

FIG. 1 is a side sectional view of a distal end portion of an endoscopic clip device for performing the above-described clip treatment, and FIG. 2 is a plan sectional view.
The clip 1 is formed by bending a spring member such as a stainless steel plate for a spring by pressing or the like, and its rear end is bent back in parallel to a substantially U-shaped half-loop shape, so that an external force is applied. When the outer tube is not applied, it is formed in a shape that expands forward from the intermediate portion. As shown in FIG. 3, when the outer tube 8 is pushed forward and covers the clip 1, the distal end portion 1a is formed. Is elastically deformed in a closed state, and when the outer tube 8 is retracted rearward, it returns to the expanded state shown in FIG.

As shown in FIGS. 1 and 2, the flexible sheath 3 is formed of a coil pipe in which, for example, a stainless steel wire having a flat cross-sectional shape is tightly wound. However, a synthetic resin tube such as a coil pipe having a circular cross section or a strong fluororesin tube may be used.
A cylindrical tip cap 10 formed of a rigid body such as a stainless pipe material or a hard plastic material is integrated with the distal end of the flexible sheath 3 by brazing or the like in series with the flexible sheath 3. The tip end portion of the tip cap 10 is a clip rear end holding chamber 11 that houses the vicinity of the rear end portion 1b of the clip 1 and holds the posture of the clip 1 constant. .

  The clip rear end holding chamber 11 is formed in a circular cross-sectional shape as shown in FIG. 9 showing a cross section taken along the line AA in FIG. The four ridge line portions 1d on the outer edge are stored in contact with the inner peripheral surface of the clip rear end holding chamber 11. Therefore, the clip 1 in a state where the front side is expanded is elastically deformed to a slightly narrowed state from the natural state by contacting the inner peripheral surface of the clip rear end holding chamber 11, and due to the repulsive force. The clip 1 is held in a stable state without rattling in the clip rear end holding chamber 11. As a result, the posture of the clip 1 in the state of protruding forward from the distal end of the flexible sheath 3 is always stable, and the clip 1 can be smoothly guided to the state where the affected part is accurately pinched.

  At a position corresponding to the bottom of the clip rear end holding chamber 11, a clip rear end abutting hole 12 having a circular cross section slightly smaller than the diameter of the clip rear end holding chamber 11 is formed. As shown in FIG. 10, which shows a cross section cut along line B, the rear end portion 1b of the clip 1 comes into contact with the inlet step portion of the clip rear end contact hole 12 at the four corners, and the clip 1 is It plays the role of a stopper that does not go into the end contact hole 12 any more. However, since the clip 1 is formed to be thin and easily deformed, the vicinity of the rear end portion 1b of the clip 1 passes through the clip rear end abutting hole 12 while being deformed when a force exceeding a certain level is applied to the back. I can dive in. Note that both the clip rear end holding chamber 11 and the clip rear end contact hole 12 may have a cross-sectional shape other than circular.

  The tightening ring 2 is formed of a rigid body such as a stainless steel pipe material or hard plastic, and is disposed so as to surround the clip 1 at a position adjacent to the front side of the portion accommodated in the clip rear end holding chamber 11. As shown in FIG. 11, which shows a cross section taken along the line CC in FIG. 1, it is formed in a rectangular cylindrical cross-sectional shape that abuts on the distal end face of the distal end cap 10. However, a cross-sectional shape other than a rectangle may be used. In FIG. 11, the illustration of the clip connecting member 4A and the like is omitted.

  As shown in FIGS. 12 and 13, the protrusion 1 c for restricting the tightening ring 2 from dropping backward from the clip 1 when the clip 1 is not attached to the distal end of the flexible sheath 3 is clipped. 1 may be formed. Such a protrusion 1c can be easily formed by deforming the clip 1 itself by press working or the like. Moreover, as shown in FIG. 13, the width of the rear end portion 1b of the clip 1 may be formed narrower than other portions so that the clip 1 can be easily deformed at the rear end portion 1b.

  The clip connecting member 4A connected to the tip of the clip holding wire 4 shown in FIG. 1 and FIG. 2 by a connecting ring 4B is formed of a material having a spring property, and in the state where no external force is applied, FIG. As shown in the figure, it expands toward the front and elastically deforms into a constricted state as shown in FIG. When engaged and projecting from the tip of the tip cap 10, it expands and disengages from the clip 1 as shown in FIG. 14.

