JP2009273677A - Clip - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a clip capable of clipping biological tissues again and securely ligating in a clamping process from a temporal clamping to a full clamping. <P>SOLUTION: The clip is an arched spring elastic body, which comprises a clip indwelling part 1 including a tip nail part 11 to ligate the biological tissues and an engagement base part 14 to be connected with the tip of a clip base end part 2 that is made of a pair of members to be left in a body after ligation of body tissues, and an engagement tip part to be connected with the engagement base part 14. Releasing a connection with the clip indwelling part 1 after the ligation of the body tissues allows the clip base end part 2 made of a pair of members to be retrieved out of the body, and a clamping ring 3 that is covered with the clip base end part 2 and slides outer surfaces of the clip indwelling part 1 and the clip base end part 2 so that the clip indwelling part 1 could be openable/closable is to be left in the body after the ligation of the body tissues. An engagement strength adjusting means 80 to express a strength/weakness of the engagement by sliding the clamping ring 3 is provided on an engagement part of the engagement base part 14 and the engagement tip part. <P>COPYRIGHT: (C)2010,JPO&INPIT

Description

  The present invention relates to a clip used as an endoscopic treatment tool for performing ligation of a bleeding site of a living tissue, stitching of a laceration, marking at the time of mucosal tissue resection, and the like via an endoscope.

  Various clip devices for living tissue have been proposed. Japanese Patent Application Laid-Open No. 2002-191609 discloses a clip, a fastening ring that fits and attaches to the clip, closes the clip, can be inserted into the fastening ring, and is engaged with the clip. The clip is provided on at least one of the coupling ring, the introduction pipe capable of accommodating the clip and the fastening ring, the operation member inserted into the introduction pipe so as to be able to advance and retreat, and the fastening ring or the introduction pipe. And an engaging means for engaging the introduction pipe and the fastening ring when the fastening ring protrudes forward of the introduction pipe, and prohibiting the fastening ring from being stored again in the introduction pipe; There is disclosed a biological tissue clip device comprising: (Claim 1). According to this biological tissue clip device, it is possible to store the clip in the introduction tube and insert the clip into the living body cavity only by advancing and retracting the operation member, and further, the clip stored only by the advance and retreat operation of the operation member The clip device for living tissue can be provided, which can be engaged at the same time as it is released and the clip can be ligated and is easy to handle.

WO2004 / 082488 A1 includes a self-expanding clip main body having a clamping portion at the tip and both arms extending from the base end, and a fastening ring. The self-expanding clip main body is a clip. The base end has a first recess, and a second recess between the first recess and the tip of the clip, and the fastening ring is mounted on the first recess and the mounting position of the first recess A clip is disclosed that is used as an endoscopic treatment tool that is slid by an external force and is attached to the second recess to close the clamping portion at the tip of the clip body.
JP 2002-191609 A (Claim 1) WO2004 / 082488 A1 (Claim 1)

  Conventionally, when ligating a living tissue with a clip, the ligation failure may be noticed in the treatment process, for example, when ligation of the living tissue has failed or the ligation position is correct but the ligation is insufficient. However, since the conventional clip device does not have a function of re-gripping the living tissue, such a problem of poor ligation cannot be solved in the treatment process. Accordingly, there has been a demand for the development of a clip capable of re-gripping the living tissue, so-called temporary fastening, and capable of reliable ligation in the fastening from the temporary fastening to the final fastening.

  Accordingly, an object of the present invention is to provide a clip that can be temporarily tightened so that a living tissue can be re-gripped and can be reliably ligated in a tightening process from temporary tightening to final tightening.

  In such a situation, the present inventor has intensively studied, and as a result, the clip body has a structure in which two one-handed members are combined, and the one-handed member is composed of two members including a distal end portion (in-body indwelling component) and a proximal end portion (extracorporeal recovery component) In the four members, two opposing one-handed members are substantially Y-shaped, and a clamping ring is provided, so that the biological tissue can be re-gripped, and further, the engaging base and the clip base end of the clip indwelling part If the engagement strength adjusting means for expressing the strength of the engagement by the sliding movement of the tightening ring is provided at the engagement portion of the engagement tip, reliable ligation can be achieved in the tightening process from the temporary tightening to the final tightening. The present inventors have found out what can be done and completed the present invention.

That is, the present invention includes a claw portion at a distal end for ligating a living tissue, a plate-shaped main body portion having a predetermined maximum width portion (W ₁ ), and an engagement base portion connected to the distal end of a clip proximal end portion. After the body tissue is ligated, the clip retaining portion of a pair of members retained in the body, the engagement tip portion connected to the engagement base portion of the clip retaining portion, and the tip protrusion of the operation wire are fitted A bow-shaped spring elastic body having a base portion, and a clip base end portion of a pair of members recovered outside the body by releasing the connection state with the clip indwelling portion after ligation of the body tissue, and the clip base end And a clip that includes a clamping ring that is slidably moved on the outer surface of the clip retaining portion and the base end portion of the clip so that the clip retaining portion can be opened and closed, and that is retained in the body after ligation of the body tissue. Engagement of the clip retaining portion An engagement strength adjusting means for expressing the strength of the engagement by sliding movement of the tightening ring is provided at the engagement portion of the engagement tip portion of the clip portion and the clip base end portion. is there.

  According to the clip of the present invention, even if an attempt to ligate the living tissue fails, the living tissue can be re-gripped only by the forward and backward operation of the operation wire. Further, in the tightening process from the temporary tightening to the final tightening, the engagement base portion and the engagement distal end portion are not detached, and a reliable ligation is possible.

(Clip description)
Next, a clip according to an embodiment of the present invention will be described with reference to FIGS. FIG. 1 is a front view of the clip, FIG. 2 is a perspective view of a part of the clip disassembled, FIG. 3A is a plan view of a clip placement portion constituting the clip, and FIG. 3B is a clip placement of FIG. (C) is an end view taken along line Z ₁ -Z _{1 in} (B), FIG. 4 is a front view of the clip retaining portion of FIG. 3, and FIG. 5 is a plan view of the clip base end portion. 6 is a front view of the clip base end of FIG. 5, FIG. 7 is a view when the base of the clip base end of FIG. 6 is fixed and an external force is applied to the tip in the direction of arrow X, and FIG. FIG. 9 is a perspective view of the ring, FIG. 9 is a perspective view seen from an angle at which the inside of the engaging portion between the clip retaining portion and the clip proximal end portion can be seen, and FIG. 10 is an enlarged view of the engaging portion between the clip retaining portion and the clip proximal end portion. FIG. 29 is a view taken along the line Z ₂ -Z ₂ of FIG.

  The clip 10 includes a clip body 1 a including four members, ie, a clip detaining portion 1, 1 and a pair of clip base end portions 2, 2, and a fastening ring 3. The four members are independent members. Therefore, the description of the clip indwelling portion 1 and the clip base end portion 2 will be described for one member.

