JP5259782B2 - Biological tissue clip device - Google Patents

Description

  The present invention relates to a clip device for a living tissue that is inserted into a body cavity of a living body and grips the living tissue.

  Conventionally, as a clipping device for living tissue, for example, Japanese Utility Model Laid-Open No. 2-6011 and Japanese Patent Laid-Open No. 63-267345 are known. In Japanese Utility Model Laid-Open No. 2-6011, the clip and the operation wire are engaged with each other via a hook provided at the tip of the operation wire and the tip of the hook via a connecting member having a hook.

  Japanese Patent Laid-Open No. 63-267345 discloses that a plurality of clips are built in an introduction tube, the clip and the operating member are connected by a low melting point substance, and the low melting point substance is continuously melted while being inserted into the body cavity. It is designed to perform ligation work.

Japanese Utility Model Publication No. 2-6011 JP-A 63-267345

  However, in Japanese Utility Model Laid-Open No. 2-6011, only one clip can be attached to the distal end of the introduction tube. Therefore, only one clip is inserted into the body cavity through the forceps channel of the endoscope once. I can not use it. For this reason, when clipping biological tissue at a plurality of locations in the living body lumen, it is necessary to pull out the clip device from the forceps channel of the endoscope every time, attach the clip, and insert it again into the forceps channel. It was. Therefore, there is a drawback that it is a complicated operation and takes too much time.

  Moreover, in cases where a clip is applied to a bleeding part, there are many cases that are very urgent, and in such cases, complicated and time-consuming work has become a very problem.

  In order to solve these problems, Japanese Patent Application Laid-Open No. 63-267345 discloses a clip device that can be continuously ligated only once through a forceps channel. In the clip device disclosed here, a plurality of clips are connected with a low melting point material, respectively, and temperature control is performed with a heating element provided at the tip, thereby performing continuous ligation. . In other words, the heating element is heated to a temperature at which the low melting point material melts, thereby releasing the connection between the clips.

  However, providing the heating element at the distal end of the sheath has a problem that the structure of the apparatus is complicated and a heat source is required separately. Further, in order to open a clip made of a shape memory material, it is necessary to heat the clip to a predetermined transformation temperature T1. That is, after the clip is opened, in order to melt the low melting point material and ligate the living tissue with certainty, the relationship between the temperature T1 for opening the clip and the temperature T2 for melting the low melting point material It is necessary to reliably control the above. However, this temperature control is very difficult. The clip device disclosed in Japanese Patent Laid-Open No. 63-267345 requires a 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.

  The present invention has been made paying attention to the above-mentioned circumstances, and the object of the present invention is to continue clipping while attaching a plurality of clips to the introduction tube and inserting them once into the forceps channel. An object of the present invention is to provide a clip device for living tissue with good operability.

  In order to achieve the above object, an invention according to claim 1 is arranged in an introduction tube that can be inserted into a living body cavity, an operation wire that is inserted in the introduction tube so as to be able to advance and retract, and each of the operation tube is a base tube. An end portion, an arm portion extending from the base end portion, a clamping portion formed at the tip of the arm portion, and a tightening ring that can be fitted over the arm portion from the base end portion, At least two or more clips and a plurality of clips positioned behind the plurality of clips are inserted into the introduction pipe so as to freely advance and retreat, and a plurality of clips in the introduction pipe are pressed by pressing the last clip of the plurality of clips. A pressing member for pushing the clip forward, and the rear end surface of the tightening ring is formed at an end surface having an angle that matches the angle of the front end surface of the clamping portion in the clip positioned after the clip of the tightening ring, Of the clamping ring A clipping device of the biological tissue, wherein a plurality of clips is contiguous in a state where the clamping portion distal end face of the clip end surface and rear end abuts in close contact.

  According to the present invention, a plurality of clips loaded in the introduction tube can be placed in the body cavity only by inserting the clip device into the body cavity once. Therefore, every time a clip is placed in the body cavity, the troublesome work of pulling the clip device out of the body cavity, reloading the clip, and reinserting it into the body cavity is not necessary. Thereby, since the procedure time can be shortened, the pain of the patient can be reduced. In addition, since the operation wires are connected to the clips, one clip can be placed in the body cavity quickly, easily, and surely. Further, the rear end surface of the clamping ring is formed on an end surface having an angle corresponding to the angle of the front end surface of the clamping portion of the clip located after the clip of the clamping ring, and the clamping ring is held between the rear end surface of the clamping ring and the clip on the rear end side. A plurality of clips are surely connected in a state in which the front end surface of the part is in close contact with and abuts.

The 1st form is shown, (a) is a vertical side view of the front-end | tip part in the clip apparatus of a biological tissue, (b) is sectional drawing which follows an AA line. The same form is shown, (a)-(c) is an operation explanatory view. The clip of the same form is shown, (a) is a plan view, (b) is a side view, (c) is a view seen from an arrow B direction, and (d) is a view seen from an arrow C direction. Sectional drawing of an operation wire which shows the same form. The same form is shown, (a) is a side view of a state where a clip is placed in a living tissue, (b) is a view seen from the direction of arrow D. The side view of the operation wire which shows a 2nd form. The same form is shown, (a)-(k) is explanatory drawing which shows the manufacturing method of an operation wire. The 3rd form is shown, (a) is a vertical side view of the front-end | tip part in the clip apparatus of a biological tissue, (b) is sectional drawing which follows an EE line. The same form is shown, (a)-(c) is a vertical side view of the front-end | tip part in the clip apparatus of a biological tissue. The clip of the same form is shown, (a) is a plan view, (b) is a side view, (c) is a view seen from an arrow B direction, and (d) is a view seen from an arrow C direction. The perspective view of the clip fastening ring which shows the same form. The perspective view which showed the same form and was notched partially of the clip unit. The side view of the state which showed the form and the clip was detained in the biological tissue. The 4th form is shown, (a) is a vertical side view of the clip apparatus of a biological tissue, (b) is sectional drawing which follows a FF line. The 5th form is shown, (a) is a vertical side view of the clip apparatus of a biological tissue, (b) is sectional drawing which follows a GG line. The perspective view of the press member of the same form. The vertical side view of the clip apparatus of the 6th form. The perspective view of the clip of a 7th form. The top view of the clip of the same form, a side view, and the expanded side view of the flat swelling part. The top view and side view of the clip of the same form. The vertical side view of the clip apparatus of an 8th form. The top view and side view of the clip of 1st Embodiment of this invention. The 1st Embodiment of this invention is shown, (a) is a longitudinal side view of the front-end | tip part of the clip apparatus of a biological tissue, (b) is the longitudinal cross-sectional view, (c) is sectional drawing which follows a HH line | wire, (D) is sectional drawing which follows an II line, (e) is sectional drawing which follows a JJ line. The longitudinal cross-sectional side view of the front-end | tip part of the clip apparatus of the biological tissue which shows the same embodiment and demonstrates an effect | action. The vertical side view of the front-end | tip part of the clip apparatus of the biological tissue which shows the 2nd Embodiment of this invention and demonstrates the effect | action. The side view of the operation part with a ratchet which shows a 9th form and controls advancing and retreating of an introduction pipe. The same form is shown, (a) is a longitudinal side view of the introduction pipe connecting portion, (b) is a sectional view taken along the line KK. The same form is shown, (a) is a longitudinal side view of the operation portion with a ratchet, (b) is a cross-sectional view along the line LL, (c) is a cross-sectional view along the line MM. The same form is shown, (a) is a longitudinal side view of the operation portion with a ratchet, (b) is a sectional view taken along line NN, (c) is a sectional view taken along line OO. A vertical side view of an operation part with a ratchet which shows a 10th form. The vertical side view of the front-end | tip part of an inlet tube which shows the same form. The other embodiment is shown, and a case where five clips are loaded on the introduction tube is shown, (a) is a longitudinal side view of the introduction tube, and (b) is a cross-sectional view taken along the line PP.

  Hereinafter, embodiments of the present invention and modes related to the embodiments of the present invention will be described with reference to the drawings.

  1 to 5 show a first embodiment, FIG. 1 (a) is a longitudinal side view of a distal end portion of a biological tissue clip device, and FIG. 1 (b) is a cross-sectional view taken along line AA. 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 which can project and retract from the distal end portion of the introduction tube 1 is detachably connected to the distal end portion of the operation wire 4.

  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 0.7 mm. In the case of a molecular resin tube, the thickness is about 0.3 to 0.8 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 end tip 2 is dimensioned so that a protrusion provided on an arm portion of the clip 3 described later can be engaged and the arm portion of the clip 3 can be opened. The tip outer diameter of the tip 2 is φ1.5 to 3.3 mm, and the tip inner diameter of the tip 2 is about φ1.0 to 2.2 mm.

  As shown in FIGS. 3 (a) to 3 (d), the clip 3 is formed by bending a metal thin strip at a central portion, and the bent portion serves as a base end portion 3a, and extends from the base end portion 3a. Both arms 3b and 3b 'are bent in the expanding 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'. The tip of the sandwiching portions 3c and 3c 'is formed with a convex shape 3d on one side and a concave shape 3e on the other side so that the living tissue X (see FIGS. 2 and 5) can be easily grasped. The arm portions 3b and 3b 'are provided with an open extension so as to open the sandwiching portion 3c. A flange 3f protruding rearward is attached to the base end portion 3a. The flange 3f is formed by bending a stainless steel thin plate extending from the base end 3a into a substantially J shape.

  Each of the arms 3b and 3b ′ is provided with protrusions 3g and 3g ′ that can be engaged with the tip 2 when the clip 3 is ligated (when the clip base end is pulled into the tip). .

  The material of the thin strip of the clip 3 is made of, for example, stainless steel having a spring property, so that it has rigidity and can securely grasp the living tissue.

  For example, if the arms 3b and 3b 'are imparted with a spreading ability as a superelastic alloy such as a nickel titanium alloy, the arms 3b and 3b' are more reliably opened when protruding from the sheath.

  When a tensile force amount of about 1 to 5 kg is applied to the flange 3f provided at the base end portion of the clip 3, the flange 3f cannot maintain the J-shape and deforms to extend in a substantially I-shape.

  Further, the thickness of the strip plate of the clip 3 is 0.15 to 0.3 mm, and the plate widths of the clamping portions 3c and 3c 'are 0.5 to 1.2 mm. The plate widths of the arm portions 3b and 3b 'are 0.5 to 1.5 mm. The size of the protrusions 3g and 3g 'is 0.2 to 0.5 mm. The plate width of the base end 3a is 0.3 to 0.5 mm. The flange 3f is projected from the proximal end portion 3a of the clip 3 with a length of about 1 to 3 mm.

  As shown in FIG. 4, the operation wire 4 includes a loop wire 4a and a proximal wire 4b. A loop wire 4a closed at the tip of a proximal end wire 4b made of a metal strand is formed. The loop wire 4a is formed by one strand of the proximal end wire 4b.

  The joining of the loop wire 4a and the proximal end wire 4b may be welded or bonded via a metal connection pipe 4c. However, after forming a closed loop with one strand of the proximal end wire 4b, the base wire is again connected. You may twist back to the end wire 4b. By forming the loop in this way, the loop can be formed at the joint between the loop wire 4a and the operation wire 4 without using a special joining component and without providing a hard part.

