JP4709822B2 - Biological tissue clip device - Google Patents

Description

  The present invention relates to a clip device for living tissue that can be inserted into a body cavity of a living body to perform a clip ligation operation.

2. Description of the Related Art Conventionally, as a biological tissue clip device, a device that incorporates a plurality of clips in an introduction tube and performs ligation work continuously is known, for example, in Patent Document 1. This is the one in which a plurality of clips are built in the introduction tube, the clip and the operation member are connected by a low melting point material, and the low melting point material is melted while being inserted into the body cavity and the clip ligation work is continuously performed. Proposed.
JP-A 63-267345

  However, the clip device disclosed in Patent Document 1 requires heating means that generates heat when the clip is opened and when the clip is ligated. For this reason, there is a problem that a complicated work is required at the time of clip ligation and it takes time. Also, the clip is protruded from the introduction tube and ligated, but when the clip is protruded, it must be operated while looking at the endoscopic image, and careful protrusion work is necessary on the hand side. There is a risk that the clip may protrude from the leading end of the introduction tube at once.

The purpose of the present invention is to provide a mechanism for preventing the clip from sticking out of the introduction tube other than the clip loaded at the leading edge, thereby eliminating the need for careful work on the hand side and simplifying the operation, It is another object of the present invention to provide a clip device for living tissue that can shorten the procedure time when performing continuous ligation and can reduce the burden on the patient and the operator.

One aspect of the present invention includes an introduction tube that can be inserted into a living body cavity, an operation wire that is inserted into the introduction tube so as to be able to advance and retreat, and a distal end of an arm portion that has a proximal end portion and extends from the proximal end portion. A living body that includes at least two or more clips having a spreadability formed in the holding portion, and performs an operation of projecting the clip from the introduction tube in accordance with a relative advancement / retraction operation of the introduction tube and the operation wire. In the tissue clip device, the introduction tube has a tip diameter-reduced portion having a tapered tip portion, and two or more clips are arranged in series in the introduction tube, so that the leading-edge first position is set. When the clip is protruded from the introduction tube, a subsequent clip protrusion prevention mechanism is provided that prevents the subsequent clip from the second position and subsequent positions from coming into contact with the inner wall of the tip reduced diameter portion and protruding from the introduction tube. Characterized by To.

According to the above configuration , by providing a mechanism for preventing the clip other than the most loaded clip from protruding from the introduction tube, a careful work on the hand side is not required, and the operation can be simplified.

According to the present invention, by providing a mechanism for preventing the clip other than the clip loaded at the leading edge of the introduction tube from protruding from the introduction tube, careful work on the hand side is not necessary, and the operation is simplified. Can do.

  Embodiments of the present invention will be described below with reference to the drawings.

  1 to 5 show a first embodiment, and FIGS. 1 to 3 are longitudinal side views of a distal end portion of a clip device for living tissue. The introduction tube 1 has flexibility that can be inserted into the channel of the endoscope, and a distal end tip 2 is provided at the distal end portion of the introduction tube 1. The tip 2 is fixed to the tip of the introduction tube 1 by welding, bonding or press fitting. An operation wire 4 is inserted into the introduction tube 1 so as to be able to advance and retreat, and a clip 3 is fixed to a distal end portion of the operation wire 4 via a ligation wire 5.

  The introduction tube 1 is, for example, a coil sheath having irregularities on the inner and outer surfaces in which a metal wire (such as stainless steel) having a round cross section is tightly wound, and a force for compressing the sheath is applied to the sheath distal end and the sheath proximal end. Even if this is done, the sheath will not buckle.

  The introduction tube 1 may be, for example, a coil sheath having a flat inner and outer surfaces that are tightly wound after crushing a metal wire (such as stainless steel) having a round cross section and making the wire cross section rectangular. In this case, since the inner surface is flat, it is easy to project the clip 3 and insert the operation wire 4. Further, a coil sheath having a large inner diameter can be realized even when the same wire diameter is used as compared with a round coil sheath. Thus, the protrusion of the clip 3 and the insertion of the operation wire 4 are further facilitated.

  Furthermore, the introduction tube 1 is made of, for example, a polymer resin (synthetic polymer polyamide, high density / low density polyethylene, polyester, polytetrafluoroethylene, tetrafluoroethylene-perfluoroalkylvinyl ether copolymer, tetrafluoroethylene- A tube sheath of hexafluoropropylene copolymer or the like may be used. In this case, since the inner and outer surfaces of the sheath are slidable, insertion into and removal from the endoscope channel, protrusion of the clip 3, and insertion of the operation wire 4 are facilitated.

  In addition, the introduction tube 1 may be, for example, a tube sheath in which a wall portion is a double tube having an inner layer and an outer layer, and a reinforcing member is interposed between the double tubes. In this case, the inner layer and the outer layer are formed of the polymer resin. The reinforcing member is formed of, for example, a cylindrical blade knitted in a lattice shape with thin metal wires. As a result, even when a force for compressing the sheath is applied to the distal end portion and the proximal end portion of the sheath, the sheath is superior in compression resistance and does not buckle as compared with the tube sheath in which the reinforcing member is not embedded. .

  The dimension of the introduction tube 1 is an outer diameter that can be inserted into the endoscope channel, and the thickness of the sheath is determined by the rigidity of the material, but a metal sheath has a high thickness of about 0.2 to 0.5 mm. In the molecular resin tube, the thickness is about 0.3 to 0.6 mm. However, by embedding a reinforcing member, there is an advantage that the thickness can be reduced and the sheath inner diameter can be increased.

  The tip 2 is a short tube made of metal (such as stainless steel), has an outer peripheral surface that is tapered, and a tip that is tapered. This facilitates the insertion of the introduction tube 1 into the endoscope channel. Further, the inner peripheral surface is also tapered, so that the clip 3 is easier to protrude than the tip 2. Further, the inner diameter of the distal end portion of the distal tip 2 is such that protrusions 3f and 3f ′ provided on arm portions 3b and 3b ′ of the clip 3 to be described later are engaged so that the arm portions 3b and 3b ′ of the clip 3 can be opened. The dimensions are set as follows. The tip outer diameter of the tip 3 is φ1.5 to 3.3 mm, and the tip inner diameter of the tip 3 is about φ1.0 to 2.2 mm.

  As shown in FIG. 4, the clip 3 is formed by bending a metal thin strip at the central portion and forming the bent portion as a base end portion 3a, and both arm portions 3b and 3b extending from the base end portion 3a. Bend 'in the spreading direction. Further, the front edge portions of the respective arm portions 3b and 3b 'are bent so as to face each other, and these are defined as sandwiching portions 3c and 3c'. One end of the sandwiching portions 3c, 3c 'is formed in a convex shape 3d and the other in a concave shape 3e so that the living tissue 6 (see FIG. 3) can be easily grasped. The arms 3b and 3b 'are provided with an open / expanding property so as to open the sandwiching portions 3c and 3c'.

  The arms 3b and 3b ′ are provided with protrusions 3f and 3f ′ that can be engaged with the distal tip 2 when the clip 3 is ligated (when the clip proximal end 3a is pulled into the distal tip 2). . As the material of the thin strip of the clip 3, for example, a superelastic alloy such as stainless steel having a spring property or a nickel titanium alloy is used.

  The operation wire 4 has an outer diameter of about 0.3 to 1.5 mm, and is, for example, a stranded wire made of stainless steel. Since it is more flexible than a single wire by using a stranded wire, the flexibility of the introduction tube 1 itself is not impaired.

  The operation wire 4 is connected to the clip 3 through a ligation wire 5. The proximal end side of the ligating wire 5 is joined to the distal end portion of the operation wire 4 by welding or adhesion. The distal end side of the ligating wire 5 is joined by welding, bonding, or forming a loop on the clip base end portion 3 a and passing it through the bent portion of the clip 3. Further, following the advance / retreat movement of the operation wire 4, it moves forward / backward with the clip 3.

  The ligating wire 5 is, for example, a stainless steel stranded wire or a single wire.

  The outer diameter of the ligating wire 5 is φ0.3 mm or less, and it is necessary to set the dimension so that the ligating wire 5 is broken by applying a force of 1 to 5 kg at the time of clip ligation.

  Next, the operation of the first embodiment will be described.

  The introduction tube 1 of the clip device is introduced into the body cavity via the endoscope channel inserted into the body cavity, and the distal end portion of the introduction tube 1 is positioned in the vicinity of the clip target tissue, for example, the gastric mucosa tissue 6. By pushing the operation wire 4 in the direction of the distal end of the introduction tube 1, the first clip 3 located at the most distal end connected to the ligation wire 5 is projected from the distal end portion of the distal end tip 2.

  Since the clip 3 is provided with an open / expanding ability to the arm portions 3b and 3b 'so as to open the sandwiching portions 3c and 3c', the sandwiching portions 3c and 3c 'are opened at the same time as protruding from the distal tip 2. The operation wire 4 is pulled in a state where the clamping portions 3c and 3c 'are pressed against the target tissue. The clip arm portions 3 b and 3 b ′ bent in the expanding direction engage with the distal end portion of the distal end tip 2.

  Further, when the operation wire 4 is pulled, protrusions 3f and 3f ′ provided on the clip arm portions 3b and 3b ′ are engaged with the distal tip 2 so that a pulling force is applied only to the clip 3, and the proximal end portion 3a of the clip 3 is moved. The target tissue can be sandwiched by plastically deforming and closing the sandwiching portions 3c and 3c ′.

