JP2009233311A - Magazine type clipping device - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a magazine type clipping device which is capable of reliably maintaining the connected state of the clips loaded successively, which is free from a fear of damaging the sheath inner wall, and which can perform clipping operation smoothly and with high precision. <P>SOLUTION: The magazine type clipping device includes: a plurality of clips loaded into a forward end portion of a sheath while being engaged with other clips longitudinally connected together; a connection ring fitted into the sheath so as to be capable of advancing and retreating and covering an engagement portion of the preceding and succeeding clips to maintain the preceding and succeeding clips in a connected state; and a manipulating wire connected to a rearmost clip of the plurality of clips and adapted to pull a clip row formed of the plurality of clips relative to the sheath. <P>COPYRIGHT: (C)2010,JPO&INPIT

Description

  The present invention relates to an endoscopic clip treatment tool used for hemostasis or wound closure in a living body and the like, and more particularly to a repetitive clip treatment tool capable of using a plurality of clips repeatedly.

  Endoscopic clip treatment tool is designed to project the clip from the distal end of the endoscope inserted into the living body, pick the treatment part after removing the bleeding part or lesion tissue with the clip, and stop hemostasis or wound closure Used for. The endoscope clip that has been used in the past has one clip detachably attached to the tip of the operation wire. Each time clipping is performed, the entire sheath is pulled out of the endoscope, and the next clip It is necessary to perform a cumbersome operation of setting and inserting it again into the endoscope and performing the next clipping.

  On the other hand, an endoscope clip device that enables continuous clipping treatment has been proposed. For example, in Patent Document 1, a plurality of clips are alternately turned 90 degrees by engaging a leading end claw portion of a rear clip with a connecting hole formed in a rear end portion of the front clip. An endoscopic clip device that is directly coupled is described. Further, in Patent Document 2, a connecting claw bent outward is formed at the rear end of a pair of leaf spring pieces constituting the clip, and the front clip has a portion near the tip of each leaf spring piece. When an engagement hole is formed to engage the connection claw and the rear clip is in a sag, the connection claw at the rear end of the front clip is inserted into the engagement hole near the tip of the rear clip. An endoscope clip device is described in which a plurality of clips are directly connected in the same direction by being locked in this state.

JP 2006-187391 A JP 2006-087537 A

  According to the devices of Patent Literature 1 and Patent Literature 2, continuous clipping treatment can be performed. However, in the above apparatus, the clip connection is maintained only by the engagement of the front and rear clips, and the connecting portion is exposed in the sheath. For this reason, the connection state is unstable, and when inserted into the endoscope, it may come off when passing through the curved part, or an excessive force is applied to the connection part, causing the clip before use to be distorted or distorted. There is a possibility. Further, the protrusions and corners of the clip of the connecting portion may damage the sheath inner wall at the curved portion.

  Further, in the devices of Patent Document 1 and Patent Document 2, the clip is accommodated in the sheath, so that the closed state of the clip is maintained, and the inner wall of the sheath is pressed by the spring force of the clip during the clipping operation. The clip is advanced and retracted within the sheath. Therefore, the traction load of the clip is unnecessarily large, and the sheath inner wall may be damaged. Further, in the devices of Patent Document 1 and Patent Document 2, the connection is maintained only by the engagement of the front and rear clips, and the forward and backward movement by the operation wire is transmitted at the connection portion. However, since there is play at this connecting portion, there is a problem that rattling occurs at the time of forward / backward movement, giving an unstable feeling to the operation side, and precise control of the forward / backward movement amount is difficult.

The object of the present invention is to eliminate the above-mentioned problems of the prior art, reliably maintain the connected state of the clip to be connected and loaded, without worrying about damaging the inner wall of the sheath, and smoothly and accurately performing the clipping operation. It is an object of the present invention to provide an endoscopic continuous clip treatment tool that can be used in a simple manner.
In addition to the above object, another object of the present invention is to more securely fix the connecting ring and the clip by closing the skirt portion of the connecting ring, thereby preventing the positional deviation between the connecting ring and the clip. Therefore, it is an object of the present invention to provide a repetitive clip treatment device that can improve operability and can be precisely controlled.

  In order to solve the above-mentioned problem, a repetitive clip treatment device of the present invention includes a plurality of clips loaded on a sheath distal end in a state where the front and rear clips are engaged, and a forward and backward insertion into the sheath. A connection ring that covers the engagement portion of the clip and maintains the connection state of the front and rear clips, and an operation wire that is connected to the rearmost clip of the plurality of clips and pulls the clip row composed of the plurality of clips. It is characterized by providing.

Here, the clip has two claw portions facing each other at one end, and when the clip is fixed, the connection ring is pressed against the tip side of the clip, and the two claw portions of the clip are closed. It preferably functions as a tightening ring that is tightened in a state.
Moreover, it is preferable to have a micro uneven surface on the inner wall of the tip portion of the connecting ring.