The clip indwelling portion 1 is connected to a distal end claw portion 11 for ligating a living tissue, a plate-like main body portion 13 having a predetermined maximum width portion (W ₁ ) 12, and a distal end of the clip proximal end portion 2. A combined base portion 14 is provided and is placed in the body after ligation of the body tissue. The claw portion 11 at the tip has a shape in which the tip overlaps and closes when the pair of clip retaining portions 1 and 1 are closed by the tightening ring 3. Thereby, the ligation force of the living tissue is improved. As the clip indwelling portion 1, for example, a stainless steel material of SUS304 can be used. Reference numeral 19 denotes a reinforcing rib member.

The predetermined maximum width portion (W ₁ ) 12 is larger than the inner diameter W ₂ of the cylindrical tightening ring 3. By providing the maximum width portion 12 in the plate-like main body portion 13, the fastening ring 3 stops at the maximum width portion 12 and is prevented from falling off to the front end side.

In the clip 10, the engagement strength adjustment that causes the engagement base 14 of the clip detainer 1 and the engagement tip 21 of the clip base end 2 to express the strength of the engagement by sliding movement of the tightening ring 3. Means 80 are provided. Specifically, the engagement strength adjusting means includes the following (1), (2) and (4):
(1) A substantially flat case-like shape in which a hole is formed by a pair of bent pieces having a spring property in which both sides of a substantially plate shape are bent at a bending angle α;
(2) The pair of bent pieces includes a first piece portion on a distal end side having a small width dimension and a second piece portion on a proximal end side having a width dimension larger than that of the first piece portion. And a bent piece that forms a step between the second piece portion;
(4) A through hole is formed in each of the pair of first pieces;
And an engagement base portion of the clip detainment portion that satisfies the following (3) and (5):
(3) A flat plate portion engaged by contact friction with the flat case-shaped hole portion;
(5) The flat plate portion has a protrusion that fits into the through hole when engaged with the engagement base;
The engagement of the clip base end with the engagement tip of the clip base end satisfying the above condition. Is disengaged, and the engagement is not disengaged by tightening with the tightening ring. The engagement strength adjusting means 80 that satisfies the requirements will be described with reference to the drawings.

  The engaging base 14 of the clip detainer 1 is a flat case-shaped hole 141c in this example, and the flat plate portion (engaging tip) 21 of the clip base end fits into the flat case-shaped hole and is engaged by contact friction. ((3) above). As a result, when a pulling force greater than the contact friction acts on both the clip indwelling portion 1 and the clip base end portion 2, the mutual engagement is released.

The substantially flat case-like engagement base portion 14 forms a hole portion 141c with a pair of bent pieces 141 having a spring property in which both sides of a substantially plate-like object are bent at a bending angle α (see FIG. 3C). (1) above. The bending angle α may be appropriately determined within a range of 5 to 40 degrees. If the bending angle α is too large, the sliding area of the clip base end portion 2 with the engagement tip end portion 21 is reduced, and it is not preferable in that it is easy to come off in an unloaded state. If it is too small, the clip base end portion 2 When the width of the engaging tip 21 is reduced, the strength of the surface is lowered and the tissue is brought closer, it is not preferable in that it tends to bend. In this example, the bending angle α is 10 to 25 degrees. The bent piece 141 includes a first piece portion 141a on the distal end side having a small width dimension and a second piece portion 141b on the proximal end side having a width dimension larger than that of the first piece portion 141a, and the first piece portion 141a and It is a bending piece which forms the level | step difference 15 with the 2nd piece part 141b (above (2)). The maximum width dimension formed by the two first pieces 141 a in the temporarily tightened state (no load) of the clip device 20 of FIG. 20 is smaller than the inner diameter of the tightening ring 3. In addition, the maximum width dimension (W ₃ ) formed by the two second pieces 141b in the temporarily tightened state (no load) of the clip device 20 of FIG. 20 is larger than the inner diameter of the tightening ring 3 (FIG. 29). The maximum width dimension formed by the two second pieces 141b in the loaded state constituting the indwelling part Z in FIG. 23 is smaller than the inner diameter of the tightening ring 3 (FIG. 30). By forming the engagement base portion 14 in such a shape, the tightening ring 3 can pass through the engagement base portion 14 in the final tightening step, and the tightening ring 3 reaches the maximum width portion 12 of the clip placement portion 1. The engagement base 14 and the flat plate portion 21 are prevented from being disengaged by the time so that reliable ligation can be performed.

Further, the slits 18 are formed so as to be separated from the ends of the pair of bent pieces 141. The slits 18 are not interfered with each other even when the bending angle α is reduced when the load F acts (the final fastening process of the clip device 20) when the pair of clip detaining portions 1 abut each other inside. It has a width (FIG. 30). Moreover, the through-hole 17 is formed in the back side of the engagement base part 14, ie, a pair of 1st piece part 141a (above (4)). The through hole 17 engages with the inner protrusion 25 formed on the flat plate portion 21 of the clip base end portion 2, and is formed on the center line X of the clip placement portion 1. The through hole 17 may be at any position as long as it is on the center line X ₁ -X ₁ shown in FIG. 3B, but the tightening ring 3 is pushed to the tip side in the final fastening step when it is on the tip side. This is preferable in that it can be surely ligated. The through-hole 17 and the inner protrusion 25 formed on the flat plate portion 21 have a weak engagement force with respect to the X-axis direction in the temporarily tightened state of FIG. Accordingly, the size of the through hole 17 is appropriately determined depending on the height of the inner protrusion 25 and the like. Even if the through-hole 17 and the inner projection 25 formed on the flat plate portion 21 are in a state where there is no weak engagement force or interference in the X-axis direction, the side surface of the plate portion of the flat plate portion 21 and the inner wall of the engagement base portion 14 Therefore, there is no problem that the engagement is easily disengaged.

  The clip base end portion 2 is a bow-shaped spring elastic body 24 having a fitting base portion 23 to which a tip protrusion (torque tip) 31 at the tip end of the operation wire 35 is fitted as a base portion. A flat plate portion (engagement convex portion) 21 that engages with the case-shaped hole portion 141c ((3), a hemispherical protrusion 22 on the outer surface adjacent to the base end side of the flat plate portion 21, and a flat plate portion 21. A pair of members having a hemispherical inner protrusion 25 on the inner side of the protrusion 22 on the inner side (above (5)), and a fitting base 23 with the inner sides of the pair of clip base ends 2 facing each other. Since the clip base end 2 is a bow-shaped spring elastic body, an external force is applied so as to narrow the tip by fixing the substantially Y-shaped fitting base 23. When it is loaded, it has a substantially I shape (see Fig. 7). Returns to the original state. Further, the clip base portion 2, after the body tissue ligating is recovered from the body by releasing the coupling state between the clip indwelling unit 1.

  The protrusion 22 restricts the movement of the tightening ring 3 toward the distal end side, and ensures re-gripping of the tissue. The position of the tightening ring 3 in the state where the claw portion 11 at the distal end is closed is adjusted so that the plate width of the clip proximal end portion 1 and the width between the clip proximal end portions 1 and 1 are adjusted to be closer to the proximal end side than the flat plate portion 21. However, since the fastening ring 3 moves to the tip side due to a slight difference in operating force on the hand side, it may be fitted on the clip detaining part 1 and cannot be reopened. In addition, the width between the protrusions 22 and 22 is slightly larger than the inner diameter of the tightening ring 3, so that the hand side operation force necessary for the claw portion 11 at the tip to be in a closed state and the tightening force The operating force required for the attachment ring 3 to move over the protrusion 22 and move to the tip side is made different so that the user can determine the limit of re-gripping on the hand operation side. If the proximal side operating force is released before the clamping ring 3 gets over the protrusion 22, the clamping ring 3 is retracted to the proximal end side, and the tip of the clip is opened, so that the tissue can be grasped again. In the present invention, the protrusion 22 is an optional component. Even without the protrusion 22, the position of the tightening ring 3 in the clip unit Y can be confirmed from the endoscopic image, the position of the hand slider of the clip device, and the like.

