JP2010063659A - Operation handle for disposing clip and repeating type clip disposing device - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a repeating type clip disposing device corresponding to clips having a plurality of sizes and performing safe and accurate clipping by simple operation. <P>SOLUTION: The repeating type clip disposing device includes a sheath, a cylindrical handle body connected to the sheath, an operation wire to which a plurality of the clips are connected, a slider which is movable in the axial direction of the handle body and with which the operation wire is engaged, a regulation means for regulating the moving quantity of the slider and a cylindrical slider guide rotatable circumferentially. Further, the regulation means has a means for altering the moving quantity of the slider corresponding to the kind of the clip. <P>COPYRIGHT: (C)2010,JPO&INPIT

Description

  The present invention relates to an endoscopic clip treatment tool that is inserted into a living body and performs treatment such as hemostasis and marking, and more specifically, treatment with a plurality of clips can be performed continuously, and the size, etc. It is related with the clip treatment tool which can respond | correspond suitably also to multiple types of clip from which this differs.

As is well known, an endoscope is inserted into a living body such as a human body and used for diagnosis and treatment of organs, collection of specimens, and the like.
In addition, the endoscope is basically connected to an insertion portion to be inserted into a human body, an operation portion for operating the endoscope such as operation of the insertion portion and air / water supply, an air supply source, a suction pump, and the like. A connector (LG (Light Guide) connector) and a universal cord (LG flexible portion) that connects the connector to the operation portion and the insertion portion are configured.

As one of the treatments (treatments) using such an endoscope, hemostasis, suturing of wounds, marking, etc. using a clip for clipping (holding) a living tissue with two arms having a claw at the tip. There is treatment of.
In the treatment using the clip, a sheath (introducing tube) that accommodates the clip is inserted into the body from the forceps channel (treatment tool insertion channel) of the endoscope, and the arm portion of the clip is extended by protruding from the sheath, for example. Then, the wound or lesion is clipped with the nail at the tip of the arm of the clip.

The treatment with such a clip requires a plurality of clips depending on the size of the living tissue to be treated.
However, the clip treatment tool for endoscopes that is currently in practical use can attach only one clip to the sheath. Therefore, when treatment with a plurality of clips is necessary, after inserting the clip treatment tool into the body and clipping it, the clip treatment tool is pulled out from the endoscope, and the clip is attached to the sheath ( Alternatively, a new clip treatment tool is used), and it is necessary to repeat the insertion of the clip treatment tool from the endoscope into the body to perform clipping.

In order to eliminate such inconvenience, a repetitive clip treatment tool that can load a plurality of clips into a sheath and continuously perform clipping with a plurality of clips without pulling out the sheath, Various proposals have been made.
For example, Patent Document 1 includes a sheath (introduction tube), a plurality of operation wires inserted through the sheath so as to be able to advance and retreat, and a plurality of clips. The clip is connected to the tip side (into the living body). There is disclosed a repetitive clip treatment tool (living tissue clip device) in which a clip and an operation wire are individually engaged while being accommodated in series in a sheath on the insertion tip side).

In the clip treatment tool disclosed in the cited document 1, by sending out the operation wire to the distal end side, the arm part of the clip is protruded from the sheath to open the arm part, so that clipping is possible (preparation state), Next, the nail | claw part is pressed on the biological tissue to be clipped, and the operation wire is pulled to perform clipping and detachment of the operation wire and the clip.
Here, the operation portion of the clip treatment tool disclosed in Patent Document 1 includes a knob connected to the operation wire, and a slider that engages with the knob and is provided so as to be movable in the axial direction of the sheath in the operation portion. By operating this slider, it is prepared for clipping, and then clipping is performed by pulling the knob.

Japanese Patent Laid-Open No. 2002-272751

By the way, there are various sizes of wounds and lesions in a living body. In other words, the size of the wound that the clip treatment instrument stops or sutures varies.
Therefore, in a clip treatment tool for an endoscope, clips of various sizes such as standard size (standard size) / short size / long size are prepared to deal with various sizes of scratches and the like.

In the apparatus disclosed in Patent Document 1, while observing an image taken with an endoscope, a slider is operated to prepare for clipping, and further, the knob is pulled to perform clipping.
Here, if the size of the clip is different, naturally, the operation amount for setting the preparation state and the operation amount for clipping differ. That is, in the clip treatment tool disclosed in Patent Document 1, the amount of operation of the slider for setting the preparation state and the amount of pulling of the knob for clipping differ depending on the size of the clip. Furthermore, in the repetitive clip treatment tool as disclosed in Patent Document 1, the operation amount varies depending on the order of clipping (the clip used at the number of times = the position of the clip in the sheath), and the clip at the rear stage, The difference in operation amount due to the difference in clip size becomes large.

  That is, in the conventional clip treatment tool disclosed in Patent Document 1 and the like, a doctor is required to perform a careful and delicate operation with an operation amount corresponding to the clip size and the number of clippings while observing the endoscope. It will be very burdensome.

  An object of the present invention is to solve the above-mentioned problems of the prior art, and in a clip treatment instrument capable of performing continuous clipping with a plurality of clips without pulling out the sheath from the living body, a standard size, a long size Suitable for various types of clips, such as clips of different sizes such as short size, etc., and operations for clip treatment instruments that enable simple and good operability to perform clipping preparation and clipping operations accurately The object of the present invention is to provide a handle and a clip treatment tool using the operation handle.

  In order to solve the above-described problems, an operation handle for a clip treatment instrument according to the present invention includes a sheath, a cylindrical handle main body connected to the sheath, and the reverse of the handle main body inserted through the sheath and the handle main body. An operation wire to which a plurality of clips are connected to an end portion on the side, a slider through which the handle body is movably inserted in an axial direction of the handle body, and the operation wire is engaged; A cylindrical slider guide that has a restricting means for restricting an amount of movement of the slider in the axial direction, and is inserted between the handle body and the slider so as to be rotatable in a circumferential direction of the handle body. And the slider guide restricting means controls the amount of movement of the slider by the restricting means according to the type of clip connected to the operation wire. Providing for clipping device operating handle and having a moving amount changing means for further.

In such an operation handle for a clip treatment instrument of the present invention, it is preferable that the restricting means is arranged in the circumferential direction of the handle body at least as many as the number of clips connectable to the operation wire. It is preferable that the plurality of restricting means restrict the amount of movement of the slider different from each other, corresponding to each of the plurality of clips.
Further, the restricting means restricts the movement amount of the slider by being in contact with the slider located in the elongated hole extending in the axial direction of the handle main body for guiding the slider. Preferably, the moving amount changing means is a moving means for moving the abutting member in the axial direction of the handle body. In this case, all the restriction means have the same long hole. In terms of length, it is preferable that the length of the contact member is a length corresponding to the amount of movement of the slider.
The handle body has an engagement groove of a predetermined length extending in its axial direction, and the slider has an engagement member that engages with the engagement groove. It is preferable that the engaging member moves along the axial direction of the handle body. In this case, the engaging member rotates the slider guide in the circumferential direction of the handle body, and the engaging hole of the handle body and the restricting means It is preferable to insert into the engaging hole and the long hole when the long hole is overlapped.

  Further, the clip treatment tool of the present invention includes a claw portion that is connected to the operation handle for the clip treatment tool of the present invention and an end of the operation wire opposite to the handle main body and is accommodated in the sheath. And a clip row having a plurality of clips connected to each other by engaging an end portion opposite to a claw portion of another clip.

According to the operation handle for a clip treatment instrument and the clip treatment instrument of the present invention having the above-described configuration, the slider connected to the operation wire and guided by the slider guide moves the operation wire in the axial direction of the handle body, that is, from the sheath. By moving in the pulling direction, preparation for clipping and clipping operation can be performed.
Here, since the amount of movement of the slider in the axial direction is restricted by the slider guide and the restricting means provided on the slider guide, an appropriate amount of movement of the slider according to the operation can be easily performed. Further, in the present invention, the slider guide regulating means includes a slider movement amount adjusting means, and the movement amount changing means is used according to the type of clip used in the clip treatment tool, such as a standard size, a long size, or a short size. The amount of movement of the slider can be changed.

Therefore, according to the present invention, in a repetitive clip treatment instrument, preparation for clipping, clipping operation, and the like are carefully performed while viewing an image taken with an endoscope with an operation amount corresponding to the size of the clip to be used. There is no need to do so, and it can be carried out accurately with very simple and good operability.
Therefore, according to the present invention, it is possible to greatly reduce the burden on the doctor who performs the treatment with the clip treatment tool in the treatment using the endoscope.

  Hereinafter, the operation handle for a clip treatment tool and the clip treatment tool of the present invention will be described in detail based on preferred embodiments shown in the accompanying drawings.

