JP5185977B2 - Ligation device - Google Patents

Description

  The present invention relates to a ligation apparatus that uses a clip to perform hemostasis and the like.

  This type of ligation apparatus has been proposed in Japanese Patent Application Laid-Open No. 8-280701. In the conventional ligation device, an operation tube having a clip unit mounting connecting ring attached and fixed at the tip is slidably disposed in the introduction tube, and an operation wire is inserted into the operation tube to operate the clip unit connected to the connection ring. The hook member attached to the tip of the wire is detachably connected.

JP 2005-95590 A

  In the conventional ligation apparatus, the clip unit is detachable from the apparatus main body. For this reason, every time the clip is to be used, it is necessary to attach the clip unit to the hook member of the apparatus main body. .

  However, since the clip unit itself is quite small, the mounting operation of the clip unit is troublesome, and there is a problem that it takes time to prepare for actually using the ligating apparatus.

  Further, by pulling the operation wire, a strong force of a certain level or more is applied to the clip unit to stretch the hook portion of the connecting plate of the clip unit and to detach the clip. For this reason, the force applied to the hook member at the moment when the connecting plate is extended and the clip is released is released, and the hook member is drawn into the coil sheath. After that, it sometimes took time to install the new clip unit.

Further, when the clip unit is attached to the apparatus main body, the clip unit connecting plate is engaged with the hook member fixed to the tip of the operation wire.
However, since the hook member is a hard member, the length of the hard portion in the vicinity of the distal end is increased by the area occupied by the hard member, and the insertion operation into the endoscope becomes heavy.

  There are types of endoscopes called side scopes and perspective scopes, but in these types, in order to project the ligation device laterally or obliquely from the endoscope tip, As described above, when the length of the hard portion near the distal end portion is increased, the operation of inserting into the endoscope becomes heavier.

  In addition, when the ligating apparatus is used in combination with a side view scope and a perspective scope, the coil sheath where the hook member is drawn is bent tightly in the side and oblique directions, so that it deforms when the hook member is drawn into the coil sheath. easy. If the hook member is deformed, it becomes difficult to attach a new clip to the apparatus main body. For this reason, it has been generally difficult to use a ligation apparatus in combination with a side view / perspective scope.

  Further, the connection method between the apparatus main body and the clip has a problem that the clip and the apparatus main body are detached due to vibration / dropping during transportation or the like. For this reason, work such as reattaching a clip may be required when used.

  The present invention has been made paying attention to the above-mentioned problems, and the object of the present invention is that the user can take out the ligation apparatus from the pack and use it immediately, and the insertion into the endoscope is good. Furthermore, another object of the present invention is to provide a ligation apparatus that can be used in combination with a side view scope or a perspective scope.

The invention according to claim 1 includes an introduction tube that can be inserted into a living body cavity, a sheath member that is inserted into the introduction tube so as to be able to advance and retract, an operation wire that is inserted into the sheath member so as to be able to advance and retract, and this operation A connecting member that is directly connected to the tip of the wire without any other member in a state in which it cannot be removed; and a clip for ligating living tissue that is removably connected to the connecting member by pulling operation of the operating wire. A clip unit that expands the clip by a pulling operation of the operation wire , closes after the expansion, and allows the clip in the closed state to irreversibly disengage from the connecting member ; and A first operating means, which is attached near the proximal end of the introduction tube and is used to perform the forward / backward operation of the introduction tube and the sheath member, is connected to the proximal end of the operation wire, and is connected to the sheath member. A second operation means for performing forward and backward operation of the serial operation wire, a ligating device single use, characterized by comprising a.

In the invention according to claim 2, the connection between the operation wire of claim 1 and the connecting member of the clip unit is performed by passing the operation wire through a hole formed in the connecting member and folding the operation wire halfway. A ligating apparatus characterized in that a connecting member is directly connected.
According to a third aspect of the present invention, in the ligation apparatus according to the first or second aspect, the sheath is at a position where the operation wire is pulled and thereby the living tissue ligation clip is stored in the distal end portion of the introduction tube. It has a spring which positions the above-mentioned clip for living tissue ligation in a waiting position to a member.

As described above, according to the present invention, the clip can be commercialized in a state in which the clip is already attached to the apparatus main body and stored in the introduction tube and sterilized. As a result, the user can use the ligating apparatus immediately without taking the troublesome work such as mounting the clip, by simply taking out the ligating apparatus from the sterilization pack.
Further, the operation wire is connected to the connecting member of the clip unit. For this reason, problems, such as a clip and an apparatus main body coming off by transportation and handling in a mounting state, are eliminated. The user does not need to take out the ligating apparatus from the pack and then attach the clip to the apparatus main body, and can use the ligating apparatus immediately. Since the operation wire is passed through the hole of the connection member of the clip unit, the operation wire is folded back and the connection member of the clip unit and the operation wire are connected, the connection member of the clip unit and the operation wire can be reliably connected.

When connecting the clip unit connection member and the operation wire, both the clip and the device main body are disposable only once. However, the connection member (hook) having a complicated shape and the coil sheath that are provided in the conventional one are used. A pipe that is attached to the tip and guides the clip can be eliminated, and joining such as brazing and fixing between the connecting member and the operation wire becomes unnecessary. For this reason, it can provide as an inexpensive thing.
Further, since the connecting member and the pipe are eliminated, it can be inserted into the endoscope (including a side view scope and a perspective scope) with a light force. In addition, even when used in combination with a side view scope or a perspective scope, the connecting member and the pipe are eliminated, so that no burden is placed on the apparatus main body.