  The inner protrusion 25 is formed on the X-axis of the clip base end portion 2 at a position where it engages with the through-hole 17, and is a member that assists in engagement between the clip placement portion 1 and the clip base end portion 2. It is. The size of the inner protrusion 25 is appropriately determined depending on the size of the through hole 17 and the like for the same reason as described in the size of the through hole 17. The operation of the through hole 17 and the inner protrusion 25 will be described in the final fastening process of the clip device described later. Note that the symbol h in FIG. 6 indicates the height of the inner protrusion 25.

In the clip indwelling portion 1, a fitting recess 16 is formed between the step 15 and the predetermined maximum width portion 12 (dimension l ₂ ) to fit the fastening ring 3 having a length l ₁ when ligating a living tissue. Yes. If l ₂ ≧ l ₁ , the proximal end of the tightening ring can surely move over the step 15 to the distal end side, and fit with the fitting recess 16. Thereby, the fastening ring 3 does not go over the step 15 and return to the proximal end side, and the clip indwelling portion 1 ligating the living tissue is not detached. The engagement base 14 of the clip detainer 1 is not limited to the flat case-shaped hole, but may be a plate-like body. In this case, the engagement tip of the clip base end 2 may be a flat case-shaped hole.

  In the clip detainer 1, the fitting base 23 has a frame portion 231 having a rectangular window frame shape in plan view, and a substantially plate-like shape extending upward and rearward from the center of one side of the frame portion 231 on the clip detainer 1 side. It consists of a locking piece 234, and a space 235 is formed by a pair of fitting bases 23 (FIG. 2). The side 232 on the base side of the frame portion 231 is bent upward at the center to form an opening. The upper fitting base 23 and the lower fitting base 23 constituting the base of the clip base end 2 are merely close to or in contact with each other. For example, the tip of the clip detainer 1 is narrowed. When an external force is applied to the upper end, the rear ends of the upper fitting base 23 and the lower fitting base 23 are separated from each other.

The tightening ring 3 has a cylindrical shape with a length l ₁ and an inner diameter W _2. The clip 10 is mounted on the clip base end 2 and slides on the outer surfaces of the clip placement part 1 and the clip base end 2 to clip the clip 10. The indwelling portion 1 is a member that can be opened and closed, and is placed in the body after ligation of the body tissue. That is, when ligating a living tissue, the clip indwelling portion 1 is moved forward to close the clip indwelling portion 1, and when the proximal end side is slightly worn from the protruding portion 22 of the clip proximal end portion 2, the clip indwelling portion 1 is opened. It is a member that moves to the base end side. The tightening ring 3 does not come to the proximal end side from the reduced diameter tube 4. The clip 10 has a clip function by being incorporated in the clip device main body. Further, the clip 10 of this example is effective as a component (intermediate) of the clip unit.

  The engagement strength adjusting means 80 includes an engagement distal end portion of the clip base end portion that satisfies the conditions (1), (2), and (4) and an engagement base portion of the clip placement portion that satisfies the conditions (3) and (5). May be engaged.

(Description of clip unit)
Next, a clip unit including the above clip will be described with reference to FIGS. FIG. 12 is a front view of the clip unit of this example, and FIG. 13 is a perspective view of a reduced diameter tube used in the clip unit. 12 and 13, the same components as those in FIG. 1 are denoted by the same reference numerals, description thereof is omitted, and different points are mainly described. The clip unit of FIG. 12 is different from the clip of FIG. 1 in that a reduced diameter tube 4 is mounted between the fastening ring 3 and the fitting base 23 at the clip base end.

  The reduced diameter tube 4 prevents the fastening ring 3 from falling off from the proximal end side, and fits the distal end ring 9 of the sheath 7 when the body tissue is ligated to close the clip indwelling portion 1 by the fastening ring 3. It is possible. As shown in FIG. 13, the reduced diameter tube 4 is formed by forming a distal end split groove 48 having a predetermined length in the axial direction that divides into two blade members 41 and 42 in the radial direction from the distal end through the axial center. Further, a first enlarged diameter portion 44 is provided on the outer peripheral surface of the front end portion, and a second enlarged diameter portion 45 is provided on the outer peripheral surface on the rear end side slightly separated from the first enlarged diameter portion 44. The reduced diameter tube 4 has a rear end split groove 47 at a position inverted by 90 degrees from the front end split groove 48. The right side in FIG. 13 is the tip side. In addition, an axial center says the axial center at the time of assuming that the reduced diameter tube 4 is an axis | shaft. Reference numeral 46 denotes a concave portion into which the distal end portion of the distal end ring 9 formed between the first enlarged diameter portion 44 and the second enlarged diameter portion 45 is fitted.

  The diameter-reduced tube 4 is made of, for example, a resin such as polyethersulfone, and when an external force acts so as to narrow the tip split groove 48, the tip portion including the two blade members 41 and 42 is bent and reduced in diameter. On the other hand, when this external force is removed, the diameter of the two blade members 41 and 42 is increased by the spring elasticity. In the reduced diameter tube 4, for example, the outer diameter of the main body is 2.0 mm, and the outer diameters of the first enlarged diameter portion 44 and the second enlarged diameter portion 45 are 2.20 to 2.50 mm.

  The members constituting the clip unit Y may be assembled as follows. First, the distal end of one clip proximal end portion 2 in the pair is inserted from the proximal end side of the reduced diameter tube 4 and attached. Next, the fastening ring 3 is attached from the tip of the clip base end 2. After the clip retaining portion 1 is mounted on the clip base end portion 2 when the tightening ring 3 is mounted, it is restricted by the maximum width of the clip retaining portion 1 and the tightening ring 3 cannot be mounted. Next, the clip indwelling portion 1 is attached to the distal end portion of the clip base end portion 2. Next, the distal end of the other clip base end portion 2 is inserted into the reduced diameter tube 4 and the fastening ring 3 from the proximal end side of the reduced diameter tube 4 and attached. Next, the other clip retaining portion 1 is attached to the distal end portion of the clip base end portion 2. The clip unit Y thus obtained is shown in FIG. The method of assembling the members constituting the clip unit Y is not limited to the above method. For example, after the clip base end portion 2 is inserted into the reduced diameter tube 4 and the tightening ring 3, the clip retaining portion 1 is attached. May be. When the mounting cartridge 50 is used, the clip unit Y is stored in the clip unit storage portion 54 of the mounting cartridge 50 in advance. The clip unit Y of this example is useful as a component of the clip device 20.

