JP2010178897A - Clip treatment tool - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a clip treatment tool permitting use of a clip corresponding to the size of a treatment part of a living body. <P>SOLUTION: The clip treatment tool includes: a sheath; a plurality of kinds of clips of different sizes; connection rings; an operating wire disposed within the sheath and having the clips connected to the distal end; a handle body connected to the sheath and having the operating wire disposed inside; a slider for moving the operating wire; and a slider movement quantity limiting member for limiting the quantity of movement of the slider to a plurality of different quantities of movement necessary for the clip treatment according to the position in the circumferential direction. One clip body is composed of one clip and one connection ring, and a plurality of kinds of clip bodies are composed of a plurality of kinds of clips of different sizes and the same connection rings. The opening quantities of the clips when the treatment of the living body is started are different. The living body is treated by using a clip body of a different size according to the size of the treatment region of the living body. <P>COPYRIGHT: (C)2010,JPO&INPIT

Description

  The present invention relates to a technical field of an endoscopic clip treatment tool used for hemostasis, wound closure, occlusion, etc. in a living body and the like, and more particularly, relates to a repetitive clip treatment tool capable of repeatedly using a plurality of clips. Is.

  In recent years, an endoscopic clip treatment tool has been used to project a clip from the distal end of an endoscope inserted into a living body, pick a treatment portion after removal of a bleeding part or a lesion tissue with a clip, and stop or stop a hemostasis or wound. Used to do A conventionally used endoscope clip is a clip in which one clip is detachably attached to the tip of an operation wire, and the entire sheath is pulled out of the endoscope each time a clip treatment is performed. A cumbersome work of setting the clip, inserting it again into the endoscope, and performing the next clipping is required.

  In Patent Document 1, a metal plate material such as a plate spring material such as stainless steel is bent at a center portion to form a loop portion, and a clip having a crossed arm portion at a position near the loop portion and a material softer than the clip. A living tissue ligating apparatus using a single-size clip in a single shot is described, which has a fastening member that is formed and has a fastening member fitted with a tip tube made of a high-strength metal such as stainless steel at its tip.

JP 2004-73646 A

Although the clip treatment is also possible in the living tissue ligation apparatus described in Patent Document 1, since it is a single shot type, when a plurality of clip treatments are performed, once the clip treatment is completed, A very complicated operation is required in which the ligation device is pulled out from the forceps channel of the mirror, a new clip is set, and the ligation device is inserted into the forceps channel of the endoscope again.
In addition, in the living tissue ligation apparatus described in Patent Document 1, in consideration of the correspondence to various types of clips having different lengths, there is no slide operation index. It is necessary to check the length of the clip to be used and the slide amount, and the operation becomes complicated.

  Further, various types of clips having different lengths have different amounts of expansion at the start of arm (arm) treatment, and the amount of expansion at the start of treatment of the arm in the living tissue ligating apparatus described in Patent Document 1 is , Determined by the length of the arm portion and the amount of pushing the loop portion drawn into the fastening member, and narrowing the inner diameter of the fastening member, that is, the portion where the loop portion is drawn in order to increase the amount of expansion at the start of treatment, There is a problem that the force required to pull in the clip increases and the operability deteriorates.

  An object of the present invention is to provide a repetitive clip treatment instrument that can eliminate the above-described problems of the prior art and can perform clipping at a plurality of locations without pulling out the entire sheath from the endoscope. Another object of the present invention is to provide a clip treatment tool that can produce clips of a plurality of types (expansion amounts at the start of treatment) at low cost and reduce the operation cost.

  In order to solve the above problems, the present invention is arranged in a cylindrical sheath, a plurality of types of clips of different sizes for gripping a living body, a connection ring for fastening the clip, and the inside of the sheath, An operation wire to which a plurality of the clips are connected to the tip, a cylindrical handle body that is connected to the sheath and in which the operation wire extending from the sheath is disposed, and an outer periphery of the handle body A slider that is movably mounted in the axial direction, engages with the operation wire, and moves the operation wire in the axial direction of the handle body; and on the outer periphery of the handle body, in the circumferential direction of the handle body. A plurality of sliders that are rotatably mounted and that are connected to the operation wire according to the circumferential position of the movement amount of the slider in the axial direction of the handle body. A slider movement amount regulating member that regulates a plurality of different movement amounts required for the clip treatment of each lip, and the operation arranged inside the sheath by moving the slider in the axial direction of the handle body A repetitive clip treatment instrument that moves the wire in the extending direction of the sheath to move the clip connected to the operation wire in the same direction to treat the living body. One clip body is composed of one connection ring, and the plurality of types of clip bodies are composed of a plurality of types of clips having different sizes and the same connection ring, and a plurality of types having different sizes. The clip is different in the amount of expansion of the clip at the start of treatment of the living body, and from among the plurality of types of the clip body, Using the clip body made of the clip of the clip size corresponding to the size of the treatment portion of the serial vivo provides a multiple clip treatment instrument and performing the treatment of the treatment portion of the living body.

  Moreover, it is preferable that the clip stroke which clamp | tightens the said multiple types of said clip is constant irrespective of the kind of said clip.

Moreover, it is preferable that the said clip has a nail | claw part and an arm part, and has a convex part in an arm part.
Furthermore, it is preferable to change the overall length of the clip by changing the length of the convex portion.
Moreover, it is preferable to change the expansion amount of the clip at the start of the treatment of the living body by changing the length of the convex portion.

  Also, it is preferable that a plurality of types of slider movement amount regulating members having different movement amounts of the slider to be regulated are prepared according to the type of the clip, and a part or all of them can be replaced.

Further, the slider movement amount regulating member is detachably attached to the handle body by being detachably attached to the cylindrical slider guide base fitted to the handle body and the slider guide base, At least one of a plurality of position restricting grooves formed at different positions on the sheath side and a plurality of position restricting steps differing in the side positions respectively formed according to the plurality of different movement amounts along the axial direction. It is preferable that the slider guide attaching / detaching portion includes a cylindrical slider guide attaching / detaching portion, and the slider guide attaching / detaching portion is replaceable according to the type of the clip.
Furthermore, the slider has an engaging portion that engages with at least one of the position restricting step and the position restricting groove, and the slider is engaged by the position restricting step or the position restricting groove that engages with the engaging portion of the slider. It is preferable that the movement amount of the slider is restricted to the plurality of different movement amounts.

  The slider is mounted on the outer periphery of the slider movement amount regulating member so as to be movable in the axial direction, and the other ends of the plurality of position regulating grooves on the proximal end side of the slider guide attaching / detaching portion are: The plurality of position restricting grooves or the plurality of position restricting steps are formed along the circumferential direction from the base end side of the slider movement amount restricting member, and the positions of the end portions on the base end side, respectively. It is preferable that the groove is formed in a step shape so that the groove depth from the position to the tip of the position restricting groove and the distance to the side position are different.

  Further, it is preferable that a part of the proximal end side of the connection ring is extended to prevent the clip and the connection ring from falling off from the distal end of the sheath during the clip treatment.

  In order to solve the above-described problems, the present invention is used in a clip treatment instrument for performing a treatment on a living body, and an operation wire arranged inside the sheath is moved in the extending direction of the sheath by an operation handle. A clip set having a plurality of types of clips for grasping a living body, housed in the sheath, connected to the operation wire, and moved in the same direction. One or more of the total length of the clip and the amount of expansion of the clip at the start of treatment of the living body are different, both of which are controlled by the operation handle for tightening the clip to perform treatment of the treatment section of the living body A clip set in which a clip stroke for moving the operation wire is constant is provided.

  Furthermore, in order to solve the above-mentioned problem, the present invention is configured such that the plurality of types of clips are configured as the same connecting ring and a plurality of types of clip bodies, and the clip treatment tool includes the plurality of types of clip bodies. The clip set is characterized in that the treatment of the living body treatment section is performed using the clip body made of the clip having a size corresponding to the size of the treatment section of the living body.

According to the present invention, a treatment of a living body treatment unit can be performed using a clip corresponding to the size of the treatment unit of a living body from a plurality of types of clips having different sizes (expansion amounts at the start of treatment).
Further, according to the present invention, a slider movement amount regulating member (hereinafter also referred to as a slider guide) is provided, and the operator adjusts by regulating the movement amount of the slider that manipulates the advancement / retraction of the clip by the slider guide. Therefore, the clip can be protruded from the sheath by an appropriate length, and the operability of the clip treatment tool can be enhanced. Moreover, it can prevent that a clip protrudes too much and falls off, and can prevent a misoperation.
Further, according to the present invention, the holding portion and the fastening ring constituting the connection ring can be shared regardless of the size of the clip (the amount of expansion at the start of treatment), and the clip and the corresponding slider guide can be If only the desired types are prepared, it is possible to easily increase the size of the clip, reduce the apparatus cost, and reduce the number of manufacturing steps.

Further, according to the present invention, since the clip treatment can be performed only by the operation of rotating one slider guide and the operation of sliding one slider, it is possible to prevent an erroneous operation from occurring at this point.
Further, according to the present invention, since a plurality of clips can be operated in order by one slider guide and one slider, the possibility of mistaken order of clips to be used can be reduced.
Further, according to the present invention, since a plurality of clips can be operated with a single operation mechanism, the number of components constituting the operation handle and the clip treatment tool can be reduced, the apparatus cost can be reduced, and the number of manufacturing steps can be reduced. Can be reduced.

