JP2010022537A - Manipulating handle for successive clipping device and successive clipping device using same - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a manipulating handle and a successive clipping device having high operability, manufactured at a low cost and clipping a plurality of parts without pulling out a sheath whole body from an endoscope. <P>SOLUTION: This manipulating handle for a successive clipping device includes: the sheath; a manipulating wire disposed in the interior of the sheath and connected with a plurality of clips at the distal end; a cylindrical handle body connected to the sheath and disposed with the manipulating wire in an interior thereof; a slider movable on the outer circumference of the handle body in its axial direction and engaged with the manipulating wire for moving the manipulating wire in the axial direction of the handle body; and a slider-movement-amount regulating member attached onto the outer circumferential surface of the handle body so as to be rotatable in a circumferential direction of the handle body, for regulating an amount of movement of the slider in the axial direction of the handle body. The manipulating wire disposed in the interior of the sheath is moved in the extension direction of the sheath to solve the problem. <P>COPYRIGHT: (C)2010,JPO&INPIT

Description

  The present invention relates to a technical field of an endoscopic clip treatment tool used for hemostasis, wound closure, occlusion and the like in a living body, and more specifically, for a continuous clip treatment tool that can use a plurality of clips repeatedly. The present invention relates to an operation handle and a repetitive clip treatment tool using the same.

  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. Used to do A conventionally used endoscope clip is a clip in which one clip is detachably attached to the tip of an operation wire, and the entire sheath is pulled out of the endoscope each time a clip treatment is performed. A cumbersome work of setting the clip, inserting it again into the endoscope, and performing the next clipping is required.

On the other hand, Patent Document 1 describes a clip device for living tissue in which a plurality of clips are arranged in one sheath. Specifically, an introduction tube that can be inserted into a living body cavity, at least two or more operation wires that are inserted into the introduction tube so as to freely advance and retract, and an arm portion that has a base end portion and extends from the base end portion In a biological tissue clip device having a sandwiching portion formed at the tip thereof and having at least two clips, a plurality of clips are arranged in series in the introduction tube, and the clips and the operation wires are engaged with each other. A tissue clip device is described.
In Patent Document 1, as an operation unit of a clip device, an operation wire is connected to each clip, a knob connected to the operation wire is provided in the operation unit, and clipping is performed by individually operating the knob. The mechanism is described.
The knob is engaged with a slider provided in the operation unit. Furthermore, the slider has a ratchet mechanism, and allows the slider to move in the axial direction with respect to the base.

Japanese Patent Laid-Open No. 2002-272751

  By disposing a plurality of clips in a single introduction tube (hereinafter referred to as a sheath) like a biological tissue clip device (hereinafter also referred to as a clip treatment tool) described in Patent Document 1, the entire sheath is internally viewed. It is possible to perform clipping (that is, clipping treatment) at a plurality of locations without pulling out from the mirror.

However, the clip device described in Patent Document 1 has a problem in that the wire is attached to each grip and the number of components increases, so that the cost of the device increases and the number of manufacturing steps also increases.
In addition, since there is no restriction on the slider amount of the slider, it is necessary for the operator (operator) to perform an operation for projecting the clip from the sheath tip. Moreover, if the slider amount of the slider is increased and the tip of the next clip is protruded, it becomes difficult to operate the clip.
Moreover, since the knob is provided corresponding to each clip, there is a possibility that the order of operations may be wrong. If the unintended clip is pulled, the clip or the sheath may be damaged.
Thus, since operations such as slider operation and wire pulling with a knob are complicated, there is a problem that operability is poor and there is a high risk of erroneous operation.

  An object of the present invention is to solve the problems based on the above-described conventional technology, to be manufactured at a low cost with high operability, and to perform clipping at a plurality of locations without pulling out the entire sheath from the endoscope. An object is to provide an operation handle for a repetitive clip treatment instrument and a repetitive clip treatment instrument using the same.

  In order to solve the above-described problem, a first aspect of the present invention is a sheath, an operation wire disposed inside the sheath and having a plurality of clips coupled to a distal end thereof, coupled to the sheath, and disposed therein. A cylindrical handle main body in which the operation wire extending from the sheath is disposed, and mounted on the outer periphery of the handle main body so as to be movable in the axial direction thereof, engage with the operation wire, and A slider that moves in the axial direction of the handle body, and a slider movement amount regulating member that is mounted on the outer periphery of the handle body so as to be rotatable in the circumferential direction and regulates the movement amount of the slider in the axial direction of the handle body. The slider is moved in the axial direction of the handle main body, and the operation wire disposed inside the sheath is moved in the extending direction of the sheath. There is provided a multiple clip treatment tool operating handle, wherein the door.

Here, the slider moves on the outer periphery of the handle body, thereby moving the operation wire in the axial direction in the handle body, and moving the operation wire in the sheath in the extending direction. Preferably, the slider movement amount regulating member regulates the movement amount of the slider to at least a plurality of different movement amounts corresponding to the plurality of clips.
Further, the slider movement amount regulating member is formed in accordance with a plurality of different movement amounts along the axial direction, and a plurality of position regulating grooves and sides having different positions on the sheath side tip are different. The slider has at least one of a plurality of position restricting steps, the slider has an engaging portion that engages with the position restricting step and the position restricting groove, and the engaging portion of the slider and the slider movement amount restriction The position restricting step of the member is engaged with at least one of the position restricting step and the position restricting groove, and the position restricting step and the position restricting groove which are engaged with the engaging portion of the slider are used to change the moving amount of the slider. It is preferable to adjust according to different movement amounts.

The slider is mounted on the outer periphery of the slider movement amount regulating member so as to be movable in the axial direction, and the slider movement amount regulating member is a cylindrical shape that regulates the movement amount of the slider toward the sheath side. The other end of the plurality of position restricting grooves on the base end side of the slider movement amount restricting member is open, and the plurality of position restricting grooves or the plurality of position restricting steps are Formed along the circumferential direction on the base end side of the slider movement amount restricting member, from the position of the end portion on the base end side to the depth of the position of the position restricting groove and the position of the side, respectively. It is preferable that they are formed in a step shape so that the distances are different.
The handle body has an engagement groove of a predetermined length formed along the axial direction, and the slider has an engagement member that is engaged with the groove of the handle body fixed thereto. It is preferable to reciprocate in the axial direction along the groove of the main body.
The engaging portion of the slider is the engaging member of the slider, and the plurality of position restricting grooves and the plurality of position restricting steps are formed so as to overlap with the engaging grooves of the handle body, respectively. When one of the plurality of position restriction grooves or one of the plurality of position restriction steps overlaps with the engagement groove of the handle body, the engagement member of the slider is It is preferable to move in the axial direction along one of the plurality of position restricting grooves overlapping with the engaging groove or one of the plurality of position restricting steps.

Further, in the first aspect, the slider movement amount regulating member is fixed to the handle main body and is rotatably fitted with the slider movement amount regulating member, and at least one of the rotation direction and the axial direction of the slider movement amount regulating member. It is preferable to have a position restricting member for restricting the position.
Further, the position restricting member and the slider moving amount restricting member have at least one position in the rotational direction and the axial direction of the slider moving amount restricting member by a taper shape and a step provided on both contact surfaces. It is preferable to regulate.
In addition, each contact surface of the position restricting member and the slider movement amount restricting member is formed with a plurality of sawtooth-shaped convex portions in which one tooth surface is the tapered shape and the other tooth surface is the step. It is preferable that a concave portion is formed between adjacent convex portions of the plurality of convex portions.
In addition, the position of the slider movement amount regulating member is regulated by inserting the convex portion of one contact surface of the position regulating member and the slider movement amount regulating member into the concave portion of the other contact surface. Is preferred.

In the first aspect, it is preferable to further include a biasing unit that biases the contact surface of the slider movement amount regulating member toward the contact surface of the position regulating member.
Further, the slider movement amount restricting member is moved to the proximal side against the urging force of the urging means, and the step on one contact surface of the position restricting member and the slider movement amount restricting member is on the other side. It is preferable that the slider movement amount regulating member rotates by overcoming the step on the contact surface.
Further, it is preferable that the position restricting member restricts the position of the slider movement amount restricting member in the rotational direction and the axial direction.
In addition, it is preferable that the position regulating member and the slider movement amount regulating member regulate the position of the slider movement amount regulating member in the rotation direction by an uneven fitting shape formed on the inner peripheral surface of the fitting. .
Further, it is preferable that the slider movement amount regulating member is rotated in one direction by a planar shape formed on one side of the concave-convex fitting shape of the position regulating member and the slider movement amount regulating member.

  In order to solve the above problem, the second aspect of the present invention is connected to a plurality of clips and a rearmost clip that are connected by the rear end of the previous clip engaging the rear end of the rear clip. A clip row composed of a connecting member; and an operation handle for a repetitive clip treatment instrument according to the first aspect, wherein the clip row composed of the plurality of clips is loaded in the sheath, A repetitive clip treatment instrument is provided that is movably disposed within the sheath and that has a distal end detachably connected to the coupling member to pull the clip row of the plurality of clips.

Here, among the plurality of clips, the last clip is preferably a member (hereinafter also referred to as a dummy clip) for connecting the operation wire and the clip row (the connection member). The plurality of different moving amounts of the slider are at least two different predetermined pulling lengths, and the first pulling the clip to make the clip projectable from the distal end of the sheath to be usable. It is preferable to include a pulling length and a second pulling length for pulling the operation wire so that the dummy clip protrudes from the distal end of the sheath and can be taken out. In addition, the first pulling length preferably includes a plurality of pulling lengths for pulling the operation wire so that the plurality of clips protrude from the distal ends of the sheaths to be usable. .
Moreover, it is preferable that the operation wire further has a connection member (hook) that is detachably connected to the coupling member of the clip row at the tip thereof.

According to the first and second aspects of the present invention, a slider movement amount regulating member (hereinafter also referred to as a slide guide) is provided, and the slide guide is used to regulate the amount of movement of the slider for operating the clip. The operator can project the appropriate distance from the sheath without adjustment, and the operability can be improved. Moreover, it can prevent that a clip protrudes too much and falls off, and can prevent a misoperation.
Further, according to the present invention, since the clip treatment can be performed only by the operation of rotating one slider guide and the pulling operation of one slider, it is possible to prevent an erroneous operation from occurring at this point.
Further, according to the present invention, since a plurality of clips can be operated in order by one slider guide and one slider, the possibility of mistaken order of clips to be used can be reduced.
Further, according to the present invention, since a plurality of clips can be operated with a single operation mechanism, the number of components constituting the operation handle and the clip treatment tool can be reduced, the apparatus cost can be reduced, and the number of manufacturing steps can be reduced. Can be reduced.