In FIG. 1, the schematic perspective view of the clip treatment tool of this invention is shown.
The clip treatment tool 10 of the present invention accommodates a clip row in which a plurality of clips 12 are connected to the distal end portion of the sheath 16 of the operation handle 48 (hereinafter referred to as the operation handle 48) for the clip treatment tool of the present invention ( 2).
Note that the distal end portion is an end portion on the distal end side that is inserted into a living body when a treatment with the clip treatment tool 10 is performed using an endoscope. Hereinafter, the distal end is referred to as the distal end side, and the side opposite to the distal end (operation handle 48 side) is referred to as the proximal end side.

In the illustrated example, the operation handle 48 includes the handle portion 50, the sheath 16, the operation wire 20 (see FIG. 2 and the like), and the like.
The sheath 16 is a normal long tube-shaped sheath used in a clip treatment tool for an endoscope, and is, for example, a flexible coil sheath in which a metal wire is tightly wound.
The operation wire 20 is, for example, a metal wire, and is a dummy clip on the most proximal end side of the clip 12 that is inserted into the sheath 16 from the handle portion 50 and is connected to the distal end portion of the sheath 16 to be described later. 18 is connected. A connecting member 21 that is engaged / connected to the connecting member 19 of the dummy clip 18 is provided at the distal end portion of the operation wire 20.

FIG. 2 shows a schematic cross-sectional view of the distal end portion of the sheath 16. 2A is a view as seen from the opening / closing direction of the arm portion 28 of the clip 12 to be described later, and FIG. 2B is a direction different from the circumferential direction of the sheath 16 by 90 ° (opening / closing direction of the arm portion 28). It is the figure seen from (orthogonal direction).
As shown in FIG. 2, the clip treatment device 10 of the illustrated example is accommodated in a sheath 16 by connecting three clips 12 (12 </ b> A, 12 </ b> B, and 12 </ b> C). That is, the clip treatment tool 10 in the illustrated example is a three-time clip treatment tool 10 that can perform three clippings continuously without pulling out the sheath.

  Note that the clip treatment device of the present invention is not limited to the three-shot clip treatment in which three clips 12 are loaded as shown in the illustrated example, and may be capable of loading two clips, or It may be possible to load four or more clips.

Each clip 12 is connected by a connection ring 14 (14A, 14B, 14C). Further, a dummy clip 18 that is engaged with the operation wire 20 is connected to the clip 12C on the most proximal side. As will be described in detail later, the operation wire 20 is inserted through the sheath 16 and is inserted into a handle operation unit 48 described later, and is connected to a slider 54 that performs clipping preparation and clipping operation.
In the following description, the distal end side is also referred to as “front”, and the proximal end side with respect to the distal end portion is also referred to as “rear” and “next”. Also, with respect to a certain clip 12, the clip immediately before is also referred to as “previous clip 12”, and the clip 12 immediately behind is also referred to as “next clip 12”.

FIG. 3 shows a schematic perspective view of the clip 12.
In the illustrated example, the clip 12 has a closed end formed by folding a long thin plate having a spring property by approximately 180 °, then crossing the two pieces, and the two ends are opposed to the two open ends. In this way, the claw portion 22 is formed by being bent. That is, the clip 12 is a so-called closed clip in which the closed end side has an annular shape with respect to the claw portion 22 that performs clipping (gripping of the living body by the clip 12).

In the clip 12, the open end side (that is, the front end side) of the intersecting portion 26 is an arm portion 28 that can be opened and closed. A wide convex portion 30 is formed in the central portion of the arm portion 28.
The tips of the arm portions 28 are bent in directions facing each other to form a claw portion 22 that grips the living tissue. In order to securely grasp the living tissue, the tip of the claw portion 22 has a male and female V shape that engage with each other.

As for the clip 12, the arm part 2 is obstruct | occluded when the arm part 28 is drawn into the connection ring 14 mentioned later, and a biological tissue is clipped by the nail | claw part 22. FIG.
Here, the convex portion 30 has a width wider than the inner diameter of the opening (hole 41 of the tightening ring 40) and the proximal end opening (hole 43 of the holding portion 42) of the connecting ring 14 described later. . In the clip treatment instrument 10, this prevents the clip 12 from entering the connection ring 14 (from both the front end side and the base end side) more than a predetermined amount.

As shown in FIG. 2, each clip 12 engages the arm portion 28 of the next clip 12 with the turn portion 24 of the previous clip 12 with the arm portion 28 of the next clip 12 closed (turn). The arm portion 28 that has been made annular by closing is passed through the portion 24).
That is, the arm portion 28 of the next clip 12B is engaged with the turn portion 24 of the top clip 12A, and the arm portion 28 of the next clip 12C is engaged with the turn portion 24 of the clip 12B. Connected. Further, the dummy clip 18 connected to the operation wire 20 is engaged with the turn portion 24 of the rearmost clip 12C.
As shown in FIG. 2, each clip 12 is alternately turned by 90 ° in order to securely engage the turn part 24 of the previous clip 12 and the arm part 28 of the next clip (opening of the arm part 28). The direction is changed and connected. Therefore, the clip 12A at the front end and the clip 12C at the rear end are connected in the same direction, and the middle clip 12B is in a state in which the 90 ° direction is changed with respect to the previous two clips 12.
Each clip is kept in the closed state of the arm portion 28 for connection by inserting the arm portion 28 into the connection ring 14.

The connection ring 14 connects the two clips 12 and also acts as a fastening member for the arm portion 28 when clipping, so that the clip 12 can be moved forward and backward in the longitudinal direction of the sheath 16. Inserted (inserted loosely).
FIG. 4 shows a schematic diagram of the connecting ring 14. 4A is a front view of the connecting ring 14 (in the same direction as the clips 12A and 12C in FIG. 2A), and FIG. 4B is a sectional view in the same direction as FIG. C) shows a bottom view (rear end face).

  As shown in FIG. 4, the connecting ring 14 includes a tightening ring 40 and a holding portion 42, and is configured by fitting / fixing the tightening ring 40 at the tip of the holding portion 42. In the illustrated example, the holding unit 42 maintains the connected state of the clip 12 before clipping, and the clamping ring 40 clips the living body by the claw portion 22 (arm portion 28) of the clip 12 when clipping is performed. To maintain.

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.
In the clip treatment instrument 10 of the illustrated example, the clip 12 is connected by the connection ring 14 so that the intersecting portion 26 is substantially in the same position as the fastening ring 40. From this state, the clip 12 is pulled into the hole 41 of the tightening ring 40 (the coupling ring 14), thereby closing both the expanded arms 28 and clipping the living body. Further, when the clip 12 clips the living body, the tightening ring 40 maintains the clipping state by the frictional force and the reaction force of the arm portion 28 clipping the living body.

Here, as described above, the fastening ring 40 is formed with a hole 41 having an inner diameter that is larger than the width of the clip 12 in the vicinity of the intersecting portion 26 and smaller than the width of the convex portion 30.
Therefore, the convex portion 30 serves as a stopper, and the clip 12 can be prevented from being pulled into the connecting ring 14 more than necessary.

The holding part 42 is a substantially cylindrical part having a hole 43 communicating with and passing through the hole 41 of the fastening ring 40, and is formed by, for example, resin molding. This hole 43 is a circular through hole larger than the hole 41 of the fastening ring 40 into which the proximal end side can be inserted from the turn part 24 of the clip 12 and the convex part 30 of the arm part 28.
In the illustrated example, the holding portion 42 includes a first region 32 that accommodates the turn portion 24 of the previous clip 12, and a second region 34 that accommodates the arm portion 28 (the front end side of the convex portion 30) of the next clip 12. Consists of

  A stepped portion for fitting the fastening 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 (the stepped portion) are fitted with a strength that does not come off in a state where the sheath 16 is loaded, a clipping operation, or a clipping state.

Further, the first region 32 gradually expands from the upper side to the lower side with respect to the axis of the connection ring 14 (center axis of the cylinder) so that the amount of spread gradually increases (inclined and spreads in a skirt shape). A skirt portion 38 is provided.
In the skirt portion 38, a base 38 a on the distal end side (upward in FIGS. 4A and 4B) is connected to the holding portion 42 (its main body), and a lower spreading portion 38 b is formed in the holding portion 42. It is partly cut off by the notch 36 so as to expand or close in the radial direction of the connecting ring 14.
In the illustrated example, the skirt portion 38 is located on both sides of the clip 12 at the same position in the pulling direction of the clip 12 (the direction of the central axis of the connecting ring 14 = the vertical direction in FIG. 4) and 180 ° apart from the central axis of the connecting ring 14. It is formed in two places.

In the state where no external force is applied to the skirt portion 38, as shown in FIG. 4, the widened portion 38 b spreads in a skirt shape due to the elasticity of the skirt portion 38 (the forming material of the connection ring 14). 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, in the state in which the connecting ring 14 is housed in the sheath 16, as shown in the second connecting ring 14B from the front in FIG. 2B, the widened portion 38b of the skirt portion 38 is pushed inward. The cylindrical connecting ring 14 enters the internal space, and the inner peripheral portion of the widened portion 38 b presses the turn portion 24 of the clip 12 held in the first region 32, so that the clip 12 rotates in the connecting ring 14. And it hold | maintains so that it may not move to the advancing / retreating direction (longitudinal (extension) direction of the sheath 16).