(Description of clip device)
Next, a clip device according to an embodiment of the present invention will be described with reference to FIGS. 14 and 15 are schematic diagrams for explaining how to use the clip device of this example, and FIG. 26 is a perspective view of the clip device main body. The clip device 20 includes a clip unit Y, a clip device body 10a, and a mounting cartridge 50. The clip device main body 10a includes an operation portion main body portion 37 having a finger ring 38 at the base end, and is fitted on the operation portion main body portion 37 and is slidable along the axial direction of the operation portion main body portion 37. A hand slider 36 formed of a cylindrical body having a portion, a bend preventing tube 39 for preventing the sheath 7 inserted into the living body cavity connected to the distal end of the operation portion main body 37, and a forward and backward movement in the sheath 7 And an operation wire 35 having a tip protrusion 31 that fits into the fitting base 23 of the clip base end 2 at the tip inserted into the clip base end 2. The proximal end portion of the sheath 7 is connected to the operation portion main body portion 37, and the proximal end portion of the operation wire 35 is connected to the proximal slider 36. Therefore, when the hand slider 36 is slid back and forth with respect to the operation portion main body portion 37, the operation wire 35 can be moved forward and backward with respect to the sheath 7.

  The mounting cartridge 50 has a sheath insertion passage having an inner diameter through which a mounting insertion port 59 into which the sheath 7 accommodating the operation wire 35 having the tip protrusion 31 is inserted is inserted, and a sheath communicating with the mounting insertion port 59. 52 and a clip unit storage portion 54 for storing the clip unit Y composed of the clip indwelling portion 1, the clip base end portion 2, the reduced diameter tube 4 and the tightening ring 3. The mouth side has a tapered portion 53 whose diameter is reduced toward the mounting insertion port side, and the connecting portion between the tapered portion 53 and the sheath insertion passage 52 has an inner diameter of the sheath insertion passage 52 that is smaller than the minimum inner diameter of the taper portion 53. Since it is large, a step 56 is formed. The tapered portion 53 has a function of reducing the diameter of the blade members 41 and 42 of the reduced diameter tube 4 when the reduced diameter tube 4 is pulled out to the mounting insertion port side. The tapered portion 53 of this example is formed with a tapered shape having a diameter that decreases toward the proximal end in the depth direction of the cartridge. The tapered portion 53 is not limited to the shape, and may be formed in a tapered shape having a diameter that decreases toward the proximal end in the width direction of the cartridge. Further, a passage having the same inner diameter as the minimum inner diameter of the tapered portion 53 and a uniform inner diameter may be formed on the insertion opening side of the tapered portion 53 so as to communicate with the tapered portion 53.

  The clip unit storage portion 54 includes a triangular first storage portion 54a in a plan view in which the clip 10 is stored, a reduced diameter tube 4 of the clip unit Y that is continuous with the clip storage portion 54a on the insertion port side, and a clip base end portion. 2 includes a second storage portion 54b in which 2 is stored. The minimum inner diameter of the tapered portion 53 is the same as or slightly smaller than the inner diameter of the tip ring 9, preferably the same as the inner diameter of the tip ring 9. That is, the sheath 7 does not pass from the tapered portion 53 to the tip side (the side opposite to the mounting insertion port), but the tip protrusion 31 passes. The clip unit storage portion 54 is not limited to the above shape as long as the clip unit Y can be stored.

  The sheath 7 is a tube member comprising a long flexible flat coil 71 and a tip ring 9 fixed to the tip of the flat coil 71. The flat coil 71 has a uniform inner diameter in the longitudinal direction, the tip ring 9 has the same inner diameter, and has a notch-like engagement groove 91 on the inner peripheral surface near the tip (see FIG. 24). The engagement groove 91 engages with the second enlarged diameter portion of the reduced diameter tube 6 so that the reduced diameter tube 4 can be fixed to the distal end of the sheath 7.

  In the clip device 20 of the present invention, when the clip unit Y is housed in the sheath 7, it can be easily performed by using the mounting cartridge 50, but the present invention is not limited to this. The clip unit Y can also be accommodated in the sheath 7 by reducing the diameter of 4 by hand.

(How to use clip device)
Next, a method of using the clip device 20 will be described with reference to FIGS. FIG. 14 is a diagram for explaining the I process for mounting the clip unit housed in the cartridge to the clip device main body, FIG. 15 is a diagram for explaining the II process performed after the I process, and FIG. FIG. 17 is a diagram for explaining the III step performed after the II step, FIG. 18 is a diagram for explaining the sheath after the III step, and FIG. 19 is a method for ligating biological tissue. 20 is a diagram for explaining the process following FIG. 19, FIG. 21 is a diagram for explaining the process following FIG. 20, FIG. 22 is a diagram for explaining the process following FIG. 21, and FIG. 24 is an enlarged cross-sectional view of the tip portion of FIG. 22, and FIG. 25 is an enlarged cross-sectional view of the tip portion of FIG. 24 as viewed from above.

(Method of attaching the clip unit Y to the clip device body)
The clip device main body includes a sheath 7 composed of a flat coil 71 and a tip ring 9, an operation wire 35 that can move forward and backward along the axial direction in the lumen of the sheath 7, and a tip protrusion attached to the tip of the operation wire 35. 31 and a hand slider 36 for operating the operation wire 35 forward and backward with respect to the sheath 7. The mounting method includes an I process in which the sheath 7 is advanced from the mounting insertion port 59 of the mounting cartridge 50, an II process in which the operation wire 35 is operated forward, and an III process in which the operation wire 35 is operated backward.

  In step I, the sheath 7 is inserted from the mounting insertion port 59 of the mounting cartridge 50 and advanced in the sheath insertion passage 52 until it hits the step 56. In this step I, the tip protrusion 31 is housed in the sheath 7 and is not visible from the outside.

  In step II, the operation wire 35 is advanced relative to the sheath 7 as shown in FIG. When the tip of the clip unit Y is open, the facing fitting base 23 that is the base of the clip base end 2 is in a closed state (FIG. 12). The tip protrusion 31 is pushed into the fitting base 23 from the base end side. The tip protrusion 31 has a shape composed of a cylindrical base portion 312 on the proximal end side and a semiconical portion 311 on the distal end side (FIG. 16). Since the main body portion of the clip base end portion 2 is a thin leaf spring, when the insertion external force of the tip protrusion 31 is received, the clip is bent outward and the tip protrusion 31 easily enters the space 235 of the fitting base 23. Since the expansion of the fitting base 23 is regulated by the inner diameter of the cartridge, when the external force of the tip protrusion 31 is removed, it returns to its original shape, and the engagement between the fitting base 23 and the tip protrusion 31 is maintained ( FIG. 15). Reference numeral 32 denotes a centering pipe having a function of holding the axial center position of the tip protrusion 31 and the like.

  In step III, when the operation wire 35 is pulled to the proximal end side, the clip proximal end portion 2 is restricted from opening by the inner diameters of the cartridge 50 and the sheath 7, so that the distal end protrusion 31 and the clip proximal end portion 2 are fitted. The base 23 is pulled into the sheath 7 while being engaged. On the other hand, a tapered portion 53 where the diameter-reduced tube 4 is reduced is present on the proximal end side of the clip unit storage portion 54. For this reason, the diameter-reduced tube 4 is reduced in diameter by the taper part 53, the outer diameter of the diameter-reduced tube 4 becomes smaller than the inner diameter of the sheath 7, and the diameter-reduced tube 4 can be accommodated in the sheath 7 (FIG. 17). ).

