JP2010000337A - Successive-firing clip treatment instrument - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a successive-firing clip treatment instrument securely retaining the connection state of clips loaded in the connected state, and allowing a user to perform the clipping treatment with sufficient tightening force of the clip at the head and the disconnection (release of connection) of the clip at the head simultaneously by a series of operation in one direction. <P>SOLUTION: The successive-firing clip treatment instrument has a connection ring for retaining the connection state of the clips. The connection ring has a connection retaining area for holding the next clip in such a state that two pawls of the next clip are closed with a tail of the previous clip held in-between, and the length of the clip in the direction of advancement/retreat in the connection holding area is equivalent to the amount of movement of a tightening part to a position where the pawls of the former clip exhibit the maximum engagement force as tightened by the tightening part at the distal end of the connection ring. <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 or 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 tip of the endoscope inserted into the living body, pick the treatment part after removal of the bleeding part or lesion tissue with the clip, and stop hemostasis or wound closure Used. 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 each time by engaging a tip claw portion of a rear clip with a connecting hole formed in a rear end portion of a 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. An engagement hole that engages the connection claw is formed, and when the rear clip is sunk, the connection claw at the rear end of the front clip is inserted into the engagement hole near the front end 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. If the clip is disconnected in the sheath, there may be a problem that the clip falls off from the sheath tip. 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. During the clipping operation, the sheath inner wall is pressed by the spring force of the clip. The clip is advanced and retracted in the sheath. Therefore, the operation 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, to reliably maintain the connected state of the clips to be connected and loaded, and to prevent the inner wall of the sheath from being damaged, making the clip treatment operation smooth and high. An object of the present invention is to provide a repetitive clip treatment device which can be accurately performed. Furthermore, an object of the present invention is to perform a continuous clip treatment in which a clip treatment with a sufficient tightening force by a leading clip and a separation (disconnection) of the leading clip can be simultaneously performed by a series of operations in one direction. It is in providing tools.

In order to solve the above-described problems, the present invention provides a plurality of clips loaded at the distal end portion of the sheath in a state of being engaged with the front and rear clips, and is fitted into the sheath so as to be able to advance and retreat, and covers the engaging portion of the clip. A connection ring that maintains the connection state of the clip, and an operation wire that is connected to the rearmost clip of the clip row composed of the plurality of clips and is movable relative to the sheath in the longitudinal direction,
The connecting ring has a tightening portion at its distal end portion that tightens the previous clip in a state in which the claw portion is closed when it moves to the distal end side of the previous clip, and at the rear end portion, the following In a state where the two claws of the clip are closed across the tail of the previous clip, the clip has a connection holding region for holding the next clip,
The length of the clip in the advancing / retreating direction of the connection holding region is equal to the amount of movement of the tightening portion to the position where the claw portion of the previous clip exhibits the maximum fitting force by tightening by the tightening portion. A repetitive clip treatment device is provided.

  Here, the clip has a length equal to the length of the connection holding region from the tip of the connection ring that holds the engagement portion with the next clip in an initial state immediately before the start of the clip treatment operation by the clip. It is preferable to have a convex part wider than the front end opening of the connection ring, which prevents intrusion into the connection ring at a position only away from the front end side.

  In addition, the convex portion of the next clip is in a position in contact with the proximal end of the connection ring in an initial state immediately before the start of the clip treatment operation by the previous clip, and prevents entry into the connection ring. preferable.

  In addition, the connecting ring is pressed against the inner wall of the sheath and closed inward in the sheath, and presses and holds at least one of the clips connected in the connecting ring, and after passing through the distal end of the sheath, the sheath It is preferable to have skirt portions that are wider than the inner diameter and prevent retreat into the sheath at the same position in the relative movement direction of the sheath and the operation wire and at two or more locations in the circumferential direction.

The leading clip is pulled by the operation wire with respect to the connection ring, 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.
Furthermore, it is preferable that after the leading clip is released and subjected to clipping, the sheath is pulled down to a position to project the next clip, so that the next clip can be used, Alternatively, after the leading clip is released and subjected to clipping, it is preferable that the operation clip is pushed out to a position where the next clip protrudes, so that the next clip can be used. .

  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. Furthermore, according to the present invention, the clip treatment with a sufficient tightening force by the leading clip and the separation (disconnection) of the leading clip can be simultaneously performed by a series of operations in one direction.

  Also, at the clip connection part, the connection ring contacts the sheath and the clip does not contact, so there is no fear of clip protrusions or corners damaging the inner wall of the sheath, and the clip can be moved smoothly during the clipping operation. it can. Furthermore, according to one aspect of the present invention, since the connecting portion of the clip is held in a fixed state by the connecting ring, the clip can be moved back and forth during the clipping operation with high accuracy.

  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 clip treatment tool 10 shown in FIG. 1 is a repetitive clip treatment tool that can continuously use clips, and is connected to a plurality of clips 12 (12A, 12B, 12C, 12D) and the last clip 12D. A dummy clip 18, an operation wire 20 connected to the dummy clip, and a coupling ring 14 (14 A, 14 B, 14 C, 14 D) that covers the engaging portion of the adjacent clip 12 and maintains the coupling state of the clip 12 are provided. These are inserted into the sheath 16.
In the following description, when performing a treatment with a clip treatment instrument using an endoscope, the leading side when inserted into the living body (endoscope) is the front or the front, and the opposite side (the rear side). ) Is also called the back or the base. That is, in the illustrated clip treatment instrument 10, the clip 12A is the front end side, and the clip 12D is the rear end side.

  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 inside the distal end 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 unit side by a predetermined length so that the next clip 12 can be used (standby state), and clipping can be performed continuously. .

  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.

  The clip 12 is a closed clip having a turn part 24 that is turned 180 degrees with respect to the claw part 22. In other words, the clip 12 is a claw that bends so that one end of a long thin plate is bent 180 degrees to make a closed end, the two pieces intersect, and the two open ends face each other. It has a shape in which the portions 22 and 22 are formed. With this intersection 26 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.

  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 pinch a target part reliably. Further, as shown in FIG. 1A, the arm portion 28 of the clip 12 is gradually widened from the intersecting portion 26 to the convex portion 30. The clip 12 can be made of a biocompatible metal, for example, SUS631 which is stainless steel for springs.

  The first clip 12A and the second clip 12B are connected to each other by being held by the connection ring 14A in a state where the claw portion 22 of the second clip 12B is engaged with the turn portion 24 of the first clip 12A and closed. Is done. 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 connection ring 14 is fitted in the sheath 16 so as to be able to advance and retract while covering the engaging portions of the two clips 12 and 12 and maintaining the connection 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. 2A to 2C show a schematic configuration of the connection ring 14. 2A is a front view of the connecting ring 14, FIG. 2B is a sectional view, and FIG. 2C is a bottom view.

  The connection ring 14 includes a tightening portion 40 and a holding portion 42. The connection ring 14 has a metal fastening part 40 fixed to the tip of a resin holding part 42 and has an integral structure with two members. The resin holding part 42 is in charge of maintaining the connected state and holding the clip in the connecting ring, and the metal fastening part 40 is in charge of fastening the clip. The connection ring 14 may be formed of one member as long as both functions of the tightening portion 40 and the holding portion 42 can be exhibited. When the connection ring 14 is made of a single resin member, minute unevenness is formed on the inner wall (inner peripheral surface) of the tip portion (the portion corresponding to the tightening portion 40), and the tightening force of the clip is formed by the minute unevenness. You may make it exhibit (frictional force).

  The tightening portion 40 is a metal cylindrical (ring-shaped) part attached to the distal end side of the connection ring 14, and is larger than the width of the clip 12 near the intersection 26 and larger than the width of the convex portion 30. A small inner diameter hole is formed. Therefore, the tightening portion 40 can move in the vicinity of the intersecting portion 26 of the clip 12 to be held, but cannot be pulled out beyond the convex portion 30.

  The fastening portion 40 closes both the arm portions 28 and 28 of the clip 12 that is widened by moving the arm portion 28 of the clip 12 from the intersecting portion 26 to the convex portion 30 side. It has a tightening function to fix. For the tightening portion 40, a biocompatible metal is used. For example, stainless steel SUS304 can be used. Since the tightening portion 40 is made of metal, it is possible to exert a frictional force as a tightening force on the metal clip 12.

  The holding portion 42 is a resin-molded, generally cylindrical (ring-shaped) part. The holding unit 42 includes a first area 32 that holds the previous clip 12 and a second area 34 that is a connected holding area that holds the next clip 12 in a state of being connected to the previous clip.

  In the first region 32, a circular hole larger than the hole of the fastening portion 40 that can accommodate the turn portion 24 of the previous clip 12 is formed. A stepped portion for engaging the tightening portion 40 is formed on the outer surface of the distal end portion of the first region 32, and the tightening portion 40 and the holding portion 42 are loaded in the sheath 16 and It is fitted with an interference fit that does not come off during the clipping operation. The first region 32 has a skirt portion 38 that is inclined and spreads in a skirt shape with respect to the axis of the main body.

  The skirt portion 38 is connected to the main body of the holding portion 42 at the tip side, that is, the upper base in FIG. 2, and the lower spreading portion is partly separated from the main body so as to expand or close in the radial direction. It has become. 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 main body of the connecting ring 14 is lowered. Therefore, it is necessary to design the number and shape in consideration of the strength. Moreover, it is preferable to arrange | position the skirt part 38 equally in the circumferential direction.

