JP2010063701A - Multiple clip package - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To permit a case storing a multiple clip unit to be attached to a loading tool while maintaining an appropriate posture. <P>SOLUTION: The multiple clip unit 13 has a clip pulling-in member 83 engaged with the tip and is stored in a clip case 81. The clip case 81 is provided with a positioning key 116 in the lower portion. The lower end of the positioning key 116 is provided with a leaf spring 116a arranged along the axial direction of the case 81. The loading tool 82 is provided with a case insertion groove 91 into which the clip case 81 is inserted. The case insertion groove 91 is provided with a positioning key groove 125 along the axial direction. The positioning key 116 regulates the rotation of the clip case 81 around the axis and movements in the axial direction by engaging with the positioning key groove 125 up to the depth. <P>COPYRIGHT: (C)2010,JPO&INPIT

Description

  The present invention relates to a connection clip package including a connection clip unit loaded in a continuous-type clip treatment tool capable of continuously performing hemostasis, wound closure, and the like in a living body and the like, and a clip case for storing the connection clip unit. About.

  The clip treatment tool is inserted into the living body through the forceps channel of the endoscope, the clip protrudes from the tip, the affected part such as the site where the bleeding part or the lesioned tissue has been removed is sandwiched between the clips, and hemostasis or wound closure is performed. Used for clip treatment. In Patent Document 1, a clip unit including a clip and a connecting member that engages with the rear end of the clip is used, and the clip unit is connected to an operation wire inserted through a sheath while being accommodated in a case. A method for loading a sheath into a sheath is described. A hook for connecting to the connecting member of the clip unit is provided at the tip of the operation wire.

  Patent Document 1 describes a holding tube that tightens the tip of a clip and closes the claw at the tip. The holding tube is loaded into the sheath together with the clip in a state of being attached to the rear end of the clip, and is advanced with respect to the clip during the clip treatment to tighten the distal end portion of the clip. The outer surface of the holding tube is closed in the sheath, and when it is pushed out of the sheath together with the clip, it opens so as to protrude in the radial direction by elasticity, and prevents the clip from retreating by engaging with the distal end of the sheath. A skirt is provided.

  Patent Document 1 also describes a case for storing an unused clip to which a holding tube is attached. In this case, in order to prevent the elastic force of the skirt portion from being lowered, the clip is accommodated with the skirt portion opened. An inclined surface for closing the skirt portion is formed at the exit portion of the case. To load the clip from the case to the sheath, insert the hook at the tip of the operation wire into the case from the outlet, connect it to the clip with a holding tube, and move the clip backward by pulling the operation wire. It is drawn into the sheath from the outlet part. During the retraction of the clip from the case into the sheath, the skirt portion contacts the inclined surface, and the skirt portion is closed.

  Since only one clip can be loaded with the clip treatment tool of Patent Document 1, the clip treatment tool is pulled out from the endoscope every time a clip treatment is performed, and the next clip is loaded and reinserted into the endoscope. It is necessary to carry out complicated work.

In order to eliminate such complications, a repetitive clip treatment tool that enables continuous clip treatment has been proposed. For example, Patent Document 2 describes a connected clip unit in which a plurality of clips are arranged in a line and connected by engaging the rear end of a front clip and the front end of a rear clip. The connecting clip unit is pushed out of the sheath in order from the top clip and used for treatment.
JP 2007-022649 A JP 2006-187391 A

  The applicant has studied and developed a method for easily loading such a connecting clip unit into a sheath. This loading method is a method in which an unused connection clip unit is pulled out from the case, is once sent into a passage formed in a dedicated loading jig, and the connection clip unit is drawn into the sheath from the passage and loaded. Many of the parts constituting the connection clip unit are made of an elastic material such as a connection member for connecting the clips to each other. Therefore, in the case, it is preferable that the elastic material is accommodated in a state where a load is not applied as much as possible so that the elastic force does not decrease. By using a dedicated loading jig, the connecting clip unit can be stored in the case until immediately before the connecting clip unit is loaded onto the sheath, and thus the connecting clip unit can be stored in a favorable environment.

  Since the loading jig should be handled integrally with the case, shipping in the form of a package in which the case is attached to the loading jig has been studied. In this case, if the case rotates inadvertently with respect to the loading jig and the proper posture collapses, not only will the connection clip unit not be properly fed from the case to the passage due to the misalignment, but also through the case to the inside of the case. There is a concern that an external force may act on the connecting clip unit to cause failure or performance degradation of the connecting clip unit.

  Patent Document 1 and Patent Document 2 have no description of such a loading jig, nor do they disclose any countermeasures against problems when using the loading jig.

  An object of this invention is to provide the connection clip package attached to a loading jig in the state in which the case which accommodates a connection clip unit maintained the appropriate attitude | position.

  The connection clip package of the present invention is a clip unit in which a plurality of clips are arranged in a row and connected to a sheath of a treatment instrument, and a connection portion connected to a hook at the tip of an operation wire that passes through the sheath. A clip unit provided at a rear end; a cylindrical case that accommodates the clip unit and can be pulled out from the top; a case connecting portion to which the case is detachably connected; and the clip unit A loading jig having a passage through which the clip unit pulled out from the case is fed from the head, and an engaging portion provided in one of the case and the case connecting portion, The engaged portion provided on the other side is engaged, and both engage to regulate the rotation of the case relative to the loading jig. Characterized by comprising a rotation restricting means for. The engaging portion and the engaged portion are fitted to the key provided on the case and protruding from the outer periphery thereof, and the key provided on the case connecting portion and formed along the axial direction of the case. It is preferable that the rotation of the case around the axis is restricted.

  The key fitted in the keyway is positioned at a predetermined position in the axial direction, and is provided with a retaining means for preventing the case from being detached by restricting the key from moving in the axial direction. And Furthermore, it is preferable that the retaining means is a click mechanism including a click protrusion provided in one of the key and the key groove and a recess or hole provided in the other.