  Further, the operation wire 4 is pulled, a traction force is applied to the ligation wire 5 joined to the proximal end portion 3a of the clip 3, the ligation wire 5 itself connected to the clip 3 is broken, and the operation wire 4 and the clip 3 are disconnected. Separate completely. Thereby, the ligation of the first clip 3 located at the most distal end is completed. The second and subsequent clips 3 can be ligated in the same manner as the first one.

  According to the first embodiment, by joining the respective clips and the operation wires with the ligation wires, the clip ligation operation can be performed quickly and easily simply by pushing and pulling the operation wires. Thereby, the procedure time can be shortened, and the burden on the patient and the operator can be reduced.

  FIG. 6 shows a second embodiment, and is a longitudinal side view of the distal end portion of the clip device. The same components as those in the first embodiment are denoted by the same reference numerals and description thereof is omitted. The proximal end side of the ligation wire 7 connecting the operation wire 4 and the clip 3 has a loop shape 7 a, and the loop 7 a is passed through the operation wire 4. Further, the distal end side of the ligating wire 7 is joined by welding, bonding, or forming a loop 7a on the proximal end portion 3a of the clip 3 and attaching it to the proximal end portion 3a of the clip 3. Furthermore, it is possible to freely move on the operation wire 4 without following the forward / backward movement of the operation wire 4.

  The ligature wire 7 is, for example, a metal stranded wire, a metal single wire, or a polymer fiber such as polyparaphenylene benzobisoxazole, polyethylene, or a liquid crystal polymer.

  Moreover, the outer diameter of the ligation wire 7 is φ0.3 mm or less. Further, it is necessary to set the dimensions such that a force of 1 to 5 kg is applied when the clip 3 is ligated and the ligature wire 7 is broken.

  Further, a stopper 8 is provided at the proximal end portion of the ligating wire 7. The stopper 8 can be inserted into the introduction tube 1 and is joined to the distal end portion of the operation wire 4 by welding or adhesion. The stopper 8 is made of, for example, stainless steel or rubber, and has a size that prevents the loop 7 a on the proximal end side of the ligating wire 7 from being detached from the operation wire 4.

  Next, the operation of the second embodiment will be described.

  The introduction tube 1 of the clip device is introduced into the body cavity via the endoscope channel inserted into the body cavity, and the distal end portion of the introduction tube 1 is positioned in the vicinity of the clip target tissue, for example, the gastric mucosa tissue 6. By pushing the operation wire 4 toward the distal end of the introduction tube 1, the proximal end portion 3 a of the clip 3 positioned at the nearest position is pushed out by the stopper 8, and force is applied from the distal end portion of the clip 3 to the clip 3 on the distal end side. The first clip 3 located farthest from the tip of the tip 2 is projected.

  Since the clip 3 is provided with an open / expanding ability to the arm portions 3b and 3b 'so as to open the sandwiching portions 3c and 3c', the sandwiching portions 3c and 3c 'are opened at the same time as protruding from the distal tip 2. When the operation wire 4 is pulled while the holding portions 3c and 3c ′ are pressed against the target tissue, the ligation wire 7 can freely move on the operation wire 4, so that the loop 7a of the ligation wire 7 on the operation wire 4 becomes the stopper 8. The clip arms 3 b and 3 b ′ that are hooked and pulled in the expanding direction by pulling the clip 3 located at the most distal end are engaged with the tip of the tip 2.

  Further, when the operation wire 4 is pulled, protrusions 3f and 3f ′ provided on the clip arm portions 3b and 3b ′ are engaged with the distal tip 2 so that a pulling force is applied only to the clip 3, and the proximal end portion 3a of the clip 3 is moved. The target tissue can be sandwiched by plastically deforming and closing the sandwiching portions 3c and 3c ′. Further, when the operation wire 4 is pulled, the connecting portion between the ligation wire 7 and the clip 3 is broken, and the operation wire 4 and the clip 3 are completely separated. Thereby, the ligation of the first clip 3 located at the most distal end is completed. The second and subsequent shots can be ligated in the same manner as the first shot.

  According to the second embodiment, compared with the first embodiment, since the operation wire and the ligation wire are not joined, the manufacturing cost can be reduced. Further, it is possible to prevent the operation wire from being hardened by welding or bonding of the ligation wire, and to reduce the traction force amount and the extrusion force amount of the operation wire when the angle of the endoscope is changed.

  7A and 7B show a third embodiment, wherein FIG. 7A is a longitudinal side view of the tip of the clip device, FIG. 7B is a longitudinal sectional view as seen from the direction of arrow B, and FIG. 7C shows a modification of the ligation wire. A side view and (d) are side views which show the modification of a press member. The same components as those in the first embodiment are denoted by the same reference numerals and description thereof is omitted.

  The operation wire 9 that is inserted into the introduction tube 1 so as to freely advance and retract is formed by folding one wire at the distal end of the introduction tube 1 and forming two wires at the proximal end of the introduction tube 1. The operation wire 9 is, for example, a metal stranded wire, a metal single wire, a polymer fiber such as polyparaphenylene benzobisoxazole, polyethylene, or a liquid crystal polymer, and the outer diameter is about φ0.3 to φ1.0 mm. is there. For example, the operation wire 9 may be coated with a high-slip polymer resin such as high density / low density polyethylene or polytetrafluoroethylene. The thickness of the coating is optimally about 0.05 mm to 0.1 mm, and further, the surface of the wire is subjected to embossing of 0.01 mm to 0.45 mm in order to increase the slidability of the operation wire 9. Alternatively, applying silicone oil is also effective.

  The clip 3 is connected to the operation wire 9 via the ligation wire 10. The ligation wire 10 has a loop shape, and the operation wire 9 and the clip 3 are connected by passing the loop through the operation wire 9 and the base end portion 3 a of the clip 3. Furthermore, the operation wire 9 can be freely moved regardless of the forward / backward movement of the operation wire 9.

  The ligation wire 10 is, for example, a metal stranded wire, a metal single wire, or a polymer fiber such as polyparaphenylene benzobisoxazole or polyethylene. Preferably, polyamide that easily slips on the operation wire 9 is desirable.

  Furthermore, the outer diameter of the ligating wire 10 is about φ0.15 to φ0.6 mm. Further, it is necessary to set the diameter at which the ligature wire 10 is broken by applying a force of 1 to 5 kg when the clip 3 is ligated. Further, the loop diameter of the ligating wire 10 is set to φ5 to φ20 mm, and is set to a sufficient length so that the clip 3 does not move following the forward / backward movement of the operation wire 9.

  Further, when the ligating wire 10 is broken and clip ligation is performed, if the ligating wire 10 does not remain on the clip side and is drawn into the introduction tube 1, the clip 3 is attached to the tip tip 2 when the second or subsequent clip 3 is projected. There are cases where the ligating wire 10 is caught and does not protrude. Therefore, the ligating wire 10 and the clip 3 are bonded or welded. Alternatively, as shown in FIG. 7 (c), a notch is provided in a portion that abuts on the operation wire 9 side, the ligation wire 10 is always broken on the operation wire 9 side, and the ligation wire 10 is attached to the clip 3 after ligation. It is desirable that

  The proximal end of the operation wire 9 is inserted into the pressing member 11. The pressing member 11 is flexible so that it can be inserted into the introduction tube 1. The clip 3 loaded in the introduction tube 1 protrudes from the distal end portion of the distal tip 2.

  The pressing member 11 is, for example, a coil sheath having irregularities on the inner and outer surfaces in which a metal wire (such as stainless steel) having a round cross section is tightly wound, and by moving the pressing member 11 toward the distal end side with respect to the introduction tube 1. The clip 3 can be pushed out from the introduction tube 1.

  The pressing member 11 may be, for example, a rectangular coil sheath having flat inner and outer surfaces that are obtained by crushing a metal wire (such as stainless steel) having a round cross section and making the wire cross section rectangular and then winding the wire tightly. Compared to a round coil sheath, a coil sheath having a larger inner diameter can be realized even if the same wire diameter is used. Thereby, the protrusion of the clip 3 and the insertion of the operation wire 9 are further facilitated.

  The pressing member 11 is made of, for example, a polymer resin (synthetic polymer polyamide, high density / low density polyethylene, polyester, polytetrafluoroethylene, tetrafluoroethylene-perfluoroalkylvinyl ether copolymer, tetrafluoroethylene-hexafluoro, (Propylene copolymer, etc.) tube sheath, and the inner and outer surfaces of the sheath are slippery, so that the insertion through the introduction tube 1 and the operation wire 9 can be facilitated.

  Further, the pressing member 11 has an outer diameter that can be inserted into the introduction tube 1 and an inner diameter that allows the operation wire 9 to be inserted. And the outer diameter is 3 mm or less. The inner diameter should be as large as possible. However, it is necessary to have a thickness that does not buckle even when a force is applied when the clip 3 is pushed out. Further, as shown in FIG. 7D, it is desirable that the pressing member 11 has a small outer diameter on the distal end side and a larger outer diameter on the proximal side.

  Next, the operation of the third embodiment will be described.

  The introduction tube 1 of the clip device is introduced into the body cavity via the endoscope channel inserted into the body cavity, and the distal end portion of the introduction tube 1 is positioned in the vicinity of the clip target tissue, for example, the gastric mucosa tissue 6. By pushing the pressing member 11 toward the distal end of the introduction tube 1, the proximal end portion 3 a of the clip 3 positioned at the nearest position is pushed out by the pressing member 11, and the clip on the distal end side from the distal end portion of the clip 3 is pushed. The force is transmitted to 3 and the first clip 3 located farthest from the tip of the tip 2 is protruded.