  The skirt portions 38, 38 spread in a skirt shape as shown in FIG. 2A when there is no external force. At this time, the inside of the first region 32 of the holding portion 42 is a columnar space as shown in FIG. On the other hand, when the connecting ring 14 is loaded into the sheath 16, for example, as shown in the second connecting ring 14B in FIG. 1 (B), the skirt portion 38 is pushed inward and enters the internal space. The portion on the inner peripheral side of the portion 38 presses the side surface (edge portion) of the turn portion 24 of the clip 12B held in the first region 32, and the clip 12B moves in the rotation direction and the forward / backward direction in the connecting ring 14B. Do not hold. The skirt portion 38 may press and hold a clip held in the second region 34, that is, a rear clip.

  As shown in the first connecting ring 14A of FIG. 1A, the skirt portions 38, 38 open simultaneously with the withdrawal 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, when the operation wire 20 is pulled and the clip 12 is retracted, the connection ring 14 advances 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 expands 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, the holding portion 42 is made of a material that is biocompatible and satisfies the elasticity and rigidity required for the skirt portion 38. The shape is determined so as to satisfy the elasticity and rigidity required for the skirt portion 38. For example, PPSU (polyphenylsulfone) can be used as the material of the holding unit 42. From the standpoint of ease of manufacture, the holding portion 42 is preferably integrally formed.

  The second region 34 is provided on the proximal end side of the first region 32, and the next clip 12 that engages with the turn portion 24 of the clip 12 held in the first region 32 is connected to the claw portions 22, 22. Is held in a closed state with the closed end (tail portion) of the turn portion 24 of the previous clip 12 in between. As shown in FIG. 2C, a hole 43 having the same inner diameter as that of the first region 32 is formed in the second region 34, and grooves (concave portions) 43a are formed at two opposing positions. . The grooves 43a and 43a can accommodate the arm portions 28 and 28 of the clip 12 held in the second region 34 with the claw portions 22 and 22 closed. Moreover, as shown to FIG. 2 (A)-(C), the slit 46 cut | disconnected from the base end is formed in the 2nd area | region 34 at two places.

  The grooves 43a and 43a are provided at two locations in the opening / closing direction (left and right direction in FIG. 2) of the claw portion 22 of the clip 12 held in the second region 34. The plate surfaces of the arm portions 28 and 28 of the clip 12 held in the second region 34 abut against the inner walls of the grooves 43a and 43a. The width (opening width) of the groove 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 43a to the wall surface of the other groove 43a is the two claw portions 22 of the clip 12. , 22 (length in the expanding direction) is approximately equal to the total length. Further, the width of the groove 43 a is smaller than the width of the convex portion 30 formed in the arm portion 28. Therefore, the convex portion 30 of the clip 12 held in the second region 34 cannot enter the groove 43a.

In addition, the distance from the wall surface to the wall surface of both grooves 43a and 43a should just be a dimension in which the engagement between the turn part 24 of the previous clip 12 and the claw parts 22 and 22 of the next clip 12 is not released. 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 claw portions 22 and 22 of the clip 12 held in the second region 34 may be in a slightly overlapped state, or with a slight gap between the claw portions 22 and 22, The connection with the clip 12 may be maintained.

  The engaging portions of the two clips 12 and 12 are held in a portion of the second region 34 that is close to the boundary with the first region 32. Since the previous clip 12 (for example, the clip 12B in the connecting ring 14B in FIG. 1B) is held by the closed skirt portion 38 of the first region 32 in the sheath 16, Forward / backward movement and rotational movement are suppressed. Further, the next (immediately following) clip 12 that engages with the previous clip 12 (for example, the clip 12C in the connecting ring 14B in FIG. 1B) is 90% away from the previous clip by the grooves 43a and 43a of the second region 34. By being held in different directions, the rotational movement is suppressed, and the forward / backward movement is suppressed by engaging with the previous clip in which the forward / backward movement is suppressed. That is, the engaging portions of the front and rear clips are held by the connection ring 14 with a very small play.

  The slits 46 are formed at two positions shifted by 90 degrees from the skirt portions 38 and 38 to a position shallower than the upper end of the second region 34. In other words, the slit 46 is provided at a position shifted by 90 degrees from the spreading direction of the clip 12 held in the second region 34.

  By providing the slit 46, the flexibility of the connecting ring 14 can be improved, and the clip treatment tool 10 can pass through a curved portion having a small curvature. Further, since the skirt (base end portion) of the connection ring 14 is partially turned up by providing the slit, the connection is made when the front and rear clips 12, 12 are connected before the clip 12 is loaded into the sheath 16. There is also an advantage that it can be easily connected by turning the skirt of the ring 14.

  The depth of the slit 46 is set to a position shallower than the skirt portion 38, and the strength of the connecting ring 14 is prevented from greatly decreasing. The depth of the slit 46 is set to the position of the rear end of the clip 12 held in the first region 32, that is, a position shallower than the engaging position of the clips 12, 12, and is loaded into the sheath 16. Even in the previous connecting clip unit, the holding of the clip 12 in the second region 34 of the connecting ring 14 can be maintained.

  As shown in FIG. 1, the claw portions 22 and 22 of the second clip 12B engage with the turn portion 24 of the first clip 12A, and the connecting 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 is a spring-like member having a shape similar to that of the half of the open end side from the crossing portion 26 of the clip 12, and engages with the turn portion of the clip 12D with the claw portion closed. When the part is opened, the clip 12D is opened. 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.

With reference to FIGS. 3-5, the structure of the connection ring 14 and the movement of each part of the clip 12 and the connection ring 14 at the time of a clip treatment operation | movement are demonstrated in detail.
3A and 3B are partial cross-sectional views showing the stepped state of the clips 12A and 12B and the connecting ring 14A during the clip treatment operation of the leading clip 12A. In FIG. 3, the illustration of the connecting ring 14B that holds the clip 12B is omitted.

  FIG. 3A shows an initial state (standby state) in which the clip 12A is usable. In the state of FIG. 3A, the region length L1 of the second region 34, which is the connection holding region, and the length L2 until the tightening portion 40 of the connection ring 14 reaches the convex portion 30 of the clip 12 are as follows. Are almost equal. The arm portions 28 and 28 of the clip 12B are held in the second region 34 with the claw portions 22 and 22 closed with the tail portion of the clip 12A interposed therebetween.

  The clip 12A and the clip 12B are held by the connection ring 14A in a connected state. However, since the skirt portion 38 of the connection ring 14A has already opened out from the distal end of the sheath 16, the clip 12A by the skirt portion 38 is opened. The pressing hold of is released. Further, the connecting ring 14 </ b> A is prevented from retreating into the sheath 16 because the skirt portion 38 is opened at the distal end of the sheath 16.

  In this state, when the clip 12B is pulled by pulling the operation wire 20 (see FIG. 1), the clip 12A is pulled by the claws 22 and 22 of the clip 12B. By pulling the operation wire 20 by a predetermined amount, the clip 12A moves by a length L2 with respect to the connecting ring 14A, and the lower end of the convex portion 30 of the clip 12A is connected to the connecting ring as shown in FIG. It comes to a position that comes into contact with the tip of 14A or a position just before it. Thereby, the fastening of the clip 12A by the fastening portion 40 of the connecting ring 14 is completed. At this time, the clip 12 </ b> A is configured to exert the maximum fitting force in the claw portions 22 and 22.

  4 is generated between the sliding amount of the connecting ring 14 with respect to the clip 12 in the clip treatment instrument 10, that is, the moving amount of the fastening portion 40 for fastening the clip 12, and the claws 22 and 22 of the clip 12. FIG. It is a graph showing the relationship with a fitting power. In the graph of FIG. 4, the horizontal axis represents the sliding amount (mm) of the connecting ring 14, and the vertical axis represents the fitting force (N) of the clip 12. The sliding amount of the connecting ring 14 is zero at the initial position (see FIG. 3A) of the connecting ring 14 (tightening portion 40) in the initial state of the clip treatment instrument 10, and from there to the distal end side of the clip 12. The amount of movement. In the graph of FIG. 4, the mating force is the pressure between the claw portions 22 and 22 in a state where the clip 12 is not sandwiched between the claw portions 22 and 22.

In FIG. 4, the fitting force is not generated until the sliding amount of the connecting ring (its tightening portion) is about 1.7 mm. During this time, the amount of expansion of the clip 12 is gradually reduced, but the claw portions 22 and 22 are not yet in contact with each other.
When the sliding amount of the connecting ring is about 1.7 mm, the claw portions 22 and 22 come into contact with each other, and a fitting force is generated between the claw portions 22 and 22. Thereafter, the mating force increases almost in proportion to the sliding amount of the connecting ring. When the sliding amount of the connection ring reaches about 3 mm, the maximum fitting force of the clip 12 reaches about 0.62N.

  The clip treatment instrument 10 is configured so that clipping is completed when the maximum fitting force is exhibited. That is, the length L2 from the lower end of the protrusion 30 of the clip 12A to the upper end of the connection ring 14A, which is the amount of movement (sliding amount) of the connection ring 14A with respect to the clip 12A until tightening is completed, is 3 mm. The pulling amount of 12A is set to 3.1 mm that is slightly larger than 3 mm in order to reliably pull the clip 12A by 3 mm to obtain the maximum resultant force.