  The outer diameter of the tightening ring 3 is smaller than the inner diameter of the sheath 7, and the tightening ring 3 is accommodated in the sheath 7. The open arm portion of the clip 10 is closed by the taper portion 53 of the cartridge 50 and the inner diameter of the sheath 7 and can be stored in the sheath 7 (FIG. 18). Through the steps I to III, the clip unit Y is completely accommodated in the sheath 7, and is inserted into the endoscope forceps hole in this state and guided into the target digestive tract.

(Living tissue ligation method)
The sheath 7 guided into the digestive tract protrudes from the endoscope forceps hole and comes close to the target living tissue. In this state, the operation wire 35 is advanced. Thereby, the clip 10 protrudes from the sheath 7, and the clip 10 is opened by self-elasticity (FIG. 19). Next, the clamping ring 3 protrudes from the sheath 7. When the distal end portion of the reduced diameter tube 4 protrudes from the sheath 7, the diameter of the reduced diameter tube 4 is expanded by spring elasticity and engaged with the distal end ring 9. That is, the first enlarged diameter portion 44 of the reduced diameter tube 4 is engaged with the distal end surface of the distal end ring 9, and the second expanded diameter portion 45 is engaged with the engagement groove 91 of the distal end ring 9 (see FIGS. 24 and 25). In this state, the reduced diameter tube 4 cannot project and house with respect to the distal end of the sheath 7.

  When the operation wire 35 is drawn from this state, the clip 10 is drawn into the tightening ring 3 to close the arm and ligate the living tissue (FIG. 20). If an attempt to ligate the living tissue fails, the clip 10 can be opened by re-advancing the operation wire 35 and re-gripping (re-ligation) can be performed. Re-gripping can be performed as long as the tightening ring 3 is not positioned on the distal end side beyond the protrusion 22 of the clip base end portion 2 (temporary tightening step). That is, in the temporary fastening step, the fastening ring 3 is located on the proximal side from the protrusion 22, so that the engagement between the clip retaining portion 1 and the clip proximal portion 2 is lower than the engagement strength in the final fastening step described later. Can maintain strength.

Next, the final fastening process is started. The action of the three members of the engagement base 14 of the clip placement part 1, the flat plate part 21 of the clip base end part 2, and the fastening ring 3 in the final fastening process, that is, the action of maximizing the engagement strength of the engagement strength adjusting means is illustrated. This will be described with reference to FIGS. 21 to 23 and FIGS. 27 to 30. FIG. 27 is a partially broken view showing the state in which the protrusion 22 enters the tightening ring 3, and FIG. 28 is a partially broken view showing the state in which the tightening ring 3 is fitted in the fitting recess 16. 29 is a cross-sectional view taken along line Z ₄ -Z _{4 in} FIG. 28, and FIG. 30 is a cross-sectional view taken along line Z ₃ -Z ₃ in FIG.

In the final tightening process, when the operation wire 35 is further pulled from the state of the temporary tightening process, the protrusion 22 of the clip base end 2 is pulled into the tightening ring 3 (FIG. 27), and inside the pair of engagement bases 14. The load F (see FIG. 3C) acts, and the bending angle α of the bending piece 14 becomes small. Therefore, the small next than the inner diameter of the maximum width W ₃ dimensions clamping ring 3 of the pair of the engagement base 14, a pair of engagement base 14 in the clamping the ring 3 can pass through (FIG. 30). When the clip base end 2 is moved over the protrusion 22 by the clamping ring 3 and moved to the distal end side and the distal end of the clamping ring 3 enters the proximal end of the clip detainer 1, the outer periphery of the engagement base 14 and the inner wall of the clamping ring 3 sliding resistance _{R 1} is generated. In this state, since the smaller the bending angle α of bending pieces 14, frictional resistance _{R 2} becomes strong (Figure ₃₀₎ of the bent piece 14 and the inner projection 25 in _{the X 1} axis _direction, the relationship of R 1 _{<R 2} It becomes. For this reason, the clip retaining portion 1 does not fall off from the clip base end portion 2 while the tightening ring 3 moves to the maximum width portion 12, and the tightening ring 3 can be reliably fitted into the fitting recess 16. That is, in the final tightening step, the relationship of R ₁ <R ₂ can be maintained by the movement of the tightening ring 3 toward the tip side, and the engagement strength can be adjusted high. If the relationship of R ₂ <R ₁ is satisfied, the clip retaining part 1 will fall off the clip base end part 2 in the middle of the movement of the tightening ring 3 to the maximum width part 12, leading to insufficient ligation. become.

In the final tightening step, the tightening ring 3 stops at a position in contact with the maximum width portion (W ₁ ) 12 of the clip indwelling portion 1 (FIGS. 21 and 28). Since the width (W ₁ ) of the maximum width portion of the clip indwelling portion 1 is larger than the inner diameter of the tightening ring 3, the tightening ring 3 does not come off at the tip of the clip 10. In this state, since the tightening ring 3 is fitted in the fitting recess 16, the load F is unloaded, the bent piece 141 is free of obstacles, and the bending angle α is restored to its original state due to the spring property. It recovers (FIG. 29). In this state, the engagement base 14 and the inner protrusion 25 are engaged with each other with a weak engagement force in the X-axis direction. That is, since the tightening ring 3 is in the stop position at the distal end, that is, in the fitting recess 16, the engagement of the clip placement portion 1 and the clip base end portion 2 can be maintained at the same engagement strength in the temporary tightening process.

  When the operation wire 35 is further pulled from this state and the pulling force overcomes the engagement friction between the clip base end portion 2 and the clip retaining portion 1, the engagement is released (FIG. 22). Thereby, the clip indwelling part 1 is indwelled in the body with the living tissue ligated (FIG. 23). That is, the clip indwelling portion 1 and the tightening ring 3 are indwelled in the body, and the reduced diameter tube 4 and the clip proximal end portion 2 remain in the sheath 7. The indwelling part Z has a short overall length and does not damage other living tissues existing around the indwelling part. In addition, it may be difficult to obstruct the visual field / operating field of the rear procedure. Further, when the clip dropped due to necrosis of the ligated tissue or the like is discharged, an adverse effect such as being caught on another digestive tract may not easily occur.

  Since the reduced diameter tube 4 is engaged with the distal end ring 9, it does not fall out from the sheath 7 when being extracted from the endoscope forceps hole. Further, the clip base end portion 2 is subjected to a force of spreading outward in the radial direction due to spring elasticity. Since the inner diameter of the reduced diameter tube 4 is formed into a shape that can be inserted only when the clip base end 2 is bent inward in the radial direction, even if the operation wire 35 is pushed out, the clip base end 2 It is not inserted into the reduced diameter tube 4 and does not protrude from the tip of the clip device.