  Further, according to the present invention, by connecting the clips together, it is possible to operate clipping of a plurality of clips with one operation wire, and it is possible to perform clipping multiple times without pulling out the sheath.

  An operation handle for a repetitive clip treatment instrument and a repetitive clip treatment instrument using the same according to the present invention will be described in detail based on embodiments shown in the accompanying drawings.

FIG. 1 is a perspective view showing a schematic configuration of an embodiment of a repetitive clip treatment device of the present invention using the operation handle for the repetitive clip treatment device of the present invention.
As shown in FIG. 1, a repetitive clip treatment instrument (hereinafter also simply referred to as “treatment instrument”) 10 is
The treatment operation unit 11 and the operation unit 50 are provided.

2A is a cross-sectional view showing a schematic configuration of a treatment operation unit of the continuous clip treatment device of the present invention, and FIG. 2B is a cross-section seen from an angle that is 90 degrees different from FIG. 2A. FIG.
In the following description, the lower side in FIG. 1 (the treatment operation unit 11 side), and therefore the upper end in FIGS. 2 (A) and 2 (B) is referred to as the tip, and FIGS. ), And therefore the end on the upper side (the operation unit 50 side) in FIG. 1 is referred to as a base end.
As shown in FIGS. 2A and 2B, the treatment operation unit 11 of the treatment instrument 10 covers the plurality of clips 12 (12 </ b> A, 12 </ b> B, 12 </ b> C) and the engagement portions of the adjacent clips 12, and the clip 12. The connection ring 14 (14A, 14B, 14C), the sheath 16 into which these are inserted, the dummy clip 18 connected to the last third clip 12C, and the connection member 19 The operation wire 20 is connected to a dummy clip. The sheath 16 and the operation wire 20 (including the distal connection member (hook) 21) of the treatment operation unit 11 and the operation unit 50 constitute the operation handle 48 of the present invention, and the plurality of clips 12 of the treatment operation unit 11 are included. (12A, 12B, 12C), the connection ring 14 (14A, 14B, 14C), the last dummy clip 18, and the connection member 19 constitute a clip row (connection clip unit) 13. The dummy clip 18 is a member that connects the operation wire 20 and the plurality of clips 12 via the connecting member 19.
From the above, as shown in FIGS. 1 and 2, the treatment instrument 10 of the present invention includes the clip row 13 and the operation handle 48 of the present invention.

2A and 2B show an initial state (standby state) immediately before the start of the clip treatment operation by the first clip 12A.
As shown in FIGS. 2 (A) and 2 (B), one clip 12 and one connection ring 14 including one fastening ring 40 described later constitute one hemostatic clip body for an endoscope, In the treatment operation unit 11 of the clip treatment tool, a plurality of the hemostatic clip bodies are loaded inside the distal end of the long sheath 16.
Further, the end of the continuous hemostatic clip body is engaged with and coupled to a dummy clip 18 which is a member for connecting the clip row 13 and the operation wire 20, and the dummy clip 18 is connected to the operation wire 20 via the connection member 19. The operation wire 20 extends to the proximal end portion of the sheath 16 and is connected to an operation portion 50 (see FIG. 1) described later.
By pulling the operation wire 20 from the operation unit 50 by a predetermined pulling 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 is moved by that amount. Is clamped by the clamping ring 40 at the tip of the connecting ring 14 holding the clip, and clip treatment (clipping) for hemostasis, marking and the like by the leading clip 12 is performed. After the clip treatment by the first clip 12 is completed, the operation wire 20 is pushed out to the distal end side of the sheath 16 by a predetermined length so that the next clip 12 can be used (standby state), and then the clip treatment is performed. It can be performed.

  2A and 2B show a state in which the leading first 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, the leading first clip 12A is shown. The clip 12 </ b> A is set in a state of being completely contained in the sheath 16. In FIGS. 2A and 2B, three clips 12 are provided as a three-shot clip treatment device, but the number of clips 12 may be any number between two and more.

  FIG. 3 is a perspective view showing a schematic configuration of the clip 12 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 thin plate 180 degrees to form a closed end, then intersecting both pieces and bending the two open ends so that the ends face each other. It has a shape in which the portions 22 and 22 are formed. With this intersection 26 as a boundary, the open end side is the arm portions 28 and 28, and the closed end side is the turn portion 24. The central portions of the arm portions 28, 28 are formed with convex portions 30, 30 that are partially widened, and each arm portion 28 is connected to the tip portion 28 a on the claw portion 22 side by the convex portion 30 and the intersecting portion 26. It is divided into a base 28b on the side. The clip 12 is preferably made of a biocompatible metal. For example, SUS630 and SUS631 that are precipitation hardening stainless steels can be used.

  In the clip 12, the fastening ring 40 fixed to the tip end portion of the connecting ring 14 fitted to the intersecting portion 26 presses the base portions 28b, 28b of the arm portions 28, 28 while moving toward the claw portions 22, 22. By moving a predetermined amount toward the convex portions 30 and 30, the arm portions 28 and 28 and the claw portions 22 and 22 are closed, and a predetermined cusp fitting force (gripping force) is applied to the claw portions 22 and 22. Demonstrate.

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 lesioned tissue removal, reliably.
Further, as shown in FIG. 3, the arm portion 28 of the clip 12 has a constant width from the claw portion 22 to the convex portion 30 at the tip portion 28a, whereas it does not change at the base portion 28b. The width gradually increases from the projection 30 to the projection 30 and has a constant width in the vicinity of the projection 30 so that the clamping ring 40 can be moved easily and reliably, and the pawls 22, 22 can be opened, closed, and fitted. It is easy and reliable, and it is easy and reliable to stop hemostasis in a living body or to suture or close a wound.

  The convex portion 30 is formed from the inner diameter of the opening on the distal end side of the connecting ring 14 (a hole 41 of a tightening ring 40 described later; FIG. 4) and the proximal end side (a hole 43 of a holding portion 42 described later). The width is wider than the portion with which the 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. 2A and 2B, 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. 2 (A), the claw portions 22 and 22 of the second clip 12B are engaged with the turn portion 24 of the first clip 12A in the orthogonal direction, and the first clip 12A and the second clip 12B are connected to each other. , They are connected in different directions by 90 degrees. Similarly, the second clip 12B and the third clip 12C are also connected in directions different by 90 degrees. That is, the first clip 12A and the third clip 12C are arranged in the same direction.

  The connecting ring 14 is fitted in the sheath 16 so as to be able to advance and retract while covering the engaging portion between the two front and rear clips 12 and 12 and maintaining the connected state. In other words, the outer diameter of the connection ring 14 is slightly smaller than the inner diameter of the sheath 16, and the connection ring 14 can smoothly move forward and backward in the sheath 16 as the clip 12 moves. 4A to 4C show a schematic configuration of an embodiment of the connection ring. 4A is a front view of the connecting ring 14, FIG. 4B is a sectional view thereof, and FIG. 4C is a bottom view thereof. 4A is a front view showing an example of the connecting ring shown in FIG. 2, FIG. 4B is a cross-sectional view of the connecting ring shown in FIG. 4A, and FIG. FIG. 5 is a bottom view of the connection ring shown in FIG.

  As shown in FIGS. 4A to 4C, the connection ring 14 includes a tightening ring 40 and a holding portion 42. The connection ring 14 is configured integrally with two members by fixing a metal fastening ring 40 to the tip of a resin holding portion 42. The resin holding portion 42 is in charge of maintaining the connected state and holding the clip 12 in the connecting ring 14, and the metal fastening ring 40 is in charge of fastening the clip 12. The connection ring 14 may be formed of one member as long as both functions of the tightening ring 40 and the holding portion 42 can be exhibited.

  The tightening ring 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 in the vicinity of the intersection 26 of the clip 12 and larger than the width of the convex portion 30. A small inner diameter hole 41 is formed. Therefore, the tightening ring 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 to the tip side. 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 ring 40 is set at a predetermined position in the vicinity of the intersecting portion 26 of the clip 12. The clamping ring 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. , 28 is closed and fixed. For the fastening ring 40, a biocompatible metal is used. For example, stainless steel SUS304, SUS303, titanium alloy, or the like can be used. Since the tightening ring 40 is made of metal, a frictional force serving as a tightening force can be exerted on the metal clip 12.

  The holding portion 42 is a resin-molded, generally cylindrical (ring-shaped) part. It has the 1st area | region 32 holding the previous clip 12, and the 2nd area | region 34 which is a connection holding | maintenance area | region which hold | maintains the next clip 12 in the state connected with the previous clip. The holding portion 42 is formed with a hole 43 that communicates with the hole 41 of the tightening ring 40 and penetrates the first region 32 and the second region 34.

  In the first region 32, a circular hole 43 larger than the hole 41 of the tightening ring 40 that can accommodate the turn part 24 of the clip 12 and the base parts 28b and 28b of the arm parts 28 and 28 is formed. A stepped portion for fitting the tightening ring 40 is formed on the outer surface of the distal end portion of the first region 32. The tightening ring 40 and the holding portion 42 are loaded in the sheath 16 and are clipped. 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.
In the skirt portion 38, the upper base 38a in FIGS. 4 (A) and 4 (B) is connected to the main body 42a of the holding portion 42, and the lower spread portion 38b is a cut 36 formed in the main body 42a. Is partially separated from the main body 42a so as to expand or close in the radial direction. 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.

  In the natural state where no external force is applied to the skirt portions 38, 38 on both sides, as shown in FIG. 4A, the widened portion 38b spreads in a skirt shape. 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, as shown in the second connecting ring 14B of FIG. 2 (B), for example, the skirt portion 38 (expanded portion 38b) is pushed inwardly. The portion that enters the space and the inner peripheral side of the skirt portion 38 (expanded portion 38b) presses the side surface (edge portion) of the turn portion 24 of the second clip 12B held in the first region 32, so that the second The clip 12B is held so as not to move in the rotation direction and the forward / backward direction in the connection ring 14B. 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. 2A, 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 first clip 12A. The inner diameter of the sheath 16 is wider than the inner diameter of the sheath 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 first clip 12A is retracted, so that the connecting ring 14A advances relative to the first clip 12A, and is a fastening ring 40 that is integrally fixed as the connecting ring 14A. Thus, the first clip 12A is tightened.