  According to the present invention, the case in which the coupling clip unit is accommodated, and the rotation in which the engaging portion provided in one of the case connecting portions provided in the loading jig and the engaged portion provided in the other are engaged. Since the rotation of the case relative to the loading jig is regulated by the regulating means, the case is attached to the loading jig in a state where the case is maintained in an appropriate posture. Therefore, since the connection clip unit is properly fed from the case to the passage of the loading jig, it is possible to prevent the connection clip unit from being broken or deteriorated in performance.

  As shown in FIG. 1, a repetitive clip treatment tool (hereinafter referred to as a “clip treatment tool”) 10 is loaded into a cylindrical sheath 11, an operation wire 12 inserted through the sheath 11, and the sheath 11. A connection clip unit 13 connected to the operation wire 12 and an operation unit 14 used for a pulling operation of the sheath 11 and the operation wire 12 are provided.

  As shown in FIG. 2, the connecting clip unit 13 includes a plurality of hemostatic clip bodies 17 (17A to 17C) connected in a row and a connecting clip body 18 connected to the last hemostatic clip body 17C. It is configured. The hemostatic clip body 17 includes a clip 19 (19A to 19C) and a cylindrical connection ring 20 (20A to 20C) attached to the outside of the clip 19.

  As shown in FIG. 3, the clip 19 is formed by bending a single elongated plate 180 degrees to form a closed end, crossing the two pieces, and bending the two open ends to oppose each other. Portions 23 and 23 are formed. The clip 19 has arm portions 25 and 25 on the open end side and a turn portion 26 on the closed end side, with a crossing portion 24 crossing the elongated plates as a boundary. Convex portions 27 and 27 that are partially wide are formed at the central portions of the arm portions 25 and 25.

  When the external force is not applied, the arm portions 25 and 25 are in an open state in which the claw portions 23 and 23 are separated, and when the arm portions 25 and 25 are elastically deformed so as to approach each other, the claw portions 23 and 23 mesh with each other. It will be in the closed state which pinches | interposes the affected part used as object. The nail | claw parts 23 and 23 are formed in the V-shaped male type and female type | mold in order to pinch | interpose an affected part reliably. The clip 19 can be made of a biocompatible metal, for example, SUS631 which is stainless steel for springs.

  The connecting ring 20, which is a cylindrical member, has a substantially cylindrical shape, and includes a metal fastening portion 30 disposed on the front end side and a plastic holding portion 31 disposed on the rear end side. The hemostatic clip body 17 is formed by inserting the clip 19 into the tightening hole 30 a formed in the tightening portion 30 from the turn portion 26 side and mounting the connecting ring 20 on the outside of the clip 19. The tightening portion 30 is set at an initial position covering the outer periphery of the intersecting portion 24, and the arm portions 25, 25 of the clip 19 are in an open state.

  When the clip 19 is pulled into the connecting ring 20, the tightening hole 30 a tightens the arm portions 25 and 25 and closes the claw portions 23 and 23. The claw portions 23 and 23 exhibit a predetermined meshing force when the arm portions 25 and 25 are tightened. Since the diameter of the fastening hole 30 a is smaller than the width of the convex portion 27 of the clip 19, the tip from the convex portion 27 of the clip 19 is not inserted into the connecting ring 20.

  As shown in FIG. 4, the holding portion 31 is formed with a holding hole 31a that is continuous with the tightening hole 30a. The turn part 26 inserted from the tightening hole 30a is accommodated in the holding hole 31a. Two skirt portions 38 are formed on the outer peripheral surface of the holding portion 31 symmetrically with respect to the central axis. The skirt portions 38, 38 are formed so as to expand in the radial direction from the front end side to the rear end side of the holding portion 31, and are opened by their own elasticity when external force is not applied, and are pressed from the outside. Sometimes it closes so as to enter the holding part 31.

  The connecting ring 20 is attached to the outside of the clip 19 so that the opening / closing direction of the claw portions 23, 23 and the opening / closing direction of the skirt portions 38, 38 are shifted by 90 °. When the connecting clip unit 13 is loaded into the sheath 11 and closed, the skirt portions 38 and 38 sandwich the turn portion 26 accommodated in the holding hole 31 a and integrate the connecting ring 20 with the clip 19.

  The plurality of hemostatic clip bodies 17 are connected in a row by engaging the claw portions 23 and 23 of the rear clip 19 with the turn portion 26 of the clip 19 disposed on the front side. The connection ring 20 covers the outside of the claw portions 23 and 23 of the rear clip 19 and maintains the connection of the clip 19 so that the claw portions 23 and 23 do not open. The projecting portion 27 of the clip 19 has a width that is greater than the diameter of the holding hole 31 a, and abuts against the rear end of the connecting ring 20 when disposed behind the connecting ring 20. Thereby, the movement of the connection ring 20 from the initial position described above to the rear end side of the connection clip unit 13 is restricted.

  Slits 44 a and 44 a are formed at two positions that are shifted from the skirt portions 38 and 38 in the circumferential direction by 90 ° in the rear end portion 44 of the connecting ring 20, that is, the rear portion of the skirt portion 38. The slits 44a and 44a are formed along the axial direction of the connecting ring 20, and the rear end portion 44 is elastically deformed so that the inner diameter thereof is expanded. The slit 44a improves the flexibility of the connecting ring 20 so that the connecting clip unit 13 is bent in accordance with the bending of the endoscope. Further, since the inner diameter of the rear end portion 44 is widened by the slit 44a, it is easy to engage the two clips 19 during assembly.

  A material that is biocompatible and satisfies the elasticity and rigidity required for the skirt portion 38 is used for the holding portion 31. For example, PPSU (polyphenylsulfone) is used as the material of the holding unit 31.