It is a perspective view which shows schematic structure of one Embodiment of the continuous-type clip treatment tool of this invention. (A) And (B) is an expanded sectional view which expands and shows the front-end | tip part of the clip treatment tool shown in FIG. It is a perspective view which shows schematic structure of the clip shown in FIG. (A)-(C) is a partial sectional view of a short type, a middle type, and a long type, respectively, of the clip shown in FIG. (A)-(C) are the fragmentary sectional views showing the relationship between the stand-by position and fitting position of a short type, a middle type, and a long type clip, respectively. FIGS. 5A to 5C are partial cross-sectional views obtained by rotating the short-type, middle-type, and long-type clips shown in FIGS. 5A to 5C by 90 degrees, respectively. (A) is a front view which shows one Example of the connection ring shown in FIG. 2, (B) is sectional drawing of the connection ring shown to (A), (C) is shown to (A). It is a bottom view of a connection ring. (A) is a figure which shows schematic structure of the operation handle shown in FIG. 1, (B) is AA sectional drawing of (A). It is a perspective view which shows schematic structure of the state which removed the slider guide from the operation handle shown in FIG. (A) is a perspective view of the slider guide of the operation handle shown in FIG. 8, and (B) is a development view of the guide groove portion of the slider guide shown in (A). It is a perspective view of a position control member. (A) is a front view showing a schematic configuration of a slider guide attaching / detaching portion, and (B) and (E) are front views showing a schematic configuration of divided pieces of the slider guide attaching / detaching portion, respectively (C ) And (D) are diagrams showing the joint surfaces of (B) and (E), respectively. (A)-(P) is a partial perspective view which respectively shows the stepped state of the operation handle at the time of the clip treatment operation | movement of the repetitive clip treatment tool shown in FIG. It is an expanded view of the guide groove part of a slider guide which shows the positional relationship of the slider guide at the time of clip treatment operation | movement, and the slider pin of a slider. (A)-(P) is a fragmentary sectional view which shows the stepped state at the time of the clip treatment operation | movement of the repetitive clip treatment tool shown in FIG. 1, respectively. (A)-(C) is an expanded sectional view which expands and shows the front-end | tip part of the clip treatment tool with which the clip from which size differs, and the clip was respectively loaded, (A) is a short type, (B) is a middle. Type (C) is a diagram of a long type clip. (A)-(C) is a partial development view of the slider guide showing the positional relationship between the slider guide and the slider pin of the slider during the clip treatment operation in clips of different sizes, respectively (A) is a short type, ( (B) is a diagram corresponding to a middle type and (C) is a diagram corresponding to a long type clip. (A)-(G) is sectional drawing which respectively shows the stepped state of the operation handle at the time of slider guide attachment / detachment part replacement | exchange. (A) And (B) is a front view which shows an example of the marking part of a slider guide attaching / detaching part. It is an expanded view of the guide groove part of the other example of the slider guide which can be used for the operating handle of this invention. It is an expanded view of the guide groove part of the other example of the slider guide which can be used for the operating handle of this invention.

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

FIG. 1 is a perspective view showing a schematic configuration of one embodiment of a repetitive clip treatment device of the present invention.
The repetitive clip treatment tool (hereinafter also simply referred to as “treatment tool”) 10 of the present invention has an operation handle 48 and a clip row 13.
The operation handle 48 includes an operation unit 50, a sheath 16, an operation wire 20, and a connection member 21, and the clip row 13 includes a plurality of clips 12, a plurality of coupling rings 14, a dummy clip 18, And a connecting member 19.
Note that the distal end side is the side that is inserted into the living body when performing treatment with the clip treatment instrument 10 using an endoscope. The side opposite to the distal end side (operation unit 50 side) is referred to as a proximal end side.

FIG. 2 (A) is a cross-sectional view showing a schematic configuration of the distal end portion of the continuous clip treatment device of the present invention, and FIG. 2 (B) is a cross-sectional view seen from an angle that is 90 degrees different from FIG. 2 (A). It is.
As shown in FIGS. 2A and 2B, the treatment instrument 10 in the illustrated example is accommodated in a sheath 16 by connecting three clips 12 (12 </ b> A, 12 </ b> B, 12 </ b> C).
The sheath 16 is an ordinary sheath used in an endoscopic clip treatment tool, for example, a flexible coil sheath in which a metal wire is tightly wound.
Each clip 12 is connected by a connection ring 14 (14A, 14B, 14C). A dummy clip that is engaged with the operation wire 20 via the connecting member 19 is attached to the rearmost clip 12C (most proximal end side, the distal end side is also referred to as “front” and the proximal end side is also referred to as “rear”). 18 are connected.
As will be described in detail later, the operation wire 20 is inserted into the sheath 16 and connected to a slider 54 of an operation unit 50 (see FIG. 1) described later, and can move back and forth in the sheath 16.

2A and 2B show an initial state (standby state) immediately before the start of the clip treatment operation by the first clip 12A.
As shown in FIGS. 2 (A) and 2 (B), one clip 12 and one connection ring 14 including one fastening ring 40 to be described later are connected to one endoscopic hemostatic clip body 15 (hereinafter referred to as “the hemostatic clip body 15”). A plurality of clip bodies 15 are loaded inside the distal end of the long sheath 16.

  By pulling the operation wire 20 from the operation unit 50 by a predetermined pulling length and moving the dummy clip 18 by a predetermined length in one direction, the series of clips 12 moves by the same amount, and the leading clip 12 moves it. It is tightened by the tightening ring 40 at the tip of the connecting ring 14 to be held, and clip treatment (clipping) for hemostasis, marking, etc. by the leading clip 12 is performed. After the clip treatment by the first clip 12 is completed, the operation wire 20 is pushed out to the distal end side of the sheath 16 by a predetermined length so that the next clip 12 can be used (standby state), and then the clip treatment is performed. It can be performed.

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

  FIG. 3 is a perspective view showing a schematic configuration of the clip 12 shown in FIG. As shown in the figure, the clip 12 is a closed clip having a turn portion 24 that is turned 180 degrees with respect to the claw portion 22, and the two open ends are bent so that the end portions face each other, and the claw portion 22 is formed. , 22 is formed. With the intersection 26 as a boundary, the open end side is the arm portions 28 and 28, and the closed end side is the turn portion 24. In the central portion of the arm portions 28, 28, convex portions 30, 30 that are partially wide are formed, and the fastening ring 40 is securely fitted to the intersecting portion 26 side of the convex portions 30, 30. A notch 31 is formed. Each arm portion 28 is divided by a convex portion 30 into a tip portion 28 a on the claw portion 22 side and a base portion 28 b on the intersecting portion 26 side. The clip 12 is preferably made of a biocompatible metal, for example, stainless steel.

  In the clip 12, the fastening ring 40 fixed to the distal end portion of the connecting ring 14 fitted to the intersecting portion 26 presses the base portions 28b and 28b of the arm portions 28 and 28 toward the claw portions 22 and 22 ( The arm portions 28 and 28 and the claw portions 22 and 22 are closed by moving a predetermined amount toward the convex portions 30 and 30), and a predetermined cusp fitting force (gripping force) is exhibited in the claw portions 22 and 22. To do.

The nail | claw parts 22 and 22 are formed in the V-shaped male type | mold and female type | mold, in order to pick up target parts, such as a treatment part after a bleeding part and lesioned tissue removal, reliably.
Further, as shown in FIG. 3, the arm portion 28 of the clip 12 has a constant width from the claw portion 22 to the convex portion 30 at the tip portion 28a, whereas it does not change at the base portion 28b. The width gradually increases from the projection 30 to the projection 30 and has a constant width in the vicinity of the projection 30 so that the clamping ring 40 can be moved easily and reliably, and the pawls 22, 22 can be opened, closed, and fitted. It is easy and reliable, and it is easy and reliable to stop hemostasis in a living body or to suture or close a wound.

  The convex portion 30 has an opening on the distal end side of the connection ring 14 (a hole 41 of a tightening ring 40 to be described later: see FIG. 7) and an inner diameter on a proximal end (a hole 43 of a holding portion 42 to be described later). The width is wider than the portion with which 30 abuts. Therefore, portions other than the convex portion 30 of the clip 12 can enter the inside of the connecting ring 14, but the convex portion 30 cannot enter the inside from the front end side or the base end side of the connecting ring 14.

The size of the projecting portion 30 determines the size of the clip 12, that is, the length of the arm portion 28 of the clip 12.
4A shows a partial cross-sectional view of the short-type clip 12a, FIG. 4B shows a middle-type clip 12b, and FIG. 4C shows a long-type clip 12c. Note that the later clip 12 is omitted, and the clip 12 is not limited to the three types shown in FIGS.
As shown in FIGS. 4A to 4C, the protrusions 30 have different lengths in each of the short, middle, and long types of clips 12.
Further, the length of the clip 12 other than the convex portion 30 is the same length regardless of the size of the clip 12. For example, the length L of the arm portion 28 from the claw 22 to the distal end side of the convex portion 30 is the same length in any size, and turns from the proximal end side of the convex portion 30 through the intersecting portion 26. The length to the base end side of the part 24 is also the same length in any size.

  FIGS. 5A to 5C and FIGS. 6A to 6C are partial cross-sectional views showing the relationship between the standby position and the fitting position of each size of the clips 12a, 12b, and 12c. . FIGS. 6A to 6C are diagrams in which the clips 12 of the respective sizes in FIGS. 5A to 5C are rotated by 90 degrees. The left half or right half, which is line symmetric, is omitted.

Since each type of clip 12 has a different length, the amount of expansion at the start of the clip treatment is different. In the present invention, the amount of expansion at the start of the clip treatment (hereinafter also referred to as initial expansion amount) is set when the clip 12 is in a preparation state (see FIG. 2) for starting the clip treatment at the distal end of the sheath 16. That is, the clip 12 and the skirt portion 38 of the connecting ring 14 are opened by projecting from the distal end of the sheath 16, and then the operation wire 20 is pulled by the operation portion 50 described later, and the proximal end side of the skirt portion 38 and the distal end of the sheath 16. The claw portion of the clip 12 when the base portions 28b and 28b of the clip 12 are in contact with the inner surface of the tip end side of the hole 41 of the fastening ring 40 when It is defined as the distance between 22 and 22.
The initial expansion amount of each size of the clip 12 is represented by a _S , a _M , and a _L in each of the short, middle, and long types in the drawings of FIGS. Is done.

When the stand-by position and the fitting position of each size of the clip 12 are compared with respect to the base end side end portion of the connecting ring 14 constituting each clip body 15, for example, a short type clip 12a shown in FIG. in the clip stroke _{C S} is 4.8 mm, the fitting position, the claw portions 22 of the leading end of the next clip 12a, the base end side end portion of the preceding coupling ring 14, i.e., the extension to be described later The overlap OL _S with the portions 44 and 44 is 0.7 mm.