  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), aromatic nylon, or the like can be used as the material of the holding unit 42. From the standpoint of ease of manufacture, the holding portion 42 is preferably integrally formed.

  The second region 34 is provided on the proximal end side of the first region 32, and the next clip 12 that engages with the clip 12 held in the first region 32, specifically, the claw portions 22, 22 thereof. And the front portions 28a and 28a of the arm portions 28 and 28 are held in a state where the claw portions 22 and 22 are closed with the closed end (tail portion) of the turn portion 24 of the previous clip 12 interposed therebetween.

  The second region 34 has a length substantially equal to the moving length required for the fastening ring 40 set to the initial position with respect to the clip 12 to complete the fastening of the clip 12 as a region length. In other words, 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 by the tightening ring 40 is completed, the engaging portions of the two clips 12, 12 are disengaged from the second region 34. Thus, the connection between the clips 12 and 12 is released.

  In the second region 34, as shown in FIGS. 4B and 4C, a hole 43 having the same inner diameter penetrating from the first region 32 is formed, and a groove (concave portion) 43a is formed at two opposing positions. Is formed. Moreover, as shown to FIG. 4 (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 can accommodate the tip portions 28a and 28a of the arm portions 28 and 28 of the clip 12 held in the second region 34 in a state where the claw portions 22 and 22 are closed.
The grooves 43a and 43a are provided at two locations on both sides of the claw portion 22 of the clip 12 held in the second region 34 in the opening and closing direction (left and right direction in FIG. 4B). The plate surfaces of the tip portions 28a and 28a 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 tip portion 28a 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 2 of the clip 12. It is substantially equal to the length obtained by adding the lengths of the two claw portions 22 and 22 (length in the expanding direction). 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.

By doing so, it is possible to prevent the subsequent clip 12 (for example, 12C) from entering the first clip 12 (for example, 12B), and as a result, 1) the relative position of the first and subsequent (front and rear) clip 12 is maintained. 2) The operation of pushing the clip 12 by the operation wire 20 (slider 54: see FIG. 5) can be maintained.
1) When the submergence occurs, the operation stroke of the operation wire 20 changes, but the submergence can be prevented and the relative positions of the front and rear clips 12 can be maintained, so that the operation stroke can be maintained.
Further, the bending rigidity of the second region 34 is lowered by the slit 46 provided in the connection ring 14, and angle suitability is given by the chain connection of the clip 12, and the later clip 12 is excessively attached to the first connection ring 14. If it goes inside, the degree of freedom decreases and the angle aptitude decreases, but it is possible to prevent the sinking and maintain the relative position of the front and rear clips 12, and therefore the angle aptitude can be maintained.

2) The operation of pushing the clip 12 by the operation wire 20 can be maintained.
<The pushing operation of the clip 12 by the operation wire 20 and the driving force transmission to the clip 12 are performed as follows. >
-The convex parts 30 and 30 of the dummy clip 18 push the base end side (end part by the side of the holding | maintenance part 42) of the connection ring 14C of the clip 12C of the 3rd shot.
The third clip 12C is integrated with the connection ring 14C in the sheath 16 by frictional contact, and the pushing force transmitted to the connection ring 14C is transmitted to the clip 12C. (At this time, in the third clip 12C, the widened portions 38b, 38b of the skirt portions 38, 38 of the connecting ring 14C are deformed inward to hold the turn portion 24 of the third clip 12C.)
The convex portions 30 and 30 of the third clip 12C push the proximal end side (end portion on the holding portion 42 side) of the connection ring 14B of the second clip 12B.
The second clip 12B is integrated with the connecting ring 14B in the sheath 16 by frictional contact, and the pushing force transmitted to the connecting ring 14B is transmitted to the clip 12B.
-The convex parts 30 and 30 of the 2nd clip 12B press the base end side (end part by the side of the holding | maintenance part 42) of the connection ring 14A of the clip 12A of the 1st shot.
The first clip 12A is integrated with the connecting ring 14A in the sheath 16 by frictional contact, and the pushing force transmitted to the connecting ring 14A is transmitted to the clip 12A and pushed out.
The pulling force of the operation wire 20 is directly applied to the clip 12, so that there is no particular influence of subsidence.
<Transmission of the pulling operation of the operation wire 20 by the clip 12 is performed as follows. >
The tip (claw portions 22, 22) of the dummy clip 18 pulled by the operation wire 20 pulls the base end side (turn portion 24) of the third clip 12 </ b> C.
The tip (claw portions 22 and 22) of the third clip 12C pulls the proximal end (turn portion 24) of the second clip 12B.
-The tip (claw portions 22 and 22) of the second shot clip 12B pulls the base end side (turn portion 24) of the first shot clip 12A.

The distance from the wall surface to the wall surface of both grooves 43a and 43a may be set to a dimension that does not disengage the turn portion 24 of the previous clip 12 and the claw portions 22 and 22 of the next clip 12. 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. In the previous clip 12 (for example, the second clip 12B in the connecting ring 14B in FIG. 2B), the turn portion 24 is held by the closed skirt portion 38 in the first region 32 inside the sheath 16. Therefore, forward / backward movement and rotational movement are suppressed. Further, the next clip 12 that engages with the previous clip 12 (for example, the third clip 12C in the connecting ring 14B of FIG. 2B) is 90 degrees different from the previous clip due to the groove 43a of the second region 34. , The rotational movement is suppressed, and the forward / backward movement is suppressed by engaging with the previous clip 12 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, 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. In addition, since the slit 46 is provided, the hem (base end) of the connection ring 14 is partially turned up. Therefore, when the front and rear clips 12 and 12 are connected before the clip 12 is loaded 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 the position of the second region 34 that does not reach the skirt portion 38 of the first region 32, and the strength of the connecting ring 14 is prevented from being significantly reduced. 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. 2A and 2B, the claw portions 22 of the second clip 12B engage with the turn portion 24 of the first clip 12A, and the coupling ring 14A holds the engaging portion. The claw portions 22 of the second clip 12B are held in a closed state by the inner wall of the connection ring 14A (the second region 34). Thereby, the connection state of the first clip 12A and the second clip 12B is maintained. Similarly, the connection state between the second clip 12B and the third clip 12C is maintained by the connection ring 14B, and the connection state between the third clip 12C and the dummy clip 18 is maintained by the connection ring 14C.

  A dummy clip 18 that is not used for clip treatment is engaged with the last third clip 12C. 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, that is, an arm portion having two claw portions. Are engaged with the turn portion of the third clip 12C with the claw portion closed, and when the claw portion is opened, the third clip 12C is opened. In addition, although the convex part is not provided in the arm part of the dummy clip 18 of the illustration example, the convex part may be provided. A connecting member 19 is attached to the base end portion of the dummy clip 18. The connecting member 19 is detachably connected to a hook-like connecting member (hook) 21 at the tip of an operation wire 20 to be described later.

  The sheath 16 is, for example, a flexible coil sheath in which a metal wire is tightly wound. The sheath 16 is inserted therein so that the clip 12 is movably inserted at the distal end side, and the operation wire 20 connected to the clip 12 via the dummy clip 18 and the connecting member 19 is accommodated. 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 where the claw portions 22 and 22 of the turn portion 24 are engaged.

  The operation wire 20 is used to move the plurality of clips 12 forward and backward in a series of clip treatments. The operation wire 20 is made of, for example, a metal wire, and is housed in the sheath 16, and is attached to the distal end (end opposite to the operation portion 50). A connecting member 21 is provided. The operation wire 20 has a distal end portion connected to the clip 12 by the connecting member 21 via the connecting member 19 and the dummy clip 18, and a proximal end portion to which the connecting member 21 is not attached is connected to the operation portion 50. Yes. Further, as described above, the proximal end portion of the sheath 16 is also attached to the operation portion 50 described later together with the operation wire 20.

Here, the connection member 21 of the operation wire 20 and the connection member 19 of the dummy grip 18 are arranged so that they do not come off when the clip 12 and the operation wire 20 move back and forth, that is, when moving inside the sheath 16. The other member can be fitted into this member. Specifically, the connection member 21 of the operation wire 20 is a protrusion having a larger diameter than the operation wire 20 (in this embodiment, a conical shape having a convex portion on the distal end side), and the connecting member 19 is connected to the connection member 21. A space that is slightly larger than approximately the same is formed, and an opening having a diameter smaller than that of the space and larger than that of the operation wire 20 is formed on the operation unit 50 side of the space. The space formed in the connecting member 19 is not a shape that covers the entire circumference of the side surface of the connecting member 21 (the surface facing the inner state surface of the sheath 16), but one direction or four directions in the circumferential direction. The two opposing directions are open.
In this way, the connecting member 21 is shaped to fit into the connecting member 19, and the connecting member 21 is inserted into the space of the connecting member 19, so that even when the operation wire 20 is pulled toward the operation unit 50, Since the surface on the operation unit 50 side is supported by the surface on which the opening of the connecting member 19 is formed, the connecting member 21 can be prevented from being detached from the connecting member 19.

Next, the operation handle for the repetitive clip treatment tool of the present invention will be described in detail.
FIG. 5 is a cross-sectional view schematically showing a schematic configuration of the operation handle shown in FIG. 6 is a perspective view showing a schematic configuration in a state in which the slider guide is removed from the operation handle shown in FIG. 5, and FIG. 7A is a perspective view showing a schematic configuration of the slider guide shown in FIG. 7B is a partial development view of the outer peripheral surface of the slider guide shown in FIG. 7A, and FIG. 8 is a perspective view showing a schematic configuration of the position regulating member shown in FIG.
As shown in FIG. 5, the operation handle 48 of the present invention includes an operation unit 50, a sheath 16, an operation wire 20, and a hook-shaped connection member (hook) 21 attached to the distal end of the operation wire 20. The operation unit 50 includes a handle main body 52, a slider 54, a slider guide 56, a position regulating member 58, an urging spring 60, and a finger hook ring 62.

  As shown in FIGS. 5 and 6, the handle main body 52 is a stepped circular tubular member having two cylindrical portions having different outer diameters, and a cylindrical portion (thick diameter portion) 52a having a larger outer diameter. A groove (engagement groove) 68 extending in the central axis direction is formed. In the handle main body 52, a distal end portion of a cylindrical portion (narrow diameter portion) 52b having a small outer diameter is connected to a proximal end of the sheath 16, and the sheath 16 is provided inside the two cylindrical portions. The operation wire 20 inserted through is extended and inserted.

