JP2010042200A - Manipulating handle for clipping device, clipping device using the manipulating handle, successive clipping device, and method for maintaining protrusion of wire - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a manipulating handle for a clipping device which allows reliable and easy attachment of clips to a manipulating wire, and to provide the clipping device, a successive clipping device, and a method for maintaining protrusion of wire. <P>SOLUTION: The manipulating handle for the clipping device comprises: a sheath; a manipulating wire which is arranged in an interior of the sheath, and has a forward end to which clips are connected; a handle body which is connected to the sheath, with the manipulating wire being arranged in an interior thereof; a slider which is attached to an outer circumferential surface of the handle body to be movable in an axial direction thereof, and engaged with the manipulating wire, for moving the manipulating wire in the axial direction; and a wire position fixing mechanism for temporarily fixing the manipulating wire in a state in which the manipulating wire protrudes from the forward end of the sheath by a given length, wherein the slider is moved in the axial direction so as to move the manipulating wire arranged in the interior of the sheath in an extending direction of the sheath. <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 stitching or occlusion in a living body, and the like, and more specifically, a clip treatment for operating the endoscopic clip treatment tool. The present invention relates to a tool operating handle, a clip treatment tool using the same, a repetitive clip treatment tool, and a wire protruding state maintaining method.

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 part after removal of a bleeding part or a lesioned 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. Set the clip, insert it into the endoscope again, and perform the next clipping.
In this way, each time the clip treatment device performs a clip treatment, a new clip is set at a predetermined position, so that the clip treatment device performs a plurality of clip treatments with one clip treatment device, so that the clip is fixed to the operation wire. Having a connection mechanism.

  For example, in Patent Document 1, as a clip device capable of attaching and ligating a clip device only by advancing and retreating an operation member, a clip and a tightening ring that closes the clip by being fitted to and attached to the clip A presser tube, a connecting member that can be inserted into the presser tube and engaged with the clip, a sheath portion that can store the clip and the presser tube, and an operation wire that is inserted into the sheath portion so as to freely advance and retract. It is provided on at least one of the presser tube or the sheath portion, and when the clip and the presser tube protrude forward of the sheath portion, the sheath portion and the presser tube are engaged with each other, and the presser tube is accommodated in the sheath portion again. A clip device having a hook portion forbidden is described.

JP 2002-191609 A

  As described in Patent Document 1, the hook formed on the distal end of the operation wire from the axial direction is inserted and engaged with the coupling member on the clip proximal end side, so that the operation wire can be operated only by moving in the front-rear direction. Clips can be attached to the wires.

As described in Patent Document 1, when the clip is attached to the operation wire simply by moving the operation wire in the front-rear direction, the clip can be attached to the operation wire regardless of the wire protrusion amount from the sheath.
However, when attaching the coupling member of the clip and the connecting member provided at the distal end of the operation wire from the direction orthogonal to the center axis of the sheath and the clip, it becomes difficult to attach if the protruding amount of the operation wire from the sheath distal end changes. There's a problem.

  Therefore, in the case of the operation handle described in Patent Document 1, if the slider moves when the clip is attached to the operation wire, the amount of protrusion of the operation wire from the sheath tip changes, that is, the connection member at the tip of the operation wire changes. Since the position changes, it becomes difficult to attach the clip to the operation wire, and there is a possibility that the operation wire is deformed due to the displacement.

  An object of the present invention is to solve the problems based on the above-described conventional technology, and to reliably and easily load a clip onto an operation wire. An operation handle for a clip treatment tool, a clip treatment tool using the same, and a repetitive clip treatment tool It is another object of the present invention to provide a wire protruding state maintaining method.

  In order to solve the above-mentioned problem, a first aspect of the present invention is a sheath, an operation wire disposed inside the sheath and having a clip connected to a distal end thereof, and the sheath connected to the sheath. A cylindrical handle main body in which the operation wire extending from is disposed, and is mounted on the outer periphery of the handle main body so as to be movable in the axial direction, and engages with the operation wire, and the operation wire is connected to the sheath And a wire position fixing mechanism for temporarily fixing the operation wire in a state in which the operation wire protrudes from the distal end of the sheath by a certain length, and the slider is attached to the handle body. An operation handle for a clip treatment instrument, wherein the operation wire arranged inside the sheath is moved in the extending direction of the sheath. It is intended to provide.

Here, it is preferable that the wire position fixing mechanism temporarily fixes a relative position between the slider and the handle body.
In addition, the operation handle for the clip treatment instrument of this aspect is further mounted on the outer periphery of the handle body so as to be rotatable in the circumferential direction, and the slider movement for restricting the movement amount of the slider in the axial direction of the handle body. It is preferable to have a quantity regulating member.
The slider moves in the axial direction on the outer periphery of the handle body, thereby moving the operation wire in the axial direction in the handle body, and extending the operation wire in the sheath. It is preferable that the slider movement amount regulating member regulates the movement amount of the slider to a plurality of different movement amounts including a movement amount corresponding to at least the clip.

The slider includes an engaging member protruding toward a central axis, and the slider movement amount regulating member is formed on the sheath side, which is formed according to a plurality of different movement amounts along the axial direction. And at least one of a plurality of position restriction grooves having different tip positions and a plurality of position restriction steps having different side positions, the engagement member of the slider, the position restriction groove of the slider movement amount restriction member, and the The amount of movement of the slider is changed to the plurality of different amounts of movement by at least one of the position restriction groove and the position restriction step that are engaged with at least one of the position restriction steps and engaged with the engagement member of the slider. It is preferable to adjust accordingly.
Further, the wire position fixing mechanism includes the engagement member of the slider and the distal end portion on the sheath side of the plurality of position restriction grooves or the plurality of position restriction steps of the slider movement amount restriction member. The position regulating groove on the sheath side or the tip on the sheath side in the position regulating step is communicated with, extends in the circumferential direction of the slider movement amount regulating member, and fits with the engaging member of the slider A position fixing groove, and the wire position fixing mechanism is configured to fit the position fixing groove and the engagement member of the slider so that the operation wire has a predetermined length from the distal end of the sheath. It is preferable that the operation wire is temporarily fixed in a protruding state.

Alternatively, the wire position fixing mechanism includes: a convex portion formed on the sheath side of the inner peripheral surface of the slider; and the distal end portion on the sheath side among the plurality of position restriction grooves or the plurality of position restriction steps. It is preferable to have a concave portion that is provided on the sheath side in the vicinity of the distal end portion on the sheath side in the position regulating groove or the position regulating step at the most sheath side and can be fitted to the convex portion.
Alternatively, the wire position fixing mechanism may include a concave portion formed on the sheath side of the inner peripheral surface of the slider, and the distal end portion on the sheath side of the plurality of position restriction grooves or the plurality of position restriction steps. It is preferable to have a convex portion that is provided on the sheath side adjacent to the distal end portion on the sheath side in the position regulating groove or the position regulating step that is closest to the sheath side and that can be fitted to the concave portion.
Moreover, it is preferable that the said convex part is the structure which can be switched by the latching by engagement with the said recessed part by elastic deformation, and the retraction | saving by open | release or detachment | leave.
Moreover, it is preferable that the said convex part is a ball plunger comprised from a compression spring and a ball | bowl. Moreover, it is also preferable that the said convex part is a latching claw using elastic deformation.