  As shown in FIG. 5, the connecting clip body 18 includes a dummy clip 47 that engages with the turn portion 6 of the rearmost clip 19 </ b> C and a connecting member 48 that holds the dummy clip 47. The dummy clip 47 is formed by bending a metal thin plate, and has claw portions 47b and 47b that engage with the turn portion 26, and convex portions 47a and 47a that abut on the rear end of the connecting ring 20C. Yes. Like the clip 19, the claw portions 47b and 47b open by their own elasticity when no external force is applied, and close by being elastically deformed when pressed from the outside.

  The connecting member 48 has a substantially cylindrical shape made of plastic and has an outer diameter comparable to that of the connecting ring 20. The connecting member 48 has a connecting portion 52 that connects to the operation wire 12.

  The sheath 11 is, for example, a flexible coil sheath in which a metal wire is tightly wound. The inner diameter of the sheath 11 is a dimension in which the engagement between the turn portion 26 of the previous clip 19 and the claws 23 and 23 of the next clip 19 is released. That is, the inner diameter of the sheath 11 is larger than the length obtained by adding the lengths of the two claw portions 23 and 23 and the width of the portion where the claw portions 23 and 23 of the turn portion 26 are engaged.

  The operation wire 12 is a metal wire formed of a metal having biocompatibility. As shown in FIG. 6, a hook 57 used for connection with the connection clip body 18 is provided at the distal end of the operation wire 12. The hook 57 includes a front hook 58 attached to the tip of the operation wire 12 and a rear hook 59.

  The substantially quadrangular pyramid-shaped front hook 58 is fitted between a pair of elastic arms 53 constituting the connecting portion 52 and abuts against a pair of clamping portions 54 formed at the end of each elastic arm 53. The operation wire 12 between the front hook 58 and the columnar rear hook 59 is clamped by the clamping unit 54. The rear hook 59 abuts on the rear end of the holding portion 54. Accordingly, the pulling and rotation of the operation wire 12 can be transmitted to the connecting clip unit 13, and the connecting clip unit 13 can be pressed so as not to move together with the sheath 11 by the frictional force generated when the sheath 11 is pulled.

  As shown in FIG. 1, the operation unit 14 includes a sheath operation handle 63 that pulls the sheath 11 and the operation wire 12, and a wire operation handle 62. The sheath operation handle 63 has a substantially cylindrical shape, and the rear end of the sheath 11 is fixed to the tip. The sheath operation handle 63 is slidably attached to the outside of a pipe 64 provided at the tip of the wire operation handle 62. By sliding along the pipe 64 toward the wire operation handle 62, the sheath 11 is operated by the operation wire. 12 is pulled to the rear end side. Reference numeral 69 is a notch for allowing the operator to feel the amount of retraction when the sheath 11 is retreated with respect to the operation wire 12. The interval between the notches 69 is set corresponding to the retraction amount for pushing out the clips 19 of the connecting clip unit 13 from the sheath 11 one by one.

  The wire operation handle 62 has a substantially cylindrical shape and has a through window 65 with a slidable operation lever 66 built therein. The operation wire 12 passes through the sheath operation handle 63, and the rear end is locked to the operation lever 66. When the operation lever 66 is slid, the operation wire 12 is pulled with respect to the sheath 11 by an amount necessary for tightening the clip 19 by the connecting ring 20.

  Next, the operation of the clip treatment tool 10 will be briefly described. As shown in FIG. 6A, the connecting clip unit 13 is loaded in the sheath 11 so that the tip of the leading clip 19 </ b> A coincides with the tip of the sheath 11. The sheath 11 is inserted into a forceps channel of an endoscope inserted in the living body. The distal end of the sheath 11 protrudes from the forceps exit at the distal end of the endoscope and approaches the affected part.

  When the sheath operation handle 63 is pulled by a predetermined amount, the sheath 11 is retracted by a predetermined amount with respect to the operation wire 12. Since the operation wire 12 and the connection clip unit 13 are connected, the connection clip unit 13 moves forward with respect to the sheath 11 and, as shown in FIG. 6B, is connected to the leading clip 19A from the distal end of the sheath 11. The ring 20A is sent out.

  At this time, a force that moves to the rear end side together with the sheath 11 acts on the coupling rings 20 </ b> A to 20 </ b> C that are in contact with the inner wall surface of the sheath 11 due to a frictional force generated between the sheath 11 and the coupling rings 20 </ b> A to 20 </ b> C. However, the connecting rings 20A to 20C are integrated with the clips 19A to 19C by the closed skirt portions 38 and 38, and the convex portions 27 of the rear clips 19B and 19C and the convex portion 47a of the dummy clip 47 The movement to the rear end side is restricted by the above. For this reason, the connection rings 20A to 20C do not move backward, but move forward with respect to the sheath 11 together with the clips 19A to 19C.

  The clip 19A coming out of the sheath 11 opens the claw portions 23 and 23 due to its own elasticity (the state shown in FIG. 2 (B)), and as shown in FIG. 2 (A), the connecting ring 20A has a skirt portion. 38 and 38 are opened wider than the inner diameter of the sheath 11, and the connecting ring 20 </ b> A is engaged so as not to return into the sheath 11.

  The clip treatment tool 10 is moved, and the claws 23 and 23 of the clip 19A in the open state are pressed against the affected part. In this state, when the operation lever 66 of the wire operation handle 62 is pulled, the operation wire 12 is pulled by a predetermined amount, and all the clips 19 </ b> A to 19 </ b> C sequentially engaged from the connecting clip body 18 are pulled uniformly. .

  As shown in FIG. 6C, the clip 19A fed from the sheath 11 is released from the press and hold by the skirt portions 38, 38 because the skirt portions 38, 38 of the connecting ring 20A are open. Further, the connecting ring 20 </ b> A is prevented from retreating into the sheath 11 by the skirt portions 38, 38. Therefore, the leading clip 19A moves backward with respect to the connecting ring 20A when the operation wire 12 is pulled. When the tightening portion 30 is pushed to just below the convex portion 27 of the clip 19A, the tightening of the clip 19A by the connecting ring 20A is completed.