The slider 54 is a cylindrical member that is disposed on the outer periphery of the handle main body 52 and is movable in the axial direction on the outer periphery of the handle main body 52. The slider 54 has a pincushion shape. Easy to move. The slider 54 has a slider pin 70 attached to a part of the inner peripheral surface of the cylindrical member so as to protrude toward the central axis. The slider pin 70 is engaged with the groove 68, and the operation wire 20 inserted through the handle body 52 is fixed. The slider pin 70 is an engagement member that is fixed to the slider 54 and engages with the engagement groove 68 of the handle body 52.
Here, by moving the slider 54 in the axial direction with respect to the handle main body 52, the operation wire 20 fixed to the slider 54 can be moved in the axial direction with respect to the sheath 16. The clip 12 connected to the tip can be moved with respect to the sheath 16.

As shown in FIGS. 5, 7 </ b> A and 7 </ b> B, the slider guide 56 is disposed on the outer peripheral surface of the handle body 52 so as to be rotatable in the circumferential direction, and the slider 54 moves in the axial direction of the handle body 52. It is a cylindrical member that regulates the amount, and is disposed on the outer peripheral surface of the handle main body 52 on the sheath 16 (the tip of the sheath 16) side of the slider 54. Also, the slider guide 56 has a convex joint portion 56a on the tip end side that can be rotated to a concave joint portion 58a on the proximal end side of the position regulating member 58 that regulates the position of the slider guide 56, which will be described later, particularly the rotational position. And is supported by the handle body 52 in a rotatable state.
The inner diameter of the distal end portion (joining portion 56a) of the slider guide 56 is substantially equal to the outer diameter of the narrow diameter portion 52b of the handle body 52 to be inserted, and the inner diameter of the proximal end side of the slider guide 56 is the handle body 52 to be inserted. The slider guide 56 is slidable on the handle main body 52, specifically, on the large diameter portion 52a and the small diameter portion 52b in the circumferential (rotation) direction and the axial direction. It is supported. Further, the outer diameter of the proximal end portion of the slider guide 56 is slightly smaller than the inner diameter of the slider 54, and can enter the inside of the slider 54 when the slider 54 moves to the distal end side. Since the slider guide 56 rotates and moves with respect to the position restricting member 58 at the distal end by the operation of the operator, the distal end side portion (the portion on the proximal end side from the joining portion 56a) is easily held by the operator. A large-diameter portion 56b whose outer diameter is larger than the outer diameter of the base end portion is formed, and an inclined surface and irregularities corresponding to the fingers are formed on the outer surface of the large-diameter portion 56b.

The slider guide 56 has an axial length extending along the central axis of the handle main body 52 for switching the movement amount of the slider in a plurality of stages, that is, to restrict the movement amount to two or more different movement amounts. Four different slider guide grooves (position regulating grooves) 66A, 66B, 66C and 66D are formed. The four slider guide grooves 66A, 66B, 66C and 66D are formed in the slider guide 56 at intervals of 90 degrees in the circumferential direction. Further, the four slider guide grooves 66A, 66B, 66C and 66D are arranged such that when the slider guide 56 is rotated, the slider guide groove 66A, the slider guide groove 66B, the slider guide groove 66C, the slider guide groove 66D, and the slider guide groove again. The guide grooves 66A are disposed in the order of the guide grooves 66A so as to overlap the grooves 68 of the handle main body 52.
Further, as shown in FIG. 7B, the four slider guide grooves 66A, 66B, 66C and 66D have different groove lengths (that is, the positions of the end portions on the sheath 16 side (tip side)). . Specifically, the slider guide groove 66A is the longest, and the slider guide groove 66D, the slider guide groove 66C, and the slider guide groove 66B become shorter in this order.
Further, on the entry side (slider 54 side) of the four slider guide grooves 66A, 66B, 66C and 66D, the slider pin 70 is not chamfered by other parts of the slider guide 56, and is easily chamfered into each groove. Has been made.

The slider guide grooves 66A, 66B, 66C, and 66D are overlapped with the grooves 68 of the handle main body 52, respectively, when the slider guide 56 is rotated to have a predetermined orientation.
The slider guide 56 has a movement limit on the side of the sheath 16 that moves in the axial direction of the handle body 52 of the slider pin 70 that moves along the groove 68 by slider guide grooves 66A, 66B, 66C, and 66D that overlap the groove 68. Regulate the position. That is, the slider pin 70 also functions as an engaging portion that engages with the slider guide groove for position regulation.
As will be described in detail later, when the slider guide 56 is rotated, the slider guide groove 66A, the slider guide groove 66B, the slider guide groove 66C, the slider guide groove 66D, and again the slider guide groove 66A, in this order, the handle body. 52 overlaps the groove 68.

  The convex joint portion 56a of the slider guide 56 is in contact with the concave contact portion 58a of the position restricting member 58 (that is, the surface where the position restricting member 58 and the slider guide 56 abut). Four sawtooth-shaped convex portions 57a that protrude in the direction parallel to the center axis of the handle main body 52 and on the distal end side and have different inclination angles of the two tooth surfaces with respect to the contact surface are formed in the circumferential direction. The four convex portions 57a have the same shape. The convex portion 57a is a sawtooth shape, that is, a convex portion having a triangular cross section in which the inclination angle of one tooth surface is gentle and tapered, and the inclination angle of the other tooth surface forms a substantially right-angled step. Moreover, the connection part of the adjacent convex part 57a and the convex part 57a becomes the recessed part 57b, and this recessed part 57b is also formed four.

On the other hand, as shown in FIG. 5, FIG. 7A and FIG. 8, the position restricting member 58 is a stepped cylindrical member that restricts the position of the slider guide 56, particularly the rotational position. 52, and the inner peripheral surface of the through hole is fixed to the thin diameter portion 52b of the handle main body 52, so that it is fixed to the handle main body 52 at the tip side of the slider guide 56. Further, the position restricting member 58 includes a concave joint 58 a that is fitted in a state where the convex joint 56 a on the distal end side of the slider guide 56 is rotatable on the base end side.
The concave joint 58a of the position restricting member 58 is in contact with the abutting surface (that is, the surface where the position restricting member 58 and the slider guide 56 abut) that abuts the convex joint 56a of the slider guide 56. In the circumferential direction, four saw-toothed convex portions 59a having different inclination angles of the two tooth surfaces are formed in a direction parallel to the central axis of 52. The four convex portions 59a have the same shape. The convex portion 59a is a sawtooth shape, that is, a convex portion having a triangular cross section in which the inclination angle of one tooth surface is a gentle taper and the inclination angle of the other tooth surface forms a substantially right-angled step. Further, a connecting portion between the adjacent convex portion 59a and the convex portion 59a becomes a concave portion 59b, and four concave portions 59b are also formed.

As described above, the joining portion 56a of the slider guide 56 also has the unevenness (four concave portions 59b and convex portions 59a) corresponding to the concave and convex portions (four concave portions 59b and convex portions 59a) on the contact surface with the position restricting member 58. Four concave portions 57b and convex portions 57a) are formed so that the inclination angles of the tooth surfaces on both sides of the convex portion are reversed.
Therefore, the joint 58a of the position restricting member 58 is in a position where its own unevenness and the unevenness of the joint 56a of the slider guide 56 are engaged (fitted), that is, the protrusion 59a protrudes into the recess 57b. When the portion 57a is fitted into the recess 59b, any one of the four slider guide grooves 66A, 66B, 66C and 66D of the slider guide 56 and the groove 68 of the handle body 52 overlap each other. Further, the slider guide 56 is formed so as to restrict the rotational direction and the axial position.
As described above, the position regulating member 58 and the slider guide 56 can regulate at least one position in the rotational direction and the axial direction of the slider guide 56 by the tapered shape and the step provided on both contact surfaces. it can.

Further, since the position restricting member 58 and the slider guide 56 are fitted with the serrated irregularities of the joint portions 58a and 56a, the slider guide 56 is unidirectional, specifically, the slider guide 56 is joined. A tooth surface (step) having a sharp inclination angle of the convex portion 57a of the portion 56a is a tooth surface having a sharp inclination angle of the convex portion 59a of the joint portion 58a of the position regulating member 58 in contact with the tooth surface (step). Rotate only in the direction away from the step. That is, for example, the convex portion 57a of the joint portion 56a of the slider guide 56 resists an urging force of an urging spring 60 described later, and the tooth surface having a gentle inclination angle of the joint portion 58a of the opposing position regulating member 58 ( Rotate in the direction of the convex portion 59a from the concave portion 59b along the tapered surface), and then move from the convex portion 59a along the tooth surface (step) having a steep inclination angle to the next concave portion 59b. The convex portions 57a are engaged with each other.
Here, the unevenness formed in the joint 58a of the position restricting member 58 and the joint 56a of the slider guide 56, and the taper shape and the step formed on both contact surfaces of the position restricting member 58 and the slider guide 56, respectively. Constitutes a position regulating mechanism that regulates at least one position of the slider guide 56 in the rotational direction and the axial direction.

The biasing spring 60 is arranged so as to stick to the outer periphery of the small-diameter portion 52 b of the handle body 52, one end portion is in contact with the slider guide 56, and the other end portion is a diameter of a cylinder with a small diameter of the handle body 52. It is in contact with the boundary surface (surface perpendicular to the central axis) of a large cylinder. The biasing spring 60 is a compression spring that biases the slider guide 56 toward the position regulating member 58.
In this way, when the external force from the operator or the like is not applied by urging the slider guide 56 toward the position restricting member 58 by the urging spring 60, the slider guide 56 in which the concave portion and the convex portion are engaged is position restricted. The structure does not rotate with respect to the member 58.

  The finger ring 62 is a ring-shaped member attached to the proximal end side of the handle main body 52, that is, the end opposite to the side connected to the sheath 16. The finger ring 62 is supported by the handle body 52 so as to be rotatable in the circumferential direction about the central axis of the handle body 52. When operating the slider 54, the operator can adjust the pulling amount of the operation wire 20 by hooking a finger on the finger ring 62 and pulling the slider 54 toward the finger ring 62.

  Further, a reinforcing tube 64 is fitted into a portion of the operation wire 20 that is inserted into the operation unit 50. The reinforcing tube 64 reinforces the operating wire 20 so that the operating wire 20 is not bent or broken inside the handle body 52 when the operating wire 20 is moved by the slider 54.