As shown in the leading connecting ring 14A in FIG. 2A, the skirt portion 38 is pulled out from the distal end of the sheath 16, and at the same time, is opened by its own elasticity. Accordingly, the holding of the clip 12 by the connecting ring 14 is released, and the width of the clip 12 becomes wider than the inner diameter of the sheath 16 to prevent the connecting ring 14 from entering (retracting) into the sheath 16.
As described above, each clip 12 is connected to the turn portion 24 of the previous clip 12 by the engagement of the arm portion 28 of the next clip 12, and the operation wire 20 is connected to the rearmost clip 12 </ b> C. The dummy clips 18 to be connected are connected.
Accordingly, when the operation wire 20 is pulled with the skirt portion 38 of the connection ring 14 protruding from the sheath 16, only the clip 12 is retracted and connected with the connection ring 14 fixed to the distal end portion of the sheath 16. It is drawn into the ring 14. Thereby, the arm portion 28 of the clip 12 is closed by the tightening ring 40 fixed to the tip of the connection ring 14, and the living body is clipped by the claw portion 22.

In the connection ring 14, the arm portion 28 of the clip 12 subsequent to the clip 12 held in the first region 32 is inserted into the second region 34 provided on the proximal end side with respect to the first region 32.
The arm portion 28 of the next clip 12 is closed by being inserted into the second region 34, and the claw portion 22 at the tip is engaged with the turn portion 24 of the previous clip 12 as described above. Thus, the two clips 12 are connected by the connecting ring 14. That is, the rear end portion of the turn portion 24 of the previous clip 12 is located at a place where the claw portion 22 of the next clip 12 can be engaged. Accordingly, the engaging portions of the two clips 12 are set in the vicinity of the boundary between the second region 34 and the first region 32.

  Here, in the second region 34, the length of the operation wire 20 in the pulling direction (the central axis direction of the connecting ring 14) is the length by which the clip 12 is pulled before the clipping is completed (drawn into the connecting ring 14). Length).

That is, the second region 34 of the connection ring 14 maintains the connection between the two clips 12 to be connected while the clipping operation is performed.
On the other hand, when clipping is completed, the rear clip 12 is pulled out from the rear end portion of the second region 34 (the connection ring 14), so that the arm portion 28 of the next clip 12 contacts the inner wall of the sheath 16. It releases until it contacts, and thereby the engagement between the turn part 24 of the clip 12 and the claw part of the next clip 12 is released. As a result, when clipping is completed, the connection of the two clips 12 by the leading connection ring 14 is released.

As shown in FIGS. 4B and 4C, a hole 43 is formed in the holding portion 42 of the connection ring 14 through the first region 32 and the second region 34. Here, in the hole 43 of the second region 34, grooves (concave portions) 43a into which the arm portion 28 of the clip 12 can be inserted are formed at two opposing positions.
In the second region 34, slits 46 cut from the base end portion are formed in two places.

The arm portion 28 of the clip 12 held in the second region 34 is inserted into the groove 43a. Here, the distance from the wall surface of one groove 43a to the wall surface of the other groove 43a is substantially equal to the length obtained by adding the lengths of the two claws 22 of the clip 12 (the length in the expanding direction).
Further, as described above, the convex portion 30 of the clip 12 has a width wider than the inner diameter of the hole 43 of the holding portion 42 of the connecting ring 14, that is, the width of the groove 43 a is formed in the arm portion 28. The width of the convex portion 30 is smaller. Therefore, the convex portion 30 of the clip 12 held in the second region 34 cannot enter the groove 43a.

  The clip treatment tool 10 having such a configuration prevents the next clip 12 from entering the previous clip more than necessary in the two clips 12 connected to the one connection ring 14, and Further, the connection of the clip 12 in the connection ring 14 is made more reliable, and the clip 12 is prevented from rotating unnecessarily in the connection ring 14.

In the illustrated example, the connection ring 14 has two positions shifted from the skirt portion by 90 ° in the circumferential direction (90 ° from the 12 expansion direction) from the rear end portion to a position shallower than the upper end of the second region. A slit 46 is formed.
By providing the slit 46, the flexibility of the connecting ring 14 can be improved, that is, the flexibility of the clip row can be improved. Therefore, even when the angle part of the endoscope is greatly curved, the clip treatment tool 10 can pass while maintaining the connection of the clip rows.

As described above, the claw portion 22 of the clip 12B engages with the turn portion 24 of the most advanced clip 12A. The claw portion 22 of the clip 12B is held in a closed state by the inner wall of the connection ring 14A (second region 34), and thereby the connection state of the clip 12A and the clip 12B is maintained.
Similarly, the connection state between the second clip 12B and the clip 12C from the tip is maintained by the connection ring 14B, and the connection state between the rearmost clip 12C and a dummy clip 18 described later is maintained by the connection ring 14C.
That is, the clip treatment tool 10 of the illustrated example accommodates a clip row formed by connecting three clips 12 and one dummy clip with three connection rings 14 at the distal end of the sheath 16 of the operation handle 48. It is composed.

A dummy clip 18 that is not used for clipping is connected to the rearmost (most proximal) clip 12C.
The dummy clip 18 has a spring-like portion (a portion similar to the arm portion 28) having a shape similar to that of the half on the open end side from the intersection portion 26 of the clip 12 at the tip portion. That is, the dummy clip 18 has a shape in which two arm portions having a claw portion at the tip are connected at an intersection portion, and engages with the turn portion 24 of the rearmost clip 12C with the claw portion closed. When the claw is opened, the clip 12C is released.
A connecting member 19 is attached to the base end side of the dummy clip 18. The connecting member 19 has a shape / configuration that can be attached to and detached from a connecting member (hook) 21 at the distal end of the operation wire 20 described later.

As described above, a clip row (a row formed by connecting the three clips 12 and the dummy clips 18 with the connecting ring 14) is inserted into the distal end portion of the sheath 16 so as to be able to advance and retreat in the longitudinal direction. The operation wire 20 is inserted through the sheath 16 and connected to the slider 54 of the handle portion 50 on the proximal end side of the operation handle 48, and the connection member 21 is fixed to the distal end portion of the operation wire 20. Engage with clip 18.
As will be described later, in the clip treatment instrument 10, the operation wire 20 is advanced and retracted (moved in the longitudinal direction of the sheath 16) in the sheath 16 by operating the slider 54, and is connected to the distal end portion of the sheath 16. Clipping operation is performed by advancing and retreating the clip row accommodated.

As described above, the clip treatment device 10 of the present invention includes the operation handle 48 and the clip row accommodated at the distal end portion of the operation handle 48 (sheath 16).
The operation handle 48 includes the sheath 16, the operation wire 20, the connection member 21 at the tip of the operation wire 20, and the handle portion 50.

FIG. 5 shows a schematic sectional view of the handle portion 50 of the operation handle 48.
As shown in FIG. 5, the handle portion 50 of the operation handle 48 includes a handle body 52, a slider 54, a slider guide 56, a rotation position regulating member 58, an urging spring 60, and a finger hooking member 62.

FIG. 6 shows a schematic perspective view when the slider guide 56 is removed from the handle portion 50.
As shown in FIGS. 5 and 6, the handle main body 52 is a stepped cylindrical member having three cylindrical portions having different outer diameters, and from the base end side, a large diameter portion 52a, a medium diameter portion 52b, and The small diameter portions 52c are formed in this order.

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

  In the handle main body 52, the sheath 16 is fixed to the distal end of the small diameter portion 52c on the most distal end side so as to communicate with the through hole 52d of the handle main body 52. The operation wire 20 is inserted through the sheath 16, protrudes from the proximal end portion of the sheath 16, is inserted through the small diameter portion 52 c and the medium diameter portion 52 b of the handle body 52, and is connected to the slider 54.

The slider 54 is disposed on the outer periphery of the handle main body 52 so as to pass through the handle main body 52 (and a slider guide 56 described later), and is a substantially cylindrical member that is movable in the axial direction of the handle main body 52 (same as above). It is.
In the illustrated example, the slider 54 has a disc-shaped flange portion projecting outward at two positions on the proximal end side of the cylinder and in the axial direction, and performs a treatment using the clip treatment instrument 10. Is easy to move the slider 54 in the axial direction by placing a finger. As an example, the doctor puts a thumb in the ring of the finger-hook member 62 and moves the slider 54 in the axial direction so that the slider 54 is sandwiched between the index finger and the middle finger between the flange portions.