In addition, a plurality of the clips are coupled to the distal ends of the operation wires arranged inside the sheath, and the plurality of different movement amounts of the slider are a plurality of different movements corresponding to at least the plurality of clips. Preferably, the clip treatment device is a repetitive clip treatment device.
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 is fixed with a second engagement member that engages with the groove of the handle body, It is preferable to reciprocate in the axial direction along the groove of the handle body.
Further, the second engagement member of the slider is the engagement member of the slider of the operation handle for the clip treatment device of this aspect, and the plurality of position restriction grooves and the plurality of position restriction steps are respectively The slider is formed so as to overlap with the engaging groove of the handle body, and when one of the plurality of position restricting grooves or one of the plurality of position restricting steps overlaps with the engaging groove of the handle body, the slider It is preferable that the engaging member moves in the axial direction along one of the plurality of position restricting grooves or one of the plurality of position restricting steps overlapping the engaging groove of the handle body.

Further, the position restricting member fixed to the handle body and rotatably fitted to 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. It is preferable to have.
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.

Moreover, it is preferable that the operation handle for a clip treatment instrument of this aspect further includes 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 regulating member is moved to the proximal end side against the urging force of the urging means, and the step on one contact surface of the position regulating member and the slider movement amount regulating member is the other. 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.
Further, the position restricting member or the slider and the slider moving amount restricting member restricts the position of the slider moving amount restricting member in the rotational direction by a concave / convex fitting shape formed on both inner and outer peripheral surfaces of the fitting. It is preferable.
Further, it is preferable that 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 or the slider and the slider movement amount regulating member. .

Moreover, in order to solve the said subject, the 2nd aspect of this invention has a clip part which consists of a clip and the connection member connected with this clip, and the operation handle for clip treatment tools of a 1st aspect. The clip portion is loaded in the sheath, and the operation wire is movably disposed in the sheath, and a distal end of the operation wire is detachably connected to the coupling member to pull the clip portion. A clip treatment device is provided.
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 clip treatment instrument according to the first aspect. The clip row of the plurality of clips is loaded in the sheath, and the operation wire is placed in the sheath. The repetitive clip treatment tool is characterized in that the clip member of the plurality of clips is pulled by being movably disposed at the distal end thereof and detachably connected to the connecting member.

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.

  In order to solve the above-described problem, the third aspect of the present invention provides a distal end on the sheath side among the engagement member of the slider and the plurality of position restriction grooves or the plurality of position restriction steps of the slider movement amount restriction member. A portion that communicates with the distal end portion on the sheath side at a position restricting groove or position restricting step that is closest to the sheath side, extends in a circumferential direction of the slider movement amount restricting member, and the engagement member of the slider A position fixing groove that can be fitted, and by fitting the position fixing groove and the engaging member of the slider, the operation wire is protruded from the distal end of the sheath by a certain length. An operation wire protruding state holding method of a clip treatment instrument having an operation handle for a clip treatment instrument provided with a wire position fixing mechanism for temporarily fixing a wire, wherein the slider is controlled by the slider movement amount And moving the slider movement amount regulating member along the axial direction of the material, and then rotating the slider movement amount regulating member to engage the engagement member and the position fixing groove, thereby moving the slider and the slider movement amount. The wire protruding state holding method is characterized in that the amount of protrusion of the operation wire from the sheath is held constant by fixing the relative position of the regulating member.

  In order to solve the above-described problem, a third aspect of the present invention includes a convex portion formed on the sheath side of the inner peripheral surface of the slider, and a plurality of position regulating grooves or a plurality of positions of the slider movement amount regulating member. Among the regulating steps, the sheath-side tip is provided on the sheath side adjacent to the sheath-side tip of the position-regulating groove on the sheath side or the position-regulating step, and is fitted with the convex portion. An operation wire protruding state holding method for a clip treatment instrument having an operation handle for a clip treatment instrument provided with a wire position fixing mechanism having a recess capable of being joined, wherein the slider is moved along the axial direction of the slider movement amount regulating member To the distal end portion on the sheath side, the convex portion of the slider and the concave portion of the slider movement amount regulating member are fitted, and the slider and the slider movement amount regulating member It is to provide a wire protruding state holding method characterized by retaining the projecting amount from the sheath of the operating wire constant by fixing the relative positions.

  In order to solve the above-described problem, a third aspect of the present invention includes a recess formed on the sheath side of the inner peripheral surface of the slider, and a plurality of position restriction grooves or a plurality of position restrictions of the slider movement amount restriction member. Of the step, the sheath-side tip is provided on the sheath side adjacent to the sheath-side tip of the position-regulating groove on the sheath side or the position-regulating step, and can be fitted to the recess. An operation wire protruding state holding method for a clip treatment instrument having an operation handle for a clip treatment instrument provided with a wire position fixing mechanism having a convex portion, wherein the slider is moved along the axial direction of the slider movement amount regulating member. The slider and the slider movement amount regulating member are moved to the distal end portion on the sheath side, and the concave portion of the slider and the convex portion of the slider movement amount regulating member are fitted. It is to provide a wire protruding state holding method characterized by retaining the projecting amount from the sheath of the operating wire constant by fixing the relative positions.

  According to the present invention, when the clip and the operation wire are connected, the clip and the operation wire can be easily connected by fixing the operation wire in a state where it protrudes from the sheath by a certain distance. In addition, according to the present invention, the amount of protrusion of the operation wire can be made constant, so that the amount of protrusion of the operation wire is small, and malfunctions such as inability to connect the clip and the operation wire occur. Can be prevented. Further, according to the present invention, since the protruding amount of the operation wire is not a desired length, it is possible to prevent a failure such as a load on the operation wire and deformation of the operation wire.

  An operation handle for a clip treatment instrument, a clip treatment instrument using the same, a repetitive clip treatment instrument, and a wire protruding state maintaining method 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 includes a treatment operation unit 11 and an operation unit 50.

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. 2A and 2B is referred to as the tip or the tip, and FIG. And the lower end in (B), and therefore the end on the upper side (the operation unit 50 side) in FIG. 1 is referred to as a base end or 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 the dummy clip 18. 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 an operation handle 48 of the present invention, and a plurality of clips of the treatment operation unit 11 12 (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 distal end portion of the connecting ring 14 fitted to the intersecting portion 26 presses the base portions 28b and 28b of the arm portions 28 and 28 toward the claw portions 22 and 22 ( The arm portions 28 and 28 and the claw portions 22 and 22 are closed by moving a predetermined amount toward the convex portions 30 and 30), and a predetermined cusp fitting force (gripping force) is exhibited in the claw portions 22 and 22. To do.

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 has an opening on the distal end side of the connecting ring 14 (a hole 41 of a tightening ring 40 described later; see FIG. 4) and an inner diameter on a proximal end (a hole 43 of a holding portion 42 described later). The width is wider than the portion with which 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. The holding unit 42 includes a first area 32 that holds the previous clip 12 and a second area 34 that is a connected holding area that holds the next clip 12 in a state of being connected to the previous clip. 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 grooves (concave portions) are formed at two opposing positions. 43a 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 arm portions 28 and 28 of the clip 12 held in the second region 34 with the claw portions 22 and 22 closed.
The grooves 43a and 43a are provided at two locations on both sides in the opening / closing direction (left and right direction in FIG. 4B) of the claw portion 22 of the clip 12 held in the second region 34. 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, respectively. 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 connection ring 14B in FIG. 2B) differs from the previous clip 12 by 90 degrees due to the groove 43a in the second region 34. The rotational movement is suppressed by being held in the direction, 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 12 are held by the connecting 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 moves the plurality of clips 12 forward and backward in a series of clip treatments. For example, the operation wire 20 is made of a metal wire and is housed in the sheath 16, and has a distal end (an end opposite to the operation unit 50). Is provided with a connecting member 21. 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 covering 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 among the four circumferential directions, Alternatively, 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. 5 is a cross-sectional view in a state where the relative positional relationship between the slider guide and the slider is different from that 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 wire position fixing mechanism 57, 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 a plurality of 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. Further, a position regulating member 58 is fixed to the small diameter portion 52b of the handle main body 52 by a fixing member 59 such as a screw (see FIG. 6).