  Since the clip 3 is provided with an open / expanding ability to the arm portions 3b and 3b 'so as to open the sandwiching portions 3c and 3c', the sandwiching portions 3c and 3c 'are opened at the same time as protruding from the distal tip 2. When the two operation wires 9 coming out from the proximal end of the introduction tube 1 are pulled with the sandwiching portions 3c and 3c 'pressed against the target tissue, the ligation wire 10 can freely move on the operation wire 9, so that the introduction tube The clip arm portions 3b and 3b ′ in which the loop of the ligation wire 10 is hooked on the folded portion of the operation wire 9 at the distal end of 1 and the distalmost clip 3 is pulled and bent in the expanding direction are Engage with the tip.

  Further, when the operation wire 9 is pulled, protrusions 3f and 3f ′ provided on the clip arm portions 3b and 3b ′ are engaged with the distal tip 2 so that a pulling force is applied only to the clip 3, and the proximal end portion 3a of the clip 3 is moved. The target tissue can be sandwiched by plastically deforming and closing the sandwiching portions 3c and 3c ′.

  Further, when the operation wire 9 is pulled, the ligation wire 10 is broken and the operation wire 9 and the clip 3 are completely separated. Thereby, the ligation of the first clip 3 located at the most distal end is completed. At that time, the ligation wires 10 other than the ligation wire 10 engaged with the clip 3 located at the most distal end have a sufficient length and do not follow the pulling of the operation wire 9 and do not move. The second and subsequent shots can be ligated in the same manner as the first shot.

  According to the third embodiment, compared to the first and second embodiments, the ligation wire is passed through the operation wire and the clip bending portion at the time of assembly, so that the assembly can be easily performed and the manufacturing cost can be reduced. Is possible. Further, since the clips other than the clip located at the most distal position do not move when pulling the operation wire at the time of clip ligation, the amount of pulling force of the operation wire can be reduced.

  8 to 10 show a fourth embodiment, FIG. 8 is a longitudinal side view of the tip portion of the clip device, FIG. 9 is a perspective view of a partition member, and FIG. 10 is a cross-sectional view taken along line CC in FIG. It is. The same components as those in the third embodiment are denoted by the same reference numerals and description thereof is omitted.

  A partition member 12 is provided between the clip 3 and the operation wire 9 in order to prevent the clip arm portions 3 b and 3 b ′ and the operation wire 9 from being entangled in the introduction tube 1. The partition member 12 is an arc member cut out from a plate material or a tube. The partition member 12 may be inserted between the clip 3 and the operation wire 9 or may be adhered and fixed to the clip 3.

  The partition member 12 is a soft member such as silicon, Teflon (registered trademark), polyurethane, polyethylene, polypropylene, polyamide, GORE-TEX, or rubber. Preferably, a biocompatible material is desirable. The partition member 12 has a thickness of 1 mm or less, a length of 5 to 20 mm, and a width of about 3 mm or less.

  Next, the operation of the fourth embodiment will be described.

  The introduction tube 1 of the clip device is introduced into the body cavity via the endoscope channel inserted into the body cavity, and the distal end portion of the introduction tube 1 is positioned in the vicinity of the clip target tissue, for example, the gastric mucosa tissue 6. By pushing the pressing member 11 toward the distal end of the introduction tube 1, the proximal end portion 3 a of the clip 3 positioned at the nearest position is pushed out by the pressing member 11, and the clip on the distal end side from the distal end portion of the clip 3 is pushed. The force is transmitted to 3 and the first clip 3 located farthest from the tip of the tip 2 is protruded.

  Since the clip 3 is provided with an open / expanding ability to the arm portions 3b and 3b 'so as to open the sandwiching portions 3c and 3c', the sandwiching portions 3c and 3c 'are opened at the same time as protruding from the distal tip 2.

  When the two operation wires 9 coming out from the proximal end of the introduction tube 1 are pulled with the sandwiching portions 3c and 3c 'pressed against the target tissue, the ligation wire 10 can freely move on the operation wire 9, so that the introduction tube The clip arm portions 3b and 3b ′ in which the loop of the ligation wire 10 is hooked on the folded portion of the operation wire 9 at the distal end of the first end and the clip 3 located at the most distal end is pulled and bent in the expanding direction are Engage with the tip of the tip 2.

  Further, when the operation wire 9 is pulled, protrusions 3f and 3f ′ provided on the clip arm portions 3b and 3b ′ are engaged with the distal tip 2 so that a pulling force is applied only to the clip 3, and the proximal end portion 3a of the clip 3 is moved. The target tissue can be sandwiched by plastically deforming and closing the sandwiching portions 3c and 3c ′.

  Further, when the operation wire 9 is pulled, the ligation wire 10 is broken and the operation wire 9 and the clip 3 are completely separated. Thereby, the ligation of the first clip 3 located at the most distal end is completed. At that time, the partition member 12 is inserted between the clip 3 and the operation wire 9 in the clip 3 other than the clip located at the most distal position in the introduction tube, and the operation wire 9 and the clip arm portions 3b, 3b ′. To prevent tangling. The second and subsequent clips 3 can be ligated in the same manner as the first one.

  According to the fourth embodiment, in addition to the effects of the third embodiment, since there is no interference between the operation wire and the arm portion of the clip, the traction force amount of the operation wire is reduced, and the operation wire and the arm portion of the clip are reduced. There is an effect that it becomes possible to prevent entanglement.

  11 and 12 show a fifth embodiment, FIG. 11 is a longitudinal side view of a tip portion of a clip device, and FIG. 12 is a side view of a regulating member. The same components as those in the third embodiment are denoted by the same reference numerals and description thereof is omitted.

  In order to prevent entanglement between the clip arm portions 3 b and 3 b ′ and the operation wire 9 in the introduction pipe 1, a tube-shaped regulating member 13 that is fitted around the arm portions 3 b and 3 b ′ of the clip 3 is provided.

  The regulating member 13 is made of a soft material such as silicon or rubber. Preferably, a biocompatible material is desirable. Further, it is desirable that the cut 13a is provided so that the clip 3 is easily opened when the clip 3 is ligated. Furthermore, it is desirable that the thickness of the regulating member 13 is about 0.3 mm or less, preferably thin and easy to tear.

  Next, the operation of the fifth embodiment will be described.

  The introduction tube 1 of the clip device is introduced into the body cavity via the endoscope channel inserted into the body cavity, and the distal end portion of the introduction tube 1 is positioned in the vicinity of the clip target tissue, for example, the gastric mucosa tissue 6.

  By pushing the pressing member 11 toward the distal end of the introduction tube 1, the proximal end portion 3 a of the clip 3 positioned at the nearest position is pushed out by the pressing member 11, and the clip on the distal end side from the distal end portion of the clip 3 is pushed. The force is transmitted to 3 and the first clip 3 located farthest from the tip of the tip 2 is protruded.

  Since the clip 3 is provided with an open / expanding ability to the arm portions 3b and 3b 'so as to open the sandwiching portions 3c and 3c', the sandwiching portions 3c and 3c 'are opened at the same time as protruding from the distal tip 2. When the two operation wires 9 coming out from the proximal end of the introduction tube 1 are pulled with the sandwiching portions 3c and 3c 'pressed against the target tissue, the ligation wire 10 can freely move on the operation wire 9, so that the introduction tube The clip arm portions 3b and 3b ′ in which the loop of the ligation wire 10 is hooked on the folded portion of the operation wire 9 at the distal end of the first end and the clip 3 located at the most distal end is pulled and bent in the expanding direction are Engage with the tip of the tip 2.

  Further, when the operation wire 9 is pulled, protrusions 3f and 3f ′ provided on the clip arm portions 3b and 3b ′ are engaged with the distal tip 2 so that a pulling force is applied only to the clip 3, and the proximal end portion 3a of the clip 3 is moved. The target tissue can be sandwiched by plastically deforming and closing the sandwiching portions 3c and 3c ′.

  Further, when the operation wire 9 is pulled, the ligation wire 10 is broken and the operation wire 9 and the clip 3 are completely separated. At that time, the clip 3 other than the clip located at the most distal position in the introduction tube prevents the operation wire 9 and the clip arm portions 3 b and 3 b ′ from being entangled by the regulating member 13. Thereby, the ligation of the first clip 3 located at the most distal end is completed.

  Similarly, in the second and subsequent shots, the pressing member 11 is pushed out toward the distal end of the introduction tube 1, thereby protruding the clip 3 positioned farthest from the tip of the tip 2. At the same time as protruding from the tip 2, the restricting member 13 is torn due to the openability of the clip 3, and the holding portions 3 c and 3 c ′ are opened. The following can be ligated in the same way as the first shot.

  According to the fifth embodiment, in addition to the effects of the third embodiment, since the spread of the arm portion of the clip in the introduction tube is restricted by the restriction member, the hook between the inner surface of the introduction tube and the arm portion of the clip is caught. Therefore, when pushing the clip toward the distal end of the introduction tube, the pushing member 11 can be pushed by a smaller force.

  FIGS. 13 to 15 show a sixth embodiment, FIG. 13 (a) is a longitudinal side view of the tip of the clip device, (b) is a view seen from the direction of arrow D, and (c) is a view from the direction of arrow E. FIG. 14 is a side view of a target tissue sandwiched between clips, and FIG. 15 is a perspective view of a clip clamping ring. Although FIG. 13A is composed of five clips, the clips may be loaded in series as long as space in the introduction pipe is allowed. That is, if there is room in the introduction pipe, six or more clips may be loaded. The same components as those in the third embodiment are denoted by the same reference numerals and description thereof is omitted.

