JP2007209775A - Clip case - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a clip case allowing a clip unit consisting of a clip, a fastening ring and a connecting member to easily attach to a clip device. <P>SOLUTION: When a slider is drawn to a distal end side while pushing all of a projecting portion 4a of a pushing tube 4 in the pushing tube 4, an operation wire 7 and a hook section 12 are drawn in a coil sheath inside. As the projecting portion 4a of the pushing tube 4 is pushed in the pushing tube 4, the clip unit 1 is drawn inside the coil sheath without being caught by the end face of a coil pipe 8. As the projecting portion 4a of the pushing tube 4 comes into contact with the inside face of the coil sheath, the projecting portion is elastically deformed and retains the state of being stored inside the pushing tube 4. In this state, a sheath section 6 is introduced into the body cavity through a forceps channel of the endoscope inserted in the body cavity previously, and the distal end of the sheath section 6 is guided to an object site while observing the body cavity with the endoscope. <P>COPYRIGHT: (C)2007,JPO&INPIT

Description

  The present invention relates to a clip case that encloses a clip, a tightening ring, a connecting member, and the like of a clip device for a living tissue that is inserted into a body cavity endoscopically and clips the living tissue.

  For example, Patent Document 1 is known as a clip device for living tissue. As shown in FIGS. 28A and 28B, the clip device includes a clip unit 101 and a clip operation device 106. The clip unit 101 is in a state in which the coupling member 103 is engaged with the clip 102 and the clip fastening ring 104 is fitted. The connection member 103 is made of a plate material, and an engagement hole 103b is provided for connection to the hook portion 112 of the clip operation device 106.

  The clip operating device 106 includes an insertion portion 106a and a proximal side operation portion 106b. The insertion portion 106a includes an introduction tube 107, an operation tube 109 inserted into the introduction tube 107, and an operation wire 110 inserted into the operation tube 109. It is composed of The operation wire 110 is provided with a hook portion 112 having a pin 111 for connecting to the connecting member 103. The hand side operation unit 106 b includes a tube joint 114 fixed to the hand side of the introduction tube 107, an operation unit body 115 that moves the operation tube 109 forward and backward, and a slider portion 116 that moves the operation wire 110 forward and backward.

  Therefore, in order to attach the clip unit 101 to the clip operating device 106 and introduce it into the body cavity, the following procedure is performed.

  (1) The operation unit main body 115 is pushed toward the distal end side, and the operation tube 109 is protruded from the introduction tube 107.

  (2) The slider portion 116 is pushed toward the distal end side, and the hook portion 103a is protruded from the operation tube 109.

  (3) The pin 111 is engaged through the engagement hole 103b while the positions of the engagement hole 103b of the connecting member 103 of the clip unit 101 and the pin 111 of the hook portion 112 of the clip operating device 106 are aligned.

  (4) Pull the slider portion 116 toward the proximal end side, and fit the fastening ring 104 of the clip unit 101 to the distal end of the operation tube 109.

  (5) Pull the operation unit main body 115 toward the proximal end side and store the clip unit 101 in the introduction tube 107.

  (6) It introduces into a body cavity through an endoscope.

  The six steps are performed.

  Next, ligation of the clip unit 101 is performed according to the following procedure.

  (1) The operation unit main body 115 is pushed to the distal end side, and the clip unit 101 is protruded from the introduction tube 107.

  (2) Pull the slider part 116 slightly toward the base end side to bring the clip 102 into an expanded state.

  (3) Pull the slider portion 116 toward the base end side, fit the fastening ring 104 onto the clip 102, and ligate the clip 102.

  The following three steps are performed.

  Further, as a configuration of an introduction tube and an operation wire, for example, an endoscope treatment tool disclosed in Patent Document 2 is known. The configuration of the endoscope treatment tool includes a mantle tube, an operation wire that is inserted into the mantle tube so as to freely advance and retreat, and is advanced and retracted by an operation from the hand side, and is attached to the operation wire and moves forward and backward. A treatment part that can operate the treatment instrument on the distal end side of the outer tube and is constituted by an elastic wire, an extension part wire that extends at least one end of the elastic wire and is introduced into the outer tube, and the extension part wire One of the operation wires is bent in the outer tube, and a plurality of bending portions are attached and fixed to the other.

  Therefore, in this endoscope treatment tool, when the operation wire is advanced and retracted by operation of the operation portion and the treatment portion is operated, the bending of the operation wire or the extension portion wire in the outer tube is reduced. Therefore, the loss of the operation amount of the operation portion is extremely reduced, and the treatment portion at the distal end of the outer tube can be reliably operated.

  Further, an endoscope injector shown in Patent Document 3 is known as a configuration of an introduction tube and an operation wire. This is an endoscopic syringe in which an operation portion and a puncture portion are connected via a double tube comprising an inner and outer tube, and the amount of protrusion of an injection needle provided at the distal end of the inner tube is made constant. A protrusion amount restricting member is provided at the distal end of the outer tube, and the amount of movement of the injection needle is restricted by sliding the side surface of the stopper and the side surface of the protrusion amount restricting member together.

Further, an endoscope injector shown in Patent Document 4 is known as a configuration of the operation unit. This includes a flexible injection tube, a tubular tip needle attached to the tip of the injection tube, a flexible outer tube through which the tip needle and the injection tube are slidably inserted, An injection pipe connected to the proximal end of the injection tube inside the proximal side of the outer tube, and a distal end needle provided at the distal end of the outer tube that protrudes from the distal end of the outer tube and hits the stopper to be regulated. A fixing mechanism for compressing and fixing the injection tube to the outer tube is provided.
JP-A-8-19548 JP-A-2-39855 Japanese Utility Model Publication No. 5-91686 Japanese Utility Model Publication No. 62-78901

  However, the clip device of Patent Document 1 includes a tube joint 114 for advancing and retracting the introduction tube 107, an operation unit main body 115 for advancing and retracting the operation tube 109, and an operation wire 110 for the proximal side operation unit 106b. A slider part 116 for moving forward and backward is provided.

  Therefore, it is necessary to advance and retract the tube joint 114, the operation portion main body 115, and the operation wire 110 in six stages from (1) to (6), and the operation is complicated.

  In order to attach the clip unit 101 to the hook portion 112, (1) while holding the connecting member 103 of the clip unit 101 in a horizontal direction with respect to the notch portion provided in the hook portion 112, (2) It is necessary to engage the engagement holes 103b provided in the connecting member 103 with the pins 111 provided on the hook portion 112 while being positioned so that the pins 111 are fitted. For this purpose, the two alignment operations of (1) facing and (2) alignment must be performed at the same time, and the mounting operation is difficult.

  Furthermore, in order to ligate the clip unit 101, it is necessary to hold the clip 102 in the maximum open state and then ligate with the target site in that state. However, if the operation is incorrect, the maximum open state will be passed and ligation will not be possible. Therefore, the slider part 116 must be delicately operated, and the operation is difficult.

  The thing of the said patent document 2 can eliminate the slack of the wire when pushing an operation wire, when the application to the operation wire of a clip operation device is considered.

  However, when the introduction tube is curved, the operation wire comes off the axial center of the introduction tube. Therefore, when the clip unit is attached to the hook portion, the position of the hook portion changes depending on the shape of the introduction pipe, and cannot be stably fixed, so that it is difficult to attach the clip unit to the hook portion.

  Further, in Patent Document 3, considering the application of the clip operating device to the hook part and the introduction pipe, the hook part can be positioned at the axial center of the introduction pipe, but the leading end of the introduction pipe is tapered. A structure to reduce the diameter is essential, and when the reduced diameter portion is an inner diameter through which the clip unit can pass, the outer diameter of the introduction pipe is increased. Also, in order to ensure that the hook part can be securely engaged with the clip unit connecting material, the length of the hook part must sufficiently protrude from the leading end of the introduction tube, and the hook part length becomes long. When the hook portion is pulled into the introduction tube, the flexibility of the introduction tube is lost, and it is difficult to insert the hook portion into the flexible endoscope and to protrude the hook portion.

  Furthermore, considering that the fixing mechanism of the operation unit of Patent Document 4 is applied to the fixing mechanism of the slider of the clip operating device, the fixing mechanism using the elastic rubber ring releases the amount of operating force when the slider is fixed. When the elastic rubber ring having a light force is used in order to facilitate fixing, the release can be performed with a light force similarly, and the fixing cannot be sufficiently performed. On the other hand, in order to make it difficult to release the elastic rubber ring with a heavy force, the fixing becomes heavy and the operation becomes difficult.

  The present invention has been made paying attention to the above circumstances, and an object thereof is to provide a clip case in which a clip unit including a clip, a fastening ring, and a connecting member can be easily attached to a clip device. It is in.

  In order to achieve the above object, the present invention provides a clip, a clamping ring that is fitted and attached to the clip, and can be inserted into the clamping ring. And a connecting member that engages with the clip, an introduction tube that can attach the clip and the tightening ring to the tip, the connecting member is engaged with the clip, and the tightening ring is connected to the connecting member. The clip, the tightening ring, and the connecting member are sealed in the fitted state, and the fixing pipe is fixed at a position where the clip, the tightening ring, and the connecting member can be stored in the introducing pipe. The clip case is characterized by that.

  According to a second aspect of the present invention, the fixing means according to the first aspect is an arm that can be elastically expanded.

  A third aspect of the present invention is characterized in that the fixing means of the first aspect is a protrusion that can be expanded elastically.

  According to a fourth aspect of the present invention, the fixing means according to the first aspect is an arm with a protrusion that can be elastically expanded.

  A fifth aspect of the present invention is characterized in that the fixing means of the first aspect is a soft resin ring.

  According to a sixth aspect of the present invention, at least a part of the case main body according to any one of the first to fifth aspects is made of a transparent or translucent material.

  According to the present invention, when a clip unit composed of an assembly of a clip, a tightening ring, and a connecting member is attached to a clip operating device, the introduction tube is inserted into the clip case and the clip unit is simply pushed into the introduction tube. Therefore, it is only necessary to hold either the clip case or the introduction pipe when attaching the clip, and there is an effect that the clip can be attached easily.

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

  FIGS. 1-6 shows 1st Embodiment, The clip apparatus of this embodiment is comprised by the clip unit 1 shown by FIG. 1, and the clip operation apparatus 5 shown by FIG. The clip unit 1 has a clip 2, a connecting member 3 as a connecting member, and a presser tube 4 as a clip fastening ring.

  The clip 2 is, for example, an arm having a spreading ability after a metal plate material such as a leaf spring material is bent at the central portion, and further, the position near the bent portion is crossed as shown in FIG. The portions 2a and 2b are provided so as to extend in a state where the distal end portions are separated from each other, and a substantially elliptical proximal end portion 2c is formed on the proximal end portion side.

  The connecting member 3 is manufactured, for example, by injection molding a resin such as liquid crystal polymer or nylon, and a hook-shaped hook hook 3a is provided at the tip of the connecting member 3 as shown in FIG. Is formed. The hook 2 is hooked on the proximal end 2c of the clip 2 to engage the clip 2.

  Further, an arrowhead hook 3 b is formed at the other end of the connecting member 3 for connection with the clip operating device 5. The base end side of the arrowhead hook 3b has a conical shape with an inclined surface 3f. The maximum outer diameter of the arrowhead hook 3b is set to φ1.0 mm to φ1.4 mm in consideration of deformation amounts of elastic arms 12a and 12b of the hook portion 12 described later.

  In addition, the inclined surface 3f is desirably 30 ° or less in order to smoothly attach the inclined surface 3f to the hook portion 12. Between the heel hook 3a and the arrowhead hook 3b, a cylindrical columnar portion 3c having a diameter smaller than that of the end of the arrowhead hook 3a is provided. Accordingly, a step is formed at the boundary between the cylindrical portion 3c and the arrowhead hook 3b, and the hook portion 12 is reliably engaged. The outer diameter of the cylindrical portion 3c is set to φ0.7 mm to φ1.0 mm in consideration of the step height that affects the amount of engagement force with the hook portion 12 and the tensile strength of the cylindrical portion 3c itself.

  Furthermore, a fracture portion 3d having a diameter of φ0.4 mm to φ0.6 mm is provided on the distal end side of the cylindrical portion 3c. When a tensile force of about 3 kgf to 5 kgf is applied to the connecting member 3, the fracture portion 3d Breaks. Further, the base end side of the hook hook 3a has a diameter larger than the inner diameter of the presser tube 4 described later, and is a circle for pressing the presser tube 4 against the inner surface to fix the position of the connecting member 3 and the presser tube 4. An arc-shaped protrusion 3e is provided. The connecting material 3 may be manufactured by injection molding a metal in order to obtain a higher breaking strength.

  The presser tube 4 is manufactured by injection molding a resin having strength such as PBT (polybutyterephthalate) and having appropriate elasticity. As shown in FIG. 1 (E), the presser tube 4 closes the arm portions 2a and 2b of the clip 2 by fitting and mounting on the arm portions 2a and 2b of the clip 2, and has an inner diameter φ1. It has a substantially tubular shape with a diameter of 2 to 1.3 mm and an outer diameter of 1.9 to 2.1 mm.

  In the standby state before the operation of closing the clip 2 is performed, the clip 2 is held in a state of being fitted on the distal end portion of the connecting member 3 as shown in FIG. Further, the presser tube 4 is elastically deformed, and is installed so as to be able to project and retract in the outer peripheral direction of the presser tube 4, and a pair of protrusions for engaging with a coil pipe 8 (see FIG. 2A) described later. 4a is provided. In consideration of the engagement with the coil pipe 8, the outer diameter of the protrusion 4a when protruding is set to φ2.2 mm or more.