The slider 54 is a cylindrical member that is disposed above the outer periphery of the handle main body 52 via the slider guide 56 and is movable in the axial direction above the outer periphery of the handle main body 52, and has a pincushion shape. It is easy for the operator to move his / her finger in the forward / backward direction. 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 body 52 in order to switch the movement amount of the slider 54 in a plurality of stages, that is, to restrict the movement amount to two or more different movement amounts. Four slider guide grooves (position regulating grooves) 66A, 66B, 66C, and 66D having different diameters 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 arranged in the order of the guide grooves 66A so as to overlap with the engagement grooves 68 of the handle 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 engagement grooves 68 of the handle body 52, respectively, when the slider guide 56 is rotated to have a predetermined orientation.
The slider guide 56 is disposed 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 engagement groove 68 by slider guide grooves 66A, 66B, 66C, and 66D that overlap the engagement groove 68. The movement limit position of is regulated. That is, the slider pin 70 also functions as an engaging member 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 with the engaging groove 68 of 52.

  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 56c 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 56c have the same shape. The convex portion 56c 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 and tapered shape, and the inclination angle of the other tooth surface forms a substantially perpendicular step. Moreover, the connection part of the adjacent convex part 56c and the convex part 56c becomes the recessed part 56d, and this recessed part 56d is also formed four.

Next, the wire position fixing mechanism 57 has a position fixing groove 72 (see FIGS. 1 and 7B). The slider pin 70 of the slider 54 also constitutes a part of the wire position fixing mechanism 57. That is, the wire position fixing mechanism 57 includes the slider pin 70 and the position fixing groove 72.
The position fixing groove 72 is connected to a surface of the distal end portion of the slider guide groove 66A on the sheath 16 side that is parallel to the central axis of the handle body 52 (in this embodiment, the surface on the slider guide groove 66B side). It is the groove | channel formed in. In the position fixing groove 72, the distal end portion on the sheath 16 side in the direction parallel to the central axis is flush with the distal end portion on the sheath 16 side of the slider guide groove 66A, and extends in the circumferential direction of the slider guide 56. The groove has a width that can be fitted to the slider pin 70.
The wire position fixing mechanism 57 is configured as described above, and the slider guide 56 is further rotated while the slider pin 70 is moved to the tip of the slider guide groove 66A on the sheath 16 side by the slider 54. Thus, the slider pin 70 is fitted in the position fixing groove 72.
The wire position fixing mechanism 57 fixes the position in the direction parallel to the central axis of the slider 54 and the slider pin 70 to a predetermined position by engaging or fitting the slider pin 70 and the position fixing groove 72 in this way. To do. That is, the slider 54 and the slider pin 70 are prevented from moving along the slider guide groove 66A, and the operation wire 20 is temporarily fixed in a state where the operation wire 20 protrudes from the sheath 16 by a certain length.

As shown in FIGS. 7 and 8, the slider guide position restricting member (hereinafter simply referred to as “position restricting member”) 58 is a stepped cylindrical member that restricts the position of the slider guide 56, particularly the rotational position. The small diameter portion 52b of the handle main body 52 is inserted into the hole, and the slider guide is fixed to the small diameter portion 52b of the handle main body 52 with a fixing member 59 (see FIG. 6) such as a screw, as is fine. It is fixed to the handle body 52 at the front end side than 56. Further, the position restricting member 58 is provided with a concave joint portion 58a, which is fitted in a state where the convex joint portion 56a on the distal end side of the slider guide 56 is rotatable, on the proximal end side, and on the distal end side thereof, A stepped body 58b is provided.
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 sawtooth-shaped convex portions 58c 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 58c have the same shape. This convex portion 58c is a sawtooth shape, that is, a convex portion having a triangular cross section in which one tooth surface has a gentle inclination angle and a tapered shape, and the other tooth surface has a substantially right angled step. Further, a connecting portion between the adjacent convex portion 58c and the convex portion 58c becomes a concave portion 58d, and four concave portions 58d are also formed.

As described above, the joint 56a of the slider guide 56 also has the unevenness (the four concave portions 58d and the convex portions 58c) corresponding to the concave and convex portions (four concave portions 58d and convex portions 58c) on the contact surface with the position restricting member 58. Four concave portions 56d and convex portions 56c) are formed so that the inclination angles of the tooth surfaces on both sides of the convex portions are reversed.
Accordingly, 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 mesh (fit), that is, the convex portion 58c projects into the concave portion 56d. When the portion 56c is fitted into the recess 58d, 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 steep inclination angle of the convex portion 56c of the portion 56a is a tooth surface having a steep inclination angle of the convex portion 58c 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 56c of the joint portion 56a of the slider guide 56 resists the biasing force of a biasing spring 60 described later, and the tooth surface (the joint portion 58a of the opposing position regulating member 58 has a gentle inclination angle ( Rotate in the direction of the convex portion 58c from the concave portion 58d along the taper-shaped surface, and then move from the convex portion 58c along the tooth surface (step) having a steep inclination angle to the next concave portion 58d. The convex portions 56c 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.
If the slider guide groove 66A overlaps the engagement 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 connecting member 21 at the tip protrudes from the tip of the sheath 16. When the slider guide groove 66B overlaps the engagement groove 68, when the slider 54 is moved until the slider pin 70 comes into contact with the end of the slider guide groove 66B on the sheath 16 side, the first clip 12A is moved. Is protruded from the sheath 16 to a position where it does not fall off the sheath 16. As a result, the first clip 12A is in a state where it can be clipped.
Similarly, when the slider guide groove 66C is overlapped with the engagement groove 68, the slider 54 is moved until the end of the slider guide groove 66C on the sheath 16 side comes into contact with the second clip. 12B protrudes from the sheath 16 to a position where it does not fall off 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 engaging groove 68, 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 with each other. 12C protrudes from the sheath 16 to a position where it does not fall off the sheath 16. Thereby, the 3rd clip 12C will be in the state where clip treatment is possible.

Here, each part of 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 body 52, and the slider guide 56 are made of PPSU (polyphenylsulfone), PSU (polysulfone), PEI (polyetherimide), PEEK (polyetheretherketone), PPS. (Polyphenylene sulfide), PES (polyethersulfone), PASF (polyallylsulfone), etc., are preferably used to make a sterilizable resin.

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 tool of the present invention will be described with reference to FIGS.
First, a method for loading a clip row into the clip treatment instrument shown in FIGS. 1 to 8 and an apparatus used therefor will be described.
FIG. 9 is a perspective view showing a schematic configuration of an embodiment of a clip case and a mounting jig for mounting a clip row on the clip treatment instrument of the present invention. FIG. 10 is a cross-sectional view showing a schematic configuration of the clip case shown in FIG. FIG. 11A is a top view showing a schematic configuration of the mounting jig shown in FIG. 9, and FIG. 11B shows an enlarged part of the clip case in the mounting jig shown in FIG. It is an expanded sectional view.

A clip case 200 shown in FIG. 9 is a case that holds a clip row 13 including three clips 12A to 12C in the illustrated example (see FIG. 10), and the mounting jig 202 removes the clip row into a clip treatment. When the clip 10 is attached to the operation wire 20 of the tool 10 and connected to the sheath 16 and loaded into the sheath 16, the clip row 13 held by the clip case 200 is received from the clip case 200 and the skirt portion 38 of the connection ring 14 is closed. At the same time, the jig is temporarily held in a closed state.
Here, the clip case 200 and the mounting jig 202 are in a connected state during distribution and storage (that is, until the clip row 13 is loaded in the clip treatment instrument 10).