The slider 54 has a slider pin 70 attached so as to protrude toward the central axis of the handle body 52. The slider pin 70 passes through the engagement groove 68 and reaches the center line of the through hole 52d of the handle body 52. An operation wire 20 inserted through the small diameter portion 52c and the medium diameter portion 52b of the handle main body 52 is fixed near the lower end portion of the slider pin (on the center line side of the through hole 52d).
As described above, the slider 54 is movable in the axial direction of the handle main body 52, and by moving the slider 54, the operation wire 20 inserted through the sheath 16 moves forward and backward (moves toward the distal end side and the proximal end side). be able to. In the clip treatment instrument 10, as described above, the clip row at the distal end of the sheath 16 is advanced and retracted by the advancement and retraction of the operation wire 20 by the slider 54 to prepare for clipping and perform clipping.

In the clip treatment instrument 10, the position where the proximal end of the engagement groove 68 contacts the slider pin 70 is the home position (HP) of the slider 54. By moving the slider 54 to the distal end side by a predetermined amount from this HP, the operation wire 20 is sent out (advanced) to the distal end side to prepare for clipping, and the slider 54 is returned to the HP side from this prepared state. Then, the operation wire 20 is pulled back (retracted) to perform clipping and disconnection of the previous clip 12 and the next clip 12.
Further, when the clip row is loaded on the sheath 16, the dummy clip 18 and the operation wire 20 are connected with the slider 54 moved to the tip side by a predetermined amount, and the slider 54 is moved to HP, A clip row is loaded on the sheath 16.
This will be described in detail later.

FIG. 7A shows a schematic perspective view of the slider guide 56.
The slider guide 56 is a member that regulates the amount of movement of the slider 54 in the axial direction, that is, the amount of advancement / retraction of the operation wire 20 in the longitudinal direction of the sheath 16, and is inserted through the handle body 52 as shown in FIGS. 5 and 7A. It is a substantially cylindrical member.
The slider guide 56 is pivotally supported on the outer peripheral surface of the handle body 52 so as to be rotatable in the circumferential direction and movable in the axial direction.

The slider guide 56 includes a joining portion 56a, a gripping / adjusting portion 56b, a guide portion 56c, and a regulating member 82 (see FIG. 8 and the like). In FIG. 7A, the regulating member 82 is omitted.
The joining portion 56a, the gripping / adjusting portion 56b, and the guide portion 56c are all substantially cylindrical portions, and the joining portion 56a, the gripping / adjusting portion 56b, and the guide portion 56c from the distal end side toward the proximal end side. In this order, they are integrally formed so as to constitute one cylinder.

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

The grip / adjustment unit 56b is a part to be gripped when the doctor rotates the slider guide 52 to perform clipping as will be described later.
In addition, a positioning groove 88 (88S, 88M, and 88L, refer to FIG. 15) is provided on the inner peripheral surface of the gripping / adjusting portion 56b. Is formed. This point will also be described in detail later.

The guide portion 56c has an inner diameter that is substantially the same as the outer diameter of the middle diameter portion 52b of the handle body 52, and an outer diameter that is substantially the same as the inner diameter of the slider 54 and the outer diameter of the large diameter portion 52a of the handle body 52. This is a substantially cylindrical portion. Accordingly, the slider 54 is guided in the outer periphery of the large diameter portion 52a and the guide portion 56c of the handle main body 52 and moves in the axial direction.
A guide groove 66 for guiding the slider 54 (slider pin 70) is formed in the guide portion 56c so as to extend in the axial direction. As described above, the clip treatment tool 10 of the illustrated example is a treatment tool that can be clipped three times without loading the sheath 16 from the body by loading three clips 12. Correspondingly, the guide portion 56c is formed with four guide grooves 66 (66A to 66D) as shown in the conceptual diagram of FIG.

As an example, when the clip row is loaded, the guide groove 66A corresponds to the first clipping, the guide groove 66C corresponds to the second clipping, and the guide groove 66D corresponds to the third clipping. In the illustrated example, as a preferable correspondence, the lengths of the guide grooves 66 are all the same and longer than the maximum movement amount of the slider 54.
As an example, the guide grooves 66 are formed at equal intervals in the circumferential direction, that is, at 90 ° intervals.

  In the present invention, as described above, the number of clips that can be loaded (successively) is not limited to three. Accordingly, in the guide portion 56c of the slider guide 56, “n + 1” guide grooves obtained by adding 1 for clip row loading to the clip treatment instrument (operation handle) according to the number n of clips 12 that can be loaded. 66 is formed.

The restricting member 82 is a member that restricts the amount of movement of the slider 54 that is guided and moved by the guide groove 66 and the engaging groove 68 of the handle body 12. The slider guide 56 of the clip treatment tool 10 (operation handle 48) of the illustrated example has four restricting members 82 (82A to 82D) corresponding to the four guide grooves 66A to 66D.
In the illustrated example, the regulating member 82 includes an abutting portion 84, an adjusting portion 86, and a positioning member 90 (see FIG. 15).

FIG. 8 is a schematic perspective view of the contact portion 84 and the adjustment portion 86 of the restriction member 82. In FIG. 8, the right side in the figure is the base end side, and the left side is the front end side.
The abutting portion 84 and the adjusting portion 86 are plate-like portions having the same bottom surface (the surface on the central axis side of the guide portion 56c) and integrally formed and having different thicknesses.
The contact portion 84 is inserted into a guide groove 66 formed in the guide portion 56c of the slider guide 56, and is guided in the guide groove 66 (and the engagement groove 68 of the handle body 52) to be moved in the axial direction. This is a part that regulates the amount of movement of the slider 54 in the axial direction by contacting the slider pin 70 of the slider 54.
On the other hand, the adjusting portion 86 is a portion inserted into the gripping / adjusting portion 56b and constitutes a position adjusting means in the axial direction of the regulating member 82 together with a positioning groove 88 formed on the inner peripheral surface of the gripping / adjusting portion 56b. This is a part for holding the positioning member 90.

  As described above, in the clip treatment tool 10 of the illustrated example, by reciprocating the slider 54 in the axial direction from the HP, the clipping operation and the clip row (three clips 12 and the dummy clip 18 to the sheath 16) are performed. A row formed by connecting the connecting rings 14 is loaded. In addition, the treatment tool can perform clipping three times without removing the sheath 16 from the body.

Here, the amount of movement of the slider 54 differs depending on when the clip row is loaded and the number of times of clipping (number of times of clipping).
Accordingly, as shown in FIGS. 7 and 8, the slider guide 56 is formed with four guide grooves 66 </ b> A to 66 </ b> D having the same length in the guide portion 56 c and four guide grooves 66 corresponding to the respective guide grooves 66. It has regulation members 82A-82D. In the slider guide 56, a regulating member 82 having an abutting portion 84 having a length that becomes an amount of movement of the slider 54 in accordance with the loading of the clip row and the number of times of clipping is disposed in each guide groove 66.

Specifically, when the clip row is loaded, the connection member 21 needs to protrude from the sheath 16, and when the slider 54 is returned to HP, the entire clip row needs to be accommodated in the sheath 16. Yes.
Therefore, as shown in FIG. 7B, the guide groove 66A corresponding to when the clip row is loaded has the shortest abutting portion 84A, and the regulating member 82A is the predetermined amount with the largest amount of movement of the slider 54. Is placed.

Clipping is sequentially performed from the clip 12 on the front end side. As a matter of course, the clip 12 and the connection ring are prepared for clipping, that is, the arm portion 28 of the clip 12 and the skirt portion 38 of the connection ring 14 protrude from the distal end of the sheath 16 as shown in FIG. The amount of movement of the tip 14 toward the tip side increases in the order of the first time, the second time, and the third time. That is, the required amount of movement of the slider from the HP to the tip side increases sequentially from the first time to the third time.
Therefore, as shown in FIG. 7B, the guide groove 66B corresponding to the first clipping (clip 12A) has the longest abutting portion 84B and the predetermined amount with the smallest moving amount of the slider 54. A regulating member 82B is arranged. Further, the guide groove 66C corresponding to the second clipping (clip 12B) has a second long contact portion 84C, and a regulating member 82C having a predetermined amount of movement of the slider 54 that is the second smallest. Be placed. Further, the guide groove 66C corresponding to the third clipping (clip 12C) is provided with a regulating member 82D having the third longest abutting portion 84D and the moving amount of the slider 54 being the third smallest amount. Is done.

The slider guide 56 is rotated in accordance with an operation such as loading of a clip row or clipping, and each guide groove 66 is aligned with the engagement groove 68 of the handle body 52.
That is, when the clip row is loaded, the guide groove 66A is in the first clipping (clip 12A), the guide groove 66B is in the second clipping (clip 12B), and the guide groove 66C is in the third clipping. In the case of (clip 12C), the slider guide 56 is rotated so that the guide grooves 66 coincide with the engaging grooves 68, respectively.
Further, in order to make this rotation smooth, the four regulating members 82 have their bottom surfaces (the contact portion 84 and the adjustment portion in a state where the contact portion 84 is accommodated in the guide groove 66, as shown in FIG. 86 is preferably the same inner peripheral surface as the inner peripheral surface of the guide portion 56c.