  In addition, the shape of the protrusion 4a is an inclined surface having an angle of 30 ° or less on the distal end side, a vertical surface on the proximal end side, and an R shape between the inclined surface and the vertical surface. When projecting from the inside of the sheath portion 6 to the tip, it is extruded with a small amount of force, and after the projection, it is surely engaged with the coil pipe 8. Further, by making the tip end side an inclined surface, it is possible to effectively receive the force applied to the vertical surface of the projection 4a when engaged with the coil pipe 8. It should be noted that three or more protrusions 4a may be provided in order to stabilize the engagement with a coil pipe 8 (see FIG. 2A) described later.

  Next, the configuration of the clip operation device 5 shown in FIG. 2 will be described. As shown in FIG. 2A, the clip operation device 5 includes a flexible sheath portion 6 and an operation wire 7 as an operation member that is inserted into the sheath portion 6 so as to freely advance and retract. Is provided.

  The sheath portion 6 includes a coil pipe 8 that is larger than the outer diameter of the presser tube 4 and smaller than the outer diameter of the protruding portion 4a, and an inner diameter that is connected to the coil pipe 8 and larger than the outer diameter of the presser tube 4 described above. A coil sheath 9 is provided. Further, the operation unit main body 10 is connected to the proximal side of the coil sheath 9. A slider 11 is connected to the proximal end of the operation wire 7. The slider 11 is installed in the operation unit main body 10 so as to freely advance and retract, and the operation wire 7 can be advanced and retracted with respect to the sheath part 6.

  A hook portion 12 is connected to the distal end of the operation wire 7. The hook portion 12 is made of a metal material having a spring property, and as shown in FIGS. 2B and 2C, the two elastic arms 12a and 12b having a closing behavior and the connection are provided. By sandwiching the cylindrical portion 3c of the material 3, gripping portions 12c and 12d that engage with the arrowhead hook 3b are provided. The elastic arms 12a and 12b have a thickness of 0.2 mm to 0.4 mm, a width of 0.5 mm to 1 mm, an outer surface having an arc shape with a diameter of φ1.8 mm to 2 mm, and a length of 4 mm to 8 mm. It is said.

  A semicircular groove 12f having the same diameter as the outer diameter of the cylindrical portion 3c is provided on the inner side of the gripping portions 12c and 12d, and due to the closing force of the elastic arms 12a and 12b, the connecting member 3 is provided. It is easy to press and hold the cylindrical portion 3c.

  Further, as shown in FIGS. 2B and 2C, inclined surfaces 12e are provided at the base end portions of the elastic arms 12a and 12b of the hook portion 12, respectively. The angle of the inclined surface 12e is desirably 30 ° or less in order to smoothly remove the connecting member 3 from the hook portion 12. Further, it is desirable that the elastic arms 12a and 12b and the gripping portions 12c and 12d of the hook portion 12 are constituted by an integral spring member in order to increase the strength. Further, the hook portion 12 may be manufactured by molding a resin having a high strength such as nylon and having a spring property.

  Next, the operation of the first embodiment will be described. In order to attach the clip unit 1 to the clip operating device 5, first, as shown in FIG. 3A, the hook portion 12 is protruded from the coil pipe 8 by pushing the slider 11 toward the distal end side. 12, the arrowhead hook 3 b of the connecting member 3 is pushed from the tip side. Then, the tip side inner surfaces of the grip portions 12c and 12d of the hook portion 12 abut against the inclined surface 3f on the arrowhead hook 3b of the connecting member 3, and the grip portions 12c and 12d are pushed outward along the inclined surface 3f.

  At this time, the elastic arms 12a and 12b are elastically deformed. Thereafter, when the connecting member 3 is further pushed into the hook portion 12, when the grip portions 12c and 12d pass the arrowhead hook 3b, the elastic arms 12a and 12b are closed by the closing force, and the cylindrical portion 3c is sandwiched between the grip portions 12c and 12d. Is done. At this time, the tip end side end face of the arrowhead hook 3b of the connecting member 3 and the base end side end face of the gripping portions 12c and 12d come into contact with each other, so that the arrowhead hook 3c cannot be detached from the hook portion 12c and the clip unit 1 is gripped by the hook portion 12. Fixed.

  Thereafter, as shown in FIG. 3B, when the slider 11 is pulled toward the proximal end while pushing all the protruding portions 4a of the presser tube 4 into the presser tube 4, the operation wire 7 and the hook portion 12 are connected to the coil sheath 9. Drawn into. At this time, since the protruding portion 4 a of the presser tube 4 is pushed into the presser tube 4, the clip unit 1 is pulled into the coil sheath 9 without being caught on the end surface of the coil pipe 8.

  At this time, the arms 2a and 2b of the clip 2 of the clip unit 1 are closed according to the inner diameter of the coil sheath 9, and the clip unit 1 is housed in the coil sheath 9 as shown in FIG. . At this time, since the protruding portion 4 a of the presser tube 4 is in contact with the inner surface of the coil sheath 9, the presser tube 4 is elastically deformed and kept in the presser tube 4. In this state, the sheath part 6 is introduced into the body cavity through the forceps channel of the endoscope previously inserted into the body cavity, and the distal end of the sheath part 6 is guided to the target site while observing the inside of the body cavity with the endoscope. .

  Next, the clip unit 1 is protruded from the coil pipe 8 as shown in FIG. At this time, since the tip side of the protrusion 4a of the presser tube 4 is an inclined surface, the clip unit 1 is pushed out smoothly and without resistance. Then, the protrusion 4 a of the presser tube 4 is released from the contact state with the inner surface of the coil sheath 9 and protrudes from the presser tube 4 in the outer peripheral direction. At this time, since the clip unit 1 is gripped and fixed to the gripping portions 12c and 12d of the hook portion 12, the clip unit 1 does not fall off the hook portion 12.

  Thereafter, by pulling the slider 11 back to the base end side, as shown in FIG. 4B, the operation wire 7 is pulled to the base end side, and the base end side end surface of the protruding portion 4a of the presser tube 4 is the coil. Engage with the end face of the pipe 8. Thereafter, when the slider 11 is further pulled to the proximal end side, the elliptical dimension W of the proximal end part 2c of the clip 2 is larger than the inner diameter dimension of the presser tube 4, so that the elliptical part of the proximal end part 2c of the clip 2 is pressed. It is crushed by being drawn into the tube 4. Then, as shown in FIG. 4C, the arm portions 2a and 2b are greatly expanded outward.

  In this state, the clip 2 is guided so as to sandwich the target living tissue. When the operation wire 7 is further retracted by further pulling the slider 11 to the proximal end side, the arms 2a and 2b of the clip 2 are drawn into the presser tube 4, and the clip as shown in FIG. The two arm portions 2a and 2b are closed. When the living tissue is securely sandwiched between the arms 2a and 2b of the clip 2 and the slider 11 is further pulled toward the proximal end and the operation wire 7 is retracted, the fractured portion 3d of the connecting member 3 of the clip 2 is illustrated. As shown in FIG. 5, the clip 2 is disengaged from the connecting member 3, and the clip unit 1 is detached from the clip operating device 5 and is left in the body cavity while holding the living tissue.

  For example, the tissue at the bleeding site in the body cavity is sandwiched between the arms 2a and 2b of the clip 2 and compressed, and the clip unit 1 is placed in that state to compress the blood vessel at the bleeding site and stop the bleeding. it can. After placement of the clip unit 1, the clip operating device 5 is removed from the forceps channel.

  In most cases, the ligation of the living tissue by the clip device is performed by ligating a plurality of clips 2 continuously, and the next clip unit 1 is often attached immediately after removal. In this embodiment, when attaching the clip unit 1 for the second and subsequent shots, after removing the clip operating device 5 from the endoscope channel, first, the slider 11 is pushed out to the distal end side, and the hook portion 12 is moved to the coil sheath. Protruding from 7. At this time, the connecting member 3 of the first clip unit 1 remains engaged with the hook portion 12c.

  In this state, the connecting member 3 of the second clip unit 1 is pushed in from the front end side of the hook portion 12 as it is. Then, the first connecting material 3 remaining on the hook portion 12 is pushed by the second connecting material 3 and pushed into the proximal end side of the hook portion 12. Then, the base end side end portion of the first connecting member 3 abuts on the inclined surface 12e on the base end side of the hook portion 12, and moves along the inclined surface 12e as shown in FIG. It is pushed out between 12b and falls off from the hook part 12c, and the removal of the first connection member 3 and the attachment of the second clip unit 1 are completed at the same time. Thereafter, the ligation and attachment of the clip 2 can be continuously performed in the same manner.

  According to the first embodiment described above, the clip unit 1 can be attached to the hook portion 12 of the clip operating device 5 simply by pushing the clip unit 1 into the hook portion 12. Since it does not fall off due to the gripping force of 12, the mounting is simple and reliable.

  Further, in order to store and release the clip unit 1 in the sheath portion 6 and then ligate the clip unit 1, it is possible to advance and retract only the slider 11, and when reloading the clip 2. Since the connecting member 3 can be removed simultaneously with the attachment of the clip 2, the operation is simple, and the treatment can be completed in a short time.

  Further, when the clip unit 1 is taken out from the sheath part 6, the slider 11 is pushed, and when the clip unit 1 is ligated, the slider 11 is pulled. Since the operation is intuitively understandable to the operator, the possibility of erroneous operation is reduced.

  Moreover, since the structure of the clip operating device 5 is simple, processing and assembly are easy, and processing and assembly can be performed at low cost.

  7 and 8 show the second embodiment. In this embodiment, only the presser tube 4 of the clip unit 1 and the coil pipe 8 of the clip operating device 5 of the first embodiment are different, and the other configurations are as follows. Are the same.

  The coil pipe 13 of the second embodiment is formed by processing a metal pipe having a spring property. As shown in FIGS. 7A and 7B, the coil pipe 13 has a substantially cylindrical shape, and has a small-diameter portion 13a having a small inner diameter on the distal end side and a large-diameter portion 13b on the proximal end side. Yes. Further, an inclined portion 13c is provided between the small diameter portion 13a and the large diameter portion 13b. In addition, as shown in FIG. 7A, the coil pipe 13 is provided with four slits from the front end side, and the arm portion 13d between the slits is elastically deformed so that the small diameter portion 13a is formed. The diameter of can be freely expanded and reduced.

  As shown in FIG. 8, the presser tube 14 of the clip unit 1 has a substantially pipe-like shape whose outer diameter is larger than the inner diameter of the small diameter portion 13a of the coil pipe 13 and smaller than the inner diameter of the large diameter portion 13b. ing. A fitting portion 14 a that is smaller than the inner diameter of the small diameter portion 13 a of the coil pipe 13 is provided on the proximal end side.

  Next, the operation of the second embodiment will be described. In order to attach the clip unit 1 to the clip operating device 5, as in the first embodiment, the slider 11 is pushed out to the tip side, the hook portion 12 is protruded from the coil pipe 13, and the connecting member 3 of the clip unit 1 is hooked. It is pushed into the part 12 and held and fixed. Thereafter, the arm portion 13d of the coil pipe 13 is elastically deformed in the outer peripheral direction, and the slider 11 is moved to the proximal end side while expanding the small diameter portion 13a of the coil pipe 13 to a diameter larger than the outer diameter of the presser tube 14. Pull the hook portion 12 and the clip unit 1 into the sheath portion 6.

  In this state, as in the first embodiment, the sheath portion 6 is guided to the target site via the endoscope. Next, the clip unit 1 is protruded from the sheath portion 6 by an operation of pushing the slider 11 again toward the distal end side. At this time, the inclined portion 13 c of the coil pipe 13 is pushed by the clip unit 1, the arm portion 13 d of the coil pipe 13 is deformed in the outer peripheral direction, and the small diameter portion 13 a becomes larger than the outer diameter of the presser tube 14 of the clip unit 1. In order to expand, the clip unit 1 can be protruded from the sheath portion 6.

  When the clip unit 1 is protruded until the fitting portion 14a of the presser tube 14 passes through the small diameter portion 13a of the coil pipe 13, the arm portion 13d of the coil pipe 13 is elastically restored, and the small diameter portion 13a of the coil pipe 13 is restored. Shrink to the diameter.

  Thereafter, when the slider 11 is pulled back to the proximal end side, the small diameter portion 13a of the coil pipe 13 and the fitting portion 14a of the presser tube 14 are fitted, and the step at the distal end side end of the fitting portion 14a and the coil pipe 13 are fitted. The end surface on the front end side comes into contact, and the presser tube 14 and the coil pipe 13 are fixed in position. Thereafter, the clip can be ligated in the same manner as in the first embodiment. Since the effect of the second embodiment is the same as the effect of the first embodiment, the description is omitted.

  9 and 10 show a third embodiment, and this embodiment relates to a fixing method between the clip unit 1 and the clip operating device 5 of the first embodiment. Only the shape of the hook portion 12 of the clip operating device 5 is different, and the other configurations are the same.