  In the sheath 7, a distal end protrusion 31 that is a distal end component of the operation wire 35 is fitted in the space 235 of the fitting base 23 of the clip proximal end 2. In addition, the clip base end portion 2 is restricted by the inner wall of the flat research sheath 71 and is in a folded state. A new clip cannot be mounted unless the reduced diameter tube 4 and the clip base end portion 2 collected in the sheath 7 are removed.

In the present invention, the engagement strength adjusting means is not limited to the engagement strength adjusting means 80, and the following (1) and (2):
(1) A substantially flat case-like shape in which a hole is formed by a pair of bent pieces having a spring property in which both sides of a substantially plate shape are bent at a bending angle α;
(2) The pair of bent pieces includes a first piece portion on a distal end side having a small width dimension and a second piece portion on a proximal end side having a width dimension larger than that of the first piece portion. And a bent piece that forms a step in the second piece part;
An engagement base portion of the clip detainment portion that satisfies the following (3):
(3) A flat plate portion engaged by contact friction with the flat case-shaped hole portion;
It is good also as a form (henceforth a "2nd engagement strength adjustment means") which is engagement with the engagement front-end | tip part of the clip base end part which satisfy | fills. In the second engagement strength adjusting means, the description of the same components as those of the engagement strength adjusting means 80 is omitted, and different points will be mainly described. That is, the second engagement strength adjusting means is different from the engagement strength adjusting means 80 in that the requirements (4) and (5) in the engagement strength adjusting means 80 are omitted and the tightening by the tightening ring. This is in that the limitation of engagement depending on the presence or absence is omitted.

  In the second engagement strength adjusting means (not shown), when there is no load with no tightening by the tightening ring 3, the engagement between the pair of bent pieces 141 bent at the bending angle α and the flat plate portion 21 is more than contact friction. The engagement base 14 and the engagement tip portion (flat plate portion) 21 are disengaged by the pulling force. On the other hand, since the pair of bent pieces 141 are bent in the closing direction by tightening with the tightening ring 3, the contact friction between the pair of bent pieces 141 and the flat plate portion 21 is compared with the case of no load without tightening by the tightening ring 3. Much larger. For this reason, when a load is applied by the tightening ring 3, the contact friction is larger than the pulling force, and the engagement between the engagement base portion 14 and the engagement tip portion 21 is not released. That is, the contact friction between the pair of bent pieces having spring properties and the flat plate portion can be adjusted by sliding the tightening ring.

  In the second engagement strength adjusting means, the inner protrusion 25 may be formed on the inner surface of the flat plate portion 21. Even in such a case, the same effect as when there is no inner protrusion on the inner surface of the flat plate portion 21 is obtained. Further, in the second engagement strength adjusting means, the engagement tip portion of the clip base end portion satisfying (1) and (2) and the engagement base portion of the clip retaining portion satisfying (3) are engaged. There may be.

Next, the third engagement strength adjusting means will be described with reference to FIGS. FIG. 31 is a bottom view of the clip detaining part constituting the clip of this example, FIG. 32 is a plan view of the clip detaining part of FIG. 31, FIG. 33 is a front view of the clip detaining part of FIG. FIG. 35 is an end view taken along line Z ₅ -Z ₅ in FIG. FIG. 36 is a partially broken view showing the state immediately before the tightening ring enters the engaging portion, and FIG. 37 is a partially broken view showing the state in which the tightening ring is fitted in the fitting recess. FIG. 38A is a cross-sectional view taken along line Z ₇ -Z _{7 in} FIG. 37, FIG. 38B is a view of the base end portion of the clip detained portion viewed from the side, and FIG. 39 is Z ₆ − in FIG. it is a sectional view taken along Z ₆ line. However, the clip base end portion is omitted in FIG. 31 to 39, the same components as those in FIGS. 3, 4 and 27 to 30 are denoted by the same reference numerals, description thereof will be omitted, and different points will be mainly described. That is, in FIG. 31 to FIG. 39, the difference from FIG. 3, FIG. 4 and FIG. 27 to FIG. 30 is that the structure of the engagement base portion of the clip detainment portion is different, and the outer protrusion of the clip base end portion is omitted It is in the point.

That is, the third engagement strength adjusting means 80a includes the following (1a), (2a) and (4a):
(1a) A hole 141c is formed by a pair of asymmetric bent pieces 141e and 141f having a spring property in which both sides of a substantially plate shape having different lengths from the base end side to the tip end side are bent at a bending angle α. A substantially flat case shape;
(2a) Among the pair of bent pieces 141e, 141f, a step 15a is formed by the bent piece 141e on the small side and the plate-like main body 13;
(4a) A notch 17a is formed in the large bent piece 141f of the pair of bent pieces 141e, 141f;
The engagement base portion 14a of the clip indwelling portion satisfying the following (3) and (5a) below:
(3) a flat plate portion engaged by contact friction with a substantially flat case-shaped hole;
(5a) the flat plate portion has a protrusion that fits into the notch when engaged with the engagement base;
The engagement base portion 14a and the engagement tip portion are engaged with the engagement tip portion (flat plate portion) 21 of the clip base end portion satisfying the condition, with no load without tightening by the tightening ring 3, and with a pulling force greater than the contact friction. The portion (flat plate portion) 21 is disengaged and is not disengaged by tightening with the tightening ring 3. When the clip is formed by a pair of members, the pair of bent pieces 141e and 141f are assembled so that one large-side bent piece 141f and the other small-side bent piece 141e face each other. (FIG. 38) and the pair of bent pieces 141e and 141f are assembled so that the bent pieces 141f on the large side and the bent pieces 141e on the small side face each other. The method is preferable in that the tightening with the tightening ring 3 can be reliably performed without causing a single contact during loading.

Bending piece 141e of the small side of those from the bottom side to the top side of predetermined length l ₃ of a substantially plate-shaped. Bending piece 141f of the large sides of are those than a predetermined length l ₃ from the bottom side to the top side of the large of substantially plate-shaped, and inside in the width direction at the tip end portion than the predetermined length l ₃ from the base end side In addition, a semicircular cutout 17a is formed. Further, a step 15 a is formed by the small-side bent piece 141 e and the main body 13. The maximum width dimension formed by the bending piece 141f on the large side and the main body 13 in the temporarily tightened state (no load) of the clip device 20 in FIG. The maximum width dimension (base end portion) formed by the two bent pieces 141e and 141f in the temporarily tightened state (no load) of the clip device 20 of FIG. 20 is smaller than the inner diameter of the ring 3 (FIG. 38A). Is larger than the inner diameter of the tightening ring 3 (FIG. 38B), and the maximum width dimension formed by the two bent pieces 141e and 141f in the loaded state constituting the indwelling part Z in FIG. 3 (Fig. 39). By forming the engagement base portion 14a in such a shape, the tightening ring 3 can pass through the engagement base portion 14a in the final tightening step, and the tightening ring 3 reaches the maximum width portion 12 of the clip placement portion 1. Thus, the engagement between the engagement base portion 14a and the flat plate portion 21 is prevented from being disengaged so that reliable ligation can be performed.