A positioning member 90 (see FIG. 15) is attached to the adjustment unit 86 inserted into the grip / adjustment unit 56b.
The positioning member 90 adjusts the axial position of the regulating member 82 (contact portion 84) according to the size of the clip 12 to be used together with the positioning groove 88 formed on the inner peripheral surface of the grip / adjustment portion 56b. Is.

The clip treatment device 10 in the illustrated example is a treatment device that can use, for example, three types of clips of a standard size (standard size / default size), a short size shorter than the standard size, and a long size longer than the standard size. .
When clipping or loading a clip row, the amount of movement of the slider 54 from the HP to the front end direction varies depending on the clip size. The positioning member 90 and the positioning groove 88 adjust the axial position of the restricting member 82 in three stages according to the size of the clip 12 loaded in the clip treatment instrument 10.
This will be described in detail later.

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

The rotational position restricting member 58 is a member that is disposed on the most proximal side of the handle portion 50, and is a cylindrical member that has a cylindrical region and a substantially hemispherical region and has a through hole in the center. .
The rotational position restricting member 58 is fixed to both the cylindrical region with the cylindrical region facing the distal end and the small diameter portion 52c of the handle main body and a part of the proximal end side of the sheath 16 through the through hole.

Further, as shown in FIG. 9, the rotational position restricting member 58 has a concave joint 58a on the base end side. As described above, the convex joint portion 56a on the distal end side of the slider guide 56 is inserted into the concave joint portion 58a in a rotatable state.
Similar to the convex joint 56a on the distal end side of the slider guide 56, the joint 58a protrudes toward the base end, and the inclination angles of the two tooth surfaces with respect to the contact surface are different at equal intervals in the circumferential direction. Four convex portions 59a having a shape are formed. The convex portion 59a is a sawtooth shape, that is, a convex portion having a triangular cross section in which the inclination angle of one tooth surface is a gentle taper and the inclination angle of the other tooth surface forms a substantially right-angled step. Moreover, between the adjacent convex part 59a and the convex part 59a, it becomes the recessed part 59b, and this recessed part 59b is also formed four.

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

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

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

Therefore, the action of the urging spring 60 prevents the slider guide 56 from rotating carelessly.
Further, by rotating the slider guide 56 in a predetermined direction, the unevenness of the joint portion 58a of the rotational position restricting member 58 and the joint portion 56a of the slider guide 56 counters the biasing force of the biasing spring 60 according to the rotation. When the slider guide 56 moves to the base end side along the concave and convex taper and deviates from the concave and convex taper (when the concave and convex part becomes a substantially vertical tooth surface), the biasing force of the biasing spring 60 again causes The slider guide 56 moves in the distal direction and is pressed against the rotational position restricting member 58.
As described above, the engagement groove 68 and the guide groove 66 are configured to coincide with each other in the circumferential direction at a position where the concave and convex portions of the joint portion 58a of the rotational position restricting member 58 and the joint portion 56a of the slider guide 56 are engaged. Is done. Therefore, a doctor who operates the clip treatment instrument 10 can easily and accurately match the engagement groove 68 and the guide groove 66 according to the number of times of clipping by rotating the slider guide 56.

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

  Further, the positioning means of the slider guide 56 in the rotational direction for matching the positions in the circumferential direction of the engagement grooves 68 and the respective guide grooves 66 is not limited to the configuration in the illustrated example, and the position regulating means using a ratchet structure Positioning means using various irregularities that engage with each other, positioning in various known rotational directions, such as a position restricting means that uses a sphere (so-called ball plunger) biased in a predetermined direction and a recess that engages with the sphere All means are available.

As described above, in the clip treatment instrument 10, the slider 54 is set to HP (base end side of the engagement groove 68) in a state where the engagement grooves 68 of the handle main body 52 are aligned with the guide grooves 66 of the slider guide. The clip 12 is moved by moving from the position where the end portion and the slider pin 70 come into contact to the position where the tip end side of the contact portion 84 inserted in the guide groove 66 comes into contact with the HP again. Clip the living body.
The clip treatment instrument 10 is a repetitive clip treatment instrument that can perform clipping three times without pulling out the sheath 16 from the endoscope.

  Hereinafter, a schematic perspective view of the handle portion 50 shown in FIGS. 10A to 10P, a developed view of the slider guide shown in FIG. 11, and a conceptual diagram showing a position (a hatched circle) of the slider pin 70 at the time of operation. With reference to the conceptual diagram of the distal end portion of the sheath 16 shown in FIGS. 12A to 12P, an example of the three clipping operations in the clip treatment instrument 10 will be described.

First, the slider guide 56 is rotated as necessary, and as shown in FIG. 10A, the guide groove 66A and the engagement groove 68 of the handle main body 52 are aligned (aligned in the circumferential direction), and the slider 54 is aligned. Is moved in the axial direction to the HP at which the slider pin 70 contacts the end face on the tip end side of the engagement groove 68. That is, the slider pin 70 of the slider 54 is moved to the position P1 shown in FIG. 11 (hereinafter, the slider pin 70 is omitted, and “slider guide is moved to position P1”, “slider guide is moved to HP”). As follows).
At this time, the distal end of the operation wire 20 is drawn into the sheath 16 as shown in FIG. This state is an initial state of treatment in the clip treatment tool 10 of the illustrated example.

  It should be noted that the present invention is not limited to restricting the amount of movement of the slider 54 in the axial direction by bringing the slider pin 70 into contact with the end face of the engagement groove 68 or the contact portion 84 of the restricting member 82. Instead, the main body of the slider 54, not the slider pin 70, and the front end side end surface or the contact portion 84 of the engagement groove 68 may be contacted to restrict the amount of movement of the slider 54 in the axial direction.

  Next, as shown in FIG. 10B, the slider 54 is moved to a position where it contacts the proximal end of the contact portion 84A inserted into the guide groove 66A, that is, a position P2 shown in FIG. . As a result, as shown in FIG. 12B, the connection member 21 of the operation wire 20 protrudes from the distal end of the sheath 16 by a predetermined amount.

In this state, the connecting member 19 of the clip row in which the three clips 12 and the dummy clip 18 are connected by the connecting ring 14 is attached to the connecting member 21 of the operation wire 20.
When the connecting member connecting member 19 of the clip row is attached to the connecting member 21 of the operation wire 20, the slider 54 is returned to the position P3 shown in FIG. 11, that is, HP as shown in FIG. By this operation, the clip row is accommodated in the sheath 16 as shown in FIG.
Thereby, the loading of the clip row connected with the clip 12 to the operation handle 50 is completed, that is, the clip treatment instrument 10 of the present invention is configured.

Thereafter, the sheath 16 is inserted into a forceps port of an endoscope inserted into the living body, and the distal end of the sheath 16 reaches the distal end of the insertion portion of the endoscope and protrudes from the distal end of the endoscope.
If necessary, the distal end of the sheath 16 of the clip treatment device 10 is moved to a target position by operating an insertion portion or an angle portion of the endoscope.

When the necessary operation is completed, as shown in FIG. 10D, the slider guide 56 is rotated by 90 ° so that the guide groove 66B and the engagement groove 68 coincide with each other.
Thereby, the position of the slider 54 (slider pin 70) moves to HP corresponding to the guide groove 66B indicated by position P4 in FIG.

Next, as shown in FIG. 10E, the slider 54 is moved to a position where it comes into contact with the proximal end of the contact portion 84B inserted into the guide groove 66B, that is, the maximum protruding position P5 shown in FIG. Move to.
By pushing out the slider 54, that is, pushing out the operation wire 20, the clip row moves in the distal direction. As shown in FIG. 12D, the leading clip clip 12A and the connecting ring 14A are moved from the distal end of the sheath 16. The first region 32 protrudes from the distal end of the sheath 16. As a result, the arm portion 28 of the clip 12A is opened, and the skirt portion 38 of the connecting ring 14A is opened.

Incidentally, the clip 12 and the connecting ring 14 have dimensional variations due to manufacturing errors. Further, in the clip treatment instrument 10 inserted through the endoscope (its insertion portion), the amount of protrusion of the operation wire 20 may decrease due to differences in inner and outer circumferences caused by bending or bending of the operation wire 20 and the sheath 16. .
Therefore, in the clip treatment instrument 10, the clip 12A does not fall off the sheath 12 at the proximal end side of the contact portion 84B of the regulating member 82B disposed in the guide groove 66B, and the clip 12 and the like are manufactured. Regardless of the error or the state of the sheath 16, the skirt portion 38 of the connecting ring 14A is surely opened so as to be at the maximum protruding position P5.
Therefore, normally, in a state where the slider 54 is pushed out to the maximum projecting position P5, the skirt portion 38 of the connecting ring 14A is positioned before the distal end portion of the sheath 16, and the skirt portion 38 and the sheath 16 are located. Is separated from

  In this regard, regarding this point, the contact portion 84C of the regulating member 82C disposed in the guide groove 66C corresponding to the second clipping 12B and the guide groove 66D corresponding to the third clipping 12C clipping. The same applies to the abutting portion 84D of the regulating member 82D disposed on the surface.