  In 3rd Embodiment, as FIG. 9 (A) shows, the metal wire is bent and the connection material 20 is shape | molded. The base end side of the connecting member 20 is bent into a pentagonal shape having sides 20a, 20b, 20c, 20d and an apex 20e, and further, as shown in FIG. 9B, the base end side end of the connecting member 20 The part 20f is bent and shifted up and down. Further, the hook portion 21 has a hollow pipe shape as shown in FIG. 10, and the width W (FIG. 9) of the pentagonal bent portion of the connecting member 20 as shown in FIG. A large-diameter portion 21b having an inner diameter larger than that of (A) is provided, and a small-diameter portion 21a having an inner diameter smaller than the width W is provided on the tip side of the large-diameter portion 21b.

  Next, the operation of the third embodiment will be described. When the connecting member 20 is pushed in from the tip end side of the hook portion 21, the sides 20b and 20c of the pentagonal bent portion of the connecting member 21 abut on the end portion on the tip end side of the small diameter portion 21a of the hook portion 21, and between the sides 20a and 20d. Until the width W becomes smaller than the diameter of the small-diameter portion 21a, it is elastically deformed and reduced around the vertex 20e of the pentagonal bent portion. Thereafter, when the connecting member 20 is further pushed in, the pentagonal bent portion passes through the small diameter portion 21a, is restored in the large diameter portion 21b, and is engaged and fixed to the step between the small diameter portion 21a and the large diameter portion 21b.

  In addition, since the operation and effect of the third embodiment are the same as those of the first embodiment, description thereof is omitted.

  11 and 12 show a fourth embodiment, and this embodiment relates to a fixing method between the clip unit 1 and the clip operating device 5 of the first embodiment, and the connection member 3 of the clip unit 1 and Only the shape of the hook portion 12 of the clip operating device 5 is different, and the other configurations are the same.

  In the fourth embodiment, as shown in FIG. 11A, the connecting member 22 is formed by bending a first connecting member 23 processed from a metal plate member and a metal plate member such as a leaf spring member. The second connecting member 24 is configured.

  As shown in FIG. 11C, a hook-shaped hook hook 23 a is provided on the distal end side of the first connecting member 23 so as to engage with the clip 2. Further, a T-shaped T hook 23b is provided on the proximal end side of the first connecting member 23 for fixing to the second connecting member. As shown in FIG. 11B, the second connecting member 24 has arm portions 24b and 24c having a closing behavior for fixing the first connecting member 23 to the slit portion 24a and the hook portion 25 for fixing. Is provided. As shown in FIG. 12, the hook portion 25 has a conical shape having an inclined surface 25a on the distal end side.

  Next, the operation of the fourth embodiment will be described. When the connecting member 22 is pushed in from the front end side of the hook portion 25, the ends of the arm portions 24b and 24c of the second connecting member 24 abut against the inclined surface 25a of the hook portion 25, and the arm portions 24b and 24c follow the inclined surface 25a. When it is elastically deformed and expanded and further pushed in, the arm portions 24 b and 24 c are closed, and the connecting member 22 is engaged and fixed to the hook portion 25.

  In addition, since the operation and effect of the fourth embodiment are the same as those of the first embodiment, description thereof is omitted.

  FIG. 13 shows a fifth embodiment. This embodiment relates to a fixing method between the clip unit 1 and the clip operating device 5 of the first embodiment, and only the connecting material 3 of the clip unit 1 is different. Other configurations are the same.

  In the fifth embodiment, as shown in FIG. 13, the connecting member 25 includes the first connecting member 23 described above and a second connecting member 26 formed by bending a metal plate such as a leaf spring. Yes.

  The second connecting member 26 has arms 26b and 26c formed by bending both ends of the plate material at an acute angle and further bending the center of the plate material into a semicircular shape. Moreover, the slit part 26a for fixation with the 1st connection material 23 is provided similarly to the connection material 24 of 4th Embodiment.

  Next, the operation of the fifth embodiment will be described. When the connecting member 25 is pushed in from the front end side of the hook part 12, the end of the second connecting member 26 hits the inclined surface 12e of the hook part 12, and the elastic arms 12a and 12b of the hook part 12 are elastically expanded. And the arm parts 26b and 26c of the 2nd connection material 26 close elastically. Thereafter, when the connecting member 25 is further pushed in, the elastic arms 12a and 12b and the arm portions 26b and 26c are restored when the end portion of the second connecting member 26 passes the gripping portions 12c and 12d of the hook portion 12, and the engagement portion 25 is engaged. Fixed.

  According to the present embodiment, since both the hook portion 12 and the second connecting member 26 are elastically deformed and restored, the amount of deformation of both members can be reduced, so that the elastic arm portion 12a. , 12b can be shortened, and the amount of advance / retreat force of the hook portion 12 can be reduced. Moreover, since the elastic arms 12a and 12b are shortened, the strength can be increased.

  Since the other operations and effects of the fifth embodiment are the same as those of the first embodiment, description thereof is omitted.

  FIG. 14 shows a sixth embodiment, and this embodiment includes a clip unit 1 and a clip case 30 as shown in FIG. The clip case 30 is manufactured, for example, by molding a resin having good slipperiness such as polyacetal. The clip case 30 is provided with a large-diameter hole 31 larger than the outer diameter of the coil pipe 8 of the clip operating device 5, and the clip unit 1 has a large-diameter hole formed by the arrowhead hook 3 b of the connecting member 3 of the clip unit 1. It is stored in the clip case 30 so as to face 31.

  In the clip case 30, a small-diameter portion 32 that is smaller than the inner diameter of the coil pipe 8 and larger than the outer shape of the presser tube 4 is provided further into the large-diameter hole 31. An inclined portion 34 is provided between the storage portion 33 in which the clip unit 1 is stored and the small diameter portion 32. The inclined portion 34 is provided to reduce the protrusion 4 a of the presser tube 4 when the clip unit 1 is pulled out from the clip case 30. In order to smoothly reduce the protruding portion 4a, it is desirable that the inclined portion 34 has an angle of 30 ° or less.

  Next, the operation of the sixth embodiment will be described. As shown in FIG. 14, with the coil pipe 8 inserted into the large-diameter hole 31 of the clip case 30, the hook portion 12 protrudes into the clip case 30 by pushing the slider 11 toward the distal end side. Then, the arrowhead hook 3b of the connecting member 3 is gripped and fixed to the hook portion 12 in the same manner as in the first embodiment.

  At this time, since the position of the coil pipe 8 and the clip unit 1 is fixed by the clip case 30, the hook portion 12 directly strikes the connecting member 3, and it is not necessary to position the hook portion 12 and the connecting member 3. Surely done. Thereafter, when the slider 11 is pulled toward the base end side, the clip unit 1 held and fixed to the hook portion 12 is also pulled toward the base end side and pulled toward the large-diameter hole 31 of the clip case 30. At this time, the protrusion 4 b of the presser tube 4 abuts against the inclined surface 34 of the clip case 30, elastically deforms along the inclined surface 34, and is pushed into the presser tube 4.

  Thereafter, the clip unit 1 is drawn into the sheath portion 6 of the clip operating device 5 through the small diameter hole 32 of the clip case 30. At this time, the protrusion 4 a of the presser tube 4 contacts the inner surface of the small diameter portion 32 of the clip case 30 and is pressed into the presser tube 4, so that the clip unit 1 is not coiled on the end surface of the coil pipe 8. 9 is drawn into. Furthermore, since each arm part 2a, 2b of the clip unit 1 is also closed along the inclined part 34, the clip unit 1 is smoothly accommodated in the sheath part 6 as shown in FIG. .

  According to this embodiment, the clip unit 1 and the clip operating device 5 are attached only by inserting the sheath portion 6 of the clip operating device 5 into the large-diameter hole 31 of the clip case 30 and moving the slider 11 forward and backward once. Thus, the positioning of the hook 12 and the connecting member 3 and the pressing operation of the protruding portion 4a of the presser tube 4 are eliminated, and the preparation of the clip device is further simplified and ensured. Since other operations and effects are the same as those of the first embodiment, description thereof is omitted.

  15 to 17 show a seventh embodiment, and the clip device of this embodiment includes a clip unit 40 as shown in FIG. 15 and a clip operation device 47 as shown in FIG. .

  As shown in FIG. 15C, the clip unit 40 houses the clip 2, the connecting member 41, the pair of slide plates 42, the slide bar 43, the connecting pipe 44, the presser tube 45 as a tightening ring, and the clip 2. A clip cover 46 is provided. The clip 2 has the same shape as the clip 2 of the first embodiment.

  The connecting member 41 is formed by photo-etching or pressing a metal plate material. As shown in FIG. 15C, a hook-like hook 41a is formed at the tip of the connecting member 41. This hook hook 41a is hooked on the proximal end 2c of the clip 2 so that the clip 2 is detachably engaged. Further, the connecting member 41 is provided with a slit portion 41b for penetrating a slide rod 43 described later.

  The slide bar 43 has a certain degree of flexibility such as resin, and is made by molding a material that can be cut. The slide bar 43 has an outer diameter that can penetrate the slit portion 41, a small hole 42a of the slide plate 42 described later, a slit portion 45c of the presser tube 45, a slit portion 44a of the connecting pipe 44, and a small hole 46a of the clip cover 46. The clip cover 46 has a cylindrical shape with a length slightly larger than the outer diameter.

  The slide plate 42 is formed by photoetching or pressing a metal plate material in the same manner as the connecting member 41. Similarly to the slit portion 41 b of the connecting member 41, the slide plate 42 is connected to a small hole 42 a for penetrating the slide bar 43, a large diameter hole 42 b for connection to the clip operating device 47, and the large diameter hole 42 b. A small-diameter hole 42c arranged as described above is provided.

  The presser tube 45 has a substantially cylindrical shape, and the outer diameter of the presser tube 45 includes a large-diameter portion 45a on the distal end side and a small-diameter portion 45b on the proximal end side. Further, similarly to the slit portion 41 b of the connecting member 41, the presser tube 45 is provided with a slit portion 45 c through which the slide bar 43 passes.

  The connection pipe 44 for connecting the presser tube 45 and the clip operating device 47 has a substantially cylindrical shape, and is provided with a slit portion 44 a for penetrating the slide rod 43, similarly to the slit portion 41 b of the connection material 41. . A blade 44b for cutting the slide rod 15 is provided at the proximal end of the slit portion 44a.

  The clip cover 46 for storing the clip 2 is made by, for example, molding a material having moderate flexibility such as Teflon (registered trademark) or polyethylene into a cylindrical shape having an inner diameter that can store the clip 2. Similar to the slit portion 41 b of the connecting member 41, the clip cover 46 is provided with a small hole 46 a for penetrating the slide bar 43.

  Therefore, in order to assemble the clip unit 1 as shown in FIGS. 15A and 15B, first, the hook 41a of the connecting member 41 is engaged with the proximal end 2c of the clip 2. In this state, the presser tube 45 is fitted on the connecting member 41 until it comes into contact with the proximal end 2c of the clip 2, and further, a small hole 42a of the slide plate 42 is inserted into the distal end of the slit 41a of the connecting member 41. In a state where the connecting member 41 is sandwiched between the pair of slide plates 42 at a position where they match, the leading end of the slit 44a of the connecting pipe 44 is aligned with the leading end of the slit 45c of the presser tube 45. The connecting pipe 44 is fitted on the connecting member 41, the pair of slide plates 42, and the small diameter portion 45 b of the presser tube 45.

  In this state, the clip cover 46 is further fitted onto the clip 2 until the small hole 46a of the clip cover 46 is aligned with the end of the slit 44a of the connection pipe 44, and the slide bar 43 is attached to the clip cover 46. By passing through the small hole 46a, the slit portion 44a of the connecting pipe 44, the slit portion 45c of the presser tube 45, the small hole 42a of the slide plate 42, and further through the slit portion 41b of the connecting member 41, the slide plate 42 and the clip cover 46 are formed. The clip unit 40 is slidably attached to the connecting member 41 and the connecting pipe 44, and the clip unit 40 can be assembled in the state shown in FIGS. 15A and 15B.

  The configuration of the clip operating device 47 is the same as that of the other elements except that the hook portion 12 of the clip operating device 5 of the first embodiment is different. As shown in FIG. 16, the hook portion 48 of the clip operating device 47 of the present embodiment has a recessed cutout portion 49 formed on the tip end side of the rod-like body. A pin 50 projects from the bottom surface of the notch 49 perpendicular to the advancing / retreating direction of the operation wire 7. The pin 50 is formed with a circular head 51 and a small diameter portion 52 having a smaller diameter than the head 51. The head 51 of the pin 50 is smaller than the large diameter hole 42b of the slide plate 42 shown in FIG. 15C and larger than the small diameter hole 42c. Further, the small diameter portion 52 of the pin 50 has a smaller size than the small diameter hole 42 c of the slide plate 42.

  Next, the operation of the seventh embodiment will be described. As shown in FIG. 17A, in order to attach the clip unit 40 to the clip operating device 47, first, the hook portion 48 is protruded from the coil pipe 8 by the operation of pushing the slider 11 to the distal end side.

  Then, after the hook portion 48 is fitted into the large-diameter hole 42b of the slide plate 42 of the clip unit 40, the entire clip unit 40 is pulled to the tip side. Then, the head portion 51 of the pin 50 is engaged with the small diameter portion 42 c of the slide plate 42. Thereafter, by the operation of pulling the slider 11 to the proximal end side, the hook portion 48 is pulled into the sheath portion 6, the connecting pipe 44 hits the coil pipe 8, and the mounting of the clip unit 40 is completed.