Similarly, in the middle type of clip 12b shown in FIG. 5 (B), for example, clip stroke _{C M} is 4.8 mm, the fitting position, the claw portions 22 of the leading end of the next clip 12b The overlap OL _M with the base end side end portion of the previous connecting ring 14, that is, the extension portions 44 and 44 described later, is 0.5 mm.
Further, in the long type of clip 12c shown in FIG. 5 (C), for example, clip stroke _{C L} is 4.8 mm, the fitting position, the claw portions 22 of the leading end of the next clip 12c, The overlap OL _L with the base end side end part of the previous connecting ring 14, that is, extension parts 44 and 44 to be described later, is 0.5 mm.
Thus, even if the length of each size of the clip is different, the length L of the arm portion 28 is common and the connecting ring 14 is also common. Therefore, the clip stroke C _X at the time of the clip treatment is as follows. The relationship shown in Expression (1) is common to the clips 12 of any size.

C _S = C _M = C _L (= 4.8 mm: example) (1)

  As shown in FIGS. 2A and 2B, the first clip 12A and the second clip 12B are closed with the claw portion 22 of the second clip 12B engaged with the turn portion 24 of the first clip 12A. The connection state is established by being held by the connection ring 14A. As shown in FIG. 2 (A), the claw portions 22 and 22 of the second clip 12B are engaged with the turn portion 24 of the first clip 12A in the orthogonal direction, and the first clip 12A and the second clip 12B are connected to each other. , They are connected in different directions by 90 degrees. Similarly, the second clip 12B and the third clip 12C are also connected in directions different by 90 degrees. That is, the first clip 12A and the third clip 12C are arranged in the same direction.

  The connecting ring 14 is fitted into the sheath 16 so as to be able to advance and retract while covering the engaging portions of the two front and rear clips 12 and 12 and maintaining the connected state. In other words, the outer diameter of the connection ring 14 is slightly smaller than the inner diameter of the sheath 16, and the connection ring 14 can smoothly move forward and backward in the sheath 16 as the clip 12 moves. 7A is a front view showing an example of the connecting ring shown in FIG. 2, FIG. 7B is a sectional view of the connecting ring shown in FIG. 7A, and FIG. FIG. 8 is a bottom view of the connection ring shown in FIG.

  As shown in FIGS. 7A to 7C, the connection ring 14 includes a tightening ring 40 and a holding portion 42. The coupling ring 14 has a metal fastening ring 40 fixed to the tip of a resin holding portion 42 and is integrally formed of two members. The resin holding portion 42 is in charge of maintaining the connected state of the clip 12 and holding the clip 12 in the connecting ring 14, and the metal fastening ring 40 is in charge of fastening the clip 12. The connection ring 14 may be formed of one member as long as both functions of the tightening ring 40 and the holding portion 42 can be exhibited.

  The tightening ring 40 is a metal cylindrical (ring-shaped) part attached to the distal end side of the connection ring 14, and is larger than the width in the vicinity of the intersection 26 of the clip 12 and larger than the width of the convex portion 30. A small inner diameter hole 41 is formed. Therefore, the tightening ring 40 can move in the vicinity of the intersecting portion 26 of the clip 12 to be held, but cannot be pulled out beyond the convex portion 30 to the tip side. That is, the convex portion 30 functions as a stopper that determines the movement limit of the connecting ring 14 that moves forward with respect to the clip 12.

  The tightening ring 40 is set at a predetermined position in the vicinity of the intersecting portion 26 of the clip 12. The clamping ring 40 moves from the initial position to the convex portion 30 side from the intersecting portion 26 where the arm portion 28 of the clip 12 becomes wide. , 28 is closed and fixed. The fastening ring 40 is made of a biocompatible metal. By making the tightening ring 40 made of metal, it is possible to exert a frictional force as a tightening force on the metal clip 12.

  The holding portion 42 is a resin-molded, generally cylindrical (ring-shaped) part. The holding unit 42 includes a first area 32 that holds the previous clip 12 and a second area 34 that is a connected holding area that holds the next clip 12 in a state of being connected to the previous clip. The holding portion 42 is formed with a hole 43 that communicates with the hole 41 of the tightening ring 40 and penetrates the first region 32 and the second region 34.

  In the first region 32, a circular hole 43 larger than the hole 41 of the tightening ring 40 that can accommodate the turn part 24 of the clip 12 and the base parts 28b and 28b of the arm parts 28 and 28 is formed. A stepped portion for fitting the tightening ring 40 is formed on the outer surface of the distal end portion of the first region 32. The tightening ring 40 and the holding portion 42 are loaded in the sheath 16 and are clipped. It is fitted with an interference fit that does not come off at times.

Further, the first region 32 has a skirt portion 38 that is inclined and spreads in a skirt shape with respect to the axis of the connecting ring 14 main body.
In the skirt portion 38, the upper base 38 a in FIGS. 7A and 7B is connected to the main body 42 a of the holding portion 42, and the lower spread portion 38 b is a notch 36 formed in the main body 42 a. Is partially separated from the main body 42a so as to expand or close in the radial direction. The skirt portions 38 are formed at two positions on both sides separated by 180 degrees at the same position in the pulling direction of the clip 12, that is, the vertical direction in FIG.

  In the natural state where no external force is applied to the skirt portions 38, 38 on both sides, as shown in FIG. 7A, the widened portion 38b spreads in a skirt shape. At this time, the inside of the first region 32 of the holding portion 42 is a columnar space as shown in FIG. On the other hand, when the connection ring 14 is loaded into the sheath 16, as shown in the second connection ring 14B of FIG. Entering the space, the inner peripheral side portion of the skirt portion 38 (the expanding portion 38b) presses the side surface (edge portion) of the turn portion 24 of the second clip 12B held in the first region 32, and the second portion The clip 12B is held so as not to move in the rotation direction and the forward / backward direction in the connection ring 14B. The skirt portion 38 may press and hold a clip held in the second region 34, that is, a rear clip.

  As shown in the first connecting ring 14A of FIG. 2A, the skirt portions 38, 38 are released from the distal end of the sheath 16, and at the same time, are opened by their own elasticity to release the holding of the first clip 12A. The inner diameter of the sheath 16 is wider than the inner diameter of the sheath 16 to prevent the connecting ring 14 </ b> A from retracting into the sheath 16. In this state, the operation wire 20 is pulled, and the first clip 12A moves backward, so that the connection ring 14A moves forward relative to the first clip 12A, and the fastening ring 40 at the tip of the connection ring 14A The first clip 12A is tightened.

  Therefore, the skirt portion 38 needs to have elasticity so that it can be closed inward within the sheath 16 and spreads in a skirt shape when released from the external force from the distal end of the sheath 16. . At the same time, the skirt portion 38 needs to have a rigidity that can hold the clip 12 inside the sheath 16 and a rigidity that can withstand a reaction force of the tightening force of the clip 12 at the distal end of the sheath 16.

  From these viewpoints, the holding portion 42 is made of a material that is biocompatible and satisfies the elasticity and rigidity required for the skirt portion 38. The shape is determined so as to satisfy the elasticity and rigidity required for the skirt portion 38. For example, PPSU (polyphenylsulfone), aromatic nylon, or the like can be used as the material of the holding unit 42. From the standpoint of ease of manufacture, the holding portion 42 is preferably integrally formed.

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

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

  In the second region 34, as shown in FIGS. 7B and 7C, a hole 43 having the same inner diameter penetrating from the first region 32 is formed, and a groove (concave portion) 43a is formed at two opposing positions. Is formed. Moreover, as shown to FIG. 7 (A)-(C), the slit 46 cut | disconnected from the base end is formed in the 2nd area | region 34 at two places. Further, an extension 44 is formed on the base end side.

  The grooves 43a and 43a can accommodate the tip portions 28a and 28a of the arm portions 28 and 28 of the clip 12 held in the second region 34 in a state where the claw portions 22 and 22 are closed. The grooves 43a and 43a are provided at two locations on both sides in the opening / closing direction (left and right direction in FIG. 7B) of the claw portion 22 of the clip 12 held in the second region 34. The plate surfaces of the tip portions 28a and 28a of the arm portions 28 and 28 of the clip 12 held in the second region 34 abut against the inner walls of the grooves 43a and 43a. Further, the width of the groove 43 a is smaller than the width of the convex portion 30 formed in the arm portion 28. Therefore, the convex portion 30 of the clip 12 held in the second region 34 cannot enter the groove 43a.

  Further, extension portions 44, 44 are formed so as to extend the grooves 43a, 43a, and the plate surfaces of the tip portions 28a, 28a of the arm portions 28, 28 of the clip 12 are extended following the inner walls of the grooves 43a, 43a. It also abuts against the inner walls of the portions 44, 44. Even if the operation wire 20 is pulled during the clipping procedure, and the claw portions 22 and 22 of the subsequent clip 12 reach the extension portions 44 and 44 from the grooves 43a and 43a, the subsequent clip that holds the turn portion 24 of the preceding clip 12 The 12 claw portions 22 and 22 are kept closed.

  By doing so, it is possible to prevent the subsequent clip 12 (for example, 12C) from entering the preceding clip 12 (for example, 12B), and as a result, the relative position of the first and subsequent (front and rear) clip 12 can be maintained. The pushing operation of the clip 12 by the operation wire 20 (slider 54: see FIG. 9) can be maintained.

  The engaging portions of the two clips 12 and 12 are held in a portion of the second region 34 that is close to the boundary with the first region 32. In the previous clip 12 (for example, the second clip 12B in the connecting ring 14B in FIG. 2B), the turn portion 24 is held by the closed skirt portion 38 in the first region 32 inside the sheath 16. Therefore, forward / backward movement and rotational movement are suppressed. Further, the next clip 12 that engages with the previous clip 12 (for example, the third clip 12C in the connecting ring 14B of FIG. 2B) is 90 degrees different from the previous clip due to the groove 43a of the second region 34. , The rotational movement is suppressed, and the forward / backward movement is suppressed by engaging with the previous clip 12 in which the forward / backward movement is suppressed. That is, the engaging portions of the front and rear clips are held by the connection ring 14 with a very small play.

  The slits 46 are formed at two positions shifted by 90 degrees from the skirt portions 38, 38 to a position shallower than the upper end of the second region 34. In other words, the slit 46 is provided at a position shifted by 90 degrees from the spreading direction of the clip 12 held in the second region 34.

  By providing the slit 46, the flexibility of the connecting ring 14 can be improved, and the clip treatment instrument 10 (the sheath 16) can pass through a curved portion having a small curvature. Further, by providing the slit 46, the extended portions 44, 44 provided at the hem (base end portion) of the connecting ring 14 can be expanded. When the clips 12 and 12 are connected, there is also an advantage that the connection ring 14 can be easily connected by expanding the hem and the extension portions 44 and 44 of the connection ring 14.