  As a result, the outer diameter of the engaging portion between the loop wire 4a and the operation wire 4 is not increased, which is very effective when it is desired to reduce the outer diameter of the operation wire 4 as much as possible. As will be described later, when a plurality of clips 3 are loaded in the introduction tube 1, the clearance in the introduction tube 1 is very small. Therefore, it is effective to use this wire. Note that the loop wire 4 a is engaged with the clip 3 by being hooked on the flange portion 3 f provided at the proximal end portion 3 a of the clip 3.

  The operation wire 4 is a stranded wire made of stainless steel, for example, and by being a stranded wire, the operation wire 4 is more flexible than a single wire, so the flexibility of the introduction tube 1 itself is not impaired. Moreover, by using a stranded wire, the wire can be arranged at an arbitrary position in the introduction tube 1 by utilizing its flexibility. Thereby, the insertion of the wire in the introduction tube 1 becomes easy, and the clip 3 protrudes and ligation becomes easier.

  The base wire 4d of the operation wire 4 includes a polymer resin (synthetic polymer polyamide, high density / low density polyethylene, polyester, polytetrafluoroethylene, tetrafluoroethylene-perfluoroalkylene vinyl ether copolymer, tetra By coating a fluoroethylene-hexafluoropropylene copolymer or the like, the slipping property of the operation wire can be improved. The optimum thickness of the coating is about 0.05 mm to 0.1 mm. Furthermore, in order to improve the slidability of the operation wire, it is also effective to perform an embossing of 0.01 mm to 0.45 mm on the wire surface.

  A force of 1 to 5 kg is applied to the loop wire 4a when the clip is ligated. At this time, it is necessary to set dimensions so that the loop wire 4a is not broken. The proximal wire 4b has an outer diameter of φ0.3 mm or more, and the loop wire 4a has a φ0.15 mm or more.

  Further, as shown in FIG. 3, the loop wire 4 a at the distal end portion of the operation wire 4 is engaged with the flange 3 f provided at the proximal end portion 3 a of the clip 3 to form the clip unit 5.

  Each component configured as described above is incorporated in the introduction pipe 1 as shown in FIG. That is, three clip units 5 are arranged in series in the introduction pipe 1. However, the number of clip units 5 is not limited to three, and a larger number of clip units 5 may be loaded in the introduction tube 1.

  For convenience of explanation, the following names are given to the clip units 5 loaded in the introduction tube 1. A clip 61, a clip 62, and a clip 63 are sequentially arranged from the clip loaded at the forefront. The operation wires engaged with the clips 61, 62, and 63 are referred to as an operation wire 64, an operation wire 65, and an operation wire 66, respectively.

  In the introduction tube 1, the operation wires 64, 65, and 66 engaged with the clips 61, 62, and 63 respectively extend to the proximal end portion of the introduction tube 1. The operation wire 64 is disposed in the introduction tube 1 so as to avoid interference with the clips 62 and 63. Further, the operation wire 65 is disposed in the introduction tube 1 so as to avoid interference with the clip 63. FIG. 1B shows a cross-sectional view of the clip 63 disposed at the most proximal end. In order to avoid interference with the arm portions 3 b and 3 b ′ of the clip 63, the operation wires 64 and 65 are arranged in a direction perpendicular to the opening leg direction of the arms 3 b and 3 b ′ of the clip 63. Thereby, the operation wires 64, 65, and 66 can be easily inserted into the introduction tube 1, and the clips 61, 62, and 63 are protruded and the ligation work becomes easier.

  Next, the operation of the first embodiment will be described. The introduction tube 1 of the clip device is introduced into the body cavity through the endoscope channel inserted into the body cavity, and the distal end portion of the introduction tube 1 is inserted into the clip target tissue X as shown in FIG. Locate in the vicinity. The clip 61 loaded in the introduction tube 1 protrudes outside the introduction tube 1. This makes it possible to project only the clip 61 from the distal tip 2 by pushing the operation wire 64 engaged with the clip 61 toward the distal end of the introduction tube 1.

  Since the clip 61 protruded from the tip 2 is provided with the openability of the arms 3b and 3b ′ so as to open the holding portions 3c and 3c ′, the clip 61 protrudes from the tip 2 and at the same time, 3c 'is opened. Then, the operation wire 64 is pulled in a state where the clamping portions 3 c and 3 c ′ are pressed against the clip target tissue X. Then, as shown in FIG. 2B, the base end portion 3a of the clip 61 is drawn into the distal tip 2 and the protrusions 3g and 3g ′ provided on the arm portions 3b and 3b ′ of the clip 61 are the distal tip. 2 is engaged with the front end surface. When the operation wire 64 is further pulled, the proximal end portion 3a of the clip 61 is plastically deformed, and the clamping portions 3c and 3c 'are closed, whereby the clip target tissue X can be sandwiched.

  Here, the operation wire 64 is further pulled, and a traction force is applied to the flange 3f attached to the proximal end portion 3a of the clip 61. As a result, the flange 3f bent in a J-shape is stretched, the loop wire 4a is separated from the flange 3f, and the operation wire 64 and the clip 61 are completely separated. As a result, as shown in FIG. 5, the clip 61 can be placed in the living tissue in the body cavity.

  Subsequently, as shown in FIG. 2C, in order to place the clip 62 on the living tissue in the body cavity, the operation wire 64 separated from the clip 61 does not interfere with the clip 62 and the clip 63 loaded on the rear side. Tow until.

  In this manner, by pulling the separated operation wire 64, it is possible to make the subsequent operation of protruding the clip 62 and the clip 63 easier. In this state, the operation wire 65 engaged with the clip 62 is pushed out toward the distal end of the introduction tube 1 so that only the clip 62 can protrude from the distal tip 2.

  The operation after this is exactly the same as the operation for placing the clip 61 in the living tissue. Then, the clip 62 can be placed in the living tissue. Further, by repeating the same operation, the plurality of clips 61, 62, 63 loaded in the introduction tube 1 can be placed in the living tissue in the body cavity.

  According to the first embodiment, a plurality of clips loaded in the insertion tube can be continuously placed in the body cavity only by inserting the clip device once into the body cavity via the forceps channel of the endoscope. . Therefore, each time a clip is placed in the body cavity, the troublesome work of pulling the clip device out of the body cavity from the forceps channel or the like, reloading the clip, and inserting it again into the body cavity is not necessary. Thereby, since the procedure time can be shortened, the pain of the patient can be reduced.

  In addition, since the operation wires are connected to the clips, each clip can be placed in the tissue in the body cavity in order, quickly, easily and reliably.

  6 and 7 show the second embodiment, FIG. 6 is a side view of the operation wire, and FIGS. 7A to 7J show a method for manufacturing the operation wire.

  As shown in FIG. 6, the operation wire 7 includes a loop wire 7a and a proximal end wire 7b. The proximal end wire 7b is composed of a metal stranded wire, and is stranded with, for example, three strands.

  Next, a method of manufacturing the operation wire 7 (for example, a method of manufacturing with a 1 × 3 twisted wire) will be shown based on FIG. The outer diameter of the wire is about φ0.3 to 0.6 mm.

  1. As shown in FIG. 7A, the wire end 7c is loosened.

  2. As shown in FIG. 7B, loosen one of the three wires A while turning. At this time, the length of about 60 mm is loosened from the wire end 7c.

  3. As shown in FIG. 7C, the second wire B or C is similarly loosened. At this time, the length of about 60 mm is similarly loosened from the wire end 7c.

  4). As shown in FIG. 7D, the second wire B or C is folded back. At this time, the folding end X and the unwinding end Y should be sufficiently separated. Further, as shown in the enlarged view, the folding is easier to bend when it is bent at a place where it becomes a mountain.

  5. As shown in FIG. 7 (e), the bent wire B is twisted by turning in the unwinding direction (in the case of Z twisting). At this time, the deformed portion at the end is cut before twisting. As shown in FIG. 8F, the untwisting length is about 30 mm.

6). As shown in FIG. 7 (f), the wire C is returned to the wire B, twisted to the wire B, and cut at the position where the wire B is turned back. At this time, the wires C and B are not spaced from each other and do not overlap. (It becomes easy to come off later when wire A is returned)
7. As shown in FIG. 7G, the wire A is returned to the wires B and C and twisted. At this time, the contact portion between the wire C and the wire B is preferably performed under a stereoscopic microscope. Also, when twisting the front and rear of the contact portion, take care not to move the wires C and B.

  Further, as shown in FIG. 7 (h), when placing the wire A, care is taken not to flip the wires B and C in the direction of the black arrow. Further, when placing the wire A, placing the wire A on the tip side (loop side) with respect to the contact portion between the wires B and C facilitates placing the wire A.

  8). As shown in FIG. 7 (i), the wire A is cut at the edge of the loop.

  9. As shown in FIG. The loop has a length of about 5 mm. Further, the wire B and C contact portions and the end portion of the wire A may be prevented from loosening by twisting or bonding.

  The operation of the second embodiment is the same as that of the first embodiment, and a description thereof will be omitted.

  According to the 2nd form, since there is no connection pipe 4c compared with the operation wire 4 of a 1st form, manufacturing cost can be reduced. Further, since the outer diameter does not increase at the joint portion between the proximal end wire 7b and the loop wire 7a, the insertion resistance of the operation wire 4 is maintained without increasing the frictional resistance with the inner surface of the introduction tube 1. Thus, the clip 3 can be easily protruded from the introduction tube 1.

  Note that the base wire 7b of the wire shown in FIG. 7 (j) can be covered with a polymer resin 7d to improve the slipperiness of the wire. As a result, the frictional resistance with the inner surface of the introduction tube 1 and the sliding resistance between the plurality of wires arranged in the introduction tube can be reduced, so that the clip can be easily protruded and ligation can be performed with a smaller force. It becomes like this. FIG. 7 (k) shows the coated wire.

  The polymer resin 7d includes synthetic polymer polyamide, high density / low density polyethylene, polyester, polytetrafluoroethylene, tetrafluoroethylene-perfluoroalkylene vinyl ether copolymer, tetrafluoroethylene-hexafluoropropylene copolymer, and the like. Is appropriate. The optimum thickness of the coating is about 0.05 mm to 0.1 mm. Furthermore, in order to improve the slidability of the operation wire, it is also effective to perform an embossing of 0.01 mm to 0.45 mm on the wire surface.

  8 to 13 show a third embodiment, and the same components as those in the first embodiment are denoted by the same reference numerals and description thereof is omitted. FIG. 8A is a longitudinal side view of a distal end portion of a biological tissue clip device, and FIG. 8B is a cross-sectional view taken along the line EE.

  The introduction tube 1 and the operation wire 4 are the same as in the first embodiment, but the distal tip 2 is welded, bonded or press-fitted to the distal end of the insertion tube 1. The tip 2 is formed of a short tube made of metal (such as stainless steel), the outer peripheral surface is tapered, and the tip is tapered. Therefore, the insertion tube 1 can be easily inserted into the channel of the endoscope. The inner peripheral surface of the tip 2 is also tapered, and the inner diameter of the tip is approximately the same as the outer diameter of the clip tightening ring 8 described later. As a result, the backlash of the clip fastening ring 8 is suppressed.

  In addition, the leading edge outer diameter of the tip 2 is φ1.5 to 3.3 mm. The tip inner diameter of the tip 2 is about φ1.0 to 2.2 mm.