  Since the clip 2 of the clip unit 40 is stored in the clip cover 46 in advance, the clip unit 40 can be introduced into the body cavity via the forceps channel of the endoscope as it is and guided to the target site.

  Next, when the operation wire 7 is pulled back to the base end side by pulling the slider 11 to the base end side, the slide bar 42 and the slide bar 43 penetrating through the small hole 42a of the slide plate 42 are pulled. Since the slide bar 43 also penetrates the small hole 46 a of the clip cover 46, the clip cover 46 is also pulled to the proximal end side when the slide bar 43 is pulled, and the clip 2 protrudes from the clip cover 46.

  At this time, since the slide rod 43 slides on the slit portion 41b, the connecting member 41 maintains the state without being pulled toward the base end side. Thereafter, when the slider 11 is further pulled toward the base end side, the slide bar 43 hits the base end side end of the slit portion 41b of the connecting member 41, and the connecting member 41 is also pulled toward the base end side. Then, as in the case of the first embodiment, the proximal end 2c of the clip 2 is crushed by being pulled into the presser tube 17, and as shown in FIG. 2b greatly expands outward.

  In this state, as in the case of the first embodiment, the target body tissue is guided, and the slider 11 is further pulled to the proximal end side. Then, the slide bar 43 abuts against the proximal end of the slit 44 a of the connecting pipe 44. Thereafter, when the slider 11 is further pulled toward the base end side, the slide bar 43 is cut by the blade 44b provided at the base end side end of the slit portion 44a, and the slide bar 43 is separated from the clip cover 46. When the slider 11 is continuously pulled, the arms 2a and 2b of the clip 2 are drawn into the presser tube 45, the arms 2a and 2b are closed, and the target tissue is sandwiched. By further pulling the slider 11 to the proximal end side in this state, the hook 41a of the connecting member 41 is deformed and extended, and the clip 2 is released from the clip operating device 47 by being disengaged from the connecting member 41 and living body. It is left in the body while holding the tissue.

  The effect of the seventh embodiment is that since the clip 2 is stored in the clip cover 46 in advance, it can be inserted into the forceps channel of the endoscope immediately after the slider 11 is advanced and retracted and the clip unit 1 is attached. Is to be simplified. Further, when the clip unit 1 is ligated, the clip unit 1 protrudes from the clip cover 46 and can be ligated as it is simply by pulling the slider 11, so that the operation becomes simple.

  Further, by adopting a structure in which the slide bar 43 is cut, the length of the slit portion 44a of the connecting pipe 44 becomes only the advance / retreat length of the clip cover 46, the entire length of the clip unit 40 can be shortened, and the forceps channel can be reduced. The penetrability is improved.

  Moreover, since the structure of the clip operating device 5 is simple, processing and assembly are easy, and processing and assembly can be performed at low cost.

  FIG. 18 shows an eighth embodiment, and the clip device of this embodiment is composed of the clip unit 50 shown in FIG. 18 and the same clip operating device 47 as that of the seventh embodiment. The clip unit 50 includes a clip 2 having the same shape as that of the first embodiment, a connecting member 51 as a connecting member, a holding tube 52 for a clip tightening ring, and a clip cover 53.

  As shown in FIG. 18B, a hook-like hook hook 51 a is formed at the distal end portion of the connecting member 51, and engages with the proximal end 2 c of the clip 2. . On the other hand, a large-diameter hole 51b and a small-diameter hole 51c are provided on the base end side of the connecting member 51 in the same manner as the base end side of the slide plate 42 of the seventh embodiment, and are detachable from the clip operating device 47. It is designed to engage.

  The clip cover 53 is formed of a material that can be easily torn, such as paper, and is fitted into the clip unit 5 in advance with the clip 2 closed as shown in FIG. On the side of the clip cover 53, perforated cuts 53a are provided on both sides.

  The clip unit 50 is attached to the clip operating device 47 and introduced into the body cavity in the same manner as in the seventh embodiment. When the slider 11 is pulled toward the proximal end after being introduced into the body cavity, the arms 2a and 2b of the clip 2 are greatly expanded outward. At this time, as shown in FIG. 18C, the clip cover 53 is torn and dropped along the cut 53a, and the target portion can be ligated by the arms 2a and 2b of the clip 2.

  Since other operations and effects are the same as those of the seventh embodiment, description thereof is omitted.

  FIG. 19 shows a ninth embodiment. The clip device according to this embodiment includes the clip unit 50, the clip cover 54, and the above-described clip operation device 47 shown in FIG.

  The clip cover 54 is manufactured by molding a soft resin such as silicon, for example, and as shown in FIG. 19A, the clip cover 54 is covered in advance with the clip 2 closed. . The clip cover 54 has a substantially cylindrical shape having an outer diameter slightly larger than the forceps channel of the endoscope, and the distal end side is closed. In addition, the outer surface on the distal end side is formed into a spherical shape in consideration of the insertion property into the endoscope.

  The clip unit 50 is attached to the clip operating device 47 and introduced into the body cavity in the same manner as in the seventh embodiment.

  After the introduction into the endoscope, the clip unit 50 and the clip cover 54 are in a state of protruding from the forceps channel of the endoscope into the body cavity, as shown in FIG. 19B. In this state, the entire clip operating device 47 is pulled to the proximal end side. Then, the clip unit 50 is drawn into the forceps channel of the endoscope. At this time, as shown in FIG. 19C, the clip cover 54 is hooked on the distal end surface of the forceps channel of the endoscope, and is detached from the clip unit 50 and dropped off. In this state, the clip unit 50 can be ligated by pushing the entire clip operation device 47 again toward the tip side.

  Since other operations and effects are the same as those of the seventh embodiment, description thereof is omitted.

  FIG. 20 shows a tenth embodiment, and the clip device of the present embodiment includes a clip unit 50, a clip cover 55, and the above-described clip operation device 47, as shown in FIG.

  The clip cover 55 is manufactured by molding a resin having moderate flexibility such as Teflon (registered trademark). As shown in FIG. 20 (A), the clip cover 55 has a cylindrical fixing portion 55a having a slightly smaller outer diameter than the outer diameter of the holding tube 52 of the clip unit 50 on the proximal end side and a semi-cylindrical cross section. A cover portion 55b having a shape and greatly expanding on the tip side is provided. As shown in FIG. 20B, the clip cover 55 is press-fitted and fixed in a state of being fitted on the presser tube 52 of the clip unit 50.

  The clip unit 50 is attached to the clip operating device 47 in the same manner as in the seventh embodiment. After the attachment, as shown in FIG. 20C, the forceps of the endoscope is closed while closing the cover portion 55b of the clip cover 55 so that the arms 2a and 2b of the clip 2 of the clip unit 50 are fitted. Insert into channel and introduce into body cavity. After the introduction, when the clip unit 50 is protruded from the forceps channel, the cover portion 55b of the clip cover 55 is formed in an expanded shape, so that the clip unit 50 can be automatically expanded and ligated. it can.

  Since other operations and effects are the same as those of the seventh embodiment, description thereof is omitted.

  FIG. 21 shows an eleventh embodiment, and the clip device of this embodiment is composed of a clip unit 50, a clip cover 56, and the aforementioned clip operation device 47, as shown in FIG.

  The clip cover 56 is manufactured by molding a material that dissolves when it comes into contact with moisture, such as an wafer. As shown in FIG. 21, the clip cover 56 is fitted in the clip unit 50 in a state where the clip 2 is closed, and has a substantially cylindrical shape having an outer diameter smaller than that of the forceps channel of the endoscope. It has a shape.

  The clip unit 50 is attached to the clip operating device 47 and introduced into the body in the same manner as in the seventh embodiment. After the introduction, when the moisture in the body cavity is touched, the clip cover 56 is dissolved and the clip unit 50 can be ligated. Further, when the moisture in the body cavity is low, the clip cover 56 can be dissolved by sending water to the forceps channel.

  Since other operations and effects are the same as those of the seventh embodiment, description thereof is omitted.

  FIG. 22 shows a twelfth embodiment. As shown in FIG. 22, the clip unit 60 includes a clip 61, a presser tube 62 that closes the clip 61 by being fitted on the clip 61, and The connecting member 51 is used.

  The clip 61 has substantially the same shape as the clip 2 shown in the first embodiment. As shown in FIG. 22 (A), the arm portions 2a and 2b, the substantially elliptical base end portion 2c, Further, projections 63 and 64 having a height of 0.3 mm to 0.5 mm are provided between the arm portions 2a and 2b and the base end portion 2c in parallel with the plate surface of the base material. The protrusions 63 and 64 have a triangular shape as shown in FIG. The presser tube 62 has the same shape as the presser tube 14 of the second embodiment.

  Next, the operation of the twelfth embodiment will be described. After the clip unit 1 is introduced into the body cavity, when the connecting member 51 is pulled toward the proximal end, the proximal end 2c of the clip 2 is pulled into the presser tube 62 and the clip 61 is expanded. At this time, as shown in FIG. 22B, the protrusions 63 and 64 of the clip 61 are engaged with each other, and the clip 61 is fixed in the expanded state. In this state, when the connecting member 51 is further pulled toward the base end side, the protrusions 63 and 64 slide along the inclined surfaces 63a and 64a, and eventually get over the protrusions 63 and 64 and engage with each other. The clip 61 can be closed by pulling the connecting member 51 toward the base end side.

  The effect of this embodiment is that the protrusions 63 and 64 provided on the clip 61 are temporarily engaged and fixed when the clip 61 is in the maximum open state, so that the operator does not care about the expanded state of the clip 61. By simply pulling the connecting member 51 to the proximal end side until the clip 61 is engaged and fixed, the clip 61 can be fully opened, so that the operation becomes simple.

  In addition, since the maximum open state is stably maintained, it is easy to aim at the target tissue and the tissue can be ligated stably.

  FIG. 23 shows a thirteenth embodiment. As shown in FIG. 23, the clip unit 65 includes a clip 66, the presser tube 62, and the connecting member 51.

  The clip 66 has substantially the same shape as the clip 2 shown in the first embodiment. As shown in FIG. 23A, the arms 2a and 2b, the base end 2c having a substantially elliptical shape, Further, a stepped portion 67 having a height of about 0.5 mm to 1.5 mm is provided between the arm portions 2a, 2b and the base end portion 2c.

  Next, the operation of the thirteenth embodiment will be described. After the clip unit 65 is introduced into the body cavity, when the connecting member 51 is pulled toward the proximal end, the proximal end 2c of the clip 65 is pulled into the presser tube 61 and the clip 2 is expanded. At this time, as shown in FIG. 23B, the stepped portion 67 of the clip 65 engages with the end surface on the front end side of the presser tube 61, and the clip is fixed in the expanded state. In this state, when the connecting member 51 is further pulled toward the proximal end side, the stepped portion 67 is deformed and released from the engaged state with the presser tube 61, and the clip 2 can be closed. Since the effect of this embodiment is the same as that of the twelfth embodiment, the description is omitted.

  FIG. 24 shows a fourteenth embodiment, and the clip unit 67 is composed of the above-described clip 2, the presser tube 68, and the above-described connecting member 51, as shown in FIG.

The presser tube 68 has a substantially cylindrical shape, and the shape of the outer surface is the presser tube 14 of the second embodiment.
Is the same. A large diameter portion 68b smaller than the elliptical portion dimension W of the clip 2 and a small diameter portion 68a having a diameter smaller than the large diameter portion 68b are provided in the inner cavity of the presser tube 68, and the large diameter portion 68a is larger than the small diameter portion 68a. A stepped portion 68c is provided between the diameter portions 68b.

  Next, the operation of the fourteenth embodiment will be described. When the connecting member 51 is pulled after the clip unit 67 is introduced into the body cavity, the proximal end 2c of the clip 2 is pulled into the presser tube 68 and the clip 2 is expanded. At this time, the proximal end 2c of the clip 2 contacts the stepped portion 68c, and the clip is fixed in the expanded state. When the connecting member 51 is further pulled strongly toward the base end in this state, the base end 2c of the clip 2 is pulled over the stepped portion 68c of the presser tube 68, and the clip 2 can be closed. Since the effect of this embodiment is the same as that of the twelfth embodiment, the description is omitted.

  FIG. 25 shows a fifteenth embodiment, and the clip device of this embodiment is composed of the above-described clip 2, the above-mentioned presser tube 68, and the connecting member 69, as shown in FIG.

  The connecting member 69 has the same shape as the connecting member 51 of the ninth embodiment, except that a circular or elliptical protrusion 69a is provided on the proximal end side of the hook-shaped hook 51a. The protruding portion 69a of the connecting member 69 is smaller than the large diameter portion 68a of the presser tube 68 described above and slightly smaller than the diameter of the small diameter portion 68b.

  Therefore, when the connecting member 69 is pulled toward the base end side in order to expand the clip unit 67, the projection 69a of the connecting member 69 contacts the stepped portion 68c of the presser tube 68, and the clip 2 is fixed in the expanded state. Is done. When the connecting member 69 is further pulled strongly in this state, the projection 69a of the connecting member 69 is deformed and drawn into the small diameter portion 68a of the presser tube 68, and the clip 2 is closed. Since the effect of this embodiment is the same as that of the twelfth embodiment, the description is omitted.

  FIG. 26 shows a sixteenth embodiment. As shown in FIG. 26, the clip device of this embodiment is composed of a clip 70, the presser tube 68 and the connecting member 51 described above.

