JP2010011973A - Successive clipping device - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a successive clipping device capable of more accurately transmitting the momentum of an operation wire in the operation part on this side of a sheath to the leading end part of the operation wire at the leading end part of the long sheath to accurately perform the preparation of a subsequent clip after the previous clip is used and enhanced in operability and accuracy. <P>SOLUTION: The successive clipping device includes a clip row composed of a plurality of the connected clips and a connection member, the sheath loaded with the clip row, the operation wire arranged in the sheath in a movable manner and connected to the connection member at its leading end in a detachable manner to draw the clip row, a plurality of spacers for holding the center axis of the sheath and the center axis of the operation wire on the same axis, and the operation part provided on the base end side of the sheath to operate the operation wire so as to advance and retract the same with respect to the sheath and the interval between the inner surface of the sheath and the outer surface of the operation wire is kept constant by the spacers. <P>COPYRIGHT: (C)2010,JPO&INPIT

Description

  The present invention relates to an endoscopic clip treatment tool used for hemostasis, wound closure, occlusion, and the like in a living body, and more particularly to a repetitive clip treatment tool that can be used in a repetitive manner.

  In recent years, an endoscopic clip treatment tool has been used to project a clip from the distal end of an endoscope inserted into a living body, pick a treatment portion after removal of a bleeding part or a lesion tissue with a clip, and stop or stop a hemostasis or wound. Is used to do.

  For example, as a clip treatment tool, Patent Document 1 discloses that a flexible ring support tube made of a coil is inserted into a sheath made of a resin tube so as to be relatively movable in the axial direction, and between the sheath and the ring support tube. For an endoscope in which a bending operation wire is inserted and arranged between them, a clip operation wire is inserted into the ring support tube, and one clip is removably engaged with the tip of the clip operation wire via a connecting member. A clip device is disclosed. In Patent Document 1, a sheath made of a resin tube and a flexible ring support tube made of a coil pipe are formed as separate bodies so as to be able to move forward and backward relative to each other. It is made to curve, and the affected part etc. which an endoscope can approach only from an oblique direction are easily clipped from the front, and a reliable hemostasis treatment etc. can be performed.

  Further, in Patent Document 2, a plurality of clips are alternately turned 90 degrees by engaging the front end claw portion of the rear clip with a connecting hole formed in the rear end portion of the front clip. Directly connected, the rear ends of the connected clips are releasably engaged with the distal end of the operation wire via the connecting member, and the connected clips are arranged in the sheath distal end. An endoscope clip device is disclosed in which an operating wire to be engaged is disposed in a sheath so as to be movable back and forth in the axial direction. In Patent Document 2, the sheath is formed by covering a coil pipe with a resin tube.

Japanese Patent Laid-Open No. 2003-608 JP 2006-187391 A

  Here, since a conventional endoscopic clip treatment tool such as the endoscopic clip device disclosed in Patent Document 1 has a thinner operation wire than the inner diameter of the sheath or ring support tube, the sheath or ring support If there is a relatively large space between the tube and the operation wire and the tube is bent during use, a difference occurs in the path length of the sheath or ring support tube and the operation wire due to the space.

Here, the cause of the difference in path length between the sheath or ring support tube and the operation wire in the conventional endoscopic clip treatment tool will be examined. Below, unlike patent documents 1 and 2, it explains as what a coil pipe itself constitutes a sheath.
First, as schematically shown in FIG. 15A, when the sheath 108 is in a linear state, the coil 102 constituting the sheath 108 has a wire rod 102a constituting the coil 102 in the axial cross section of the coil 102. The interval between them is equal. At this time, in the cross section in the axial direction of the coil 102 shown in FIG. 15A, the length in the axial direction of the upper portion and the lower portion of the center line of the coil 102 is equal, and this length is curved. Since the length in the axial direction of the center 104 of the non-sheath 108 is equal, the distance between the centers of both ends (not shown) of the sheath 108 is referred to as an effective distance in a straight line.

  Next, when the sheath 108 is curved, as schematically shown in FIG. 15B, the inner peripheral portion of the coil 102 is contracted in the B direction, and the outer peripheral portion of the curve is A. Extend in the direction. Here, the contraction length in the B direction and the extension length in the A direction are not equal because the contraction allowance in the B direction is small. Therefore, when the length along the axis of the sheath center 106 from one end to the other end (not shown) of the sheath 108 at the time of bending is defined as the effective distance at the time of bending, the effective distance at the time of bending is a portion on the outer peripheral side of the curve. In other words, the smaller the curvature radius, the longer the effective distance in a straight line.

  Next, in the clip treatment instrument shown in FIG. 16, the relationship between the sheath 108 and the operation wire 110 in a curved state is shown. The operation wire 110 moves back and forth in the sheath 108 in order to move a clip (not shown) attached to the tip of the operation wire 110 back and forth. However, the operation wire 110 needs to be rigid enough not to buckle due to its forward / backward movement. It is. Then, the operation wire 110 in the bending portion is subjected to a force that tends to be linear due to its bending rigidity, and therefore follows the outer peripheral side of the bending portion in the sheath 108, that is, the longest path. Thereby, the path followed by the operation wire 110 is a path longer than the effective distance at the time of bending, which is the length along the axis of the curved sheath center 106 from one end of the sheath 108 to the other end (not shown). Become.

  As shown in FIG. 16, when the operation wire 110 has taken the longest path, even if the operation wire 110 is advanced / retreated by the operation unit (not shown) at hand, in addition to the advance / retreat operation of the operation wire 110, The effective distance of the sheath 108 calculated along the sheath center 106 by the movement of the operation wire 110 along the outer peripheral side of the sheath 108 in the bending portion and moving toward the sheath center 106, and the like. There is a deviation from the effective distance, and the amount of movement of the operation wire 110 relative to the sheath 108 at the operation portion and the amount of movement of the operation wire 110 relative to the sheath 108 at the distal end of the sheath 108 do not match.

As described above, in the conventional endoscopic clip treatment tool, when the operation wire is thinner than the inner diameter of the sheath or the ring support tube, the operation wire may be attached to the sheath at the operation portion depending on the curved state of the sheath. The amount of movement relative to the sheath that has been moved forward and backward does not necessarily match the amount of movement of the clip at the distal end of the operation wire, and it may be difficult to obtain the optimum amount of movement.
However, in the case where the clip attached to the distal end portion of the operation wire is a single-shot clip treatment instrument as in the endoscope clip device disclosed in Patent Document 1, a minute amount of movement of the distal end of the long sheath Tow / adjust the wire with the operation section at hand, for example, pull the wire length of 1 mm or less of the operation wire on the distal end side of the sheath from the operation section side separated by about 2 m to prepare the next clip There was no need to perform such operations, and high traction accuracy was not required.
For this reason, in the case of one single-shot type clip treatment instrument disclosed in Patent Document 1, the difference in path length between the sheath or ring support tube and the operation wire is not a serious problem even if it is curved.

Further, as in the case of the endoscope clip device disclosed in Patent Document 2, when the clip attached to the distal end portion of the operation wire is a plurality of continuous clip treatment devices, the operation is performed in comparison with the inner diameter of the sheath or ring support tube. If the wire is thin and the sheath is bent, the amount of movement of the operation wire at the operation portion at hand and the amount of movement of the clip at the distal end portion of the operation wire do not match and cannot be adjusted to an accurate amount of movement. After using the second clip, there was a problem that the second clip could not be accurately prepared.
That is, in the case of a continuous-type clip treatment tool, when performing continuous clipping treatment, after using the first clip, the operation wire is moved forward and backward to prepare for the second clip. Since the amount of movement of the operation wire is not accurately transmitted to the clip at the tip, there is a problem that the tip of the operation wire cannot be moved with high precision, and the preparation work for the second clip takes time and effort. .

  The object of the present invention is to solve the above-mentioned problems and the problems of the prior art, and more accurately transmit the amount of movement of the operation wire at the operation part at the hand of the sheath to the operation wire tip part at the long sheath tip part. It is an object of the present invention to provide a repetitive clip treatment device that can accurately prepare a later clip after using the clip, and has improved operability and accuracy.