As shown in FIG. 10, the clip case (hereinafter simply referred to as “case”) 200 is a case for distribution and storage of the clip row 13 to be loaded in the clip treatment instrument 10, and includes a case main body 212, a cap 214, and the like. Have
The case main body 212 has a cylindrical shape and accommodates the clip row 13 including a plurality of hemostatic clip bodies including the clips 12 (12A to 12C) and the connection rings 14 (14A to 14C). As shown in FIGS. 9 and 10, the case main body 212 is configured by combining two case parts 212 a and 212 b having a semicylindrical shape and substantially the same shape. A mounting jig 202 is fitted to the front ends of the two case components 212a and 212b, and a cap 214 is fitted to the rear ends thereof to keep the case main body 212 closed.

  The case body 212 is preferably transparent or translucent so that the inside can be seen. In addition, due to impact resistance, ease of handling, and ease of molding, the ambient temperature, that is, the temperature range of use, and the range of sterilization temperature in the sterilization process (for example, 5 ° C. to 70 ° C.) and EOG (ethylene oxide gas) sterilization It is preferably formed of a resin that does not deteriorate due to low-temperature plasma sterilization or γ-ray sterilization. In the present embodiment, the case body 212 is cylindrical, but the outer shape of the case body 212 is not limited to a columnar shape, and may be a prism.

  The case 200 needs to keep the inside of the case main body 212 hermetically sealed in order to store the medical clip 12. Therefore, the outer surface of the case parts 212a and 212b of the case main body 212 is covered with a cover 216 made of a transparent resin, so that the inside of the case main body 212 is secured. Alternatively, the case body 212 is made of the case parts 212a and 212b made of an elastic material, and the case parts 212a and 212b are held by the cap 214 and a mounting jig 202 to be described later in a state where the case parts 212a and 212b are pressed on the mating surfaces. It may be ensured. Further, a seal may be secured by providing a packing between the case components 212a and 212b.

  The cap 214 may be anything that seals the case components 212a and 212b in a sealed state, and can be made of rubber or resin. The cap 214 is removable. When the clip row 13 in the case main body 212 is loaded onto the sheath, the clip row 13 inside the case main body 212 is pulled out to the mounting jig 202 in a connected state (see FIG. 11A).

As shown in FIG. 10, the case body 212 has a hole having an inner diameter slightly larger than the outer diameter of the connection ring 14 and substantially equal to the inner diameter of the sheath 16 into which the clip row 13 is loaded. The three clips 12A to 12C and the dummy clip 18 that are formed and connected to the holes, the three connection rings 14A to 14C that cover these connection portions, and the connection that is connected to the rear end of the dummy clip 18. A clip row 13 composed of the member 19 is accommodated. The tip of the top clip 12A is protected by the mounting jig 202. Further, the connecting member 19 at the rear end of the dummy clip 18 connected to the rearmost clip 12C is held by the cap 214.
Further, the pulling bar 232 of the mounting jig 202 is connected to the tip of the top clip 12A.

  Further, as shown in FIG. 10, a recess 224 corresponding to the shape of the skirt portion 38 is provided on the inner surface of the case main body 212 (case components 212a and 212b) at a position where the coupling rings 14A to 14E are accommodated. Yes. The concave portion 224 includes a first inclined portion 220 that extends from the straight portion 218 in the radial direction substantially at the same angle as the inclination of the skirt portion 38 in the natural state, and substantially coincides with the spread of the skirt portion 38. The inclined portion 220 is formed by a second inclined portion 222 that narrows in the radial direction from the widened end portion (rear end).

As described above, the clips 12A to 12C are connected to each other by changing the direction by 90 degrees. Correspondingly, the connecting rings 14A to 14C change the direction from the front and rear connecting rings 14 by 90 degrees to the clips 12A to 12C. It is fitted. Therefore, the position of the recess 224 in the case main body 212 is also shifted by 90 degrees in the circumferential direction at positions corresponding to the connection rings 14A to 14C.
Accordingly, in FIG. 10, the concave portions 224 corresponding to the skirt portions 38 of the coupling rings 14A and 14C are shown in two upper and lower portions, respectively. Although not shown, the recesses 224 corresponding to the skirt portion 38 of the connecting ring 14B are formed at two locations in a direction perpendicular to the paper surface of FIG. In addition, you may form the recessed part 224 over the perimeter in the position corresponding to the skirt part 38 of each connection ring 14 of the inner surface of the case main body 212. FIG.

Due to the first oblique portion 220 of the recess 224, the connection rings 14A to 14C are accommodated in the case body 212 in a state where the skirt portion 38 is expanded without receiving external force. Therefore, the elasticity of the skirt portion 38 can be prevented from deteriorating while being stored in the case main body 212, and the performance of the coupling rings 14A to 14C can be maintained.
In the present embodiment, the second oblique portion inclined by a predetermined angle is provided between the rear end surface of the first oblique portion 220 and the straight portion 218. However, the present invention is not limited to this. It is good also as a surface at right angles to the straight part 218 along the skirt part 38 of the open state between the surface of the rear end side and the straight part 218.

Next, as illustrated in FIG. 11A, the mounting jig 202 includes a jig body 230, a pulling bar 232, and an opening diameter variable member 234.
The jig body 230 has a rectangular parallelepiped shape in which the extending direction of the case 200 is the longitudinal direction, and engages with the end portion on the distal end side of the case 200. The jig body 230 has a recess 231 formed on the base end side thereof, an engagement groove 240 formed in the recess 231 and engaged with the case 200 and the distal end of the sheath 16 being inserted, and an engagement groove. 240, the circular guide path 42 formed to extend on the extension line 240, and open to the side surface of the jig body 230, and is formed between the engagement groove 240 and the guide path 242, and has a variable opening diameter member 234. And a hollow portion 244 that movably supports in a direction orthogonal to the guide path 242. In the present embodiment, the jig main body 230 has a rectangular parallelepiped shape, but the shape of the jig main body 230 is not limited to a rectangular parallelepiped shape, and may be any shape, such as a columnar shape, a prismatic shape, a columnar shape, and a half shape. A cylindrical shape, a cone shape, etc. may be sufficient.

The engagement groove 240 has an inner diameter slightly larger than the outer diameters of the case 200 and the sheath 16. The engagement groove 240 is a groove into which the case 200 is first fitted and then the case 200 is pulled out, and the sheath 16 is fitted instead. , Formed in the recess 231 of the mounting jig 202 along the longitudinal direction. The engaging groove 240 is open at the top.
The guide path 242 is a circular hole formed through the inside of the jig main body 230 on the extension line of the engagement groove 240 for closing the skirt 38 of the connection ring 14 opened in the case 200. One end portion of the guide path 242 faces the engagement groove 240 through the hollow portion 244, and the other end portion is an opening formed in the end surface of the jig main body 230. Further, the guide path 242 basically has a shape having the same inner diameter as the inner diameter of the straight portion 218 of the case main body 212, and a portion near the end opposite to the engaging groove 240 has a larger diameter than the other portions. It is. The guide path 242 may be configured by a pipe line or the like.
The hollow portion 244 is a rectangular parallelepiped space between the engagement groove 240 and the guide path 242 that is perpendicular to the guide path 242 and parallel to the surface where the engagement groove 240 is open. .
An opening diameter variable member 234 is fitted and supported in the hollow portion 244.

  The tow bar 232 is a bar-like member inserted through the guide groove 240, and one end thereof is engaged with the tip of the clip 12A as shown in FIG. Is provided with a finger ring 233 so that it can be pulled by the user.