  For example, the clip 70 is formed by processing a thin plate of SEA alloy (Super Elastic Arroy) such as nickel titanium into a ribbon shape having a length of 4 mm to 40 mm by a press process or the like, and further, a central portion in the longitudinal direction of the ribbon is illustrated. As shown by 26, it is formed by bending it into a U-shape. Therefore, the length L of the arm of the clip 70 is 2 mm to 20 mm.

  At this time, the opening width H of the clip 70 is bent to 3 mm to 25 mm, which is sufficient to ligate the tissue in the body cavity. The length of the ribbon (= the length of the arm of the clip) varies depending on the opening width H of the clip 70. For example, when the opening width H = 3 mm, the length L of the arm of the clip 70 is 2 mm (= the ribbon length 4 mm), When the opening width is 10 mm, the arm length L of the clip 70 is 6 mm (ribbon length 12 mm), and when the opening width H is 25 mm, the arm length L of the clip 70 is 15 mm.

  Next, the operation of the sixteenth embodiment will be described. At the time of introduction into the body cavity, the clip 70 is closed and introduced to an outer diameter of 3 mm or less that can be inserted into the forceps channel of the endoscope. After the introduction, the clip 70 needs to be expanded to an opening width of 3 mm to 25 mm sufficient for ligating the tissue in the body cavity. However, since the clip 70 is a SEA alloy having a wide elastic range, From the closed state of an outer diameter of 3 mm that can be inserted into the channel, the original shape is elastically restored to a sufficiently expanded state, and the tissue can be ligated.

  When the bending of the endoscope is tight, the arm part of the clip 70 is a hard part having a certain degree of hardness. Therefore, when the length L of the arm of the clip 70 exceeds 20 mm, the arm part of the clip 70 is introduced into the body cavity. In this case, it becomes difficult to move along the forceps channel of the endoscope, and the insertion resistance increases. On the other hand, when the length L of the arm of the clip 70 is shorter than 2 mm, the deep tissue cannot be ligated. For example, in the case of hemostasis, the deep blood vessel cannot be ligated, so that a sufficient hemostatic effect is obtained. I can't. Further, the blood vessel diameter at the bleeding site in gastrointestinal bleeding is often φ1 mm to φ3 mm. When the opening width H of the clip 70 is smaller than 3 mm, it is difficult to ligate blood vessels. Conversely, if the opening width H exceeds 25 mm, the amount of tissue sandwiched between the arms of the clip 70 becomes too large, the amount of ligation force decreases, and a sufficient hemostatic effect cannot be obtained.

  Next, the effect of this embodiment will be described. Since the clip 70 is made of SEA alloy, it can be elastically restored from a closed state where the clip 70 can be inserted into the forceps channel of the endoscope to an expanded state necessary for ligating the tissue in the body cavity. Therefore, it is not necessary to adjust the opening width of the clip when the clip is ligated after being introduced into the body cavity, and the operation is simplified. In addition, hemostasis of gastrointestinal bleeding is often urgent, and it is necessary to store the clip in a state where it can be inserted into the forceps channel of the endoscope and prepare it in advance so that it can be used immediately. Many. In such a case, the clip 70 is stored in a closed state of φ3 mm or less for a long time.

  However, since the clip 70 of this embodiment is an SEA alloy, even after a long closed state, the clip 70 can be elastically and reliably restored to the expanded state necessary for ligating the tissue in the body cavity. it can. Therefore, the desired opening width cannot be obtained when trying to use. In addition, since the clip has a U-shaped shape, both arms are arranged in a straight line, so that the ends of the arms can be reliably engaged without being displaced during ligation.

  FIG. 27 shows the seventeenth embodiment. As shown in FIG. 27, the clip unit 1 and the clip operating device 5 according to the first embodiment are fixed to each other. Only the shape of the hook portion 12 of the operating device 5 is different, and the other configurations are the same.

  In the seventeenth embodiment, the hook portion 80 is manufactured by molding a high-strength resin such as a liquid crystal polymer or polyimide, for example. The hook portion 80 has a substantially cylindrical shape, and as shown in FIG. 27A, since the slit 80a is provided from the front end side, an elastically deformable arm portion is provided on both sides of the slit 80a. 80b and 80c are formed.

  Further, arrow tip hooks 80f and 80g having an outer diameter larger than the outer diameter of the arm portions 80b and 80c are provided on the distal end sides of the chest portions 80b and 80c in a semi-conical shape having inclined surfaces 80d and 80e. The outer diameters of the arrowhead hooks 80f and 80g can be expanded and contracted by elastic deformation of the arm portions 80b and 80c.

  Further, as shown in FIG. 27 (A), the connecting member 81 has a hollow pipe shape on the base end side, and has a larger diameter than the arrowhead hooks 80f and 80g of the connecting member 80 described above. A small-diameter portion 81a having an inner diameter smaller than that of the arrowhead hooks 80f and 80g and an inner diameter larger than that of the arm portions 80b and 80c is provided on the base end side of the large-diameter portion 81b. Further, a hook hook 81c similar to that of the first embodiment is provided on the distal end side of the connecting member 81, and the clip 2 is engaged by being hooked on the proximal end 2c of the clip 2. Yes.

  Next, the operation of the seventeenth embodiment will be described. When the connecting member 81 is pushed in from the front end side of the hook portion 80, the inclined surfaces 80d and 80e of the arrowhead hooks 80g and 80f of the hook portion 80 are the inner surfaces of the small diameter portions 81a of the connecting member 81 as shown in FIG. The outer diameters of the arrowhead hooks 80g and 80f are reduced along the inclined surfaces 80d and 80e. At this time, the arm portions 80b and 80c are elastically deformed. Thereafter, when the arrowhead hooks 80g and 80f pass through the small diameter portion 81a of the connecting member 81, the arm portions 80b and 80c are restored in the large diameter portion 81b of the connecting member 81, as shown in FIG. The arrowhead hooks 80g and 80f are engaged and fixed at the step between the small diameter portion 81a and the large diameter portion 81b. Since the operation and effect of the seventeenth embodiment are the same as those of the first embodiment, description thereof is omitted.

  FIGS. 29-34 shows 18th Embodiment, and is embodiment regarding a clip unit and a clip operation apparatus. The clip unit 120 of the present embodiment has the same configuration except that the connecting material 3 of the clip unit 1 of the first embodiment is changed and a presser pipe 122 is added.

  As shown in FIG. 33, the clip operating device 130 of the present embodiment is configured such that the coil sheath 9 of the clip operating device 5 of the first embodiment is composed of a large diameter coil 135, a small diameter coil 136, and a connecting portion 137. . Further, a centering tube 131, an arrowhead hook 132, and a fixing tip 133 are added on the operation wire 7.

  As shown in FIG. 29, the clip unit 120 includes a clip 2, a presser tube 4, a connecting member 121, and a presser pipe 122. As shown in FIGS. 30 and 31, a hook portion 121a that engages with the clip 2 is provided on the distal end side of the connecting member 121.

  Further, on the base end side of the connecting member 121, an elastic arm portion 121b, a slope portion 121d of 10 ° to 90 °, and a pore portion 121c having an inner diameter larger than a shaft portion 132c of an arrowhead hook 132 described later are provided. Yes. Therefore, when the arrowhead hook 132 is pushed from the base end side of the connecting member 121, the elastic arm portion 121b is deformed and expanded, and when further pushed, the pore portion 121c is in a state of gripping the shaft portion 132c and is engaged. It can be fixed.

  In addition, the connecting member 121 is provided with a fracture portion 121e having an outer diameter of Φ0.3 to Φ0.6, and the connecting member 121 is pulled to the base end side from the state of the clip unit 120 shown in FIG. Thus, the clip 2 is closed, and when it is further pulled, the breaking portion 121e is broken at about 2.5 kg to 4 kg.

  Further, the connecting member 121 is provided with a protrusion 121f that protrudes larger than the inner diameter of the presser tube 4, and in the state of the clip unit 120, since the protrusion 121f is press-fitted into the inner diameter of the presser tube 4, the presser tube 4 The connecting member 121 is softly fixed.

  Further, the connecting member 121 is provided with a shaft part 121g. As shown in FIG. 32, the connecting part 121 is provided with an outer part so as not to interfere when the protruding part 4a provided on the presser pipe 4 protrudes and sinks inside the presser pipe 4. It has a cylindrical shape with a diameter of Φ0.6mm to Φ1mm. The presser pipe 122 has an inner diameter that is larger than the outer diameter on the distal end side of the presser tube 4, and is provided so as to be fitted on the distal end side of the presser tube 4.

  As shown in FIGS. 33 and 34, the coil sheath 9 includes a large-diameter coil 135 having an inner diameter capable of accommodating the clip unit 120, a small-diameter coil 136 having an inner diameter slightly larger than the outer diameter of the operation wire 7, and the large-diameter The connecting portion 137 connects the coil 135 and the small diameter coil 136. The connecting portion 137 has an inner diameter that is larger than the outer diameter of the operation wire 7 and smaller than the outer diameter of the fixing tip.

  The coil tip 8 has a substantially tubular shape having the same inner diameter as the inner diameter of the coil sheath 9. In addition, since the coil tip 8 is hard while the coil sheath 9 is flexible, the length of the coil tip 8 is set to the wire width of the coil sheath 9 in order to reduce the change in flexibility. On the other hand, the length is about 0.5 to 3 times. Further, the outer diameter on the distal end side of the coil chip 8 is reduced in a taper shape in consideration of the insertion property into the endoscope. The coil tip 8 and the coil sheath 9 are connected to each other by laser welding or the like without contacting with a special fitting structure.

  The arrowhead hook 132 is fixed to the distal end of the operation wire 7, and has a conical shape having an inclined surface 132a on the distal end side. The maximum outer diameter of the arrowhead hook 132 is set to Φ1.0 mm to Φ1.4 mm in consideration of the deformation amount of the elastic arm portion of the connecting member 121. Further, the inclined surface 132a is preferably 30 ° or less in order to smoothly engage the connecting member 121.

  A shaft portion 132c having an outer diameter smaller than the maximum outer diameter of the inclined surface 132a is provided on the base end side of the inclined surface 132a of the arrowhead hook 132, and a step is formed between the inclined surface 132a and the shaft portion 132c. Thus, the elastic arm portion 121b of the connecting member 121 is securely engaged.

  Further, a vertical surface 132d is provided on the further rear end side of the shaft portion 132c, and is added to the operation wire 7 when the clip unit 120 housed in the large diameter coil 135 is pushed forward of the large diameter coil 135. The generated force can be efficiently transmitted to the connecting member 121.

  The centering tube 131 has an inner diameter larger than that of the operation wire 7, an outer diameter smaller by 0.05 mm to 0.3 mm than the inner diameter of the coil pipe 8 and the large diameter coil 135, and about 0 mm to 300 mm on the distal end side of the operation wire 7. The operation wire 7 is provided so as to cover the operation wire 7 and is fixed to the arrow tip hook 132 and the fixing chip 133 provided on the operation wire 7 by adhesion or press-fitting.

  The connecting member 121 is made by injection molding a resin having high strength such as liquid crystal polymer or nylon and having appropriate elasticity. The presser pipe 122 is made by processing a metal pipe such as stainless steel.

  The arrowhead hook 132 and the fixing tip 133 are made of metal such as stainless steel. The centering tube 131 is made of a flexible material such as Teflon (registered trademark) or polyethylene.

  According to the above-described eighteenth embodiment, compared to the first embodiment, the connecting member 121 of the clip unit 120 that is disposable after a single use is made of an elastic member made of resin, and the clip device main body that is used repeatedly is used. By making the hook portion a metal inelastic member, it is possible to make it difficult to break when the clip operation device 130 is repeatedly used.

  In addition, by fitting the presser pipe 122 on the distal end side of the presser tube 4, when the clip 2 is pulled into the presser tube 4 and the tissue is ligated, deformation and breakage of the distal end of the presser tube 4 are prevented and ensured. I can ligate.

  In this embodiment, when the clip unit 120 is attached to the arrowhead hook 132, the slider 11 is operated to cause the operation wire 7 and the arrowhead hook 132 to protrude from the coil sheath 9. At this time, the gap between the inner diameter of the large-diameter coil 135 and the outer diameter of the operation wire 7 is filled with the centering tube 131, so that the operation wire 7 is thick regardless of the curved shape of the large-diameter coil 135. It is located at the axial center of the radial coil 135. Therefore, the arrowhead hook 132 protruding from the tip of the large diameter coil 135 is also located at the axial center of the large diameter coil 135.

  Therefore, as shown in FIG. 14, when the clip unit 120 is enclosed in the clip case 30 and the large diameter coil 135 and the clip unit 120 are positioned with their axes aligned, the large diameter coil 135 has any shape. Even in this case, the arrowhead hook 132 is positioned at the axial center of the large-diameter coil 135 simply by projecting the arrowhead hook 132 from the tip of the large-diameter coil 135, so that the connection member 121 can be reliably engaged. As described above, in order to ensure that any shape of the large-diameter coil 135 is aligned with the center of the shaft, the centering tube 121 is at least 20 mm or more, preferably 50 mm or more from the position in the vicinity of the arrowhead hook 132 on the operation wire 7. It is necessary to coat.

  Further, when the clip unit 120 housed in the large diameter coil 135 is projected forward of the large diameter coil 135, the operation wire 7 can push the clip unit 120 straight without meandering through the large diameter coil 135. The clip unit 120 can be efficiently projected with less force. The positioning of the coil sheath 9 and the operation wire 7 and the reduction of the projecting output amount are not limited to the clip operation device, but are the same for all treatment tools that project the treatment portion from the inside of the sheath, such as a snare, basket, injection needle, and indwelling snare. effective.