The present inventor is excellent in operability and accuracy capable of accurately preparing a subsequent clip after using the previous clip in order to solve the above problems and the problems of the prior art and achieve the above object. As a result of extensive research on the continuous clip treatment tool, when the outer diameter of the operation wire is smaller than the inner diameter of the sheath, there is a gap between the sheath and the operation wire, and when the sheath is bent, the sheath and the operation wire In the sheath having an inner diameter of 0.8 mm and an overall length of about 2 m, the knowledge that the operation wire having an outer diameter of 0.7 mm and the path difference of about 3.5 mm occurs at the distal end of the sheath is obtained. It has been found that the operation wire is approximately 3.5 mm inside the sheath at the distal end of the sheath.
On the other hand, there is also a problem of reducing the bending rigidity of the operation wire as much as possible. When the sheath inner diameter and the outer diameter of the operation wire are almost the same, there is little clearance between the sheath and the operation wire, and when the sheath is bent, strong rigidity occurs at the contact point due to contact with the operation wire. However, the bending rigidity can be reduced if the operation wire itself is as thin as possible.
For this purpose, it is necessary to further reduce the diameter of the operation wire. For example, an operation wire having an outer diameter of 0.7 mm can be used as an operation wire having an outer diameter of 0.4 mm. There is a problem that the path difference between the operation wires is further increased.

In order to suppress the path difference between the sheath and the thinned operation wire, there are methods of using a spacer to hold the sheath and the operation wire substantially on the same axis, or making the sheath inner diameter closer to the outer diameter of the operation wire. When the inner diameter of the sheath is brought closer to the outer diameter of the operation wire, the above-mentioned bending rigidity problem occurs. In addition, when a flexible coil sheath in which a metal wire is closely wound around the sheath is used, there is a problem in that the cost increases in order to further reduce the diameter of the sheath.
In view of this, the present inventor decided to attach a plurality of spacers to the operation wire in order to hold the central axis of the sheath and the central axis of the operation wire coaxially in order to reduce the path difference while suppressing the bending rigidity. . As a result, the difference in path length can be eliminated, and the amount of movement of the operation wire at the operating part at hand can be accurately and accurately transmitted to the amount of movement of the clip at the tip, so that the movement accuracy of the tip of the operation wire is highly accurate. It has been found that the preparation work for the next clip can be performed easily and accurately in a short time, and the bending rigidity of the operation wire can be suppressed, and the present invention has been achieved.

  In order to solve the above-mentioned problems, the present invention provides a clip row comprising a plurality of clips connected by engaging the leading end of a rear clip with the rear end of the previous clip and a connecting member connected to the rearmost clip. A sheath in which the clip rows of the plurality of clips are loaded, and a movably disposed in the sheath, and a tip of the sheath is detachably connected to the connection member to pull the clip rows of the plurality of clips An operation wire, a plurality of spacers for coaxially holding the central axis of the sheath and the central axis of the operation wire, and a proximal end side of the sheath, the advancement / retraction of the operation wire with respect to the sheath An operation portion that can be operated in such a manner that the distance between the inner surface of the sheath and the outer surface of the operation wire is maintained constant by the spacer. It is to provide a multiple clip treatment tool for.

Here, it is preferable that the plurality of spacers are provided in a portion from the distal end side to the proximal end side of the operation wire.
Moreover, it is preferable that the space | interval between the said adjacent spacers is equal intervals.
Moreover, it is preferable that the space | interval between the said adjacent spacers differs in each part of the said sheath.
Moreover, it is preferable that the space | interval between the said adjacent spacers in the front end side of the said sheath is narrower than the space | interval between the said adjacent spacers in the said base end side.
Moreover, it is preferable that the plurality of spacers also serve as sliding members that reduce frictional resistance with the inner wall of the sheath.

According to the present invention, by inserting the spacer between the operation wire and the sheath, the path of the operation wire is made substantially coincident with the center of the sheath, and the movement amount of the operation wire in the operation portion by the advancing / retreating operation is kept as it is. The amount of movement of the operation wire at the tip can be set, and when performing clipping treatment, the amount of movement of the operation wire of the operation portion can be accurately transmitted to the tip, making work such as clipping treatment easy. can do.
Further, according to a preferred aspect of the present invention, the spacer can also serve as a sliding member that reduces sliding resistance, so that the operation wire can be operated smoothly, loss due to wear of the sheath and the operation wire can be prevented, and durability can be improved. Can be raised.

  Furthermore, according to another preferred aspect of the present invention, the distance between the spacers on the distal end side of the sheath is made narrower than that on the proximal end side, so that the path of the operation wire can be routed even in a curved portion having a small curvature radius. The amount of movement of the operation wire in the operation section that is substantially the same as the center of the sheath can be used as it is as the amount of movement of the operation wire at the distal end of the sheath. Thus, the amount of movement of the operation wire can be accurately transmitted to the tip, and operations such as clipping can be facilitated.

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

  First, a first embodiment of the present invention will be described. FIG. 1A is a schematic partial cross-sectional view showing the main part of one embodiment of a repetitive clip treatment device of the present invention, and FIG. 1B is an angle different from that of FIG. 1A by 90 degrees. FIG. 2A is a partial cross-sectional plan view showing a schematic configuration of an embodiment of the operation unit on the proximal end side of the repetitive clip treatment instrument shown in FIG. 1A, and FIG. It is the fragmentary sectional front view seen from the angle which differs 90 degrees from 2 (A). 3A is a schematic cross-sectional view showing the distal end side of the repetitive clip treatment device shown in FIG. 1A in more detail, and FIG. 3B is 90 degrees different from FIG. 3A. It is sectional drawing seen from the angle.

As shown in FIGS. 1A and 1B, the clip treatment device 10 is a repetitive clip treatment device in which a plurality of clips can be used continuously, and a plurality (5 in the example shown in FIG. 3A). ) Clips 12 (12A, 12B, 12C, 12D, and 12E (see FIG. 3A)) and a connection ring 14 (14A) that covers the engaging portions of adjacent clips 12 and maintains the connection state of the clips 12. , 14B, 14C, 14D, and 14E (see FIG. 3A)), a sheath 16 that movably accommodates the clip 12 connected by the connecting ring 14, and a dummy connected to the rearmost clip 12E. A clip 18, an operation wire 20 connected to the dummy clip via the connection member 19, a plurality of spacers 48 that hold the operation wire 20 coaxially with the sheath 16, the sheath 16, and And a push evacuable attaching operation unit 50 (see FIG. 2 (A) and (B)) at their proximal end to create the wire 20. The clip 12, the connecting ring 14, the dummy clip 18, the operation wire 20, and the spacer 48 are accommodated inside the sheath 16 so as to be movable.
FIGS. 1A and 1B show an initial state immediately before the start of the clip treatment operation by the head clip 12.

  One clip 12 and one connection ring 14 constitute one hemostatic clip body for an endoscope, and the clip treatment tool 10 is a plurality of the hemostatic clip bodies loaded inside the distal end of a long sheath 16. It is. The end of the continuous hemostatic clip body is engaged with and coupled to 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 described later. By pulling the operation wire 20 from the operation unit by a predetermined length 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 the leading clip 12 holds it. A clip treatment (clipping) for hemostasis or marking by the leading clip 12 is performed by being tightened by the connection ring 14. After the clip treatment with 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 then the clip treatment is performed. Can do.

  3 (A) and 3 (B) show a 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. 8 (A) described later is used. As shown, the leading clip 12A is set in a state of being completely contained within the sheath 16. 3A and 3B, five clips 12 are provided as a five-shot clip treatment device 10, but the number of clips 12 may be two or more.

  FIG. 4 is a perspective view of the clip of the repetitive clip treatment tool shown in FIG. As shown in the figure, the clip 12 is a closed clip having a turn part 24 turned 180 degrees with respect to the claw part 22. That is, the clip 12 is made by bending a single elongated plate 180 degrees to form a closed end, and then intersecting the two pieces and bending the two open ends so that the ends are opposed to each other. 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, 30 that are partially wide are formed at the central portions of the arm portions 28, 28. The clip 12 can be made of a biocompatible metal, such as SUS631 that is stainless steel for springs.

  The clip 12 is moved by a predetermined amount toward the claw portions 22 and 22 while the front end portion (clamping portion 40 described later) of the connecting ring 14 fitted to the intersecting portion 26 presses the arm portions 28 and 28. By doing so, the arm portions 28 and 28 and the claw portions 22 and 22 are closed, and a predetermined fitting force is exhibited in the claw portions 22 and 22.