  Next, the clip 9 will be described with reference to FIGS. 10 (a) to 10 (d). A thin metal strip is bent at the central portion, and the bent portion becomes a base end portion 9 a, and the base end portion 9 a Both extended arm portions 9b and 9b 'cross each other. Therefore, the base end portion 9a side of the clip 9 is substantially elliptical. Further, the front edge portions of the respective arm portions 9b and 9b 'are bent so as to face each other, and these are defined as clamping portions 9c and 9c'. One end of the sandwiching portions 9c and 9c 'has a convex shape 9d and the other has a concave shape 9e so that the living tissue can be easily grasped. The arms 9b and 9b 'are provided with an open and expandability so as to open the holding portions 9c and 9c'. A deformable collar 9f that protrudes rearward is attached to the base end portion 9a. The flange 9f is realized by forming a band plate in a J shape in advance and bending it at the base end.

  The clip 9 is made of, for example, stainless steel and is made of stainless steel. The clip 9 is rigid and can securely grasp a living tissue. For example, a superelastic alloy such as a nickel titanium alloy may be used. When the arm portions 9b and 9b 'are provided with a spreading habit, the arms 9b and 9b' are more reliably opened when protruding from the introduction tube 1.

  When a tensile force of about 1 to 5 kg is applied to the flange 9f provided at the base end portion 9a of the clip 9, the flange 9f cannot maintain the J-shape, deforms and extends into a substantially I-shape. .

Since the flange 3f of the clip 3 of the first embodiment is formed by bending a stainless steel thin plate extending from the base end 3a to form a J-shape, the amount of force by which the flange 3f is deformed due to variations due to processing. There was a problem of being different. However, since the flange 9f in the clip 9 of this embodiment is formed by bending the flange 9f formed in a J shape in advance at the proximal end portion 9a of the clip 9, the amount of force with which the flange 9f is deformed can be stabilized. There is an advantage that you can.

  The thickness of the strip forming this clip 9 is 0.15 to 0.3 mm. The plate widths of the clamping portions 9c and 9c 'are 0.5 to 1.2 mm, and the plate widths of the arm portions 9b and 9b' are 0.5 to 1.5 mm. The flange 9f is projected from the base end portion 9a of the clip 9 with a length of about 1 to 3 mm.

  Next, the clip fastening ring 8 will be described with reference to FIG. 11. The clip fastening ring 8 is formed of a strong and elastic resin, metal or the like. In addition, a pair of two blades 8a and 8a '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 8a and 8a 'is not limited to one pair and 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 8a and 8a 'are folded on the inner surface of the ring. Since the blades 8a and 8a 'are in contact with the inner surface of the introduction tube 1 and the inner surface of the tip end 2, the tip side is inclined surfaces 8b and 8b' and can be pushed out smoothly and without resistance.

  The clip tightening ring 8 closes the arm portions 9b and 9b 'of the clip 9 by being fitted and attached to the arm portions 9b and 9b' of the clip 9, and has a substantially tubular shape. The clip 9 and the operation wire 4 are engaged by hooking the loop wire 4a to the flange 9f. As shown in FIG. 12, even when the clip 9 is pushed out by the operation wire 4, in order to maintain the engagement between the clip 9 and the operation wire 4 and to temporarily fix the clip 9 and the clip fastening ring 8, A polymer material 9 c such as silicone is fitted into the clip fastening ring 8.

  The blades 8a and 8a 'of the clip fastening ring 8 may be loaded in the introduction tube 1 in a folded state, but the blade 8a is more preferably loaded in the introduction tube 1 with the blades 8a and 8a' protruding. , 8a 'can be maintained over a long period of time. Further, since the contact area between the inner surface of the introduction tube 1 and the blades 8a and 8a 'is reduced, the protruding force amount of the clip 9 can also be reduced.

  The clip tightening ring 8 is formed by, for example, injection molding of a strong resin (polybutyterephthalate, polyamide, polyphenylamide, liquid crystal polymer, polyether ketone, polyphthalamide) or the like. Note that an elastic metal (a superelastic alloy such as stainless steel or nickel titanium alloy) or the like may be formed by injection molding, cutting, plastic processing, or the like.

  The clip tightening ring 8 has an inner diameter of about 0.6 to 1.3 mm and an outer diameter of about 1.0 to 2.1 mm, and the outermost diameter portion when the blades 8a and 8a ′ protrude from the tip tip 2 is Considering engagement, the thickness is 1 mm or more.

  Next, the clip unit 10 will be described with reference to FIG. 12. The clip 9 is fitted into the clip fastening ring 8, and the distal end portion of the operation wire 4 is attached to the flange 9 f provided at the proximal end portion 9 a of the clip 9. The loop wire 4a is engaged. A polymer material 9c such as silicone is fitted in the clip tightening ring 8 so that the clip tightening ring 8 and the clip 9 and the hook 9f and the loop wire 4a are not easily separated from each other. Note that the clip 9 is a clip clamping ring so that the opening direction of the arms 9b, 9b ′ of the clip 9 matches the direction of the two blades 8a, 8a ′ provided on the clip clamping ring 8. 8 is fitted.

  Each component configured as described above is incorporated in the introduction pipe 1 as follows. That is, in the introduction pipe 1, three clip units 10 are arranged in series. However, the number of clip units 10 is not limited to three, and a larger number of clip units 10 may be loaded in the introduction tube 1. Although FIG. 32 includes five clips 9, the clip 9 may be loaded as long as the space in the introduction tube 1 is allowed. That is, if the space in the introduction pipe 1 has a margin, six or more clips 9 may be loaded.

  For convenience of explanation, the following names are given to the clip units 10 loaded in the introduction tube 1. A clip 71, a clip 72, and a clip 73 are sequentially set from the clip loaded at the forefront. The clip tightening rings into which the clips 71, 72, and 73 are respectively fitted are referred to as a clip tightening ring 74, a clip tightening ring 75, and a clip tightening ring 76. The operation wires engaged with the clips 71, 72, and 73 in the clip tightening ring are referred to as an operation wire 77, an operation wire 78, and an operation wire 79, respectively.

  In the introduction tube 1, operation wires 77, 78, 79 extending from the respective clips 71, 72, 73 extend to the proximal end portion of the introduction tube 1. The operation wire 77 is disposed in the introduction tube 1 so as to avoid interference with the clips 72 and 73. Further, the operation wire 78 is disposed in the introduction tube 1 so as to avoid interference with the clip 73. The operation wires 77 and 78 are arranged in a direction perpendicular to the leg opening direction of the arm portions 9 b and 9 b ′ of the clip 73 in order to avoid interference with the arm portions 9 a and 9 a ′ of the clip 73.

  FIG. 8B shows a cross-sectional view of the clip fastening ring 76 disposed at the most proximal end. As shown here, the operation wires 77 and 78 are disposed in the introduction tube 1 so as to avoid interference with the blades 8a and 8a 'of the clip fastening ring 76, and extend to the proximal end portion. By arranging the operation wires 77, 78, and 79 as described above, the operation wires 77, 78, and 79 can be easily inserted into the introduction tube 1, and the clips 71, 72, and 73 are more easily protruded and ligated. become.

  Next, the operation of the third embodiment will be described. The tip of the introduction tube 1 is guided to the target site while observing the inside of the body cavity with an endoscope. The clip 71 loaded in the introduction tube 1 protrudes outside the introduction tube 1. This makes it possible to project only the clip 71 and the clip clamping ring 74 from the tip 2 by pushing the operation wire 77 engaged with the clip 71 in the direction of the distal end of the introduction tube 1. The blades 8 a and 8 a ′ of the clip tightening ring 74 are folded into the clip tightening ring 74 when passing through the tip 2, but when passing through the tip 2, the blades 8 a and 8 a ′ project again. As a result, the clip fastening ring 74 can be prevented from entering the tip 2 again.

  When it is confirmed that the blades 8 a and 8 a ′ of the clip tightening ring 74 protrude from the introduction pipe 1, the operation wire 77 is pulled. Then, the blades 8 a and 8 b ′ of the clip tightening ring 74 are engaged with the end surface of the tip 2. When the operation wire 77 is further pulled, the elliptical portion of the proximal end portion 9 a of the clip 71 is drawn into the clip fastening ring 74. Here, since the size of the elliptical portion of the base end portion 9 a is larger than the inner diameter of the clip fastening ring 74, the elliptical portion is crushed by the clip fastening ring 74. Then, the arm portions 9b and 9b 'are greatly expanded to the outer diameter. In this state, the clip 71 is guided so as to sandwich the target biological tissue, and the clamping portions 9c and 9c 'of the clip 71 are pressed against the clip target tissue X. Further, by pulling the operation wire 77, the arm portions 9b and 9b 'of the clip 71 are drawn into the clip tightening ring 74, and the holding portions 9c and 9c' of the clip 71 are closed so that the living tissue can be grasped. When the operation wire 77 is further pulled, the flange 9f provided at the proximal end portion 9a of the clip 9 is extended, and the engagement between the clip 71 and the operation wire 77 is released. In this way, as shown in FIG. 13, the clip 71 can be placed in the living tissue in the body cavity.

  Subsequently, in order to place the clip 72 in the living tissue in the body cavity, the operation wire 77 separated from the clip 71 is pulled to a position where it does not interfere with the clip 73 and the clip fastening ring 76 loaded rearward. Thus, by pulling the separated operation wire 77, the clip 72 and the clip 73 can be more easily protruded.

  After this state, the clip 72 and the clip fastening ring 75 can be protruded from the tip 2 by pushing the operation wire 78 of the clip 72 toward the tip of the introduction tube 1.

  The operation after this is exactly the same as the operation for placing the clip 71 in the living tissue. Then, the clip 72 and the clip fastening ring 75 can be placed in the living tissue.

  Furthermore, by repeating the same operation, the multiple clips 71, 72, 73 loaded in the introduction tube 1 can be placed in the living tissue in the body cavity.

  According to the third aspect, in addition to the effect of the first aspect, the clip tightening ring closes the arm portion of the clip, so that a stronger force can ligate the living tissue.

  FIG. 14 shows a fourth embodiment, and the same components as those of the third embodiment are denoted by the same reference numerals and description thereof is omitted. (A) is the vertical side view of the front-end | tip part in the clip apparatus of a biological tissue, (b) is sectional drawing which follows the FF line.

  In this embodiment, the pressing member 11 is added to the third embodiment, and the other configuration is the same as that of the third embodiment.

  The pressing member 11 has flexibility so as to be able to be inserted into the introduction tube 1, and is disposed behind the clip tightening ring 76 loaded at the most proximal end portion in the introduction tube 1.

  For example, the pressing member 11 is formed of a coil sheath having irregularities on the inner and outer surfaces of a metal wire (stainless steel or the like) having a round cross section, and the clip unit 10 can easily protrude from the introduction tube 1. .