Moreover, it is preferable that the connection ring has a skirt portion that is pressed against the inner wall of the sheath and closes inward in the sheath and presses and holds at least one of the front and rear clips connected in the connection ring.
Further, the skirt portion of the coupling ring is formed at two or more locations in the circumferential direction at the same position in the pulling direction of the clip, and opens wider than the inner diameter of the sheath after passing through the distal end of the sheath. It is preferable to prevent retreat.
Further, the clip has two claw portions opposed at one end, two arm portions supporting these two claw portions and intersecting each other, and a turn portion connecting the two arm portions at the other end, It is preferable to have one or more convex portions formed around the turn portion and meshing with the skirt portion of the connecting ring.

In addition, it is preferable that the plurality of clips are connected such that the front and rear clips are alternately turned by 90 degrees.
In addition, the leading clip is pulled with respect to the connection ring by the operation wire, and the engagement with the subsequent clip comes out of the connection ring, so that the connection with the subsequent clip is released. Is preferred,
After the leading clip is released and subjected to clipping, the sheath is moved to the proximal end side, or the operation wire is pushed to push the next clip, so that the sheath moves the next clip to the sheath. It is preferable that the next clip is in a usable state by being pulled down relatively to the position where it protrudes from.
The connecting ring is preferably made of a resin material.
Moreover, it is preferable that the said connection ring consists of the resin-made holding parts which maintain the connection state of the said front and back clips, and the said metal clamp | tightening parts provided in the front end side of the said holding part.

According to the present invention, since the connection state of the clip is maintained by the connection ring, the connection state can be reliably maintained, and the connection can be disconnected or the clip can be twisted or distorted at the connection portion. Can be suppressed. In addition, since the connection ring contacts the sheath, there is no fear that the protrusions and corners of the clip damage the inner wall of the sheath, and the clip can be moved smoothly during the clipping operation.
Furthermore, according to one aspect of the present invention, the connecting portion of the clip is held in a fixed state by the connecting ring, so that the forward / backward movement during the clipping operation can be performed with high accuracy.

  Further, according to a preferred aspect of the present invention, the connecting ring and the clip are more securely fixed by providing the convex portion at the turn portion (intersection portion on the base end side) of the clip and closing the skirt portion of the connecting ring. The clip ring is prevented from being displaced and the clip holding force of the connection ring as a member for holding the connection of the clip is increased, and the connected clip is given a sense of unity, thereby operating the clip treatment tool. Improvement and precise control can be achieved.

  The continuous clip treatment device according to the present invention will be described in detail below based on a preferred embodiment shown in the accompanying drawings.

1A and 1B are schematic cross-sectional views showing a first embodiment of a repetitive clip treatment device of the present invention, and FIG. 1B is an angle that is 90 degrees different from FIG. It is the figure seen from.
The continuous-type clip treatment tool 10 shown in the figure includes a plurality of clips 12 (12A, 12B, 12C, 12D), a dummy clip 18 connected to the last clip 12D, and an operation wire connected to the dummy clip 18. 20 and a connection ring 14 (14A, 14B, 14C, 14D) that covers the engaging portions of two adjacent (front and rear) clips 12 and maintains the connection state of the clips 12, and these are within the sheath 16. Is inserted. FIGS. 1A and 1B show an initial state immediately before the start of the clip treatment operation by the head clip 12.

  One clip 12 and one connection ring 14 constitute one hemostatic clip body for an endoscope, and the clip treatment tool 10 is a plurality of the hemostatic clip bodies loaded on the distal end portion of a long sheath 16. It is. The end of the continuous hemostatic clip body is meshed with the dummy clip 18 and the operation wire 20 extends to the proximal end portion of the sheath 16 and is connected to an operation portion (not shown). By pulling the operation wire 20 by a predetermined length from the operation unit and moving the dummy clip 18 by a predetermined length in one direction, the series of clips 12 are moved by the same amount, and hemostasis or marking by the leading clip 12 is performed. Clipping for (clipping) is performed. After the clipping by the first clip 12 is completed, the sheath 16 is pulled to the operation portion by a predetermined length, or the operation wire 20 is pushed, so that the next clip 12 becomes usable (standby state) and continues. Clipping can be performed.

  FIGS. 1A and 1B show the state in which the leading clip 12A protrudes from the distal end of the sheath 16, but when the clip 12 or the like is loaded into the sheath 16, FIG. As shown, the leading clip 12A is set in a state of being completely contained within the sheath 16. In FIG. 1, four clips 12 are provided as a four-shot clip treatment device, but the number of clips 12 may be two or more.

  FIG. 2 is a perspective view of the first embodiment of the clip. The clip 12 is a closed clip having a turn part 24 that is turned 180 degrees with respect to the claw part 22. That is, the clip 12 bends one long thin plate in half by 180 degrees to form a closed end, and the open end is formed with claw portions 22 and 22 that are bent so that the end portions face each other. In the portion between the portions 22 and 22 and the closed end, both pieces are twisted 180 degrees to intersect each other. With the crossing portion 26 twisted 180 degrees as a boundary, the open end side is the arm portions 28 and 28, and the closed end side is the turn portion 24. Convex portions 30 are formed at the central portions of the arm portions 28, 28. In addition, it is preferable to form the nail | claw parts 22 and 22 in a V-shaped male type | mold and a female type | mold, in order to pick up a target reliably. The clip 12 can be made of a biocompatible metal such as SUS631.