The nail | claw parts 22 and 22 are formed in the V-shaped male type | mold and female type | mold in order to pick up target parts, such as a treatment part after a bleeding part and a lesioned tissue removal, reliably. Further, as shown in FIG. 4, the arm portion 28 of the clip 12 is gradually widened from the intersecting portion 26 to the convex portion 30.
The convex portion 30 has a width wider than the portion of the opening on the distal end side and the opening on the proximal end side of the connection ring 14 with which the convex portion 30 abuts. Therefore, portions other than the convex portion 30 of the clip 12 can enter the inside of the connecting ring 14, but the convex portion 30 cannot enter the inside from the front end side or the base end side of the connecting ring 14.

  As shown in FIGS. 3 (A) and 3 (B), the first clip 12A and the second clip 12B are closed with the claw portion 22 of the second clip 12B engaged with the turn portion 24 of the first clip 12A. The connection state is established by being held by the connection ring 14A. As shown in FIG. 3 (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 , They are connected in different directions by 90 degrees. Similarly, the following clips 12C, 12D, and 12E are connected with their orientations alternately changed 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 engagement portion between the two clips 12 and 12 and maintaining the connection state. In other words, the outer diameter of the connection ring 14 is substantially equal to the inner diameter of the sheath 16, and can smoothly move forward and backward within the sheath 16 as the clip 12 moves.
FIGS. 5A to 5C each show a schematic configuration of an embodiment of such a connection ring. 5A is a front view of the connecting ring, FIG. 5B is a cross-sectional view, and FIG. 5C is a bottom view.

  The connection ring 14 shown in FIGS. 5A to 5C 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.

  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. That is, the convex portion 30 functions as a stopper that determines the movement limit of the connecting ring 14 that moves forward with respect to the clip 12.

The tightening portion 40 is set at a predetermined position in the vicinity of the intersecting portion 26 of the clip 12. The tightening portion 40 moves from the initial position to the convex portion 30 side from the intersecting portion 26 where the arm portion 28 of the clip 12 becomes wide, so that both the arm portions 28 of the clip 12 that has spread. , 28 is closed and fixed. 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 tightening portion 40 that can accommodate the turn portion 24 of the clip 12 is formed. A stepped portion for fitting the tightening portion 40 is formed on the outer surface of the distal end portion of the first region 32. The tightening portion 40 and the holding portion 42 are in a state in which they are loaded in the sheath 16 and a clipping operation. It is fitted with an interference fit that does not come off at times. Further, 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 connecting ring 14 main body.

  The skirt portion 38 has a distal end side, that is, an upper root in FIGS. 5A and 5B connected to the main body of the holding portion 42, and a lower spread portion is partly separated from the main body so as to extend in the radial direction. It spreads and closes. The skirt portions 38 are formed at two positions on both sides separated by 180 degrees at the same position in the pulling direction of the clip 12, that is, the vertical direction in FIG.

  The skirt portions 38 on both sides expand in a skirt shape as shown in FIG. 5A in a natural state where no external force is applied. 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 14 </ b> B of FIG. 3B, the skirt portion 38 is pushed inward to enter the internal space, and the skirt portion The inner peripheral side portion of 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 does not move in the rotation direction and the forward / backward direction in the connecting ring 14B. To 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. 3A, the skirt portions 38, 38 are released from the distal end of the sheath 16, and at the same time, are opened by their own elasticity to release the holding of the clip 12A. It becomes wider than the inner diameter of 16 to prevent the connecting ring 14 </ b> A from retracting into the sheath 16. In this state, the operation wire 20 is pulled and the clip 12A moves backward, whereby the connecting ring 14A moves forward relative to the clip 12A and tightens the clip 12A.

  Therefore, the skirt portion 38 needs to have elasticity so that it can be closed inward within the sheath 16 and spreads in a skirt shape when released from the external force from 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 claw portions 22, 22 of the next clip 12 that engages with the clip 12 held in the first region 32 are the previous clips. The closed end (tail) of the 12 turn parts 24 is held in a closed state.

  The second region 34 has a length substantially equal to the moving length required for the tightening portion 40 set at the initial position with respect to the clip 12 to complete the tightening of the clip 12 as the region length. That is, the second region 34 of the connection ring 14 holds the connection between the two clips 12 and 12 held therein while the clip 12 is retracted and tightened relative to the connection ring 14. In addition, the traction force of the rear clip 12 is transmitted to the front clip 12, and when the tightening is completed, the engaging portions of the two clips 12, 12 are disengaged from the second region 34, whereby the clip 12 , 12 are released.

  In the second region 34, as shown in FIG. 5C, a hole 43 having the same inner diameter as that of the proximal end portion of the first region 32 is formed, and grooves (concave portions) 43a are formed at two opposing positions. Is formed. 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. 5 (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. 5B) 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 connection ring 14B in FIG. 3B) is held by the closed skirt portion 38 of the first region 32 inside the sheath 16, Forward / backward movement and rotational movement are suppressed. Further, the next clip 12 that engages with the previous clip 12 (for example, the clip 12C in the connecting ring 14B in FIG. 3B) is held in a direction different by 90 degrees from the previous clip by the groove 43a of the second region 34. Thus, the rotational movement is suppressed, and the forward / backward movement is suppressed by engaging 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 connecting ring 14 is partially turned up by providing the slit 46, when connecting the front and rear clips 12, 12 before loading the clip 12 into the sheath 16, There is also an advantage that the connection ring 14 can be easily connected by turning the skirt.

  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 FIGS. 3A and 3B, the claw portions 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 of the second clip 12B and the third clip 12C is determined by the connection ring 14B, and the connection state of the third clip 12C and the fourth clip 12D is determined by the connection ring 14C and the fifth clip 12D and the fifth clip 12C. The connection state with the clip 12E is maintained by the connection ring 14D, and the connection state between the fifth clip 12E and the dummy clip 18 is maintained by the connection ring 14E.

  A dummy clip 18 that is not used for clip treatment is engaged with the rearmost clip 12E. The dummy clip 18 has a spring-like portion having a shape similar to that of the half on the open end side from the crossing portion 26 of the clip 12 at the tip, and the clip 12E is turned with the claw portion closed. The clip 12E is released when the claw is opened. A connection member 19 is provided at the proximal end portion of the dummy clip 18, and an operation wire 20 is connected to the connection member 19.

  The sheath 16 is, for example, a flexible coil sheath in which a metal wire is tightly wound. The sheath 16 accommodates an operation wire 20 into which the clip 12 is movably fitted on the distal end side and is connected to the clip 12 via a dummy clip 18 and a connection member 19. Connected to the operation unit 50. 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.

  The operation wire 20 moves the plurality of clips 12 forward and backward in a series of clip treatments. For example, the operation wire 20 is made of a metal wire and is housed in the sheath 16. One end of the operation wire 20 is clipped via the connection member 19 and the dummy clip 18. 12, the other end extends to the proximal end side of the sheath 16, and is connected to the operation unit 50. The operation wire 20 is desirably thin to prevent the occurrence of rigidity due to contact with the sheath 16 and to reduce the bending rigidity of the operation wire 20 itself.

As shown in FIG. 6, the spacer 48 holds the operation wire 20 coaxially with the sheath 16, that is, maintains a constant distance between the inner surface of the sheath 16 and the outer surface of the operation wire 20. The sheath 16 is slidably inserted. The operation wire 20 passes through the center portion of the spacer 48. Here, the spacer 48 is fixed to the operation wire 20, for example, bonded and fixed by bonding or the like, or mechanically fixed. In this case, the spacer 48 and the sheath 16 are not fixed, and the spacer 48 is configured to be slidable on the inner wall of the sheath 16 and moves together with the operation wire 20 to prevent the operation wire 20 from moving. There is nothing.
Here, since the spacer 48 is in contact with the inner wall of the sheath 16 when the operation wire 20 is advanced or retracted, sliding resistance is generated. In order to improve the operation of the operation wire 20, the spacer 48 also serves as a sliding member that reduces sliding resistance, that is, a material having a low friction coefficient, for example, a resin such as PTFE (polytetrafluoroethylene). It is preferable to do. As a result, the operation wire 20 can be operated smoothly, loss due to wear of the sheath 16 and the operation wire 20 can be prevented, and durability can be increased.