  The pressing member 11 may be, for example, a rectangular coil sheath having a flat inner and outer surfaces, which is formed by crushing a metal wire (such as stainless steel) having a round cross section and making the wire cross section rectangular and then tightly winding the wire. Thus, a pressing member having a large inner diameter can be realized even under the condition of the same waist strength. Thereby, the operation wire 4 can be easily inserted, and the force at the time of ligating the clip 9 can be reduced. For example, polymer resin (synthetic polymer polyamide, high density / low density polyethylene, polyester, polytetrafluoroethylene, tetrafluoroethylene-perfluoroalkylene vinyl ether copolymer, tetrafluoroethylene-hexafluoropropylene copolymer, etc. ), The inner and outer surfaces of the sheath are slidable, so that the insertion through the introduction tube 1 and the operation wire 4 are facilitated. Thereby, the protrusion of the clip 9 is facilitated, and the force at the time of ligating the clip 9 can be reduced.

  Further, the pressing member 11 may be, for example, a tube sheath in which a wall portion has an inner layer and an outer layer, and a tube sheath embedded with a reinforcing member interposed between the double tubes. It is made of a polymer resin such as The reinforcing member is formed of, for example, a cylindrical blade knitted in a lattice shape with thin metal wires. Compared to a tube sheath in which no reinforcing member is embedded, the sheath is superior in compression resistance, so that the sheath does not buckle when the clip 9 is projected.

  Further, the pressing member 11 has an outer diameter that can be inserted into the introduction tube 1 and an inner diameter that allows a plurality of operation wires 4 to be inserted. For example, the outer diameter is 3 mm or less, and the inner diameter is made as large as possible. However, the thickness needs to be a dimension that can reliably transmit the amount of force necessary to protrude the clip 9 without the pressing member 11 buckling.

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

  The tip of the introduction tube is guided to the target site while observing the inside of the body cavity with an endoscope. The clip 71 and the clip clamping ring 74 loaded in the introduction pipe 1 are projected out of the introduction pipe 1. This is achieved by extruding the pressing member 11 in the introduction tube 1 in the distal direction. The pressing member 11 is inserted behind the clip fastening ring 76 in the introduction tube 1, but by pushing the pressing member 11 in the distal direction of the introduction tube 1, the force applied by the pressing member 11 is The clip tightening ring 76 and the clip 73 are transmitted to the clip tightening ring 75 and the clip 72, and the clip tightening ring 74 and the clip 71. Thus, the clip 71 and the clip tightening ring 74 are protruded from the tip 2 by the force applied to the pressing member 11.

  The operation after protruding the clip 71 and the clip fastening ring 74 is the same as in the first embodiment.

  After the clip 71 is placed in the living tissue, the operation wire 77 separated from the clip 71 is pulled to a position where it does not interfere with the clip fastening ring 76 loaded rearward. Specifically, the operation wire 77 is pulled into the inner cavity of the pressing member 11. Thus, by pulling the separated operation wire 77, the clip 72 and the clip 73 can be more easily protruded.

  The action of the clip 72 and the clip 73 protruding and indwelling in the living tissue is the same as the action of the clip 71. By repeating the same operation as the clip 71, a plurality of clips 71, 72, 73 loaded in the introduction tube 1 can be placed in the living tissue.

  According to this embodiment, the clip can be more easily and reliably projected.

  15 and 16 show a fifth embodiment, and the same components as those of the third embodiment are denoted by the same reference numerals and description thereof is omitted. FIG. 15A is a longitudinal side view of a part of the clip device for living tissue, FIG. 15B is a sectional view taken along line GG, and FIG. 16 is a perspective view of the pressing member. In this embodiment, a pressing member 12 is added to the third embodiment, and other configurations are the same as those in the third embodiment.

  The pressing member 12 is flexible enough to be inserted into the introduction tube 1 and is disposed behind the clip tightening ring 76. The operation wires 77, 78, and 79 have a plurality of lumens 12a, 12b, and 12c through which the operation wires 77 can be inserted independently.

  The pressing member 12 is made of, for example, a polymer resin (synthetic polymer polyamide, high density / low density polyethylene, polyester, polytetrafluoroethylene, tetrafluoroethylene-perfluoroalkylvinyl ether copolymer, tetrafluoroethylene-hexafluoro, Tube sheath of propylene copolymer. The operation wires 4 extended from the plurality of clip units 8 are distributed to the plurality of lumens 12 a, 12 b, 12 c provided on the pressing member 12, and inserted to the base end portion of the pressing member 12.

  Furthermore, the pressing member 12 has an outer diameter that can be inserted into the introduction tube 1, and the number of lumens 12 a, 12 b, and 12 c needs to be at least the number of clips. Further, the inner diameters of the lumens 12a, 12b, and 12c are such dimensions that at least one operation wire 4 can be inserted. The outer diameter of the pressing member 12 is 3 mm or less, and the inner diameter of the lumen is 0.3 mm or more.

  According to the fifth embodiment, the operation wires 77, 78, 79 respectively engaged with the clips 71, 72, 73 are inserted one by one into the plurality of lumens 12a, 12b, 12c provided in the pressing member 12. The lead pipe 1 is guided to the proximal end side. Accordingly, since the operation wires 77, 78, and 79 are inserted in the introduction tube 1 in a state of being isolated from each other, the three operation wires 77, 78, and 79 do not interfere with each other in the introduction tube 1. As a result, the sliding frictional resistance between the operation wires 77, 78, 79 decreases in the introduction pipe 1, so that the amount of traction force can be transmitted to the tip of the introduction pipe 1 without loss. That is, the ligation operation can be performed with a smaller force.

  FIG. 17 shows the sixth embodiment, and the engagement structure between the clip and the operation wire is different from that of the third embodiment. The clip 13 of this embodiment does not have the flange 6f in the clip 6 of the third embodiment.

  The operation wire 14 includes a loop wire 14a and a proximal end wire 14b. A closed loop wire 14a is formed at the distal end of a proximal end wire made of a metal stranded wire. The loop wire 14a is formed by one strand of the proximal end wire 14b. When a twisted core wire is used for the loop wire 14a, the assemblability is good. The core wire may be a stranded wire or a single wire. The loop wire 14a and the proximal end wire 14b are joined or welded via a metal connection pipe 14c.

  The operation wire 14 is a stranded wire made of stainless steel, for example, and is more flexible than a single wire by being a stranded wire, so that the flexibility of the introduction tube 1 itself is not impaired. The base wire 14b of the operation wire 14 has an outer diameter of φ0.3 to φ0.6 mm, and the loop wire 14a has a diameter of about φ0.1 to 0.2 mm.

  The operation wire 14 includes a polymer resin 14d (synthetic polymer polyamide, high density / low density polyethylene, polyester, polytetrafluoroethylene, tetrafluoroethylene-perfluoroalkylene vinyl ether copolymer, tetrafluoroethylene-hexa. By coating a fluoropropylene copolymer or the like, the slipping property of the operation wire can be improved. The optimum thickness of the coating is about 0.05 mm to 0.1 mm. Furthermore, in order to improve the slidability of the operation wire, it is also effective to perform an embossing of 0.01 mm to 0.45 mm on the wire surface.

  According to this embodiment, the loop wire 14 a is directly engaged with the proximal end portion 13 a of the clip 13. A force of 1 to 5 kg is applied to the loop wire 14a when the clip 13 is ligated, and the dimensions are set so that the loop wire 14a is broken when these forces are applied. When the loop wire 14a is broken, the clip 13 and the operation wire 14 are separated, and the clip 13 can be placed in the living tissue.

  In this embodiment, the engagement of the clip 13 and the operation wire 14 is separated by the breakage of the loop wire 14a. As a modified example, in the loop wire described in the second embodiment, the untwisted length of the wire B is set short and the loop is untwisted at the time of ligation, so that the engagement between the clip and the operation wire is separated. Also good. As the untwisted length, about 5 to 10 mm is appropriate.

  According to this embodiment, compared with the third embodiment, since the base end portion of the clip is free from wrinkles, the clip can be formed at a lower cost.

  18 to 20 show a seventh embodiment, wherein FIG. 18 is a perspective view of the clip, FIG. 19 is a plan view of the clip, a side view and an enlarged side view of the flat bulge, and FIG. 20 is a plan view and a side view of the clip. FIG.

  In this embodiment, the engagement structure of the clip and the operation wire is different, and other configurations are the same as those of the third embodiment. The clip 15 does not have the flange 3f in the clip 3 as shown in the first embodiment, and a hole 15h through which the operation wire 140 can be inserted is provided in the base end portion 15a.

  The operation wire 140 is a single wire made of metal and has a diameter of about 0.2 to 0.7 mm. The operation wire 140 is inserted into the hole 15h, and a flat bulging portion 140a that prevents the operation wire 140 from being pulled out is formed. As a method of forming the flat bulging portion 140a, for example, caulking is fixed. The diameter of the hole 15h is suitably about 0.2 to 0.7 mm, and the operation wire 140 that can be inserted into the hole 15h is used. The maximum diameter of the flat bulging portion 140a is necessarily larger than the diameter of the hole 15h and is about 0.25 to 1 mm.

  The operation wire 140 includes a polymer resin 140d (synthetic polymer polyamide, high density / low density polyethylene, polyester, polytetrafluoroethylene, tetrafluoroethylene-perfluoroalkylene vinyl ether copolymer, tetrafluoroethylene-hexa. By coating a fluoropropylene copolymer or the like, the slipping property of the operation wire can be improved. The optimum thickness of the coating is about 0.05 mm to 0.1 mm. Furthermore, in order to improve the slidability of the operation wire, it is also effective to perform an embossing of 0.01 mm to 0.45 mm on the wire surface.

  According to the present embodiment, the operation wire 140 is pulled in a state where the sandwiching portions 15c and 15c ′ are pressed against the target tissue. The arm portions 15 b and 15 b ′ of the clip 15 bent in the expanding direction engage with the distal end portion of the distal end tip 2. When the operation wire 140 is further pulled, the arm portions 15b and 15b 'of the clip 15 are drawn into the distal tip 2 and the clamping portions 15c and 15c' are closed, whereby the target tissue can be sandwiched.

  Further, by pulling the operation wire 140, the flat bulging portion 15 a at the distal end of the operation wire 140 is pulled out from the hole 15 h of the base end portion 15 a of the clip 15. This is because the operation wire 140 is separated from the clip 15 when the diameter of the flat bulging portion 140a is deformed and reduced, or the hole 15h of the base end portion 15a of the clip 15 is deformed and enlarged. Thereby, the clip 15 can be placed in the living tissue.

  In addition, as shown in FIG. 20, the distal end of the operation wire 140 is looped in the clip fastening ring 8, and the flat bulging portion 14 a is provided outside the elliptical portion of the proximal end portion 15 a of the clip 15, thereby The amount of force for releasing the engagement of the operation wire 140 can be increased. Accordingly, when the tissue is closed in the sandwiching portions 15c and 15c ', a larger force can be applied to the clip 15, so that a strong ligation force can be obtained.

  According to the present embodiment, by directly engaging the clip and the operation wire, the number of parts of the engagement portion between the clip and the operation wire is reduced. Thereby, the manufacturing cost can be reduced. In addition, it is easy to attach the clip during manufacture.

  FIG. 21 shows the eighth embodiment, and is a longitudinal side view showing an engagement structure between a clip and an operation wire. This embodiment is different from the third embodiment in the engagement structure between the clip and the operation wire, and the other configurations are the same.