  Simultaneously with the completion of the fastening of the clip 19A, the engaging portion of the clip 19A and the next clip 19B comes out from the rear end of the connecting ring 20A. The arm portions 25, 25 of the clip 19B are expanded by their own elastic force until they hit the inner wall of the sheath 11, and the gap between the claw portions 23, 23 opens wider than the width of the turn portion 26 of the clip 19A. The connection with the clip 19B is released. As shown in FIG. 6D, when the distal end of the sheath 11 is separated from the affected part, the hemostatic clip body 17 </ b> A comes out from the distal end of the sheath 11.

  When the pulling operation of the operation lever 66 is stopped, the operation lever 66 returns to the original position by a biasing force of a spring (not shown). As a result, the operation wire 12 moves to the distal end side in the sheath 11 and the connecting clip body 18 and the clips 19B and 19C are pushed. As shown in FIG. The distal end moves to a position that substantially coincides with the distal end of the sheath 11. Thereafter, similarly to the first hemostatic clip body 17A, the operation unit 14 can be operated to perform the clip treatment with the second and third hemostatic clip bodies 17B and 17C.

  Next, the connection clip package 80 will be described. As shown in FIGS. 7 to 9, the connection clip package 80 includes a cylindrical clip case 81 that houses the connection clip unit 13, and a rectangular loading jig 82 into which the tip of the clip case 81 is inserted. Yes. The loading jig 82 incorporates a clip retracting member 83 that pulls the coupling clip unit 13 from the clip case 81 into the loading jig 82, and a slider 84 that is used to couple the operation wire 12 and the coupling clip body 18. ing.

  The clip case 81 is provided with a clip accommodating portion 87 which is a cylindrical space on the inner side. The outer diameter of the clip case 81 and the inner diameter of the clip housing portion 87 are substantially the same as the outer diameter and inner diameter of the sheath 11. In the clip accommodating portion 87, the connecting clip unit 13 is accommodated so that the leading clip 19A is arranged on the distal end side of the clip case 81.

  The loading jig 82 is a jig for closing the skirt portions 38 of the coupling clip unit 13 drawn from the clip case 81 and loading the coupling clip unit 13 into the sheath 11. A recess 90 that is recessed in the height direction is formed on one end side in the longitudinal direction of the loading jig 82. In the recess 90, a case insertion groove 91 having an inner diameter slightly larger than the outer diameter of the clip case 81 and having an open upper portion is formed. A case insertion hole 92 having the same diameter is formed on the side surface in the recess 90 so as to be continuous with the case insertion groove 91.

  A clip case 81 is inserted into the case insertion groove 91 and the case insertion hole 92. When the connecting clip unit 13 is loaded from the loading jig 82 to the sheath 11, the clip case 81 is extracted from the case insertion groove 91 and the case insertion hole 92, and the sheath 11 is inserted instead. The upper part of the clip case 81 or the sheath 11 inserted into the case insertion groove 91 is partially exposed. Therefore, the clip case 81 and the loading jig 82 or the sheath 11 and the loading jig 82 can be held together by gripping the inside of the recess 90.

  On the upper surface of the loading jig 82, a connection opening 95 and a wire slit 96 are provided adjacent to the recess 90. The connection opening 95 is an opening for inserting the hook 57 of the operation wire 12 into the loading jig 82 from the lateral direction perpendicular to the insertion direction of the clip case 81, and the outer diameter when the hook 57 is viewed from the side. The opening area is larger than the dimension. The wire slit 96 is formed so as to connect the case insertion hole 92 and the connection opening 95, and has a width dimension in which the operation wire 12 can be inserted from the side. The operation wire 12 and the hook 57 are inserted into the wire slit 96 and the connection opening 95 at the same time when the sheath 11 is inserted into the case insertion groove 91, and are drawn into the loading jig 82. To the connecting member 48 (see FIG. 5).

  A skirt closing passage 97 that is a cylindrical space is provided in the loading jig 82 at the back of the case insertion hole 92. The skirt closing passage 97 has the same inner diameter as the sheath 11 and the clip accommodating portion 87, and the inner diameter surface thereof is connected to the inner diameter surface of the clip case 81 and the sheath 11 inserted into the case insertion hole 92. The skirt closing passage 97 closes each skirt portion 38 of the connection clip unit 13 drawn from the clip accommodating portion 87 by pushing the inner diameter surface.

  The clip retracting member 83 includes a substantially elliptical traction portion 98 protruding outward from the other end side in the longitudinal direction of the loading jig 82, an insertion portion 99 provided with the traction portion 98 at one end, and the insertion portion 99. And an engaging portion 100 (see also FIG. 10) provided at the other end. The insertion part 99 is a rod-like body having a length penetrating the skirt closing passage 97 and is inserted into the skirt closing passage 97. The engaging portion 100 is inserted into the clip accommodating portion 87 and is engaged with the leading clip 19A.

  The clip retracting member 83 is elastically deformed so as to crush the ring of the pulling portion 98 and is inserted into the case insertion hole 92 together with the clip case 81. The insertion portion 99 is inserted into the skirt closing passage 97, and the pulling portion 98 protrudes out of the loading jig 82 through a pulling hole (see reference numeral 103 in FIGS. 14 to 16) formed at the end of the skirt closing passage 97. Is done. When the pulling portion 98 is pulled with respect to the loading jig 82, the leading clip 19 </ b> A is pulled by the engaging portion 100 and the connected clip unit 13 is drawn from the clip accommodating portion 87 into the skirt closing passage 97.

  The slider 84 is slidably inserted into a slider passage 101 provided so as to penetrate the side surface of the loading jig 82. The slider 84 is pushed into the slider passage 101 when the connecting clip body 18 drawn into the loading jig 82 and the hook 57 inserted from the connecting opening 95 are connected.