  In addition, since the inner diameter of the connection portion 137 is smaller than the outer diameter of the fixing tip 133, when the operation wire 7 is pulled, it eventually interferes with the connection portion 137, and the operation wire 7 is drawn into the coil sheath 134 more than necessary. Can be prevented.

  Further, since the coil chip 8 is not a fitting structure, but a structure in which the coil chip 8 is fixed by welding only, the hard portion can be shortened and insertion into the endoscope is facilitated. Further, the processing of the coil tip 8 and the coil sheath 9 is simplified and can be manufactured at low cost.

  FIG. 35 shows a nineteenth embodiment, and the clip operating device of the present embodiment is the same in other configurations only by changing the centering tube 131 of the eighteenth embodiment.

  That is, as shown in FIG. 35, instead of the centering tube 131 shown in the eighteenth embodiment, one centering tip 140 is placed at a position of 0 mm to 10 mm from the proximal end of the arrowhead hook 132, 20 to 20 mm. A total of two are provided at a position of 50 mm. Thus, by providing a plurality of centering tips 140 over a certain range, the operation wire 7 can be positioned stably.

  The centering tip 140 is made of, for example, a hard material such as metal, and has a substantially spherical shape having an outer diameter larger than the outer diameter of the operation wire 7 and smaller than the inner diameter of the large-diameter coil 135. .

  The centering chip 140 may be formed by insert molding or the like on the operation wire 7 with a hard resin such as liquid crystal polymer or nylon, or a soft resin such as silicon or Teflon (registered trademark).

  The operation and effect of this embodiment are the same as those of the eighteenth embodiment.

  FIGS. 36 and 37 show the twentieth embodiment and relate to the operation unit 150 of the clip operation device 130 of the eighteenth embodiment.

  The operation unit 150 includes an operation unit main body 151, a slider 152, an operation pipe 153, a lock 154, a lock spring 155, and a slider spring 156. A coil sheath 9 is attached to the operation unit main body 151 on the distal end side. The slider 152 is provided on the operation unit main body 151 so as to be slidable in the horizontal direction of the drawing. An operation pipe 153 is attached to the slider 152, and an operation wire 7 is attached to the operation pipe 153. The lock 154 is provided on the operation unit main body 151 so as to be slidable in the vertical direction of the paper surface, and is always urged upward by the lock spring 155.

  A slope 152a having an acute angle (an angle of about 10 ° to 90 °) and a slope 152b having an obtuse angle (an angle larger than the slope 152a) are provided on the tip side of the slider 152. The inner diameter of the lock 154 is larger than the outer diameter of the slope 152a of the slider 152.

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

  When the slider 152 is slid to the distal end side, the slope 152a of the slider 152 abuts against the proximal end surface 154a of the inner diameter of the lock 154. When the slider 152 is further slid to the tip side in this state, the lock 154 is pushed down by the slope 152a of the slider 152. At this time, since the slope 152a is an acute slope, the lock 154 can be pushed down with a small amount of force.

  When the slider 152 is further slid to the tip side, the slope 152a of the slider 152 eventually moves over the lock 154 and moves to the tip side, and the lock 154 contacts the small diameter portion 152c of the slider 152 by the action of the lock spring 155. become. At this time, the slider 152 is pushed to the base end side by the slider spring 156, but since the slope 152b has an obtuse angle, the amount of pushing force of the slider spring 156 is greater than the amount of force overcoming the end face 154b of the lock 154. Since it is small, the slider 152 is temporarily fixed.

  In this state, when the slider 152 is pulled strongly toward the base end side, the lock 154 is pushed down by the inclined surface 152b, and the slider 152 is released from the lock 154, so that the slider 152 can be released from the fixed state.

  According to the present embodiment, the two slopes 152a and 152b having different angles are provided on the front end side of the slider 152, whereby the amount of force for sliding the lock 154 up and down can be changed, and the slider 152 is moved to the front end side. By simply pushing, the slider 152 can be fixed with a light push, and can be removed by pulling it strongly. Therefore, the slider 152 itself can be fixed and released only by operating the slider 152 without providing a special mechanism such as a fixed ON / OFF button, and the clip unit 120 can be attached and detached easily and quickly. It can be carried out.

  Further, by providing a slider spring 156 that biases the slider 152 toward the proximal end side, the clip unit 120 is engaged with the distal end of the coil sheath 9 as shown in FIG. While performing, the engagement state of the clip unit 120 with the coil sheath 9 can be automatically maintained, and the operation can be performed stably.

  As a first modification of the present embodiment, as shown in FIG. 38, the lock 154 may be provided with two inclined surfaces 154a and 154b having different angles. Furthermore, as a second modification, as shown in FIG. 39, a lock 154 may be provided on the slider 152, and the operation section main body 151 may be provided with two inclined surfaces 151a and 151b having different angles.

  Further, the slider fixing mechanism of the present embodiment has the same effect not only on the clip operation device but also on all treatment tools that project the treatment portion from the inside of a sheath such as a snare, a basket, an injection needle, and an indwelling snare.

  40 to 43 show a twenty-first embodiment, and this embodiment relates to a clip case 160 that encloses the clip unit 120 of the eighteenth embodiment. That is, as shown in FIG. 40, the clip case 160 is composed of two parts, a case main body 161 and a case lid 162. The case main body 161 and the case lid 162 have an appropriate hardness such as ABS and polystyrene, and are manufactured by injection molding a transparent resin. As shown in FIG. 41, there are six engaging claws 161a on the inner surface of the case main body 161, and the case lid 162 is provided with six engaging claws corresponding to the engaging claws 161a. The state shown in FIG. 40 is assembled by engaging with the joint hole 162a. Therefore, the clip unit 120 can be enclosed in the clip case 160 by assembling after the clip unit 120 is disposed between the case main body 161 and the case lid 162.

  The case main body 161 and the case lid 162 are provided with semicircular grooves 161b and 162b in the right half area on the paper surface, and are enlarged in a tapered shape at the end surfaces. Therefore, in the assembled state as shown in FIG. 40, a circular hole 163 is formed by the semicircular groove 161b of the case body 161 and the semicircular groove 162b of the case lid 162, as shown in FIG. The circular hole 163 has an inner diameter larger than the outer diameter of the coil sheath 9 of the clip operating device 130 described above. In addition, a funnel portion 163a is formed on the end face that has a funnel shape that is 1.5 to 3 times larger than the inner diameter of the circular hole 163.

  As shown in FIG. 43, at the center of the case main body 161 and the case lid 162, a small diameter smaller than the inner diameter of the coil pipe 9 and larger than the outer diameter of the presser tube 4 on the left side of the circular hole 163 on the paper surface. A part 164 is provided. A slope 165 is provided on the further left side of the small diameter part 164 and is connected to the connecting material storage part 166. The connecting material storage portion 166 is formed with a sufficient width so as not to interfere even if the elastic arm portion of the connecting material 121 is deformed by insertion of an arrowhead hook.

  On the further left side of the connecting material storage portion 166, a presser tube storage portion 167 having an inner diameter slightly larger than the outer diameter of the presser tube 4 is provided. On the further left side of the presser tube storage unit 167, a clip storage unit 168 for storing the clip 2 is provided.

  Further, on the circular hole 163, coil fixing arms 169 and 170 are provided in the vicinity of the small diameter portion 164. As shown in FIG. 42, the coil fixing arm is composed of coil fixing portions 169a and 170a projecting about 0.1 mm to 0.5 mm in the inner diameter direction of the circular hole 163 and arm portions 169b and 170b having a diameter of about 0.5 mm to 3 mm.

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

  First, the slider 152 of the clip operating device 150 according to the eighteenth to twentieth embodiments is pushed out toward the distal end, and the arrowhead hook 131 is projected from the distal end of the coil sheath 9. At this time, the slider 152 is fixed by a lock 154. In this state, the tip of the coil sheath 9 is inserted into the circular hole 163 from the funnel portion 163a of the clip case 160. When the coil sheath 9 reaches the coil fixing arms 169 and 170, the arm portions 169b and 170b are deformed by the pushing force of the coil sheath 9, and the coil fixing portions 169a and 170a are spread.

  In this state, the coil sheath 9 is pushed in until the distal end of the coil sheath 9 abuts against the step between the circular hole 163 and the small diameter portion 164. At this time, since the arm portions 169b and 170b are elastically deformed, the coil sheath 9 is sandwiched between the coil fixing portions 169a and 170a by a restoring force, so that the coil sheath 9 is softly fixed to the clip case 160.

  When the coil sheath 9 is pushed into the clip case 160, the arrowhead hook 131 protrudes from the tip of the coil sheath 8, so that the arrowhead hook 131 passes through the small diameter portion 164 of the clip case 160 and is connected to the coupling material storage portion 166. It is pushed into. At this time, since the axial centers of the circular hole 163 and the presser tube storage portion 167 are aligned, the arrowhead hook 131 is reliably pushed into the proximal end side of the connection material 121 arranged in the connection material storage portion 166, and the connection The material 121 and the arrowhead hook 131 are engaged.

  At this time, since the connecting member 121 is provided with the inclined surface portion 121d, even if the position of the arrowhead hook 131 is slightly shifted up and down, the position is corrected in the center direction by contacting the inclined surface portion 121d and the engagement is ensured. Match.

  Further, since the clip case 160 is made of a transparent material, the presence / absence of the clip unit 120 in the clip case 160 and the engagement state of the connecting member 121 and the arrowhead hook 131 can be visually confirmed.

  After confirming the engagement between the connecting member 121 and the arrowhead hook 131, when the slider 152 is pulled to the proximal end side, the operation wire 7 is pulled, and the arrowhead hook 131 and the clip unit 120 are pulled into the coil sheath 9. At this time, the protrusion 4a of the presser tube 4 abuts against the inclined surface 165 of the case main body 161 and the case lid 162, the protrusion 4a is pressed inward of the presser tube 4, and without engaging the end surface of the coil pipe 8, It can be pulled into the coil sheath 9. Thereafter, the coil sheath 9 is pulled strongly and pulled out from the clip case 160.

  According to the present embodiment, the clip case 160 can be assembled simply by pushing the case lid 162 into the case main body 161, the assembly is simple, and the manufacturing cost can be reduced. Further, by providing the coil fixing arms 169 and 170, the clip case 160 and the coil sheath 9 can be fixed, and it is not necessary to have both the coil sheath 9 and the clip case 160, and the clip unit 120 can be easily attached. Furthermore, since the clip case 160 is made of a transparent material, the presence of the clip unit 120 in the clip case 160 and the engagement between the coupling member 121 and the arrowhead hook 131 can be confirmed, so that the clip unit 120 can be securely connected. Mounted on.

  FIG. 44 shows a twenty-second embodiment. In this embodiment, the coil fixing arms 169 and 170 of the twenty-first embodiment are eliminated, and the coil fixing protrusions 180 and 181 are directly provided on the inner diameter side of the circular hole 163. Is. The coil sheath 9 is fixed by elastic deformation of the case main body 161 and the case lid 162 itself, instead of the deformation of the arm portions 169b and 170b.

  According to this embodiment, it is not necessary to provide an arm part, and it becomes easy to manufacture a mold for injection molding. Other effects are the same as those in the twenty-first embodiment.

  FIG. 45 shows a twenty-third embodiment. This embodiment eliminates the coil fixing portions 169a and 170a of the coil fixing arms 169 and 170 of the twenty-first embodiment, and moves the arm portions 169b and 170b toward the inner diameter of the circular hole 163. It is provided at an angle protruding from The coil sheath 9 is fixed by the arm portions 169b and 170b directly contacting and deforming the coil sheath 9 to fix the coil sheath 9. The effect of this embodiment is the same as that of the twenty-first embodiment.

  FIG. 46 shows a twenty-fourth embodiment. In this embodiment, the coil fixing arms 169 and 170 of the twenty-first embodiment are eliminated, and an O-ring 182 made of soft resin such as silicon is provided on the inner diameter side of the circular hole 163. It is a thing. The coil sheath 9 is fixed by elastic deformation of the O-ring 182 instead of deformation of the arm portion.

  The effect of the present embodiment is that there is no need to provide a protrusion, making it easy to manufacture a mold for injection molding, and fixing the entire circumference of the coil sheath 8 by the O-ring 182 so that the amount of fixing force is stabilized.

  47 to 51 show a twenty-fifth embodiment, and this embodiment relates to a frame 170 that encloses and encloses a plurality of clip cases shown in the twenty-first to twenty-fourth embodiments.

  The frame 170 is provided with a total of 12 case insertion holes 171 whose one side into which the clip case 160 can be inserted is closed. Considering the overall size of the frame 170, the number of case insertion holes 171 is preferably about 3 to 24. Further, the height H of the frame 170 is made larger than the height of the clip case 160. As shown in FIG. 49, a fixing projection 171a for fixing the clip case 160 is provided in the case insertion hole 171 of the clip case 160, and the clip case 160 is press-fitted and fixed by inserting the clip case 160. . The clip case 160 can be fixed by providing an engaging groove at a position corresponding to the fixing projection 171a of the frame 170 on the clip case 160.