  The clip 14 of the present embodiment is formed by bending a thin metal strip at the middle portion and forming the bent portion as a base end portion 14a. The arms 14b and 14b ′ extending from the base end portion 14a are crossed with each other. It has a different shape. The base end portion 14a side of the clip 14 has a substantially elliptical shape. Furthermore, the front edge portions of the arm portions 14b and 14b 'of the clip 14 are bent so as to face each other, and these are used as clamping portions 14c and 14c'. One end of the sandwiching portions 14c and 14c 'is formed in a convex shape 14d and the other is formed in a concave shape 14e so that the living tissue can be easily grasped. The arm portions 14b and 14b 'are provided with an open and expandability so as to open the sandwiching portions 14c and 14c'. As the material of the thin strip of the clip 14, a superelastic alloy such as stainless steel having a spring property or nickel titanium alloy is used.

  Further, a clip fastening ring 15 is fitted to the clip 14. The clip tightening ring 15 is formed of a resin or metal having strength and elasticity. In addition, a pair of two blades 15a and 15a 'which are elastically deformed and can be protruded and retracted in the circumferential direction are provided on the outer periphery of the ring. The number of blades is not limited to one pair or two, but may be three or four. When an external force is applied in a direction perpendicular to the circumferential surface of the ring, the blades 15a and 15a 'are folded on the inner surface of the tightening ring. Since the blades 15a and 15a ′ are in contact with the inner surface of the introduction tube 1 and the inner surface of the tip 2, the tip side is inclined surfaces 15b and 15b ′, and the blades 15a and 15a ′ are extruded from the introduction tube 1 and the tip 2 smoothly and without resistance. Can be done.

  The clip tightening ring 15 closes the clip arm portions 14b and 14b 'by being fitted and attached to the clip arm portions 14b and 14b', and has a substantially tubular shape. The clip 14 and the operation wire 9 are engaged by passing the ligating wire 10 through the clip base end portion 14a.

  The blades 15a and 15a ′ of the clip clamping ring 15 may be loaded in the introduction tube 1 in a folded state, but the blades 15a and 15a ′ may be loaded into the introduction tube 1 in a state of protruding. , 15a ′ can be maintained over a long period of time. Further, since the contact resistance between the inner surface of the introduction pipe 1 and the blades 15a, 15a 'is reduced, the force when the clip 14 is moved in the introduction pipe 1 can also be reduced.

  The clip clamping ring 15 is formed by injection molding, for example, a strong and elastic resin (polybutyterephthalate, polyamide, polyphenylamide, liquid crystal polymer, polyetherketone, polyphthalamide). Alternatively, for example, an elastic metal (superelastic alloy such as stainless steel or nickel titanium alloy) or the like is formed by injection molding, cutting, plastic processing, or the like.

  The tubular portion of the clip tightening ring 15 has an inner diameter of about 0.6 to 1.3 mm and an outer diameter of about 1.0 to 2.1 mm. In consideration of the engagement with the tip 2, the outermost diameter portion when the blades 15 a and 15 a ′ protrude is set to φ1 mm or more.

  Next, the operation of the sixth embodiment will be described.

  The introduction tube 1 of the clip device is introduced into the body cavity via the endoscope channel inserted into the body cavity, and the distal end portion of the introduction tube 1 is positioned in the vicinity of the clip target tissue, for example, the gastric mucosa tissue 6. By pushing the pressing member 11 toward the distal end of the introduction tube 1, the proximal end portion of the clip clamping ring 15 located at the nearest position is pushed out by the pressing member 11, and is positioned at the nearest position from the clip clamping ring 15. The force is transmitted to the clip 14 to be moved, and further, the force is transmitted from the distal end portion of the clip 14 to the clip clamping ring 15 on the distal end side, and the first clip 14 located farthest from the distal end portion of the distal end tip 2. And the clip clamping ring 15 is protruded.

  The blades 15 a and 15 a ′ of the clip fastening ring 15 are folded when passing through the tip 2, but when passing through the tip 2, the blades 15 a and 15 a ′ project again. This prevents the clip clamping ring 15 from entering the tip 2 again.

  When the two operation wires 9 coming out from the proximal end of the introduction tube 1 are pulled with the holding portions 14a and 14a 'of the clip 14 pressed against the target tissue, the ligation wire 10 can freely move on the operation wire 9. The loop of the ligation wire 10 is hooked on the folded portion of the operation wire 9 at the distal end of the introduction tube 1, the clip 14 located at the most distal end is pulled, and the blades 15a and 15a 'of the clip fastening ring 15 are at the tips. Engage with the tip of the tip 2.

  Further, when the operation wire 9 is pulled, the elliptical portion of the base end portion 14 a of the clip 14 is drawn into the clip tightening ring 15. Here, since the size of the elliptical part is larger than the inner diameter of the clip fastening ring 15, the elliptical part is crushed by the clip fastening ring 15. Then, the clip arm portions 14b and 14b 'are greatly expanded outward.

  In this state, the clip 14 is guided so as to sandwich the target living tissue. Further, by pulling the operation wire 9, the arm portions 14 b and 14 b ′ of the clip 14 are drawn into the clip fastening ring 15, and the clamping portions 14 c and 14 c ′ of the clip 14 are closed. In a state where the living tissue is sandwiched between the clip arms 14b and 14b ', the operation wire 9 is further pulled, the ligation wire 10 is broken, and the engagement between the operation wire 9 and the clip 14 is released. Thereby, the first clip 14 located at the most distal position can be placed in the body cavity while holding the living tissue. The second and subsequent shots can be ligated in the same manner as the first shot.

  According to the sixth embodiment, in addition to the effects of the third embodiment, the clip tightening ring closes the arm portion of the clip, so that there is an effect that the living tissue can be ligated with a stronger force.

  FIG. 16 shows a seventh embodiment, and FIGS. 16A to 16D are longitudinal side views of the distal end portion of the clip device. The same components as those in the third embodiment are denoted by the same reference numerals and description thereof is omitted.

  As shown in FIG. 16, the distal end tip 2 whose inner diameter gradually narrows toward the distal end is fixed to the distal end of the introduction tube 1. As shown in FIG. 16, the operation wire 22 includes a bulging portion 22a and a proximal end wire 22 '. The proximal wire 22 'and the operation wire 22 are welded or bonded. Alternatively, when the core wire of the base end wire 22 ′ composed of a metal stranded wire is used as the operation wire 22, a single wire can be used and the number of parts can be reduced, so that the manufacturing cost can be reduced. The diameter of the proximal end wire 22 'is about 0.3 to 1.5 mm.

  A plurality of clips 3 are loaded in series on the distal side of the introduction tube 1. These clips 3 are basically the same clips 3 as in the first embodiment, but an opening 3g is provided in a bent portion of the base end 3a, and an operation wire 22 is inserted into the opening 3g. ing. A bulging portion 22 a slightly larger than the opening 3 g is provided at the distal end portion of the operation wire 22, and the bulging portion 22 a is engaged with the proximal end portion 3 a of the most advanced clip 3. When the clip 3 is loaded in the introduction tube 1, the holding portions 3 c and 3 c ′ of the clip 3 are in contact with the state in which the proximal end portion 3 a of the clip 3 immediately before is held.

  Next, the operation of the seventh embodiment will be described.

  When the proximal end wire 22 ′ is advanced or the introduction tube 1 is retracted from the state shown in FIG. 16A, the most advanced clip 3 is advanced through the second and third clips 3. If the button is further pressed, the holding portions 3c and 3c ′ of the second clip 3 holding the first base end portion 3a come into contact with the inner wall of the tip 2 as shown in FIG. This prevents the clip 3 from protruding from the tip of the introduction tube 1. As shown in FIG. 4B, the arms 3b and 3b 'of the foremost clip 3 are greatly opened. When the proximal end wire 22 ′ is pulled in this state, the protrusions 3 f and 3 f ′ provided on the arm portions 3 b and 3 b ′ of the clip 3 are engaged with the distal end portion of the distal end tip 2, and a traction force is applied only to the clip 3. Is done. Further, when the proximal end wire 22 ′ is pulled, the proximal end portion 3 a of the clip 3 is plastically deformed, and the sandwiching portions 3 c and 3 c ′ are closed to sandwich the target tissue 6.

  When the proximal wire 22 ′ is further pulled, the hole 3g of the proximal end 3a of the clip 3 is deformed and enlarged by the distal bulging portion 22a of the operational wire 22 as shown in FIG. 22 can place the clip 3 in the living tissue. Note that the second and subsequent clips 3 can be performed in the same manner as the first operation, and only one clip can be ejected and ligated.

  Therefore, it is not necessary to perform a protruding operation carefully, the operation can be simplified, the procedure time can be shortened when performing continuous ligation, and the burden on the patient and the operator can be reduced. . In addition, since the number of parts is small, the manufacturing cost can be reduced.

  FIGS. 17 to 19 show an eighth embodiment, FIGS. 17A to 17E are longitudinal side views showing the tip of the clip device, and FIG. 18A is a side view of the operation unit of the clip device. (B) is sectional drawing which follows the FF line, FIG. 19 is a vertical side view of a clip clamping ring. The same components as those in the sixth embodiment are denoted by the same reference numerals and description thereof is omitted.

  As shown in FIG. 17, in the introduction pipe 1, three clips 14 having the same shape as in the sixth embodiment and clip fastening rings 29 as shown in FIG. 19 are alternately arranged in series. As shown in FIG. 15, the clip clamping ring 29 has the same structure as that of the sixth embodiment. Blades 30a and 30a 'as engaging means are provided, and the tips of the blades 30a and 30a' are inclined downwardly inclined surfaces 30b and 30b toward the tip of the clip clamping ring 29 in order to contact the inner surface of the tip 2. 'Is formed. The base end portion 31 of the clip tightening ring 29 is provided with a cylindrical small diameter portion 31a.