  By pulling the clip by the operation wire 20, the clip 12B is also moved by the same amount as the clip 12A. The region length L1 of the second region 34 that is the connection holding region is equal to the length L2 from the lower end of the convex portion 30 of the clip 12A to the upper end of the connection ring 14A, and is 3 mm. Therefore, when the clip 12A is pulled by L2 = 3 mm, the clip 12B moves by L1 = 3 mm, and the tip of the clip 12B comes out of the base end of the connecting ring 14A as shown in FIG. 3B. The engaging portion of the clip 12A and the clip 12B is disengaged from the second region 34 of the connection ring 14A.

  That is, the clip treatment instrument 10 connects the clip treatment with the clip 12A and the movement of the tightening portion 40 reaching 3 mm so that the claws 22 and 22 of the clip 12A reach the maximum fitting force. The length L1 of the second region 34 of the ring 14 is realized.

  As described above, the inner diameter of the sheath 16 is larger than the length obtained by adding the lengths of the two claws 22 and 22 of the clip 12B and the width of the portion of the turn 24 where the claws 22 and 22 are engaged. Therefore, the clip 12B detached from the connection ring 14A expands to a position where the arm portion 28 hits the inner wall of the sheath 16, and a gap is formed between the claw portions 22 and 22 so that the lower end portion of the clip 12A can pass through.

  FIG. 5 is an enlarged cross-sectional view of the lower end portion of the connection ring 14A just before the clip 12B is detached from the connection ring 14A, and the engagement between the proximal end portion of the connection ring 14A and the clips 12A and 12B in the sheath 16 Shows the part. As shown in FIG. 5, when the width of the portion of the clip 12A where the clip 12B engages is A, the length of the claw portion 22 of the clip 12B is B, and the inner diameter of the sheath 16 is C, these relationships are as follows: C> A + B × 2. For example, when A = 0.3 mm, B = 0.7 mm, and C = 2.2 mm, the clip 12 </ b> B that is out of the second region 34 of the connecting ring 14 </ b> A has the arm portion 28 widened, and both the claw portions 22. , 22 is 2.2 mm−0.7 mm × 2 = 0.8 mm, and a clip 12A having a width of 0.3 mm can pass therethrough.

  Thereby, the connection between the clip 12A and the clip 12B is released, the clip 12A and the connection ring 14A can be detached from the sheath 16, and the clip treatment by the clip 12A and the connection ring 14A is completed.

  As described above, the area length L2 of the second area 34 that is the connection holding area (the length of the clip in the advancing / retreating direction) L1 is such that the claws 22 and 22 of the clip 12 exhibit the maximum fitting force when tightened by the tightening section 40. By making the movement amount L2 of the tightening portion 40 (the coupling ring 14) to the position where the first clip 12A is moved, the clip treatment with a sufficient tightening force by the first clip 12A and the first clip 12A and the next clip 12B Disconnection (connection release) can be performed simultaneously by a series of operations in one direction of the operation wire 20.

  Even when a clip with a different amount of spread is used as the clip 12, the protrusion 30 is formed on the various clips so that the length from the tightening portion 40 to the protrusion in the initial state of the clip is 3 mm, and By designing the clip so that the clip exhibits the maximum fitting force when the tightening portion 40 comes directly below the convex portion 30, the same connecting ring 14 and the same operation wire 20 can be used. It is possible to realize the maximum fitting force of the clip and the clip treatment operation with the pulling amount of.

  Next, the action of clipping of the repetitive clip treatment tool 10 will be described with reference to FIG. FIGS. 6A to 6E are partial cross-sectional views showing a stepped state during the clipping operation of the clip treatment instrument 10.

  First, as shown in FIG. 6A, after four hemostatic clip bodies comprising clips 12A to 12D and connecting rings 14A to 14D are loaded on the sheath 16, the sheath 16 is inserted into the forceps channel of the endoscope. The 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. It can be performed by attaching to the distal end of the wire 20 and then moving the sheath 16 forward relative to the operation wire 20 so that the leading clip 12A is completely accommodated in the sheath 16.

  In the illustrated example, the tip of the clip 12A substantially coincides with the tip of the sheath 16 as shown in FIG. 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 tightening portion 40 is in the vicinity of the intersecting portion 26 of the clips 12A to 12D. At this time, the upper ends in FIG. 6A of the protrusions 30 of the clips 12B to 12D are positioned directly below the coupling rings 14A to 14C, respectively.

  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 unchanged, and only the sheath 16 remains on the operation portion side (rear side / It is pulled to the base end side. When the sheath 16 is pulled for a predetermined stroke, the distal end of the sheath 16 is lowered to a position where the skirt portion 38 of the leading connecting ring 14A is opened, and the claws 22 and 22 of the clip 12A protruding from the sheath 16 are biased. Expands to the state of FIG. 6 (B). As a result, the first clip 12A can be used. In FIG. 6B, the skirt portion 38 of the connecting ring 14A is not shown in the figure because it is in the direction perpendicular to the paper surface.

  Since the coupling portion between the clip 12A and the clip 12B is located immediately below the skirt portion 38 of the connecting ring 14A, the tip of the clip 12B 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 is substantially equal to the distance between the tip of the clip 12A loaded in the sheath 16 and the tip of the clip 12B.

  Further, when the sheath 16 is pulled, a frictional force acts between the sheath 16 and the connection rings 14A to 14D fitted in the sheath 16, but the skirt portion is provided between the connection rings 14A to 14D and the clips 12A to 12D. In addition to the elastic force of 38 and the holding force due to the spring force of the clips 12 </ b> A to 12 </ b> D, the convex portion 30 of the clips 12 </ b> B to 12 </ b> D comes into contact with the base ends of the connecting rings 14 </ b> A to 14 </ b> C. Therefore, even if the sheath 16 is pulled, the connection rings 14A to 14D do not move unnecessarily. Therefore, the connection rings 14A to 14D can maintain the state of holding the clips 12A to 12D, respectively.

  Next, the clip treatment tool 10 in the state of FIG. 6B is moved, and the claw portions 22 and 22 of the expanded clip 12A are pressed against the site to be clipped, and an operation wire is formed on the proximal end side of the sheath 16. Pull 20 a predetermined amount. By pulling the operation wire 20, all the clips 12 </ b> A to 12 </ b> D (clip rows (rows formed by connecting the four clips 12 and the dummy clips 18 with the connecting ring 14)) sequentially engaged from the dummy clip 18 are Pulled uniformly.

  At this time, in the state shown in FIGS. 6B and 6C, the connecting ring 14A protruding from the distal end of the sheath 16 has the skirt portion 38 open, and the holding of the clip 12A by the connecting ring 14A is released. As shown in FIG. 6C, the leading clip 12A moves backward with respect to the connecting ring 14A. When the tip of the connection ring 14A, that is, the tightening portion 40 is pushed down to just below the convex portion 30 of the clip 12A, the fastening of the clip 12A by the connection ring 14A is completed. At this time, the claw portions 22 and 22 of the clip 12A exhibit the maximum fitting force.

  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. When the engaging portion of the clip 12A and the clip 12B is disengaged from the connecting ring 14A, 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 turn portion of the clip 12A is between the claws 22 and 22. Opening wider than 24, the connection between the clip 12A and the clip 12B is released. 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, 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 and the connection ring 14 other than the leading clip 12 and the connection ring 14 that holds the head clip 12 and the connection ring 14 move integrally with respect to the sheath 16, and the connection state of the clips 14 </ b> B to 14 </ b> D and the dummy clip 18 is the connection ring. Maintained by 14B-14D.

  The operation wire 20 is configured so that a certain amount can always be pulled. This fixed amount is the region length L1 of the second region 34 of the connecting ring 14 shown in FIG. 3A, that is, the length from the lower end of the convex portion 30 of the previous clip 12 to the upper end of the connecting ring 14. The amount is equal to or slightly larger than L2. In addition, the operation wire 20 is adapted to return by a certain amount immediately after the certain amount is pulled. The operation wire 20 pulled from the state of FIG. 6B to the state of FIG. 6C returns to the original position when the pulling force is released in the operation portion, and becomes the state of FIG. 6D. 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 the case of FIG.

Next, in order to make the second clip 12B usable, the sheath 16 is pulled for a predetermined stroke. As a result, the distal end of the sheath 16 is lowered to a 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 to be in the state of FIG. .
After that, 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. Thereby, the fastening of the clip 12B by the connecting ring 14B is completed, and at the same time, the connection between the clip 12B and the clip 12C is released, and the clip treatment by the clip 12B is completed.

As described above, in the clip treatment device 10 of the present invention, the connection portion of the clip 12 is covered and held by the connection ring 14, so that the connection state of the plurality of clips 12 is reliably maintained. Then, the operation clip 20 pulls the dummy clip 18 and the plurality of clips 12 connected to the dummy clip 18 in one direction by a predetermined length, whereby the leading clip 12 is tightened by the tightening portion 40 of the connecting ring 14 and the next clip. The clip treatment with the leading clip 12 can be performed simultaneously with the release of the connection with the clip 12. In addition, the movement length of the connection ring 14 to the position where the region length L1 of the second region 34, which is the connection holding region, exhibits the maximum fitting force of the clip 12 by tightening by the tightening portion 40 (connection ring 14) ( Therefore, it is possible to perform reliable clipping with the maximum fitting force of the clip 12.
Further, by pulling the sheath 16 back to the operation portion by a predetermined length, the next clip 12 can be used and treatment can be performed continuously.