  As shown in FIGS. 1A and 1B, the first clip 12A and the second clip 12B are closed by engaging the claw portion 22 of the second clip 12B with the turn portion 24 of the first clip 12A. By being held by the connection ring 14A in the state, the connection state is obtained. As shown in FIG. 1 (A), the claw portions 22 and 22 of the second clip 12B are engaged with and joined to the turn portion 24 of the first clip 12A in the orthogonal direction, and the first clip 12A and the second clip 12B are connected to each other. , They are connected in different directions by 90 degrees. Similarly, the following clips 12C and 12D are connected by alternately changing the direction by 90 degrees.

The connecting ring 14 is fitted into the sheath 16 so as to be able to advance and retract while covering the engaging portions of the two front and rear clips 12 and 12 and maintaining the connected state. That is, the outer diameter of the connection ring 14 is substantially equal to the inner diameter of the sheath 16, and the connection ring 14 can smoothly move back and forth in the sheath 16 as the clip 12 moves.
3A to 3C show a schematic configuration of the connection ring 14. 3A is a front view of the connecting ring 14, FIG. 3B is a cross-sectional view, and FIG. 3C is a bottom view.

  The connection ring 14 includes a first region 32 that holds the previous clip 12 and a second region 34 that holds the next clip 12. The first region 32 includes a reduced diameter portion 36 at the tip and a skirt portion 38 that is inclined and spreads in a skirt shape with respect to the central axis of the coupling ring body. The material of the connection ring 14 is not particularly limited, but is required to be biocompatible. For example, the connection ring 14 can be made of a biocompatible resin material or metal material.

  In the first region 32, a circular hole that can accommodate the turn portion 24 of the previous clip 12 is formed. Further, as shown in FIG. 3C, a hole 43 having the same inner diameter as that of the first region 32 is formed in the second region 34, and the claw portion 22 of the clip 12 held in the second region 34 is formed. Grooves (concave portions) 43a are formed at two locations in the opening and closing direction (left and right direction in FIG. 3). The concave portion 43a can accommodate the arm portions 28 and 28 of the clip 12 held in the second region 34 in a state where the claw portions 22 and 22 are closed.

  The inner walls of the groove portions 43 a and 43 a abut against the plate surfaces of the arm portions 28 and 28 of the clip 12. That is, the width (opening width) of the groove portion 43a is slightly larger than the maximum width of the arm portion 28 of the clip 12, and the distance from the wall surface of one groove portion 43a to the wall surface of the other groove portion 43a is two claws of the clip 12. It is substantially equal to the length obtained by adding the lengths of the portions 22 and 22 (the length in the expanding direction). Further, the width of the groove 43 a is smaller than the width of the convex portion 30 formed on the arm portion 28. Therefore, the convex portion 30 of the clip 12 held in the second region 34 cannot enter the groove portion 43a.

  In addition, the distance from the wall surface of both groove parts 43a and 43a to a wall surface should just be a dimension which the engagement with the turn part 24 of the previous clip 12 and the nail | claw parts 22 and 22 of the following clip 12 is not removed. What is necessary is just to make shorter than the length which added the length of the two nail | claw parts 22 and 22 and the width | variety of the part which the nail | claw parts 22 and 22 of the turn part 24 engage. For example, the distance between the wall surfaces of the groove portions 43a and 43a is shorter than the length obtained by adding the two claw portions 22 and 22, and the claw portions 22 and 22 of the clip 12 held in the second region 34 are slightly overlapped. It may be made to become.

The reduced diameter portion 36 of the first region 32 and the outer diameter of the second region 34 are substantially equal to the inner diameter of the sheath 16. The skirt portion 38 is connected to the main body of the connecting ring 14 at the tip side, that is, the upper base in the figure, and the lower expanding portion is partly separated from the main body so as to expand or close in the radial direction. ing. In the illustrated example, the skirt portion 38 is formed at two positions 180 degrees apart at the same position in the pulling direction of the clip 12, that is, the vertical direction in FIG.
Note that the number of the skirt portions 38 is not limited to two and may be any number as long as it is two or more. However, if a large number of skirt portions 38 are formed, the strength of the connecting ring 14 main body is lowered, so that it is necessary to design the strength considering the strength. Moreover, it is preferable to arrange | position the skirt part 38 equally in the circumferential direction.

  The skirt portion 38 expands in a skirt shape as shown in FIG. 3A when there is no external force. At this time, the inside of the connecting ring 14 is a cylindrical space as shown in FIG. On the other hand, when the connecting ring 14 is loaded into the sheath 16, for example, like the second connecting ring 14B shown in FIG. 1 (B), the skirt portions 38, 38 formed at two locations in the circumferential direction are The inside of the skirt portions 38, 38 is folded into the inner space, and the inner peripheral side portion of the skirt portions 38, 38 presses the side surface (edge portion) of the turn portion 24 of the clip 12B held by the first region 32. The clip 12 is held so as not to move in the rotational direction and the forward / backward direction within the connecting ring 14. The skirt portion 38 may press and hold a clip held in the second region 34, that is, a rear clip.