  As shown in FIG. 17, the clip 3 is connected to the operation wire 9 via the ligation wire 10. The ligation wire 10 has a loop shape, and the operation wire 9 and the clip 3 are connected by passing the loop through the operation wire 9 and the base end portion 3 a of the clip 3. Furthermore, the operation wire 9 can be freely moved regardless of the forward / backward movement of the operation wire 9.

  As shown in FIG. 18, the operation unit 23 is provided with a rod-shaped operation unit main body 24. A proximal end portion of the introduction tube 1 is fixed to a distal end portion of the operation portion main body 24 by a fixing screw 25. The proximal end portion of the pressing member 11 inserted into the introduction tube 1 is inserted into the inner cavity of the operation portion main body 24 and connected to a first slider 26 that is fitted to the operation portion main body 24 so as to be able to advance and retract. Further, the proximal end portion of the operation wire 9 inserted through the pressing member 11 is extended to the proximal end side of the operation portion main body 24 and is connected to a second slider 27 that is fitted to the operation portion main body 24 so as to be movable forward and backward. Yes. Also, a finger ring 28 is provided at the base end portion of the operation unit main body 24.

  Accordingly, the pressing member 11 can be moved forward by operating the first slider 26 and the clip 3 can be protruded, and the ligation operation of the clip 14 can be performed via the operating wire 9 by operating the second slider 27.

  Next, the operation of the eighth embodiment will be described.

  The introduction tube 1 of the clip device is introduced into the body cavity via the endoscope channel inserted into the body cavity, and the distal end portion of the introduction tube 1 is positioned in the vicinity of the clip target tissue 6. When the first slider 26 is operated from the state shown in FIG. 17A to push the pressing member 11 toward the distal end of the introduction tube 1, the operation is performed from the distal end of the distal tip 2 as shown in FIG. The first-most clip 14 and the clip clamping ring 29 connected to the wire 9 protrude.

  The blades 30 a and 30 a ′ of the clip tightening ring 29 are folded when passing through the tip 2, but when passing through the tip 2, the blades 30 a and 30 a ′ project again.

  As shown in FIG. 3C, when the operation wire 9 is pulled toward the hand side by operating the second slider 27, the proximal end portion 31 of the clip fastening ring 29 is drawn into the introduction tube 1 from the distal tip 2. However, the blades 30a and 30a ′ abut against the tip 2 to prevent the clip fastening ring 29 from entering the introduction tube 1 again. When the operation wire 9 is further pulled toward the proximal side, the proximal end portion 14a of the clip 14 is drawn into the clip fastening ring 29 via the ligating wire 10, and the clamping portions 14c and 14c 'of the clip 14 are expanded.

  In this state, when the operation wire 9 is further pulled in a state where the clamping portions 14 a and 14 a ′ of the clip 14 are pressed against the target tissue 6, the arm portions 14 b and 14 b ′ of the clip 14 are drawn into the clip fastening ring 29. The clamping portions 14c and 14c ′ of the clip 14 are closed. When the operation wire 9 is further pulled in a state where the target tissue 6 is sandwiched between the sandwiching portions 14c and 14c ', the ligation wire 10 is broken as shown in FIG. Therefore, the clip 14 including the clip fastening ring 29 and the operation wire 9 are separated.

  In this ligation operation, as shown in FIG. 5B, the small diameter portion 31a at the proximal end portion 31 of the clip fastening ring 20 connected to the second clip 14 is clamped by the clip portions 14c and 14c. 'Is held, and the second clip 14 can be prevented from protruding from the tip of the introduction tube 1. The second and subsequent clips 14 can be ligated in the same manner as the first operation.

  According to the embodiment, since the clip 14 can reliably receive the force applied by the operation wire 9 by the engaging means, the living tissue can be ligated with a stronger force. Further, since the arm portions 14b and 14b 'of the clip 14 are closed by the clip tightening ring 29, the living tissue can be ligated with a stronger force.

  Further, when the clip portions 14c and 14c ′ of the clip 14 grip the clip tightening ring 29, the clip portions 14c and 14c ′ of the clip 14 collide with the tip 2 and the clip 14 and the clip clamp securely positioned at the forefront. Only the attachment ring 29 can be protruded.

  Furthermore, since the small-diameter portion 31a of the base end portion 31 of the clip tightening ring 29 is cylindrical, the area gripped by the clip portions 14c and 14c 'of the clip 14 is increased, and there is an effect that it is easy to grip.

  The shape of the clip fastening ring 29 is not limited to the above embodiment, and the base end portion 31 may be conical as shown in FIG. If formed in this way, even if the holding portions 14c and 14c ′ of the clip 14 are once removed from the base end portion 31 of the clip tightening ring 29, the base end portion 31 is conical, and therefore the pressing member 11 is pushed. Thus, the clip portions 14 c and 14 c ′ of the clip 14 can naturally grip the proximal end portion 31 of the clip tightening ring 29. Further, it is not necessary to intentionally hold the base end portion 31 of the clip fastening ring 29 by the holding portions 14c and 14c 'of the clip 14 at the time of assembly, so that the assembly can be facilitated.

  FIG. 21 shows a ninth embodiment, and FIGS. 21A to 21D are longitudinal side views showing the tip of the clip device.

  As shown in FIG. 21, three clips 14 and clip fastening rings 29 having the same shape as in the eighth embodiment are alternately arranged in series in the introduction pipe 1. However, the base end portion 31 of the clip fastening ring 29 of the present embodiment does not have the small diameter portion 31a. In this embodiment, the length of the operation wire 9 inserted through the introduction tube 1 is limited, and when the clip 14 and the clip fastening ring 29 are protruded from the distal end portion of the introduction tube 1 by the pressing member 11, the operation wire 9. Is configured so as not to protrude from the tip of the introduction tube 1.

  Next, the operation of the ninth embodiment will be described.

  The introduction tube 1 of the clip device is introduced into the body cavity via the endoscope channel inserted into the body cavity, and the distal end portion of the introduction tube 1 is positioned in the vicinity of the clip target tissue 6. When the pressing member 11 is pushed out from the state shown in FIG. 21A toward the distal end of the introduction tube 1, as shown in FIG. 21B, the most distal end connected to the operation wire 9 from the distal end portion of the distal tip 2. The first clip 14 and the clip fastening ring 29 located at the position protrude.

  The blades 30 a and 30 a ′ of the clip tightening ring 29 are folded when passing through the tip 2, but when passing through the tip 2, the blades 30 a and 30 a ′ project again.

  As shown in FIG. 5C, when the operation wire 9 is pulled toward the hand side, the proximal end portion 31 of the clip fastening ring 29 is drawn into the introduction tube 1 from the distal tip 2, but the blades 30 a and 30 a ′ are It abuts against the tip 2 and prevents the clip clamping ring 29 from entering the introduction tube 1 again. When the operation wire 9 is further pulled toward the proximal side, the proximal end portion 14a of the clip 14 is drawn into the clip fastening ring 29 via the ligating wire 10, and the clamping portions 14c and 14c 'of the clip 14 are expanded.

  In this state, when the operation wire 9 is further pulled in a state where the clamping portions 14 a and 14 a ′ of the clip 14 are pressed against the target tissue 6, the arm portions 14 b and 14 b ′ of the clip 14 are drawn into the clip fastening ring 29. The clamping portions 14c and 14c ′ of the clip 14 are closed. When the operation wire 9 is further pulled in a state where the target tissue 6 is sandwiched between the sandwiching portions 14c and 14c ', the ligation wire 10 is broken as shown in FIG. Therefore, the clip 14 including the clip fastening ring 29 and the operation wire 9 are separated.

  During this ligation operation, the length of the operation wire 9 is regulated so as not to protrude from the distal end portion of the introduction tube 1, and the proximal end from the rear end of the blades 30 a and 30 a ′ of the first clip fastening ring 29. The length of the clip 14 is set so as to extend from the tip of the tip 2, so that the second clip 14 can be prevented from protruding from the tip of the introduction tube 1. The second and subsequent clips 14 can be ligated in the same manner as the first operation.

  According to this embodiment, since only the length of the operation wire 9 is regulated, a complicated structure is not required and the number of parts is small, so that the manufacturing cost can be reduced.

  FIG. 22 shows the tenth embodiment, and FIGS. 22A to 22D are longitudinal side views showing the tip of the clip device.

  As shown in FIG. 22, three clips 14 and clip fastening rings 29 having the same shape as in the ninth embodiment are alternately arranged in series in the introduction tube 1. A distal end portion of the operation wire 9 is connected to a proximal end portion 14 a of the clip 14 via a ligation wire 10.

  The base end portion 31 of the clip tightening ring 29 is provided with a plurality of expansion pieces 31b that can be expanded and contracted in the radial direction. A cylindrical expansion member 34 is fixed to the middle portion of the connecting wire 9. The expansion member 34 is press-fitted between the expansion pieces 31 b of the clip fastening ring 29, and the expansion piece 31 b is expanded, and the introduction pipe is expanded. 1 is loaded.

  The expansion member 34 is made of a strong metal, resin, or the like, and is fixed to the ligature wire 10 by welding, adhesion, press fitting, or the like. The expansion member 34 has an outer diameter of about 0.7 to 1.5 mm and a length of 0.5 mm or more.

  Next, the operation of the tenth embodiment will be described.

