JP2010264110A - Clip package and clip loading method - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a clip package having a simple configuration and allowing a user to take out a plurality of clips easily, and also to provide a clip loading method allowing a user to take out a plurality of clips easily. <P>SOLUTION: The clip package includes a clip body including clips for pinching objects by means of claw portions and cylindrical connection rings fitted to the clips so as to advance and retreat, and a tubular case that receives a clip row including a plurality of clips wherein the front end of a rear clip is connected to the rear end of a front clip and a connection member connected to the rearmost clip. The connection ring has a skirt portion that projects outward while centering its body as a rotary axis during a natural condition and closes when pressed inward. The case has openings at positions corresponding to the skirt portions of the connection rings of the received clip body so as to keep the skirt portions in the natural condition. When the clip row is rotated by a predetermined angle, the skirt portions close to the position of the inner surface of the case. <P>COPYRIGHT: (C)2011,JPO&INPIT

Description

  The present invention relates to a clip package for distribution and storage of an endoscopic treatment clip used for occlusion of an affected part such as hemostasis or a wound in a living body, and a clip loading method for an endoscopic treatment clip, in particular, Clip package containing a plurality of endoscopic treatment clips used in a repetitive clip treatment instrument in which a plurality of endoscopic treatment clips are continuously used, and a sheath of the repetitive clip treatment instrument from the clip package The present invention relates to a clip loading method of an endoscope clip.

  Endoscopic clip treatment tool projects the clip from the tip of the endoscope inserted into the living body, picks the treatment part after removing the bleeding part or lesion tissue, and blocks the affected part such as hemostasis or wound It is used to perform etc. The conventional clip treatment tool has a clip with an open tip and a fastening part for closing and fastening the clip, and the clip is closed by advancing the fastening part with respect to the opened clip. It has become.

  For example, in Patent Document 1, a clip clamping ring is attached to a rear end portion of a clip, and the clip is pulled into the clip clamping ring to hold the clip leading end portion. The structure which closes a part and hold | grips a biological tissue is described. When the clip is pushed out from the tip of the introduction tube (sheath), the clip clamping ring of Patent Document 1 is pushed out together. This clip tightening ring has two blades that can be protruded and retracted. If the clip passes through the tip attached to the tip of the introduction tube, the blade protrudes, and even if the clip is pulled after that, the clip tightening ring The ring does not retract into the inlet tube. By pulling the clip in this state, the clip is tightened by the clip tightening ring. Thereafter, the clip clamping ring is placed in the body cavity together with the clip.

However, the clip treatment device conventionally used including the clip device described in Patent Document 1 has only one clip attached to the tip of the operation wire, and every time a clip treatment is performed. The cumbersome operation | work which pulls out the whole sheath from an endoscope, sets a next clip in a sheath, inserts a sheath in an endoscope again, and performs the next clip treatment is needed.
On the other hand, an endoscope clip device that enables continuous clip treatment has been proposed. For example, in Patent Document 2, a plurality of clips are alternately turned by 90 ° by engaging a front end claw portion of a rear clip with a connecting hole formed in a rear end portion of a front clip. An endoscope clip device is described which is adapted to be directly connected.

Further, in the clip device described in Patent Document 1 and the conventional clip treatment instrument, the clip is usually stored in the clip case at the time of storage or distribution, and taken out from the clip case at the time of use, and the clip It is connected to an operation wire for clip operation that is disposed so as to be able to advance and retract within the sheath of the treatment instrument, and is loaded into the sheath. After this, insert the sheath of the clip treatment instrument into the endoscope inserted in the living body, position the sheath at the distal end of the endoscope, project the clip from the distal end, and remove the bleeding part and lesion tissue It is used for hemostasis of the treatment section of the patient and obstruction of the wound.
For this reason, it is easy to connect the clip housed in the clip case and the operation wire disposed in the sheath of the clip treatment instrument, and the clip in the clip case can be loaded into the sheath of the clip treatment instrument. An easy clip case has been proposed.
For example, Patent Document 3 discloses that a clip and a presser tube (clamping ring) that closes the clip by being fitted to the clip, and that can be inserted into the presser tube and engaged with the clip, on the opposite side of the clip side. There has been proposed a clip case that houses a clip unit composed of a connecting member having an arrowhead hook at an end.

The clip case proposed in Patent Document 3 is a plate-like member, and a storage portion that stores the clip unit in a state in which the protruding portion of the pressing tube of the connecting material protrudes, and an arrowhead hook of the connecting member of the clip unit in the storage portion. Large diameter holes larger than the outer diameter of the coil pipe of the clip operating device on the outer peripheral surface of the facing surface, communicated with the large diameter hole, smaller than the inner diameter of the coil pipe formed on the surface on the storage unit side, A small diameter portion larger than the outer shape is formed. The clip case has an inclined portion formed between the storage portion and the small diameter portion.
Further, in Patent Document 3, by providing an inclined portion between the storage portion and the small diameter portion, when the clip unit is pulled out from the clip case, the protruding portion of the pressing tube can be reduced. It is described that it can be smoothly accommodated in the coil pipe and coil sheath of the sheath part.