  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 clip treatment tool 10 of this invention, the connection ring 14 is made into resin as a preferable form. Therefore, the friction between the connection 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 are smooth, and the inner wall of the sheath 16 is damaged. There is no worry.
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 clip treatment instrument 10 of the present invention, when the connection ring 14 is set in the sheath 16, the skirt portion 38 presses and holds the clip 12, so that the connection portion of the clip 12 is in a constant state. And the play of the clip 12 is extremely small. 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 example, 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. is there. 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. In addition, the use of a closed clip having a turn part is preferable in that a spring force (biasing force) that presses the turn part and expands to the arm part can be applied, but the present invention has a turn part. The present invention can also be applied to those using no open clip (U-shaped clip).

  7A to 7C show other examples of connection rings. 7A is a front view of the connecting ring 50, FIG. 7B is a sectional view, and FIG. 7C is a bottom view. The connection ring 50 is different from the connection ring 14 in the first embodiment in that the holding portion 42 is connected to the first region 32 holding the previous clip 12 and the previous clip 12. The third area 36 is a connection release area that enables the connection between the two clips 12 and 12 to be continued from the second area 34 that is a connection holding area for holding the clip.

  The third region 36 is provided on the proximal end side of the second region 34, that is, on the proximal end portion of the connecting ring 50. In the third region 36, as shown in FIGS. 7B and 7C, a hole having the same diameter as the hole 43 following the hole 43 in the second region 34, and grooves 43a and 43a in the second region 34, Grooves 44 and 44 having the same position and a deep depth are formed.

  The grooves 43a and 43a of the second region 34 are similar to the above example in that the distance between the wall surfaces is the sum of the lengths of the two claws 22 and 22 of the clip 12 (the length in the expanding direction). The arm portions 28, 28 of the clip 12 are accommodated with the claw portions 22, 22 closed with the closed end (tail portion) of the turn portion 24 of the previous clip 12 sandwiched therebetween. As a result, the second region 34 maintains the connected state of the two front and rear clips 12, 12.

  On the other hand, the grooves 44 and 44 in the third region 36 have the distance between the opposing inner walls 44a and 44a so that the length of the two claw portions 22 and 22 of the clip 12 and the claw portions 22 and 22 of the turn portion 24 are the same. Slightly larger than the combined length of the engaging portions (tails), the two claws 22 and 22 of the clip 12 open, and the tail of the front clip 12 between the claws 22 and 22 Gives an interval at which can deviate.

  On the other hand, the width (opening width) of the groove 44 is the same as the width of the groove 43 a in the second region 34. That is, the width of the groove 44 is slightly larger than the maximum width of the arm portion 28 of the clip 12 like the width of the groove 43a, but smaller than the width of the convex portion 30 formed in the arm portion 28, and the second region. The convex part 30 of the clip 12 held by 34 cannot enter the groove 44.

  8A to 8C are partial cross-sectional views showing stepwise states of the clips 12A and 12B and the connection ring 50A during the clip treatment operation of the leading clip 12A. In addition, in the same figure, illustration of the connection ring 50B holding the clip 12B is omitted.

  FIG. 8A shows an initial state (standby state) in which the clip 12A is usable. Similar to the example of FIG. 3A described above, the region length L1 of the second region 34, which is the connection holding region, and the length until the tightening portion 40 of the connection ring 50 reaches the convex portion 30 of the clip 12. The length L2 is substantially equal.

  In this state, when the clip 12B is pulled by pulling the operation wire, the clip 12A is pulled by the claws 22 and 22 of the clip 12B. By pulling the operation wire by a predetermined amount, the clip 12A moves by a length L2 with respect to the connection ring 50A, and as shown in FIG. 8B, the lower end of the convex portion 30 of the clip 12A is connected to the connection ring 50A. It comes to the position where it touches the tip of or the position just before it. Thereby, the fastening of the clip 12A by the fastening portion 40 of the connecting ring 50A is completed. The clip 12 </ b> A is similar to the above example, and exhibits the maximum fitting force at the claw portions 22, 22 when the tightening portion 40 comes directly below the convex portion 30.

  At this time, the clip 12B also moves by the same amount as the clip 12A, that is, moves by the region length L1 of the second region 34 that is substantially equal to L2, and the tip of the clip 12B moves from the second region 34 of the connecting ring 50A. The clip 12A and the clip 12B are disengaged from the second region 34 and enter the third region 36.

  As described above, the groove 44 formed in the third region 36 is deeper in the expanding direction of the clip 12B than the groove 43a formed in the hole 43 of the second region 34, and the inner walls of the two grooves 44 and 44 are formed. The distance between 44a and 44a is slightly larger than the length obtained by adding the lengths of the two claw portions 22 and 22 of the clip 12B and the width of the portion where the claw portions 22 and 22 of the turn portion 24 are engaged. Therefore, the clip 12 </ b> B moved to the third region 36 has its arm portion 28 widened, and a gap through which the lower end portion of the clip 12 </ b> A can pass is formed between the claw portions 22 and 22. That is, the clip 12A and the clip 12B are disengaged from each other, and the connection can be released.

  Thus, even when the connection ring 50 has the third region 36 that is the connection release region following the second region 34 that is the connection holding region, the region length L1 of the second region 34 that is the connection holding region. However, since the claw portions 22 and 22 of the clip 12 are equal to the movement amount L2 of the tightening portion 40 to the position where the maximum fitting force is exerted by the tightening by the tightening portion 40, the leading clip 12A is sufficient. The clip treatment with the tightening force and the separation (disconnection) of the leading clip 12A and the next clip 12B can be performed simultaneously by a series of operations in one direction of the operation wire 20.

  When the operation wire is further pulled and the clip 12B is pulled, only the clip 12B moves by the region length L3 of the third region 36, and the tip of the clip 12B is connected to the connecting ring 50A as shown in FIG. 8C. The third region 36 is removed from the connection ring 50A. Thereby, the clip 12A and the connection ring 50A can be detached from the sheath 16, and the clip treatment by the clip 12A and the connection ring 50A is completed.

  Since the connection ring 50 has the third region 36 that is a connection release region, the clip 12 held in the sheath 16 is displaced from the connection ring 50 due to the curvature of the sheath 16 or some other reason. Thus, even when the connecting portion of the clip 12 is pulled out from the second region 34, which is the connection holding region of the connecting ring 50, to the proximal end side, the clip 12 is unlikely to be detached from the connecting ring 50, and the connection of the clip 12 is not the sheath 16. There is an advantage that it is possible to prevent the occurrence of a problem such that it immediately comes off inside and spills from the tip of the sheath 16.

  In the present embodiment, the pulling amount of the operation wire for one clip treatment is equal to or larger than the region length (L1) of the second region 34 + the region length (L3) of the third region 36. Amount. L 1, that is, L 2 is a length necessary for fastening the clip 12 A, and L 3 is a length necessary for releasing the connection of the clip 12. This operation wire can be pulled by one continuous pulling operation.

Next, a second embodiment of the present invention will be described.
In the first embodiment, the sheath 16 is pulled toward the operation portion to bring the next clip 12 into a usable state (standby state). In this embodiment, the operation wire 20 is pushed out to the distal end side. Thus, the next clip 12 can be used.

In FIG. 9, the typical perspective view of the continuous-type clip treatment tool of this embodiment is shown. The continuous clip treatment tool 80 shown in FIG. 9 uses many of the same members as the continuous clip treatment tool 10 shown in FIG. 1, such as the clip 12, the connection ring 14, the sheath 16, and the operation wire 20. Therefore, the same reference numerals are given to the same members, and the following explanation will mainly be made on different parts.
This repetitive clip treatment instrument 80 accommodates a clip row formed by connecting a plurality of clips 12 with a connecting ring 14 at the distal end portion of the sheath 16 fixed to the operation handle 82 (see FIG. 10 and the like). Is done.

FIG. 10 is a schematic cross-sectional view of the distal end portion of the sheath 16. 10A is a view as seen from the opening / closing direction of the arm portion 28 of the clip 12, and FIG. 10B is a direction different from the circumferential direction of the sheath 16 by 90 ° (perpendicular to the opening / closing direction of the arm portion 28). It is the figure seen from (direction).
As shown in FIG. 10, the clip treatment tool 80 is accommodated in the sheath 16 so that the three clips 12 (12A, 12B, and 12C) are connected to each other so as to be able to advance and retreat. That is, the illustrated clip treatment tool 80 is a three-shot clip treatment tool capable of performing three clippings continuously without pulling out the sheath.
In addition, the clip treatment tool of this embodiment is not limited to the three-shot clip treatment as shown in the illustrated example, and two clips may be loaded, or four or more clips may be loaded. It may be similar to the previous example.