The spacer 48 may be attached to the operation wire 20 in any way, and there is no particular limitation. The spacing between the adjacent spacers 48 may be uniform or may be different in each part of the sheath 16, and the number thereof is not particularly limited, but is plural as shown in FIG. 7. Is preferred. In this case, as shown in FIG. 7, it is preferable that a plurality of sheaths 16 are provided over the entire length. By doing so, even when the sheath 16 is bent, the operation wire 20 can be held at the center of the sheath 16 more accurately and reliably.
In the first embodiment of the present invention, as shown in FIG. 7, the plurality of spacers 48 are preferably provided from the distal end portion to the proximal end portion of the operation wire 20. As shown in FIG. 4, it is preferable that the gaps are provided at regular intervals. As a result, the plurality of spacers 48 provided on the operation wire 20 are arranged at equal intervals in the sheath 16 over the entire length thereof.
Thus, since the operation wire 20 is held at the sheath center 100 by the plurality of spacers 48, the path of the operation wire 20 is the sheath even if the sheath 16 is curved, that is, the curved portion of the sheath 16. It almost coincides with the center 100.

As a result, the length of the operation wire 20 existing in the sheath 16 can be the same as the length of the sheath 16, and the movement amount (distance) of the operation wire 20 in the operation unit 50 at the hand of the sheath 16 and the sheath The movement amount (distance) of the operation wire 20 at the 16 tips can be made the same. Therefore, the amount of movement of the operation wire 20 at the operation portion 50 at the hand of the sheath 16 can be more accurately transmitted to the distal end portion of the operation wire 20 at the distal end portion of the sheath 16, and after the use of the previous clip 12 The clip 12 can be accurately prepared.
In the above-described example, the spacer 48 is fixed to the operation wire 20, and the spacer 48 slides in the sheath 16 as the operation wire 20 moves. However, the present invention is not limited to this. On the contrary, the spacer 48 may be similarly fixed to the sheath 16, and the operation wire 20 may be slidably penetrated through the central portion of the spacer 48.

Next, with reference to FIG. 2 (A) and (B), the operation part which operates an operation wire and a sheath is demonstrated.
As shown in these drawings, the proximal ends of the operation wire 20 and the sheath 16 are attached to the operation unit 50. In these drawings, the operation unit 50 has a left end on the distal end side connected to the operation wire 20 coupled to the clip 12 and the sheath 16 for housing the clip 12, and a right end on the rear end side operated by the operator. (Or a proximal end side), and includes a wire operation handle 52 that is an operation portion main body and a sheath operation handle 54 having a gripping portion function for gripping the proximal end portion of the sheath 16. Here, the sheath operation handle 54 is configured to be slidable relative to the wire operation handle 52.

The wire operation handle 52 includes a cylindrical case 58, a positioning pipe 56 that is fixed to the tip of the case 58 with its axis aligned, and a lever 60 and a spring 62 that are held inside the case 58. .
The lever 60 is held inside the case 58 so as to be movable in the front-rear direction (the axial direction of the wire operation handle 52). A part of the rear end side of the lever 60 appears in a through window 59 provided in the central portion of the case 58 so that the operator can pull the lever 60 toward the rear end side by placing a finger. A spring 62 is attached to the rear end of the lever 60. The spring 62 is compressed by pulling the lever 60 backward, and when the force pulling the lever 60 is released, the spring 60 pushes the lever 60 forward by a repulsive force. Thereby, the lever 60 returns to the original position (home position).

The rearward movement limit of the lever 60 is defined by the through window 59. That is, the position at which the surface 60 a on which the finger of the lever 60 is applied coincides with the rear end of the through window 59 is the movement limit of the lever 60. Note that a restriction plate may be provided behind the lever 60, and the rearward limit of the lever 60 may be defined by the rear end of the lever 60 hitting the restriction plate.
On the other hand, a regulating plate 61 is provided in front of the lever 60 to define the home position of the lever 60. The lever 60 is urged by the spring 62 and moves forward, stops against the restriction plate 61, and returns to the home position.
Thus, the lever 60 can move only a certain amount from the home position to the rearward movement limit in the front-rear direction.
In FIG. 2A, the spring 62 is shown as a coil spring. However, the spring 62 only needs to be able to bias the lever 60 forward, and a biasing means such as a leaf spring or other elastic body may be used. good.

An operation wire 20 for pulling the clip 12 is fixed to the tip of the lever 60. The operation wire 20 passes through the sheath operation handle 54 and the positioning pipe 56 and reaches the lever 60.
When the operator inserts a finger into the penetrating window 59 and pulls the lever 60 so that the lever 60 moves backward, the operation wire 20 attached to the tip of the lever 60 also moves in the same manner, and the tip of the operation wire 20 is moved. Moves backward. When the pulling force of the lever 60 is released and the lever 60 returns to the original position, the operation wire 20 moves in the same manner, and the tip thereof returns to the original position.

  Since the pulling amount of the operation wire 20 in the clip treatment is a very small amount such as 3.1 mm, for example, the pulling amount of the operation wire 20 and the operation amount of the lever 60 are given in order to give a reliable operation feeling in the operation unit 50. Between them, a mechanism for changing the pulling amount of the operation wire 20 may be provided, and the movement amount of the lever 60 may be a predetermined multiple of the movement amount of the operation wire 20.

The positioning pipe 56 is a hollow pipe-like member through which the operation wire 20 passes. Further, the inner diameter of the positioning pipe 56 is larger than the outer diameter of the sheath 16, and the sheath 16 can be inserted into the positioning pipe 56. As shown in FIG. 2B, a plurality of notches 66 are formed on the upper surface of the positioning pipe 56 at a predetermined interval L in the axial direction. The distal end portion of the positioning pipe 56 is inserted into the sheath operation handle 54, and a retaining ring 64 is attached to the distal end portion.
As shown in FIG. 2A, a hole slightly larger than the outer diameter of the sheath 16 is formed at the center of the retaining ring 64. The retaining ring 64 holds the sheath 16 so as to be movable in the axial direction.

The sheath operation handle 54 includes a cylindrical case 68, a support block 70, and a sheath holding ring 72.
The support block 70 is disposed at the rear end portion of the sheath operation handle 54 and supports the positioning pipe 56 inserted into the sheath operation handle 54 so as to be slidable. Further, as shown in FIG. 2B, the support block 70 has a surface on the tip side abutting against a retaining ring 64 attached to the tip of the positioning pipe 56, and the positioning pipe 56 is connected to the sheath operation handle 54. To prevent it from coming off.

  The sheath holding ring 72 is provided at the distal end of the case 68 on the axis line of the sheath operation handle 54 and fixedly holds the outer periphery of the sheath 16 inserted into the sheath operation handle 54. Accordingly, when the sheath operation handle 54 moves, the sheath 16 also moves.

  The sheath operation handle 54 further includes a button 74 protruding outside the case 68 and a claw 76 provided inside the case 68 and interlocking with the movement of the button 74. The claw 76 is urged in a direction to be pressed against the positioning pipe 56 and is hooked on the notch 66 of the positioning pipe 56 to determine the position of the sheath operating handle 54 with respect to the wire operating handle 52 and stop the movement.

When the button 74 is pressed, the claw 76 is lifted and rides up from the notch 66, and the sheath operation handle 54 can move with respect to the wire operation handle 52. When the sheath operating handle 54 is moved relative to the wire operating handle 52 by releasing the button 74, the movement is stopped when the claw 76 is caught by the next notch 66. Therefore, the sheath operation handle 54 and the sheath 16 can move in the unit L of the length of one stroke with the interval L of the notch 66 as one stroke. This L is, for example, 15.5 mm.
When the sheath 16 moves with the movement of the sheath operation handle 54, the proximal end of the sheath 16 advances through the hole of the retaining ring 64 and enters the positioning pipe 56.

  Next, with reference to FIGS. 8 (A) to 8 (E) and FIGS. 1 (A), (B), 6 and 7, the operation of the continuous clip treatment device of the present invention will be described. 8 (A) to 8 (E) are partial cross-sectional views showing a stepped state during the clip treatment operation of the repetitive clip treatment tool of the present invention.