  As shown in FIGS. 7A to 7C, the extended portions 44 and 44 further extend a part of the proximal end side of the second region 34. The extensions 44 and 44 are located outside the grooves 43a and 43a, and the arms 28 and 28 of the later clip 12 are held following the grooves 43a and 43a. Further, since the clip body 15 is held so as not to fall from the distal end of the sheath 16, the outer diameters of the extension portions 44 and 44 are smaller than the inner diameter of the sheath 16 and larger than the holding portion 42.

  For example, when the clip 12 sinks when the sheath 16 is bent, the clip 12 can be further protruded from the standard protruding position by the operation unit 50 described later. By providing this, it is possible to reliably prevent the sheath 16 from coming off at the tip.

Further, by providing the extension portions 44, 44, the clip strokes (C _S , C _M , C _L ) for tightening the clip 12 are made the same length for the clip 12 of each size of short, middle, and long. The connection ring 14 can be made common.

  Further, when the clip 12 is rotated in order to change the expanding direction of the clip 12, the wide projections 30 and 30 of the clip 12 and the extension portions 44 and 44 come into contact with each other. It is possible to convey more.

  The clip body 15 including the clip 12 and the connection ring 14 having the above-described configuration is prepared in a plurality of sizes depending on the size of the treatment target portion (portion to be grasped). A clip treatment instrument 10 is loaded with a plurality of clips connected. Specifically, the clip 12 has the same basic shape as the above-described clip 12, but the clip 12 has a different length and a different length of the entire clip 12. The connecting ring 14 is the same for all size clips.

  As shown in FIG. 2, the last third clip 12C is engaged with a dummy clip 18 that is not used for clip treatment. The dummy clip 18 has a spring-like portion having a shape similar to that of the half on the open end side from the crossing portion 26 of the clip 12 at the tip portion, and the third clip 12C with the claw portion closed. The third clip 12C is released when the claw portion is opened. A connecting member 19 is attached to the base end portion of the dummy clip 18. The connecting member 19 is detachably connected to a hook-like connecting member (hook) 21 at the tip of an operation wire 20 to be described later.

  The sheath 16 is, for example, a flexible coil sheath in which a metal wire is tightly wound. The sheath 16 is inserted therein so that the clip 12 is movably inserted at the distal end side, and the operation wire 20 connected to the clip 12 via the dummy clip 18 and the connecting member 19 is accommodated. To the operation unit 50.

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

  The connection member 21 of the operation wire 20 and the connecting member 19 of the dummy clip 18 are attached to one member so that the clip 12 and the operation wire 20 do not come off when the clip 12 and the operation wire 20 move forward and backward, that is, when the clip moves in the sheath 16. The other member can be fitted. Even when the operation wire 20 is pulled to the operation unit 50 side by fitting the connection member 21 into the connection member 19 and fitting the connection member 21 into the space of the connection member 19, the operation member 50 side of the connection member 21 is connected. Since this surface is supported by the surface in which the opening of the connecting member 19 is formed, it is possible to prevent the connecting member 21 from being detached from the connecting member 19.

Next, the operation handle for the repetitive clip treatment tool of the present invention will be described in detail.
8A is a cross-sectional view schematically showing a schematic configuration of the operation handle 48 of the repetitive clip treatment instrument shown in FIG. 1, and FIG. 8B is a cross-sectional view taken along line AA in FIG. 8A. It is sectional drawing. 9 is a perspective view showing a schematic configuration in a state where the slider guide 56 is removed from the operation handle 48 shown in FIG. 8, and FIG. 10A shows a schematic configuration of the slider guide 56 shown in FIG. 10B is a partially developed view of the outer peripheral surface of the slider guide 56 shown in FIG. 10A, and FIG. 11 is a perspective view showing a schematic configuration of the position restricting member 58 shown in FIG. FIG.
As shown in FIG. 8, the operation handle 48 of the present invention includes an operation unit 50, a sheath 16, an operation wire 20, and a hook-shaped connection member (hook) 21 attached to the distal end of the operation wire 20. The operation unit 50 includes a handle main body 52, a slider 54, a slider guide 56, a position regulating member 58, an urging spring 60, and a finger hook ring 62.

  As shown in FIG. 8A, the handle main body 52 is a stepped circular tubular member having three cylindrical portions having different outer diameters. As shown in FIG. A groove (engagement groove) 68 extending in the central axis direction is formed in the large diameter portion) 52a. In the handle main body 52, a distal end portion of a cylindrical portion (narrow diameter portion) 52b having a small outer diameter is connected to a proximal end of the sheath 16, and inside thereof, that is, inside the two cylindrical portions 52a and 52b, The operation wire 20 inserted through the sheath 16 extends and is inserted. A portion (base end portion) 52c having the largest outer peripheral diameter in the handle main body 52 is located on the most base end side in the handle main body 52, and a finger hook ring 62 to be described later is attached.

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

The slider stopper 78 is a substantially U-shaped member disposed in the recess 52c on the proximal end side of the handle main body 52, and a stopper portion 78a on the distal end side of the slider stopper 78 on the proximal end side of the slider 54. It defines the movement range. The width of the slider stopper 78 (the width in the direction perpendicular to the paper surface in FIG. 8) can be pushed by the operator when replacing the slider guide attaching / detaching portion 76 described later, and does not hinder the operation during normal clip treatment. And it is sufficient. For example, the width can be approximately the same as the groove 68 of the handle body 52.
In normal use, such as during clip treatment, the slider stopper 78 has an end portion on the proximal end side of the slider 54, with the stopper portion 78 a protruding outward from the outer periphery of the proximal end portion 52 c of the handle body 52 by the biasing spring 78 b. Since the slider 54 abuts against the stopper portion 78a, the slider 54 is regulated so as not to move to the proximal end side of the operation portion 50 with respect to the stopper portion 78a.
Further, when the slider stopper 78 is replaced when a slider guide attaching / detaching portion 76, which will be described later, is replaced, the stopper portion 78a enters inward of the outer periphery of the base end portion 52c, and the slider 54 is inserted into the operating portion 50 more than the stopper portion 78a. It becomes possible to move to the base end side.

  As shown in FIG. 8A, the slider guide 56 is configured integrally by combining a slider guide base 72 and a slider guide attaching / detaching portion 76. The slider guide 56 is a cylindrical member that is disposed on the outer peripheral surface of the handle main body 52 so as to be rotatable in the circumferential direction, and that regulates the amount of movement of the slider 54 in the axial direction of the handle main body 52. The slider 54 is disposed on the sheath 16 side (the distal end side of the sheath 16). The slider guide base 72 includes a convex joint 56a on the distal end side and a large-diameter portion 56b for the operator to rotate and rotate the slider guide 56. Also, the slider guide 56 has a convex joint portion 56a on the tip end side that can be rotated to a concave joint portion 58a on the proximal end side of the position regulating member 58 that regulates the position of the slider guide 56, which will be described later, particularly the rotational position. And is supported by the handle body 52 in a rotatable state.

The inner diameter of the distal end portion (joining portion 56a) of the slider guide 56 is substantially equal to the outer diameter of the narrow diameter portion 52b of the handle body 52 to be inserted, and the inner diameter of the proximal end side of the slider guide 56 is the handle body 52 to be inserted. The slider guide 56 is slidable on the handle main body 52, specifically, on the large diameter portion 52a and the small diameter portion 52b in the circumferential (rotation) direction and the axial direction. It is supported. Further, the base end side portion of the slider guide 56, that is, the outer diameter of the slider guide attaching / detaching portion 76 is slightly smaller than the inner diameter of the slider 54, and when the slider 54 moves to the tip end side, the slider guide attaching / detaching portion 76 54 can enter inside.
Since the slider guide 56 rotates and moves with respect to the position restricting member 58 at the tip end thereof by the operator's operation, the operator can easily hold the slider guide base portion 72 (portion on the base end side from the joint portion 56a). Further, a large-diameter portion 56b whose outer diameter is larger than the outer diameter of the slider guide attaching / detaching portion 76 is formed, and an inclined surface and irregularities corresponding to the fingers are formed on the outer surface of the large-diameter portion 56b.

  As shown in FIGS. 10A and 10B, the slider guide 56 has a central axis of the handle body 52 for switching the movement amount of the slider in a plurality of stages, that is, for restricting the movement amount to two or more different movement amounts. Four slider guide grooves (position restricting grooves) 66A, 66B, 66C and 66D extending in the direction of the shaft and having different restricting positions in the axial direction are formed. The four slider guide grooves 66A, 66B, 66C and 66D are formed at intervals of 90 degrees in the circumferential direction of the slider guide 56.

As shown in FIG. 10B, the four slider guide grooves 66A, 66B, 66C, and 66D have different groove restricting positions (that is, the positions of the end portions on the sheath 16 side (front end side)). Specifically, the slider guide groove 66A is the most distal side, and is the base end side in the order of the slider guide groove 66D, the slider guide groove 66C, and the slider guide groove 66B.
Further, on the entry side (slider 54 side) of the four slider guide grooves 66A, 66B, 66C and 66D, the slider pin 70 is not chamfered by other parts of the slider guide 56, and is easily chamfered into each groove. Has been made.

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

  The slider guide grooves 66 </ b> A to 66 </ b> D regulate the movement range of the operation wire 20 during the clip treatment operation by guiding the slider pin 70 and defining the movement range thereof. On the other hand, the amount of movement of the operation wire 20 required during the clip treatment operation differs depending on the type (length) of the clip 12. Therefore, in the clip treatment instrument 10, the slider guide attaching / detaching portion 76 of the slider guide 56 in which the slider guide groove is formed can be replaced, and different types of clips 12 can be used in the same clip treatment instrument 10.

  As shown in FIG. 8A, the slider guide 56 includes a slider guide base 72 and a slider guide attaching / detaching portion 76, and the slider guide base 72 and the slider guide attaching / detaching portion 76 are attachable / detachable. The slider guide base 72 is provided with a slider guide locking portion 74 for locking the slider guide attaching / detaching portion 76. The slider guide attaching / detaching portion 76 is fitted into the slider guide base portion 72. The slider guide base 72 is slidable in the circumferential direction and the axial direction with respect to the handle body 52. The slider guide base 72 constitutes a joint portion 56 a and a large diameter portion 56 b of the slider guide 56.