The operation handle 48 and its operation unit 50 are basically configured as described above.
When the slider guide groove 66A overlaps the groove 68, the slider 54 is moved until the slider pin 70 and the end of the slider guide groove 66A on the sheath 16 side come into contact with each other. The connection member 21 protrudes from the distal end of the sheath 16. Further, when the slider guide groove 66B overlaps the groove 68, when the slider 54 is moved until the slider pin 70 contacts the end of the slider guide groove 66B on the sheath 16 side, the first clip 12A is moved to the sheath 68. It protrudes from the sheath 16 to a position where it does not fall off the 16. As a result, the first clip 12A is in a state where it can be clipped. Similarly, when the slider guide groove 66C overlaps the groove 68, when the slider 54 is moved until the slider pin 70 contacts the end of the slider guide groove 66C on the sheath 16 side, the second clip 12B is moved. It protrudes from the sheath 16 to a position where it does not fall off from the sheath 16. Thereby, the 3rd clip 12C will be in the state where clip treatment is possible. Similarly, when the slider guide groove 66D overlaps the groove 68, when the slider 54 is moved until the slider pin 70 and the end of the slider guide groove 66D on the sheath 16 side come into contact, the third clip 12C is moved. It protrudes from the sheath 16 to a position where it does not fall off from the sheath 16. Thereby, the 3rd clip 12C will be in the state where clip treatment is possible.

Here, each part in the operation handle 48 is preferably made of the following materials.
Metal members such as the sheath 16, the operation wire 20, and the slider pin 70 can be made of austenitic stainless steel (for example, SUS303, SUS304, SUS316, etc.) or precipitation hardened stainless steel (for example, SUS630, SUS631, etc.). Preferably, it is more preferable to make it from precipitation hardening stainless steel from the viewpoint of wear resistance.
Resin parts such as the slider 54, the handle main body 52, and the slider guide 56 are made of PPSU (polyphenylsulfone), PSU (polysulfone), PEI (polyetherimide), PEEK (polyetheretherketone), PPS (polyestersulfone). It is preferable that the resin is made of a resin suitable for sterilization, such as polyphenylene sulfide), PES (polyethersulfone), PASF (polyallylsulfone).

Further, since the slider pins and the end surfaces of the slider guide grooves are in contact with each other and a certain amount of force acts, it is preferable that both are made of a material having good slidability and wear resistance. By manufacturing with these materials, it is possible to suppress wear of the slider pin and the slider guide groove end face.
It is also preferable to form a fluororesin or DLC (diamond-like carbon) film on the end surfaces of the slider pin and the slider guide groove. By forming a film having the above composition, wear resistance and slidability can be improved. In particular, by forming a DLC film, the friction resistance (μ) is reduced and the surface hardness is increased, so that wear resistance is higher than when nothing is formed on the slider pin and the slider guide groove. Can greatly improve the performance.
In addition, since the operation handle 48 is cleaned and sterilized for each treatment, it is made of a material having γ-ray sterilization suitability, EOG sterilization suitability (ethylene oxide gas suitability), and autoclave sterilization suitability (heat resistance, steam resistance suitability). It is preferable to do. When the operation handle 48 is made disposable, it may be made of a material that does not have the above characteristics.

Next, the operation of the continuous clip treatment device of the present invention shown in FIGS. 1 to 8 will be described.
Here, FIGS. 9A to 9P are partial perspective views showing the stepped state of the operation handle during the clip treatment operation of the repetitive clip treatment tool, and FIG. 10 shows the slider during the clip treatment operation. 11A and 11P are partial development views showing the positional relationship between the guide and the slider pin of the slider, and FIGS. 11A to 11P show the stepwise state of the treatment operation unit during the clip treatment operation of the repetitive clip treatment tool. It is sectional drawing. Hereinafter, the operation of the repetitive clip treatment tool 10 will be described while explaining the correspondence between the states of FIGS. 9, 10, and 11.

  First, as shown in FIG. 9A, the slider guide 56 is oriented so that the slider guide groove 66A overlaps the groove 68, and the slider 54 is positioned at the end of the moving area of the handle body 52 on the finger ring 62 side (hereinafter referred to as the handle body). 52, the end of the moving area on the finger ring 62 side is moved to “home position”. That is, the slider pin 70 of the slider 54 is moved to the position P1 in FIG. At this time, the operation wire 20 is drawn into the sheath 16 as shown in FIG. This state is the initial state.

Next, as shown in FIG. 9B, the slider 54 is moved to the end of the slider guide groove 66A on the sheath 16 side (that is, the slider pin 70 is moved to the position P2 in FIG. 10). As shown in (B), the connecting member 21 of the operation wire 20 is projected from the distal end of the sheath 16.
Thereafter, the connecting member 19 of the dummy clip 18 to which the three clips are connected is attached to the connecting member 21 of the operation wire 20.

After attaching the connecting member 19 of the dummy clip 18 to which the three clips are connected to the connecting member 21 of the operation wire 20, as shown in FIG. 9C, the slider 54 is moved to the home position (that is, the slider pin). 70 is moved to a position P3 in FIG. 10), and the three clip rows 13 connected to the dummy grip 19 are stored in the sheath 16 as shown in FIG. 11C.
Thereafter, the sheath 16 is inserted from the distal end into an endoscope forceps port or the like inserted into the living body, and the distal end of the sheath reaches the distal end of the insertion portion of the endoscope and protrudes from the distal end of the endoscope.

  Thereafter, as shown in FIG. 9D, the slider guide 56 is rotated by 90 ° so that the slider guide groove 66B of the slider guide 56 and the groove 68 overlap each other. Thereby, the slider pin 70 is moved to the home position (position P4 in FIG. 10) on the extension line of the slider guide groove 66B.

Next, as shown in FIG. 9E, the slider 54 is moved to the end of the slider guide groove 66B on the sheath 16 side (that is, the maximum protruding position) (that is, the slider pin 70 is moved to the position P5 in FIG. 10). 11D, the first clip 12A is projected from the distal end of the sheath 16, and the skirt portion 38 of the first clip 12A is opened.
Here, the maximum projecting position means that the clip (here, the first clip 12A) does not fall off the sheath 12, and the projecting amount is reduced due to variations in the dimensions of the component parts and the inner and outer circumferences of the wire and sheath. However, it is a position where the skirt portion 38 opens and becomes available.

After that, the slider 54 is moved to the finger ring 62 side by a predetermined distance, specifically, to the standard protruding position (that is, the slider pin 70 is moved to the position P5 ′ in FIG. 10), as shown in FIG. As described above, the skirt portion 38 of the first clip 12 </ b> A is brought into contact with the distal end of the sheath 16. By pulling to the standard protruding position, even when the first clip 12A protrudes too much, the skirt portion 38 and the distal end of the sheath 16 can be brought into contact with each other, and a treatment by the first clip 12A is possible.
In this way, the distance from the maximum protruding position to the standard protruding position becomes a buffer of the dimensional variation of the component parts and the inner and outer circumference differences of the wire and sheath, and once protruding to the maximum protruding position, regardless of error, The skirt portion 38 can be opened, and then pulled to the standard protruding position, so that the skirt portion 38 and the distal end of the sheath 16 can be brought into contact with each other regardless of errors.

Thereafter, the clip treatment tool 10 is moved, and the nail portions 22 and 22 of the first clip 12A that has been expanded are pressed against a diseased site such as an affected part to be clipped, and the slider 54 is moved as shown in FIG. 9 (F). A predetermined distance is moved to the finger ring 62 side, specifically, to a clip completion position (that is, the slider pin 70 is P6 in the position in FIG. 10).
At this time, the skirt portion 38 is open at the connection ring 14A that protrudes from the distal end of the sheath 16, and the pressing and holding of the first 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, the first first clip 12A moves backward with respect to the connection ring 14A. The tightening ring 40 at the tip of the connecting ring 14A is pushed from the crossing portion 26 side to the position immediately below the convex portion 30 along the base portion 28b of the arm portion 28 of the first clip 12A, so that the nail portions 22 and 22 are affected by the diseased part. And the tightening of the first clip 12A by the tightening ring 40 at the tip of the connecting ring 14A is completed.

  At the same time, the engaging portion between the first clip 12A and the next second clip 12B comes out from the rear end of the connecting ring 14A. When the engaging portion of the first clip 12A and the second clip 12B is disengaged from the connecting ring 14A, the arm portion 28 is expanded until the arm portion 28 hits the inner wall of the sheath 16 by the spring force of the second clip 12B. Opens wider than the width of the turn portion 24 of the first clip 12A, and the connection between the first clip 12A and the second clip 12B is released. Accordingly, as shown in FIG. 11 (F), the first clip 12A and the connection ring 14A can be detached from the sheath 16, and the clip of the diseased part by the tightening ring 40 at the tip of the first clip 12A and the connection ring 14A. Treatment is complete.

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

  When the clip treatment by the first clip 12A and the connecting ring 14A is completed, the slider 54 is moved to the home position as shown in FIG. 9 (G). That is, the slider pin 70 is moved to the position P7 in FIG. Thus, as shown in FIG. 11G, the clip 12B and the clip 12C are drawn into the sheath 16.

  Thereafter, as shown in FIG. 9H, the slider guide 56 is rotated by 90 ° so that the slider guide groove 66C of the slider guide 56 and the groove 68 overlap each other. Thus, the slider pin 70 is moved to the home position (position P8 in FIG. 10) on the extension line of the slider guide groove 66C.

  Next, as shown in FIG. 9I, the slider 54 is moved to the end of the slider guide groove 66C on the sheath 16 side (that is, the maximum protruding position) (that is, the slider pin 70 is moved to the position P9 in FIG. 10). 11 (H), the second clip 12B is projected from the distal end of the sheath 16, and the skirt portion 38 of the second clip 12B is opened.

  After that, the slider 54 is moved to the finger ring 62 side by a predetermined distance, specifically, to the standard protruding position (that is, the slider pin 70 is moved to the position P9 ′ in FIG. 10), as shown in FIG. As described above, the skirt portion 38 of the second clip 12B is brought into contact with the distal end of the sheath 16.

Thereafter, the clip treatment tool 10 is moved, and the claws 22 and 22 of the expanded second clip 12B are pressed against the portion to be clipped, and the slider 54 is moved to the finger-holding ring 62 side as shown in FIG. To a predetermined distance, specifically, to the clip completion position (that is, the slider pin 70 is moved to the position P10 in FIG. 10).
By moving the slider 54 to the clip completion position, tightening by the second clip 12B is completed, and the connection between the second clip 12B and the third clip 12C is released, and as shown in FIG. The clip 12B and the connection ring 14B can be detached from the sheath 16, and the clip treatment of the diseased part by the fastening ring 40 at the tip of the second clip 12B and the connection ring 14B is completed.