  First, as shown in FIG. 8A, after five hemostatic clip bodies (hereinafter simply referred to as clip bodies) including clips 12A to 12E and connecting rings 14A to 14E are loaded on the sheath 16, Inserted into the forceps channel of the endoscope. 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. Each of the connection rings 14A to 14E is fitted so that the tightening portion 40 comes to an initial position in the vicinity of the intersecting portion 26 of the clips 12A to 12E. At this time, the upper ends of the convex portions 30 of the clips 12B to 12E are positioned directly below the coupling rings 14A to 14D, 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, in the operation unit 50 shown in FIGS. 2 (A) and 2 (B), the sheath The sheath operating handle 54 is pulled so that the claw 76 of the operating handle 54 moves from the first notch 66 to the second notch 66 by a length L. Since the sheath 16 is fixed to the sheath operation handle 54, the sheath 16 moves backward by the same amount L as the movement amount L of the sheath operation handle 54. By this operation, the operation wire 20 does not move, and only the sheath 16 is pulled toward the operation unit 50. At this time, as shown in FIGS. 6 and 7, since the operation wire 20 is held at the approximate center of the sheath 16 by the spacer 48, the distal end of the sheath 16 is against the spacer 48 fixed to the operation wire 20. The same movement amount L is also applied to the connection hemostatic clip body (clip 12 (all clips 12A to 12E) + connection ring 14 (all connection rings 14A to 14E)) that slides and is connected to the operation wire 20 and the tip thereof. (See FIGS. 1A and 1B).

When the sheath 16 is pulled by a predetermined amount L corresponding to the distance between the first notch 66 and the second notch 66, the distal end of the sheath 16 is accurately moved by the moving amount L with respect to the connected hemostatic clip body, and the head The skirt portion 38 of the connecting ring 14A is lowered to the open position, and the claws 22 and 22 of the clip 12A protruding from the sheath 16 are spread by the urging force to be in the state of FIG. As a result, the first clip 12A can be used. In FIG. 8B, 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.

  When the sheath 16 is pulled, a frictional force acts between the sheath 16 and the connection rings 14 </ b> A to 14 </ b> E fitted into the sheath 16. However, between the connecting rings 14A to 14E and the clips 12A to 12E, the pressing force of the clip 12 by the inner portion of the closed skirt portion 38 and the spring to open the claw portion 22 of the rear clip 12 are opened. A pressing force is applied to the inner wall surface of the connecting ring 14 (second region 34, see FIG. 5) by force. Further, the protrusions 30 of the clips 12B to 12E abut against the base ends of the connection rings 14A to 14D and cannot enter the holes 43 (see FIG. 5) of the connection ring 14. Therefore, even if the sheath 16 is pulled, the connection rings 14A to 14E do not move unnecessarily. Therefore, the connection rings 14A to 14E can maintain the state in which the clips 12A to 12E are held, respectively.

  Next, the clip treatment tool 10 in the state of FIG. 8B is moved, and the claw portions 22 and 22 of the expanded clip 12A are pressed against the portion to be clipped, and the lever of the operation unit 50 (see FIG. 2). By pulling 60, the operation wire 20 is pulled by a predetermined amount. By pulling the operation wire 20, all the clips 12A to 12E engaged in order from the dummy clip 18 are pulled uniformly. Also in this case, since the operation wire 20 is held at the approximate center of the sheath 16 by the spacer 48, the pulling amount of the lever 60 can be accurately adjusted at both the proximal end and the distal end of the sheath 16. The connected hemostatic clip body transmitted as the pulling amount and connected to the distal end of the operation wire 20 can be pulled more accurately by the same pulling amount (see FIGS. 1A, 1B, 6 and 7).

  At this time, in the state shown in FIGS. 8B and 8C, the skirt portion 38 of the connecting ring 14A that protrudes from the distal end of the sheath 16 is open, and the pressing and holding of the clip 12A by the skirt portion 38 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. Therefore, as shown in FIG. 8C, 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 accurately pushed down to just below the convex portion 30 of the clip 12A, the tightening of the clip 12A by the connection ring 14A is reliably completed.

  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 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 accurately and reliably.

On the other hand, the subsequent clips 12B to 12E are held so as not to move in the rotational direction and the forward and backward direction with respect to the connection rings 14B to 14E by the connection rings 14B to 14E with the skirt portion 38 closed. Furthermore, the claw part 22 is caused to expand in the second region of the coupling rings 14B to 14E by the force (biasing force) of the claw part 22 of the clips 12C to 12E engaging with the clips 12B to 12E and the claw part of the dummy clip 18. 34 (see FIG. 5), and the frictional force between the clips 12B to 12E and the connection rings 14B to 14E is increased. Therefore, the connection rings 14B to 14E move accurately with the movement of the clips 14B to 14E.
That is, the clips 12B to 12E and the connecting rings 14B to 14E other than the leading clip 12A and the connecting ring 14A that holds the leading clip 12A move forward and backward with respect to the sheath 16, and the clips 14B to 14E and the dummy clip 18 are connected. The state is maintained by connection rings 14B-14E.

  The operation wire 20 is configured so that it can be more accurately pulled from the initial state with respect to the sheath 16. The fixed amount is equal to or slightly larger than the region length of the second region 34 of the connecting ring 14 and at the same time holds the clip 12 from the lower end of the convex portion 30 of the clip 12. The amount is equal to or slightly smaller than the length to the tip of the connecting ring 14. This fixed amount is determined by the length from the home position of the lever 60 to the rearward movement limit in the operation unit 50 of FIG.

  The operation wire 20 is pulled back by a certain amount by a spring 62 that biases the lever 60 of the operation unit 50, and then immediately returns by the certain amount. When the operation wire 20 pulled from the state of FIG. 8B to the state of FIG. 8C releases the pulling force of the lever 60 in the operation unit 50, the lever 60 returns to the original position, thereby the operation wire. 20 returns to the original position, and the state shown in FIG. That is, the tip of the second clip 12B returns to a position that substantially coincides with the tip of the sheath 16 as in FIG. 8B.

  Next, in order to make the second clip 12B usable, the sheath 16 is pulled by a predetermined stroke, that is, by a predetermined moving length L. 2A, the sheath operation handle 54 is moved from the second notch 66 to the third notch 66 by a length L. In the operation unit 50 shown in FIG. 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. .

  The length L for one stroke of pulling the sheath 16 is substantially equal to the distance between the tips of the two front and rear clips 12 loaded in the sheath 16, that is, the loading interval of the clips 12 in the sheath 16. Further, the length L for one stroke for pulling the sheath 16 is determined by the length between the notches 66 of the operation unit 50.

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 connection ring 14B is completed accurately and reliably, 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 accurately and reliably.
Thereafter, in the clip treatment tool 10 of the present invention, the clip treatment with the clips 12C, 12D, and 12E can be sequentially and accurately performed in the same manner.

Here, in the clip treatment instrument 10 of the present invention, as shown in FIG. 7, the operation wire 20 to be advanced and retracted in the above-described series of clip treatments has a certain amount from the proximal end portion to the distal end portion. Spacers 48 are attached that are slidable relative to the sheath 16 at intervals. For this reason, since the operation wire 20 is held at the sheath center 100 by the spacer 48, the path of the operation wire 20 substantially coincides with the sheath center 100 even in the curved portion.
Since the path of the operation wire 20 substantially coincides with the sheath center 100, the movement amount of the operation wire 20 due to the bending of the sheath 16 can be suppressed, and the clip treatment by the clip 12 at the distal end of the sheath 16 can be performed accurately and reliably. It can be carried out.

  Moreover, in the clip treatment tool 10 of this invention, since the connection part of the clip 12 is covered and hold | maintained with the connection ring 14 as mentioned above, the connection state of the some clip 12 is maintained reliably. 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 12 can be clipped by the leading clip 12 at the same time, and the next clip 12 can be used by pulling the sheath 16 by a predetermined length L toward the operation portion side. The clip treatment can be performed subsequently.

  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 at the corner portion of the connecting portion of the clip 12 at the time of a clip treatment operation or the like, and the sheath 16 is used as an endoscope. The possibility of twisting and distortion of the clip 12 at the connecting portion is extremely small even when the connector is inserted.

  Further, by arranging the spacer 48 on the operation wire 20, the path of the operation wire 20 can be made to substantially coincide with the sheath center 100 of the sheath 16, so that the movement amount of the operation wire 20 by the operation portion 50 due to the advance / retreat operation Can be transmitted as the amount of movement of the operation wire 20 at the distal end of the sheath 16 more accurately as it is, and when performing clipping treatment or the like, the amount of movement of the operation wire 20 of the operation unit 50 can be accurately transferred to the clip 12. The operation of the clip 12 at the distal end of the sheath 16 by the operation wire 20 in the operation unit 50 can be performed easily and reliably, and operations such as clipping treatment by the clip 12 can be performed easily and reliably. be able to.