  The operation wire 16 has a distal end bent and engaged with the flange 6 f of the clip 6, and the two operation wires 16 are inserted to the proximal end portion of the introduction tube 1. The operation wire 16 may be coated with a polymer resin 16a having good slipperiness such as high density / low density polyethylene. The optimum thickness of the coating is about 0.05 mm to 0.1 mm. Further, in order to increase the slipperiness of the operation wire 16, it is also effective to perform an embossing process of 0.01 mm to 0.45 mm on the wire surface.

  The operation wire 16 is a stranded wire or a single wire made of stainless steel or the like, and has an outer diameter of about 0.2 to 0.5 mm.

  According to the present embodiment, the two operation wires 16 are pulled together, and other operations are the same as those of the third embodiment. According to this form, compared with the 3rd form, a clip and an operation wire can be engaged more cheaply.

Further, the provision of the coating increases the slipperiness of the operation wire, reduces the frictional resistance with the inner surface of the introduction pipe, and transmits the amount of traction force to the tip of the introduction pipe without loss. Thereby, a ligation operation can be performed with a smaller force.

  22 to 24 show a first embodiment of the present invention, FIG. 22 is a plan view and a side view of a clip, FIG. 23 (a) is a longitudinal side view of a distal end portion of a biological tissue clip device, and FIG. (C) is a sectional view taken along the line H-H, (d) is a sectional view taken along the line I-I, (e) is a sectional view taken along the line JJ, and FIG. It is a vertical side view of the front-end | tip part of the clip apparatus of the biological tissue for demonstrating.

  The introduction tube 1 of the present embodiment has an outer diameter that can be inserted into the channel of the endoscope, and has an outer diameter larger than the outer diameter of an operation member to be described later, and is the same as the first embodiment. .

  As shown in FIG. 22, the clip 17 of the present embodiment is formed by bending a metal thin strip at the center portion, and forming the bent portion as a base end portion 17a, and both arm portions extending from the base end portion 17a. 17b and 17b ′ cross each other. The base end portion 17a side is substantially elliptical.

  Further, the front edge portions of the respective arm portions 17b and 17b 'are bent so as to face each other, and these are used as sandwiching portions 17c and 17c'. One end of the sandwiching portions 17c and 17c 'is formed in a convex shape 17d and the other is formed in a concave shape 17e so that the living tissue can be easily grasped. The arm portions 17b and 17b 'are provided with an open and expandability so as to open the sandwiching portions 17c and 17c'. A flange 17f that protrudes rearward is attached to the base end portion 17a. A flange 17f that protrudes rearward is attached to the base end portion 17a. The flange 17f is formed by bending a stainless steel thin plate extending from the base end into a substantially J shape.

  The clip 17 is made of, for example, a thin stainless steel plate made of stainless steel having a spring property, has rigidity, and can securely grasp a living tissue. For example, if the clip 17 is formed of a superelastic alloy such as a nickel-titanium alloy and the arm portions 17b and 17b ′ are provided with an expansive habit, the arm portions 17b and 17b are more sure than when protruding from the introduction tube 1. 'Opens the leg.

  When a tensile force of about 1 to 5 kg is applied to the flange 17f provided on the base end portion 17a of the clip 17, the flange 17f cannot maintain the J-shape, deforms, and extends substantially in an I-shape. .

  Further, the clip 17 has a band plate thickness of 0.15 to 0.3 mm, and the sandwiching portions 17c and 17c 'have a plate width of 0.5 to 1.2 mm. The plate widths of the arm portions 17b and 17b 'are 0.5 to 1.5 mm. The plate width on the base end portion 17a side is 0.3 to 0.5 mm. The flange 17f is projected from the proximal end portion 17a of the clip 17 with a length of about 1 to 3 mm.

  As shown in FIG. 23, the operation wire 18 is obtained by joining two operation wires to the operation wire 16 by a method such as adhesion or welding to form a joint 18b to form a closed loop 18a.

  The operation member 19 is flexible enough to be inserted into the introduction tube 1. It arrange | positions behind the clip clamping ring 86 mentioned later loaded in the introductory tube 1, and receives the force applied by the operation wire 18 at the time of clip ligation.

  The operation member 19 is, for example, a coil sheath having irregularities on the inner and outer surfaces of a metal wire (stainless steel or the like) having a round cross section, and by moving the operation member 19 toward the distal end side with respect to the introduction tube 1, The clip 17 and the clip fastening ring 20 can be protruded from the introduction tube 1.

  Further, the operation member 19 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. 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 17 and the insertion of the operation wire 18 are further facilitated.

  Further, the operation member 19 is made of, for example, a polymer resin (synthetic polymer polyamide, high density / low density polyethylene, polyester, polytetrafluoroethylene, tetrafluoroethylene-perfluoroalkylene vinyl ether copolymer, tetrafluoroethylene- When the tube sheath of hexafluoropropylene copolymer or the like is used, the inner and outer surfaces of the sheath have slipperiness, so that the insertion through the introduction tube 1 and the operation wire 18 are facilitated.

  For example, when a tube sheath in which a metallic wire (such as stainless steel) is embedded in a tube sheath made of a polymer resin, the sheath does not buckle compared to a tube sheath in which no wire is embedded.

  The operation member 19 has an outer diameter that can be inserted into the introduction tube 1 and an inner diameter that allows the operation wire 18 to be inserted, and has an outer diameter of 3 mm or less. The inner diameter should be as large as possible. However, it is necessary to have a thickness that can reliably project the protruding force and does not buckle even if a force is applied when the clip 17 is ligated.

  The clip tightening ring 20 closes the clip arm portions 17b and 17b 'by being fitted to the arm portions 17b and 17b' of the clip 17, and has a substantially tubular shape. The clip 17 and the operation wire 18 are engaged by hooking the loop wire 18a to the flange 18f. The base end portion 20 a of the clip clamping ring 20 is formed in accordance with the bending angle of the clamping portions 17 c and 17 c ′ of the clip 17, and the clamping portions 17 c and 17 c ′ are formed on the base end portion 20 a of the clip clamping ring 20. It comes to contact reliably. As a result, even when a compressive force is applied between the clip 17 and the operation member 19, the clip 17 and the clip fastening ring 20 can reliably transmit the applied compressive force to the tip without tilting.

  The clip fastening ring 20 is injection-molded with, for example, a strong resin (polybutyterephthalate, polyamide, polyphenylamide, liquid crystal polymer, polyetherketone, polyphthalamide).

  The clip clamping ring 20 may be formed by, for example, an elastic metal (such as stainless steel) by injection molding, cutting, plastic processing, or the like, and has an inner diameter of φ0.6 to 1.3 mm and an outer diameter of φ1.0 to 2. It is formed to about 1 mm.

  Further, in the clip unit 50, the clip 17 is fitted in the clip fastening ring 20, and the closed loop 18 a at the distal end portion of the operation wire 18 is engaged with a flange 17 f provided at the proximal end portion 17 a of the clip 17. . A polymer material 20c such as silicone is fitted in the clip tightening ring 20 so that the clip tightening ring 20 and the clip 17, and the hook 17f and the loop wire 17a are not easily separated from each other.

  Each component configured as described above is incorporated in the introduction pipe 1 as follows.

  In the introduction pipe 1, three clip units 50 are arranged in series. However, the number of clip units 50 is not limited to three, and a larger number of clip units 50 may be loaded in the introduction tube 1.

  For convenience of explanation, the following names are given to the clip units 50 loaded in the introduction tube 1. A clip 81, a clip 82, and a clip 83 are sequentially set from the clip loaded at the forefront. The clip fastening ring 20 into which the clips 81, 82, and 83 are respectively fitted is referred to as a clip fastening ring 84, a clip fastening ring 85, and a clip fastening ring 86. The operation wires 18 engaged with the clips 81, 82, and 83 in the clip tightening ring 20 are referred to as an operation wire 87, an operation wire 88, and an operation wire 89, respectively.

  The operation member 19 is inserted behind the clip tightening ring 86. The operation wire 87 is inserted into the gap 91 of the clamping portion of the clip 82, is guided to the clearance 90 between the operation member 18 and the introduction tube 1 while avoiding interference with the clip 83, and as shown in FIG. It is inserted to the proximal end portion of the introduction tube 1.

  The operation wire 88 is inserted through the gap 92 in the holding portion of the clip 83, is guided to the clearance 90 between the operation member 19 and the introduction tube 1, and is inserted to the proximal end portion of the introduction tube 1. As shown in FIG. 23E, a wire insertion hole 95 may be provided in the holding portions 17c and 17c 'of the clips 82 and 83 so that the operation wires 87 and 88 can be easily inserted. On the other hand, the operation wire 89 is guided to the inner cavity of the operation member 19 and inserted to the proximal end portion of the introduction tube 1.

  Thus, by arranging the three sets of operation wires 87, 88, 89 so as not to interfere with each other in the introduction tube 1, the insertion of the operation wires 87, 88, 89 is facilitated, and the clips 81, 82, 83 protrudes and ligation becomes easier.

Next, the operation of the first embodiment will be described.
The tip of the introduction tube 1 is guided to the objective site while observing the inside of the body cavity with an endoscope. The clip 81 and the clip fastening ring 84 loaded in the introduction pipe 1 are projected from the introduction pipe 1. This is realized by pulling the introduction pipe 1 to the proximal end side. Alternatively, it can be realized by pushing the operating member 19 toward the distal end side of the introduction tube 1.

  When the operation wire 87 is pulled in a state where the clip 81 and the clip fastening ring 84 protrude from the introduction tube 1, the force applied by the operation wire 87 is transmitted to the clip 81. Since the operation member 19 is fixed, the applied force acts as a compression force between the clip 81 and the operation member 19. Due to this compressive force, the elliptical portion of the proximal end portion 17 a of the clip 81 is drawn into the clip fastening ring 84. Here, since the dimension of the ellipse is larger than the inner diameter of the clip tightening ring 84, the ellipse is crushed by the clip tightening ring 84 as shown in FIG. Then, the arm portions 17b and 17b 'are greatly expanded outward.

  The compressive force acts not only on the clip 81 but also on the clip 82 and the clip 83, but the clip 82 and the clip 83 are not drawn into the clip fastening rings 85 and 86, respectively, and the arm portions 17b and 17b ′ are large. There is no spread. That is, the clip 82, the clip tightening ring 85, the clip 83, and the clip tightening ring 86 act as a hard connecting member provided between the clip 81 and the operation member 19, and are applied between the clip 81 and the operation member 19. It will receive compressive force.

  The reason why the clip 82 and the clip 83 are not drawn into the clip fastening rings 85 and 86 is that the arms 17b and 17b 'of the clips 82 and 83 are not expanded beyond the inner diameter of the introduction tube 1. Because. That is, even if a compressive force is applied to the clip 82 and the clip 83, the expansion of the arm portions 17b and 17b ′ of the clip 81 is stopped when the arm portions 17b and 17b ′ of the clip 81 abut against the inner wall of the introduction tube 1. However, since it does not expand further, the elliptical portion does not contract at the proximal end portion 17 a of the clip 81 and is not drawn into the clip tightening ring 20.

  With the arms 17b and 17b 'of the clip 81 being expanded, the clip 81 is guided so as to sandwich the target living tissue. Further, by pulling the operation wire 87, the arm portions 17b and 17b 'of the clip 81 are drawn into the clip fastening ring 84, and the clamping portions 17c and 17c' of the clip 81 are closed. The operation wire 87 is further pulled while the living tissue is securely sandwiched between the arm portions 17b and 17b 'of the clip 81, and the hook 17f is extended to release the engagement between the clip 81 and the operation wire 87. Thereby, the clip 81 can be placed in the body cavity while holding the living tissue.