The opening diameter variable member 234 is a member that is fitted in the hollow portion 244 and is movable in a direction orthogonal to the guide path 242. A recess (not shown) having an inner diameter substantially the same as the outer diameter of case 200 and sheath 16 is formed.
The opening diameter variable member 234 is pushed into and fitted into the hollow portion 244 to push the connecting member 21 at the tip of the operation wire 20 of the operation handle 48 into a position where it is inserted into the guide path 242 and a case. 200 and the sheath 16 are provided with a function of alternately sandwiching them in the concave portion of the bifurcated portion.
The clip case and mounting jig used in the present invention are basically configured as described above.

Hereinafter, a method of loading the clip row held in the clip case used in the present invention into the sheath of the clip treatment instrument of the present invention will be described.
Here, FIG. 12 is a perspective view showing a state in which the clip row in the clip case shown in FIG. 10 is moved inside. FIG. 13 is a top view showing the relationship between the clip and the tow bar in the mounting jig shown in FIG. FIGS. 14A to 14C are top views showing states of the operation handle in each step, and FIGS. 15A and 15B are a mounting jig 202 and a clip treatment tool 10, respectively. FIG.

First, at the time of storage, the case 200 in which the clip row 13 is held and the mounting jig 202 are connected.
From this state, the hook hook 232 of the mounting jig 202 is pulled away from the jig body 230.
By pulling the tow bar 232, the clip row 13 engaged with the tow bar 232 is pulled toward the mounting jig 202, and the clip row 13 is held inside the guide path 242 as shown in FIG. It becomes a state. The clip row 13 is held in the guide path 242 having the same diameter as the straight portion 218 of the case main body 210, so that the skirt portion 38 is closed.
Also, as shown in FIG. 12, when the end engaged with the clip 12A reaches a region having a larger diameter than the other part of the guide path 242, the tip of the clip 12A is moved as shown in FIG. The traction bar 232 can be removed from the clip 12A.
At this time, the connecting member 19 of the dummy clip 18 at the rearmost end of the clip row 13 is partly placed on the opening diameter variable member 234.

On the other hand, as shown in FIG. 14A, the clip treatment instrument 10 rotates the slider guide 56 so that the slider guide groove 66A and the engagement groove 68 of the handle main body 52 overlap each other, and the orientation of the slider guide 56 is changed. adjust. At this time, the slider pin 70 is held at the end of the movable region of the slider pin 70 (and the slider 54) on the finger ring 62 side (hereinafter referred to as “home position”).
Next, as shown in FIG. 14B, the slider 54 and the slider pin 70 are moved to the end of the slider guide groove 66A on the sheath 16 side. In this way, by moving the slider 54 and the slider pin 70 to the end portion on the sheath 16 side of the slider guide groove 66A, the operation wire 20 protrudes from the distal end of the sheath 16 by a predetermined distance.
Next, the slider guide 54 is rotated to fit the slider pin 70 into the position fixing groove 72. Thus, by fitting the slider pin 70 to the position fixing groove 72, the slider pin and the slider guide 54 cannot move along the slider guide groove 66A. It is temporarily fixed in a state protruding by a predetermined distance.

Next, the connection member 21 of the operation wire 20 that is protruded from the distal end of the sheath 16 by a predetermined distance is connected to the connection member 19 of the dummy clip 18 at the end of the clip row held by the mounting jig 202.
Specifically, as shown in FIG. 15A, the distal end of the sheath 16 is moved onto the opening diameter variable member 234.
Thereafter, the sheath 16 is fitted into the engagement groove 240, and the connection member 21 of the operation wire 20 in a state of protruding a predetermined distance from the distal end of the sheath 16 is placed on the opening diameter variable member 234. The connecting member 19 is overlaid.
Next, the opening diameter variable member 234 is moved so that the opening having the same diameter as the guide path 242 is on the same straight line as the guide path 242. At this time, the portion of the opening diameter variable member 234 that is divided into two portions passes through the portion where the connecting member 21 and the connecting member 19 overlap, and the connecting member 21 is pushed into the connecting member 19. The connecting member 19 and the connecting member 21 are engaged with each other.

  Thereafter, the slider guide 54 is rotated in the direction in which the slider guide groove 66A and the slider pin 70 are engaged, and then the slider 54 is moved to the home position side. It is pulled by 20 and is loaded in the sheath 16.

Thus, according to the clip treatment instrument 10, when the connecting member 19 of the dummy clip 18 and the connection member 21 of the operation wire 20 are connected, the operation wire 20 is fixed in a state where the operation wire 20 protrudes from the sheath 16 by a certain distance. Therefore, the connecting member 19 and the connecting member 21 can be easily connected. In particular, when the connecting member 19 and the connecting member 21 are connected from a direction other than the extending direction of the operation wire 20 and the clip 12 as in the present embodiment, the operation wire 20 can be operated with a constant protrusion amount. Sexuality can be increased.
Further, since the protruding amount of the operation wire 20 can be made constant, the protruding amount of the operating wire 20 is small, and it is possible to prevent malfunctions such as the connection member 19 and the connecting member 21 being unable to be connected. it can. Further, since the protruding amount of the operation wire is not a desired length, it is possible to prevent a failure such as a load on the operation wire and deformation of the operation wire.

Next, the clip treatment operation by the continuous clip treatment tool of the present invention will be described.
Here, FIGS. 16A to 16P are partial perspective views showing the stepped state of the operation handle during the clip treatment operation of the continuous clip treatment device, and FIG. 17 shows the slider during the clip treatment operation. FIGS. 18A to 18P are partial development views showing the positional relationship between the guide and the slider pin of the slider. FIGS. It is a fragmentary sectional view. Hereinafter, the operation of the continuous clip treatment device 10 will be described while explaining the correspondence between the states of FIGS. 16, 17, and 18.

  First, as shown in FIG. 16A, the slider guide 56 is set so that the slider guide groove 66A overlaps with the engagement groove 68, and the slider 54 is moved to the end of the movement region on the finger ring 62 side of the handle body 52 (that is, Move 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. 16B, 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. 17). As shown in (B), the connecting member 21 of the operation wire 20 is projected from the distal end of the sheath 16. Thereafter, as described above, the slider 54 is rotated to fit the slider pin 70 into the position fixing groove 72.
Thereafter, the connecting member 19 of the dummy clip 18 held by the mounting jig and connected to the three clips 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, the slider 54 is moved to the home position as shown in FIG. 70 is moved to a position P3 in FIG. 17), and as shown in FIG. 18C, the three clip rows 13 connected to the dummy grip 18 are stored in the sheath 16.
Thereafter, the sheath 16 is inserted from the distal end into the forceps opening of the endoscope inserted into the living body, and the distal end of the sheath 16 reaches the distal end of the insertion portion of the endoscope and protrudes from the distal end of the endoscope. .

  Thereafter, as shown in FIG. 16D, the slider guide 56 is rotated by 90 ° so that the slider guide groove 66B of the slider guide 56 and the engagement groove 68 overlap each other. As a result, the slider pin 70 is moved to the home position (position P4 in FIG. 17) on the extension line of the slider guide groove 66B.

Next, as shown in FIG. 16E, 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. 17). 18D, the first clip 12A is protruded 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.

Thereafter, 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. 17), 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 expanded first clip 12A are pressed against the diseased part such as the affected part to be clipped, and the slider 54 is moved as shown in FIG. A predetermined distance is moved to the finger ring 62 side, specifically, to the clip completion position (that is, the slider pin 70 is moved to the position P6 in FIG. 17).
At this time, the skirt portion 38 is open in the connecting 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. As a result, as shown in FIG. 18 (F), the first clip 12A and the connection ring 14A can be detached from the sheath 16, and the clip of the disease site 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 fastening ring 40 at the tip of the connecting ring 14A 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 P7 in FIG. As a result, as shown in FIG. 18G, the clip 12B and the clip 12C are drawn into the sheath 16.