Next, for example, while viewing the image of the endoscope, as shown in FIG. 10F, the slider 54 is pulled back to the HP side, and the standard protruding position P5 where the skirt portion 38 of the connecting ring 14A contacts the distal end portion of the sheath 16 is obtained. Pull back the clip row until '. That is, the clip row is pulled back to the sheath 16 until the state shown in FIG. The state shown in FIG. 12E is the same as the state shown in FIG.
Thus, the preparation for the first clipping (clipping by the first clip 12) is completed (the clip is ready for clipping).

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

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

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

  Further, in a state where the slider 54 is returned to the position P7 which is HP, the clip row from which the clip 12A and the connection ring 14A are separated is pulled into the sheath 16 as shown in FIG. 12 (G). .

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

The operation of the clip treatment instrument 10 of the present invention is as described above. The slider 54 is pushed out to the maximum projecting position, and then the slider is returned to the standard projecting position. There is no limitation to the connection opening.
For example, if the leading clip 12 is firmly held at the maximum projecting position and there is no possibility of dropping (very low), the slider 54 is not returned from the maximum projecting position to the standard projecting position. From the protruding position to the HP, the slider 54 may be pulled back at once to perform clipping and clip row connection / release.

  Moreover, in the clip treatment instrument 10, when the slider 54 passes the clip completion position P6 (P10, P14), there are known means such as a concavity and convexity that engage with each other, a biased sphere and a concavity that engages with this. Thus, it is also preferable to generate a small impact (so-called click feeling) so that the treating doctor can know that clipping has been completed.

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

Next, as shown in FIG. 10 (I), the slider 54 is moved to the maximum projecting position P9 shown in FIG. 11 that contacts the proximal end of the contact portion 84C inserted in the guide groove 66C. By this operation, as shown in FIG. 12 (H), the second clip 12B and the first region 32 of the connecting ring 14B protrude from the sheath 16 from the distal end of the sheath 16, the arm portion 28 opens, and the skirt Part 38 opens.
As shown in FIG. 10J, the slider 54 is pulled back to the standard protruding position P9 ′ where the skirt portion 38 abuts against the distal end of the sheath 16, and the state shown in FIG. As a result, a second clipping preparation state (by the clip 12B) is entered.

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

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

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

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

Next, as shown in FIG. 10 (M), the slider 54 is moved to the maximum projecting position P13 that contacts the proximal end of the contact portion 84D inserted in the guide groove 66D. By this operation, as shown in FIG. 12L, the third clip 12C and the connecting ring 14B protrude from the sheath 16 from the distal end of the sheath 16, the arm portion 28 is opened, and the skirt portion 38 is opened.
As shown in FIG. 10 (N), the slider 54 is pulled back to the standard protruding position P13P ′ to be in a preparation state for the third clipping shown in FIG. 12 (M).

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

  Further, in the state where the slider 54 is returned to the position P11 which is HP, the dummy clip from which all the clips 12 are cut is the clip row from which the clip 12B and the connecting ring 14B are cut, as shown in FIG. The sheath 16 is drawn into the interior.

When the clipping by the three clips 12 is completed, the slider guide 56 is rotated by 90 ° as shown in FIG. 10 (P) so that the guide groove 66A and the engagement groove 68 are aligned. As a result, the position of the slider 54 returns to the HP corresponding to the guide groove 66A indicated by the position P1 in FIG.
Thereafter, the sheath 16 of the clip treatment instrument 10 is pulled out from the endoscope.
After the sheath 16 is pulled out, the slider 54 is pushed out to the contact portion 84A inserted into the guide groove 66A up to the position P2 where it comes into contact with the proximal end, and as shown in FIG. The connecting member 21, the dummy clip 18 and the connecting member 19 are protruded, and the dummy clip 18 and the connecting member 19 are removed from the connecting member 21 at the tip of the operation wire 20.

As described above, according to the clip treatment tool 10 of the present invention, clipping can be performed a plurality of times without pulling out the sheath.
Further, only by rotation of the slider guide 56 and reciprocation of the slider 54, an appropriate amount of the clip row in the axial direction (longitudinal direction of the sheath 16) according to the number of times of clip (first time / second time). Move to get ready for clipping, clipping and detaching connected clips. That is, according to the present invention, accurate clipping can be performed with a simple operation.

By the way, as described above, the clip treatment tool 10 in the illustrated example can use three types of clips 12 of a standard size (standard type), a short size (short type), and a long size (long type). It is a clip treatment tool for mirrors.
In other words, the operation handle 48 of the illustrated example can be loaded with a clip row of three types of clips 12 of standard size, short size, and long size.

FIG. 13A shows a schematic diagram of an example of a standard size clip 12 and a connecting ring 14. The standard size clip 12 is generally used, and the arm portion 28 and the like have a standard length.
FIG. 13B shows a schematic diagram of an example of the long-size clip 12 and the connection ring 14. The long size clip 12 is used for a large wound or a hemostatic part, and has a long arm portion 28 or the like as compared with a standard size clip, and the connecting ring 14 also has a length (axial direction) corresponding thereto. It has become.
Further, FIG. 13C shows a schematic diagram of an example of the short-sized clip 12 and the connecting ring 14. The short size clip 12 is used for a small wound or a hemostatic part, and has a short arm portion 28 or the like as compared with a standard size clip, and the connecting ring 14 has a length corresponding thereto. .

As a matter of course, when the size (length) of the clip 12 is different, the length of the clip row formed by connecting the clip 12 and the dummy clip 18 with the connecting ring 14 is different.
Therefore, in FIG. 11, the slider 54 is pushed out to the position P2, the clip row is connected to the connecting member 21 at the tip of the operation wire 20, and the position of each clip 12 when pulled back to HP is the standard size, short size, And different in long size. Specifically, as shown in FIGS. 13A to 13C, the first clip 12A, the second clip 12B, and the third clip 12C are both at the tip (nail) of the clip 12. As for the position of the portion 22), the long size is closest to the tip of the sheath 16, and the short size is farthest from the tip of the sheath 16. In the example shown in FIG. 13, the tip position of the dummy clip 18 is the same for all sizes.

Therefore, when performing the clipping operation, the first region 32 of the connection ring 14 corresponding to the clip 12 located at the most distal point at that time is protruded from the distal end of the sheath 16, and the skirt portion 38 is opened to prepare for clipping. Therefore, the required amount of extrusion of the clip row differs depending on the size of the clip.
That is, the amount of movement of the slider 57 from HP to the maximum projecting positions P5, P9, and P13 (standard projecting positions P5 ′, P9 ′, and P13 ′) for setting a clipping ready state varies depending on the size of the clip.

Specifically, in the case of the standard size clip 12, it is necessary to push out the clip row by the distance M-1 in order to set the clipping preparation state at the first clipping, and the maximum protruding position P5 is shown in FIG. The position is indicated by the line M1 in the 14 guide grooves 66B.
On the other hand, in the case of the long size clip 12, in order to be in a preparation state for clipping at the time of the first clipping, it is necessary to push out the clip row by a distance L-1 shorter than the distance M-1, and the maximum protruding position. P5 is a position indicated by a line L1 in the guide groove 66B in FIG. 14 closer to the line M1 (base end side).
Further, in the case of the short-sized clip 12, in order to set the clipping preparation state at the first clipping, it is necessary to push out the clip row by the distance S-1 longer than the distance M-1, and the maximum protruding position. P5 is a position indicated by a line S1 in the guide groove 66B in FIG. 14 that is farther (on the tip side) than the line M1.

  Similarly, at the time of the second clipping, in the standard size, it is necessary to push out by the distance M-2 in order to be in the preparation state, and the maximum projecting position P5 is the position indicated by the line M2 in the guide groove 66C. Further, in the long size, it is necessary to push the distance L-2 shorter than the distance M-2 in order to be in a ready state, and the maximum protruding position P5 is a position indicated by a broken line L2 in the guide groove 66C closer to the line M. Further, in the short size, it is necessary to push the distance S-2 longer than the distance M-2 in order to be in the ready state, and the maximum protruding position P5 is a position indicated by the line S in the guide groove 66C farther from the line M.

Here, as described above, the leading end position of the dummy clip 18 is the same size for the three sizes of the clip 12, and in the example shown in FIG. 13, the standard clip size is prepared for the third clipping. The distance M-3 for making the state, the distance S-3 for making the preparation state in the short size, and the distance L-3 for making the preparation state in the long size are all equal.
Therefore, in the guide groove 66D corresponding to the third clipping, the maximum protruding position P13 (lines M3, S3, and L3) is the same for the standard size, the short size, and the long size.