  The slider passage 101 is formed in a direction orthogonal to the case insertion groove 91. The slider passage 101 has a rectangular shape having a width substantially equal to the width dimension of the slider 84 and is provided so as to penetrate the short direction of the loading jig 82.

  The insertion part 99 of the clip retracting member 83 is inserted into the pulling hole 103 (see FIGS. 14 to 16) located on the opposite side of the case insertion groove 91. As shown in FIG. 10, a slit 99a is provided at the end of the insertion portion 99 on the engaging portion 100 side so as to penetrate the side surface. On the top and bottom of the slit 99a, check protrusions 99b extending from the pulling portion 98 toward the engaging portion 100 are provided. The check protrusion 99b jumps out of the loading jig 82 from the pulling hole 103 when the insertion portion 99 is elastically deformed at the slit 99a portion. The check protrusion 99b locks the insertion portion 99 so that the insertion portion 99 does not return into the skirt closing passage 97 again.

  The engaging part 100 has a pair of guide pieces 100a, 100a that have the same outer diameter as the connection ring 20 and are arranged in the vertical direction. A rib 100b that keeps the distance between the guide pieces 100a and 100a is integrally provided between the guide pieces 100a and 100a. Engagement pieces 100c and 100c protruding in the left-right direction are integrally formed on both side surfaces of the rib 100b at positions close to the insertion portion 99.

  The engaging part 100 is accommodated in the clip accommodating part 87 of the clip case 81 together with the connecting clip unit 13. The leading clip 19A is pushed into the closed state by the clip accommodating portion 87, and engages the claw portions 23 and 23 with the engaging pieces 100c and 100c. When the pulling portion 98 is pulled with respect to the loading jig 82, the insertion portion 99 moves in the skirt closing passage 97, and the engaging portion 100 moves from the clip accommodating portion 87 into the skirt closing passage 97.

  The connecting clip unit 13 is pulled by the engaging portion 100 and pulled into the skirt closing passage 97. In the vicinity of the pulling hole 103 of the skirt closing passage 97, a release groove 104 (see FIGS. 14 to 16) protruding in the left-right direction is formed. The release groove 104 has a width dimension that allows the arms 25 and 25 of the leading clip 19 </ b> A to open to the extent that the engagement with the engagement portion 100 of the clip retracting member 83 is released. The release groove 104 is arranged so that the leading clip 19 </ b> A reaches the release groove 104 when the connection portion 52 of the connection clip body 18 reaches a position facing the connection opening 95.

  When the leading clip 19 </ b> A reaches the release groove 104, the top clip 19 </ b> A is displaced into an open state by its own elasticity, and releases the engagement with the engagement portion 100. Thereby, the connecting clip unit 13 is stopped in the skirt closing passage 97 so that the connecting portion 52 of the connecting clip body 18 is positioned in the slider passage 101 in the case insertion hole 92.

  In addition, since the opening and closing direction of the claw portions 23 and 23 and the opening and closing direction of the skirt portions 38 and 38 are shifted by 90 °, the hemostatic clip body 17 has a leading end even when the leading clip 19A is in the release groove 104. The skirt portions 38, 38 of the connecting ring 20A are not opened.

  The pulling portion 98, the insertion portion 99, and the engaging portion 100 constituting the clip retracting member 83 are integrally formed of, for example, plastic having appropriate elasticity. Note that the insertion portion 99 and the engagement portion 100 may be formed separately and connected in the loading jig 82.

  As shown in FIG. 9, the slider 84 includes an operation unit 105 that is used for pushing into the slider passage 101, and a lower piece 106 and an upper piece 107 that are bifurcated from the operation unit 105 and face each other in the vertical direction. , Molded integrally with plastic. The lower piece 106 and the upper piece 107 are inserted into the slider passage 101 and sandwich the sheath 11 and the clip case 81.

  First recesses 108 and 108 and second recesses 109 and 109 having the same inner diameter as the outer diameters of the sheath 11 and the clip case 81 are formed on the upper surface of the lower piece 106 and the lower surface of the upper piece 107, respectively. The slider 84 is slidable between an initial position where the first recesses 108, 108 on the distal end side match the case insertion hole 92 and a connection position where the second recesses 109, 109 match the case insertion hole 92. Yes.

  When the upper piece 107 of the slider 84 is slid from the initial position to the connecting position, the hook 57 in the case insertion hole 92 is pressed through the slider passage 101, and the hook 57 is attached to the connecting member 48 of the connecting clip body 18. A connecting slope 110 to be connected is provided.

  The hook 57 inserted from the lateral direction into the connection opening 95 is inserted between the elastic arms 53 and 53 of the connection member 48 through the connection opening 95 at the corners of the square column part 58a of the front hook 58 (see FIG. 5). When the slider 84 is pushed into the slider passage 101, the connecting slope 110 comes into contact with the front hook 58 and the rear hook 59 and gradually presses them downward. The front hook 58 rotates so that a square pillar-shaped outer peripheral surface follows the connecting slope 110, elastically deforms the elastic arms 53, 53, and is pushed in between them. The operation wire 12 also spreads between the holding portions 54 and 54 and enters between them. Further, the rear hook 59 abuts against the rear end surfaces of the holding portions 54 and 54.

  The clip case 81 is formed by joining a semi-cylindrical lower case (lower case member) 111 and an upper case (upper case member) 112 to each other. The lower case 111 and the upper case 112 are provided with semicircular receiving recesses 111a and 112a that constitute a cylindrical clip receiving portion 87 when they are joined together. The clip accommodating portion 87 is open on both the front end side where the leading clip 19A is accommodated and the rear end side where the connecting clip body 18 is accommodated. The opening on the distal end side of the clip accommodating portion 87 is a delivery port for sending the connecting clip unit 13 out of the clip accommodating portion 87 from the head side.

  The clip case 81 is formed of, for example, a transparent plastic so that the connection clip unit 13 accommodated in the clip accommodating portion 87 can be seen from the outside of the clip case 81. For joining the lower case 111 and the upper case 112, for example, adhesion using an adhesive, welding using ultrasonic waves, engagement by an engaging claw, or the like can be used. Further, a transparent plastic film may be wound around the outer periphery in a state where the lower case 111 and the upper case 112 are combined.