  The skirt portions 38 and 38 are opened at the same time as the first connecting ring 14A shown in FIG. 1A is pulled out from the distal end of the sheath 16, release the holding of the clip 12, and are wider than the inner diameter of the sheath 16. Thus, the connection ring 14 </ b> A is prevented from retracting into the sheath 16. In this state, the operation wire 20 is pulled and the clip 12 is retracted, so that the connecting ring 14 moves forward relative to the clip 12 and tightens the clip 12.

  Therefore, the skirt portion 38 needs to have elasticity so that it closes inward inside the sheath 16 and spreads in a skirt shape when it comes out of the distal end of the sheath 16. At the same time, the skirt portion 38 needs to have a rigidity that can hold the clip 12 inside the sheath 16 and a rigidity that can withstand a reaction force of the tightening force of the clip 12 at the distal end of the sheath 16.

  From these viewpoints, it is preferable to use a material that is biocompatible and satisfies the elasticity and rigidity required for the skirt portion 38 for the connection ring 14. The shape is determined so as to satisfy the elasticity and rigidity required for the skirt portion 38. As a material for such a connection ring 14, it is preferable to use a biocompatible resin material. For example, PPSU (polyphenylsulfone) can be used. Moreover, it is preferable that the connection ring 14 is integrally formed from the viewpoint of ease of manufacture.

  The engaging portions of the two front and rear clips are held in a portion of the second region 34 adjacent to the boundary between the second region 34 and the first region 32. The previous clip 12 (for example, the clip 12B in FIG. 1B) is moved forward and backward and rotated in the sheath 16 because the turn portion 24 is held by the closed skirt portion 38 of the first region 32. Movement is suppressed. Further, the next clip 12 that engages with the previous clip 12 (for example, the clip 12C of FIG. 1B) is held in a direction different from the previous clip by the groove 43a of the second region 34, and rotated. The forward / backward movement is suppressed by engaging with the previous clip 12 in which the movement is suppressed and the forward / backward movement is suppressed. That is, the engaging portions of the front and rear clips 12 are held by the connecting ring 14 with a very small play.

With reference to FIG. 1 again, the holding of the clip 12 by the connecting ring 14 will be described.
As described above, the claw portions 22 and 22 of the second clip 12B engage with the turn portion 24 of the first clip 12A, and the coupling ring 14A holds the engaging portion. The claw portions 22 of the second clip 12B are held in a closed state by the inner wall of the connection ring 14A (the second region 34). Thereby, the connection state of the first clip 12A and the second clip 12B is maintained. Similarly, the connection state between the second clip 12B and the third clip 12C is by the connection ring 14B, and the connection state between the third clip 12C and the fourth clip 12D is by the connection ring 14C by the fourth clip 12D and the dummy clip. The connection state with 18 is maintained by the connection ring 14D.

  A dummy clip 18 that is not used for clipping is engaged with the last clip 12D. The dummy clip 18 has a shape similar to that of the half of the open end side from the crossing portion 26 of the clip 12. When the claw portion 22 is closed, the dummy clip 18 is engaged with the turn portion of the clip 12D and the claw portion is opened. The clip 12D is released. An operation wire 20 is fixedly connected to the base of the dummy clip 18.

  The sheath 16 is, for example, a coil sheath in which a metal wire is tightly wound. The inner diameter of the sheath 16 is such that the engagement between the turn portion 24 of the previous clip 12 and the claw portions 22 of the next clip 12 is released. That is, the inner diameter of the sheath 16 is larger than the total length of the lengths of the two claw portions 22 and 22 and the width of the portion of the turn portion 24 where the claw portions 22 and 22 are engaged.

Next, the clipping operation of the repetitive clip treatment instrument 10 will be described with reference to FIG. 4A to 4E are schematic cross-sectional views showing a stepped state in the clipping operation of the repetitive clipping treatment instrument 10. The transition from the state shown in FIGS. 4A to 4B and the state shown in FIG. 4D to FIG. 4E is exemplified to move the sheath 16 downward in the figure, but the present invention is limited to this. Of course, the clip 12 may be pushed out from the distal end of the sheath 16 by pushing the operation wire 20 as described below.
First, as shown in FIG. 4 (A), after the sheath 16 is loaded with four hemostatic clip bodies (the clip row consisting of the four clips 12A to 12D) including the clips 12A to 12D and the connection rings 14A to 14D. The sheath 16 is inserted into the forceps channel of the endoscope. For example, four hemostatic clip bodies (the clip 12 fitted with the connection ring 14) and the dummy clip 18 are connected in advance, and the dummy clip 18 is protruded from the distal end of the sheath 16. Attach to the distal end of the wire 20, and then push the sheath 16 forward or pull the operating wire 20 to advance the sheath 16 relative to the operating wire 20 so that the leading clip 12A is completely This can be done by housing in the sheath 16.