Similar to the clip treatment 10 shown in FIG. 1 described above, each clip 12 is connected by a connection ring 14 (14A, 14B, 14C). Further, a dummy clip 18 that is engaged with the operation wire 20 is connected to the rearmost (proximal end) clip 12C.
As will be described in detail later, the operation wire 20 is inserted through the sheath 16 and is inserted into a handle portion 84 of an operation handle 82 described later, and is connected to a slider 54 that performs clipping preparation and clipping operation. In the clip treatment instrument 80, by operating the slider 54, the operation wire 20 is advanced and retracted (extruded and pulled, that is, moved in the longitudinal direction of the sheath 16) in the sheath 16, and is connected to the distal end portion of the sheath 16 and accommodated. Clipping operation is performed by advancing and retreating all the clips 12A to 12C (clip train).

Here, in the above-described clip treatment instrument 10 shown in FIG. 1, the dummy clip 18 is directly connected to the operation wire 20.
On the other hand, in the clip treatment instrument 80 shown in FIGS. 10 and 11, the connection member 21 is fixed to the distal end of the operation wire 20, and the hole 19 a into which the connection member 21 can be fitted at the rear end of the dummy clip 18. The formed connecting member 19 is fixed, and the dummy clip 18 and the operation wire 20 are connected by fitting the connecting member 21 into the hole 19a of the connecting member 19 (engaging both).

As described above, the clip treatment instrument 80 includes the operation handle 82 and the clip row accommodated in the distal end portion of the operation handle 82 (sheath 16).
The operation handle 82 includes the sheath 16, the operation wire 20, the connection member 21 at the tip of the operation wire 20, and the handle portion 84.

FIG. 11 is a schematic cross-sectional view of the handle portion 84 of the operation handle 82.
As shown in FIG. 11, the handle portion 84 of the operation handle 82 includes a handle body 52, a slider 54, a slider guide 56, a rotation position restricting member 58, an urging spring 60, and a finger hooking member 62.

FIG. 12 shows a schematic perspective view when the slider guide 56 is removed from the handle portion 84 (handle main body 52).
As shown in FIGS. 11 and 12, the handle main body 52 is a stepped cylindrical member having three cylindrical portions having different outer diameters, and from the base end side, a large diameter portion 52a, a medium diameter portion 52b and a small diameter portion. They are formed in the order of the parts 52c.

The handle main body 52 is formed with a through hole 52d having the same diameter through the large diameter portion 52a, the medium diameter portion 52b, and the small diameter portion 52c. The finger hooking member 62 is fixedly fitted into the through hole 52d. The finger hanging member 62 is for a doctor to hang a thumb when operating the slider 54 described later, and has a ring-shaped portion.
An engagement groove 68 that is a long through hole is formed in the middle diameter portion 52b of the handle main body 52 so as to extend in the central axis direction of a cylinder (= through hole 52d) that forms the handle main body 52. . In addition, a substantially cylindrical slider guide 56, which will be described later, is rotatably inserted into the middle diameter portion 52b.
In the following description, the central axis direction of the cylinder forming the handle body 52 is also referred to as “axial direction”, and the circumferential direction centering on this axial direction is also referred to as “circumferential direction”.

In the handle main body 52, the sheath 16 is fixed to the distal end of the small diameter portion 52c on the most distal end side so as to communicate with the through hole 52d of the handle main body 52. The operation wire 20 is inserted through the sheath 16, protrudes from the proximal end portion of the sheath 16, is inserted through the small diameter portion 52 c and the medium diameter portion 52 b of the handle body 52, and is connected to the slider 54.
Therefore, in the clip treatment instrument 80, the sheath 16 is not pulled back (advanced / retracted) unlike the clip treatment instrument 10 shown in FIG.

The slider 54 is disposed on the outer periphery of the handle main body 52 so as to pass through the handle main body 52 (and a slider guide 56 described later), and is a substantially cylindrical member that is movable in the axial direction of the handle main body 52 (same as above). It is.
In the illustrated example, the slider 54 has disk-shaped flange portions projecting outward at two locations, the proximal end portion of the cylinder and the middle in the axial direction, and performs a treatment using the clip treatment tool 80. It is easy for the doctor to move the slider 54 in the axial direction by placing a finger. As an example, the doctor puts a thumb in the ring of the finger-hook member 62 and moves the slider 54 in the axial direction so that the slider 54 is sandwiched between the index finger and the middle finger between the flange portions.

The slider 54 has a slider pin 70 attached so as to protrude toward the central axis of the handle body 52. The slider pin 70 passes through the engagement groove 68 and reaches the center line of the through hole 52d of the handle body 52. An operation wire 20 inserted through the small diameter portion 52c and the medium diameter portion 52b of the handle main body 52 is fixed near the lower end portion of the slider pin (on the center line side of the through hole 52d).
As described above, the slider 54 is movable in the axial direction of the handle main body 52, and by moving the slider 54, the operation wire 20 inserted through the sheath 16 moves forward and backward (moves toward the distal end side and the proximal end side). be able to. In the clip treatment instrument 80, as described above, the clip row at the distal end of the sheath 16 is advanced and retracted by the advancement and retreat of the operation wire 20 by the slider 54, and the next clip 12 can be used (clipping preparation state). In addition, clipping is performed.

In the clip treatment instrument 80, the position where the proximal end of the engagement groove 68 and the slider pin 70 abut is the home position (HP) of the slider 54. By moving the slider 54 to the distal end side by a predetermined amount from this HP, the operation wire 20 is sent out (advanced) to the distal end side to prepare for clipping, and the slider 54 is returned to the HP side from this prepared state. Then, the operation wire 20 is pulled back (retracted) to perform clipping and disconnection of the previous clip 12 and the next clip 12.
Further, when the clip row is loaded on the sheath 16, the dummy clip 18 and the operation wire 20 are connected with the slider 54 moved to the tip side by a predetermined amount, and the slider 54 is moved to HP, A clip row is loaded on the sheath 16.
This will be described in detail later.

FIG. 13A shows a schematic perspective view of the slider guide 56.
The slider guide 56 is a member that regulates the amount of movement of the slider 54 in the axial direction, that is, the amount of advancement / retraction of the operation wire 20 in the longitudinal direction of the sheath 16, and is inserted through the handle body 52 as shown in FIGS. 11 and 13A. It is a substantially cylindrical member.
The slider guide 56 is pivotally supported on the outer peripheral surface of the handle body 52 so as to be rotatable in the circumferential direction and movable in the axial direction.

The slider guide 56 includes a joint portion 56a, a grip portion 56b, and a guide portion 56c.
The joining portion 56a, the gripping portion 56b, and the guide portion 56c are all substantially cylindrical portions, and in the order of the joining portion 56a, the gripping portion 56b, and the guide portion 56c from the distal end side to the proximal end side, It is integrally formed so as to constitute one cylinder.

The joint portion 56a is a substantially cylindrical portion having an inner diameter substantially the same as the outer diameter of the small diameter portion 52c of the handle body 52, and the convex tip portion restricts the rotational position of the slider guide 56, which will be described later. Is inserted into a joint 58 a formed on the rotational position regulating member 58.
In the joint portion 56a, four convex portions 57a and four concave portions 57b between the convex portions 57a are formed in a sawtooth shape. The convex portion 57a and the concave portion 57b engage with the convex portion 59a and the concave portion 59b formed in the joint portion 58a of the rotational position regulating member 58. This will be described in detail later.

  The gripping part 56b is a part for gripping when the doctor rotates the slider guide 56 to perform clipping as will be described later.

The guide portion 56c has an inner diameter that is substantially the same as the outer diameter of the middle diameter portion 52b of the handle body 52, and an outer diameter that is substantially the same as the inner diameter of the slider 54 and the outer diameter of the large diameter portion 52a of the handle body 52. This is a substantially cylindrical portion.
Accordingly, the slider 54 is guided in the outer periphery of the large diameter portion 52a and the guide portion 56c of the handle main body 52 and moves in the axial direction.

FIG. 13B shows a developed view of the guide portion 56c.
Guide grooves 66A to 66D for guiding the slider 54 (slider pin 70) are formed in the guide portion 56c so as to extend in the axial direction. That is, as described above, the clip treatment tool 80 of the illustrated example is a treatment tool that can be clipped three times without loading the sheath 16 from the body by loading the three clips 12. Correspondingly, the guide portion 56c is formed with four guide grooves.

As an example, the guide groove 66A corresponds to the first clipping, the guide groove 66B corresponds to the second clipping, the guide groove 66D corresponds to the second clipping, and the guide groove 66D corresponds to the third clipping when the clip row is loaded. Formed at intervals of 90 °.
In the present invention, as described above, the number of clips that can be loaded (successively) is not limited to three. Accordingly, in the guide portion 56c of the slider guide 56, “n + 1” guide grooves obtained by adding 1 for clip row loading to the clip treatment instrument (operation handle) according to the number n of clips 12 that can be loaded. 66 is formed.

The guide grooves 66 </ b> A to 66 </ b> D guide the movement of the slider 54 (slider pin 70) together with the engagement groove 68 of the handle body 12 and restrict the movement amount of the slider 54.
As described above, in the clip treatment tool 80 of the illustrated example, by reciprocating the slider 54 in the axial direction from the HP, the clipping operation and the clip row (three clips 12 and the dummy clip 18 to the sheath 16) are performed. A row formed by connecting the connecting rings 14 is loaded. In addition, the treatment tool can perform clipping three times without removing the sheath 16 from the body.