  Thereafter, as shown in FIG. 16H, the slider guide 56 is rotated by 90 ° so that the slider guide groove 66C of the slider guide 56 and the engagement groove 68 overlap. As a result, the slider pin 70 is moved to the home position (position P8 in FIG. 17) on the extension line of the slider guide groove 66C.

  Next, as shown in FIG. 16I, the slider 54 is moved to the end of the slider guide groove 66C on the sheath 16 side (that is, the maximum projecting position) (that is, the slider pin 70 is moved to the position P9 in FIG. 17). 18H, the second clip 12B is protruded from the distal end of the sheath 16, and the skirt portion 38 of the second clip 12B is opened.

  Thereafter, 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. 17), and is 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 claw portions 22 and 22 of the second clip 12B that are expanded are pressed against the site to be clip-treated, and the slider 54 is moved to 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 P10 in FIG. 17).
By moving the slider 54 to the clip completion position, the tightening by the second clip 12B is completed, 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 fastening ring 40 at the tip of 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. 16L, the slider guide 56 is rotated by 90 ° so that the slider guide groove 66D of the slider guide 56 and the engagement groove 68 overlap each other. As a result, the slider pin 70 is moved to the home position (position P12 in FIG. 17) on the extension line of the slider guide groove 66D.

  Next, as shown in FIG. 16M, 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. 17). 18C, 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 as shown in FIG.

  Thereafter, 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. 17), 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, and the slider 54 is moved to 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. 17).
By moving the slider 54 to the clip completion position, the tightening by the third clip 12C is completed, and the connection between the third clip 12C and the dummy clip 18 is released. 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. 18 (O), the dummy clip 18 is pulled into the sheath 16.

  Thereafter, as shown in FIG. 16 (P), the slider guide 56 is rotated by 90 ° so that the slider guide groove 66A of the slider guide 56 and the engagement groove 68 overlap each other. As a result, the slider pin 70 is moved to the home position (position P16 in FIG. 17) 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 the position P2 in FIG. 17), and FIG. As shown, 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.

  Thus, according to the clip treatment tool of the present invention, it is possible to perform clipping multiple times 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.

Also, a slider guide is provided, and the operator adjusts the clip by regulating the amount of movement of the slider that controls the advancement / retraction of the clip (ie, whether it 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 slider pin and the position fixing groove are fitted as the position fixing mechanism, but the present invention is not limited to this, and the position fixing mechanism includes the slider and the slider guide. The above effect can also be obtained by providing a concave portion on one of the two members and a convex portion on the other. In this case, the concave portion and the convex portion need to be provided at a position where the concave portion and the convex portion are fitted at a position where the slider is fixed (that is, a position where the operation wire protrusion amount is fixed). Moreover, it is necessary to fit a recessed part and a convex part in the state which can be attached or detached.

Hereinafter, another specific configuration of the position fixing mechanism used in the present invention will be described.
FIGS. 19A and 19B, FIGS. 20A and 20B, and FIGS. 21A and 21B are partial sectional views showing other examples of the position fixing mechanism of the present invention, respectively. It is. Here, in FIG. 19, FIG. 20, and FIG. 21, (A) shows a state in which the slider is movable, and (B) shows a state in which the position of the slider is fixed. 19A and 19B, FIGS. 20A and 20B, and FIGS. 21A and 21B are different in the shape of the clip treatment instrument 10 and the slider and the position of the slider pin 70. Since the basic functions are the same, description thereof is omitted.

A position fixing mechanism 300 shown in FIGS. 19A and 19B has a convex portion 302 provided on the inner peripheral surface of the slider 52 and a concave portion 304 formed on the outer peripheral surface of the slider guide 56.
The convex portion 302 is a member that is movable in a direction in which the urging force is applied to the slider guide 56 side and is separated from and in contact with the slider guide 56. Specifically, the convex portion 302 is a ball 302a (that is, a ball plunger) urged toward the slider guide 56 by the urging spring 302b. Further, the convex portion 302 is provided at the same position as the slider pin 70 in the circumferential direction and closer to the sheath 16 than the slider pin 70 of the slider 54 in the moving direction of the slider pin 70.
The recess 304 is formed on the sheath side by a predetermined distance from the end portion on the sheath 16 side of the slider guide groove 66A on the outer peripheral surface of the slider guide 54.
Further, as shown in FIG. 19B, the concave portion 304 and the convex portion 302 are formed when the slider pin 70 comes into contact with the end portion on the sheath side of the slider guide groove 66A (that is, when the slider pin 70 is moved to the maximum projecting position). ) To be fitted to each other.
With the above-described configuration of the position fixing mechanism 300, the operation wire 20 (and the slider 54) can be temporarily fixed in a state where the operation wire 20 protrudes from the sheath 16 by a predetermined distance.

Further, in the position fixing mechanism 300 shown in FIG. 19, the convex portion 302 is configured by a ball plunger, but the convex portion 312 is formed on the slider guide 56 as in the position fixing mechanism 310 shown in FIGS. It is good also as a resin-made engaging claw which has the protrusion 316 fitted to the recessed part 304 in the contact surface of the cantilever 314 urged | biased toward the slider guide 56 of this cantilever 314. FIG. In this case, it is necessary to provide a space in the handle body 52 so that the cantilever 314 can move.
As described above, as shown in FIG. 20B, when the slider pin 70 is moved to a position where the slider pin 70 comes into contact with the end portion on the sheath 16 side of the slider guide groove 66A as shown in FIG. 304 is fitted, and the slider 54 is fixed at a predetermined position. Thus, even with the position fixing mechanism 310, the operation wire 20 can be temporarily fixed with the operation wire 20 protruding from the sheath 16 by a predetermined distance.

In the position fixing mechanisms 300 and 310, the convex portions 302 and 312 are provided in the slider 54 and the concave portion 304 is provided in the slider guide 56. However, the concave portion and the convex portion may be provided in reverse.
A position fixing mechanism 320 shown in FIGS. 21A and 21B includes a convex portion 322 provided on the outer peripheral surface of the slider guide 56 and a concave portion 324 provided on the inner peripheral surface of the slider 54.
The convex portion 322 is formed on the sheath 16 side by a predetermined distance from the end portion on the sheath 16 side of the slider guide groove 66A. Here, the convex portion 322 is a member that is applied with an urging force on the slider 54 side and is movable in a direction in which the slider guide 56 is separated from and contacting the slider guide 56. Specifically, the convex portion 322 is a resin having a cantilever 326 biased toward the slider guide 56 and a protrusion 328 that fits the concave portion 324 on the contact surface of the cantilever 326 with the slider guide 56. It is an engagement claw made of.
The cantilever 326 is a cantilever whose longitudinal direction is the direction parallel to the axis of the slider guide 56 (the moving direction of the slider 54) and whose end in the longitudinal direction is the base end.
As described above, the position fixing mechanism 320 may be provided with the convex portion 322 on the slider guide 56 side and the concave portion 324 on the slider 54 side.