  The clips 12 </ b> A to 12 </ b> D are loaded so that the leading end of the leading clip 12 </ b> A is completely contained in the sheath 16. The leading clip 12 </ b> A is held closed by the inner wall of the sheath 16. In the initial state, each of the connection rings 14A to 14D is fitted so that the reduced diameter portion 36, which is a tightening portion thereof, is in the vicinity of the intersecting portion 26 of the clips 12A to 12D. At this time, the upper ends in FIG. 4 of the protrusions 30 of the clips 12A to 12D are located directly below the coupling rings 14A to 14D.

  When the distal end of the sheath 16 reaches the distal end of the insertion portion of the endoscope inserted into the living body and protrudes from the distal end of the endoscope, the operation wire 20 remains as it is, and only the sheath 16 is pulled toward the operation portion. Alternatively, the sheath 16 is left as it is, and only the operation wire 20 is pushed. When the sheath 16 is pulled by a predetermined amount (a predetermined one stroke) or the operation wire 20 is pushed out by a predetermined amount, the distal end of the sheath 16 is relatively lowered to a position where the skirt portion 38 of the leading connecting ring 14A is opened. The claws 22 and 22 of the clip 12A protruding from the sheath 16 expand to be in the state shown in FIG. As a result, the first clip 12A can be used. In FIG. 4A, the skirt portion 38 of the connecting ring 14A is not shown because it is in the direction perpendicular to the paper surface. In addition, since the coupling portion between the clip 12A and the clip 12B is located directly below the skirt portion 38 of the connecting ring 14A, the tip of the clip 12B is almost at the tip of the sheath 16 in the state of FIG. Match.

  Next, the repetitive clip treatment instrument 10 in the state of FIG. 4A is moved, and the claw portions 22 and 22 of the clip 12A are pressed against a portion to be clipped, and the operation wire 20 is moved on the proximal end side of the sheath 16. Pull a predetermined amount. By this operation, all the clips 12 </ b> A to 12 </ b> D engaged in order from the dummy clip 18 are pulled uniformly.

  At this time, in the state of FIGS. 4A and 4B, the connecting ring 14A that has come out at the tip of the sheath 16 has the skirt 38 open, and the holding of the clip 12A by the connecting ring 14A is released. As shown in FIG. 4B, the leading clip 12A moves backward with respect to the connecting ring 14A. The distal end of the connecting ring 14A, that is, the reduced diameter portion 36, which is a tightening portion, is pushed down to just below the convex portion 30 of the clip 12A, whereby the fastening of the clip 12A by the connecting ring 14A is completed. That is, at this time, the connecting ring 14A functions as a fastening ring for the clip 12A.

  At the same time, the engaging portion between the clip 12A and the next clip 12B comes out from the rear end of the connecting ring 14A. Since the inner diameter of the sheath 16 is larger than the length obtained by adding the length of the two claws 22 and the width of the engaging portion of the turn portion 24, the engaging portion of the clip 12A and the clip 12B is separated from the connecting ring 14A. When disengaged, the arm portion 28 is expanded by the spring force of the clip 12B until it hits the inner wall of the sheath 16, and the gap between the claw portions 22 and 22 opens wider than the width of the turn portion 24 of the clip 12A. Is disconnected. Thereby, the leading clip 12A can be detached, and the clipping by the clip 12A is completed.

  On the other hand, the subsequent clips 12B to 12D are held by the connection rings 14B to 14D with the skirt portion 38 closed so as not to move in the rotational direction and the forward / backward direction with respect to the connection rings 14B to 14D. Further, the claws 22 are engaged with the clips 12C to 12D and the claws 22 of the clips 12D and the claws 22 of the dummy clips 18 are caused to spread (biasing force) by the claws 22 in the second regions of the coupling rings 14B to 14D. 34 (see FIG. 3), and the frictional force between the clips 12B to 12D and the connection rings 14B to 14D is increased. Therefore, the connection rings 14B to 14D move with the movement of the clips 14B to 14D. That is, the clip 12 other than the head clip and the connection ring 14 move forward and backward integrally with respect to the sheath 16, and the connection state of the clips 14B to 14D and the dummy clip 18 is maintained in the connection rings 14B to 14D.

  The operation wire 20 is configured so that a certain amount can always be pulled during the clip treatment. This fixed amount is an amount that is equal to or slightly smaller than the length from the tip of the connection ring 14 to the end surface of the convex portion 30 of the clip 12 when the connection of the clip 12 is held. Further, the operation wire 20 is configured to return immediately after the predetermined amount is pulled. The operation wire 20 pulled from the state of FIG. 4A to the state of FIG. 4B returns to the original position when the pulling force is released in the operation portion, and becomes the state of FIG. That is, the distal end of the second clip 12B returns to a position that substantially coincides with the distal end of the sheath 16 as in FIG.