  Subsequently, in order to place the clip 82 on the living tissue in the body cavity, the operation wire 87 separated from the clip 81 is pulled to a position where it does not interfere with the clip tightening ring 86 loaded rearward. Specifically, the operation wire 87 is pulled into the lumen of the operation member 19. In this manner, the clip 82 and the clip 83 can be more easily protruded by pulling the separated operation wire 87. After this state, the introduction tube 1 is pulled to the proximal end side, and the clip 82 projects from the distal end of the introduction tube 1.

  The operation after this is exactly the same as the operation for placing the clip 81 in the living tissue. Then, the clip 82 can be placed in the living tissue. Further, by repeating the same operation, a plurality of clips 81, 82, 83 loaded in the introduction tube 1 can be placed in the living tissue in the body cavity.

  According to the present embodiment, in addition to the effects of the third embodiment, the following effects are obtained. The operation of projecting the clip from the introduction tube can be performed more easily and reliably. Further, since the amount of compressive force at the time of clip ligation is received between the operation member and the clip, the force is well transmitted and ligation can be performed with a small force. Further, as in the third embodiment, the clip tightening ring 8 does not require engaging members such as the blades 8a and 8a ', so that the cost is further reduced.

  FIG. 25 shows a second embodiment of the present invention. The same components as those of the first embodiment are denoted by the same reference numerals and description thereof is omitted. FIG. 25 is a longitudinal side view of the distal end portion of the biological tissue clip device.

  This embodiment is different from the first embodiment only in the shape of the distal end portion of the introduction tube. The introduction pipe 51 of this embodiment is obtained by reducing the diameter of the distal end portion 51a of the introduction pipe 1 in the first embodiment by a manufacturing method such as thermoforming.

  The inner diameter of the distal end portion of the introduction tube 1 is formed substantially the same as the outer diameter of the clip fastening ring 84. As a result, the backlash and inclination of the clip 81 and the clip fastening ring 84 are eliminated at the distal end portion 51a of the introduction pipe 51.

  The inner diameter of the small-diameter portion at the distal end portion of the introduction tube 51 is approximately the same as the outer diameter of the clip fastening ring 84 and is about φ1.0 to 2.2 mm. In addition, the length in the axial direction of the small diameter portion is a length that can fix the clip fastening ring 84 and is 3 mm or more.

  According to the present embodiment, the clip 81 and the clip fastening ring 84 pushed out by the operation member 19 protrude from the distal end portion 51 a of the introduction pipe 51. At this time, the clip tightening ring 84 is temporarily fixed to the narrow diameter portion of the distal end portion 51 a of the introduction tube 51, and therefore the clip tightening ring 84 is free of rattling and inclination with respect to the introduction tube 51. In this state, the operation wire 87 is pulled and the clip 81 can be placed in the living tissue.

  Therefore, according to this embodiment, since there is no backlash or inclination of the clip and the clip tightening ring with respect to the introduction pipe, the compression force can be reliably received, and the clip can be placed with a smaller force. become. It is also easy to aim at the target organization.

  26 to 29 show a ninth embodiment, FIG. 26 is a side view of an operation portion with a ratchet for controlling the advancement and retraction of the introduction tube, FIG. 27A is a longitudinal side view of the introduction tube connecting portion, and FIG. ) Is a cross-sectional view taken along the line KK, FIG. 28A is a longitudinal side view of the operation portion with a ratchet, (b) is a cross-sectional view taken along the line LL, and (c) is a cross section taken along the line MM. FIG. 29A is a longitudinal side view of the operation portion with a ratchet, FIG. 29B is a sectional view taken along the line NN, and FIG. 29C is a sectional view taken along the line OO.

  As shown in FIG. 27, the introduction pipe connecting member 21 is formed in a substantially cylindrical shape, and a cylindrical protrusion 21a is provided at the tip. The projecting portion 21a is press-fitted and fixed to the proximal end portion of the introduction pipe 1 made of a polymer resin, and a connecting cylinder 21c having an external thread portion 21b on the outer peripheral surface is provided at the rear end portion.

  As shown in FIG. 28, a female thread portion 22 a at the distal end portion of the substantially cylindrical introduction tube slider 22 is screwed and connected to the male thread portion 21 b of the introduction tube connecting member 21, and the proximal end of the introduction tube slider 22 is connected. The part is provided with a flange 22b.

  The introduction tube slider 22 has a cylindrical lumen 22c, and an operation member slider 23 is inserted into the lumen 22c. The operation member slider 23 is formed in a substantially cylindrical shape, and a ratchet 23a is provided in a part of the outer peripheral surface along the axial direction. It is fitted in a lumen 22c provided in the introduction tube slider 22 so as to be able to advance and retract.

  A claw fitting recess 22d is provided in the inner peripheral portion of the introduction pipe slider 22 located at the flange portion 22b, and a claw member 24 is accommodated in the claw fitting recess 22d. The claw member 24 is a substantially rectangular parallelepiped member, and a claw 24 a that can be engaged with the ratchet 23 a of the operation member slider 23 is provided at the tip of the claw member 24. A pin 24b protrudes from an intermediate portion at the rear end of the claw member 24, and a spring 24c fitted to the pin 24b is provided inside the claw fitting recess 22d. The claw member 24 is urged toward the ratchet 23a by the spring 24c. Further, two through holes 22e are formed on the side opposite to the claw member 24 of the flange portion 22b of the introduction pipe slider 22, and a rod 25 is fitted into these through holes 22e so as to be able to advance and retract. The distal end portion of the rod 25 is fixed to the claw member 24, and a button 26 is provided at the proximal end portion.

  When the button 26 is pushed in the direction of the introduction tube slider 22, it is transmitted to the claw member 24 through the rod 25, and the spring 24c is compressed. As a result, the claw member 24 is disengaged from the ratchet 23 a provided on the operation member slider 23, and the introduction tube slider 22 can move on the operation member slider 23 in the axial direction.

  An operation member 27 and a base end member 28 are connected to each other in the axial direction by a connecting member 29 inside the introducing tube 1 connected to the introducing tube connecting member 21. The connecting member 29 is substantially cylindrical, and notches 29a and 29a 'are provided on a part of the outer surface. Then, the operation wires 87 and 88 are introduced into the inner cavity of the base end member 28 from the notches 29a and 29a '.

  The base end member 28 has the same structure, shape, material, and characteristics as the operation member 27, and is larger in size than the operation member 27 in both inner diameter and outer diameter. Of the three sets of operation wires 87, 88, 89 led from the clips 81, 82, 83 at the distal end of the introduction tube 1, the operation wire 89 is guided through the lumen of the operation member 27 and passes through the connecting member 29. Then, it is directly inserted into the lumen of the proximal end member 28.

  The remaining two sets of operation wires 87 and 88 are guided to the clearance 90 between the introduction tube 1 and the operation member 27 and inserted to the position of the connecting member 29. It is led from the notches 29 a and 29 a ′ of the connecting member 29 to the inner cavity of the proximal end member 28. That is, three sets of operation wires 87, 88, 89 led from the clips 81, 82, 83 at the distal end portion of the introduction tube 1 are connected to the inside of the proximal end member 28 via the connecting member 29. It is inserted through the cavity.

  Further, as shown in FIGS. 27 and 28, a cylindrical protection pipe 30 is fitted to the base end member 28, and a distal end portion 30 a of the protection pipe 30 is welded to the base end portion of the base end member 28. . A proximal end portion 30 b of the protective pipe 30 is bonded to a distal end portion of the operation member slider 23. The three sets of operation wires 87, 88, 89 guided from the lumen of the proximal end member 28 are guided to the lumen of the protective pipe 30 as they are and inserted into the lumen 23 b of the operation member slider 23. The protective pipe 30 is provided for the purpose of preventing the operating wires 87, 88, 89 from sagging in the lumen 22 a of the introduction tube slider 22 and allowing the operating member slider 23 to slide easily.

  Operation pipes 40 a, 40 b, and 40 c are welded to the base ends of the three sets of operation wires 87, 88, and 89 led to the inner cavity of the operation member slider 23. Three knobs 41a, 41b, and 41c are welded to the base end portions of the operation pipes 40a, 40b, and 40c, and these three knobs 41a, 41b, and 41c are arranged in the circumferential direction so as not to interfere with each other. Joined in an inclined state of 120 degrees.

  As shown in FIGS. 29A to 29C, a slider seat 42 is fixed to the base end portion of the operation member slider 23 by screws 42d, 42e, and 42f. The slider seat 42 contains three slips 42a, 42b and 42c along the axial direction. The three slits 42a, 42b, and 42c are provided to be inclined in the circumferential direction by 120 degrees. Knobs 41a, 41b, and 41c are fitted into the slits 42a, 42b, and 42c, respectively, and the knobs 41a, 41b, and 41c are slidable in the slits 42a, 42b, and 42c. It is.

Next, the operation of the ninth embodiment will be described.
The introduction tube 1 is inserted into the body cavity through the forceps channel of the endoscope. At this time, the distal end portion of the introduction tube 1 is positioned in front of the distal end of the clip 81, and the clip 81 is included in the lumen.

  The introduction tube 1 is inserted in the vicinity of the target tissue, the collar portion 22b of the introduction tube slider 22 is gripped, and the introduction tube slider 22 is pulled to the proximal end portion. At this time, the endoscope image is sufficiently observed to confirm that the arm portions 17 b and 17 b ′ of the clip 81 protrude from the distal end of the introduction tube 1. Further, the introduction tube slider 22 is gradually pulled, and the introduction tube 1 is arranged at a position where the tip of the clip fastening ring 84 protrudes from the introduction tube 1. When pulling the introduction tube slider 22, care should be taken that the arms 17 b and 17 b ′ of the clip 82 do not protrude from the tip of the introduction tube 1. This is because if the arms 82 b and 17 b ′ of the clip 82 are protruded, there is no means for controlling the clip 81, so that it is very difficult to place it in the target living tissue.

  When the introduction tube slider 22 is pulled, the claw member 24 is always engaged with the ratchet 23a of the operation member slider 23 by the urging force of the spring 24c. Therefore, even if the hand is released from the introduction pipe slider 22 at a certain point, the introduction pipe slider 22 does not move on the operation member slider 23. The introduction tube slider 22 is movable when a force is applied in the pulling direction, but the claw member 24 and the ratchet 23a are engaged so that the introduction tube slider 22 cannot move even when a force is applied in the distal direction of the introduction tube 1. Yes.

  When the introduction pipe slider 22 is pulled too much, the button 26 may be pushed to release the engagement between the claw member 24 and the ratchet 23a. When the button 26 is pushed in the direction of the flange 22b, the applied force is transmitted to the claw member 24 through the rod 25, compressing and deforming the spring 24c, and the engagement between the claw member 24 and the ratchet 23a is released.

  When the tip of the clip fastening ring 84 protrudes from the introduction tube 1, the knob 41a is pulled. When the knob 41a is pulled, a force is applied to the tip clip 81 via the operation wire 87, so that the clip 81 can be placed in the living tissue.