  The introduction tube 1 of the clip device is introduced into the body cavity via the endoscope channel inserted into the body cavity, and the distal end portion of the introduction tube 1 is positioned in the vicinity of the clip target tissue 6. The pressing member 11 is pushed out from the state shown in FIG. At this time, a cylindrical expansion member 34 is fixed to the middle part of the ligature wire 10, and since this expansion member 34 is press-fitted between the expansion pieces 31b of the clip tightening ring 29 to expand the expansion pieces 31b, The extension piece 31b abuts against the inner surface of the tip 2 and, as shown in FIG. 5B, the first clip 14 located at the most distal position connected to the operation wire 9 from the tip of the tip 2 The clip clamping ring 29 protrudes.

  The blades 30 a and 30 a ′ of the clip tightening ring 29 are folded when passing through the tip 2, but when passing through the tip 2, the blades 30 a and 30 a ′ project again.

  As shown in FIG. 5C, when the operation wire 9 is pulled toward the hand side, the proximal end portion 31 of the clip fastening ring 29 is drawn into the introduction tube 1 from the distal tip 2, but the blades 30 a and 30 a ′ are It abuts against the tip 2 and prevents the clip clamping ring 29 from entering the introduction tube 1 again. When the operation wire 9 is further pulled toward the proximal side, the proximal end portion 14a of the clip 14 is drawn into the clip fastening ring 29 via the ligating wire 10, and the clamping portions 14c and 14c 'of the clip 14 are expanded. Further, the expansion member 34 escapes from the expansion piece 31b of the clip fastening ring 29, and the expansion piece 31b contracts.

  In this state, when the operation wire 9 is further pulled in a state where the clamping portions 14 a and 14 a ′ of the clip 14 are pressed against the target tissue 6, the arm portions 14 b and 14 b ′ of the clip 14 are drawn into the clip fastening ring 29. The clamping portions 14c and 14c ′ of the clip 14 are closed. When the operation wire 9 is further pulled in a state where the target tissue 6 is sandwiched between the sandwiching portions 14c and 14c ', the ligation wire 10 is broken as shown in FIG. Therefore, the clip 14 including the clip fastening ring 29 and the operation wire 9 are separated. The second and subsequent clips 14 can be ligated in the same manner as the first operation.

  According to this embodiment, since the clip fastening ring 29 abuts on the distal end tip 2 of the introduction tube 1 by the expansion member 34, only the clip 14 and the clip fastening ring 29 located at the foremost end can be protruded.

  FIG. 23 shows the eleventh embodiment, and FIGS. 23A to 23E are vertical side views showing the tip of the clip device.

  As shown in FIG. 23, three clips 14 and clip fastening rings 29 having the same shape as in the ninth embodiment are alternately arranged in series in the introduction tube 1. A distal end portion of the operation wire 9 is connected to a proximal end portion 14 a of the clip 14 via a ligation wire 10. The base end portion 31 of the clip clamping ring 29 has an outer diameter that expands when a compressive force is applied, and a bellows-shaped expansion member 35 that decreases the outer diameter when the compressive force is released. It is loaded.

  The bellows-shaped expansion member 35 is made of a springy metal, polymer resin, or the like. When the compression force is applied, the expanded outer diameter is always larger than the inner diameter of the tip of the tip, and φ1.1 to 3.5 mm Degree. The expansion member 35 is fixed to the proximal end portion of the clip tightening ring 29 by welding, adhesion, press-fitting, or the like.

  Next, the operation of the eleventh embodiment will be described.

  The introduction tube 1 of the clip device is introduced into the body cavity via the endoscope channel inserted into the body cavity, and the distal end portion of the introduction tube 1 is positioned in the vicinity of the clip target tissue 6. As shown in FIG. 23A, when the pressing member 11 is pushed out toward the distal end of the introduction tube 1, the third clip 14 presses the expansion member 35 of the clip fastening ring 29 of the second clip 14. Since the second clip 14 presses the expansion member 35 of the clip tightening ring 29 of the first clip 14, the expansion member 35 is compressed and the outer diameter is expanded.

  Accordingly, as shown in FIG. 5B, when the pressing member 11 is pushed out toward the distal end of the introduction tube 1, the expansion member 35 is expanded, so that the expansion member 35 comes into contact with the inner surface of the distal tip 2 and the distal end The first clip 14 and the clip clamping ring 29 located at the most distal end connected to the operation wire 9 are protruded from the tip of the tip 2.

  The blades 30 a and 30 a ′ of the clip tightening ring 29 are folded when passing through the tip 2, but when passing through the tip 2, the blades 30 a and 30 a ′ project again.

  As shown in FIG. 5C, when the operation wire 9 is pulled toward the hand side, the proximal end portion 31 of the clip fastening ring 29 is drawn into the introduction tube 1 from the distal tip 2, but the blades 30 a and 30 a ′ are It abuts against the tip 2 and prevents the clip clamping ring 29 from entering the introduction tube 1 again. When the operation wire 9 is further pulled toward the proximal side, the proximal end portion 14a of the clip 14 is drawn into the clip fastening ring 29 via the ligating wire 10, and the clamping portions 14c and 14c 'of the clip 14 are expanded.

  In this state, when the operation wire 9 is further pulled in a state where the clamping portions 14 a and 14 a ′ of the clip 14 are pressed against the target tissue 6, the arm portions 14 b and 14 b ′ of the clip 14 are drawn into the clip fastening ring 29. The clamping portions 14c and 14c ′ of the clip 14 are closed. When the operation wire 9 is further pulled in a state where the target tissue 6 is sandwiched between the sandwiching portions 14c and 14c ', the ligation wire 10 is broken as shown in FIG. Accordingly, since the expansion member 35 is separated from the second clip 14, the pressing force on the expansion member 35 is released, the expansion member 35 has a reduced outer diameter, and the expansion member 35 passes through the tip 2, As shown in e), the clip 14 including the clip fastening ring 29 and the operation wire 9 are separated. The second and subsequent clips 14 can be ligated in the same manner as the first operation.

  According to this embodiment, since the clip fastening ring 29 abuts on the distal end tip 2 of the introduction tube 1 by the expansion member 35, only the clip 14 and the clip fastening ring 29 located at the foremost end can be projected.

  FIG. 24 shows the twelfth embodiment, and FIGS. 24A to 24D are longitudinal side views showing the tip of the clip device.

  FIG. 24 shows a state in which the last clip 14 and the clip fastening ring 29 having the same shape as in the ninth embodiment are arranged in the introduction tube 1. A distal end portion of the operation wire 9 is connected to a proximal end portion 14 a of the clip 14 via a ligation wire 10. A stopper 36 made of a short tube is fitted to the distal end portion of the pressing member 11 so that the outer diameter of the distal end portion of the pressing member 11 is large.

  The stopper 36 is made of metal, polymer resin, or the like, and is securely fixed to the distal end portion of the pressing member 11 by welding, adhesion, press fitting, or the like. The outer diameter of the stopper 36 is necessarily larger than the inner diameter of the tip of the tip, and is about φ1.1 to 3.5 mm. Further, when the length of the stopper 36 becomes long, it becomes a hard part and the clip 14 may not be pushed at an angle, so it is desirable that the length is as short as possible.

  Next, the operation of the twelfth embodiment will be described.

  The introduction tube 1 of the clip device is introduced into the body cavity via the endoscope channel inserted into the body cavity, and the distal end portion of the introduction tube 1 is positioned in the vicinity of the clip target tissue 6. As shown in FIG. 24 (a), when the pressing member 11 is pushed out toward the distal end of the introduction tube 1, the last clip 14 and the clip clamping ring 29 are moved toward the distal end of the introduction tube 1 as shown in FIG. 24 (b). It protrudes through the chip 2. At this time, the stopper 36 at the distal end of the pressing member 11 contacts the inner surface of the distal tip 2, and the distal end of the pressing member 11 does not protrude from the distal end of the introduction tube 1.

  The blades 30 a and 30 a ′ of the clip tightening ring 29 are folded when passing through the tip 2, but when passing through the tip 2, the blades 30 a and 30 a ′ project again.

  As shown in FIG. 5C, when the operation wire 9 is pulled toward the hand side, the proximal end portion 31 of the clip fastening ring 29 is drawn into the introduction tube 1 from the distal tip 2, but the blades 30 a and 30 a ′ are It abuts on the tip 2 and prevents the clip clamping ring 9 from entering the introduction tube 1 again. When the operation wire 9 is further pulled toward the proximal side, the proximal end portion 14a of the clip 14 is drawn into the clip fastening ring 29 via the ligating wire 10, and the clamping portions 14c and 14c 'of the clip 14 are expanded.

  In this state, when the operation wire 9 is further pulled in a state where the clamping portions 14 a and 14 a ′ of the clip 14 are pressed against the target tissue 6, the arm portions 14 b and 14 b ′ of the clip 14 are drawn into the clip fastening ring 29. The clamping portions 14c and 14c ′ of the clip 14 are closed. When the operation wire 9 is further pulled in a state where the target tissue 6 is sandwiched between the sandwiching portions 14c and 14c ', the ligation wire 10 is broken as shown in FIG. Therefore, the clip 14 including the clip fastening ring 29 and the operation wire 9 are separated.

  According to the present embodiment, since the stopper 36 is provided at the distal end portion of the pressing member 11, the distal end portion of the pressing member 11 does not protrude from the distal end portion of the introduction tube 1, and only the last clip 14 and the clip fastening ring 29 are provided. Can stick out.

  FIG. 25 shows the thirteenth embodiment, and FIGS. 25A to 25D are longitudinal side views showing the tip of the clip device.