  The connected clip unit 13 is accommodated in the clip accommodating portion 87 so that the claw portions 23 of the leading clip 19A open and close in the horizontal direction. The clip 19 </ b> A is pushed by the inner wall of the clip accommodating portion 87 and is in a closed state. As described above, the hemostatic clip bodies 17A to 17C are connected so that the opening and closing directions of the claw portions 23 and 23 are alternately rotated by 90 °, and the opening and closing directions of the claw portions 23 and 23 and the skirt portions 38 and 38 are also 90 °. It is off. Therefore, the connecting rings 20A and 20C open and close the skirt portion 38 in the vertical direction, and the connecting ring 20B opens and closes the skirt portion 38 in the left and right direction.

  The lower case 111 and the upper case 111 are formed with skirt openings 114 for accommodating the skirt portions 38 of the connecting rings 20A and 20C in an open state. Further, at the joint of the lower case 111 and the upper case 111, a notch 115 serving as a skirt opening for accommodating the skirt portion 38 of the connection ring 20B is formed when the two are joined. Accordingly, it is possible to prevent a reduction in restoring force (elastic force) in the opening direction of the skirt portion 38 due to being stored in the case 81 while the skirt portion 38 is pushed in the closing direction. A recess may be provided instead of the opening.

  As shown in FIG. 11, a positioning key 116 (engagement portion) that protrudes from the outer periphery is provided at a substantially central portion in the axial direction of the case 81 at the lower portion of the lower case 111. The positioning key 116 is formed integrally with the lower case 111. The positioning key 116 has a leaf spring 116 a disposed along the axial direction of the case 81 at the lower end thereof. The leaf spring 116 a has a base end on the rear end side of the case 81 and an open end on the front end side, and is elastic in a direction perpendicular to the axial direction of the case 81. A semi-cylindrical click protrusion 116b is provided on the tip side surface of the leaf spring 116a.

  In the assembly work of the connection clip package 80 including the operation of accommodating the connection clip unit 13 in the clip case 81, first, the clips 19A to 19C, the connection rings 20A to 20C, the dummy clip 47, and the connection member are placed on the lower case 111. Connect.

  After the connection is completed, the connection clip unit 13 is stored in the lower case 111 such that each skirt portion 38 is inserted into the skirt opening 114 and the notch 115 (see FIG. 10). The engaging portion 100 of the clip retracting member 83 is also accommodated in the lower case 111, the arms 25, 25 of the leading clip 19A are closed, and the claw portions 23, 23 are engaged with the engaging piece 100c. Thereafter, the upper case 112 is put on the lower case 111 to join them together to form the clip case 81.

  The clip case 81 in which the connection clip unit 13 is accommodated is attached to the loading jig 82, and the assembly work of the connection clip package 80 is completed.

  As shown in FIG. 12, the loading jig 82 is formed by joining a plate-like lower jig 120 and an upper jig 121. On the upper surface 120 a of the lower jig 120, a semicircular case concave portion 122 that forms a case insertion groove 91 and a case insertion hole 92 when the upper jig 121 is joined is formed.

  As shown in FIG. 13, a positioning key groove 125 (engaged portion) is provided in the case recess 122. The positioning key groove 125 is formed along the axial direction of the clip case 81, and the positioning provided in the clip case 81 when the clip case 81 is inserted into the case insertion groove 91 and the case insertion hole 92 from the axial direction. The key 116 is fitted to restrict the rotation of the clip case 81 about the axis. Since the positioning key 116 and the positioning key groove 125 are engaged with each other, the clip case 81 functions as a rotation restricting unit that restricts the rotation of the clip case 81 with respect to the loading jig 82. Set by.

  A click hole 126 having a rectangular cross section is provided on the side surface of the positioning key groove 125. The click hole 126 is disposed at a position corresponding to the click protrusion 116b provided in the positioning key 116, and constitutes a click mechanism together with the click protrusion 116b. When the positioning key 116 is inserted to a predetermined position in the positioning key groove 125, the click protrusion 116b enters the click hole 126 and is engaged. Thus, the click protrusion 116b and the click hole 126 function as a retaining means for preventing the clip case 81 from being detached from the loading jig 82 by restricting the clip case 81 from moving in the axial direction. Further, the click feeling when the click protrusion 116 b engages with the click hole 126 can notify that the clip case 81 has been inserted to an appropriate predetermined position of the case insertion hole 92. In FIG. 13, the click hole 126 is formed so as to penetrate to the side surface of the lower jig 120. However, the shape is not limited to this, and any shape that engages with the click protrusion 116 b may be used. A click recess that engages with the click protrusion 116b may be used.

  Returning to FIG. 12, a semicircular skirt closing recess 128 that forms a skirt closing passage 97 when joined to the upper jig 121 is formed in the back of the case recess 122. On the other end side in the longitudinal direction of the lower jig 120, a rectangular release recess 129 that extends from the skirt closing recess 128 in the left-right direction is formed. A rectangular cutout 130 into which the insertion portion 99 of the clip retracting member 83 is inserted is formed at the end of the skirt closing recess 128.

  A slider recess 133 is formed below the case recess 122. The slider recess 133 forms the slider passage 101 when joined to the upper jig 121, and guides the slider 84 in a direction orthogonal to the axial direction of the connecting clip unit 13. The slider recess 133 has a rectangular shape having a width substantially equal to the width dimension of the slider 84, and is provided so as to penetrate the short direction of the lower jig 120.

  A connection piece 136 made of a plate-like body connecting both sides of the slider recess 133 is provided at a substantially central portion of the slider recess 133. The connection piece 136 serves as a stopper when the slider 84 is pushed into the slider passage 101 while preventing the strength of the loading jig 82 from being reduced by the slider recess 133. The connection piece 136 is provided with a part of the case recess 122. In the case recess 122, a connection auxiliary opening 136 a is formed so as to be continuous with the slider recess 133.