  The slider guide locking portion 74 is provided on the slider guide base portion 72, and corresponds to the button 74a that can be elastically deformed in the radial direction of the slider guide base portion 72, a claw 74b provided inside the button 74a, and the button 74a. In the position, it is comprised from the recessed part 74c formed in the internal peripheral surface of the slider guide base 72. FIG. The nail | claw 74b exists in the recessed part 74c, and is provided in the inner peripheral side of the button 74a (refer FIG. 8 (B)). The slider guide attaching / detaching portion 76 has a convex portion 76c that is provided so as to be engaged with the concave portion 74c and elastically deformable in the radial direction of the slider guide attaching / detaching portion 76, and the convex portion 76c and the concave portion 74c are engaged with each other. Thus, the slider guide attaching / detaching portion 76 is fixed to the slider guide base portion 72 in the axial direction and the circumferential direction of the handle main body 52. By pressing the button 74a, the projection 76c of the slider guide attaching / detaching portion 76 is pushed down by the claw 74b, the engagement between the projecting portion 76c and the recessed portion 74c is released, and the fitting between the slider guide attaching / detaching portion 76 and the slider guide base 72 is released. Then, the slider guide attaching / detaching portion 76 can be detached from the slider guide base portion 72.

FIG. 12 is a diagram showing details of the slider guide attaching / detaching portion 76. As shown in FIG. 12A, the convex portion 76c is provided so as to protrude from the outer surface of the slider guide attaching / detaching portion 76 on the tip side (left side in FIG. 12).
As shown in FIGS. 12A to 12E, the slider guide attaching / detaching portion 76 can be removed from the operation portion 50 after the fitting with the slider guide base portion 72 is released. It can be divided in half in the direction. The slider guide attaching / detaching portion 76 includes a divided piece 76 a and a divided piece 76 b that are divided in half in the axial direction of the slider guide 56.

  The split piece 76a is provided with an engagement pin 84, and the split piece 76b is provided with an engagement hole 86 so that the split piece 76a and the split piece 76b can be engaged with each other. By engaging the engaging pin 84 of the divided piece 76a and the engaging hole 86 of the divided piece 76b with each other, the divided piece 76a and the divided piece 76b are integrated to form a cylindrical slider guide attaching / detaching portion 76. To do.

The slider guide attaching / detaching portion 76 can be replaced according to the type of the clip 12, and a plurality of types of slider guide attaching / detaching portions 76 are used according to the type of the clip 12. Therefore, by changing the pitch and position of the engagement pin 84 / the engagement hole 86 according to the clip of each size, it is possible to prevent the split pieces 76a and 76b having different sizes from being combined and to prevent misuse. preferable.
The form of the slider guide grooves 66A to 66D corresponding to the type of each clip 12 will be described in detail later.

  As shown in FIG. 10A, the convex joint 56a at the tip of the slider guide 56 has an abutting surface that contacts the concave joint 58a of the position regulating member 58 (that is, the position regulating member 58 and the slider guide). 56, which protrudes in the direction parallel to the central axis of the handle main body 52 and toward the distal end, and in the circumferential direction, sawtooth-shaped convex portions 57a having different inclination angles of the two tooth surfaces with respect to the contact surface. Four are formed. The four convex portions 57a have the same shape. The convex portion 57a is a sawtooth shape, that is, a convex portion having a triangular cross section in which the inclination angle of one tooth surface is gentle and tapered, and the inclination angle of the other tooth surface forms a substantially right-angled step. Moreover, the connection part of the adjacent convex part 57a and the convex part 57a becomes the recessed part 57b, and this recessed part 57b is also formed four.

  As shown in FIGS. 8A and 11, the position restricting member 58 is a stepped cylindrical member that restricts the position of the slider guide 56, particularly the rotational position, and the small diameter portion of the handle main body 52 is formed in the internal through hole. 52 b is inserted, and the inner peripheral surface of the through hole is fixed to the small diameter portion 52 b of the handle main body 52, so that it is fixed to the handle main body 52 on the tip side of the slider guide 56. Further, the position restricting member 58 includes a concave joint 58 a that is fitted in a state where the convex joint 56 a on the distal end side of the slider guide 56 is rotatable on the base end side.

  The concave joint 58a of the position restricting member 58 is in contact with the abutting surface (that is, the surface where the position restricting member 58 and the slider guide 56 are in contact) with the convex joint 56a of the slider guide 56. A convex portion 59a having a shape that meshes with the convex portion 57a on the tip surface of 56a is formed. In other words, the joint 58a has four sawtooth-shaped protrusions 59a that protrude proximally in a direction parallel to the central axis of the handle main body 52 and have different inclination angles of the two tooth surfaces with respect to the contact surface in the circumferential direction. Is formed. The four convex portions 59a have the same shape. The convex portion 59a is a sawtooth shape, that is, a convex portion having a triangular cross section in which the inclination angle of one tooth surface is a gentle taper and the inclination angle of the other tooth surface forms a substantially right-angled step. Further, a connecting portion between the adjacent convex portion 59a and the convex portion 59a becomes a concave portion 59b, and four concave portions 59b are also formed.

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

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

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

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

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

The operation handle 48 and its operation unit 50 are basically configured as described above.
When the slider guide groove 66A overlaps the groove 68, when the slider 54 is moved until the slider pin 70 comes into contact with the end of the slider guide groove 66A on the sheath 16 side, the connecting member at the tip of the operation wire 20 is moved. 21 protrudes from the tip of the sheath 16. Further, when the slider guide groove 66B overlaps the groove 68, when the slider 54 is moved until the slider pin 70 contacts the end of the slider guide groove 66B on the sheath 16 side, the first clip 12A is moved to the sheath 68. It protrudes from the sheath 16 to a predetermined position where it does not fall off. As a result, the first clip 12A is in a state where it can be clipped.

  Similarly, when the slider guide groove 66C overlaps the groove 68, when the slider 54 is moved until the slider pin 70 contacts the end of the slider guide groove 66C on the sheath 16 side, the second clip 12B is moved. It protrudes from the sheath 16 to a predetermined position where it does not fall off from the sheath 16. Thereby, the 2nd clip 12B will be in the state in which clip treatment is possible. Similarly, when the slider guide groove 66D overlaps the groove 68, when the slider 54 is moved until the slider pin 70 and the end of the slider guide groove 66D on the sheath 16 side come into contact, the third clip 12C is moved. It protrudes from the sheath 16 to a predetermined position where it does not fall off from the sheath 16. Thereby, the 3rd clip 12C will be in the state where clip treatment is possible.

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

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

Next, the operation of the continuous clip treatment tool of the present invention shown in FIGS. 1 to 12 will be described.
FIGS. 13A to 13P are partial perspective views showing the stepped state of the operation handle during the clip treatment operation of the repetitive clip treatment tool, and FIG. 14 shows the slider guide and the slider during the clip treatment operation. FIG. 15A to FIG. 15P are partial cross-sectional views showing a stepped state during a clip treatment operation of the distal end portion of the repetitive clip treatment device. . Hereinafter, the operation of the repetitive clip treatment instrument 10 will be described while explaining the correspondence between the states of FIGS. 13, 14 and 15.

  First, as shown in FIG. 13A, the slider guide 56 is oriented so that the slider guide groove 66A overlaps the groove 68, and the slider 54 is positioned at the end of the moving area of the handle body 52 on the finger ring 62 side, that is, the slider stopper 78. (Hereinafter, the end of the moving region on the finger ring 62 side of the handle body 52 is referred to as “home position”). That is, the slider pin 70 of the slider 54 is moved to the position P1 in FIG. At this time, the operation wire 20 is drawn into the sheath 16 as shown in FIG. This state is the initial state of the operation wire 20.

Next, as shown in FIG. 13B, the slider 54 is moved to a position where the slider pin 70 contacts the end of the slider guide groove 66A on the sheath 16 side (that is, the slider pin 70 is moved to the position P2 in FIG. 14). And the connecting member 21 of the operation wire 20 is projected from the distal end of the sheath 16 as shown in FIG.
Thereafter, the connecting member 19 of the dummy clip 18 to which the three clips 12 are connected is attached to the connecting member 21 of the operation wire 20.

After the connecting member 19 of the dummy clip 18 to which the three clips 12 are connected is attached to the connecting member 21 of the operation wire 20, the slider 54 is moved to the home position as shown in FIG. The pin 70 is moved to a position P3 in FIG. 14), and the three clips 12 connected to the dummy grip 19 are stored in the sheath 16 as shown in FIG.
Thereafter, the sheath 16 is inserted from the distal end into an endoscope forceps port or the like inserted into the living body, and the distal end of the sheath reaches the distal end of the insertion portion of the endoscope and protrudes from the distal end of the endoscope.

  Thereafter, as shown in FIG. 13D, the slider guide 56 is rotated by 90 ° so that the slider guide groove 66B of the slider guide 56 overlaps the groove 68. As a result, the slider pin 70 is moved to the home position (position P4 in FIG. 14) on the extension line of the slider guide groove 66B. The base end side of the slider guide 56 is spaced from the base end portion 52c of the handle main body 52, and when the slider guide 56 is rotated, the convex portion 57a of the slider guide 56 is convex of the position restricting member 58. In order to get over the portion 59a, that is, to get over the lock pawl, a height over the lock pawl is secured so that the slider guide 56 can move slightly to the base end side.

Next, as shown in FIG. 13E, the slider 54 is moved to the end of the slider guide groove 66B on the sheath 16 side (that is, the maximum protruding position) (that is, the slider pin 70 is moved to the position P5 in FIG. 14). 15D, the first clip 12A is protruded from the distal end of the sheath 16, and the skirt portion 38 of the first clip 12A is opened.
Here, the maximum projecting position means that the clip (here, the first clip 12A) does not fall off the sheath 12, and the projecting amount is reduced due to variations in the dimensions of the component parts and the inner and outer circumferences of the wire and sheath. However, it is a position where the skirt portion 38 opens and becomes available.

