JP4981536B2 - Endoscopic clip device - Google Patents

Description

  The present invention relates to an endoscopic clip device, and more particularly to a so-called continuous-type endoscopic clip device in which a plurality of clips are connected in series in the distal end of a sheath.

In a continuous endoscopic clip device, a plurality of clips are generally arranged in a state of being constricted and connected in series in the distal end of a sheath inserted into and removed from a treatment instrument insertion channel of the endoscope. A plurality of clips are sequentially pushed out from the distal end of the sheath by an operation wire disposed in the sheath so as to be able to advance and retreat in the axial direction. It is comprised so that connection with a clip can be released (for example, patent document 1).
JP 2006-87537 A

  In the continuous endoscopic clip device as described above, a plurality of clips are interposed between the clip clipped to the affected mucous membrane and the operation wire, and the operation wire advances and retreats as described above. It is configured to operate the clip at the tip transmitted by a plurality of clips.

  However, for example, after the clip at the tip could not be properly clipped to the affected mucous membrane, it stuck to the mucosa, or after the clip at the tip could be clipped successfully to the affected mucosa, the connection with the clip located after that If it does not come off, it will be in a so-called “neither or neither” state, and in some cases, a surgical measure may be required.

  The present invention provides an endoscopic clip that can eliminate the situation without performing a surgical procedure when the clip does not operate as intended during the clipping procedure, and when the clip stops working. An object is to provide an apparatus.

  In order to achieve the above object, an endoscope clip device according to the present invention is connected in series with a plurality of clips constricted in the distal end of a sheath inserted into and removed from a treatment instrument insertion channel of an endoscope. A plurality of clips are sequentially pushed out from the distal end of the sheath by an operation wire that is arranged in the sheathed state so as to be able to advance and retreat in the axial direction in the sheath. In an endoscopic clip device configured to be able to release the connection between a tip clip and a next clip, each clip and an operation wire are each formed of a conductive member and are electrically connected to each other. In addition to being connected to the state, the sheath is formed of an electrically insulating member, and connection means for connecting the proximal end of the operation wire to a high-frequency power source is provided.

  In addition, the weak part which is easy to be thermally destroyed may be formed near the rear end part of each clip, and the weak part is formed by making the cross-sectional area of the clip smaller than other parts locally, It may be mechanically fragile.

  According to the present invention, each clip and the operation wire are each formed of a conductive member, and are connected to a state where they are electrically connected, and the sheath is formed of an electrically insulating member, and the proximal end of the operation wire By providing a connection means for connecting to a high-frequency power supply, if the clip does not operate as intended during the clipping procedure, and if it stops working at all, the high-frequency current is applied to the clip. The situation can be resolved without surgical treatment.

  A plurality of clips are placed in a state of being connected in series in the distal end of the sheath inserted into and removed from the treatment instrument insertion channel of the endoscope, and are arranged in the sheath so as to be movable forward and backward in the axial direction. It is configured so that multiple clips can be sequentially pushed out from the tip of the sheath with the operation wire, and the clip located at the foremost position can be opened and closed and then the connection between the foremost clip and the next clip can be released. In addition, in the endoscope clip device, each clip and the operation wire are each formed by a conductive member and are connected to a state where they are electrically connected, and the sheath is formed by an electrically insulating member, and the operation wire A connecting means for connecting the base end of the clip to a high frequency power source is provided, and a fragile portion easily damaged by heat is formed in the vicinity of the rear end portion of each clip.

Embodiments of the present invention will be described below with reference to the drawings.
FIG. 1 shows an endoscopic clip device according to an embodiment of the present invention, and 1 is a flexible sheath made of an electrically insulating flexible tube such as a tetrafluoroethylene resin tube. Yes, it can be inserted into and removed from a treatment instrument insertion channel of an endoscope (not shown).

  In the tip cap 2 attached to the tip of the sheath 1, a C-ring 3 having a spring property is disposed. The C-ring 3 is prevented from moving in the axial direction, but can be elastically deformed so as to be expanded in the tip cap 2.

  In the sheath 1, an operation wire 4 made of a conductive metal that can be arbitrarily advanced and retracted from an operation unit 30 connected to the proximal end side of the sheath 1 is inserted and arranged, and a distal end of the operation wire 4 is connected via a connection tube 5. Thus, the connecting ring 6 is fixedly connected.

  In the vicinity of the distal end of the sheath 1, a plurality of clips 10 formed of a conductive metal member are arranged in series so as to be electrically connected to each other. Each clip 10 and the operation wire 4 are also electrically connected via the connecting pipe 5 and the connecting ring 6.