  On the lower surface 121 a of the upper jig 121, as with the lower jig 120, a case notch 139 that forms the case insertion groove 91 and a semicircular case recess 140 that forms the case insertion hole 92 are formed. ing. Further, a skirt closing recess 141 that forms a skirt closing passage 97, a release recess 142, and a notch 143 having the same shape as the notch 130 are formed on the lower surface 121a. Further, on the case recess 140, a slider recess 144 that forms the slider passage 101, a connection piece 145, and a connection auxiliary opening 145 a are formed. The connection auxiliary opening 145a faces the connection opening 95 (see FIG. 7).

  The release recess 129 and the release recess 142 form a release groove 148 (see FIGS. 17 to 19) protruding in the left-right direction of the skirt closing passage 97 when the lower jig 120 and the upper jig 121 are joined. . The release groove 148 has a width dimension that allows the arms 25 and 25 of the leading clip 19 </ b> A to open to the extent that the engagement with the engagement portion 100 of the clip retracting member 83 is released. The release groove 148 is arranged so that the leading clip 19A reaches the release groove 148 when the engaging portion 50 of the connection clip body 18 reaches the position facing the connection auxiliary opening 145a. Moreover, the notches 130 and 143 form a rectangular pulling hole 103 (see FIGS. 14 to 16) through which the insertion portion 99 of the clip retracting member 83 is inserted.

  The loading jig 82 is made of, for example, transparent plastic so that the connecting clip unit 13, the case 81, the clip retracting member 83, the slider 84, and the like can be seen from the outside. For joining the lower jig 120 and the upper jig 121, for example, adhesion using an adhesive, welding using an ultrasonic wave, engagement by an engaging claw, or the like can be used.

  With reference to FIGS. 14-16, the method to load the connection clip unit 13 to the sheath 11 from the connection clip package 80 is demonstrated. First, before the connection clip unit 13 is loaded, in the unused connection clip package 80, the positioning key 116 of the clip case 81 is fitted to the back of the positioning key groove 125 as shown in FIG. Further, the click protrusion 116 b is engaged with the click hole 126. As a result, the clip case 81 is attached to the loading jig 82 in a state where the rotation around the axis is restricted, and the movement in the axial direction is restricted and the clip case 81 is prevented from being detached from the loading jig 82. ing.

  Next, as shown in FIG. 7, the clip case 81 and the loading jig 82 are held together using the recess 90, and the pulling portion 98 is pulled from the loading jig 82. The insertion portion 99 is pulled out from the loading jig 82, and the engaging portion 100 follows this and moves to the skirt closing passage 97. The connecting clip unit 13 is pulled by the engaging portion 100 and pulled into the skirt closing passage 97 from the clip accommodating portion 87. The clip case 81 is attached to the loading jig 82 in a state in which the rotation around the axis and the movement in the axial direction are restricted with respect to the loading jig 82 and an appropriate posture is maintained. When the connecting clip unit 13 is pulled, an excessive force is not applied, and the connecting clip unit 13 before use does not cause failure or performance deterioration.

  As shown in FIG. 14A, the connection clip unit 13 drawn into the skirt closing passage 97 is closed by pressing each skirt portion 38 of each connection ring 20 against the inner wall of the skirt closing passage 97. When the leading clip 19A reaches the release groove 104, the arms 25 and 25 of the clip 19A are released, and the engagement between the claw portions 23 and 23 and the engaging portion 100 is released. The connecting clip unit 13 stops at a predetermined position in the skirt closing passage 97. At this stop position, the connecting member 48 of the connecting clip body 18 reaches a position corresponding to the connecting opening 95. The clip retracting member 83 is pulled until the check protrusion 99b protrudes out of the loading jig 82.

  As shown in FIG. 14B, the clip case 81 is extracted from the case insertion hole 92 in the axial direction. When the clip case 81 is extracted, a part of the connection member 48 of the connection clip body 18 is exposed from the case insertion hole 92. The connecting portion 52 of the connecting member 48 faces the connecting opening 95 through the slider passage 101.

  From the distal end of the sheath 11, the operation wire 12 and the hook 57 protrude in advance by a pulling operation of the sheath operation handle 63 with respect to the wire operation handle 62. As shown in FIG. 15A, the sheath 11, the operation wire 12, and the hook 57 are inserted laterally from above the loading jig 82 into the case insertion groove 91, the wire slit 96, and the connection opening 95. Is done. After insertion of the sheath 11 or the like, the sheath 11 and the loading jig 82 are held together using the recess 90. The front hook 58 is inserted between the elastic arms 53, 53 at the corners of the square column part 58 a.

  When the slider 84 is pushed into the slider passage 101, the connecting slope 110 presses the front hook 58 and the rear hook 59 downward. As shown in FIG. 15B, the front hook 58 pressed by the slider 84 is inserted between the elastic arms 53 and 53. Further, the operation wire 12 is sandwiched between the sandwiching portions 54 and 54. The rear hook 59 comes into contact with the rear end surfaces of the holding portions 54 and 54.

  As shown in FIG. 16A, the entire clip treatment instrument 10 is pressed against the loading jig 82. As a result, the sheath 11 is pushed into the case insertion hole 92 and the inner diameter surface of the sheath 11 and the inner diameter surface of the skirt closing passage 97 are connected. Further, the connecting clip unit 13 pushed by the rear hook 59 advances in the skirt closing passage 97.

  Next, the operation wire 12 is pulled with respect to the sheath 11. For example, by pulling the wire operation handle 62 with respect to the sheath operation handle 63, the operation wire 12 can be moved largely with respect to the sheath 11.