Thereafter, the slider 54 is moved to the finger ring 62 side by a predetermined distance, specifically, to the standard protruding position (that is, the slider pin 70 is moved to the position P5 ′ in FIG. 14), as shown in FIG. As described above, the skirt portion 38 of the first clip 12 </ b> A is brought into contact with the distal end of the sheath 16. By pulling to the standard protruding position, even when the first clip 12A protrudes too much, the skirt portion 38 and the distal end of the sheath 16 can be brought into contact with each other, and a treatment by the first clip 12A is possible.
In this way, the distance from the maximum protruding position to the standard protruding position becomes a buffer of the dimensional variation of the component parts and the inner and outer circumference differences of the wire and sheath, and once protruding to the maximum protruding position, regardless of error, The skirt portion 38 can be opened, and then pulled to the standard protruding position, so that the skirt portion 38 and the distal end of the sheath 16 can be brought into contact with each other regardless of errors.
Accordingly, it is possible to more reliably prevent the clip 12 from being accidentally dropped due to excessive protrusion from the sheath 16, and the first clip 12A that is securely held can be pressed against a living body that is firmly clipped.

  Thereafter, the clip treatment tool 10 is moved, and the nail portions 22 and 22 of the expanded first clip 12A are pressed against a diseased part such as an affected part to be clipped, and the slider 54 is moved as shown in FIG. A predetermined distance is moved to the finger ring 62 side, specifically, the clip completion position (that is, the slider pin 70 is moved to the position P6 in FIG. 14).

  At this time, the skirt portion 38 is open at the connection ring 14A that protrudes from the distal end of the sheath 16, and the pressing and holding of the first clip 12A by the skirt portion 38 is released. Further, the connecting ring 14 </ b> A is prevented from retreating into the sheath 16 because the skirt portion 38 is opened at the distal end of the sheath 16. Therefore, the first first clip 12A moves backward with respect to the connection ring 14A. The tightening ring 40 at the tip of the connecting ring 14A is pushed from the crossing portion 26 side to the position immediately below the convex portion 30 along the base portion 28b of the arm portion 28 of the first clip 12A, so that the nail portions 22 and 22 are affected by the diseased part. And the tightening of the first clip 12A by the tightening ring 40 at the tip of the connecting ring 14A is completed.

  At the same time, the engaging portion between the first clip 12A and the next second clip 12B comes out from the rear ends of the extending portions 44, 44 of the connecting ring 14A. When the engaging portion of the first clip 12A and the second clip 12B is disengaged from the extension portions 44, 44 of the connecting ring 14A, the arm portion 28 is expanded by the spring force of the second clip 12B until it hits the inner wall of the sheath 16, and the claw The space between the portions 22 and 22 is wider than the width of the turn portion 24 of the first clip 12A, and the connection between the first clip 12A and the second clip 12B is released. As a result, as shown in FIG. 15 (F), the first clip 12A and the connection ring 14A can be detached from the sheath 16, and the clip of the disease site by the tightening ring 40 at the tip of the first clip 12A and the connection ring 14A. Treatment is complete.

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

  When the clip treatment by the first clip 12A and the connecting ring 14A is completed, the slider 54 is moved to the home position as shown in FIG. That is, the slider pin 70 is moved to the position P7 in FIG. As a result, as shown in FIG. 15G, the clip 12B and the clip 12C are drawn into the sheath 16.

  The movement of the slider pin 70 from the standard protruding position P5 'to the home position P7 via the clip completion position P6 may be performed by a series of operations. Further, for example, if the first clip 12A at the head is firmly held at the maximum protruding position and there is no possibility of dropping (very low), the slider 54 is once moved from the maximum protruding position to the standard protruding position. The clip treatment may be performed by pulling back the slider 54 at a stroke from the maximum projecting position to the home position without performing the returning operation.

  Next, as shown in FIG. 13H, the slider guide 56 is rotated by 90 ° so that the slider guide groove 66C of the slider guide 56 overlaps the groove 68. Thereby, the slider pin 70 is moved to the home position (position P8 in FIG. 14) on the extension line of the slider guide groove 66C.

  Hereinafter, the clip treatment is also performed on the second clip 12B and the third clip 12C by the same operation as the first clip 12A.

  First, as shown in FIG. 13I, the slider 54 is moved to the end of the slider guide groove 66C on the sheath 16 side (that is, the maximum projecting position) (that is, the slider pin 70 is moved to the position P9 in FIG. 14). As shown in FIG. 15H, the second clip 12B is protruded from the distal end of the sheath 16, and the skirt portion 38 of the second clip 12B is opened.

  Next, the slider 54 is moved to the finger ring 62 side by a predetermined distance, specifically, to the standard protruding position (that is, the slider pin 70 is moved to the position P9 ′ in FIG. 14), and FIG. As shown, the skirt portion 38 of the second clip 12B is brought into contact with the distal end of the sheath 16.

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

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

  Thereafter, as shown in FIG. 13L, the slider guide 56 is rotated 90 ° so that the slider guide groove 66D of the slider guide 56 overlaps the groove 68. As a result, the slider pin 70 is moved to the home position (position P12 in FIG. 14) on the extension line of the slider guide groove 66D.

  Next, as shown in FIG. 13M, the slider 54 is moved to the end of the slider guide groove 66D on the sheath 16 side (that is, the maximum protruding position) (that is, the slider pin 70 is moved to the position P13 in FIG. 14). 15C, the third clip 12C is projected from the tip of the sheath 16, and the skirt portion 38 of the third clip 12C is opened as shown in FIG.

  Thereafter, the slider 54 is moved to the finger ring 62 side by a predetermined distance, specifically, to the standard protruding position (that is, the slider pin 70 is moved to the position P13 ′ in FIG. 14), as shown in FIG. Then, the skirt portion 38 of the third clip 12C is brought into contact with the distal end of the sheath 16.

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

  When the clip treatment by the tightening ring 40 at the tip of the third clip 12C and the connection ring 14C is completed, the slider 54 is moved to the home position as shown in FIG. That is, the slider pin 70 is moved to the position P15 in FIG. Thereby, as shown in FIG. 15 (O), the dummy clip 18 is pulled into the sheath 16.

  Thereafter, as shown in FIG. 13 (P), the slider guide 56 is rotated by 90 ° so that the slider guide groove 66 A of the slider guide 56 overlaps the groove 68. As a result, the slider pin 70 is moved to the home position (position P16 in FIG. 13) on the extension line of the slider guide groove 66A.

Thereafter, the sheath 16 is extracted from the endoscope.
Further, after the sheath 16 is extracted, the slider 54 is moved to the end of the slider guide groove 66A on the sheath 16 side (that is, the slider pin 70 is moved to P2 in FIG. 14), and the state shown in FIG. As described above, the connecting member 21, the dummy clip 18, and the connecting member 19 are projected from the distal end of the sheath 16.
Thereafter, when the process is ended, the dummy clip 18 and the connecting member 19 are removed, and the slider 54 is moved to the home position.
When performing clip treatment with another clip, after removing the dummy clip 18 and the connecting member 19, the connecting member 19 of the dummy clip 18 to which the other three clips 12 are connected is attached to the connecting member 21. Repeat the process.
The clip treatment tool 10 is used for the clip treatment of the affected part as described above.

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

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

  Next, the operation amount of the operation wire 20 required for the clip treatment and the forms of the slider guide grooves 66A to 66D corresponding to the different types of the clip 12 will be described.

  FIGS. 16A to 16C are cross-sectional views of the distal end portion of the sheath 16 showing three types of clips having different lengths and a state when each clip is loaded on the sheath 16 of the clip treatment device 10. is there. 16A shows a short type clip 12a, FIG. 16B shows a middle type clip 12b, and FIG. 16C shows a long type clip 12c.

Each type of clip 12 (12a, 12b, 12c), as shown in FIG. 16 (A) ~ (C) , a clip stroke _C S, is _{C M,} and _{C L} the same, the slide stroke _S S, S _M and S _L are different from the protruding amount of the first to third clips 12 (T _{X1 to} T _X3 : X is S, M, or L. The same applies hereinafter). Here, the clip stroke refers to the connection between the subsequent clip 12 and the previous clip 12 by closing the arm portion and gripping the target portion from the state where the arm portion is most expanded at the distal end portion of the sheath 16. The stroke until it is released. The slide stroke is the length of one clip 12, the length for projecting the first clip 12 from the distal end of the sheath 16 (hereinafter referred to as the first projecting amount), 2 This is the difference from the length (hereinafter referred to as the second projecting amount) for projecting the first clip 12 from the distal end of the sheath 16. That is, the first protrusion amount plus the slide stroke is the second protrusion amount. The protruding amount of the clip 12 is the amount of movement of the clip 12 from the position of the clip 12 when the slider 54 is in the home position until the clip treatment is possible at the distal end portion of the sheath 16. .

  Compared with the middle-type clip 12b, the long-type clip 12c has a long overall length, so that the slide stroke is long and the protrusion amount is short. Compared with the middle type clip 12b, the short type clip 12a has a short overall length, so that the slide stroke is short and the protrusion amount is long.

Further, as an example of the protrusion amount of each type, the protrusion amounts T _S1 , T _S2 , and T _S3 of the short type clip 12 are the same as those of the top clip 12 when the clip 12 is housed three times from the tip of the sheath 16. If the length to the tip and X _S, can be expressed as the following equation (2) to (4). (See Fig. 4 (A))

T _S1 = X _S + L + b _S + C _S + Y _S + Z _S (2)
T _S2 = X _S + T _S1 + S _S (3)
T _S3 = X _S + T _S1 + 2S _S (4)

The protruding amount T _M1 , T _M2 , and T _{M3 of the} middle type and long type clip 12 and T _L1 , T _L2 , and T _L3 also housed three clips 12 from the tip of the sheath 16 in the same manner as the short type. when the head of the clip 12 to the tip length, respectively, and _X M, _{X L} of the case, can be expressed as the following equation (5) to (7) and (8) to (10). (See FIGS. 4B and 4C)

T _M1 = X _M + L + b _M + C _M + Y _M + Z _M (5)
T _M2 = X _M + T _M1 + _SM (6)
T _M3 = X _M + T _M1 + 2S _M (7)
_{T L1 = X L + L +} b L + C L + Y L + Z L (8)
T _L2 = X _L + T _L1 + S _L (9)
T _L3 = X _L + T _L1 + 2S _L (10)

  Here, C, Y, and Z are the relationships of the following formulas (11) to (13).