That is, the moving distance of the slider 54 from the HP to the maximum projecting position for clipping differs depending on the size of the clip 12, and the difference in the moving distance depending on the number of times of clipping also differs for each clip size. .
In other words, as shown in FIG. 13, in the first and second clipping operations and the second and third clipping operations, there is a difference in the slide stroke SM in the distance from the HP to the maximum protruding position in the standard size. In the short size, there is a difference in the slide stroke SS in the distance from the HP to the maximum protruding position, and in the long size, there is a difference in the slide stroke SL in the distance from the HP to the maximum protruding position. The slide strokes SM, SS and SL Are different from each other.

  Therefore, a slider guide that can regulate only one movement amount of the slider 54 for each clipping (that is, in each guide groove 66), a plurality of types having different lengths such as a standard size, a short size, and a long size. Cannot handle other clips.

  On the other hand, in the clip treatment instrument 10 (operation handle 48) of the present invention, a regulating member 82 having an abutting portion 84 that abuts on the slider 54 and regulates the amount of movement is provided, and a guide groove 66 for guiding the slider 54 is provided. In addition, by inserting the contact portion 84, the amount of movement of the slider 54 in each clipping is restricted, and the position of the restriction member 82 (contact portion 84) is set in the axial direction, that is, the movement of the slider 82. By making the direction adjustable, it is possible to suitably cope with a plurality of types of clips 12 having different lengths, such as a standard size, a short size, and a long size.

FIG. 15 conceptually shows the grip / adjustment unit 56 b of the slider guide 56.
As described above, the restriction member 82 includes the contact portion 84, the adjustment portion 86, and the positioning member 90. As described above, the contact portion 84 and the adjustment portion 86 are plate-like members having the same bottom surface that are integrally formed with the contact portion 84 as the base end side and the adjustment portion 86 as the distal end side ( 8), the contact portion 84 is inserted into the guide groove 66, while the adjustment portion 86 is inserted (inserted) into the grip / adjustment portion 56b from the end portion. Further, the positioning member 90 is fixed to the adjustment unit 86.

The regulating member 82 is supported by the grip / adjustment part 56b, the handle main body 52 (mainly the medium diameter part 52b), and the guide part 66 so as to be movable in the axial direction.
That is, by moving the regulating member 82 in the axial direction, it is possible to adjust the distal end position of the proximal end side of the contact portion 84 in the guide groove 66, and to adjust the amount of movement of the slider 54 toward the distal end side. be able to.

In the illustrated example, the positioning member 90 fixed to the adjusting unit 86 inserted into the gripping / adjusting unit 56b is a long operation unit formed by bending a long rectangular plate material at a position closer to the end than the center. It has a substantially V-shape with 90a and a short base 90b.
The positioning member 90 has the base portion 90b fixed to the adjusting portion 86 with the V-shaped open end facing the distal end side. Further, the positioning member 90 has a spring property having a biasing force in a direction to open the V-shape, and therefore the operation unit 90a presses the inner wall surface of the substantially cylindrical grip / adjustment unit 56b (the grip / adjustment unit). The inner wall surface 56b and the adjusting portion 86 are urged in the direction of spreading.
Further, the operation portion 90a is refracted in the middle, and the predetermined region on the tip side is made parallel to the base portion 90b. A protrusion 92 is formed in a region of the operation unit 90a that gradually separates from the base 90a (in the vicinity of the end on the tip side). Further, a button 94 for performing a position adjustment operation is formed at the tip end of the parallel region of the operation unit 90a.

On the other hand, as described above, the grip / adjustment unit 56b is a substantially cylindrical member, and the positioning groove 88 is formed on the inner wall surface at the same position as the guide groove 66 in the circumferential direction. The positioning grooves 88 are arranged in the axial direction, and three positioning grooves 88L, positioning grooves 88M, and positioning grooves 88S are formed from the base end side toward the distal end side. The positioning groove 88 is formed at a position where the projection 92 formed on the operation portion 90 a of the positioning member 90 can be engaged, and has a shape that allows the projection 92 to be engaged.
Similarly, a long hole 96 extending in the axial direction is formed in the grip / adjustment portion 56b at the same position in the circumferential direction as the guide groove. The button 94 formed on the operation portion 90a of the positioning member 90 is projected from the elongated hole 96 to the outside of the grip / adjustment portion 56b. That is, by moving the button 94 in the axial direction along the long hole 96, the regulating member 82 can be moved in the axial direction. Further, by depressing the button 94, the operation portion 90a of the substantially V-shaped positioning member 90 biased in the opening direction can be pushed down.

Therefore, when the projection 92 and any one of the positioning grooves 88 are engaged, the button 94 is pressed, and the button 94 (that is, the regulating member 82) is slightly moved toward the proximal end or the distal end. When the button 94 (that is, the restricting member 82) is further moved in the proximal or distal direction, the restricting member 82 is positioned again by engaging the protrusion 92 with another positioning groove 88. be able to.
As described above, since the positioning groove 88L, the positioning groove 88M, and the positioning groove 88S are formed, the restricting member 82 includes the positioning groove 88 of the grip / adjustment unit 56b and the positioning member 90 (the operation unit 90a). Can be positioned at three positions in the axial direction.

Here, in the positioning groove 88 at the same position in the circumferential direction as the guide groove 66B, that is, in the positioning groove 88 corresponding to the regulating member 82B for performing the first clipping, the positioning groove 88L is formed when the projection 92 is engaged. In addition, the tip of the contact portion 84B of the regulating member 82B is formed at a position (axial position) where the line L1 in FIG. Similarly, the positioning groove 88M is formed at a position where the tip of the contact portion 84B becomes the line M1 when the protrusion 92 is engaged. Furthermore, similarly, the positioning groove 88S is formed at a position where the tip of the contact portion 84B becomes the line S1 when the protrusion 92 is engaged.
Further, in the positioning groove 88 at the same position in the circumferential direction as the guide groove 66C, that is, in the positioning groove 88 corresponding to the regulating member 82C for performing the second clipping, the positioning groove 88L is formed when the projection 92 is engaged. The tip of the contact portion 84C of the restricting member 82C is formed at a position where it becomes the line L2 in FIG. Similarly, the positioning groove 88L is formed at a position where the tip of the contact portion 84B becomes the line M2 when the protrusion 92 is engaged. Similarly, the positioning groove 88S is formed at a position where the tip of the contact portion 84B becomes the line S2 when the projection 92 is engaged.

  In the illustrated clip treatment instrument 10, the amount of movement of the slider 54 from the HP when the clip row is loaded onto the sheath 16 (that is, the slider 54 is placed on the most distal side for loading the clip row into the sheath 16. And the amount of movement (maximum protruding position) of the slider 54 from the HP when performing the third clipping is the same regardless of the size of the clip 12.

Therefore, the positioning groove 88 at the same position in the circumferential direction as that of the guide groove 66A, that is, the positioning groove 88 corresponding to the restriction member 82A for loading the clip row, is an example in which the positioning groove 88M and the protrusion 92 are engaged. In this case, a positioning groove 88M is formed at a position where the tip of the contact portion 84A of the regulating member 82A becomes the lines S, M, and L in FIG. Therefore, in the illustrated example, basically, the positioning grooves 88L and 88S are not used.
In addition, the positioning groove 88 at the same position in the circumferential direction as the guide groove 66D, that is, the positioning groove 88 corresponding to the restriction member 82D for performing the third clipping, as an example, the positioning groove 88M and the protrusion 92 are engaged. In this case, the positioning groove 88M is formed at a position where the tip of the contact portion 84D of the regulating member 82D becomes the lines S3, M3, and L3 in FIG. Therefore, as before, in the illustrated example, the positioning grooves 88L and 88S are basically not used.

As is clear from the above description, when the clip 12 of the standard size is used in the clip treatment instrument 10, all the guide grooves 66 are operated by operating the buttons 94 of the positioning members 90 corresponding to the respective guide grooves 66. After the projection 92 and the positioning groove 88M are engaged with the positioning member 90 corresponding to the above, the operation shown in FIGS. 10 to 12 is performed, so that an appropriate operation corresponding to the standard size clip 12 is performed. Thus, clipping can be performed three times.
When using a short-sized clip, the positioning member 90 corresponding to the guide grooves 66A and 66D operates the button 94 to engage the projection 92 and the positioning groove 88M, and further, the guide groove 66B. The positioning member 90 corresponding to 66C and 66C operates the button 94 to engage the projection 92 and the positioning groove 88S, and then performs the operation shown in FIGS. Clipping can be performed three times by an appropriate operation according to the clip 12.
Furthermore, when using a long size clip, the positioning member 90 corresponding to the guide grooves 66A and 66D operates the button 94 to engage the projection 92 and the positioning groove 88M, and further, the guide groove 66B. The positioning member 90 corresponding to 66C and 66C operates the button 94 to engage the projection 92 with the positioning groove 88L, and then performs the operation shown in FIGS. Clipping can be performed three times by an appropriate operation according to the clip 12.