  As shown in FIG. 25, three clips 14 and clip fastening rings 29 having the same shape as in the ninth embodiment are alternately arranged in series in the introduction tube 1. A plate-like joining member 37 that contacts the tip 2 is connected to the tip of the operation wire 9. A ligation wire 10 is inserted into the operation wire 9, and the ligation wire 10 is engaged with the joining member 37 or engaged with the distal end portion of the operation wire when the clip is ligated. The bonding member is made of a strong resin, metal, or the like, and is fixed to the tip of the operation wire by welding, bonding, or the like. Further, it is desirable that the joining member has a size that does not get in the way when the clip protrudes when the ligating wire is broken when the clip is ligated.

  Next, the operation of the thirteenth embodiment will be described.

  The introduction tube 1 of the clip device is introduced into the body cavity via the endoscope channel inserted into the body cavity, and the distal end portion of the introduction tube 1 is positioned in the vicinity of the clip target tissue 6. As shown in FIG. 25 (a), when the pressing member 11 is pushed out in the direction of the distal end of the introduction tube 1, as shown in FIG. The first clip 14 located at the most distal end connected to the operation wire 9 and the clip tightening ring 29 protrude from the tip portion of the tip 2.

  The blades 30 a and 30 a ′ of the clip tightening ring 29 are folded when passing through the tip 2, but when passing through the tip 2, the blades 30 a and 30 a ′ project again.

  As shown in FIG. 5C, when the operation wire 9 is pulled toward the hand side, the proximal end portion 31 of the clip fastening ring 29 is drawn into the introduction tube 1 from the distal tip 2, but the blades 30 a and 30 a ′ are It abuts against the tip 2 and prevents the clip clamping ring 29 from entering the introduction tube 1 again. When the operation wire 9 is further pulled toward the proximal side, the proximal end portion 14a of the clip 14 is drawn into the clip fastening ring 29 via the ligating wire 10, and the clamping portions 14c and 14c 'of the clip 14 are expanded.

  In this state, when the operation wire 9 is further pulled in a state where the clamping portions 14 a and 14 a ′ of the clip 14 are pressed against the target tissue 6, the arm portions 14 b and 14 b ′ of the clip 14 are drawn into the clip fastening ring 29. The clamping portions 14c and 14c ′ of the clip 14 are closed. When the operation wire 9 is further pulled in a state where the target tissue 6 is sandwiched between the sandwiching portions 14c and 14c ', the ligation wire 10 is broken as shown in FIG. Therefore, the clip 14 including the clip fastening ring 29 and the ligating wire 10 are separated. The second and subsequent clips 14 can be ligated in the same manner as the first operation.

  According to this embodiment, since the joining member 37 abuts on the tip 2, only the clip 14 and the clip tightening ring 29 located at the foremost end can be protruded.

  FIG. 26 shows the fourteenth embodiment, and FIGS. 26A to 26D are longitudinal side views showing the tip of the clip device.

  As shown in FIG. 26, three clips 14 and clip fastening rings 29 having the same shape as in the ninth embodiment are alternately arranged in series in the introduction tube 1. A guide wire 38 is stretched along the axial direction inside the introduction tube 1, and the distal end portion of the guide wire 38 is connected to a post 39 projecting in the vicinity of the distal end portion of the introduction tube 1.

  A ligation wire 10 is connected to the base end portion 14 a of the clip 14, and the ligation wire 10 is movably inserted into the guide wire 38. Similarly, the ligation wire 10 is movably inserted into the folded back operation wire 9. The post 39 is made of metal or resin, and is securely fixed to the inner surface of the tip or the tip of the introduction tube by welding, adhesion, press fitting, or the like. The post 39 has a size that does not get in the way when the clip protrudes, and preferably has an outer diameter of 1 mm or less and a length of 1.5 mm or less. The guide wire 38 is a metal single wire or a stranded wire, a polymer fiber, or the like, and preferably has a diameter as small as possible. The guide wire 38 and the post 39 are fixed by welding, bonding or the like.

  Next, the operation of the fourteenth embodiment will be described.

  The introduction tube 1 of the clip device is introduced into the body cavity via the endoscope channel inserted into the body cavity, and the distal end portion of the introduction tube 1 is positioned in the vicinity of the clip target tissue 6. As shown in FIG. 26 (a), when the pressing member 11 is pushed out toward the distal end of the introduction tube 1, it is connected via a ligature wire 10 located at the distal end of the operation wire 9 as shown in FIG. 26 (b). The first distal clip 14 and the clip clamping ring 29 which are located at the most distal end protrude. At this time, the loop portion of the ligature wire 10 is locked to the post 39 at the distal end portion of the guide wire 38, and the ligature wire 10 does not protrude from the distal end portion of the introduction tube 1.

  The blades 30 a and 30 a ′ of the clip tightening ring 29 are folded when passing through the tip 2, but when passing through the tip 2, the blades 30 a and 30 a ′ project again.

  As shown in FIG. 5C, when the operation wire 9 is pulled toward the hand side, the proximal end portion 31 of the clip fastening ring 29 is drawn into the introduction tube 1 from the distal tip 2, but the blades 30 a and 30 a ′ are It abuts against the tip 2 and prevents the clip clamping ring 29 from entering the introduction tube 1 again. When the operation wire 9 is further pulled toward the proximal side, the proximal end portion 14a of the clip 14 is drawn into the clip fastening ring 29 via the ligating wire 10, and the clamping portions 14c and 14c 'of the clip 14 are expanded.

  In this state, when the operation wire 9 is further pulled in a state where the clamping portions 14 a and 14 a ′ of the clip 14 are pressed against the target tissue 6, the arm portions 14 b and 14 b ′ of the clip 14 are drawn into the clip fastening ring 29. The clamping portions 14c and 14c ′ of the clip 14 are closed. When the operation wire 9 is further pulled in a state where the target tissue 6 is sandwiched between the sandwiching portions 14c and 14c ', the ligation wire 10 is broken as shown in FIG. Therefore, the clip 14 including the clip fastening ring 29 and the operation wire 9 are separated. The second and subsequent clips 14 can be ligated in the same manner as the first operation.

  According to this embodiment, the ligature wire 10 is locked to the post 39 at the distal end portion of the guide wire 38, and the ligature wire 10 does not protrude from the distal end portion of the introduction tube 1. Only the clamping ring 29 can be ejected. The second and subsequent clips 14 can be ligated in the same manner as the first operation.

  According to each of the embodiments, the following configuration is obtained.

  (Supplementary Note 1) An introduction tube that can be inserted into a living body cavity, an operation wire that is inserted into the introduction tube so as to be able to advance and retreat, at least two clips, and a coupling structure that engages the clip and the operation wire. A biological tissue clipping device comprising: the biological tissue clipping device, wherein when the clip is ligated, the pulling force of the operation wire is always applied only to the clip located at the most distal position.

  (Supplementary note 2) In the biological tissue clip device according to supplementary note 1, the clip located at the most distal position engages with the operation wire, and the other clips can freely move on the operation wire. A clip device for living tissue, characterized by having a structure.

  (Supplementary note 3) The biological tissue clipping device according to supplementary note 1, wherein the connection structure is a loop-shaped wire formed between the operation wire and the clip.

  (Supplementary note 4) In the biological tissue clip device according to any one of Supplementary notes 1 to 3, a clip fastening ring for closing the clip clamping portion by fitting and attaching to the arm portion of the clip; Provided on at least one of the introduction pipe or the fastening ring, and when the clip and the fastening ring protrude forward of the introduction pipe, the introduction pipe and the fastening ring are engaged, and the fastening is performed. A clip device for living tissue, comprising engagement means for prohibiting the ring from being stored again in the introduction tube.

  (Supplementary Note 5) In the biological tissue clip device according to any one of Supplementary Notes 1 to 3, when a tensile force is applied between the clip and the operation wire, the connection structure is deformed more than the operation wire. Or the clip device of the biological tissue characterized by being easy to fracture | rupture.

  (Appendix 6) An introduction tube that can be inserted into a living body cavity, an operation wire that is inserted into the introduction tube so as to be able to advance and retreat, at least two or more clips, and a coupling structure that engages the clip and the operation wire A biological tissue clip device comprising: a partition member provided between the clip and the operation wire.

  (Supplementary note 7) In the biological tissue clip device according to supplementary note 6, a clip clamping ring that closes a clip clamping portion by being fitted and attached to an arm portion of the clip, and the introduction tube or Provided in at least one of the tightening rings, and when the clip and the tightening ring protrude forward of the introduction tube, the introduction tube and the tightening ring are engaged, and the tightening ring is in the introduction tube. And a clip device for living tissue, characterized in that it comprises an engaging means for prohibiting it from being stored again.

  (Supplementary Note 8) In the biological tissue clip device according to Supplementary Note 6, when a tensile force is applied between the clip and the operation wire, the connection structure is more easily deformed or broken than the operation wire. A biological tissue clip device.

  (Supplementary Note 9) An introduction tube that can be inserted into a living body cavity, an operation wire that is inserted into the introduction tube so as to freely advance and retract, at least two clips, and a coupling structure that engages the clip and the operation wire A biological tissue clipping device comprising: a regulating member for externally fitting at least a part of the pair of arms of the clip.

  (Supplementary note 10) In the biological tissue clip device according to supplementary note 9, a clip tightening ring that closes a clip clamping portion by fitting and attaching to an arm portion of the clip, and the introduction tube or Provided in at least one of the tightening rings, and when the clip and the tightening ring protrude forward of the introduction tube, the introduction tube and the tightening ring are engaged, and the tightening ring is in the introduction tube. And a clip device for living tissue, characterized in that it comprises an engaging means for prohibiting it from being stored again.