  After the clip 81 is placed in the living tissue, the knob 41 a is pulled until the tip of the operation wire 87 is positioned behind the clip fastening ring 86.

  In order to protrude the second clip 82 from the introduction tube 1, the flange portion 22 b of the introduction tube slider 22 is gripped again, and the introduction tube slider 22 is pulled to the proximal end side. Then, the introduction pipe slider 22 is pulled until the tip of the clip fastening ring 85 protrudes from the introduction pipe 1. When the tip of the clip tightening ring 85 protrudes from the introduction tube 1, the knob 41b is pulled. When the knob 41b is pulled, a force is applied to the tip clip 82 via the operation wire 88, so that the clip 82 can be similarly placed in the living tissue. After the clip 82 is placed in the living tissue, the knob 41 b is pulled until the tip of the operation wire 88 is positioned behind the clip fastening ring 86.

  By repeating the above operation, a plurality of clips 81, 82, 83 can be placed in the living tissue.

  According to this form, the operation | work which pulls an introduction pipe and protrudes a clip can be performed more reliably. Moreover, since the ratchet is attached, the delicate protruding length of the introduction pipe can be adjusted.

  30 and 31 show the tenth embodiment, FIG. 30 is a longitudinal side view of the proximal end portion of the clip device for living tissue, FIG. 31 is a longitudinal side view of the introduction tube, and the ratchet structure of the operation member slider 23 is shown. Unlike the ninth embodiment, the other configurations are the same.

  The operation member slider 32 is formed of a substantially cylindrical member, and ratchets 32p, 32q, 32r, and 32s are provided along the axial direction on one surface of the outer peripheral surface, and are fitted into a lumen 22c provided in the introduction tube slider 22. Has been. When the claw member 24 is not engaged with the ratchets 32p, 32q, 32r, 32s (when the claw member 24 is positioned in the parallel portions 32t, 32u, 32v), the inside of the lumen 22c of the introduction tube slider 22 is obtained. Can be slid forward and backward without load.

  The length a ′ required to project the most distal clip 81 from the introduction tube 1 corresponds to the length a of the operation member slider 32 on the hand operation unit side. When the introduction tube 1 is inserted into the channel of the endoscope, the claw member 24 is engaged with the ratchet 32p, and the introduction tube 1 does not slide easily with respect to the loaded clips 81, 82, 83. .

  The length b 'of the clip fastening ring 84 corresponds to the length of the ratchet 32q. The length c ′ for projecting the clip 82 from the introduction tube 1 after the clip 81 is placed in the living tissue corresponds to the parallel portion 32u. The length d 'of the clip fastening ring 85 corresponds to the length of the ratchet 32r.

  The length e ′ for projecting the clip 83 from the introduction tube 1 after the clip 82 is placed in the living tissue corresponds to the parallel portion 32v. The length f of the clip fastening ring 85 corresponds to the length of the ratchet 32s.

  When the clip 81 protrudes from the introduction tube 1, the claw member 24 comes into contact with the parallel portion, so that the introduction tube slider 22 can be coarsely moved. When the clip tightening ring 84 is protruded from the introduction pipe 1, the claw member 24 engages with the ratchet 32q, so that the introduction pipe slider 22 can be finely moved. The proper position of the clip 81 to project is when the clip clamping ring 84 is at the tip of the introduction tube 1. Therefore, when the introduction pipe 1 is adjusted to this proper position, the introduction pipe slider 22 can be finely moved. Further, since the operation of the introduction tube slider 22 becomes heavy because the claw member 24 is engaged with the ratchet 32q, the surgeon can recognize that the protrusion of the clip 81 is close to the proper position.

Next, the operation of the tenth embodiment will be described.
The introduction tube 1 is inserted into the living body cavity through the forceps channel of the endoscope. At this time, the distal end portion of the introduction tube 1 is positioned in front of the distal end of the clip 81, and the clip 81 is included in the lumen. On the operation portion side, the claw member 24 is engaged with the ratchet 32p, so that the operation member slider 32 does not slide easily in the lumen 22c of the introduction tube slider 22. Thus, the clip 81 does not protrude in the forceps channel.

  The introduction tube 1 is inserted in the vicinity of the target tissue, the collar portion 22b of the introduction tube slider 22 is gripped, and the introduction tube slider 22 is pulled to the proximal end side. Then, the claw member 24 gets over the ratchet 32p and comes into contact with the parallel portion 32t on the hand operation portion side. As a result, sliding of the introduction pipe slider 22 becomes light, and the introduction pipe slider 22 can be easily pulled. When the introduction tube slider 22 is pulled to the base end portion 32t 'of the parallel portion 32t, the clip 81 just protrudes from the introduction tube 1 on the distal end side. That is, the introduction pipe slider 22 can be roughly moved up to the position where the clip 81 protrudes.

  Further, when the introduction pipe slider 22 is pulled, the claw member 24 engages with the ratchet 32q, and the sliding resistance of the introduction pipe slider 22 increases. From this, the operator can also perceive sensibly that the proper position of the protrusion of the clip 81 is close. The introduction pipe slider 22 can be pulled while being adjusted with a minute length by the engagement of the claw member 24 and the ratchet 32q. If the introduction pipe slider 22 is arranged in a state where the clip clamping ring 84 protrudes from the tip of the introduction pipe 1, preparation for ligating the clip 81 is completed. In this state, as in the ninth embodiment, the knob 41a is pulled to place the clip 81 in the living tissue.

  In order to project the clip 82 from the tip of the introduction tube 1, the introduction tube slider 22 is further pulled to bring the claw member 24 into contact with the parallel portion 32u. The sliding of the introduction tube slider 22 becomes light, and the introduction tube slider 22 can be easily pulled again. When the introduction pipe slider 22 is pulled to the parallel portion 32 u ′, the clip 82 just protrudes from the introduction pipe 1 on the distal end side. That is, the introduction pipe slider 22 can be roughly moved up to the position where the clip 82 protrudes.

  Further, when the introduction pipe slider 22 is pulled, the claw member 24 engages with the ratchet 32r, and the sliding resistance of the introduction pipe slider 22 increases. Thus, the surgeon can also perceive that the proper position of the protrusion of the clip 82 is close. Then, the engagement between the claw member 24 and the ratchet 32r makes it possible to pull the introduction pipe slider 22 while adjusting it with a small length. If the introduction pipe slider 22 is arranged in a state where the clip fastening ring 85 protrudes from the tip of the introduction pipe 1, preparation for ligating the clip 82 is completed. If it will be in this state, the knob 41b is pulled similarly to 1st Embodiment, and the clip 82 is detained in a biological tissue.

  The operation of projecting the clip 83 from the tip of the introduction tube 1 is also realized by repeating the above operation. That is, when the introduction tube slider 22 is pulled and the claw member 24 comes into contact with the proximal end portion 32v ′ of the parallel portion 32v, the clip 83 protrudes from the introduction tube 1 on the distal end side. That is, the introduction pipe slider 22 can be roughly moved up to the position where the clip 83 protrudes.

  Further, when the introduction tube slider 22 is pulled, the claw member 24 engages with the ratchet 32s, and the sliding resistance of the introduction tube slider 22 increases. From this, the operator can also perceive sensibly that the proper position of the protrusion of the clip 83 is close. Then, the engagement between the claw member 24 and the ratchet 32s makes it possible to pull the inlet pipe slider 22 while adjusting the introduction pipe slider 22 with a minute length. If the introduction pipe slider 22 is disposed in a state where the clip fastening ring 86 protrudes from the tip of the introduction pipe 1, preparation for ligating the clip 83 is completed. In this state, as in the ninth embodiment, the knob 41c is pulled to place the clip 83 in the living tissue. By the above operation, a plurality of clips 81, 82, 83 can be placed in the living tissue.

  According to this embodiment, since the ratchet functions only when the operation of protruding the clip clamping ring is performed, the operation of protruding the clip more easily than the eleventh embodiment, and It can be performed accurately in a short time.

  According to the above, the following configuration is obtained.

  (Appendix 1) An introduction tube that can be inserted into a living body cavity, at least two or more operation wires that are inserted in the introduction tube so as to freely advance and retract, and an arm portion that has a proximal end portion and extends from the proximal end portion In a biological tissue clip device having a clamping portion at the tip and having at least two or more clips, a plurality of clips are arranged in series in the introduction tube, and the clips and the operation wires are engaged with each other. A biological tissue clip device.

  (Supplementary note 2) The biological tissue clipping device according to supplementary note 1, wherein the clip is imparted with open-up expansibility.

  (Supplementary note 3) The biological tissue clip device according to Supplementary note 1 or 2, wherein an operation wire is disposed in the introduction tube at a position that does not interfere with the direction in which the arm portion of the clip expands. apparatus.

  (Supplementary note 4) The biological tissue clipping apparatus according to supplementary note 3, wherein an operation wire is disposed in the introduction tube in a direction perpendicular to a direction in which the arm portion of the clip is expanded.

  (Supplementary note 5) In the biological tissue clip device according to supplementary note 3, the operation wire engaged with the clip disposed on the distal end side of the introduction tube has an arm portion of the clip disposed on the proximal end portion of the introduction tube. A living tissue clip device, wherein the clip portion is inserted to the proximal end side of the introduction tube.

  (Supplementary note 6) The biological tissue clip device according to supplementary note 5, wherein a clearance through which an operation wire can be inserted is provided in a clip holding portion.

  (Supplementary note 7) In the biological tissue clip device according to any one of Supplementary notes 1 to 6, provided on at least one of the introduction tube and the clip, when the clip protrudes forward of the introduction tube, the introduction tube and the clip are engaged. And an engaging means for prohibiting the clip from being housed again in the introduction tube.

  (Supplementary note 8) In the biological tissue clip device according to any one of Supplementary notes 1 to 6, at least two or more clips tightened to close the clip clamping portion by being fitted and attached to the arm portion of the clip Provided on at least one of the ring and the introduction tube or the clip fastening ring. When the clip and the clip fastening ring protrude forward of the introduction tube, the introduction tube and the clip fastening ring are engaged, and the clip fastening ring is An apparatus for clipping a living tissue, comprising engagement means for prohibiting re-storage in an introduction tube.

  (Supplementary note 9) The biological tissue clip device according to supplementary note 8, wherein an operation wire is disposed at a position where the manipulation wire is not brought into contact with an engagement means provided on the clip fastening ring.

  (Supplementary Note 10) The biological tissue clip device according to any one of Supplementary notes 1 to 9, wherein a pressing member inserted in the vicinity of the clip loaded at the most proximal end portion in the introduction tube is provided so as to freely advance and retract. Biological tissue clip device.

  (Supplementary note 11) The biological tissue clipping device according to supplementary note 10, wherein the pressing member has a plurality of flexible lumens.

  (Supplementary note 12) The biological tissue clipping device according to any one of supplementary notes 1 to 6, wherein an operation member inserted into the introduction tube so as to freely advance and retract is provided.

  (Supplementary note 13) The biological tissue clipping device according to supplementary note 12, wherein the operation member has a plurality of flexible lumens.

  (Supplementary note 14) In the biological tissue clip device according to supplementary note 12 or 13, the proximal end portion of the clip disposed on the distal end side of the introduction tube and the distal end portion of the clip disposed on the proximal end side of the introduction tube are A clip device for living tissue, wherein the clip device is disposed so as to abut.