Here, the amount of movement of the slider 54 differs depending on when the clip row is loaded and the number of times of clipping (number of times of clipping). Accordingly, as shown in FIG. 13, in the slider guide 56, four guide grooves 66A to 66D having different axial lengths are formed in the guide portion 56c.
Accordingly, the length of each guide groove is a length that is the amount of movement of the slider 54 according to the loading of the clip row and the number of times of clipping.

Specifically, when the clip row is loaded, the connection member 21 needs to protrude from the sheath 16, and when the slider 54 is returned to HP, the entire clip row needs to be accommodated in the sheath 16. Yes.
Therefore, as shown in FIG. 13B, the guide groove 66A corresponding to the time when the clip row is loaded is formed to a length that is a predetermined amount with the largest amount of movement of the slider 54.

Clipping is sequentially performed from the clip 12 on the front end side. As will be described later, the HP of the clipping operation is the same regardless of the number of times. Therefore, a state where the next clip is usable (preparation state for clipping), that is, a state where the arm portion 28 of the clip 12 and the skirt portion 38 of the connecting ring 14 protrude from the distal end of the sheath 16 as shown in FIG. Therefore, the amount of movement of the clip 12 and the connecting ring 14 toward the tip side increases in the order of the first time, the second time, and the third time. That is, the required amount of movement of the slider from the HP to the tip side increases sequentially from the first time to the third time.
Accordingly, as shown in FIG. 13B, the guide groove 66B corresponding to the first clipping (clip 12A) is formed to a length that makes the moving amount of the slider 54 the smallest amount. Further, the guide groove 66C corresponding to the second clipping (clip 12B) is formed to a length that makes the movement amount of the slider 54 the second smallest predetermined amount. Further, the guide groove 66C corresponding to the third clipping (clip 12C) is formed so that the moving amount of the slider 54 is the third smallest amount.

The slider guide 56 is rotated in accordance with an operation such as loading or clipping of a clip row, and each guide groove is aligned with the engagement groove 68 of the handle body 52.
That is, when the clip row is loaded, the guide groove 66A is in the first clipping (clip 12A), the guide groove 66B is in the second clipping (clip 12B), and the guide groove 66C is in the third clipping. In the case of (clip 12C), the slider guide 56 is rotated so that the guide grooves 66 coincide with the engaging grooves 68, respectively.

As described above, the four convex portions 57a and the concave portions 57b are alternately formed at equal intervals in the circumferential direction (rotating direction around the axis) at the tip of the joint portion 56a.
The four convex portions 57a have the same shape and are serrated, that is, a tapered shape having a gentle inclination angle of one tooth surface, and a triangular cross section in which the inclination angle of the other tooth surface forms a substantially perpendicular step. It is a convex part. Further, a recess 57b is formed between the adjacent protrusions 57a and the protrusions 57a.
The convex portion 57a and the concave portion 57b engage with the convex portion 59a and the concave portion 59b formed in the joint portion 58a of the rotational position regulating member 58.

The rotational position restricting member 58 is a member disposed on the most proximal side of the handle portion 84, and is a cylindrical member having a cylindrical region and a substantially hemispherical region and having a through hole in the center. .
The rotational position restricting member 58 is fixed to the handle main body 52 by inserting the small diameter portion 52c of the handle main body 52 through the through hole with the cylindrical region facing the front end side.

As shown in FIG. 14, the rotational position restricting member 58 has a concave joint 58 a on the base end side. As described above, the convex joint portion 56a on the distal end side of the slider guide 56 is inserted into the concave joint portion 58a in a rotatable state.
Similar to the convex joint 56a on the distal end side of the slider guide 56, the joint 58a protrudes toward the base end, and the inclination angles of the two tooth surfaces with respect to the contact surface are different at equal intervals in the circumferential direction. Four convex portions 59a having a shape are formed. The convex portion 59a is a sawtooth shape, that is, a convex portion having a triangular cross section in which the inclination angle of one tooth surface is a gentle taper and the inclination angle of the other tooth surface forms a substantially right-angled step. Moreover, between the adjacent convex part 59a and the convex part 59a, it becomes the recessed part 59b, and this recessed part 59b is also formed four.

The convex portion 57a of the joint portion 56a of the slider guide 56 and the concave portion 59b of the joint portion 58a of the rotational position restricting member 58, and the convex portion of the concave portion 57b of the joint portion 56a of the slider guide 56 and the joint portion 58a of the rotational position restricting member 58. 59a has a shape that meshes with each other.
That is, the slider guide 56 is positioned at 90 ° intervals in the rotational direction by the rotational position restricting member 58.

Here, the guide grooves 66 </ b> A to 66 </ b> D of the slider guide 56 are formed with the engagement grooves 68 of the handle main body 52 when the concavities and convexities of the joint 58 a of the rotation position restricting member 58 and the joint 56 a of the slider guide 56 mesh. It is formed so that the positions in the circumferential direction overlap. That is, the rotation of the slider guide 56 is restricted by the rotation position restricting member 58 so that the guide groove 66 stops at a position where the guide groove 66 and the engagement groove 68 of the handle body 52 overlap.
In addition, since both the convex portions have a tapered inclination angle on one tooth surface and a substantially right angle on the other tooth surface, the rotation direction of the slider guide 56 is defined in one direction. The shape of the tooth surface of the convex portion is formed so that the rotation direction of the slider guide is in the order of overlapping with the engaging groove 68 in the order of the guide groove 66A, the guide groove 66B, the guide groove 66C, and the guide groove 66D. The

Further, a step between the middle diameter portion 52 a and the small diameter portion 52 c of the handle main body 52 (a front end side end surface of the medium diameter portion 52 b formed by this step) and a base end side end surface of the joint portion 56 a of the slider guide 56. A biasing spring 60 is disposed between them.
The urging spring 60 is a compression spring that is arranged so as to stick to the outer periphery of the small-diameter portion 52c of the handle main body 52, and separates the distal end side end surface of the intermediate diameter portion 52b and the proximal end side end surface of the joint portion 56a. Energize to do. That is, the urging spring 60 keeps the slider guide 56 pressed against the rotational position restricting member 58.

Therefore, the action of the urging spring 60 prevents the slider guide 56 from rotating carelessly.
Further, by rotating the slider guide 56 in a predetermined direction, the unevenness of the joint portion 58a of the rotational position restricting member 58 and the joint portion 56a of the slider guide 56 counters the biasing force of the biasing spring 60 according to the rotation. When the slider guide 56 moves to the base end side along the concave and convex taper and deviates from the concave and convex taper (when the concave and convex part becomes a substantially vertical tooth surface), the biasing force of the biasing spring 60 again causes The slider guide 56 moves in the distal direction and is pressed against the rotational position restricting member 58.
As described above, the engagement groove 68 and the guide groove 66 are configured to coincide with each other in the circumferential direction at a position where the concave and convex portions of the joint portion 58a of the rotational position restricting member 58 and the joint portion 56a of the slider guide 56 are engaged. Is done. Therefore, a doctor who operates the clip treatment instrument 80 can easily and accurately match the engagement groove 68 and the guide groove 66 according to the number of times of clipping by rotating the slider guide 56.

  The slider guide 56 is pressed against the rotational position restricting member 58 and has a step between the middle diameter portion 52a and the large diameter portion 52a of the handle main body 52 (the front end side of the large diameter portion 52a formed by this step). Between the end face) and the base end side end according to the amount of movement of the joint 58a of the rotation position restricting member 58 and the joint 56a of the slider guide 56 to the base end side due to the unevenness, etc. The length in the axial direction is set to have

As described above, in the clip treatment instrument 80, the slider 54 is set to HP (the base end side of the engagement groove 68) in a state where the engagement grooves 68 of the handle main body 52 and the guide grooves 66 of the slider guide are aligned with each other. The living body is clipped by the clip 12 by moving from the position where the end and the slider pin 70 abut) to the position where the end of the guide groove 66 is abutted and returning to the HP again.
The clip treatment tool 80 is a repetitive clip treatment tool that can perform clipping three times without pulling out the sheath 16 from the endoscope.

  Hereinafter, a schematic perspective view of the handle portion 84 shown in FIGS. 15A to 15P, a development view of the slider guide 56 shown in FIG. 16, and a position of the slider pin 70 (a hatched circle) at the time of operation are schematically shown. An example of the operation of three clippings in the clip treatment instrument 80 will be described with reference to the drawings schematically shown and the conceptual diagram of the distal end portion of the sheath 16 shown in FIGS.

First, the slider guide 56 is rotated as necessary, and as shown in FIG. 15A, the guide groove 66A and the engagement groove 68 of the handle main body 52 are aligned (aligned in the circumferential direction), and the slider 54 is aligned. Is moved in the axial direction to the HP at which the slider pin 70 contacts the end face on the tip end side of the engagement groove 68. That is, the slider pin 70 of the slider 54 is moved to a position P1 shown in FIG. 16 (hereinafter, the slider pin 70 is omitted, and “slider guide is moved to position P1”, “slider guide is moved to HP”). As follows).
At this time, the tip of the operation wire 20 is drawn into the sheath 16 as shown in FIG. This state is an initial state of treatment in the clip treatment tool 80 of the illustrated example.