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. 22 is a partially developed view of the outer peripheral surface of another embodiment 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.
A slider guide 80 having slider guide grooves 82A, 82B, 82C and 82D shown in FIG. 22 is a slider having 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. 22, 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 slider 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. The shape from the end on the home position side to the maximum protruding position may be a straight line, and the first protruding position may be curved in the rotational direction first.
In this case, even if the slider is moved to the maximum projecting 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 slider 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 beyond 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. 23 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. 23 is different from the slider guide 56 shown in FIGS. 7A, 7B and 17 in that the slider guide groove for regulating the movement 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. 23, in the developed view, the slider guide 90 has a short side on the finger ring 62 side (base end side) that is basically parallel to a plane orthogonal to the central axis, and the center of the handle body. Five sides 92 (sides 92A, 92B, 92C, 92D, and 92E) having different positions in the axial 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.
Similarly to the slider guide 56, a position fixing groove 72 is formed on the surface connected to the side 92A and parallel to the central axis.
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. 23 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, and the clip 12 is a sheath. Jumping out of 16 can be prevented.
Further, by providing the position fixing groove 72 on a surface parallel to the central axis connected to the side 92A, the operation wire can be fixed in a state where the operation wire protrudes from the sheath tip by a certain amount when the clip is loaded. .

  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 clip treatment instrument 10, in order to improve operability, for example, between the slider guide 56 and the handle main body 52, the position regulating member 58, a taper shape and a step on the contact surface thereof, unevenness formed by them, etc. Although one of the slider guide grooves (66A to 66D) and the groove 68 of the handle main body 52 are appropriately overlapped with each other, the present invention is not limited to this, and the operator does not limit the slider guide groove. An operation of overlapping one and the groove of the handle body is required, but a position restricting member and a position restricting mechanism are not necessarily provided.
In addition, in the clip treatment instrument 10, since the erroneous operation can be prevented more reliably, the slider guide is rotated only in one direction by the position regulating member 58. However, the present invention is not limited to this, and the bidirectional rotation is performed in both directions. You may make it make it.
Further, 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, but only one of the functions is provided. Also good.
For example, when the position regulating member has a function of regulating the rotation direction of the slider guide in one direction as a position regulating mechanism, the contact surface between the position regulating member and the slider guide is independent of the position of the slider guide groove. May have 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 slider 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.

FIGS. 24, 25 (A) and (B), FIGS. 26 (A) and (B), and FIGS. 27 (A) and (B) are diagrams of slider guides as position restricting mechanisms applicable 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 FIG. 25, FIG. 26 and FIG. 27, (A) is a circumferential sectional view, and (B) is an axial sectional view.
The position regulating mechanism 100 shown in FIG. 24 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. 24, the convex portion 102 is constituted by a ball plunger. However, like the position restricting mechanism 110 shown in FIGS. As a resin 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 cantilever 114 with the slider guide 56. Good. In this case, it is necessary to provide a space for the cantilever 114 to move in the handle main body 52.

26 (A) and 26 (B) 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 movable in a direction in which the urging force is applied to the handle main body 52 side and is in contact with and away from the handle main body 52. 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.
As described above, the position regulating mechanism may be provided with a convex portion on the slide guide 56 side and a concave portion 124 on the handle body 52 side.

  In FIGS. 26A and 26B, the cantilever 126 constituting the convex portion 122 is a cantilever whose longitudinal direction is the direction parallel to the axis of the handle body 52 and whose end in the longitudinal direction is the base end. Although the beam is used, as shown in FIGS. 27A and 27B, the cantilever 134 of the convex portion 132 of the position restricting mechanism 130 may be a curved cantilever along the circumferential direction of the handle body. .

Here, in the position restriction mechanisms 100, 110, 120, and 130 shown in FIGS. 24 to 27, the rotation direction of the slider guide 56 is not restricted, but the shapes of the concave and convex portions are changed (for example, the asymmetric shape). Thus, the rotation direction of the slider guide can be restricted to one direction.
28A to 28D 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. 24, as a modified example thereof, as in the position restricting mechanism 101 shown in FIG. 28 (A), the surface that contacts the slider guide 56 of the ball 142a of the ball plunger constituting the convex portion 142. A protrusion (specifically, a protrusion having a surface perpendicular to the tangent to the ball 142a) 142b may be provided at 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. 25A and 25B, 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. 26A and 26B, as a modified example, the protrusion 146a of the convex portion 146 is formed in the circumferential direction as in the position restricting mechanism 121 shown in FIG. One of the end faces may be a tapered surface with a gentle slope, and the other end face may be a step with 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. 27A and 27B, 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 of the end faces may be a tapered surface with a gentle slope, and the other end face may be a step with 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.
FIG. 29A is a circumferential sectional view showing the relationship between the slider and the slider guide, and FIG. 29B is a sectional view taken along line BB in FIG. FIG. 30 is a diagram showing an example of the positional relationship between the slider guide groove of the slider guide shown in FIG. 29 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. Note that the slider 150 and the slider guide 152 shown in FIGS. 29A, 29B, 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. 29A and 29B, the slider 150 is provided with a convex portion 154 that is provided with an urging 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. 29B and FIG. 30, 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 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 instrument according to the present invention and the repetitive clip treatment instrument 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.

In any of the above embodiments, since clipping can be performed a plurality of times at a time, the clips are connected to each other and connected to one operation wire. However, the present invention is not limited to this. However, the operability is lowered, but an operation wire may be provided for each clip, and an operation wire in which a plurality of clips are connected to a plurality of tips inside one sheath may be provided. Further, although the operability is further reduced, a configuration may be adopted in which one operation wire is provided inside one sheath and one clip is connected to the end of the operation wire.
When the operation handle is not provided with a slider guide, the position fixing mechanism may be provided on the handle body and the slider. In this case, the groove of the handle body may be used as the slider guide groove.

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. It is a perspective view which shows schematic structure of one Example of the clip case and mounting jig | tool for mounting | wearing a clip row | line | column with the clip treatment tool of this invention. It is sectional drawing which shows schematic structure of the clip case shown in FIG. (A) is a top view which shows schematic structure of the mounting jig shown in FIG. 9, (B) is an expanded sectional view which expands and shows a part of clip case in the mounting jig shown in FIG. is there. It is a perspective view of the mounting jig | tool which shows the state which moved the clip row | line | column in the clip case shown in FIG. 10 to the inside. FIG. 10 is a top view showing the relationship between the clip and the traction rod in the mounting jig shown in FIG. 9. (A)-(C) is a top view which shows the state in each process of the operation handle shown in FIG. 5, respectively. (A) And (B) is a perspective view which shows the relationship between the clip treatment tool of this invention, and a mounting jig, respectively. (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 the repetitive clip treatment tool of this invention, 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 of the present invention. (A)-(P) is a fragmentary sectional view which shows the stepped state of the treatment operation part at the time of the clip treatment operation | movement of the repetitive clip treatment tool of this invention, respectively. (A) And (B) is a fragmentary sectional view showing other examples of a position fixing mechanism of the present invention. (A) And (B) is a fragmentary sectional view showing other examples of a position fixing mechanism of the present invention. (A) And (B) is a fragmentary sectional view showing other examples of a position fixing mechanism of the present 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 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 one Example of the combination of the position control mechanism and slider guide which are each used for the operating handle of this invention. (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. 30 is a partial development view showing one embodiment of the configuration of the outer peripheral surface of the slider guide shown in FIG. 29.