  Next, in order to make the second clip 12B usable, the sheath 16 is pulled for a predetermined stroke or the operation wire 20 is pressed for a predetermined stroke. As a result, the distal end of the sheath 16 is relatively lowered to the position where the skirt portion 38 of the next connecting ring 14B is opened, and the claws 22 and 22 of the clip 12B protruding from the sheath 16 are expanded, as shown in FIG. It becomes a state.

  Since the coupling portion between the clip 12B and the clip 12C is located immediately below the skirt portion 38 of the connecting ring 14B, the tip of the clip 12C substantially coincides with the tip of the sheath 16 in the state of FIG. ing. That is, the length of one stroke for pulling the sheath 16 or pushing the operation wire 20 is equal to the distance between the tip of the clip 12B loaded in the sheath 16 and the tip of the clip 12C.

  Further, when the sheath 16 is pulled or the operation wire 20 is pushed, a frictional force acts between the sheath 16 and the connection ring 14 (14B to 14D in this case) fitted in the sheath 16, but the connection ring 14 In addition to the elastic force of the skirt portion 38 and the holding force due to the spring force of the clip 12 acting between the clip 12 (here, 12B to 12D), the convex portion 30 of the clip 12 Since it abuts on the base end (lower end in FIG. 4) and cannot enter the hole 43 of the second region 34 of the connection ring 14, the connection rings 14 </ b> B to 14 </ b> D are unnecessary even if the sheath 16 is pulled or the operation wire 20 is pushed. Never move on. Therefore, the connection rings 14B to 14D can maintain the state of holding the clips 12B to 12D, respectively.

  Thereafter, as in the case of the above-described clip 12A, the claw portion of the clip 12B is pressed against the portion to be clipped, and the operation wire 20 is pulled by a predetermined amount. As a result, the state shown in FIG. 4E is obtained, and at the same time when the clip 12B is tightened by the connecting ring 14B, the connection between the clip 12B and the clip 12C is released, and the clipping by the clip 12B is completed.

  As described above, in the continuous clip treatment device 10 of the present invention, the connection state of the front and rear clips 12 is maintained by the connection ring 14, so that the connection state of the clips 12 is reliably maintained. Further, since the connecting portion of the clip 12 is covered with the connecting ring 14, there is no fear of damaging the inner wall of the sheath 16 with a corner portion of the connecting portion of the clip 12 or the like at the time of clipping operation, and the sheath 16 is inserted into the endoscope. In such a case, the possibility that the clip 12 will be twisted or distorted at the connecting portion is extremely small.

Moreover, in the continuous-type clip treatment tool 10 of this invention, the connection ring 14 is made into resin as a preferable form. Therefore, the friction between the connecting ring 14 and the inner wall of the sheath 16 is small, and the operation for moving the clip 12 forward and backward by the operation wire 20 and the operation for pulling the sheath 16 or pushing the operation wire 20 are smooth. There is no worry of damaging the inner wall of the sheath 16.
Further, when the sheath 16 loaded with the clip 12 is inserted into the endoscope inserted into the living body, it needs to pass through the bending portion of the endoscope, but when the connecting ring 14 is made of resin. The connecting ring 14 is excellent in flexibility and can be bent while holding the connecting portion of the clip 12.

  Further, in the state set in the sheath 16, the skirt portion 38 of the connecting ring 14 presses and holds the clip 12, so that the connecting portion of the clip 12 can be held in a constant state, and the play of the clip 12 There is very little. Therefore, the forward / backward movement at the time of operation by the operation wire 20 is stable, the movement amount error is small, and the movement can be performed with high accuracy.

  In the above embodiment, the clip 12 is connected by changing the direction by 90 degrees. However, the present invention is not limited to this, and the internal shape of the connecting clip can be selected according to the shape of the engaging portion. It is. For example, a clip having a shape twisted by 90 degrees at a portion between the claw portions 22 and 22 and the turn portion 24 may be used, and continuous clips may be connected in the same direction. Moreover, although it is preferable at the point which can give the spring force which presses a turn part and expands to an arm part by using the closed clip which has a turn part, this invention is an open clip (without a turn part). It can also be applied to those using a U-shaped clip.

Next, a second embodiment of the present invention will be described. FIG. 5 is a schematic cross-sectional view showing a second embodiment of a connection ring used in the continuous clip treatment device of the present invention.
In addition to the first function of maintaining the connection state of the two clips 12 and 12 and the second function of holding the clip 12 in the connection ring 44, the connection ring 14 of the first embodiment described above is a clipping function. It also had a third function of tightening the clip 12 at the time. Therefore, in order to exhibit this third function more effectively, the connection ring 40 of FIG. 5 includes a minute uneven surface 42 on the inner peripheral surface of the reduced diameter portion 36 of the first region 32.
By providing such a micro uneven surface 42, the connection ring 40 can exhibit a sufficient tightening force (friction force) against the clip 12 even if it is made of resin.

The minute uneven surface 42 is preferably an unevenness of 0.1 mm or more. The minute irregularities may be formed only on a part of the inner peripheral surface of the reduced diameter portion 36 that is in contact with the clip 12 or on the entire surface. Further, a groove perpendicular to the axial direction of the connecting ring 40 may be formed instead of the minute irregularities.
As another form, the surface roughness of the tightening position of the clip 12 by the connecting ring 40 or the connecting ring 14 may be roughened to increase the frictional force between the clip 12 and the connecting rings 40 and 14.