  It should be noted that the present invention is not limited to the configuration that restricts the amount of movement of the slider 54 in the axial direction by contacting the end surface of the engagement groove 68 or the end of the guide groove 66 with the end of the guide groove 66 and the slider pin 70. Instead of the slider pin 70, the main body of the slider 54 and the front end side end surface of the engagement groove 68 or the front end side end portion of the guide groove 66 are in contact with each other to restrict the amount of movement of the slider 54 in the axial direction. Good.

Next, as shown in FIG. 15B, the slider 54 is moved to a position where it abuts against the end of the guide groove 66A, that is, the maximum protruding position P2 shown in FIG.
As a result, as shown in FIG. 17B, the connection member 21 of the operation wire 20 protrudes from the tip of the sheath 16 by a predetermined amount.

In this state, the connecting member 19 of the dummy clip 18 is attached to the connecting member 21 of the operation wire 20. Accordingly, the clip row in which the three clips 12 and the dummy clips 18 are connected by the connecting ring 14 is connected to the operation wire 20.
When the connecting member connecting member 19 of the clip row is attached to the connecting member 21 of the operation wire 20, the slider 54 is returned to the position P3 shown in FIG. 16, that is, HP as shown in FIG. By this operation, the clip row is accommodated in the sheath 16 as shown in FIG.
Thereby, the loading of the clip row connected with the clip 12 to the operation handle 82 is completed, that is, the clip treatment tool 80 is configured.

Thereafter, the sheath 16 is inserted into a forceps port of an endoscope inserted into the living body, and the distal end of the sheath 16 reaches the distal end of the insertion portion of the endoscope and protrudes from the distal end of the endoscope.
Further, the distal end of the sheath 16 of the clip treatment instrument 80 is moved to a target position by an operation of an insertion portion or an angle portion of the endoscope.

When the necessary operation is completed, as shown in FIG. 15D, the slider guide 56 is rotated by 90 ° so that the guide groove 66B and the engagement groove 68 are aligned.
Thereby, the position of the slider 54 (slider pin 70) moves to HP corresponding to the guide groove 66B indicated by position P4 in FIG.

Next, as shown in FIG. 15E, the slider 54 is moved to a position where it abuts against the end of the guide groove 66B, that is, moves to the maximum protruding position P5 shown in FIG.
By pushing out the slider 54, that is, pushing out the operation wire 20, the clip row moves in the distal direction. As shown in FIG. 17D, the leading clip clip 12A and the connecting ring 14A are moved from the distal end of the sheath 16. The first region 32 protrudes from the distal end of the sheath 16. As a result, the arm portion 28 of the clip 12A is opened, and the skirt portion 38 of the connecting ring 14A is opened.

Incidentally, the clip 12 and the connecting ring 14 have dimensional variations due to manufacturing errors. Further, in the clip treatment instrument 80 inserted through the endoscope (its insertion portion), the amount of protrusion of the operation wire 20 may decrease due to differences in inner and outer circumferences caused by bending or bending of the operation wire 20 and the sheath 16. .
For this reason, in the clip treatment instrument 80, the end of the guide groove 66B on the distal end side does not drop the clip 12A from the sheath 12, and the connection ring reliably does not depend on the manufacturing error of the clip 12 or the like or the state of the sheath 16. The skirt portion 14A of 14A is formed to be the maximum projecting position P5 that is open.
Therefore, normally, in a state where the slider 54 is pushed out to the maximum projecting position P5, the skirt portion 38 of the connecting ring 14A is positioned before the distal end portion of the sheath 16, and the skirt portion 38 and the sheath 16 are located. Is separated from

  In addition, regarding this point, the front end side end of the guide groove 66C corresponding to clipping by the second clip 12B and the front end side end of the guide groove 66D corresponding to clipping by the third clip 12C also apply. The same.

Next, for example, while viewing the image of the endoscope, as shown in FIG. 15F, the slider 54 is pulled back to the HP side, and the standard protruding position P5 where the skirt portion 38 of the connecting ring 14A contacts the distal end portion of the sheath 16 is obtained. Pull back the clip row until '. That is, the clip row is pulled back to the sheath 16 until the state shown in FIG. The state shown in FIG. 17E is the same as the state shown in FIG.
Thus, the preparation for the first clipping (clipping by the first clip 12) is completed (the clip is ready for clipping).

  When the slider 54 is returned to the standard protruding position P5 ′ and the preparation state for clipping is reached, the endoscope is operated to press the nail portion 22 of the expanded clip 12A to the living body position to be clipped, and FIG. ), The slider 54 is moved to the proximal end side and pulled back to HP, that is, the position P7.

In the ready state, since the skirt portion 38 of the connecting ring 14A is open, the pressing and holding of the clip 12A by the skirt portion 38 in the connecting ring 14A is open. Further, the connecting ring 14 </ b> A is prevented from retreating into the sheath 16 because the skirt portion 38 is opened at the distal end of the sheath 16.
Therefore, by the movement of the slider 54, the leading clip 12A is drawn into the connecting ring 14A, the open arm portion 28 is closed by the tightening portion 40, and the claw portion 22 is moved as shown in FIG. Obstruct and clip the living body. Further, when the slider 54 moves from the standard protruding position P5 ′ to the clip completion position P6 (moves by the clip stroke from the standard protruding position P5 ′), as described above, the connecting ring 14A extends to the position immediately below the convex portion 30 of the arm portion 28. To complete the clipping.

Simultaneously with the completion of this clipping, as shown in FIG. 17 (F), the proximal end of the leading clip 12A (the proximal end of the folded portion 24) and the claw 22 of the second clip 12B. However, it discharges | emits from the base end side edge part of 14 A of connection rings.
As a result, the arm portion 28 of the second clip 12B that has been blocked by the second region 34 of the connecting ring 14A is released to the inner diameter of the sheath 16, and the folded portion 24 of the previous clip 12A and the next clip 12B are opened. Thus, the clip 12A and the connecting ring 14A are separated from the clip row and can be discharged from the sheath 16.

  In the state where the slider 54 is returned to the position P7 which is HP, the clip row from which the clip 12A and the connecting ring 14A are separated is drawn into the sheath 16 as shown in FIG. .

As is clear from the above description, the distance from the maximum projecting position P5 (P9, P13) to the standard projecting position P5 ′ (P9 ′, P13 ′) depends on the manufacturing error of the component parts, the inner and outer peripheral differences of the sheath 16, and the like. It becomes a buffer to absorb. Therefore, once the slider 54 (that is, the clip row (the most advanced clip 12)) is pushed out to the maximum projecting position P5, the arm portion 28 is surely secured regardless of the manufacturing error of the clip 12 and the state of the sheath 16 in the body. The skirt 38 can be opened to perform clipping.
Further, as a preferable operation, the clip row is pushed out to the maximum projecting position P5, then returned to the standard projecting position P5 ′, and then the nail 22 is brought into contact with the living body to perform clipping (the slider 54 up to P7 which is HP). By pulling back, it is possible to more reliably prevent the clip 12 from dropping off due to excessive protrusion from the sheath 16, and the clip 12 that is securely held can be pressed against a living body that clips firmly. .

The operation of the clip treatment tool 80 of the present invention is as described above. The slider 54 is pushed out to the maximum projecting position, and then the slider is returned to the standard projecting position, and then the slider is returned to HP and clipping is performed. There is no limitation to the connection opening.
For example, if the leading clip 12 is firmly held at the maximum projecting position and there is no possibility of dropping (very low), the slider 54 is not returned from the maximum projecting position to the standard projecting position. From the protruding position to the HP, the slider 54 may be pulled back at once to perform clipping and clip row connection / release.

  Further, in the clip treatment instrument 80, known means such as an unevenness that engages with each other when the slider 54 passes the clip completion position P6 (P10, P14), an energized sphere, and a recessed portion that engages with the sphere. Thus, it is also preferable to generate a small impact (so-called click feeling) so that the treating doctor can know that clipping has been completed.

After the slider 54 is returned to the HP position P7 and the first clipping (clipping by the first clip 12A) is completed, the slider guide 56 is then rotated 90 ° as shown in FIG. Thus, the guide groove 66C and the engagement groove 68 are matched.
Thereby, the position of the slider 54 moves to HP corresponding to the guide groove 66C indicated by a position P8 in FIG.

Next, as shown in FIG. 15I, the slider 54 is moved to the maximum projecting position P9 shown in FIG. 16, which is in contact with the end of the guide groove 66C. By this operation, as shown in FIG. 17H, the second clip 12B and the first region 32 of the connecting ring 14B protrude from the sheath 16 from the distal end of the sheath 16, the arm portion 28 opens, and the skirt Part 38 opens.
As shown in FIG. 15J, the slider 54 is pulled back to the standard protruding position P9 ′ where the skirt portion 38 abuts against the distal end of the sheath 16, and the state shown in FIG. As a result, a second clipping preparation state (by the clip 12B) is entered.

  Similarly, when the clip is ready for clipping, the claw portion 22 of the expanded clip 12B is pressed to the clipping position, and the slider 54 is moved to the base end side as shown in FIG. That is, it is pulled back to the position P11.

  As a result, like the first clipping, clipping is performed as shown in FIG. 17K, and the second clip 12 performs clipping by moving the slider from the standard protruding position P9 ′ to the clip completion position P10. Is completed, and the second clip 12B and the next (most proximal end) clip 12C are cut off, and the clip 12B and the connecting ring 14B can be discharged from the sheath 16.