  As shown in FIGS. 2 and 3, the clip 10 has a pair of opening and closing arms 11 that are independently formed as shown in FIG. 2 and FIG. The front-end claw portion 12 formed in is bent in a state facing and facing inward.

  Shaft holes 13 are formed in the vicinity of the rear ends of the pair of opening and closing arms 11, and the pair of opening and closing arms 11 is freely opened and closed in a bowl shape toward the front centering on the support shaft 14 passed therethrough. can do.

  15 is a connection tail portion formed at the rear end portion of an annular connection ring 15a that controls the connection with the operation wire 4, and a pair of parallel plate portions that gently sandwich the vicinity of the rear end portion of the opening and closing arm 11; A support hole 16 through which the support shaft 14 is passed is formed. The connection tail 15 is not directly connected to the operation wire 4 but is connected to the operation wire 4 via the rear clip 10, a connection clip 20 described later, or the like.

  Reference numeral 18 denotes a fastening ring for forcibly opening and closing the pair of opening / closing arms 11, and in a standby state, as shown in FIG. 4, it is loosely fitted near the base of the opening / closing arm 11. .

  Then, as shown in FIG. 5, when the fastening ring 18 is moved rearward relative to the opening / closing arm 11, the fastening ring 18 collides with the drive cam 11 a formed at the rear end of the opening / closing arm 11 to open / close the opening / closing arm 11. The arm 11 is opened.

  When the clip 10 is pushed out from the distal end of the sheath 1, the distal end surface of the fastening ring 18 once comes into contact with the C-ring 3 and stops at that position. Is pushed from the inside of the sheath 1, the fastening ring 18 is pushed forward of the distal end cap 2 while expanding the C-ring 3 with the open / close arm 11 fully opened.

  On the contrary, as shown in FIG. 6, when the fastening ring 18 moves forward, the open / close arm 11 is forcibly closed. When the coupling tail 15 is pulled back into the sheath 1 after the fastening ring 18 is pushed forward of the front end cap 2, the rear end surface of the fastening ring 18 comes into contact with the C-ring 3 to perform such an operation.

  Returning to FIG. 1, in the vicinity of the distal end of the sheath 1, the connection tail 15 of the clip 10 positioned on the front side of the two clips 10, 10 positioned in the front-rear direction, and the clip 10 positioned on the rear side. The opening / closing arm 11 is connected.

  Specifically, the front end claw portion 12 of the open / close arm 11 of the rear clip 10 in the closed state is inserted into the connecting ring 15a located at the rear end of the front clip 10 and is electrically connected. Is engaged in a state.

  As shown in FIGS. 2 and 3, a fragile portion 19 that is easily damaged by heat is formed in the connecting tail portion 15 of the clip 10. The fragile portion 19 is formed by locally reducing the cross-sectional area of the clip 10 to a fraction of that of the other portions, and is mechanically fragile.

  Reference numeral 20 shown in FIG. 1 is a connecting clip that has the same configuration as the clip 10 and is connected to the connecting ring 6 so that it cannot be separated from the connecting ring 6, and is connected to the clip 10 positioned on the front side in the same manner as the other clips 10. Has been. All the clips 10 and 20 connected in this way are closed in the sheath 1, and the sheath 1 is inserted into and removed from the treatment instrument insertion channel of the endoscope in this state.

  In the operation unit 30, a slide operation member 32 is slidably engaged with an operation unit body 31 connected to the base end of the sheath 1, and the base end of the operation wire 4 is fixed to the slide operation member 32. It is connected to. Therefore, the operation wire 4 advances and retreats in the sheath 1 by sliding the slide operation member 32 in the operation unit 30.

  In addition, a connection terminal 33 for connecting a high-frequency power cord (not shown) is arranged on the slide operation member 32 so as to be electrically connected to the proximal end of the operation wire 4. Therefore, by connecting the high-frequency power cord to the connection terminal 33, the base end of the operation wire 4 is connected to the high-frequency power source, and a high-frequency current can be passed through the clip 10 via the operation wire 4.

  7 to 9 show the use state of the endoscope clip device. When the sheath 1 is passed through the treatment instrument insertion channel and the distal end approaches the affected area to be clipped, the operation wire 4 is moved from the proximal end side. By performing the pushing operation, as shown in FIG. 7, the most advanced clip 10 protrudes forward from the distal end of the sheath 1 and is in an open state.

  Then, after pushing the sheath 1 forward and pinching the affected mucous membrane between the pair of opening and closing arms 11 of the most advanced clip 10, the operation wire 4 is pulled toward the proximal end as shown in FIG. As a result, the open / close arm 11 of the cutting edge clip 10 slightly pulled back is forcibly closed by the fastening ring 18, and the cutting edge clip 10 is clipped to the affected mucous membrane. .