Next, a second embodiment of the present invention will be described.
FIG. 9 is a schematic partial cross-sectional view showing another embodiment of the repetitive clip treatment device according to the second embodiment of the present invention, and shows the positional relationship between the sheath, the operation wire, and the spacer of the clip treatment device. It is sectional drawing.
The clip treatment tool 11 according to the second embodiment of the present invention shown in FIG. 9 is arranged between the clip treatment tool 10 according to the first embodiment of the present invention shown in FIG. 7 and the spacer 48 disposed on the operation wire 20. The sheath 16 shown in FIGS. 1A and 1B and FIGS. 3A and 3B has the same configuration as that of the clip treatment instrument 10 shown in FIG. The configuration of the connected hemostatic clip body (all the clips 12A to 12E) at the tip of the head and the operation unit 50 shown in FIGS. 2 (A) and 2 (B) can be applied, compared with the clip treatment tool 10 shown in FIG. The arrangement interval of the spacers 48 arranged on the wire 20 is such that the distal end side has a higher density than the proximal end side of the sheath 16, that is, the interval is narrower. Basically the same as ingredient 10. Because, like reference numerals denote like elements, and detailed description thereof will be omitted. In the following, differences between the clip treatment tool 11 of the present embodiment and the clip treatment tool 10 shown in FIG. 7 will be mainly described.

When the clip treatment tool 10 is used with an endoscope, the body cavity such as the stomach, esophagus, small intestine, and large intestine into which the endoscope is inserted is curved. The distal end side of the endoscope needs to be curved, and for example, a case where the curvature is 25 mm is considered. At this time, the distal end portion of the sheath 16 also has a curvature radius of 25 mm at the same time as the curvature of the endoscope. If the interval between the adjacent spacers 48 is wider than the circumferential length of the curved portion, The effect is not sufficiently exhibited, and the longest path of the operation wire 20 due to bending is more likely to occur at the distal end portion of the sheath 16 than at the proximal end portion.
Therefore, the distance between the adjacent spacers 48 on the distal end side of the sheath 16 is narrower than that on the proximal end side, thereby reducing the path difference between the sheath center 100 and the operation wire 20 at the curved portion of the sheath 16. it can.

As a result, the path of the operation wire 20 substantially coincides with the sheath center 100 of the sheath 16 even in a curved portion having a small radius of curvature, and the amount of movement of the operation wire 20 due to the advance / retreat operation of the operation portion is unchanged. The amount of movement of the operation wire 20 at the distal end portion of the operation portion is determined, and when the clipping treatment or the like is performed, the movement amount of the operation wire 20 of the operation portion is accurately transmitted to the distal end portion, thereby facilitating the work such as clipping treatment.
Moreover, it is preferable that the spacer 48 also serves as a sliding member that reduces sliding resistance, as in the first embodiment.
Further, by narrowing or widening the interval between the adjacent spacers 48 in the middle of the entire length of the sheath 16, the density of the spacers 48 that are highly likely to be bent can be increased and bent. Of course, the arrangement of the spacers 48 can be optimized, for example, by reducing the density of the spacers 48 in the low-performance portion.

  Next, another example of the operation unit used in the continuous clip treatment tool of the present invention will be described. In the above embodiment, when the leading clip 12 is protruded from the sheath 16, the sheath 16 is pulled toward the hand side by the sheath operation handle 54 of the operation unit 50, and the sheath 16 is retracted from the clip 12. 12, the operation wire 20 connected to the clip 12 was pulled to the proximal side by the lever 60 of the operation unit 50, and the clip 12 was moved forward and backward with respect to the sheath 16. On the other hand, in the present embodiment, the sheath 16 is fixed, the clip 12 and the sheath 16 are relatively moved only by the forward / backward operation of the operation wire 20, and the clip 12 is protruded from the sheath 16; Take action.

  FIG. 10 is a cross-sectional view illustrating a schematic configuration of another example of the operation unit. The operation unit 120 shown in the figure can be used for a three-shot clip treatment device. In the clip treatment devices 10 and 11 of the first and second embodiments described above, three clips 12 are loaded and three-shot operation is performed. Can be used instead of the operation unit 50. Even when the operation unit 120 is used, the relative positional relationship of each part of the clip loading portion (the distal end portion of the sheath 16) in the clip treatment operation or the like is the same as in the above examples, and the operation wire 20 and the sheath are the same. The operation and effect obtained by inserting the spacer 48 between the first and second components is the same as in the above examples.

  The operation unit 120 is connected to the clip 12 and the sheath 16 on the left side in the drawing, and is operated by the operator on the right side in the drawing. In the following description, the left end in FIG. 10 is referred to as the distal end, and the right end is referred to as the proximal end.

  The operation unit 120 is provided on the outer side of the main body rail 122, a main body rail 122 that forms the center, a tip member 124 that is fixed to the front end of the main body rail 122, a finger hook ring 126 that is attached to the base end of the main body rail 122. The wire fixing member 128, the adjustment dial 130, the slider 132, and the lock dial 134, the slider guide 138 provided on the outer side of the tip member 124, and the position restriction mechanism 142.

  The proximal end of the sheath 16 is held at the distal end of the distal end member 124, and the proximal end of the operation wire 20 is held by the wire connecting portion 128 a of the wire fixing member 128. For example, the operator can place his / her thumb on the finger ring 126, his / her index finger and middle finger on the slider 132, and slide the slider 132 in the forward / backward direction with respect to the finger ring 126. When the slider 132 moves, the wire fixing member 128 also moves, and the operation wire 20 held by the wire connecting portion 128a also moves. On the other hand, the sheath 16 is connected to the finger ring 126 via the tip member 124 and the main body rail 122. Therefore, the operation wire 20 can be moved back and forth with respect to the sheath 16 by the movement operation of the slider 132 with respect to the finger ring 126. Hereinafter, the configuration of each unit of the operation unit 120 will be described in detail.

  As shown in FIG. 11, the main body rail 122 has a shape in which two rod members 122b and 122b having a substantially semicircular cross section extend from a cylindrical base end portion 122a. The two rod members 122b and 122b are arranged with a predetermined interval therebetween with the plane portions facing each other, and the curved surfaces of both members form one cylindrical surface. In other words, the rod members 122b and 122b have a shape in which the center of a cylinder that is coaxial with the base end portion 122a and thinner than that is scraped off with a predetermined width along the axis. In FIG. 10, the main body rail 122 has the bar member 122b on the front side in the figure removed, and the flat portion of the bar member 122b on the back side is displayed.

  The distance between the two rod members 122b and 122b is such that the wire connecting portion 128a of the wire fixing member 128 and the tip of the slider pin 136 attached to the slider 132 can be inserted. As shown in FIG. 10, the wire connecting portion 128 a and the slider pin 136 are inserted between the two rod members 122 b and 122 b and guided by the rod members 122 b and 122 b in the extending direction of the main body rail 122. Can move. That is, in the main body rail 122, the rod members 122b and 122b function as rails for the wire connecting portion 128a (wire fixing member 128) and the slider pin 136 (slider 132).

  The distal end member 124 is a cylindrical part having a flange-shaped portion 124a having a large diameter at the proximal end portion. The distal end of the body rail 122 is fixed to the end surface of the proximal end of the distal end member 124. The proximal end portion of the sheath 16 is inserted and held at the distal end of the distal end member 124. The operation wire 20 extends from the proximal end of the sheath 16 and penetrates the space inside the distal end member 124. The outer diameter of the cylindrical portion of the tip member 124 is substantially equal to the inner diameter of the tip portion of the slider guide 138 disposed outside the tip member 124, and the outer diameter of the flange-like portion 124 a is on the rear end side of the slider guide 138. It is almost equal to the inner diameter. As a result, the slider guide 138 can slide with respect to the tip member 124.

  The finger ring 126 is a part having a ring portion through which an operator can insert a finger, and is attached to the cylindrical base end portion 122 a of the main body rail 122.

  The wire fixing member 128 is a cylindrical member having an inner diameter substantially equal to the outer diameter of the two rod members 122b and 122b of the main body rail 122. A screw is cut on the outer peripheral surface of the proximal end portion of the wire fixing member 128. A wire connecting portion 128 a that protrudes toward the inner surface is formed at a substantially central portion in the axial direction of the wire fixing member 128. The proximal end of the operation wire 20 extending through the distal end member 124 is fixed at a position corresponding to the central axis of the wire fixing member 128 (that is, the central axis of the operation unit 120) of the wire connecting portion 128a. The operation wire 20 is covered with a reinforcing pipe 148 from the inside of the distal end of the sheath 16 to the range of the wire connection portion 128a, and is reinforced so as not to be broken inside the operation portion 120.