  Further, in a state where the slider 54 is returned to the position P11 which is HP, the clip row from which the clip 12B and the connection ring 14B are separated is drawn into the sheath 16 as shown in FIG. .

When the second clipping is completed, as shown in FIG. 15L, the slider guide 56 is then rotated by 90 ° so that the guide groove 66D and the engagement groove 68 coincide with each other.
Thereby, the position of the slider 54 moves to HP corresponding to the guide groove 66D indicated by a position P12 in FIG.

Next, as shown in FIG. 15 (M), the slider 54 is moved to the maximum projecting position P13 in contact with the end of the guide groove 66D. By this operation, as shown in FIG. 17L, the third clip 12C and the connecting ring 14B protrude from the sheath 16 from the distal end of the sheath 16, the arm portion 28 is opened, and the skirt portion 38 is opened.
As shown in FIG. 15 (N), the slider 54 is pulled back to the standard protruding position P13P ′ to be in a preparation state for the third clipping shown in FIG. 17 (M).

Similarly, when the clip is ready for clipping, the claw portion 22 of the expanded clip 12C is pressed to the clipping position, and the slider 54 is moved to the base end side as shown in FIG. That is, it is pulled back to the position P15.
As a result, similarly to the above, clipping is performed as shown in FIG. 17N, and clipping by the third clip 12C is completed by the movement of the slider 54 from the standard protruding position 13P ′ to the clip completion position P14. Further, the third clip 12C and the dummy clip 18 are cut off, and the clip 12C and the connection ring 14C can be discharged from the sheath 16.

  Further, in the state where the slider 54 is returned to the position P15 which is HP, the dummy clip 18 from which all the clips 12 are separated is drawn into the sheath 16 as shown in FIG.

When the clipping by the three clips 12 is completed, as shown in FIG. 15P, the slider guide 56 is rotated by 90 ° so that the guide groove 66A and the engagement groove 68 are aligned. As a result, the position of the slider 54 returns again to the HP corresponding to the guide groove 66A, which is indicated by the position P1 in FIG.
Thereafter, the sheath 16 of the clip treatment instrument 80 is pulled out from the endoscope.
After the sheath 16 has been pulled out, the slider 54 is pushed out to a position P2 where it abuts against the end of the guide groove 66A, and as shown in FIG. The member 19 is protruded, and the dummy clip 18 and the connecting member 19 are removed from the connecting member 21 at the distal end of the operation wire 20.

  As described above, according to the repetitive clip treatment tool 80, it is possible to perform multiple clippings without pulling out the sheath. Further, only by rotation of the slider guide 56 and reciprocation of the slider 54, an appropriate amount of the clip row in the axial direction (longitudinal direction of the sheath 16) according to the number of times of clip (first time / second time). Move to get ready for clipping, clipping and detaching connected clips. Moreover, since the connection part of a clip is covered and hold | maintained with a connection ring similarly to the previous example, the connection state of a some clip is maintained reliably. Then, by pulling the clip row in one direction by a predetermined length with the operation wire, the top clip is tightened by the fastening portion of the connection ring and the connection with the next clip is released at the same time. The clip treatment can be performed. In addition, the region length of the second region, which is the connection holding region, is equal to the movement amount (slide amount) of the connection ring to the position where the maximum fitting force of the clip is exerted by tightening by the tightening portion (connection ring). The clip can be reliably clipped with the maximum fitting force of the clip. That is, accurate clipping can be performed with a simple operation.

  The continuous clip treatment device according to the present invention has been described in detail above. However, the present invention is not limited to the above-described embodiments, and various improvements and modifications may be made without departing from the gist of the present invention. Of course. Moreover, the continuous clip treatment tool of the present invention can be used for a rigid endoscope as well as a flexible endoscope. Furthermore, the clip treatment tool of the present invention can be used not only for hemostasis but also for various types of clips such as marking and suturing.

(A) And (B) is a fragmentary sectional view showing a 1st embodiment of a repetitive clip treatment instrument of the present invention. (A)-(C) are figures which show an example of a connection ring, (A) is a front view, (B) is sectional drawing, (C) is a bottom view. (A) And (B) is a fragmentary sectional view which shows the mode of clip connection holding | maintenance by the connection ring of FIG. It is a graph showing the relationship between the sliding amount of a connection ring, and the fitting force of the nail | claw part of a clip. It is an expanded sectional view showing the relation of a clip, a connection ring, and a sheath. (A)-(E) are the fragmentary sectional views which show the stepped state in the clipping operation of the clip treatment tool of FIG. (A)-(C) are figures which show the other example of a connection ring, (A) is a front view, (B) is sectional drawing, (C) is a bottom view. (A)-(C) are the fragmentary sectional views which show the mode of clip connection holding | maintenance by the connection ring of FIG. It is a typical perspective view which shows 2nd Embodiment of the clip treatment tool of this invention. (A) And (B) is typical sectional drawing of the front-end | tip part of the clip treatment tool shown in FIG. It is typical sectional drawing of the handle | steering-wheel part of the continuous-type clip treatment tool shown in FIG. It is a typical perspective view which shows the state which removed the slider guide from the handle | steering-wheel part shown in FIG. (A) is a schematic perspective view of a guide portion of the slider guide of the handle portion shown in FIG. 11, and (B) is a diagram schematically showing a state in which the slider guide is developed. FIG. 10 is a schematic perspective view of a rotation position restricting member of the handle portion shown in FIG. 9. (A)-(P) are typical perspective views for demonstrating the effect | action of the clip treatment of the clip treatment tool shown in FIG. It is a figure which shows typically the state which expand | deployed the slider guide for demonstrating the effect | action of the clip treatment of the clip treatment tool shown in FIG. (A)-(P) is typical sectional drawing of the front-end | tip part of the continuous-type clip processing tool for demonstrating the effect | action of the clip treatment of the clip treatment tool shown in FIG.

DESCRIPTION OF SYMBOLS 10, 80 Clip treatment tool 12 Clip 14, 50 Connection ring 16 Sheath 18 Dummy clip 20 Operation wire 22 Claw part 24 Turn part 26 Intersection part 28 Arm part 30 Protrusion part 32 1st area | region 34 2nd area | region (connection holding area)
36 3rd area (disconnection area)
38 Skirt portion 40 Tightening portion 42 Holding portion 43 Hole 43a, 44 Groove 44a Inner wall 46 Slit 52 Handle body 54 Slider 56 Slider guide 56a Joining portion 56b Holding portion 56c Guide portion 58 Rotation position regulating member 60 Biasing spring 62 Finger hooking member 66A , 66B, 66C, 66D Guide groove 68 Engaging groove 70 Slider pin 82 Operation handle 84 Handle part

Claims (7)

A plurality of clips loaded on the sheath tip in an engaged state with the front and rear clips;
A coupling ring that is fitted in the sheath so as to be able to advance and retreat, covers an engagement portion of the clip, and maintains the coupling state of the clip;
An operation wire connected to the last clip of the clip row composed of the plurality of clips and movable relative to the sheath in the longitudinal direction;
The connecting ring has a tightening portion at its distal end portion that tightens the previous clip in a state in which the claw portion is closed when it moves to the distal end side of the previous clip, and at the rear end portion, the following In a state where the two claws of the clip are closed across the tail of the previous clip, the clip has a connection holding region for holding the next clip,
The length of the clip in the advancing / retreating direction of the connection holding region is equal to the amount of movement of the tightening portion to the position where the claw portion of the previous clip exhibits the maximum fitting force by tightening by the tightening portion. A repetitive clip treatment tool characterized by.   In the initial state immediately before the start of the clip treatment operation by the clip, the clip has a length equal to the length of the connection holding region from the front end of the connection ring that holds the engagement portion with the next clip. The repetitive clip treatment tool according to claim 1, further comprising: a protrusion that is wider than a distal end opening of the connection ring and prevents the entry to the connection ring at a position apart from the opening.   The convex portion of the next clip is in a position in contact with the proximal end of the connection ring in an initial state immediately before the start of the clip treatment operation by the previous clip, and prevents entry into the connection ring. 2. The continuous clip treatment device according to 2.   In the sheath, the connecting ring is pressed against the inner wall of the sheath and closes inward, presses and holds at least one of the clips connected in the connecting ring, and after passing through the distal end of the sheath, from the inner diameter of the sheath 4. The skirt portion that opens widely and prevents retreat into the sheath at the same position in the relative movement direction of the sheath and the operation wire and at two or more locations in the circumferential direction thereof. The continuous-type clip treatment tool according to crab.   The leading clip is pulled with respect to the connection ring by the operation wire, and the connection with the succeeding clip is released when an engaging portion with the succeeding clip comes out of the connection ring. 5. The continuous clip treatment device according to any one of 1 to 4.   The first clip is used after the first clip is released and subjected to clipping, and then the sheath is pulled down to a position where the next clip protrudes, whereby the next clip becomes usable. The repetitive clip treatment device according to any one of the above.   6. After the leading clip is released and subjected to clipping, the operation wire is pushed out to a position where the next clip protrudes, whereby the next clip becomes usable. The continuous-type clip treatment tool according to any one of the above.