Next, a third embodiment of the present invention will be described. FIG. 6 is a schematic cross-sectional view showing a third form of the connection ring used in the continuous clip treatment device of the present invention.
In the connection ring 44 of FIG. 6, the first region 32 includes a resin main body 48 and a metal fastening ring 46, and the reduced diameter portion 36 serves as the fastening ring 46. The fastening ring 46 is fitted to the main body 48 with an interference fit that does not come off during the clipping operation. For the fastening ring 46, a biocompatible metal such as SUS304 can be used.

  In this way, the metal fastening ring 46 is fixed to the tip of the resin connection ring 44, and the two members are integrated to form a resin connection ring portion (the main body 48 and the first region 32). The second region 34) is responsible for maintaining the connection and holding the clip within the connection ring, and the metal clamping ring 46 is responsible for clamping the clip. By providing the metal tightening ring 46, it is possible to sufficiently exert a frictional force as a tightening force on the metal clip 12. Therefore, the connection ring 44 has a first function of maintaining the connection state of the two clips 12, 12, a second function of holding the clip 12 in the connection ring 44, and tightening of the clip 12 at the time of clipping. All the third functions can be effectively exhibited.

In the above-described embodiment, when the clip row composed of the plurality of clips 12 connected by the plurality of connection rings 14 is loaded in the sheath 16, the skirt 38 of the connection ring 14 is stored in the connection ring 14. Then, by pressing the turn portion 24 of the clip 12 in the connection ring 14, the connection ring 14 and the clip 12 are coupled by the frictional force of both, but in the present invention, the connection ring and the clip Means for preventing misalignment between the two may be provided.
FIG. 7A is a perspective view of another embodiment of a clip provided with such a displacement prevention means, and FIG. 7B is a partially enlarged front view of the clip shown in FIG.
Since the clip 50 shown in FIGS. 7A and 7B has the same configuration except that the clip 12 and the turn part 24 shown in FIG. The same components are denoted by the same reference numerals, and detailed description thereof is omitted.

A clip 50 shown in FIGS. 7A and 7B is obtained by providing a convex portion 52 on the turn portion 24.
In the clip 50 in the illustrated example, a total of eight convex portions 52 are provided along each of both end surfaces (side surfaces) of both plate pieces of the turn portion 24. For example, when the front and rear clips 50 are connected by the connecting ring 14 like the front and rear clips 12 shown in FIG. 1 or FIG. 7, the clips 50 in front of these clips 50 are The convex part 52 of the turn part 24 accommodated in the hole 43 inside the one region 32 is arranged so as to be opposed to the skirt part 38 of the connecting ring 14.
As shown in FIG. 7B, the convex part 25 of the turn part 24 has a shape with a pointed tip in order to bite into the inner wall surface of the skirt part 38 of the connecting ring 14 and securely fix the skirt part 38. It has become.

Here, when the front and rear clips 50 are loaded in the sheath 16 in a state of being connected by the connecting ring 14, the skirt portion 38 of the connecting ring 14 is pushed and closed by the inner wall of the sheath 16. It enters the hole 43 inside the first area 32 and pierces the convex part 52 of the turn part 24 of the previous clip 50 accommodated in the first area 32.
For this reason, the turn portion 24 of the previous clip 50 is reliably locked to the skirt portion 38 of the connecting ring 14 by the protrusion 52 and is securely held by the connecting ring 14. Thus, the clip 50 is securely fixed to the connection ring 14. Accordingly, the holding force of the clip 50 by the connecting ring 14 that holds the connection of the front and rear clips 50 can be increased. As a result, even when the two clips 50 connected by the connecting ring 14 move in the sheath 16 in the connected state, the clip 50 can reliably and firmly maintain the connection with the connecting ring 14. 50 and the connecting ring 14 can be reliably prevented from being displaced.
Further, by integrating the two clips 50 connected by the connecting ring 14 to give a sense of unity, it is possible to improve operability and precise control in the repetitive clip treatment instrument 10 of the present invention.

  In the illustrated example, the convex portions 52 are located at substantially the same position along the end surfaces (edge surfaces: side surfaces) of both plate pieces of the turn portion 24 of the clip 50, that is, along the pulling direction of the operation wire 20. However, the present invention is not limited to this, and as long as the end surface of the turn portion 24 is formed, the formation position of the convex portion 52 is not particularly limited. The number of the convex portions 52 is not particularly limited as long as at least one is formed on at least one of both end surfaces of each plate piece, and any number may be used, and each end piece of the turn portion 24 is different for each end surface. A number of convex portions 52 may be formed. If a large number of convex portions 25 are formed, when the clip 50 moves in the connection ring 14 during the clip treatment, the clip 50 bites into the inner wall surface of the expanded skirt portion 38 to become resistance to movement, or the skirt portion 38. Since excessive friction is generated even when releasing the pressure holding due to the above, it is preferable to set the number in consideration of this. Further, in the illustrated example, the convex portion 52 has a pointed apex shape, but the present invention is not particularly limited, and the convex portion 25 bites into the inner wall surface of the skirt portion 38 and exhibits a predetermined holding force. Any shape may be used as long as it is a shape. Further, although the height of the convex portion 52 is not particularly limited, when the clip 50 moves in the connection ring 14 during the clip treatment, it does not bite into the inner wall surface of the expanded skirt portion 38 and does not become a resistance to movement. It is good to be high.