  Returning to FIGS. 1 and 2, reference numeral 13 denotes a cylindrical member disposed at a position where the clip connecting member 4 </ b> A is narrowed, and is disposed so as to be rotatable around the axis along the inner periphery of the tip cap 10. Therefore, by rotating the clip holding wire 4 around the axis with respect to the flexible sheath 3, the clip connecting member 4 </ b> A in a state of being pressed into the cylindrical member 13 rotates lightly in the tip cap 10. The clip 1 can be easily rotated with respect to the tip cap 10 so as to be opened in a desired direction.

  With such a configuration, as shown in FIG. 15, when the operation portion 5 performs an operation of pushing the flexible sheath 3 forward, a portion near the rear end of the clip 1 is deformed and the clip rear end contact hole is formed. At the same time, the tightening ring 2 is pushed by the flexible sheath 3 (strictly, it is pushed by the distal end face of the distal end cap 10) and moves toward the distal end of the clip 1. Is forcibly closed by the tightening ring 2. In this state, the portion near the rear end of the clip 1 is deformed into a shape that loosely passes through the clip rear end abutment hole 12 and the clip rear end holding chamber 11, so that the flexible sheath 3 is connected to the clip holding wire. If the operation of retracting backward is performed with respect to 4, the clip 1 in a state of being forcibly closed by the tightening ring 2 is lightly pushed forward from the tip base 10.

  The present invention is not limited to the above-described embodiment. For example, the rear end portion 1b of the clip 1 only needs to be bent back into a shape having a bulge, and as shown in FIG. You may form in the shape of a loop which crossed in the shape. In that case, the clamping ring 2 is disposed at a position surrounding the portion of the clip 1 that intersects with the approximately α shape, and the clip 1 is moved from the flexible sheath 3 by the portion in which the clip 1 at the rear position swells in a loop shape. It is preferable that the movement is restricted so that the tightening ring 2 does not fall out behind the clip 1 when it is removed.

1 is a side cross-sectional view of a distal end portion of an endoscope clip device according to a first embodiment of the present invention. The plane sectional view of the tip part of the clip device for endoscopes of the 1st example of the present invention. The side sectional view of the tip part in the state where the clip was closed with the outer tube of the clip device for endoscopes of the 1st example of the present invention. The side fragmentary sectional view showing the whole endoscope clip device composition of the 1st example of the present invention. The side fragmentary sectional view showing the whole composition of the state where the clip device for endoscopes of the 1st example of the present invention was operated. The side fragmentary sectional view showing the whole composition of the state where the clip device for endoscopes of the 1st example of the present invention was operated. The side fragmentary sectional view showing the whole composition of the state where the clip device for endoscopes of the 1st example of the present invention was operated. The side fragmentary sectional view showing the whole composition of the state where the clip device for endoscopes of the 1st example of the present invention was operated. Sectional drawing of the state cut | disconnected by the AA of FIG. 1 of the clip apparatus for endoscopes of 1st Example of this invention. Sectional drawing of the state cut | disconnected by the BB line of FIG. 2 of the clip apparatus for endoscopes of 1st Example of this invention. Sectional drawing of the state cut | disconnected by CC line of FIG. 1 of the clip apparatus for endoscopes of 1st Example of this invention. Side surface sectional drawing of the clip of the modification of the clip apparatus for endoscopes of 1st Example of this invention. The fragmentary perspective view of the clip of the modification of the clip apparatus for endoscopes of the 1st Example of this invention. BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a side sectional view of a distal end portion in a state in which an endoscope clip device according to a first embodiment of the present invention is operated. BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a side sectional view of a distal end portion in a state in which an endoscope clip device according to a first embodiment of the present invention is operated. Side surface sectional drawing of the front-end | tip part of the clip apparatus for endoscopes of the 2nd Example of this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 ... Clip 1b ... Rear-end part 2 ... Fastening ring 3 ... Flexible sheath 4 ... Clip holding wire (clip holding member)
4A ... Clip connecting member 8 ... Mantle tube 10 ... Tip cap (tip portion of sheath)
11 ... Clip rear end holding chamber 12 ... Clip rear end contact hole 13 ... Cylindrical member

Claims (18)