  When the clip treatment by the second clip 12B and the connection ring 14B is completed, the slider 54 is moved to the home position as shown in FIG. That is, the slider pin 70 is moved to the position P11 in FIG. As a result, the third clip 12C is pulled into the sheath 16 as shown in FIG.

  Thereafter, as shown in FIG. 9L, the slider guide 56 is rotated by 90 ° so that the slider guide groove 66D of the slider guide 56 and the groove 68 overlap each other. Thereby, the slider pin 70 is moved to the home position (position P12 in FIG. 10) on the extension line of the slider guide groove 66D.

  Next, as shown in FIG. 9M, the slider 54 is moved to the end of the slider guide groove 66D on the sheath 16 side (that is, the maximum protruding position) (that is, the slider pin 70 is moved to the position P13 in FIG. 10). 11C, the third clip 12C is protruded from the distal end of the sheath 16, and the skirt portion 38 of the third clip 12C is opened.

  After that, the slider 54 is moved to the finger ring 62 side by a predetermined distance, specifically, to the standard protruding position (that is, the slider pin 70 is moved to the position P13 ′ in FIG. 10), as shown in FIG. Then, the skirt portion 38 of the third clip 12C is brought into contact with the distal end of the sheath 16.

Thereafter, the clip treatment tool 10 is moved and the claws 22 and 22 of the expanded third clip 12C are pressed against the portion to be clipped, so that the slider 54 is placed on the finger ring 62 side as shown in FIG. To a predetermined distance, specifically, to the clip completion position (that is, the slider pin 70 is moved to the position P14 in FIG. 10).
By moving the slider 54 to the clip completion position, the fastening by the third clip 12C is completed, and the connection between the third clip 12C and the dummy clip 18 is released, and as shown in FIG. Then, the connection ring 14C can be detached from the sheath 16, and the clip treatment of the disease site by the third clip 12C and the fastening ring 40 at the tip of the connection ring 14C is completed.

  When the clip treatment by the fastening ring 40 at the tip of the third clip 12C and the connection ring 14C is completed, the slider 54 is moved to the home position as shown in FIG. That is, the slider pin 70 is moved to the position P15 in FIG. Thereby, as shown in FIG. 11 (O), the dummy clip 18 is pulled into the sheath 16.

  Thereafter, as shown in FIG. 9P, the slider guide 56 is rotated by 90 ° so that the slider guide groove 66A of the slider guide 56 and the groove 68 overlap each other. Thereby, the slider pin 70 is moved to the home position (position P16 in FIG. 10) on the extension line of the slider guide groove 66A.

Thereafter, the sheath 16 is extracted from the endoscope.
Further, after the sheath 16 is extracted, the slider 54 is moved to the end of the slider guide groove 66A on the sheath 16 side (that is, the slider pin 70 is moved to P2 in FIG. 10), and the state shown in FIG. As described above, the connecting member 21, the dummy clip 18, and the connecting member 19 are projected from the distal end of the sheath 16.
Thereafter, when the process is ended, the dummy clip 18 and the connecting member 19 are removed, and the slider 54 is moved to the home position.
When performing clip treatment with another clip, after removing the dummy clip 18 and the connecting member 19, the connecting member 19 of the dummy clip 18 to which the other three clips 12 are connected is attached to the connecting member 21. Repeat the process.
The clip treatment tool 10 performs the clip treatment on the affected part as described above.

  As described above, according to the clip treatment tool of the present invention, it is possible to perform multiple clippings without pulling out the sheath. By connecting clips and performing clipping in order, clipping of a plurality of clips can be operated with a single operation wire.

In addition, a slide guide is provided, and the operator adjusts the clip by regulating the amount of movement of the slider that controls the advance / retreat of the clip (ie, whether the clip is the first clip or the second clip). Therefore, it is possible to make it protrude from the sheath by an appropriate distance, and the operability can be improved. Moreover, it can prevent that a clip protrudes too much and falls off, and can prevent a misoperation.
Further, since the clip treatment can be performed only by an operation of rotating one slider guide and an operation of pulling one slider, it is possible to prevent an erroneous operation at this point from occurring.
Further, since a plurality of clips can be operated in order with one slider guide and one slider, the possibility of mistaken order of clips to be used can be reduced.
In addition, since a plurality of clips can be operated with one operation mechanism, the number of components constituting the operation handle and the clip treatment tool can be reduced, the apparatus cost can be reduced, and the number of manufacturing steps can be reduced. .

Here, in the clip treatment tool of the present invention, the distance from the maximum projecting position of the slider guide groove to the standard projecting position is used as a buffer for the dimensional variation of the component parts and the inner and outer circumference differences of the wire and sheath, regardless of the error. Although the skirt portion of the clip is opened, the region from the maximum projecting position to the standard projecting position of the slider guide groove may be curved in the rotation direction of the slider.
FIG. 12 is a partial development view of the outer peripheral surface of another example of the slider guide that can be used in the operation handle of the present invention and the clip treatment instrument of the present invention.
The slider guide 80 having the slider guide grooves 82A, 82B, 82C and 82D shown in FIG. 12 is a slider having the slider guide grooves 66A, 66B, 66C and 66D shown in FIGS. Since it has the same configuration except for the shape of the guide 56 and each groove, it can be used for the operation unit 50, the operation handle 48, and the clip treatment instrument 10 in the illustrated example in the same manner instead of the slider guide 56. .
As shown in FIG. 12, the slider guide grooves 82B, 82C, and 82D of the slider guide 80 are respectively in the standard protruding positions (P5 ′, P9 ′, and P13 ′, respectively) from the end portions (P4, P8, and P12) on the home position side. ) Is a straight line, and the portion from the standard protruding position (P5 ′, P9 ′, P13 ′) to the maximum protruding position (P5, P9, P13, respectively) is curved in the rotational direction (that is, rotated with respect to the straight line). The shape is bent at a predetermined angle in the direction).
In this way, the portion from the standard protruding position to the maximum protruding position is curved in the rotational direction, so that the operator can clearly determine the standard protruding position from the state of the slide guide 80 and the force acting on the slider 54. Can be recognized.
Even when the slider 54 is moved to the maximum protruding position, the slider 54 can be automatically returned to the standard protruding position by the restoring force of the slider guide 80. Therefore, the operator can move the slider 54 to the standard protruding position only by releasing the hand after moving the slider 54 to the maximum protruding position.
Further, the slider 54 can be moved to the maximum projecting position only when the skirt portions 38 of the clip 12 are not opened.

In the slider guide 80, the slide guide groove has a shape in which the portion from the standard protruding position to the maximum protruding position is curved in the rotational direction. However, the present invention is not limited to this, and the slider guide groove is made longer than the maximum protruding position. The shape from the end on the home position side to the maximum protruding position may be a straight line, and the shape may be curved in the rotational direction first from the maximum protruding position.
In this case, even if the slider is moved to the maximum protruding position due to the deformation of the operation wire exceeding the range of error, the clip does not move the sheath for some reason, etc., the skirt of the clip is more than the tip of the sheath. When not projecting, the slide may be moved from the maximum projecting position to a portion curved in the previous rotation direction so that the skirt portion of the clip projects from the tip of the sheath.
As described above, by providing the groove curved in the rotational direction before the maximum projecting position, it is possible to cope with an unexpected situation. Further, by bending in the rotational direction before the maximum projecting position, the slider can be easily adjusted so as not to move before the maximum projecting position during normal use.

In the clip treatment instrument 10 described above, the slider guide groove is provided in the slider guide, but the present invention is not limited to this, and a step corresponding to the protruding position of each clip is formed in the slider guide instead of the slider guide groove. May be.
FIG. 13 is a partial development view of the outer peripheral surface of another example of the slider guide that can be used in the operation handle of the present invention and the clip treatment instrument of the present invention.
The slider guide 90 shown in FIG. 13 is different from the slider guide 56 shown in FIGS. 7A and 7B and FIG. 10 except that the slider guide groove for regulating the moving amount of the slider 54 is a step. Since it has the same configuration, it can be used for the operation unit 50, the operation handle 48, and the clip treatment instrument 10 in the illustrated example in exactly the same manner instead of the slider guide 56.
As shown in FIG. 13, in the developed view, the slider guide 90 has a short side on the finger ring 62 side (base end side) basically parallel to a plane orthogonal to the central axis, and the handle main body 52 has a short side. Five sides 92 (sides 92A, 92B, 92C, 92D, and 92E) having different positions in the central axis direction are formed. Here, of the five sides 92, the side 92A is closest to the distal end side of the sheath, and the side 92E, side 92D, side 92C, side 92B are closer to the finger ring side in this order. Further, the five sides 92 are formed in the order of side 92A, side 92B, side 92C, side 92D, and side 92E in the rotation direction, and side 92E and side 92A are adjacently connected.

Here, the position of the side 92A in the central axis direction of the handle body is the same as the end of the slider guide groove 66A on the sheath side (tip side), and the position of the side 92B in the central axis direction of the handle body is the slider. The side and the position between the guide groove 66A and the slider guide groove 66B. The side 92C has the same position in the central axis direction of the handle body as the end of the slider guide groove 66B on the sheath side. The position of the handle main body in the central axis direction is the same position as the end of the slider guide groove 66C on the sheath side, and the side 92E is positioned in the direction of the central axis of the handle main body with the end of the slider guide groove 66D on the sheath side. Position.
A step 94A is formed between the side 92A and the side 92B, a step 94B is formed between the side 92B and the side 92C, a step 94C is formed between the side 92C and the side 92D, and a step 94C is formed between the side 92D and the side 92E. A step 94D is formed, and a step 94A ′ is formed between the side 92E and the side 92A. Here, the steps 94A, 94B, 94C and 94D of the slider guide 90 shown in FIG. 13 respectively correspond to the slider guide grooves 66A, 66B, 66C and 66D of the slider guide 56 shown in FIG.

  As in the case of the slider guide 90, instead of the slider guide groove, a side is formed at a position corresponding to the slider guide groove to form a step shape, and a step is provided for each position of the slider guide 90. The position of the slider pin 70 in the central axis direction of the handle main body 52 can be regulated by rotating and switching the step and the side overlapping the groove 68 of the handle main body 52, that is, the side (step) of the slider guide 90. The movement limit position of the slider pin 70 can be set every time, and similarly to the slider guide groove of the slider guide 56 or 80, the position of the slider 54 can be regulated corresponding to the clip 12, so that the clip 12 is a sheath. Jumping out of 16 can be prevented.