  The clip case 160 in which the clip unit 120 is sealed is pushed into the case insertion hole 171 of the frame 170 in a state where the funnel portion 164 of the clip case 160 faces the opening side of the case insertion hole 171. After the clip case 160 is pushed into all of the case insertion holes 171, the seal paper 172 is heat sealed so as to close the case insertion holes 171 as shown in FIGS.

  The seal paper 172 is heat-sealed in a grid pattern so as to seal each case insertion hole 171 independently. The seal paper 172 is made of a material that passes a sterilizing gas (ethylene oxide gas), and is placed on the seal paper 172 so that the case insertion holes 171 can be opened one by one, along the grid-shaped seal portion 172b. A peel portion 172a is provided with a part of the sticker paper 172 protruding from the frame 170. In this state, sterilization is performed with ethylene oxide gas or the like. The frame 170 is made by blow molding polypropylene or injection molding ABS or polystyrene.

  In order to attach the clip unit 120 to the clip operating device 5, the peel part 172a described above is pinched by hand and peeled off. At this time, since the seal paper 172 is peeled off along the perforation, only the case insertion hole 171 in which the clip unit 120 to be used is enclosed can be opened. Thereafter, the clip unit 120 can be loaded into the clip operating device 5 in the same manner as in the twenty-first embodiment.

  According to the present embodiment, by enclosing the clip case 120 in the frame 170, the frame 170 can be stably placed on a work table such as a desk, and the clip operation can be performed without the clip case 120. The clip unit 120 can be loaded into the clip operating device 5 simply by holding the device 5 and operating it. Further, by providing the peeler 172a and the perforation in the sticker paper 172, the sticker paper 172 can be surely peeled off one by one corresponding to the case insertion holes 171, and the operation becomes simple.

  According to the embodiment described above, the following configuration is obtained.

  (Supplementary Note 1) Clip, a fastening ring that closes the clip by being fitted to the clip, a connecting member that can be inserted into the fastening ring and engages the clip, An introduction pipe capable of accommodating a clip and a tightening ring; an operation member which is inserted into the introduction pipe so as to advance and retreat; and is provided on at least one of the tightening ring or the introduction pipe. Engagement means for engaging the introduction pipe and the clamping ring when protruding forward of the introduction pipe and prohibiting the clamping ring from being stored again in the introduction pipe. Clip device for living tissue.

  (Additional remark 2) The clip device of the biological tissue of Additional remark 1 characterized by the above-mentioned.

  (Supplementary note 3) The biological tissue clip device according to supplementary note 1, wherein the engaging means is provided in the introduction tube.

  (Supplementary Note 4) The engaging means is a protrusion that protrudes in a radial direction of the tightening ring when the tightening ring protrudes forward from the introduction pipe and engages with the introduction pipe. The biological tissue clip device according to Additional Item 2.

  According to the said structure, a connection member is engaged with a clip, and also it attaches to an operation wire in the state which covered the clamping ring. Thereafter, the operating member is operated, and the clip, the connecting member, and the tightening ring are all accommodated in the introduction tube and introduced into the body cavity. After the introduction, the operation member is operated to cause the clip, the connecting member, and the tightening ring to protrude out of the introduction tube, and the introduction tube and the tightening ring are engaged. Thereafter, the operation member is operated again, the fastening ring is fitted on the clip, and the clip is ligated.

  Therefore, the clip device can store the clip in the introduction tube and insert the clip into the living body cavity only by advancing / retracting the operation wire, and can further store the clip stored only by advancing / retreating the operation wire as an operation member. At the same time as it is released from the introduction tube, it can be engaged and the clip can be ligated. As described above, the clip device can be attached and ligated only by moving the operation wire forward and backward, which is convenient.

  (Additional remark 5) The clip apparatus of the biological tissue of Additional remark 1 characterized by comprising the said introduction tube with the member which has the flexibility which can be introduce | transduced in a body cavity through a flexible endoscope.

  (Appendix 6) The biological tissue clip device according to appendix 1, wherein the operation member is formed of a flexible wire that can be introduced into a body cavity via a flexible endoscope.

  According to the said structure, introduction into a body cavity can be performed with a flexible endoscope.

  (Supplementary note 7) The clip, the tightening ring, and the connecting member are sealed in the state where the connecting member is further engaged with the clip and the fastening ring is fitted to the connecting member, and the fastening is performed. The clip device for living tissue according to claim 1, further comprising a clip case that allows the ring to be accommodated in the introduction tube.

  (Additional remark 8) The clip apparatus of the biological tissue of Additional remark 7 characterized by providing the said clip case with the diameter reduction means to reduce the said engagement means to the diameter which can be accommodated in the said introductory tube.

  According to the said structure, a connection member is engaged with a clip and it encloses in a clip case in the state which fitted the clamping ring. Thereafter, the introduction tube is attached to the clip case, and the operation member is operated, whereby the clip is attached to the operation member and further accommodated in the introduction tube. At this time, the protrusion provided on the tightening ring is stored in the tightening ring by the clip case, and is reduced to a diameter that can be accommodated in the introduction pipe, so that the tightening ring is not engaged with the introduction pipe and introduced. It is stored in the tube.

  (Supplementary note 9) a clip, a fastening ring that fits and attaches to the clip, closes the clip, a connecting member that can be inserted into the fastening ring and engages the clip, An introduction tube in which a clip and a fastening ring can be attached to the tip, an operation member inserted in the introduction tube so as to be able to advance and retreat, and the living tissue are ligated from a closed state in which the clip can be inserted into an endoscope. And a cover provided on the clip that can be shifted to the expanded state necessary for the operation.

(Additional remark 10) The clip apparatus of the biological tissue of Additional remark 9 characterized by the said cover retreat | retreating to a base end side, and the said clip is open | released from this cover and is made into an expanded state.

  (Supplementary note 11) The living tissue according to Supplementary note 9, wherein the cover is advanced to the distal end side and dropped from the clip, whereby the clip is released from the cover to be in an expanded state. Clip device.

  (Additional remark 12) The clip apparatus of the biological tissue of Additional remark 9 characterized by the said clip being open | released from this cover and being made into an expanded state by destroying the said cover.

  (Additional remark 13) The clip apparatus of the biological tissue of Additional remark 9 characterized by the said clip being open | released from this cover and being made into an expanded state by the said cover being expanded.

  (Additional remark 14) The clip apparatus of the biological tissue of Additional remark 9 characterized by the said cover being melt | dissolved and the said clip being open | released from this cover and being made into an expanded state.

  (Supplementary note 15) The biological tissue clip device according to supplementary note 9, wherein the introduction tube is configured by a flexible member that can be introduced into a body cavity via a flexible endoscope.

  (Supplementary note 16) The biological tissue clip device according to supplementary note 9, wherein the operation member is formed of a flexible wire that can be introduced into a body cavity via a flexible endoscope.

  According to the above configuration, the clip is engaged with the connecting member, the fastening ring is fitted, and the cover is fitted on the clip, and then the clip is attached to the operating member and introduced into the body cavity. After the introduction, the cover is moved to an expanded state where the clip can be ligated by the action of moisture in the living body. Thereafter, the clip can be ligated by drawing the clip into the tightening ring by operating the operation wire.

  Therefore, since this clip device is provided with a cover for introduction into the body cavity in advance, the clip device can be inserted into the body cavity immediately after the clip is attached. Thereafter, the clip can be changed from the stored state to the opened state by simply moving the operation wire forward and backward, and the clip can be ligated. Thus, since it can be introduced into the body cavity immediately after attachment and the ligation operation can be performed only by advancing and retracting the operation wire, it is simple.

  (Supplementary Note 17) Clip, fastening ring that closes the clip by being fitted to the clip, a connecting member that can be inserted into the fastening ring and engages with the clip, a tip An operation wire having a hook, and at least one of the connecting member and the hook is deformed and restored when the connecting member is at an arbitrary circumferential position with respect to the axial direction of the hook, thereby connecting the connecting member. And a deforming means for engaging the hook with the hook.

  (Supplementary note 18) The biological tissue clip device according to supplementary note 17, wherein the deformation means is provided on the hook.

  (Supplementary note 19) The biological tissue clip device according to supplementary note 17, wherein the deforming means is provided in the connecting member.

  (Supplementary note 20) The living tissue clip device according to supplementary note 17, wherein the deformation means is provided on the connecting member and the hook.

  (Supplementary note 21) The living tissue according to supplementary note 17, wherein the hook is provided with an arm portion having obstruction behavior and a gripping portion for gripping and fixing the proximal end portion of the connecting member. Clip device.

  (Supplementary note 22) The biological tissue clip according to supplementary note 17, wherein the connecting member is provided with an arm portion having a closing behavior and a grip portion for gripping and fixing a tip portion of the hook. apparatus.

  (Supplementary Note 23) The hook is provided with a lumen having a small diameter on the distal end side, and a base end portion whose outer diameter can be expanded and contracted is provided on the connecting member, and the hook and the connecting member are engaged and fixed. The biological tissue clip device according to appendix 17, wherein

  (Supplementary Note 24) The connecting member is provided with a lumen having a small diameter on the tip side, and provided with a tip portion whose outer diameter can be expanded and contracted on the hook, so that the connecting member and the hook can be engaged and fixed. The biological tissue clipping device according to appendix 17, wherein:

  (Supplementary note 25) The biological tissue clip device according to supplementary note 17, wherein the deformation means is an elastic member.

  According to the above configuration, the coupling member is engaged with the clip, and the coupling member is pushed into the hook attached to the operation member without adjusting the circumferential position in a state where the fastening ring is fitted. When the connecting member and / or the hook is deformed and restored, the connecting member and the hook are engaged. Thereafter, the clip is introduced into the body cavity and ligated.

  (Supplementary Note 26) In the state where the connecting member is further engaged with the clip and the fastening ring is fitted to the connecting member, the clip, the fastening ring, and the connecting member are sealed, and the connecting member The biological tissue clip device according to item 17, further comprising a clip case that enables engagement between the hook and the hook.

  According to the said structure, a connection member is engaged with a clip and it encloses in a clip case in the state which fitted the clamping ring. Thereafter, the operating tube is attached to the clip case, and the operating member is operated to attach the clip to the operating member.

  Therefore, the present clip device is engaged when the connecting member or the hook is elastically deformed and restored by pushing the connecting member into the hook at an arbitrary circumferential position with respect to the forward / backward axis of the hook. In this way, since the connecting member and the hook can be engaged without matching the direction of the connecting member and the hook, the connecting member can be easily attached to the hook.

  Therefore, the clip can be easily attached to the hook by previously enclosing the clip in a clip case that facilitates the attachment of the clip.

  (Supplementary note 27) a clip, a fastening ring that fits and attaches to the clip, closes the clip, a connecting member that can be inserted into the fastening ring and engages the clip, And a holding means for temporarily holding the expanded state when the clip is expanded to the maximum extent.

  (Supplementary note 28) The biological tissue clip device according to supplementary note 27, wherein the holding means is provided in the clip.

  (Supplementary note 29) The biological tissue clip device according to supplementary note 27, wherein the holding means is provided in the clamping ring.

  (Additional remark 30) The clip device of the biological tissue of Additional remark 27 characterized by providing the said holding means in the said connection member.

  (Supplementary note 31) The biological tissue clipping device according to supplementary note 27, wherein the holding means is a step provided on each arm of the clip and engaged with each other.

  (Supplementary note 32) The biological tissue clip device according to supplementary note 27, wherein the holding means is a step provided on each arm of the clip and engaged with the clamping ring.

  According to the above configuration, the clip is introduced into the body cavity with the coupling member engaged with the clip and the tightening ring fitted. At this time, the clip is closed so that it can be inserted into the body cavity. After introduction into the body cavity, the clip is expanded until the tissue can be ligated.

This expanded state is held by the holding means until the target tissue is aimed. Thereafter, the tissue is ligated by fitting a clamping ring onto the clip.

  Therefore, at the time of clip ligation, it is necessary to open the clip once and hold a state where it can be ligated (maximum open state). Since the present clip is temporarily locked in this maximum open state, the operation becomes simple.

  (Supplementary Note 33) A clip made of a superelastic alloy, a fastening ring that fits and attaches to the clip, and can be inserted into the fastening ring and engages with the clip. A biological tissue clip device comprising a connecting member.

  (Additional remark 34) The clip part of the biological tissue of Additional remark 33 characterized by bending the center part of the said clip and forming the arm part which has the open width which can ligate a biological tissue.

  (Additional remark 35) The clip apparatus of the biological tissue of Additional remark 33 characterized by the opening width of the said clip being 3-25 mm, and the length of the arm part having been 2-20 mm.

  (Appendix 36) The clip can be elastically deformed and restored from a closed state in which the clip can be accommodated in a forceps channel of an endoscope to an expanded state in which a living tissue can be ligated. 34. A biological tissue clipping device according to 33.

  (Supplementary Note 37) The clip is elastic from a closed state in which the clip can be accommodated in a lumen having an inner diameter of 3 mm or less in a forceps channel of an endoscope to an expanded state in which an open width is 3 to 25 mm capable of ligating a living tissue. 34. The biological tissue clip device according to additional item 33, wherein the biological tissue clip device is deformable.

  (Additional remark 38) The clip apparatus of the biological tissue of Additional remark 33 characterized by comprising the said clip with the plate-shaped superelastic alloy.