A clip formed of a material having a spring property in a shape expanded toward the front in a state where the rear end is bent back into a loop shape or a half loop shape and no external force is applied;
A cylindrical tightening ring that is fitted in a state of covering the clip and forcibly closing the clip;
A sheath for forcibly closing the clip by advancing the clamping ring toward the distal end of the clip with its distal end abutting the clamping ring;
A clip holding member that is inserted and arranged in the sheath so as to be movable in the axial direction relative to the sheath, and a distal end portion of which is detachably connected to a rear end portion of the clip in the vicinity of the distal end of the sheath; In the endoscope clip device provided,
An endoscopic clip device characterized in that a clip rear end holding chamber for storing the vicinity of the rear end portion of the clip and holding the posture of the clip constant is provided at the distal end portion of the sheath.   2. The endoscope clip device according to claim 1, wherein the clip rear end holding chamber is formed in a cylindrical shape that accommodates the vicinity of the rear end portion of the clip.   The endoscope clip device according to claim 1 or 2, wherein a ridge line portion of an outer edge of a portion near the rear end of the clip is in contact with an inner peripheral surface of the clip rear end holding chamber. An endoscope clip device in which a vicinity of a rear end portion is housed in the clip rear end holding chamber.   The endoscope clip device according to any one of claims 1 to 3, wherein a portion near the rear end of the clip is pulled into a portion behind the clip rear end holding chamber in the sheath by deformation. Endoscopic clip device that is possible.   The endoscope clip device according to claim 4, wherein a rear end portion of the clip abuts on a position corresponding to a bottom portion of the clip rear end holding chamber and the rear end portion of the clip is deformed. A clip device for an endoscope in which a clip rear end contact hole that can pass is formed.   The endoscopic clip device according to any one of claims 1 to 5, wherein the sheath is formed of a flexible member, and the clip rear end holding chamber is formed of a rigid body so that the distal end of the sheath is formed. Endoscopic clip device fixed integrally with the endoscope.   The endoscope clip device according to any one of claims 1 to 6, wherein an outer tube that elastically deforms the clip in a closed state by placing a distal end portion of the clip on the clip is the sheath and An endoscope clip device that is fitted to the sheath so as to be movable in the axial direction relative to both of the clip holding members.   The endoscope clip device according to any one of claims 1 to 7, wherein a rear end bending return portion of the clip is formed to have a narrower width than other portions.   The endoscope clip device according to any one of claims 1 to 8, wherein the fastening ring surrounds the clip at a position closer to a front side than a portion stored in the clip rear end holding chamber. Endoscopic clip device.   The endoscope clip device according to claim 9, wherein the sheath is pushed forward relative to the clip holding member so that a portion near the rear end of the clip is deformed while the sheath is deformed. An endoscope in which the clamping ring is pushed by the sheath and moves in the distal direction of the clip at the same time as it is pulled into the back part from the rear end holding chamber of the clip, and the clip is forcibly closed. Clip device.   The endoscope clip device according to claim 10, wherein a portion near the rear end of the clip is deformed and drawn into a portion deeper than the clip rear end holding chamber in the sheath, and the clip is An endoscopic clip device in which a portion near the rear end of the clip is deformed into a state in which it can pass loosely through the rear end holding chamber of the clip when it is forcibly closed by a tightening ring.   12. The endoscope clip device according to claim 1, wherein a rear end portion of the clip is bent back into a substantially U-shaped half loop shape.   13. The endoscope clip device according to claim 12, wherein the tightening ring surrounds the clip at a position closer to the front than a portion accommodated in the clip rear end holding chamber in the vicinity of the rear end portion of the clip. An endoscopic clip device, wherein the clip is formed with a protrusion for restricting the fastening ring from falling off behind the clip.   The endoscope clip device according to claim 13, wherein the protrusion is formed by deforming a member itself forming the clip.   The endoscopic clip device according to any one of claims 1 to 11, wherein a rear end portion of the clip is bent back into a loop shape intersecting substantially in an α shape.   The endoscopic clip device according to claim 15, wherein the tightening ring is disposed at a position surrounding a portion of the clip that intersects substantially α-shape, and the clip at a rear position thereof is formed in a loop shape. An endoscope clip device in which movement of the tightening ring is restricted by a swollen part so that the fastening ring does not fall off to the rear of the clip.   The endoscope clip device according to any one of claims 1 to 16, wherein the clip holding member is made of a material having a spring property in a shape that expands forward when no external force is applied to the tip of the clip holding member. A clip connecting member formed, and the clip connecting member is elastically deformed in a constricted state in the sheath and expands when engaged from the distal end of the sheath to engage with the clip Endoscopic clip device that is in a state of disengagement.   18. The endoscope clip device according to claim 17, wherein a cylindrical member for constricting the clip connecting member rotates around an axis adjacent to a rear side of the clip rear end holding chamber at a distal end portion of the sheath. Endoscopic clip device arranged freely.

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