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 20 operation wire 21 connecting member (hook)
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 | maintenance area | region)
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
56c, 58c, 102, 112, 122, 132, 142, 144, 146,
148, 154, 302, 312, 322 Protrusions 56d, 58d, 104, 124, 143, 145, 147, 149, 156,
304,324 Recessed portion 57,300,310,320 Wire position fixing mechanism 58 Position regulating member 58b Stepped body 60 Biasing spring 62 Finger ring 64 Reinforcement pipes 66A, 66B, 66C, 66D, 82A, 82B, 82C, 82D Slider guide groove 68 Engagement groove 70 Slider pin 72 Position fixing groove 92A, 92B, 92C, 92D Side 94A, 94B, 94C, 94D Step 100, 101, 110, 111, 120, 121, 130, 131 Position restriction mechanism

Claims (29)

A sheath,
An operation wire disposed inside the sheath and having a clip connected to 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 extending direction of the sheath;
A wire position fixing mechanism for temporarily fixing the operation wire in a state where the operation wire protrudes from the distal end of the sheath by a certain length;
An operation handle for a clip treatment instrument, wherein the slider is moved in an axial direction of the handle main body, and the operation wire disposed inside the sheath is moved in an extending direction of the sheath.   The clip treatment instrument operation handle according to claim 1, wherein the wire position fixing mechanism temporarily fixes a relative position between the slider and the handle body.   The slider movement amount regulating member according to claim 1, further comprising a slider movement amount regulating member that is rotatably mounted on an outer circumference of the handle body and that regulates a movement amount of the slider in an axial direction of the handle body. Operation handle for clip treatment tool. The slider moves in the axial direction 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. Is to be moved,
The clip handle operating handle according to claim 3, wherein the slider movement amount regulating member regulates the movement amount of the slider to a plurality of different movement amounts including a movement amount corresponding to at least the clip. The slider has an engaging member protruding toward the central axis side,
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 position restricting groove and the position for engaging the engaging member of the slider with at least one of the position restricting groove and the position restricting step of the slider moving amount restricting member and engaging the engaging member of the slider The operation handle for a clip treatment instrument according to claim 3 or 4, wherein the moving amount of the slider is adjusted according to the plurality of different moving amounts by at least one of the restriction steps. The wire position fixing mechanism is
The engagement member of the slider;
Of the plurality of position restriction grooves or the plurality of position restriction steps of the slider movement amount restriction member, the sheath-side tip portion of the sheath side is closest to the sheath side. A position fixing groove that communicates with the tip portion, extends in a circumferential direction of the slider movement amount regulating member, and is engageable with the engagement member of the slider;
The wire position fixing mechanism temporarily fits the operation wire in a state where the operation wire protrudes from the distal end of the sheath by a predetermined length by fitting the position fixing groove and the engagement member of the slider. The operation handle for a clip treatment instrument according to claim 5, which is fixed to the clip treatment tool. The wire position fixing mechanism is
A convex portion formed on the sheath side of the inner peripheral surface of the slider;
Of the plurality of position restriction grooves or the plurality of position restriction steps, the distal end portion on the sheath side is closest to the distal end portion on the sheath side in the position restriction groove or the position restriction step that is closest to the sheath side. The operation handle for a clip treatment instrument according to claim 5, wherein the handle is provided on the sheath side and has a concave portion that can be fitted to the convex portion. The wire position fixing mechanism is
A recess formed on the sheath side of the inner peripheral surface of the slider;
Among the plurality of position restriction grooves or the plurality of position restriction steps, the distal end portion on the sheath side is closest to the distal end portion on the sheath side in the position restriction groove or the position restriction step that is closest to the sheath side. The operation handle for a clip treatment instrument according to claim 5, wherein the handle is provided on the sheath side and has a convex portion that can be fitted into the concave portion.   The operation handle for a clip treatment instrument according to claim 7 or 8, wherein the convex portion has a structure capable of switching between locking and retracting with the concave portion by elastic deformation.   The clip treatment instrument operating handle according to any one of claims 7 to 9, wherein the convex portion is a ball plunger including a compression spring and a ball.   The operation handle for a clip treatment instrument according to any one of claims 7 to 9, wherein the convex portion is a locking claw using elastic deformation. A plurality of the clips are connected to the tip of the operation wire disposed inside the sheath,
The plurality of different movement amounts of the slider include at least a plurality of different movement amounts corresponding to the plurality of clips,
The operation handle for a clip treatment tool according to any one of claims 1 to 11, wherein the clip treatment tool is a repetitive clip treatment tool. A clip portion comprising a clip and a connecting member connected to the clip;
An operation handle for a clip treatment instrument according to any one of claims 1 to 11,
In the sheath, the clip portion is loaded,
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 the clip portion. 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 clip treatment instrument according to claim 12,
In the sheath, the clip row of the 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. An operation wire protruding state holding method for a clip treatment instrument having the operation handle for the clip treatment instrument according to claim 6,
Moving the slider to the sheath-side distal end along the axial direction of the slider movement amount regulating member;
Thereafter, the slider movement amount regulating member is rotated, the engagement member and the position fixing groove are engaged, and the relative position between the slider and the slider movement amount regulating member is fixed, so that the sheath of the operation wire is removed. A method of maintaining a protruding state of a wire, wherein the protruding amount of the wire is held constant. An operation wire protruding state holding method for a clip treatment instrument having the operation handle for the clip treatment instrument according to claim 7,
Moving the slider to the sheath-side distal end along the axial direction of the slider movement amount regulating member;
The protrusion of the operation wire is protruded from the sheath by fitting the convex portion of the slider and the concave portion of the slider movement amount regulating member and fixing the relative position of the slider and the slider movement amount regulating member. A method of maintaining a wire protruding state, wherein the wire is held constant. An operation wire protruding state holding method for a clip treatment instrument having the operation handle for the clip treatment instrument according to claim 8,
Moving the slider to the sheath-side distal end along the axial direction of the slider movement amount regulating member;
The amount of protrusion of the operation wire from the sheath by fitting the concave portion of the slider with the convex portion of the slider movement amount regulating member and fixing the relative position of the slider and the slider movement amount regulating member. A method of maintaining a wire protruding state, characterized in that the wire is held constant. 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 base 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 base end side. The operation handle for a clip treatment instrument according to any one of claims 5 to 12, which 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,
The slider is fixed with a second engagement member that engages with a groove of the handle body, and reciprocates in the axial direction along the groove of the handle body. An operation handle for the described clip treatment tool. The second engagement member of the slider is the engagement member of the slider of the operation handle for the clip treatment instrument according to any one of claims 5 to 12,
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 restricting grooves or one of the plurality of position restricting steps overlaps with the engaging groove of the handle main body, the engaging member of the slider is connected to the engaging groove of the handle main body. The operation handle for a clip treatment instrument according to claim 19, wherein the operation handle for the clip treatment instrument moves in the axial direction along one of the plurality of overlapping position restriction grooves or one of the plurality of position restriction steps.   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 clip treatment instrument according to any one of claims 1 to 12 and 18 to 20.   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 clip treatment instrument according to claim 21.   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 clip treatment instrument according to claim 22, wherein a recess is formed between adjacent protrusions of the protrusion.   24. The position of the slider movement amount regulating member is regulated by fitting 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 clip treatment instrument described in 1.   The operation handle for a clip treatment instrument according to any one of claims 21 to 24, further comprising urging means for urging the contact surface of the slider movement amount restricting member toward the contact surface of the position restricting member.   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 clip treatment instrument according to any one of claims 21 to 25, wherein the slider movement amount regulating member rotates by overcoming the step on the contact surface.   27. The operation handle for a clip treatment instrument according to any one of claims 21 to 26, wherein the position restricting member restricts a position in a rotational direction and an axial direction of the slider movement amount restricting member.   The position restricting member or the slider and the slider moving amount restricting member restrict the position of the slider moving amount restricting member in the rotational direction by a concave and convex fitting shape formed on the inner peripheral surface of the fitting. The operation handle for a clip treatment instrument according to any one of 21 to 27.   29. The slider movement amount regulating member is rotated in one direction by a planar shape formed on one side in the rotational direction of the concave-convex fitting shape of the position regulating member or the slider and the slider movement amount regulating member. Operation handle for clip treatment tool.