  As described above, according to the clip treatment tool 10 of the present invention, the clipping process can be accurately and safely performed three times by a simple operation of reciprocating the slider 54. By having an adjusting means for adjusting the position of the restricting member 82 that restricts the amount of movement 54, it is suitable for a plurality of clips 12 of different sizes and types, such as standard size, short size, and long size, as described above. Accurate and safe clipping processing can be performed with a simple operation.

In the clip treatment instrument 10 shown in the drawing, as described above, the restriction member 82A of the guide groove 66A corresponding to the loading of the clip row and the restriction member 82D of the guide groove 66D corresponding to the third clipping are clipped. Regardless of the size of 12, the projection 92 and the positioning groove 88M are used at the engaged position.
Therefore, for example, the clip treatment tool 10 has a fixing means for fixing the movement of the restricting member 82A and / or the restricting member 82D in the axial direction, such as a fixing member for fixing the positioning member 90 by being fitted into the long hole 96. Is preferred. Alternatively, the regulating member 82A and / or the regulating member 82D may be fixed so as not to move in the axial direction.

Further, in the clip treatment tool (the operation handle for the clip treatment tool) of the present invention, the positioning means in the axial direction of the regulating member 82 is a substantially V-shaped spring-like member biased in the spreading direction of the illustrated example, The projection is not limited to a projection formed on the spring-like member and the projection is a groove, and various configurations can be used.
For example, known long plate-like positioning means such as a positioning means that uses concaves and convexes that engage with each other, a positioning means that uses a ball plunger, and a positioning means that uses a ratchet mechanism can all be used.

In the clip processing tool 10 of the illustrated example, as a preferable aspect, the lengths of all the guide grooves 66 formed in the guide portion 56c of the slider guide 56 are uniform.
By adopting such a configuration, for example, when it is necessary to cope with a clip 12 of a new size such as an ultra-long size, an ultra-short size, for hemostasis, or for marking, the length according to the size of the clip 12 or the like. By exchanging the restricting member 82 having the abutting portion 84, it becomes possible to easily and suitably cope with continuous clipping using a wide variety of clips 12. Similarly, if the amount of operation of the slider 54 (the amount of movement in the axial direction) required for clipping is changed due to a change in the shape of the clip, etc., it can be handled easily and appropriately. It becomes.

However, the present invention is not limited to this, and various configurations can be used.
For example, the length of the guide groove 66 formed in the guide portion 56c is individually set according to the preparation of clipping for each number of times and the amount of movement of the slider 54 necessary for clipping (the amount of movement from HP to the maximum protruding position). It may be different. In this case, the length of the contact portion 84 may be uniform.

In addition, as described above, the clip treatment tool 10 in the illustrated example has a movement amount of the slider 54 for loading the clip row on the sheath 16 and a movement amount of the slider 54 for performing the third clipping. All of the seed clips are uniform. Therefore, the guide groove 66A and / or the guide groove 66D corresponding to this operation has a length corresponding to the moving amount of the slider 54 corresponding to the loading of the clip row, and the guide groove 66A and / or the guide groove 66D. Alternatively, a configuration in which the regulating member 82 is not disposed may be employed.
Further, since the movement amount of the slider 54 is the largest when the short size clip 12 is used, the length of the guide groove 66 is set to a length corresponding to the clipping by the short size clip 12, and the regulating member 82. The slider movement amount may be adjusted only when the standard size and the long size are used.

  As described above, the operation handle for the clip treatment instrument and the repetitive clip treatment instrument of the present invention have been described in detail. However, the present invention is not limited to the above-described embodiments, and various types can be made without departing from the gist of the present invention. Improvements and changes may be made.

It is the schematic of an example of the continuous-type clip treatment tool of this invention. (A) And (B) is a schematic sectional drawing of the front-end | tip part of the clip treatment tool shown in FIG. It is a schematic perspective view of an example of the clip used with the clip treatment tool shown in FIG. It is the schematic of an example of the connection ring used with the clip treatment tool shown in FIG. 1, (A) is a front view, (B) is sectional drawing, (C) is a bottom view. It is a schematic sectional drawing of the handle | steering-wheel part of the continuous-type clip treatment tool shown in FIG. It is a schematic perspective view which shows the state which removed the slider guide from the handle | steering-wheel part shown in FIG. (A) is a schematic perspective view of the guide part of the slider guide of the handle | steering-wheel part shown in FIG. 5, (B) is a figure which shows notionally the state which expand | deployed this slider guide. It is a schematic perspective view of the regulating member of the slider guide of the handle part shown in FIG. It is a schematic perspective view of the rotation position control member of the handle part shown in FIG. (A)-(P) is a schematic perspective view for demonstrating the effect | action of the clip treatment of the repetitive clip treatment tool shown in FIG. It is a figure which shows notionally the state which expand | deployed the slider guide for demonstrating the effect | action of the clip treatment of the repetitive type clip treatment tool shown in FIG. (A)-(P) is a schematic sectional drawing of the front-end | tip part of the repetitive clip processing tool for demonstrating the effect | action of the clip treatment of the repetitive clip treatment tool shown in FIG. (A) is a schematic diagram for explaining a standard size clip, (B) for a short size clip, and (C) for explaining a short size clip. It is a figure which shows notionally the state which expanded the slider guide for demonstrating operation corresponding to the clip of each size. FIG. 6 is a schematic cross-sectional view of the grip / operation unit of the handle unit shown in FIG. 5.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10 Clip treatment tool 12 Clip 14 Connection ring 16 Sheath 18 Dummy clip 19 Connection member 21 Connection member 20 Operation wire 22 Claw part 24 Turn part 26 Intersection part 28 Arm part 30 Convex part 32 1st area 34 2nd area 36 Cut 38 Skirt Part 40 Tightening ring 41, 43 Hole 42 Holding part 46 Slit 48 (for clip treatment instrument) Operation handle 50 Handle part 52 Handle body 54 Slider 56 Slider guide 56a Joint part 56b Gripping / adjusting part 56c Guide part 58 Position regulating member 60 Biasing spring 62 Finger ring 66 (66A, 66B, 66C, 66D) Guide groove 68 Engaging groove 70 Slider pin 82 (82A, 82B, 82C, 82D) Restricting member 84 (84A, 84B, 84C, 84D) Abutting portion 86 Adjustment part 88 ( 88S, 88M, 88L) Positioning groove 90 Positioning member 92 Projection 94 Button 96 Long hole

Claims (8)

A sheath,
A cylindrical handle body coupled to the sheath;
An operation wire that is inserted into the sheath and the handle body, and has a plurality of clips connected to the end opposite to the handle body;
A slider through which the handle main body is inserted so as to be movable in the axial direction of the handle main body, and the operation wire is engaged;
A cylindrical means for inserting a handle main body so as to be rotatable in a circumferential direction of the handle main body between the handle main body and the slider. A slider guide,
Further, the regulating means of the slider guide has a moving amount changing means for changing the moving amount of the slider by the regulating means according to the type of the clip connected to the operation wire. Operation handle.   2. The operation handle for a clip treatment instrument according to claim 1, wherein the restriction means is arranged in the circumferential direction of the handle body more than the number of clips connectable to the operation wire.   The operation handle for a clip treatment instrument according to claim 2, wherein the plurality of regulating means regulates different amounts of movement of the slider, corresponding to each of the plurality of clips.   A long hole extending in the axial direction of the handle main body for guiding the slider, and a contact member that is located in the long hole and restricts the movement amount by contacting the slider. The clip treatment instrument operation handle according to claim 1, wherein the movement amount changing means is a movement means for moving the abutting member in an axial direction of the handle body.   5. The operation handle for a clip treatment instrument according to claim 4, wherein all of the restriction means have the same long hole, and the length of the contact member is a length corresponding to the amount of movement of the slider. The handle body has an engagement groove of a predetermined length extending in its axial direction,
The clip slider according to any one of claims 1 to 5, wherein the slider has an engaging member that engages with the engaging groove, and moves in the axial direction of the handle body along the engaging groove. Operation handle.   The engagement member is inserted into the engagement hole and the elongated hole when the slider guide is rotated in the circumferential direction of the handle body and the engagement hole of the handle body and the elongated hole of the restricting means are overlapped. The operation handle for a clip treatment instrument according to claim 6. An operation handle for a clip treatment instrument according to any one of claims 1 to 7,
The claw portion connected to the end portion of the operation wire opposite to the handle main body and accommodated in the sheath was connected by engaging the end portion on the opposite side to the claw portion of the other clip. A repetitive clip treatment tool comprising: a clip row having a plurality of clips.

Images