Further, slits 18 are formed so as to be separated from the ends of the pair of bent pieces 141e and 141f. The slit 18 is configured such that when the pair of clip detaining portions 1 abut on each other and the load F acts (the final tightening process of the clip device 20), the bending pieces 141e and 141f of each other are not affected even when the bending angle α is reduced. It has a width that does not interfere (FIG. 31). The notch 17a engages with the inner protrusion 25 formed on the flat plate portion 21 of the clip base end portion 2b, and is formed so that the center of the semicircular shape is on the center line X of the clip placement portion 1. Yes. Centers of semicircular notches 17a may be any position as long as the center line X ₁ -X ₁ shown in FIG. 31, but rather on the front end side, the clamping ring 3 in the clamping step is the tip side It is preferable in that it can be surely ligated without coming off until it is pushed in. The notch 17a and the inner protrusion 25 formed on the flat plate portion 21 have a weak engagement force with respect to the X-axis direction in the temporarily tightened state of FIG. Accordingly, the size of the notch 17a is appropriately determined depending on the height of the inner protrusion 25 and the like. Even if the notch 17a and the inner projection 25 formed on the flat plate portion 21 are in a weak engagement force or no interference with respect to the X-axis direction, the side surface of the plate portion of the flat plate portion 21 and the inner wall of the engagement base portion 14 Therefore, there is no problem that the engagement is easily disengaged.

The final tightening step in the clip having the third engagement strength adjusting means 80a will be described. In the final fastening step, when the operation wire 35 is further drawn from the state of the temporary fastening step, the maximum width portion 211 connected to the proximal end of the flat plate portion 21 of the clip proximal end portion 2b is drawn into the fastening ring 3 (FIG. 36). ), A load F (see FIG. 34) acts on the inner side of the pair of engagement bases 14a, and the bending angle α of the bending pieces 141e and 141f becomes small. Therefore, the small next than the inner diameter of the maximum width W ₃ dimensions clamping ring 3 of the pair of engagement base 14a, a pair of engagement base 14a in clamping the ring 3 can pass through (FIG. 39). When the tightening ring 3 moves over the maximum width portion 211 of the clip base end portion 2b and moves to the distal end side, and the distal end of the tightening ring 3 enters the proximal end of the clip retaining portion 1, the outer periphery of the engagement base portion 14a and the tightening ring 3 sliding resistance R ₁ is generated in the inner wall. In this state, the bent piece 141e, since the smaller the bending angle α of 141f, bending pieces 141e in _{the X 1} axis direction, the frictional resistance _{R 2} of 141f and the inner projection 25 becomes stronger (Fig. _{39), R} 1 < R ₂ relationship. For this reason, the clip retaining portion 1b does not fall off from the clip base end portion 2b during the movement of the tightening ring 3 to the maximum width portion 12, and the tightening ring 3 can be reliably fitted into the fitting recess 16. That is, in the final tightening step, the relationship of R ₁ <R ₂ can be maintained by the movement of the tightening ring 3 toward the tip side, and the engagement strength can be adjusted high.

In the final tightening step, the tightening ring 3 stops at a position in contact with the maximum width portion (W ₁ ) 12 of the clip retaining portion 1b (FIGS. 21 and 28). Since the width (W ₁ ) of the maximum width portion of the clip indwelling portion 1 b is larger than the inner diameter of the tightening ring 3, the tightening ring 3 does not come off at the tip of the clip 10. In this state, since the tightening ring 3 is fitted in the fitting recess 16, the load F is unloaded, and the bent pieces 141e and 141f are free of obstacles, and the bending angle α is the original due to the spring property. The state is restored (FIG. 38). In this state, the engagement base 14a and the inner protrusion 25 are engaged with each other with a weak engagement force in the X-axis direction. That is, since the tightening ring 3 is in the stop position at the distal end, that is, in the fitting recess 16, the engagement of the clip placement portion 1 and the clip base end portion 2 can be maintained at the same engagement strength in the temporary tightening process. Subsequent operations are the same as those of the engagement strength adjusting means 80, and a description thereof will be omitted.

  The third engagement strength adjusting means 80a includes an engagement distal end portion of the clip base end portion that satisfies the conditions (1a), (2a), and (4a) and a clip placement portion that satisfies the conditions (3) and (5a). Engagement with an engagement base may be sufficient.

The third engagement strength adjusting means 80a is not limited to the above engagement strength adjusting means, and the following (1a) and (2a):
(1a) A substantially flat case in which a hole is formed by a pair of asymmetric bent pieces having a spring property in which both sides of a substantially plate shape having different lengths from the proximal end side to the distal end side are bent at a bending angle α. Is;
(2a) A step is formed by the small-side bent piece and the plate-shaped main body portion in the pair of bent pieces;
An engagement base portion of the clip detainment portion that satisfies the following (3):
(3) A flat plate portion engaged by contact friction with the substantially flat case-shaped hole portion;
It is good also as a form (henceforth a "4th engagement strength adjustment means") which is engagement with the engagement front-end | tip part of the clip base end part which satisfy | fills. In the fourth engagement strength adjusting means, the description of the same components as the engagement strength adjusting means 80a will be omitted, and different points will be mainly described. That is, the fourth engagement strength adjusting means is different from the engagement strength adjusting means 80a in that the requirements (4a) and (5a) in the engagement strength adjusting means 80a are omitted and tightening by a tightening ring. This is in that the limitation of engagement depending on the presence or absence is omitted.

  In the fourth engagement strength adjusting means (not shown), when there is no load with no tightening by the tightening ring 3, it is the engagement between the pair of bent pieces 141 bent at the bending angle α and the flat plate portion 21, and more than contact friction. The engagement base 14 and the engagement tip portion (flat plate portion) 21 are disengaged by the pulling force. On the other hand, since the pair of bent pieces 141 are bent in the closing direction by tightening with the tightening ring 3, the contact friction between the pair of bent pieces 141 and the flat plate portion 21 is compared with the case of no load without tightening by the tightening ring 3. Much larger. For this reason, when a load is applied by the tightening ring 3, the contact friction is larger than the pulling force, and the engagement between the engagement base portion 14 and the engagement tip portion 21 is not released. That is, the contact friction between the pair of bent pieces having spring properties and the flat plate portion can be adjusted by sliding the tightening ring.

  In the fourth engagement strength adjusting means, the inner protrusion 25 may be formed on the inner surface of the flat plate portion 21. Even in such a case, the same effect as when there is no inner protrusion on the inner surface of the flat plate portion 21 is obtained. Further, in the fourth engagement strength adjusting means, the engagement tip portion of the clip base end portion satisfying (1a) and (2a) and the engagement base portion of the clip retaining portion satisfying (3) are engaged. There may be.

  According to the clip of the present invention, in the tightening process from the temporary tightening to the final tightening, the engagement base portion and the engagement distal end portion are not detached, and reliable ligation can be performed. The present invention can be suitably used as an endoscopic treatment tool for performing ligation of sites, laceration of a wound, marking at the time of mucosal tissue resection, and the like.