  Further, by making the slider guide into a staircase shape, it is possible to prepare for clipping of the next clip by rotating the slider guide without returning the slider to the home position. Thereby, the operation amount of the operator can be reduced.

Further, in the above-described clip treatment instrument 10, in order to improve the operability, for example, the position regulating member 58 and the contact surface thereof are tapered and stepped between the slider guide 56 and the handle main body 52. A position regulating mechanism such as an unevenness is provided, and one of the slider guide grooves (66A to 66D) and the groove 68 of the handle body 52 are appropriately overlapped. However, the present invention is not limited to this, and the slider guide is operated by the operator. Although an operation of overlapping one of the grooves with the groove 68 of the handle main body 52 is required, a position restricting member or a position restricting mechanism is not necessarily provided.
Further, in the clip treatment instrument 10 shown in the figure, since the erroneous operation can be prevented more reliably, the slider guide is rotated only in one direction by the position restricting member 58. However, the present invention is not limited to this, and both You may make it rotate to direction.
In the above embodiment, the position restricting member and the position restricting mechanism have the function of restricting both the stop position of the slider guide and the rotation direction of the slider guide. However, only one of the functions is provided. May be.
For example, when the position restricting member has a function of restricting the rotation direction of the slider guide to one direction as a position restricting mechanism, the position restricting member and the slider guide are in contact with each other regardless of the position of the slider guide groove. The surface may be a structure in which a plurality of serrated irregularities are formed in the circumferential direction (that is, a ratchet structure).

  In addition, when the position restricting mechanism has only the function of restricting the stop position of the slider guide, the position restricting mechanism is formed with a concave portion in the slider guide at an interval corresponding to the slider guide groove and provided at one position of the handle body. A structure in which an urging force is applied to the slide guide side and a movable convex portion is provided, and a structure in which the concave and convex portions engage with each other at a position where the slider guide groove and the handle main body groove overlap each other may be adopted. Moreover, you may form reversely the formation position of a recessed part and a convex part.

14, FIG. 15 (A) and (B), FIG. 16 (A) and (B), and FIG. 17 (A) and (B), respectively, are slider guides that can be applied to the present invention. It is sectional drawing which shows schematic structure of one Example of the combination of the handle | steering-wheel main body which gave only the function which controls a stop position, a slider guide, and a position control mechanism. Here, in FIGS. 15, 16 and 17, (A) is a circumferential sectional view and (B) is an axial sectional view.
A position regulating mechanism 100 shown in FIG. 14 is provided on the handle main body 52 and is provided on the outer peripheral surface of the convex portion 102 urged toward the slider guide 56 and the slider guide 56 on the same cross section where the convex portion 102 is formed. And recesses 104 formed at intervals (four in this embodiment) corresponding to each of the slider guide grooves 66A to 66D. Here, the convex portion 102 is a member that is applied with an urging force on the slider guide 56 side and is movable in a direction in which the convex portion 102 contacts and separates from the slider guide 56. Specifically, the convex portion 102 is a ball 102a (that is, a ball plunger) urged toward the slider guide 56 by the urging spring 102b.
The four recesses 104 are formed so that the groove 68 of the handle body 52 and one of the slider guide grooves 66A to 66D overlap when the respective recesses 104 and the protrusions 102 overlap (fit). ing.
By configuring the position restricting mechanism 100 as described above, the slider guide grooves 66A to 66D and the groove 68 of the handle main body 52 overlap each other, and the slider guide 56 stops so that the slider guide 56 stops at the overlapping position. The position can be regulated.

  Further, in the position restricting mechanism 100 shown in FIG. 14, the convex portion 102 is constituted by a ball plunger. However, like the position restricting mechanism 110 shown in FIGS. 15A and 15B, the convex portion 112 is changed to the slider guide 56. As a resin-made engaging claw having a cantilever 114 biased toward the surface and a projection 116 that fits into the recess 104 of the slider guide 56 on the contact surface of the slider guide 56 of the cantilever 114. Also good. In this case, it is necessary to provide a space for the cantilever 114 to move in the handle main body 52.

16A and 16B includes a convex portion 122 provided on the outer peripheral surface of the slider guide 56 and an inner peripheral surface of the handle main body 52 on the same cross section where the convex portion 122 is formed. And recesses 124 formed at intervals (four in this embodiment) corresponding to each of the slider guide grooves 66A to 66D. Here, the convex portion 122 is a member that is applied with an urging force on the handle main body 52 side and is movable in a direction in which the convex portion 122 contacts and separates from the slider guide 56. Specifically, the convex portion 122 is fitted into the concave portion 124 of the handle main body 52 on the contact surface between the cantilever 126 biased toward the handle main body 52 and the handle main body 52 of the cantilever 126. This is a resin-made engaging claw having a projection 128 to be operated.
The cantilever beam 126 is a cantilever beam whose longitudinal direction is parallel to the axis of the handle main body 52 and whose end in the longitudinal direction is the base end.
As described above, the position restriction mechanism may be provided with a convex portion on the slide guide 56 side and a concave portion on the handle body 52 side.

  In the position regulating mechanism 120 shown in FIGS. 16A and 16B, the direction parallel to the axis of the handle body 52 of the cantilever 126 constituting the convex portion 122 is the longitudinal direction, and the end portion in the longitudinal direction is the longitudinal direction. Although the base end is a cantilever, as shown in FIGS. 17A and 17B, the cantilever 134 of the convex portion 132 of the position regulating mechanism 130 is curved along the circumferential direction of the handle body 52. It can be a cantilever.

Here, in the position restricting mechanisms 100, 110, 120, and 130 shown in FIGS. 14 to 17, the rotation direction of the slider guide 56 is not restricted, but the shapes of the concave portion and the convex portion are changed (for example, the asymmetric shape). Thus, the rotation direction of the slider guide can be restricted to one direction.
18 (A) to 18 (D) are partial cross-sectional views showing a schematic configuration of another embodiment of the position regulating mechanism used for the operation handle of the present invention.
In the case of the position restricting mechanism 100 shown in FIG. 14, as a modification thereof, as in the position restricting mechanism 101 shown in FIG. 18A, the surface of the ball plunger constituting the convex portion 142 that contacts the slider guide 56 A protrusion (specifically, a protrusion having a surface perpendicular to the tangent to the ball 142a) 142b may be provided on a part of the protrusion 142 (specifically, the end of the slider guide 56 on the downstream side in the rotation direction). At this time, it goes without saying that the slider guide 56 is provided with a recess 143 that fits into the ball 142a having the protrusion 142b. As a result, the slider guide 56 rotates from the direction without the projecting portion 142b to the direction in which the projecting portion 142b is present, that is, the direction indicated by ○ in the figure, but in the opposite direction, that is, the direction indicated by x in the figure. You can avoid it.
In the case of the position restricting mechanism 110 shown in FIGS. 15A and 15B, as a modification, the protrusion 144a of the convex portion 144 is arranged in the circumferential direction as in the position restricting mechanism 111 shown in FIG. The end face may be a tapered surface with a gentle slope, and the other end face may be a step with a steep slope. At this time, the slider guide 56 is provided with a recess 145 that fits into the protrusion 144a. As a result, the slider guide 56 rotates from the side of the tapered surface with a gentle inclination angle toward the stepped side with a steep inclination (in the direction indicated by a circle in the figure), but in the opposite direction (in the figure). It is possible not to rotate in the direction indicated by x.

Similarly, in the case of the position restricting mechanism 120 shown in FIGS. 16A and 16B, as a modified example, the protrusion 146a of the convex portion 146 is arranged in the circumferential direction as in the position restricting mechanism 121 shown in FIG. One end face in the above may be a tapered surface having a gentle slope, and the other end face may be a step having a steep slope. The slider guide 56 is provided with a recess 147 that fits with the protrusion 146a.
Similarly, in the case of the position restricting mechanism 130 shown in FIGS. 17A and 17B, as a modification, the protrusion 148a of the convex portion 148 is formed in the circumferential direction as in the position restricting mechanism 131 shown in FIG. One end face in the above may be a tapered surface having a gentle slope, and the other end face may be a step having a steep slope. The slider guide 56 is provided with a recess 147 that fits with the protrusion 146a.
As described above, the protrusions 146 and 148a of the protrusions 146 and 148 are formed so that the end on the upstream side in the rotation direction of the slider guide 56 has a planar shape perpendicular to the step, for example, the circumferential direction (tangent to the rotating body). By configuring, the rotation of the slider guide 56 can be restricted in one direction (direction indicated by ○ in the figure).

  The method, means and mechanism for regulating the stop position of the slider guide and the rotation direction of the slider guide are not limited to the above method, means and mechanism, and various methods, means and mechanisms having an interlock function may be used. it can.

Here, in the operation handle of the present invention, it is preferable to provide a mechanism for transmitting to the operator via the slider that the slider pin has reached the clip completion position.
19A is a circumferential sectional view showing the relationship between the slider and the slider guide, and FIG. 19B is an axial sectional view of FIG. 19A. 20 is a diagram showing an example of the positional relationship between the slider guide groove of the slider guide shown in FIG. 19 and the slider pin of the slider during the clip treatment operation and the positional relationship of the concave portion of the slider guide that fits with the convex portion of the slider. FIG. In addition, the slider 150 and the slider guide 152 shown in FIGS. 19A, 19B, and 20 have the convex portion 154 in the slider 150 and the concave portion 156 in which the slider guide 152 fits the convex portion 154. Except for this point, the configuration is the same as that of the slider 54 and the slider guide 56 shown in FIGS.

Specifically, as shown in FIGS. 19A and 19B, the slider 150 is provided with a convex portion 154 that is provided with a biasing force on the slider guide 152 side and is movable in the center direction of the slider 150. ing. The convex portion 154 of the present embodiment is a ball 154a (that is, a ball plunger) urged toward the slider guide by the urging spring 154b. The configuration of the convex portion 154 is not particularly limited, and may be a mechanism that is biased toward the slider guide 152 and has a desired elasticity. For example, a resin engagement biased toward the slider guide 152 may be used. It may be a nail.
On the other hand, as shown in FIG. 19B and FIG. 20, on the outer peripheral surface of the slider guide 152, the convex portion 154 is located at a position corresponding to the position of the convex portion 154 when the slider pin 70 reaches the clip completion position. A recess 156 to be fitted is formed.
Here, the recess 156 is formed corresponding to the clip completion position (P6, P10, P14) of each slider guide groove (66B to 66D). For this reason, the concave portion corresponding to the slider guide groove (66A) for loading the clip row 13 into the operation wire 20 is not provided.