  The adjustment dial 130 is a cylindrical part with a flange fitted to the outside of the wire fixing member 128. A screw is cut on the inner peripheral surface of the base end side of the adjustment dial 130, and this screw portion is fitted to the screw portion of the wire fixing member 128. The adjustment dial 130 is advanced or retracted along the screw of the wire fixing member 128 according to the rotation direction by turning the flange portion by the operator. On the outer peripheral surface of the thin portion of the adjustment dial 130, a convex portion that engages with the concave portion of the slider 132 is provided over the entire circumference.

  The slider 132 has a pincushion shape so that the operator can easily move it in the forward / backward direction with his / her finger. A wire fixing member 128 is inserted through the slider 132. Further, the base end side portion of the slider 132 has a large inner diameter, and the adjustment dial 130 is inserted from the base end side. A concave portion that engages with the convex portion of the adjustment dial 130 is formed on the entire inner circumferential surface of the slider 132. Due to the engagement between the concave portion and the convex portion, the slider 132 moves integrally with the adjustment dial 130 in the axial direction, but the adjustment dial 130 and the slider 132 are rotatable in the circumferential direction.

  The lock dial 134 is a ring-shaped component in which a screw corresponding to the screw at the proximal end of the wire fixing member 128 is cut on the inner peripheral surface. After the position of the adjustment dial 130 is adjusted, the screw is tightened until the lock dial 134 comes into contact with the end face of the base end of the adjustment dial 130, thereby locking the position of the adjusted adjustment dial 130.

  The slider 132 and the adjustment dial 130 are engaged by a concave portion and a convex portion, and the adjustment dial 130, the lock dial 134, and the wire fixing member 128 are engaged by a screw portion. When these are moved in the middle and left and right directions), these four parts move together.

  The slider pin 136 is inserted and fixed to the tip portion of the slider 132 from the outside to the inside. The tip of the slider pin 136 reaches between the bar members 122b and 122b of the main body rail 122, and can move between the two bar members 122b and 122b.

  The slider guide 138 is a substantially cylindrical member provided outside the tip member 124. As described above, the inner diameter of the distal end portion of the slider guide 138 is substantially equal to the outer diameter of the cylindrical portion of the distal end member 124, and the inner diameter of the slider guide 138 on the proximal end side is the outer diameter of the flange portion 124a of the distal end member 124. The slider guide 138 is slidably supported by the flange-shaped portion 124a. Further, the outer diameter of the proximal end portion of the slider guide 138 is slightly smaller than the inner diameter of the slider 132, and can enter the inside of the slider 132 when the slider 132 moves to the distal end side. The slider guide 138 is rotationally moved with respect to the position restricting mechanism 142 at the tip of the slider guide 138 by an operation of the operator, and thus an inclined surface is formed on the outer surface so that the operator can easily hold it.

  A coil spring 144 is disposed between the flange portion 124 a of the tip member 124 and the inner surface of the slider guide 138 with the tip member 124 as the center. The coil spring 144 is a compression spring, and urges the slider guide 138 toward the distal end side against the distal end member 124 (the flange portion 124a), which is a fixed member, and presses the slider guide 138 toward the position regulating mechanism 142. The position regulating mechanism 142 is fixed to the tip member 124.

  With reference to FIGS. 12 and 13, the slider guide 138 and the position regulating mechanism 142 will be described in more detail. 12A is a perspective view of the slider guide 138, and FIG. 12B is a development view of a guide groove portion on the proximal end side of the slider guide 138. FIG. FIG. 13 is a perspective view of the position regulating mechanism 142.

  As shown in FIG. 12A, the joint portion 138a of the front end portion of the slider guide 138 with the position restricting mechanism 142 has a sawtooth-shaped convex portion with two inclined angles different in the circumferential direction on the end surface. Are formed at intervals of 90 degrees. The sawtooth-shaped convex portion has a gentle inclination angle on one surface and a substantially right angle on the other surface. Further, as shown in FIG. 13, the joint 142a of the rear end portion of the position regulating mechanism 142 with the slider guide 138 is also provided with four convex portions similar to the convex portion of the joint 138a of the slider guide 138. ing.

  Since the slider guide 138 is pressed against the position restricting mechanism 142 by the coil spring 144 while being engaged with the position restricting mechanism 142, the slider guide 138 rotates with respect to the position restricting mechanism 142 unless an external force is applied from the operator. do not do. Further, since the position restricting mechanism 142 and the slider guide 138 are engaged with each other by saw-tooth irregularities, when the operator tries to turn the slider guide 138 around the axis, the slider guide 138 has its joint 138a. And the convex portions of 142a rotate in the direction in which the steep slopes (substantially right-angled surfaces) are separated from each other, but do not rotate in the direction in which the opposite steep slopes abut. In the illustrated example, the slider guide 138 can rotate counterclockwise as viewed from the base end side (the right side in FIG. 12A), but cannot rotate clockwise.

  When the gentle slope of the joint portion 138a rotates along the gentle slope of the joint portion 142a of the position regulating mechanism 142 and the slider guide 138 rotates 90 degrees and overcomes the top of each other, the slider guide 138 meshes with the next unevenness. Thereby, the slider guide 138 rotates by 90 degrees.

  As shown in FIG. 12A, the cylindrical portion on the proximal end side of the slider guide 138 has four slider guide grooves 140A, 140B, 140C, and 140D extending along the rotation axis from the proximal end surface. , Formed at intervals of 90 degrees. As shown in FIG. 12B, the slider guide grooves 140A to 140D have different groove lengths. In the illustrated example, the slider guide groove 140A is the longest, and the slider guide groove 140D, the slider guide groove 140C, and the slider guide groove 140B become shorter in this order. In FIG. 10, the shortest slider guide groove 140B appears on the upper side in the drawing, and the second longest slider guide groove 140D appears on the lower side.

  The slider guide grooves 140 </ b> A to 140 </ b> D have a function as a guide groove for the slider pin 136, and the width of the groove is substantially equal to the diameter of the slider pin 136. Each time the slider guide 138 rotates 90 degrees, any one of the slider guide grooves 140A to 140D is arranged so as to coincide with the rail position of the main body rail 122, that is, the position between the two rod members 122b and 122b. Therefore, when the slider 132 moves in the forward / backward direction by the operation of the operator, the slider pin 136 is guided to the main body rail 122 at the tip portion and at the same time, the middle portion is guided to any of the slider guide grooves 140A to 140D. The amount of movement of the slider 132 is determined by the length of the slider guide grooves 140A to 140D.

  That is, the slider guide 138 regulates the limit of movement of the slider pin 136 moving along the main body rail 122 by the slider guide grooves 140 </ b> A to 140 </ b> D, thereby adjusting the slider 132 and the adjustment dial 130 moving together therewith. The movement positions of the wire fixing member 128 and the lock dial 134 are defined, and the movement position of the operation wire 20 connected to the wire fixing member 128 is defined.

  The movement limit on the base end side of the slider 132 or the like is defined by the position where the base end side end surface of the lock dial 134 contacts the front end side end surface of the base end portion 122 a of the main body rail 122.

The operation of the operation unit 120 will be described with reference to FIG.
FIG. 14 is a development view of the slider guide grooves 140A to 140D showing the positional relationship between the slider guide 138 and the slider pin 136 during the clip treatment operation. The position of the slider pin 136 when the slider 132 or the like is at the movement limit on the proximal end side is defined as a home position P1. The home position of the slider 132 is a position when the slider 132 is pulled to the most proximal end side, and is defined by the lock dial 134 coming into contact with the proximal end portion 122 a of the main body rail 122. When the slider pin 136 is at the home position P1, the distal end of the operation wire 20 is in a position retracted from the distal end of the sheath 16 by the amount of the three clips 12, the dummy clip 18, and the connecting member 19 (see FIG. 8). .