  When clipping is performed on the affected mucous membrane as described above, when the operation wire 4 is pushed again from the proximal end side as shown in FIG. 9, the cutting edge clip 10 is closed and the sheath 1 is clipped. Next, the second clip 10 is pushed out and opened to release the connection with the most advanced clip 10, and the most advanced clip 10 is left in the body.

  During such a clipping procedure, for example, as shown in FIG. 8, when the cutting edge clip 10 is clipped to the affected mucous membrane and its open / close arm 11 can no longer be opened, It is possible that the connection with the second clip 10 cannot be broken, so that neither can be done at all. FIG. 10 shows only that part extracted.

  In such a case, when a high-frequency current is applied to the clip 10 via the connection terminal 33 and the operation wire 4, the weakened portion 19 generates heat to a high temperature because the cross-sectional area is extremely small as a high-frequency current supply path. , That part becomes brittle.

  Therefore, if the operation wire 4 is pulled from the operation unit 30, as shown in FIG. 11, the fragile portion 19 of the most advanced clip 10 is broken into a state where it is torn off by the second clip 10. The connection between the clip 10 and the second clip 10 is released, and the state-of-the-art clip 10 clipped to the affected mucous membrane is safely placed in the body.

However, this invention is not limited to the said Example, For example, the thing which abbreviate | omitted the weak part 19 may be sufficient.
In that case, as shown in FIG. 12 where only the most advanced clip 10 is extracted, a high-frequency current is applied when the clip 10 at the distal end cannot be clipped to the affected mucosa and cannot be separated from the affected mucosa. As a result, as shown in FIG. 13, the affected mucosa side is cauterized, and the clip 10 can be safely removed from the affected mucosa side by dividing the tissue side without bleeding (or with very little bleeding).

It is side surface sectional drawing of the whole structure of the clip apparatus for endoscopes of the Example of this invention. It is a perspective view of the clip simple substance of the clip device for endoscopes of the example of the present invention. It is a disassembled perspective view of the clip of the clip apparatus for endoscopes of the Example of this invention. It is side surface sectional drawing of the clip single-piece | unit of the clip apparatus for endoscopes of the Example of this invention. It is side surface sectional drawing of the state by which the clip of the clip apparatus for endoscopes of the Example of this invention was forcedly opened. It is side surface sectional drawing of the state in which the clip of the clip device for endoscopes of the Example of this invention was forcedly closed. It is side surface sectional drawing which shows operation | movement of the clip apparatus for endoscopes of the Example of this invention in order. It is side surface sectional drawing which shows operation | movement of the clip apparatus for endoscopes of the Example of this invention in order. It is side surface sectional drawing which shows operation | movement of the clip apparatus for endoscopes of the Example of this invention in order. It is a perspective view which shows the state just before the connection between two clips is forcibly released in the clip apparatus for endoscopes of the Example of this invention. It is a perspective view which shows the state immediately after the connection between two clips was forcibly released in the clip device for endoscopes of the example of the present invention. It is a perspective view which shows the state from which the most advanced clip was no longer separated with respect to an affected part mucous membrane in the clip apparatus for endoscopes of the Example of this invention. It is a perspective view which shows the state in which the most advanced clip was forcibly separated from the mucous membrane of the affected part in the clip apparatus for endoscopes of the Example of this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Sheath 4 Operation wire 10 Clip 11 Opening / closing arm 18 Fastening ring 19 Fragile part 20 Linking clip 33 Connection terminal (connection means)

Claims (1)

A plurality of clips are arranged in a state of being constricted in a distal end of a sheath that is inserted into and removed from a treatment instrument insertion channel of an endoscope, and are arranged so as to be movable forward and backward in the axial direction in the sheath. The plurality of clips are sequentially pushed out from the distal end of the sheath by the operation wire, and the clip located at the foremost position is once opened and then closed, and then the connection between the foremost clip and the next clip can be released. In the endoscope clip device configured as described above,
They each clip and the operating wire is formed by each conductive member is coupled to the state of electrical conduction, the sheath is formed by an electrically insulating member Rutotomoni, the proximal end of the operating wire A connection means for connecting to a high frequency power supply is provided,
Each of the clips includes a pair of opening and closing arms made of a conductive member that can be opened and closed forward about a support shaft and is not biased in the opening and closing direction. An annular connecting ring made of a conductive member for connecting to a positioned clip is formed, and the open / close arm of the clip located behind is engaged with the connecting ring in a closed state. An endoscopic clip device characterized by comprising:

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