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

[First Embodiment]
An endoscope ligation apparatus according to a first embodiment of the present invention will be described with reference to FIGS.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Second Embodiment]
An endoscopic ligation apparatus according to a second embodiment of the present invention will be described with reference to FIG.

(Constitution)
In this embodiment, the difference from the first embodiment described above is that a hole formed at the proximal end of the connecting plate 10 is formed as a hook 20. Other configurations are the same as those of the first embodiment described above. The hook 20 has a strength sufficiently higher than the extension strength of the hook portion 12 at the tip of the connecting plate 10. In addition, the width of the opening portion 21 of the hook 20 is slightly narrower than the diameter of the operation wire 3.

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

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

[Third Embodiment]
An endoscopic ligation apparatus according to a third embodiment of the present invention will be described with reference to FIGS.

(Constitution)
The present embodiment is different from the first embodiment only in the connecting plate 10, the operation wire 3, the operation portion main body 5, the slider 6, and the clip 7, and the other configurations are the same as those in the first embodiment. It is.

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

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

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

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

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

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

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

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

(Action)
The operational effects of this embodiment are the same as those of the first embodiment described above.

(effect)
According to the present embodiment, when the grip 4 is operated and the coil sheath 2 and the introduction tube 1 are advanced and retracted, the force can be changed due to the press-fitting of the protrusion 56 and the inclined surface portion 57, so that the operation can be performed sensibly. Furthermore, since the fixing mechanism for the grip 4 and the operation portion main body 5 is constituted by the protrusion 56 and the inclined surface portion 57, no other members are required, and therefore it can be manufactured at low cost. Further, by engaging and fixing the slider 6, there is no adhesive or bonding work, and it can be manufactured at low cost.

  Further, the present invention is not limited to the above-described embodiments. According to the above description, the following items or combinations of items can be obtained.

(Appendix)
1. An introduction tube that can be inserted into the body cavity;
A sheath member inserted into the introduction tube so as to freely advance and retract;
An operation wire inserted into the sheath member so as to freely advance and retract;
A connecting member for directly connecting the distal end of the operating wire; and a living tissue ligating clip that is detachably connected to the connecting member, and the clip is closed after being expanded by a pulling operation of the operating wire. Clip unit
A first operation means attached near the proximal end of the introduction tube, for performing an advance / retreat operation of the introduction tube and the sheath member;
An endoscopic ligation apparatus comprising: a second operation means connected to a proximal end of the operation wire and performing an advance / retreat operation with the sheath member.
2. The connection between the operation wire and the connecting member of the clip unit according to the supplementary item 1 is that the operation wire and the clip unit are connected by passing the operation wire through a hole formed in the connecting member and folding the operation wire halfway. A characteristic ligation device.
3. A ligating apparatus characterized in that both of the two operation wires folded back in the middle of the supplementary item 2 are fixed to the operation slider of the second operation means.
4). A ligating apparatus characterized by embossing the inner surface of the introduction pipe according to additional items 1 to 3.

  5). The ligation apparatus characterized by embossing the outer surface of the inlet pipe of the additional notes 1-4.

  6). A ligation apparatus characterized by embossing the inner and outer surfaces of the introduction pipe according to additional items 1-5.

  7). Additional holes for retaining the clip are provided in the connection member of the clip unit of Additional Items 1 and 2, and an opening is provided in a part of the hole so that the connection member and the clip are detachable. A ligation device characterized by that.

DESCRIPTION OF SYMBOLS 1 ... Introduction tube, 2 ... Coil sheath (sheath member),
3 ... operation wire, 4 ... grip (first operation means),
5 ... operation unit main body, 6 ... slider (second operation means),
7 ... clip (unit), 8 ... nail, 9 ... presser tube,
10 ... connecting plate (connecting member), 11 ... hole in connecting plate,
12 ... Hook of connecting plate, 15 ... Spring.

Claims (3)

An introduction tube that can be inserted into the body cavity;
A sheath member inserted into the introduction tube so as to freely advance and retract;
An operation wire inserted into the sheath member so as to freely advance and retract;
A connecting member that is directly connected to the distal end of the operation wire without any other member and is connected to the connecting member so as to be detachable from the connecting member by a pulling operation of the operating wire. A clip unit that expands the clip by a pulling operation of the operation wire , closes after the expansion, and detaches the clip in the closed state from the connecting member irreversibly. ,
A first operation means attached near the proximal end of the introduction tube, for performing an advance / retreat operation of the introduction tube and the sheath member;
A second operation means connected to the proximal end of the operation wire, for performing an advance / retreat operation of the operation wire with respect to the sheath member;
A single-use ligation apparatus characterized by comprising: The connection between the operation wire according to claim 1 and the connecting member of the clip unit is such that the operation wire is passed through a hole formed in the connecting member, and the operation wire is folded back halfway, thereby directly connecting the operation wire and the connecting member . A ligation apparatus characterized by that. The second operating means pulls the operating wire, thereby positioning the biological tissue ligating clip at a standby position with respect to the sheath member at a position where the biological tissue ligating clip is housed in the distal end portion of the introduction tube. The ligation apparatus according to claim 1 or 2, further comprising a spring.

Images