_CS = _CM = _CL (11)
Y _S = Y _M = Y _L (12)
Z _S = Z _M = Z _L (13)

17A to 17C show slider guides 56α, 56β, and 56γ corresponding to the respective types of clips 12a, 12b, and 12c, in which the lengths of the slider guide grooves 66B, 66C, and 66D shown in FIG. 14 are different. . In these drawings, reference numerals such as P1 indicating the position of the slider pin 70 are the same as those in the example of FIG. The slider guide groove 66A has the same length for each type since it is a position for attaching and detaching the clip, and has a length that allows a predetermined number of the longest type of clips 12 to be attached and detached.
The slider guide grooves 66B, 66C, and 66D of the slider guide 56 have a length corresponding to each size (short, middle, long) of the clip 12, and when the short type clip 12a is used, FIG. When the middle type clip 12b is used, the middle type slider guide 56β shown in FIG. 17B is used, and when the long type clip 12c is used, the short type slider guide 56α shown in FIG. 17C is used. The long type slider guide 56γ shown in FIG.

Each type of slider guide groove 66B, 66C and 66D has a length corresponding to each slide stroke (S _S , S _M , S _L ) and protrusion amount (T _S , T _M , T _L ). Simply by moving the slider 54 along each slider guide groove 66B, 66C and 66D regardless of the size of the clip 12, that is, by the same operation regardless of the size of the clip 12, the clip 12 can be easily clipped with each size. It can be performed.
Further, since each type of slider guide 56 (56α, 56β, 56γ) can be replaced by replacing a slider guide attaching / detaching portion 76 described later, the clip 12 of each size can be easily clipped with one operating handle 48. Treatment can be performed.

Next, a method for replacing the slider guide attaching / detaching portion 76 of the slider guide 56 will be described.
18A to 18F are explanatory views showing a method of exchanging the slider guide attaching / detaching portion 76 that can be used in the operation handle of the present invention and the clip treatment instrument of the present invention.
FIG. 18A is a cross-sectional view in use. In this state, the slider guide attaching / detaching portion 76 is inserted into the slider 54, and the slider guide attaching / detaching portion 76 cannot be removed.

  First, as shown in FIG. 18 (B), the slider 54 is moved along the axial direction of the handle main body 52 toward the proximal end side of the operation portion 50 until it hits the stopper portion 78a of the slider stopper 78 (in the direction of arrow J in the figure). ). Here, the end portion on the distal end side of the slider 54 and the end portion on the proximal end side of the slider guide attaching / detaching portion 76 are substantially at the same position. This position is the same as the home position at the time of clip treatment, that is, the maximum retracted position at the time of clip loading. Even when the slider 54 is configured to move from the base end side of the slider guide attaching / detaching portion 76 to the base end side of the operation unit 50, the slider 54 is held by the base end portion 52 c of the handle body 52. The center in the axial direction of the slider 54 and the center in the axial direction of the handle body 52 are substantially the same, and the center of the slider 54 can be prevented from being displaced from the center of the handle body 52 and being caught by the slider guide attaching / detaching portion 76.

Next, when the slider stopper 78 is pressed in the direction of arrow K in FIG. 18C, the stopper portion 78 a that has been in contact with the slider 54 is accommodated inside the proximal end portion 52 c of the handle body 52, thereby causing the slider 54. Can move further to the base end side (arrow J direction) of the operation unit 50.
As shown in FIG. 18C, the slider 54 can move until the slider pin 70 comes into contact with the terminal end of the proximal end of the groove 68 of the handle body 52. At this time, the length β between the end on the proximal end side of the slider guide attaching / detaching portion 76 and the end on the distal end side of the slider 54 becomes a margin for retreating when the slider guide attaching / detaching portion 76 is attached / detached. Further, the length α in which the distal end side of the slider guide attaching / detaching portion 76 is fitted into the slider guide base portion 72 is an allowance between the slider guide attaching / detaching portion 76 and the slider guide base portion 72, and α and β satisfy α <β. It becomes a relationship.

  Next, as shown in FIG. 18D, when the button 74a of the slider guide locking portion 74 provided on the slider guide base 72 is pressed, the claw 74b is attached to and detached from the slider guide as shown in FIG. The convex part 76c of the part 76 is pushed down, and the engagement between the concave part 74c of the slider guide locking part 74 and the convex part 76c of the slider guide attaching / detaching part 76 is released. Then, the slider guide attaching / detaching portion 76 can freely advance and retreat in the axial direction of the operation portion 50, and as shown in FIG. 18 (F), the slider guide attaching / detaching portion 76 is moved to the base end side (the direction of arrow L in the drawing). It can be moved.

  Next, the slider guide attaching / detaching portion 76 is moved to the proximal end side of the operation portion 50 until it comes into contact with the surface 52d of the proximal end portion 52c of the handle main body 52. Then, the front end side of the slider guide attaching / detaching portion 76 fitted in the slider guide base 72 is disengaged from the slider guide base 72. Thereby, as shown in FIG. 18G, the slider guide attaching / detaching portion 76 can be detached from the handle body 52 by being divided into the divided pieces 76a and the divided pieces 76b.

Next, in order to attach the slider guide attaching / detaching portion 76 corresponding to the clip 12 of a new size to be used, new divided pieces 76a and 76b are put on the handle main body 52, and the engaging pin 84 of the new divided piece 76a is newly added. Engage with the engagement hole 86 of the split piece 76b.
The circumferential position of the handle body 52 is aligned so that the convex portion 76c of the slider guide attaching / detaching portion 76 engages with the concave portion 74c of the slider guide engaging portion 74, that is, the convex portion 76c of the slider guide attaching / detaching portion 76 is the slider guide. The position of the slider guide attaching / detaching portion 76 is aligned so that it is on the same straight line as the button 74 a of the locking portion 74, and the slider guide attaching / detaching portion 76 is moved to the distal end side of the operation portion 50 and fitted into the slider guide base 72. . Then, the convex portion 76 c of the slider guide attaching / detaching portion 76 engages with the concave portion 74 c of the slider guide engaging portion 74, and the slider guide attaching / detaching portion 76 is fixed to the slider guide base 72 in the axial direction and the circumferential direction of the handle body 52. The

  Next, when the slider 54 is moved to the distal end side of the handle main body 52, the stopper portion 78a of the slide stopper 78 stored in the proximal end portion 52c of the handle 52 by the slider 54 is moved to the proximal end portion by the biasing spring 78b. A part protrudes out of 52c. Then, the position of the proximal end side of the operation portion 50 of the slider 54 is defined by the stopper portion 78a. This position is a home position at the time of clip treatment, that is, a maximum pull-in position at the time of clip loading. After that, a new size clip 12 corresponding to a new slider guide attaching / detaching portion 76 can be loaded and treated.

  The slider guide attaching / detaching portion 76 preferably has the same color as each size clip and clip case by using a colored resin. The clip case is a case in which a new clip is stored. When the operator uses a new clip, the clip case 10 is loaded with a new clip from the clip case.

  The slider guide attaching / detaching portion 76 preferably does not change the color of the slider guide attaching / detaching portion 76 as a whole, but is preferably provided with a marking portion 88 as shown in FIG. The marking portion 88 is applied to the slider guide attaching / detaching portion 76 by labeling or printing. For example, the marking portion 88 can have the same color as the clip 12 and the clip case of each size. Further, the slider guide attaching / detaching portion 76 has the same clip size (the same arm length) among the clips 12 of the respective sizes, but the same one can be used for the clips 12 having different angles at the claw tip of the clip 12 (FIG. 19 ( As shown in B), it is also preferable to display a plurality of colors such as a color indicating the angle of the nail tip on the marking portion 88. Further, the marking unit 88 may display not only coloring but also characters, symbols, barcodes, two-dimensional codes, and the like.

  Here, Table 1 shows an example of the correspondence between the slider guide attaching / detaching portion 76 and the color of the clip case storing the clip 12.

In the example of Table 1, the long size clip 12 has both the clip case and the slider guide attaching / detaching portion 76 in blue, the middle size clip 12 has both the clip case and the slider guide attaching / detaching portion 76 in yellow, and the short size clip 12 has the clip case. The slider guide attaching / detaching portion 76 is both white or transparent. In addition to changing the color of the entire slider guide attaching / detaching portion 76, the color of the marking portion 88 may be changed (see FIG. 19A).
Thereby, the slider guide attaching / detaching portion 76 and the clip case can be easily identified, and the wrong type of the clip 12 to be used can be prevented. For example, when using the long type clip 12, the clip size can be easily identified by using the blue slider guide attaching / detaching portion 76 or the slider guide attaching / detaching portion 76 having the blue marking portion 88 and the blue clip case. can do.

  Table 2 shows another example of the correspondence between the color of the slider guide attaching / detaching portion 76 and the clip case storing the clip 12.

  In the example of Table 2, in addition to the example of Table 1, there are two types of angles of the claw tip of the clip 12. In the middle size and short size clip 12, there are two types of clip 12 with claw tip angles of 90 ° and 135 °. The clip case and the slider guide attaching / detaching portion 76 are respectively provided with a middle size and claw tip angle. When the angle is 135 °, it is pink, and when the nail tip angle is 135 °, it is green. Here, the slider guide attaching / detaching portion 76 does not need to be used properly depending on the difference in the claw tip angle. In the case of the middle-sized clip 12, the same slider guide attaching / detaching portion 76 is provided at the claw tip angle of 90 ° and 135 °. Can be used. Therefore, as shown in FIG. 19 (B), two marking portions 88 are provided on the slider guide attaching / detaching portion 76 and yellow and pink are displayed, so that the clip 12 with any nail tip angle can be used. Can be identified.

  In the case of the short size, similarly to the middle size, by displaying white (or transparent) and green, it is possible to identify that the clip 12 at any nail tip angle can be used. In the example of Table 2, since the long type clip 12 is one type having a claw tip angle of 90 °, the marking portion 88 may display blue as in the case of the clip 12 of other sizes, and the slider guide The entire detachable portion 76 may be colored blue.

  In the above-mentioned clip treatment tool, the distance from the maximum protruding position of the slider guide groove to the standard protruding position is used as a buffer for the dimensional variation of the component parts and the difference between the inner and outer circumferences of the wire and sheath. The skirt portion of the slider guide groove is open, but the area from the maximum projecting position of the slider guide groove to the standard projecting position is shown in FIG. 20, as shown in FIG. 20, in the slider rotation direction as shown in slider guide grooves 82A, 82B, 82C, and 82D. It may be curved. In this case, the slider stops once at the standard protruding position. When the endoscopic image shown on the monitor is confirmed and the skirt portion 38 of the clip 12 is not open, the clip 54 is further moved by moving the slider 54 to the maximum projecting position while twisting. The skirt portion 38 can be opened by extruding.