  In the above-described embodiment, the use of a closed clip having a turn part is preferable in that a spring force (biasing force) for pressing the turn part and expanding the arm part can be applied. Can also be applied to those using an open clip (a U-shaped clip) that does not have a turn portion.

  The continuous clip treatment device according to the present invention has been described in detail above, but the present invention is not limited to the various embodiments described above, and various improvements and modifications can be made without departing from the spirit of the present invention. Of course it is good. Moreover, the clip treatment tool of the present invention can be used for a rigid endoscope as well as a flexible endoscope.

(A) And (B) is typical sectional drawing which shows 1st Embodiment of the continuous-type clip treatment tool of this invention, respectively. It is a perspective view of 1st Embodiment of the clip used for the repetitive clip treatment tool shown in FIG. (A) is the front view of 1st Embodiment of the connection ring used for the repetitive clip treatment tool shown in FIG. 1, (B) is the sectional view, (C) is the bottom view. (A)-(E) are typical sectional drawings which show the stepped state in the clipping operation of the repetitive clip treatment instrument of FIG. 1, respectively. It is typical sectional drawing which shows the 2nd form of the connection ring used for the repetitive clip treatment tool shown in FIG. It is typical sectional drawing which shows the 3rd form of the connection ring used for the repetitive clip treatment tool shown in FIG. (A) And (B) is the perspective view and partial enlarged front view which respectively show 2nd Embodiment of the clip used for the repetitive type clip treatment tool shown in FIG.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10 Repetitive clip treatment tool 12, 50 Clip 14, 40, 44 Connection ring 16 Sheath 18 Dummy clip 20 Operation wire 22 Claw part 24 Turn part 26 Intersection part 28 Arm part 30 Convex part 32 1st area 34 2nd area 36 Contraction Diameter portion 38 Skirt portion 42 Minute uneven surface 43 Hole 43a Groove portion 46 Fastening ring 48 Main body 52 Convex portion

Claims (11)

A plurality of clips loaded on the sheath tip with the front and rear clips engaged;
A connection ring that is fitted in the sheath so as to be able to advance and retreat, covers an engagement portion of the front and rear clips, and maintains a connection state of the front and rear clips;
A repetitive clip treatment instrument comprising: an operation wire connected to a rearmost clip of the plurality of clips and pulling a clip row formed of the plurality of clips.   The clip has two claw portions opposed to each other at one end, and the coupling ring is pressed against the distal end side of the clip when the clip is fixed, and tightened in a state where the two claw portions of the clip are closed. The continuous clip treatment tool according to claim 1, which functions as a tightening ring.   The repetitive clip treatment tool according to claim 2, wherein the inner wall of the distal end portion of the connection ring has a minute uneven surface.   The said connection ring has a skirt part which presses and hold | maintains at least one of the said front-and-back clips connected in the said connection ring, pressing inside the sheath inner wall and closing inside. The repetitive clip treatment device according to any one of the above.   The skirt portion of the coupling ring is formed at the same position in the pulling direction of the clip, and is formed at two or more locations in the circumferential direction. After passing through the distal end of the sheath, it opens wider than the inner diameter of the sheath and enters the sheath. The continuous clip treatment device according to claim 4, wherein retreat is prevented.   The clip has two claw portions opposed at one end, two arm portions that support the two claw portions and intersecting each other, a turn portion that connects the two arm portions at the other end, and this turn The repetitive clip treatment device according to claim 4 or 5, further comprising one or more convex portions formed around the portion and meshing with a skirt portion of the connection ring.   The continuous clip treatment device according to any one of claims 1 to 6, wherein the plurality of clips are connected such that the front and rear clips are alternately turned 90 degrees.   The leading clip is pulled with respect to the connecting ring by the operation wire, and the connection with the succeeding clip is released by the engagement portion with the succeeding clip coming out of the connecting ring. The continuous-type clip treatment tool according to any one of -7.   After the leading clip is released and subjected to clipping, the sheath is moved to the proximal end side, or the operation wire is pushed to push the next clip, so that the sheath moves the next clip to the sheath. The repetitive clip treatment tool according to any one of claims 1 to 8, wherein the next clip is usable by being relatively lowered to a position where the clip is protruded from the position.   The continuous clip treatment tool according to claim 1, wherein the connection ring is made of a resin material.   The said connection ring consists of the resin-made holding | maintenance part which maintains the connection state of the said front and back clips, and the said metal | tightening part provided in the front end side of the said holding | maintenance part. The continuous clip treatment device according to 1.

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