  First, the slider guide 138 is rotated to set the slider guide groove 140 </ b> A at a position that coincides with the slider pin 136. Next, when the slider 132 is moved forward and the slider pin 136 is moved to the maximum projecting position P2 at the tip of the slider guide groove 140A, the operation wire 20 is moved to the tip side by the length of the slider guide groove 140A. The tip of the operation wire 20 protrudes from the tip of the sheath 16 so that the connection member 19 can be attached to the operation wire 20. After the connecting member 19 is attached to the operation wire 20, the slider 132 is moved backward to return the slider pin 136 to P3 which is the same position as the home position P1, and the operation wire 20 is drawn into the sheath 16. As a result, the connection member 19 connected to the distal end of the operation wire 20, the dummy clip 18, and the subsequent three clips 12 are drawn into the sheath 16. Thereby, the loading of the clip into the sheath 16 is completed.

  Next, the slider guide 138 is rotated 90 degrees. As a result, the position of the slider pin 136 becomes the position P4 where the position in the axial direction is the same as the home positions P1 and P3 and the position in the circumferential direction is different by 90 degrees, and the slider pin 136 coincides with the position of the slider guide groove 140B. When the slider 132 is moved forward and the slider pin 136 is moved to the protruding position P5 at the tip of the slider guide groove 140B, the operation wire 20 and the clip 12 connected to the operation wire 20 corresponding to the length of the slider guide groove 140B are moved. Move to the tip side.

  Here, the length of the slider guide groove 140B is made to coincide with the amount of movement of the operation wire 20 until the leading clip 12 protrudes from the distal end of the sheath 16 and the skirt portion 38 of the connecting ring 14 opens. Therefore, by moving the slider 132 until the slider pin 136 reaches the protruding position P5, the leading clip 12 can be used (standby state).

  Subsequently, when the slider 132 is moved backward, at the time when the slider pin 136 moves to the clip completion position P6, the treatment operation portion at the distal end of the sheath 16 tightens the leading clip 12 with the connection ring 14 and Separation from the clip 12 is performed. This completes the first clipping procedure.

  Subsequently, the slider 132 is moved rearward, the slider pin 136 is returned to the same position P7 as the home position P4, and the slider guide 138 is rotated 90 degrees in the same direction as before for the next clip treatment. Is made to coincide with the home position P8 of the slider guide groove 140C.

  The slider guide grooves 140 </ b> C and 140 </ b> D are respectively matched with the movement amount of the operation wire 20 for causing the second and third clips 12 to protrude from the sheath 16. Thereafter, in the same manner as the first shot, the second and third clip treatments can be performed by sequentially moving the slider 132 forward, moving backward, and rotating the slider guide 138 by 90 degrees. it can.

  When the operation wire 20 is extended during long-term use, the following adjustment is performed. First, the lock dial 134 is loosened, and then the adjustment dial 130 is turned to move the adjustment dial 130 toward the distal end side with respect to the wire fixing member 128. Since the slider 132 is engaged with the convex portion of the adjustment dial 130, the slider 132 moves together with the slider 132 in the axial direction. However, since the adjustment dial 130 and the slider 132 are free to move in the rotational direction, only the adjustment dial 130 can rotate with respect to the slider 132 whose movement in the circumferential direction is restricted by the slider pin 136. When the adjustment dial 130 is moved by an amount corresponding to the loosening of the operation wire 20, the lock dial 134 is tightened again to lock the positions of the adjustment dial 130 and the slider 132.

  Since the home position of the slider 132 is defined by the lock dial 134 coming into contact with the base end portion 122a of the main body rail 122, the position of the slider 132 relative to the main body rail 122 at the home position does not change. On the other hand, by moving the adjustment dial 130 and the slider 132 toward the distal end side with respect to the wire fixing member 128, the wire fixing member 128 is moved rearward relative to the slider 132, and the wire connecting portion 128a is also connected. Move in the same way. Accordingly, the proximal end of the operation wire 20 at the home position moves backward, and the slack due to the extension of the operation wire 20 can be eliminated.

In each of the above examples, the clip 12 is connected by changing the direction by 90 degrees, but the present invention is not limited to this. 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).

  As described above, the continuous clip treatment device of the present invention has been described in detail. However, the present invention is not limited to the above embodiment, and various improvements and modifications are made without departing from the gist of the present invention. Also good. Moreover, the continuous clip treatment tool of the present invention can be used for a rigid endoscope as well as a flexible endoscope.

(A) And (B) is a typical fragmentary sectional view which shows the principal part of one Embodiment of the repetitive clip treatment tool of this invention, respectively. (A) And (B) is the partial cross-section top view and partial cross-section front view which show schematic structure of one Embodiment of the operation part used for the repetitive clip treatment tool shown in FIG. 1 (A), respectively. (A) And (B) is a fragmentary sectional view which shows in detail the front end side of the repetitive clip treatment tool shown in FIG. 1 (A), respectively. It is a perspective view of the clip of the repetitive clip treatment instrument shown in FIG. (A), (B), and (C) are the front view, sectional drawing, and bottom view of one Example of the connection ring of the repetitive clip treatment instrument shown in FIG. 1 (A), respectively. It is a typical fragmentary sectional view showing an example of arrangement to a sheath of a spacer of a repetitive clip treatment instrument shown in Drawing 1 (A). It is a typical fragmentary sectional view which shows the positional relationship of the sheath of the repetitive clip treatment tool shown in FIG. 1 (A), an operation wire, and a spacer. (A)-(E) is a fragmentary sectional view which shows the stepped state in the clip treatment operation of the repetitive clip treatment tool of FIG. 3, respectively. It is a typical fragmentary sectional view showing other embodiments of the repetitive clip treatment instrument of the present invention. It is sectional drawing which shows schematic structure of the other example of an operation part. It is a perspective view of a main body rail. (A) is a perspective view of a slider guide, and (B) is a development view of a guide groove portion on the base end side of the slider guide. It is a perspective view of a position control mechanism. It is an expanded view of the slider guide part which shows the positional relationship of the slider guide and slider pin at the time of clip treatment operation | movement. (A) And (B) is explanatory drawing of the sheath length at the time of the straight line and the curve of the sheath of a clip treatment tool, respectively. It is explanatory drawing which shows the positional relationship of the sheath and operation wire of the conventional clip treatment tool.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10, 11 Clip treatment tool 12 Clip 14 Connection ring 16 Sheath 18 Dummy clip 19 Connection member 19a Connection ring 19b Cover 20 Operation wire 20a Claw-shaped member 22 Claw part 24 Turn part 26 Intersection part 28 Arm part 30 Convex part 32 1st Area 34 Second area (connected holding area)
38 Skirt portion 40 Tightening portion 42 Holding portion 43 Hole 43a, 44 Groove 44a Inner wall 46 Slit 48 Spacer 50 Operation portion 52 Wire operation handle 54 Sheath operation handle 56 Positioning pipe 58, 68 Case 59 Through window 60 Lever 61 Restriction plate 62 Spring 64 Retaining ring 66 Notch 70 Support block 72 Sheath holding ring 74 Button 76 Claw 100 Sheath center 120 Operation part 122 Main body rail 124 Tip member 126 Finger ring 128 Wire fixing member 128a Wire connection part 130 Adjustment dial 132 Slider 134 Lock dial 136 Slider Pin 138 Slider guide 140A to 140D Slider guide groove 142 Position restriction mechanism 144 Spring 148 Reinforcement tube

Claims (6)

A clip row comprising a plurality of clips connected by engaging the tip of the rear clip with the rear end of the previous clip and a connecting member connected to the rearmost clip;
A sheath into which the clip row of the plurality of clips is loaded;
An operation wire that is movably disposed in the sheath, and whose tip is detachably connected to the connection member to pull the clip row of the plurality of clips;
A plurality of spacers for coaxially holding the central axis of the sheath and the central axis of the operation wire;
An operation portion that is provided on the proximal end side of the sheath and can be operated so as to advance and retract the operation wire with respect to the sheath;
A repetitive clip treatment instrument characterized in that the spacer maintains a constant distance between the inner surface of the sheath and the outer surface of the operation wire.   The continuous clip treatment tool according to claim 1, wherein the plurality of spacers are provided in a portion from the distal end side to the proximal end side of the operation wire.   The repetitive clip treatment tool according to claim 1 or 2, wherein the distance between the adjacent spacers is equal.   The repetitive clip treatment device according to claim 1 or 2, wherein a distance between adjacent spacers is different in each part of the sheath.   The continuous clip treatment device according to claim 4, wherein a distance between adjacent spacers on a distal end side of the sheath is narrower than a distance between adjacent spacers on the proximal end side.   The continuous clip treatment tool according to any one of claims 1 to 5, wherein the plurality of spacers also serve as sliding members that reduce frictional resistance with the inner wall of the sheath.

Images