  According to the above configuration, the clip is introduced into the body cavity with the coupling member engaged with the clip and the tightening ring fitted. At this time, the clip is closed so that it can be inserted into the body cavity. After being introduced into the body cavity, since the clip is made of a superelastic alloy, the clip expands to a state where the tissue can be ligated elastically. Thereafter, the tissue is ligated by fitting a clamping ring onto the clip.

  Therefore, since the clip is made of a superelastic alloy, the clip is expanded in order to elastically restore from the closed state where it can be inserted into the endoscope to the expanded state necessary for ligating the tissue in the body cavity. Since ligation can be performed without adjusting the state, the operation becomes simple.

  (Supplementary note 39) A flexible introduction tube that can be introduced into a flexible endoscope, a flexible operation member that is inserted into the introduction tube so as to freely advance and retract, and a flexible positioning means, An endoscopic treatment tool comprising positioning means provided on an operating member and positioning the operating member at the axial center of the introduction tube.

  (Supplementary Note 40) A flexible introduction tube that can be introduced into a flexible endoscope, a flexible operation member that is inserted into the introduction tube so as to freely advance and retreat, and the operation member provided on the operation member. An endoscopic treatment tool comprising a plurality of positioning means for positioning a member at the axial center of the introduction tube.

  (Supplementary note 41) A flexible introduction tube that can be introduced into a flexible endoscope, a flexible operation member that is inserted into the introduction tube so as to freely advance and retract, and a flexible positioning means, A living tissue clip device comprising positioning means provided on an operating member and positioning the operating member at the axial center of the introduction tube.

  (Supplementary Note 42) A flexible introduction tube that can be introduced into a flexible endoscope, a flexible operation member that is inserted into the introduction tube so as to freely advance and retreat, and the operation member provided on the operation member. A biological tissue clip device comprising a plurality of positioning means for positioning a member at the axial center of the introduction tube.

  According to Supplementary Notes 39 to 42, when the clip unit (the assembly of the clip, the tightening ring, and the connecting member) is attached to the clip operating device, first, the slider is pushed to the tip side to project the arrowhead hook. Then, the connecting member of the clip unit is pushed into the arrowhead hook. At this time, the arrowhead hook is fixed at the center of the introduction tube (coil sheath) by positioning means (centering tube). At this time, the connecting member elastically deforms and recovers and engages with the arrowhead hook. After the engagement, the slider is pulled while pushing the protrusion of the clamping ring (presser tube) into the clamp ring (presser tube), and the clip unit is pulled into the introduction tube (coil sheath).

  In this clip device, when the clip is attached and detached, the operation wire is positioned at the axial center of the coil sheath, regardless of the shape of the coil sheath. Moreover, since unnecessary meandering of the operation wire can be eliminated, the operation wire can be pushed out without loss.

  This effect is the same not only for the clip device but also for all treatment instruments that project the operation member from the inside of a sheath such as a snare, basket, injection needle, and indwelling snare.

  (Supplementary Note 43) An introduction pipe, an operation member inserted into the introduction pipe so as to be movable back and forth, an operation portion main body attached to the introduction pipe, and an operation member attached to the operation member. A slider for advancing and retreating with respect to the surface, a slope portion having two slopes provided at at least one of the operation portion main body or the slider, and at least one of the operation portion main body or the slider, and the slider An endoscopic treatment tool comprising an engaging portion that engages with the inclined surface portion by moving the step.

  According to Supplementary Note 43, when a clip unit (an assembly of a clip, a tightening ring, and a connecting member) is attached to the clip operating device, first, the slider is pushed to the tip side to project the arrowhead hook. At this time, the slider is engaged with a slope portion provided on either the slider or the operation unit body, and is softly fixed to the operation unit body. Next, the clip unit is engaged with the arrowhead hook, and the slider is pulled strongly while pushing the protrusion of the presser tube into the presser tube. Then, the fixing of the slider is released by the slope portion, and the clip unit can be drawn into the introduction tube (coil sheath).

  In this clip apparatus, since the slider can be fixed / released only by advancing and retracting the slider itself, the clip can be attached and detached easily and speedily. In addition, since it is not necessary to provide a special release mechanism, the manufacturing cost can be reduced.

  (Supplementary Note 44) A clip, a fastening ring that fits and attaches to the clip, closes the clip, a connecting member that can be inserted into the fastening ring and engages the clip, In the state where the clip and the fastening ring can be attached to the tip, the clip and the fastening ring in a state where the connection member is engaged with the clip and the fastening ring is fitted to the connection member. A clip case comprising: a fixing member that encloses the connection member and fixes the introduction pipe at a position where the clip, the tightening ring, and the connection member can be accommodated in the introduction pipe.

  (Supplementary note 45) The clip case according to supplementary note 44, wherein the fixing means is an elastically expandable arm.

  (Supplementary note 46) The clip case according to supplementary note 44, wherein the fixing means is an elastically expandable protrusion.

  (Supplementary note 47) The clip case according to supplementary note 44, wherein the fixing means is an arm with a protrusion that is elastically expandable.

  (Supplementary note 48) The clip case according to supplementary note 44, wherein the fixing means is a soft resin ring.

  (Supplementary note 49) The clip case according to any one of supplementary notes 44 to 47, wherein at least a part of the clip case is made of a transparent or translucent material.

According to Supplementary Notes 44 to 49, when the clip unit (assembly of clip, tightening ring, and connecting member) is attached to the clip operating device, first, the slider is pushed to the tip side to project the arrowhead hook. Next, the introduction tube (coil sheath) is inserted into the insertion hole of the clip case. Since the insertion hole and the clip unit are positioned with their axes aligned, the arrowhead hook and the clip unit are engaged by simply pushing the introduction tube (coil sheath). At this time, the introduction tube (coil sheath) is softly fixed to the clip case by introduction tube fixing means provided in the clip case (clip case).

  By providing a coil sheath fixing mechanism in the clip case, it is only necessary to hold either the clip case or the coil sheath when attaching the clip, and the clip attachment can be performed easily.

  By making the clip case transparent or semi-transparent, the presence or absence of the clip unit enclosed in the clip case and the engagement state of the connecting material and hook can be confirmed visually. It can be done easily.

  (Supplementary Note 50) A clip, a fastening ring that fits and attaches to the clip, closes the clip, a connecting member that can be inserted into the fastening ring and engages the clip, In the state where the clip and the fastening ring can be attached to the tip, the clip and the fastening ring in a state where the connection member is engaged with the clip and the fastening ring is fitted to the connection member. A clip case comprising: a slope portion that encloses a connecting member and that closes the clip and the engaging means provided on the tightening ring so as to be housed in the introduction pipe.

  According to Supplementary Note 50, when a clip unit (an assembly of a clip, a tightening ring, and a connecting member) is attached to the clip operating device, first, the slider is pushed to the tip side to project the arrowhead hook. Next, the introduction tube (coil sheath) is inserted into the insertion hole of the clip case. Since the insertion hole and the clip unit are positioned with their axes aligned, the arrowhead hook and the clip unit are engaged by simply pushing the introduction tube (coil sheath). When the slider is pulled in this state, the clip unit is pulled, and the engaging means (protrusion) of the tightening ring (presser tube) is pushed by the inclined surface provided in the clip case, and the clip unit is introduced into the introduction tube (coil sheath). ) Can be stored smoothly.

  (Supplementary note 51) The biological tissue clip device according to supplementary note 1, wherein the coupling member is an elastic member made of resin, and a hook provided at a distal end of the operation member is a non-elastic member made of metal.

  The connection material of the clip unit that is disposable after a single use is made of an elastic plastic part with low durability, and the hook of the clip device that is repeatedly used is made of a durable metallic non-elastic part. Sexuality can be increased.

1A and 1B show a first embodiment of the present invention, in which (A) is a longitudinal side view of a clip unit, (B) is a side view of a clip, (C) is a perspective view of a connecting member, and (D) is a perspective view of a presser tube. , (E) is a longitudinal side view of a presser tube equipped with a clip. The embodiment is shown, (A) is a side view of a clip operating device, (B) is a perspective view of a hook part, (C) is a longitudinal side view of the hook part. It is operation | movement explanatory drawing of the embodiment, (A) (B) (C) is a vertical side view of the state which connected the clip unit to the clip operation apparatus. It is operation | movement explanatory drawing of the embodiment, (A) (B) (C) is a vertical side view of the state which connected the clip unit to the clip operation apparatus. It is action | operation explanatory drawing of the embodiment, and is a perspective view of a connection material. It is an operation explanatory view of the embodiment, and is a longitudinal side view showing a relationship between a presser tube and a connecting member. The 2nd Embodiment of this invention is shown, (A) is a perspective view of a coil pipe, (B) is the longitudinal cross-sectional side view. The perspective view of the presser tube of the embodiment. The 3rd Embodiment of this invention is shown, (A) is a vertical side view of a clip unit and a clip operation device, and (B) is the same vertical plan view. The embodiment is shown, (A) is a perspective view of a hook part, (B) is the longitudinal cross-sectional side view. The 4th Embodiment of this invention is shown, (A) is a vertical side view of a clip unit, (B) is the perspective view, (C) is a side view of a 1st connection material. The side view of the hook part which shows the embodiment. The 5th Embodiment of this invention is shown, (A) is a vertical side view of a clip unit, (B) is a perspective view of a connection material. The 6th Embodiment of this invention is shown, The vertical side view of a clip unit. The 7th Embodiment of this invention is shown, (A) is a vertical side view of a clip unit, (B) is the perspective view, (C) is an exploded perspective view. The side view of the clip operation apparatus of the embodiment. It is operation | movement explanatory drawing of the embodiment, (A) (B) (C) is a vertical side view of the state which connected the clip unit to the clip operation apparatus. The 8th Embodiment of this invention is shown, (A) is a longitudinal cross-sectional side view of a clip unit and a clip cover, (B) is a side view of a connection member, (C) is a side view of a clip cover. The 9th Embodiment of this invention is shown, (A) is a side view of a clip unit and a clip cover, (B) (C) (D) is a perspective view explaining an effect | action. The 10th Embodiment of this invention is shown, (A) is a side view of a clip unit and a clip cover, (B) (C) is a side view explaining an effect | action. The 11th Embodiment of this invention is shown, The side view of a clip unit and a clip cover. The 12th Embodiment of this invention is shown, (A) is a perspective view of a clip unit, (B) is a perspective view of a clip, (C) is the side view which expanded a part of clip. The 13th Embodiment of this invention is shown, (A) is a perspective view of a clip unit, (B) is a perspective view of a clip. The 14th Embodiment of this invention is shown, The vertical side view of a clip unit. The 15th Embodiment of this invention is shown, The vertical plan view of a clip unit. The 16th Embodiment of this invention is shown, and the side view of a clip unit. The 17th Embodiment of this invention is shown, (A)-(C) is a vertical side view of a clip unit and a clip operating device. A prior art example is shown, (A) is a vertical side view of a clip unit and a clip operating device, and (B) is a vertical side view of the clip operating device. The 18th Embodiment of this invention is shown, The vertical side view of a clip unit. The side view of the connection material of the embodiment. The longitudinal section side view of a part of connecting material of the embodiment. The longitudinal side view of the front-end | tip part of the coil sheath of the embodiment. The vertical side view of the coil sheath of the embodiment. The side view of the arrowhead hook of the embodiment. The 19th Embodiment of this invention is shown, The vertical side view of a coil sheath. The 20th Embodiment of this invention is shown and the vertical side view of the operation part of a clip apparatus is shown. The side view which showed the embodiment and cut down a part of clip apparatus. The vertical side view of the operation part of the clip apparatus which shows the modification 1 of the embodiment. The vertical side view of the operation part of the clip apparatus which shows the modification 2 of the embodiment. The perspective view of the clip case which shows 21st Embodiment of this invention. The perspective view of the separation state of the case main body and case lid of the clip case of the embodiment. The vertical side view of the clip case of the embodiment. The top view of the case cover of the embodiment. The 22nd Embodiment of this invention is shown, The vertical side view of a clip case. The 23rd Embodiment of this invention is shown, The vertical side view of a clip case. The 24th Embodiment of this invention is shown, The vertical side view of a clip case. The perspective view of the frame which shows 25th Embodiment of this invention and encloses a clip case. The expanded top view of the A section of FIG. 47 which shows the same embodiment. Sectional drawing which shows the same embodiment and follows the BB line of FIG. The perspective view of the flame | frame which shows the same embodiment and encloses a clip case. The top view of the flame | frame which shows the same embodiment and encloses a clip case.

Explanation of symbols

  2 ... Clip, 120 ... Clip unit, 121 ... Connection member, 160 ... Clip case, 169, 170 ... Coil fixing arm (fixing means)

Claims (6)

Clips,
A clamping ring that closes the clip by fitting and attaching to the clip;
A connecting member insertable into the clamping ring and engaged with the clip;
An introduction tube capable of attaching the clip and the fastening ring to the tip;
The clip, the tightening ring, and the connection member are enclosed while the connection member is engaged with the clip and the tightening ring is fitted to the connection member. A clip case comprising fixing means for fixing the introduction pipe at a position where a member can be accommodated in the introduction pipe.   The clip case according to claim 1, wherein the fixing means is an elastically expandable arm.   The clip case according to claim 1, wherein the fixing means is an elastically expandable protrusion.   The clip case according to claim 1, wherein the fixing means is an arm with a protrusion that can be elastically expanded.   The clip case according to claim 1, wherein the fixing means is a soft resin ring.   The clip case according to any one of claims 1 to 5, wherein at least a part of the case body is made of a transparent or translucent material.

Images