  (Supplementary note 11) In the biological tissue clip device according to supplementary note 9, when a tensile force is applied between the clip and the operation wire, the connection structure is more easily deformed or broken than the operation wire. A biological tissue clip device.

  (Supplementary Note 12) An introduction tube that can be inserted into a living body cavity, an operation wire that is inserted into the introduction tube so as to be able to advance and retreat, and a clamping portion that has a proximal end portion and extends from the proximal end portion And a clip device for living tissue comprising at least two or more clips having an open and expandability, wherein two or more clips are arranged in series in the introduction tube, and the clip is protruded from the introduction tube. A clip device for living tissue, comprising a mechanism for preventing the clip other than the most loaded clip from protruding from the introduction tube.

  (Supplementary note 13) The biological tissue clipping device according to supplementary note 12, wherein the clip holding part grips the proximal end portion of the clip located at the adjacent distal end.

  (Supplementary note 14) In the biological tissue clip device according to supplementary note 12, a clip clamping ring that closes a clip clamping part by being fitted and attached to an arm part of the clip, and an introduction tube or a clamping ring Engagement means provided at least on one side, for engaging the introduction tube and the fastening ring when the clip and the fastening ring protrude forward of the introduction tube, and prohibiting the fastening ring from being stored again in the introduction tube And an operating member that is inserted through an introduction tube disposed behind the clip fastening ring located at the nearest position so as to be able to advance and retreat.

  (Supplementary note 15) The biological tissue clip device according to supplementary note 14, wherein each clip holding portion grips a proximal end portion of a clip fastening ring located at an adjacent distal end.

  (Supplementary note 16) The biological tissue clipping device according to supplementary note 15, wherein the shape of the proximal end portion of the clip clamping ring is a cylinder.

  (Supplementary note 17) The biological tissue clipping device according to supplementary note 15, wherein the shape of the proximal end portion of the clip clamping ring is a cone.

  (Supplementary note 18) The biological tissue clipping device according to supplementary note 14, wherein the operation wire is arranged behind the distal end of the introduction tube and does not protrude from the distal end portion of the introduction tube.

  (Supplementary note 19) In the biological tissue clip device according to supplementary note 14, the base end portion of the clip tightening ring abuts the distal end portion of the introduction tube by the expansion member fitted into the base end portion of each clip tightening ring. A clip device for living tissue, wherein the expansion member can be separated from the distal end portion of the introduction tube by being removed from the clip clamping ring by ligation.

  (Supplementary note 20) The biological tissue clip device according to supplementary note 14, wherein an expansion member whose outer diameter expands when a compression force is applied to a proximal end portion of each clip clamping ring is provided. .

  (Supplementary note 21) The biological tissue clipping device according to supplementary note 14, wherein the operating member does not protrude from the distal end of the introduction tube.

  (Supplementary note 22) In the biological tissue clip device according to supplementary note 14, the proximal end portion of the clip clamping ring and the joining member abut against the distal end portion of the introduction tube when the clip is projected by the joining member attached to the distal end of the operation wire. A biological tissue clip device.

  (Supplementary note 23) The biological tissue clip device according to supplementary note 14, wherein the connecting member for engaging the clip and the operation wire is disposed behind the distal end portion of the introduction tube and does not protrude from the distal end of the introduction tube. Biological tissue clip device.

The 1st Embodiment of this invention is shown, and the vertical side view of the front-end | tip part of a clip apparatus is shown. The longitudinal cross-sectional side view of the front-end | tip part of the clip apparatus which shows the same embodiment. The longitudinal cross-sectional side view of the front-end | tip part of the clip apparatus which shows the same embodiment. The clip of the same embodiment is shown, (a) is a top view, (b) is a side view, (c) is a figure seen from arrow A direction. The side view of the state which showed the same embodiment and pinched | interposed the target structure | tissue with the clip. The 2nd Embodiment of this invention is shown, and the vertical side view of the front-end | tip part of a clip apparatus is shown. 3 shows a third embodiment of the present invention, (a) is a longitudinal side view of the tip of the clip device, (b) is a longitudinal sectional view as seen from the direction of arrow B, and (c) is a modification of the ligation wire. Side view, (d) is a side view showing a modification of the pressing member. The vertical side view of the front-end | tip part of the clip apparatus which shows 4th Embodiment of this invention. The perspective view of the partition member which shows the embodiment. Sectional drawing which shows the same embodiment and follows CC line of FIG. The vertical side view of the front-end | tip part of the clip apparatus which shows 5th Embodiment of this invention. The side view of the control member which shows the embodiment. The 6th Embodiment of this invention is shown, (a) is the vertical side view of the front-end | tip part of a clip apparatus, (b) is the figure seen from the arrow D direction, (c) is the figure seen from the arrow E direction. The side view of the state which showed the same embodiment and pinched | interposed the target structure | tissue with the clip. The perspective view of the clip clamping ring which shows the same embodiment. The 7th Embodiment of this invention is shown, (a)-(d) is a vertical side view of the front-end | tip part of a clip apparatus. The 8th Embodiment of this invention is shown, (a)-(e) is a vertical side view of the front-end | tip part of a clip apparatus. The same embodiment is shown, (a) is a side view of an operation part, (b) is a sectional view which meets an FF line. The longitudinal section side view of the clip clamp ring which shows the embodiment. The vertical side view which shows the modification of the clip fastening ring of the embodiment. The 9th Embodiment of this invention is shown, (a)-(d) is a vertical side view of the front-end | tip part of a clip apparatus. The 10th Embodiment of this invention is shown, (a)-(d) is a vertical side view of the front-end | tip part of a clip apparatus. The 11th Embodiment of this invention is shown, (a)-(e) is a vertical side view of the front-end | tip part of a clip apparatus. The 12th Embodiment of this invention is shown, (a)-(d) is a vertical side view of the front-end | tip part of a clip apparatus. The 13th Embodiment of this invention is shown, (a)-(d) is a vertical side view of the front-end | tip part of a clip apparatus. The 14th Embodiment of this invention is shown, (a)-(d) is a vertical side view of the front-end | tip part of a clip apparatus.

Explanation of symbols

  DESCRIPTION OF SYMBOLS 1 ... Introduction tube, 2 ... Tip, 3 ... Clip, 4 ... Operation wire, 5 ... Ligation wire

Claims (7)

An introduction tube that can be inserted into a living body cavity, an operation wire that is inserted into the introduction tube so as to be able to advance and retreat, and an opening that has a proximal end portion and that has a clamping portion formed at the distal end of an arm portion that extends from the proximal end portion. A biological tissue clip device comprising at least two or more clips having extensibility, and performing an operation of projecting the clip from the introduction tube in accordance with a relative advance / retreat operation of the introduction tube and the operation wire,
The introduction tube has a tip diameter-reduced portion whose tip portion is tapered,
When two or more clips are arranged in series in the introduction tube, and the clip at the most advanced first shot position is protruded from the introduction tube, the subsequent clip after the second shot position becomes the tip reduced diameter portion. A clip device for living tissue, comprising a protrusion prevention mechanism for a succeeding clip that abuts against the inner wall of the tube and prevents the protrusion from protruding from the introduction tube.   The protrusion preventing mechanism is configured such that the holding portion of the clip at the second shot position that holds the proximal end portion of the clip at the first shot position hits the reduced diameter portion of the introduction tube. The biological tissue clip device according to claim 1, wherein: The clip has a clip tightening ring that closes the arm by fitting and attaching to the arm.
The protrusion preventing mechanism is configured such that the clip portion of the clip at the second shot position that holds the proximal end portion of the clip tightening ring of the clip at the first shot position hits the reduced diameter portion of the introduction tube. The biological tissue clip device according to claim 1, wherein the device is a living tissue clip device.   The clip tightening ring is provided with at least a pair of engaging means projecting in a circumferential direction on an outer peripheral portion of a cylindrical ring tip portion, and the tip diameter-reduced portion of the introduction tube is provided at the tip of the engaging means. The living tissue clip device according to claim 3, wherein a descending inclined surface to be contacted is formed, and a cylindrical small-diameter portion is provided at a base end portion of the ring.   The biological tissue clip device according to claim 4, wherein the small-diameter portion of the clip tightening ring is formed in a conical shape. The clip has a clip fastening ring that closes the arm portion by fitting and attaching to the arm portion, and the base end portion is connected to the operation wire via a ligature wire,
The introduction pipe has a pressing member that pushes the clip tightening ring and the clip toward the distal end of the introduction pipe,
The protrusion preventing mechanism has such a length that the operation wire does not protrude from the distal end portion of the introduction tube when the pressing member projects the clip and the clip clamping ring from the distal end portion of the introduction tube. The biological tissue clip device according to claim 1. The clip has a clip fastening ring that closes the arm portion by fitting and attaching to the arm portion, and the base end portion is connected to the operation wire via a ligature wire,
The introduction pipe has a pressing member that pushes the clip tightening ring and the clip toward the distal end of the introduction pipe,
The protrusion prevention mechanism is provided with a plurality of expansion pieces that can be expanded and contracted in the radial direction at the base end portion of the clip tightening ring, and an expansion member is fixed to a middle portion of the ligature wire,
With the expansion member press-fitted between the expansion pieces at the base end of each clip clamping ring, the expansion pieces are expanded and loaded into the introduction pipe,
When the clip at the most advanced first position is protruded from the introduction tube, the expansion member is removed from the clip tightening ring by ligation, so that the first position from the reduced diameter portion of the introduction tube. 2. The clip according to claim 1, wherein the clip can be separated, and a proximal end portion of the clip fastening ring of the subsequent clip after the second position is in contact with the reduced diameter portion. Biological tissue clip device.

Images