Thus, by providing the slider 150 with the convex portion 154 and forming the concave portion 156 in the slider guide 152, when the slider pin 70 reaches the clip completion position (P6, P10, P14), the convex portion 154 of the slider 150 is It fits into the recess 156 of the slider guide 152. The shock at this time is transmitted to the operator as a click feeling.
Thus, the operator can feel that the clipping operation has been completed with a click feeling, and can feel the operation feeling.

  As described above, the operation handle for the repetitive clip treatment device and the repetitive clip treatment device using the same have been described in detail, but the present invention is not limited to the above-described embodiments, examples, and modifications. Various modifications and changes may be made without departing from the scope of the present invention.

  For example, in the clip treatment instrument 10 described above, since three clips 12 are loaded in one sheath and clipping is performed three times, four slider guide grooves (three grooves and clips corresponding to each clip 12) are used. However, the present invention is not limited to this, and the slider guide has a number of slider guide grooves equal to the number of clips to be loaded plus one for loading clips. What is necessary is just to form.

It is a perspective view which shows schematic structure of one Embodiment of the repetitive clip treatment tool of this invention using the operation handle for repetitive clip treatment tools of this invention. (A) And (B) is an expanded sectional view which expands and shows the front-end | tip part of the clip treatment tool shown in FIG. It is a perspective view which shows schematic structure of the clip shown in FIG. (A) is a front view which shows one Example of the connection ring shown in FIG. 2, (B) is sectional drawing of the connection ring shown to (A), (C) is shown to (A). It is a bottom view of a connection ring. It is sectional drawing which shows schematic structure of the operation handle shown in FIG. FIG. 6 is a perspective view illustrating a schematic configuration in a state where a slider guide is removed from the operation handle illustrated in FIG. 5. (A) is a perspective view which shows schematic structure of the slider guide shown in FIG. 5, (B) is a partial expanded view of the outer peripheral surface of the slider guide shown in (A). It is a perspective view which shows schematic structure of the position control member shown in FIG. (A)-(P) is a partial perspective view which shows the stepped state of the operation handle at the time of the clip treatment operation | movement of a repetitive clip treatment tool, respectively. It is a partial development view showing the positional relationship between the slider guide and the slider pin of the slider during the clip treatment operation of the repetitive clip treatment tool. (A)-(P) is a fragmentary sectional view which shows the step state of the treatment operation part at the time of the clip treatment operation | movement of a repetitive clip treatment tool, respectively. It is the partial expanded view of the outer peripheral surface of the other Example of the slider guide which can be used for the operating handle of this invention. It is the partial expanded view of the outer peripheral surface of the other Example of the slider guide which can be used for the operating handle of this invention. It is sectional drawing which shows schematic structure of one Example of the position control mechanism used for the operating handle of this invention. (A) is the circumferential direction sectional view which shows schematic structure of the other Example of the position control mechanism used for the operating handle of this invention, (B) is an axial direction sectional view of (A). (A) is the circumferential direction sectional view which shows schematic structure of the other Example of the position control mechanism used for the operating handle of this invention, (B) is an axial direction sectional view of (A). (A) is the circumferential direction sectional view which shows schematic structure of the other Example of the position control mechanism used for the operating handle of this invention, (B) is an axial direction sectional view of (A). (A)-(D) is a fragmentary sectional view which shows schematic structure of the other Example of the position control mechanism used for the operation handle of this invention, respectively. (A) is a circumferential sectional view showing a relationship between a slider and a slider guide used in the operation handle of the present invention, and (B) is an axial sectional view of (A). FIG. 20 is a partial development view showing one embodiment of the configuration of the outer peripheral surface of the slider guide shown in FIG. 19.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10 Clip treatment tool 11 Treatment operation part 12 Clip 13 Clip row | line | column (connection clip unit)
14 connecting ring 16 sheath 18 dummy clip 19 connecting member 21 connecting member (hook)
20 Operation wire 22 Claw part 24 Turn part 26 Intersection part 28 Arm part 30 Convex part 32 1st area | region 34 2nd area | region (connection holding area)
36 Notch 38 Skirt 40 Fastening ring 41, 43 Hole 42 Holding part 43a Groove 46 Slit 48 Operation handle 50 Operation part 52 Handle body 54, 150 Slider 56, 80, 90, 152 Slider guide 56a, 58a Joint part 56b Large diameter Part
57a, 59a, 102, 112, 122, 132, 142, 144, 146,
148, 154 Convex part 57b, 59b, 104, 124, 143, 145, 147, 149, 156 Concave part 58 Position regulating member 60 Biasing spring 62 Finger ring 64 Reinforcement pipe 66A, 66B, 66C, 66D, 82A, 82B, 82C , 82D Slider guide groove 68 Groove 70 Slider pin 92A, 92B, 92C, 92D Side 94A, 94B, 94C, 94D Step 100, 101, 110, 111, 120, 121, 130, 131 Position restriction mechanism

Claims (16)

A sheath,
An operation wire disposed inside the sheath and connected to a plurality of clips at the tip;
A cylindrical handle body connected to the sheath and having the operation wire extending from the sheath disposed therein;
A slider that is mounted on the outer periphery of the handle body so as to be movable in the axial direction, engages with the operation wire, and moves the operation wire in the axial direction of the handle body;
A slider movement amount regulating member mounted on the outer periphery of the handle body so as to be rotatable in the circumferential direction and regulating the movement amount of the slider in the axial direction of the handle body;
An operation handle for a repetitive clip treatment tool, wherein the slider is moved in the axial direction of the handle body, and the operation wire disposed inside the sheath is moved in the extending direction of the sheath. The slider moves on the outer periphery of the handle body, thereby moving the operation wire in the axial direction in the handle body and moving the operation wire in the sheath in the extending direction. Yes,
The operation handle for a repetitive clip treatment instrument according to claim 1, wherein the slider movement amount regulating member regulates the movement amount of the slider to at least a plurality of different movement amounts corresponding to the plurality of clips. The slider movement amount regulating member is formed in accordance with a plurality of different movement amounts along the axial direction, and has a plurality of position regulating grooves and sides having different positions on the sheath-side tip. Having at least one of the position regulation steps,
The slider has an engaging portion that engages with the position restricting step and the position restricting groove,
The position restricting step for engaging the engaging portion of the slider with at least one of the position restricting step and the position restricting groove of the slider movement amount restricting member and engaging the engaging portion of the slider; The operation handle for a repetitive clip treatment instrument according to claim 1 or 2, wherein the movement amount of the slider is adjusted according to the plurality of different movement amounts by the position restricting groove. The slider is mounted on the outer periphery of the slider movement amount regulating member so as to be movable in the axial direction thereof,
The slider movement amount regulating member is a cylindrical member that regulates the movement amount of the slider toward the sheath side,
The other end of the plurality of position restricting grooves on the base end side of the slider movement amount restricting member is open,
The plurality of position restricting grooves or the plurality of position restricting steps are formed along the circumferential direction on the proximal end side of the slider movement amount restricting member, and each of the position restricting grooves from the position of the end portion on the proximal end side. The operation handle for a repetitive clip treatment instrument according to claim 3, wherein the operation depth of the continuous clip treatment tool is formed in a step shape so that the groove depth to the position of the distal end portion and the distance to the side position are different. The handle body has an engagement groove of a predetermined length formed along the axial direction,
5. The repetitive type according to claim 1, wherein an engaging member that engages with a groove of the handle main body is fixed to the slider, and reciprocates in the axial direction along the groove of the handle main body. Operation handle for clip treatment tool. The engaging portion of the slider is the engaging member of the slider;
The plurality of position restriction grooves and the plurality of position restriction steps are formed so as to overlap the engagement grooves of the handle body,
When one of the plurality of position restriction grooves or one of the plurality of position restriction steps overlaps with the engagement groove of the handle body, the engagement member of the slider becomes the engagement groove of the handle body. The operation handle for a repetitive clip treatment instrument according to claim 5, which moves in the axial direction along one of the plurality of position restricting grooves or one of the plurality of position restricting steps overlapped with each other.   And a position restricting member that is fixed to the handle body and that rotatably fits with the slider moving amount restricting member and restricts at least one position in the rotational direction and the axial direction of the slider moving amount restricting member. The operation handle for a repetitive clip treatment instrument according to any one of claims 1 to 6.   The position restricting member and the slider moving amount restricting member restrict at least one position in the rotational direction and the axial direction of the slider moving amount restricting member by a taper shape and a step provided on both contact surfaces. The operation handle for a repetitive clip treatment tool according to claim 7.   Each contact surface of the position restricting member and the slider movement amount restricting member is formed with a plurality of sawtooth-shaped convex portions having one tooth surface having the tapered shape and the other tooth surface being the step. The operation handle for a repetitive clip treatment instrument according to claim 8, wherein a concave portion is formed between adjacent convex portions.   The position of the slider movement amount regulating member is regulated by inserting a convex portion of one contact surface of the position regulating member and the slider movement amount regulating member into a concave portion of the other contact surface. The operation handle for the repetitive clip treatment instrument described in 1.   The operation for a repetitive clip treatment instrument according to any one of claims 7 to 10, further comprising biasing means for biasing the contact surface of the slider movement amount regulating member toward the contact surface of the position regulating member. handle.   The slider movement amount restricting member is moved to the proximal side against the urging force of the urging means, and the step on one contact surface of the position restricting member and the slider movement amount restricting member is contacted with the other. The operation handle for a repetitive clip treatment instrument according to any one of claims 7 to 11, wherein the slider movement amount regulating member rotates by overcoming the step on the contact surface.   The operation handle for a repetitive clip treatment instrument according to any one of claims 7 to 12, wherein the position restricting member restricts a position in a rotational direction and an axial direction of the slider movement amount restricting member.   8. The position regulating member and the slider movement amount regulating member regulate the position of the slider movement amount regulating member in the rotational direction by an uneven fitting shape formed on the inner peripheral surface of the fitting. Operation handle for continuous clip treatment tool.   The repetitive type according to claim 14, wherein the slider movement amount regulating member is rotated in one direction by a planar shape formed on one side in the rotation direction of the concave-convex fitting shape of the position regulating member and the slider movement amount regulating member. Operation handle for clip treatment tool. 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;
An operation handle for a repetitive clip treatment instrument according to any one of claims 1 to 15,
In the sheath, the clip row of a plurality of clips is loaded,
The repetitive clip treatment tool, wherein the operation wire is movably disposed in the sheath, and a distal end of the operation wire is detachably connected to the connecting member to pull a clip row of the plurality of clips.

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