  As shown in FIG. 16B, when the operation wire 12 is pulled, the connection clip unit 13 connected to the operation wire 12 is drawn together into the sheath 11 from the rear end side. Since the skirt closing passage 97 and the inner diameter surface of the sheath 11 are connected while the connecting clip unit 13 is being loaded, the connecting clip unit 13 can be moved while the skirt portion 38 is closed, and the resistance can be reduced. it can. Thereby, the connection clip unit 13 can be loaded into the sheath 11 without causing a positional shift between the clips 19A to 19C and the connection rings 20A to 20C.

  When the sheath operating handle 63 is engaged with the first notch 69 of the wire operating handle 62, the loading of the connecting clip unit 13 is completed. The sheath 11 loaded with the connecting clip unit 13 is removed from the loading jig 82.

  As described above, according to the present invention, with the engagement of the positioning key 116 and the positioning key groove 125, the rotation of the clip case 81 with respect to the loading jig 82 is restricted, and the proper posture is maintained. Since the connecting clip unit 13 is pulled, it is possible to prevent the connecting clip unit 13 from being damaged due to an external force such as twisting or distortion, or causing performance deterioration. Therefore, the connection clip unit 13 is loaded into the sheath 11 without worrying about failure or performance deterioration, and the clip treatment instrument 10 can maintain its original performance. Further, since the click protrusion 116b engages with the click hole 126, the movement of the clip case 81 in the axial direction is restricted and is prevented from being detached from the loading jig 82. Can be further maintained.

  In the above embodiment, the click protrusion 116 b provided on the side surface of the positioning key 116 engages with the click hole 126 provided on the side surface of the positioning key groove 125 to restrict the movement of the clip case 81 in the axial direction. Not limited to this, as shown in FIGS. 17 and 18, the click protrusion 151 provided on the bottom surface of the positioning key 116 engages with the click recess 152 provided on the bottom surface of the positioning key groove 125. It is good also as a structure which controls the movement in an axial direction.

  In each of the above embodiments, the clip case 81 is provided with a positioning key and a click protrusion, and the loading jig 82 is provided with a positioning key, a click hole, or a click recess. A positioning key, a click hole, or a click recess may be provided, and the loading jig 82 may be provided with a positioning key and a click protrusion. In the above embodiment, the positioning key 116 is provided only on the lower case 111. However, the positioning key 116 is not limited to this, and the positioning key 116 having the same shape is symmetrical to the center axis of the clip case 81. You may make it provide in a position. As a result, the lower case 111 and the upper case 112 have the same shape, and the manufacturing cost of the clip case 81 can be further reduced.

  The connection clip package according to the present invention has been described in detail above. However, the present invention is not limited to the above-described embodiments, and various improvements and modifications may be made without departing from the gist of the present invention. Of course. Moreover, the repetitive clip treatment tool using the connection clip package of the present invention can be used not only for a flexible endoscope but also for a rigid endoscope.

It is a perspective view which shows an example of a repetitive clip treatment tool. It is sectional drawing of the sheath front end side of a repetitive clip treatment tool. It is a perspective view of a clip and a connection ring. It is sectional drawing of a connection ring. It is a perspective view which shows the connection state of the last hemostatic clip body, the clip body for connection, and an operation wire. It is a fragmentary sectional view which shows the stepped state in the clip treatment operation of a repetitive clip treatment tool. It is a perspective view of a connection clip package. It is sectional drawing of a connection clip package. It is a disassembled perspective view of a connection clip package. It is an exploded perspective view of a connection clip unit, and a perspective view of a clip case and a clip retracting member. It is a bottom side perspective view of a connection clip package. It is a disassembled perspective view of a loading jig. It is a perspective view which shows the positioning keyway periphery of a loading jig. It is sectional drawing which shows the state which pulled the connection clip unit from the clip case to the loading jig, and extracted the clip case from the loading jig. It is sectional drawing which shows the state which inserted the sheath etc. in the loading jig | tool and connected the connection clip unit and the operation wire. It is sectional drawing which shows the state which inserted the sheath in the loading jig | tool and pulled the connection clip unit in the sheath from the loading jig | tool. It is a bottom side perspective view of the connection clip package which provided the click protrusion on the bottom of the positioning key. It is a side perspective view of the loading jig which provided the click recessed part in the bottom face of the positioning keyway.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10 Clip treatment tool 11 Sheath 12 Operation wire 13 Connection clip unit 14 Operation part 17 Hemostatic clip body 18 Connection clip body 19 Clip 20 Connection ring 23 Claw part 27 Projection part 38 Skirt part 47 Dummy clip 48 Connection member 57 Hook 80 Connection clip Package 81 Clip case 111 Lower case 112 Upper case 114 Skirt opening 115 Notch 116 Positioning key 125 Positioning keyway

Claims (4)

A clip unit in which a plurality of clips are connected in a row and connected to a sheath of a treatment instrument, and a connection unit connected to a hook at the tip of an operation wire inserted through the sheath is provided at the rear end When,
A cylindrical case that houses the clip unit and can be pulled out from the top of the clip unit;
A loading jig having a case connecting portion to which the case is detachably connected, and a passage through which the clip unit pulled out from the case is fed from the top when the clip unit is loaded into the sheath;
It consists of an engaging part provided in one of the case and the case connecting part and an engaged part provided in the other, and both engage to regulate the rotation of the case with respect to the loading jig. A connection clip package comprising a rotation restricting means.   The engaging portion and the engaged portion are fitted to the key provided on the case and protruding from the outer periphery thereof, and the key provided on the case connecting portion and formed along the axial direction of the case. The connection clip package according to claim 1, wherein the connection clip package comprises a keyway and restricts rotation of the case around an axis.   The key fitted in the keyway is positioned at a predetermined position in the axial direction, and is provided with a retaining means for preventing the case from being detached by restricting the key from moving in the axial direction. The connection clip package according to claim 2.   The connected clip package according to claim 3, wherein the retaining means is a click mechanism including a click protrusion provided in one of the key and the key groove and a recess or hole provided in the other.

Images