It is a front view of the clip of this example. It is a perspective view of some components which decomposed | disassembled a clip. (A) is a plan view of a clip detained portion constituting the clip, (B) is a bottom view of the clip detained portion of (A), and (C) is an end surface viewed along the Z ₁ -Z ₁ line of (B). FIG. It is a front view of the clip detainment part of FIG. It is a top view of a clip base end part. It is a front view of the clip base end part of FIG. It is a figure at the time of fixing the base part of the clip base end part of FIG. 6, and applying an external force to the front-end | tip in the direction of the arrow X. FIG. It is a perspective view of a clamping ring. It is the perspective view seen from the angle which can see the inner side of the engaging part of the clip detainment part 1 and the clip base end part 2. FIG. 4 is an enlarged view of an engagement portion between a clip placement part 1 and a clip base end part 2. Is a view taken along the _Z 2 -Z ₂ line in FIG. 10. It is a front view of the clip unit of this example. It is a perspective view of the reduced diameter tube used with a clip unit. It is a figure explaining I process of mounting | wearing the clip apparatus with the clip unit accommodated in the cartridge. It is a figure explaining the II process implemented following the I process of FIG. It is a schematic diagram explaining engagement with a front-end | tip protrusion and a clip base end part. It is a figure explaining III process implemented following II process. It is a figure explaining the sheath after III process. It is a figure explaining the ligation method of a biological tissue. It is a figure explaining the process following FIG. It is a figure explaining the process following FIG. It is a figure explaining the process following FIG. It is a front view of an indwelling component. It is an expanded sectional view of the sheath front-end | tip part of FIG. FIG. 25 is an enlarged cross-sectional view of a distal end portion when FIG. 24 is viewed from above. It is a perspective view of a clip device main part. It is the figure which fractured | ruptured and showed the state which protrusion had entered in the clamping ring. It is the figure which fractured | ruptured and showed the state which the fastening ring fitted to the fitting recessed part. It is a sectional view taken along the _Z 4 -Z ₄ line in FIG 28. It is a sectional view taken along the _Z 3 -Z ₃ line in FIG 27. It is a bottom view of the clip detainment part which comprises the clip of another example. FIG. 32 is a plan view of the clip indwelling portion of FIG. 31. FIG. 32 is a front view of the clip indwelling portion of FIG. 31. FIG. 32 is a right side view of FIG. 31. FIG. 32 is an end view seen along the Z ₅ -Z ₅ line of FIG. 31. It is the figure which fractured | ruptured and showed the state immediately before a fastening ring enters an engaging part. It is the figure which fractured | ruptured and showed the state which the fastening ring fitted to the fitting recessed part. (A) is a cross-sectional view taken along the Z ₇ -Z ₇ line in FIG. 37, (B) is a view of the proximal end portion of the clip indwelling unit from the side. Is a sectional view taken along the _Z 6 -Z ₆ line in FIG. 36.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Clip indwelling part 2 Clip base end part 3 Fastening ring 4 Reduced diameter tube 7 Sheath 9 End ring 10 Clip 20 Clip apparatus 30 Detaching cartridge 31 End protrusion
35 Operating wire 36 Hand slider 41, 42 Blade member 50 Cartridge for mounting 71 Plane coil 71 Connection part (taper part)
80 Engagement strength adjusting means

Claims (8)

After ligation of the body tissue, comprising a claw portion at the distal end for ligating the biological tissue, a plate-like main body portion having a predetermined maximum width portion (W ₁ ), and an engagement base connected to the distal end of the clip proximal end portion A clip detainment part of a pair of members detained in the body;
A bow-shaped spring elastic body comprising an engagement tip connected to an engagement base of the clip detainment part and a fitting base to which a tip protrusion of an operation wire is fitted, and the clip after ligation of the body tissue A clip base end portion of a pair of members recovered outside the body by releasing the connection state with the indwelling portion;
A clip ring mounted on the base end of the clip and slidably moved on the outer surface of the base end of the clip to open and close the clip indwelling part; A clip comprising:
Engagement strength adjusting means for expressing the strength of the engagement by sliding movement of the tightening ring is provided in the engagement portion of the engagement base portion of the clip retaining portion and the engagement distal end portion of the clip base end portion. And clip. The engagement strength adjusting means includes the following (1) and (2):
(1) A substantially flat case-like shape in which a hole is formed by a pair of bent pieces having a spring property in which both sides of a substantially plate shape are bent at a bending angle α;
(2) The pair of bent pieces includes a first piece portion on a distal end side having a small width dimension and a second piece portion on a proximal end side having a width dimension larger than that of the first piece portion. And a bent piece that forms a step between the second piece portion;
An engagement base portion of the clip detainment portion that satisfies the following (3):
(3) A flat plate portion engaged by contact friction with the substantially flat case-shaped hole portion;
Is the engagement with the engagement tip of the clip base end that satisfies
Or an engagement tip portion of a clip base end portion satisfying (1) and (2) and an engagement base portion of a clip retaining portion satisfying (3). clip.   The clip according to claim 2, wherein a protrusion is formed on an inner surface of the flat plate portion which is an engagement tip portion of the clip base end portion. The engagement base of the clip indwelling portion is the following (4):
(4) A through hole is formed in each of the pair of first pieces;
The engaging tip of the clip base end is the following (5):
(5) The flat plate portion has a protrusion that fits into the through hole when engaged with the engagement base;
Or is the engagement between the engagement base and the engagement tip.
Or the engagement tip of the clip base end satisfying (1), (2) and (4) and the engagement base of the clip retaining portion satisfying (3) and (5), The engagement base part and the engagement tip part are disengaged with no load without tightening by the tightening ring and with a pulling force greater than the contact friction, and the engagement cannot be disengaged by tightening with the tightening ring. The clip according to claim 2, wherein the clip is provided. The engagement strength adjusting means includes the following (1a) and (2a):
(1a) A substantially flat case in which a hole is formed by a pair of asymmetric bent pieces having a spring property in which both sides of a substantially plate shape having different lengths from the proximal end side to the distal end side are bent at a bending angle α. Is;
(2a) A step is formed by the small-side bent piece and the plate-shaped main body portion in the pair of bent pieces;
An engagement base portion of the clip detainment portion that satisfies the following (3):
(3) A flat plate portion engaged by contact friction with the substantially flat case-shaped hole portion;
Is the engagement with the engagement tip of the clip base end that satisfies
Or the engagement base portion of the clip base end portion satisfying (1a) and (2a) and the engagement base portion of the clip detaining portion satisfying (3). clip.   6. The clip according to claim 5, wherein a protrusion is formed on an inner surface of the flat plate portion which is an engagement tip portion of the clip base end portion. The engagement base portion of the clip detainment portion is the following (4a):
(4a) Of the pair of bent pieces, a notch is formed in the bent piece on the larger side;
The engagement tip of the clip base end is (5a) below.
(5a) the flat plate portion has a protrusion that fits into the notch when engaged with the engagement base;
Or is the engagement between the engagement base and the engagement tip.
Or the engagement tip of the clip base end satisfying (1a), (2a) and (4a) and the engagement base of the clip retaining portion satisfying (3) and (5a), The engagement base part and the engagement tip part are disengaged with no load without tightening by the tightening ring and with a pulling force greater than the contact friction, and the engagement cannot be disengaged by tightening with the tightening ring. The clip according to claim 5, wherein the clip is provided.   8. A fitting recess into which a tightening ring is fitted when the living tissue is ligated is formed between the step of the maximum width portion and the bent piece. Clip.

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