  (Supplementary note 15) In the biological tissue clip device according to any one of Supplementary notes 12 to 14, at least two or more clips tightened so as to close a clip holding portion by being fitted and attached to an arm portion of the clip A biological tissue clipping device comprising a ring.

  (Supplementary Note 16) In the biological tissue clipping device according to Supplementary Note 15, the proximal end portion of the clip fastening ring disposed on the distal end side of the introduction tube and the distal end portion of the clip disposed on the proximal end side of the introduction tube Is a living tissue clip device characterized by being arranged in contact with each other.

  (Supplementary note 17) The biological tissue clip device according to supplementary note 15 or 16, wherein the inner diameter of the distal end of the introduction tube is substantially equal to the outer diameter of the clip fastening ring.

  (Supplementary note 18) In the biological tissue clip device according to any one of Supplementary notes 12 to 17, at least one of the proximal end portion of the introduction tube or the proximal end portion of the operation member includes an introduction tube protrusion amount control member. A biological tissue clip device.

  (Supplementary note 19) In the biological tissue clip device according to supplementary note 18, the introduction tube protrusion amount control member includes a ratchet claw provided at a proximal end portion of the introduction tube, and the operation member so as to be engaged with the ratchet claw. A biological tissue clip device comprising a ratchet provided at a proximal end portion.

  (Supplementary note 20) The biological tissue clipping device according to supplementary note 19, wherein the ratchet at the base end portion of the operating member is provided with alternating parallel portions and ratchet portions.

  (Supplementary note 21) In the biological tissue clip device according to any one of supplementary notes 1 to 20, at least one of the engagement means provided at at least one of the proximal end portion of the clip or the distal end portion of the operation wire is at the time of clip ligation. A biological tissue clipping device, wherein one of the two is deformed to release the engagement between the clip and the operation wire.

  (Supplementary note 22) The biological tissue clipping device according to supplementary note 21, wherein a deformable ridge projecting in a direction opposite to the arm portion is provided at a clip base end portion.

  (Supplementary note 23) The biological tissue clipping device according to supplementary note 21, wherein a closed loop portion is provided at the tip of the operation wire.

  (Supplementary note 24) In the biological tissue clip device according to supplementary note 23, at least one of the strands of a stranded wire in which at least two strands are twisted together, is used at the tip of the stranded wire. A clip device for living tissue, characterized in that an operation wire or an engaging means is formed by a stranded wire formed by forming a loop and re-twisting the wire forming the loop back to the stranded wire.

  (Supplementary note 25) In the biological tissue clip device according to Supplementary notes 23 and 24, when a force in a direction to separate the proximal end portion of the clip and the distal end portion of the operation wire is applied, the loop portion breaks and the clip and the manipulation are performed. A clip device for living tissue, wherein the wire is disengaged.

  (Supplementary note 26) In the biological tissue clipping device according to supplementary note 21, a hole provided in a proximal end portion of a clip through which a distal end of an operation wire can be inserted, and a distal end portion of the operation wire provided at a proximal end portion of the clip A clip device for living tissue, characterized in that a bulging portion larger than the hole is formed.

  (Supplementary Note 27) 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 holding portion at a distal end of an arm portion that has a proximal end portion and extends from the proximal end portion In a biological tissue clip device comprising at least two or more clips formed and having a spreadability, a plurality of clips are arranged in series in the introduction tube, and the clip loaded at the most proximal end in the introduction tube A clip device for living tissue, comprising a pressing member that is inserted in such a manner as to freely move backward and backward.

  (Supplementary note 28) The biological tissue clip device according to supplementary note 27, wherein at least two or more clip tightening rings that close the clip holding portion by being fitted and attached to the arm portion of the clip, and the introduction tube Alternatively, it is provided on at least one of the clip tightening rings. When the clip and the clip tightening ring protrude forward of the introduction tube, the introduction tube and the clip tightening ring are engaged, and the clip tightening ring is stored again in the introduction tube. A clip device for living tissue, characterized by comprising engagement means for prohibiting the action.

  According to Supplementary Note 1, a plurality of clips loaded in the introduction tube can be placed in the body cavity only by inserting the clip device into the body cavity once. Thereby, since the procedure time can be shortened, the pain of the patient can be reduced. In addition, since the operation wires are connected to the clips, one clip can be placed in the body cavity quickly, easily, and surely.

  According to Supplementary Note 2, in addition to Supplementary Note 1, there are the following effects. Since the arm part and the clamping part of the clip are more widely opened, the target tissue to be ligated can be grasped more reliably.

  According to Supplementary Notes 3 and 4, in addition to Supplementary Notes 1 and 2, the following effects can be obtained. Since the operation wire is arranged so as not to interfere with the clip, the clip can be easily protruded. Moreover, when ligating a clip, it can be ligated with a smaller force.

  According to Supplementary Note 5, in addition to the effect of Supplementary Note 3, the following effect is obtained. Since the operation wire engaged with the clip extends straight backward, there is little loss of force transmission, and the clip can be easily protruded. Moreover, when ligating a clip, it can be ligated with a smaller force.

  According to Appendix 6, in addition to the effect of Appendix 5, the following effect is obtained. Since the operation wire is not sandwiched between the clip clamping portions, the clip can be easily projected. Moreover, when ligating a clip, it can be ligated with a smaller force.

  According to Supplementary Note 7, in addition to the effects of Supplementary Notes 1 to 6, there are the following effects. Since the force applied by the operation wire can be reliably received by the engaging means, the living tissue can be ligated with a stronger force.

  According to Supplementary Note 8, in addition to the effects of Supplementary Notes 1 to 6, there are the following effects. Since the force applied by the operation wire can be reliably received by the engaging means, the living tissue can be ligated with a stronger force. In addition, since the clip arm is closed by the clip tightening ring, the living tissue can be ligated with a stronger force.

  According to Supplementary Note 9, in addition to Supplementary Note 8, the following effects can be obtained. Since the operation wire is disposed so as not to interfere with the engaging means of the clip and the clip fastening ring, the clip can be easily protruded. Moreover, when ligating a clip, it can be ligated with a smaller force.

  According to Supplementary Note 10, in addition to the effects of Supplementary Notes 1 to 9, the following effect is obtained. The clip can be more easily and reliably projected.

  According to Supplementary Note 11, in addition to the effect of Supplementary Note 10, the following effect can be obtained. Since the plurality of operation wires are inserted in the introduction tube in a state of being isolated from each other, the operation wires do not interfere with each other in the introduction tube. As a result, the sliding frictional resistance between the operation wires decreases in the introduction pipe, so that the amount of traction force can be transmitted to the leading end of the introduction pipe without loss. That is, the ligation operation can be performed with a smaller force.

  According to Supplementary Note 12, in addition to the effects of Supplementary Notes 1 to 6, there are the following effects. The operation of projecting the clip from the introduction tube can be performed more easily and reliably. Further, since the amount of compressive force at the time of clip ligation is received between the operation member and the clip, the force is well transmitted and ligation can be performed with a small force.

  According to Supplementary Note 13, in addition to the effect of Supplementary Note 12, the following effect is obtained. Since the plurality of operation wires are inserted in the operation member in an isolated state, the operation wires do not interfere with each other in the operation member. As a result, the sliding frictional resistance between the operation wires is reduced in the operation member, so that the amount of traction force can be transmitted to the front end of the operation member without loss. That is, the ligation operation can be performed with a smaller force.

  According to Supplementary Note 14, in addition to the effects of Supplementary Notes 12 and 13, there are the following effects. Since the arrangement length of the plurality of clips is shortened, the insertion of the endoscope channel is improved.

  According to Supplementary Note 15, in addition to the effects of Supplementary Notes 12 to 14, the following effect is obtained. Since the clip arm is closed by the clip tightening ring, the living tissue can be ligated with a stronger force.

  According to Supplementary Note 16, in addition to the effect of Supplementary Note 15, the following effect is obtained. Since the arrangement length of the plurality of clips is shortened, the insertion of the endoscope channel is improved.

  According to Supplementary Note 17, in addition to Supplementary Notes 15 and 16, the following effects are obtained. Since there is no backlash or inclination of the clip and the clip tightening ring with respect to the introduction pipe, the compression force can be reliably received, and the clip can be placed with a smaller force. It is also easy to aim at the target organization.

  According to the supplementary notes 18 and 19, in addition to the supplementary notes 12 to 17, there are the following effects. The operation of pulling the introduction tube and projecting the clip can be performed more reliably. In addition, the delicate protruding length of the introduction pipe can be adjusted.

  According to Supplementary Note 20, in addition to Supplementary Notes 18 and 19, the following effects are obtained. Since the ratchet functions only when fine adjustment of the operation of protruding the clip tightening ring is performed, the operation of protruding the clip can be performed more easily and accurately in a short time.

  According to Supplementary Notes 21, 22, 23, 25, and 26, in addition to Supplementary Notes 1 to 16, the following effects are obtained. Since the engagement structure between the clip and the operation wire is simplified and the number of parts can be reduced, the manufacturing cost can be reduced. In addition, it is possible to facilitate the mounting operation of the clip at the time of manufacture. Furthermore, since there is no special engagement component, the second clip can be protruded and ligated smoothly after the first clip is placed in the living tissue.

  According to Supplementary Note 24, the following effects can be obtained in addition to Supplementary Note 23. Since the outer diameter of the coupling portion between the loop portion and the tip of the operation wire does not increase, the operation wire can easily slide in the introduction tube. In addition, since a plurality of operation wires can be inserted into the introduction tube, a plurality of clips can be loaded into the introduction tube.

  According to Supplementary Note 27, a plurality of clips loaded in the introduction tube can be placed in the body cavity only by inserting the clip device into the body cavity once. Thereby, since the procedure time can be shortened, the pain of the patient can be reduced. In addition, since the operation wires are connected to the clips, one clip can be placed in the body cavity quickly, easily, and surely. Further, the clip can be more easily and reliably projected.

  According to Supplementary Note 28, in addition to the effect of Supplementary Note 27, the following effect is obtained. Since the clip arm is closed by the clip tightening ring, the living tissue can be ligated with a stronger force.

DESCRIPTION OF SYMBOLS 1 ... Introduction pipe 2 ... Tip end 4 ... Operation wire 17 ... Clip 19 ... Operation member 84 ... Clip clamping ring

Claims (1)

An introduction tube that can be inserted into the body cavity;
An operation wire inserted into the introduction tube so as to freely advance and retract;
Arranged in the introduction tube, each can be fitted over the base end, the arm extending from the base end, the clamping part formed at the tip of the arm, and the arm from the base end At least two or more clips comprising a clamping ring,
A push that is positioned behind the plurality of clips and is inserted in the introduction tube so as to be movable forward and backward, and presses the last clip of the plurality of clips to push the plurality of clips forward in the introduction tube. Members,
Comprising
The rear end surface of the clamping ring is formed on an end surface having an angle corresponding to the angle of the front end surface of the clamping portion in the clip located after the clip of the clamping ring, and the clamping portion in the rear end surface of the clamping ring and the clip on the rear end side A clip device for living tissue, wherein a plurality of clips are connected in a state in which the distal end surface is in close contact with and abuts.

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