Further, in the slider guide 80 of FIG. 20, the slide guide groove has a shape curved in the rotational direction from the standard protruding position to the maximum protruding position. However, the present invention is not limited to this, and the slider guide groove is formed from the maximum protruding position. The length from the end on the home position side to the maximum protruding position may be a straight line, and the shape may be curved in the rotational direction first from the maximum protruding position.
In this case, even if the slider is moved to the maximum projecting position due to the deformation of the operation wire exceeding the error range or the clip not moving the sheath for some reason, the skirt of the clip is still at the tip of the sheath. If it does not protrude further, the slide may be moved from the maximum protruding position to a portion curved in the previous rotational direction, and the skirt portion of the clip may protrude beyond the distal end of the sheath.
As described above, by providing the groove curved in the rotational direction before the maximum projecting position, it is possible to cope with an unexpected situation. In addition, by bending in the rotational direction before the maximum projecting position, the slider can be easily adjusted so as not to move before the maximum projecting position during normal use.

  Further, in the clip treatment instrument 10 described above, the slider guide groove is provided in the slider guide. However, the present invention is not limited to this, and as shown in FIG. A step corresponding to the protruding position may be formed.

  As shown in the slider guide 90 of FIG. 21, instead of the slider guide groove, sides 92A, 92B, 92C, and 92D are formed at positions corresponding to the slider guide groove to form a staircase shape. Even if 94A, 94B, 94C, and 94D are provided, the slider pin 90 in the central axis direction of the handle body 52 is switched by rotating the slider guide 90 and switching the step and the side that overlap the groove 68 of the handle body 52. In other words, the movement limit position of the slider pin 70 can be set for each side (step) of the slider guide 90, and the clip 12 can be set in the same manner as the slider guide grooves of the slider guides 56 and 80. The position of the slider 54 can be regulated correspondingly, and the clip 12 jumps out of the sheath 16 It is possible to prevent the Gil.

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

Further, in the above-described clip treatment instrument 10, in order to improve the operability, for example, the position regulating member 58 and the contact surface thereof are tapered and stepped between the slider guide 56 and the handle main body 52. Although a position restriction mechanism such as an unevenness is provided so that one of the slider guide grooves (66A to 66D) and the groove 68 of the handle body 52 overlap appropriately, the present invention is not limited to this, and the position restriction member, The position restriction mechanism is not necessarily provided. In this case, however, the operator needs to overlap one of the slider guide grooves with the groove 68 of the handle body 52.
Further, in the clip treatment tool 10 of the illustrated example, in order to prevent erroneous operation more reliably, the slider guide is rotated only in one direction by the position regulating member 58, but the present invention is not limited to this, You may make it rotate in both directions.

In the above embodiment, the position restricting member and the position restricting mechanism have the function of restricting both the stop position of the slider guide and the rotation direction of the slider guide. However, only one of the functions is provided. May be.
For example, when the position restriction member has only a function of restricting the rotation direction of the slider guide in one direction as the position restriction mechanism, the position restriction member and the slider guide are not affected regardless of the position of the slider guide groove. The contact surface may have a structure in which a plurality of serrated irregularities are formed in the circumferential direction (that is, a ratchet structure).

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

In the above-described embodiment, the case of three types of clips having different total lengths and expansion amounts at the start of treatment has been described. However, only either the total length or the expansion amount at the start of treatment may be different. The types of clips may be a clip set in which two or more types of clips differing in one or more of the total length and the amount of expansion at the start of treatment.
Further, the plurality of types of clip bodies may be used not only for the continuous clip treatment tool but also for the single shot clip treatment tool.

  As described above, the continuous clip treatment device according to the present invention has been described in detail, but the present invention is not limited to the above-described embodiments, examples, and modifications, and in a range not departing from the gist of the present invention. Various improvements and changes may be made.

  For example, in the clip treatment instrument 10 described above, since three clips 12 are loaded in one sheath and clipping is performed three times, four slider guide grooves (three grooves and clips corresponding to each clip 12) are used. However, the present invention is not limited to this, and the number of slider guides is equal to the number corresponding to the number of clips to be loaded plus one for loading clips. The grooves may be formed in the circumferential direction, and the slider guide may be rotated so as to correspond to the position of each groove.

DESCRIPTION OF SYMBOLS 10 Clip treatment tool 12 Clip 13 Clip row 14 Connection ring 15 Clip body 16 Sheath 18 Dummy clip 19 Connection member 20 Operation wire 21 Connection member (hook)
22 Claw part 24 Turn part 26 Intersection part 28 Arm part 30 Convex part 31 Notch 32 1st area | region 34 2nd area | region (connection holding | maintenance area | region)
36 notch 38 skirt portion 40 tightening ring 41, 43 hole 42 holding portion 43a groove 44 extension portion 46 slit 48 operation handle 50 operation portion 52 handle body 54 slider 56, 80, 90 slider guide 56a, 58a joint portion 56b large diameter portion 57a, 59a Convex part 57b, 59b Concave part 58 Position regulating member 60 Energizing spring 62 Finger ring 64 Reinforcement pipe 66A, 66B, 66C, 66D, 82A, 82B, 82C, 82D Slider guide groove 68 Groove 70 Slider pin 72 Slider guide base part 74 Slider guide latching part 74a Button 74b Claw 74c Recess 76 Slider guide attaching / detaching part 76a, 76b Split piece 76c Protruding part 78 Slider stopper 78a Stopper part 78b Energizing spring 84 Engaging pin 86 Engaging hole 88 Marking part 92A, 92B, 92C, 92D Side 94A, 94B, 94C, 94D Step

Claims (12)

A cylindrical sheath;
Multiple types of clips of different sizes for gripping the living body,
A connecting ring for fastening the clip;
An operation wire disposed inside the sheath and connected to a plurality of the clips at the tip;
A cylindrical handle body connected to the sheath and having the operation wire extending from the sheath disposed therein;
A slider that is mounted on the outer periphery of the handle body so as to be movable in the axial direction, engages with the operation wire, and moves the operation wire in the axial direction of the handle body;
A plurality of sliders are mounted on the outer periphery of the handle body so as to be rotatable in the circumferential direction of the handle body, and the amount of movement of the slider in the axial direction of the handle body is coupled to the operation wire according to the circumferential position. A slider movement amount regulating member that regulates a plurality of different movement amounts required for the clip treatment of each of the clips,
The clip connected to the operation wire is moved in the same direction by moving the slider in the axial direction of the handle body and moving the operation wire arranged in the sheath in the extending direction of the sheath. It is a repetitive clip treatment tool that moves the body to treat the living body,
One clip body is composed of one clip and one connection ring,
The plurality of types of clip bodies are composed of a plurality of types of clips having different sizes and the same connection ring,
The plurality of types of clips having different sizes are different in the amount of expansion of the clip at the start of treatment of the living body,
The treatment of the treatment section of the living body is performed using the clip body composed of the clip having a clip size corresponding to the size of the treatment section of the living body from the plurality of types of the clip bodies. Type clip treatment tool.   The repetitive clip treatment tool according to claim 1, wherein a clip stroke for fastening the plurality of types of the clips is constant regardless of the type of the clips.   The said clip has at least a nail | claw part and an arm part, and has a convex part in an arm part, The continuous-type clip treatment tool of Claim 1 or 2 characterized by the above-mentioned.   The continuous clip treatment device according to claim 3, wherein the length of the convex portion is changed to change the overall length of the clip.   5. The continuous clip treatment tool according to claim 3, wherein the amount of expansion of the clip at the start of processing of the living body is changed by changing the length of the convex portion.   A plurality of types of slider movement amount regulating members having different amounts of movement of the slider to be regulated are prepared according to the type of the clip, and a part or all of them can be replaced. Item 6. The continuous clip treatment device according to any one of Items 1 to 5. The slider movement amount regulating member is detachably attached to the handle body by being detachably attached to the cylindrical slider guide base fitted to the handle body and the slider guide base, and the axial direction A cylindrical shape having at least one of a plurality of position restricting grooves having different positions on the sheath side and a plurality of position restricting steps having different positions on the sides respectively formed according to the plurality of different movement amounts. The slider guide attachment / detachment part
The continuous clip treatment device according to any one of claims 1 to 6, wherein the slider guide attaching / detaching portion is replaceable according to the type of the clip. The slider has an engaging portion that engages with at least one of the position restricting step and the position restricting groove,
The continuous clip treatment tool according to claim 7, wherein the movement amount of the slider is restricted to the plurality of different movement amounts by the position restriction step or the position restriction groove engaged with the engagement portion of the slider. The slider is mounted on the outer periphery of the slider movement amount regulating member so as to be movable in the axial direction thereof,
The other end of the plurality of position restricting grooves on the base end side of the slider guide attaching / detaching portion is open,
The plurality of position restricting grooves or the plurality of position restricting steps are formed along the circumferential direction from the base end side of the slider movement amount restricting member, and each of the position restricting grooves from the position of the end portion on the base end side. The repetitive clip treatment tool according to claim 7 or 8, which is formed in a step shape so that the groove depth to the position of the tip portion and the distance to the side position are different.   The base end side of the connection ring is partially extended to prevent the clip and the connection ring from falling off from the distal end of the sheath during clip treatment. Continuous clip treatment tool. Used in a clip treatment tool for performing a treatment of a living body, and an operation wire disposed in the sheath is moved in the extending direction of the sheath by an operation handle, and is accommodated in the sheath, and the operation wire A clip set having a plurality of types of clips for gripping a living body, which are connected to each other and moved in the same direction,
The plurality of types of clips differ in one or more of the total length of the clip and the amount of expansion of the clip at the start of treatment of the living body, and all of the clips are used to perform treatment of the treatment section of the living body. A clip set for fastening, wherein a clip stroke for moving the operation wire by the operation handle is constant. The plurality of types of clips are configured as the same connecting ring and a plurality of types of clip bodies, respectively.
The clip treatment tool performs treatment of the treatment section of the living body using the clip body including the clip having a size corresponding to the size of the treatment section of the living body from the plurality of types of the clip bodies. A clip set characterized by that.