Japanese Patent Laid-Open No. 2002-272751 JP 2006-187391 A JP 2007-222649 A

By the way, as described above, the clip device described in Patent Document 1, and the conventionally used clip treatment tools, remove the clip stored in the clip case every time a clip treatment is performed. However, since the clip, the connection ring, and the like are small members, there is a problem that this connection operation is a complicated manual operation.
For this reason, Patent Document 3 proposes a clip case that can easily perform such a connecting operation, and this clip case has a protruding portion of a clip holding tube on an inclined portion near the outlet of the clip case. The projecting part is housed inside the holding tube by butting, but the direction of inclination of the projecting part and the direction of inclination of the inclining part with respect to the direction parallel to the moving direction of the clip are reversed. There is a problem that the protrusion (part) (skirt) may be loaded and the protrusion may be damaged.

  By the way, according to the clip apparatus of patent document 2, a continuous clip treatment can be performed. However, in the above clip device, the clip connection is maintained only by the engagement of the front and rear clips, and the connecting portion is exposed in the sheath. For this reason, the connection state is unstable, and when inserted into the endoscope, it may come off when passing through the curved part, or an excessive force is applied to the connection part, causing the clip before use to be distorted or distorted. There was a problem that it might end.

In Patent Document 2, a clip case for storing a plurality of connecting clips used in a clip device, and how to connect a plurality of connecting clips stored in a clip case to an operation wire of the clip device, Since how to load a plurality of connected connecting clips into the sheath is not disclosed at all, as in the case of the single clip described above, a complicated manual operation is required. Since the clips are connected, there is a problem that the manual operation becomes more complicated.
For this reason, even if it is going to apply the clip case of patent documents 3 as a clip case which stores a plurality of connection clips, the clip treatment instrument indicated by patent documents 3 uses only one clip, and patent documents Since the clip case described in 3 stores only one clip, there is a problem that it is difficult to maintain the connection between the clips even if a plurality of connection clips are stored with the same structure. .

  An object of the present invention is to provide a clip package that eliminates the problems based on the conventional technology, has a simple configuration, and can easily take out a plurality of clips. Another object of the present invention is to provide a clip loading method capable of easily taking out a plurality of clips.

  In order to achieve the above object, according to a first aspect of the present invention, a clip is provided in which two arm portions each having a claw portion are provided at a base end portion, and the arm portion is closed and an object is sandwiched between the claw portions. A clip body having a connecting ring that is inserted into the clip so as to be able to move forward and backward, and an inner diameter slightly larger than an outer diameter of the connecting ring, and a rear clip at a proximal end portion of the clip of the previous clip body A clip row comprising a plurality of clip bodies connected to each other by covering the claws of the body clip and covered by the connecting ring, and a connecting member connected to the last clip body. And the connecting ring projects in a radially outward direction with its body as a rotation shaft and presses inward in the radial direction in a natural state where no external force is applied. Closes inward The case has a cart portion, the case has an opening for maintaining the skirt portion in a natural state at a position corresponding to the skirt portion of the coupling ring of the clip body accommodated, and the clip row is The clip body is housed in the case with the skirt portion of the clip body projecting from the opening, and the skirt portion of the case is rotated when the case and the clip row are relatively rotated by a predetermined angle. The present invention provides a clip package which is pressed on the inner surface and closes inward to the position of the inner surface of the case.

In the present invention, the skirt portion is formed by cutting the peripheral surface of the connecting ring into a substantially U shape, leaving an end extending in the axial direction, and the skirt portion extends around the end side. It is preferable to rotate as a moving shaft and spread outward in the radial direction or close inward.
In the present invention, it is preferable that the clips in the clip row are connected by alternately changing the direction in which the arms are closed by 90 °.
Furthermore, in the present invention, it is preferable that the surface of the opening of the case aligns with a side extending in the axial direction of the connection ring of the skirt portion, and is configured by an inclined surface.

  According to a second aspect of the present invention, there are provided two arm portions each having a claw portion formed at a base end portion thereof, the arm portion is closed and an object is sandwiched between the claw portions, and a forward and backward movement with respect to the clip. A clip including a connecting ring that can be inserted, and a connecting member that has one end engaged with the base end of the clip and the other end clamped by a claw of the other clip to connect a plurality of clips. A clip body having an inner diameter slightly larger than the outer diameter of the body and the connecting ring. A cylindrical case that houses therein a plurality of clip bodies that are connected with their end portions sandwiched, and a clip row that includes another connection member that is connected to a connection member of the last clip body; The connection ring is naturally free of external force In this state, the body has a skirt portion that extends outward in the radial direction with the body as a rotation axis, and closes inward when pressed inward in the radial direction, and the clip row has the opening in the opening portion. The skirt portion of the clip body is housed in the case in a protruding state, and when the case and the clip body are relatively rotated by a predetermined angle, the skirt portion is pressed by the inner surface of the case. The clip package is characterized in that it closes inward to the position of the inner surface of the case.

  In the present invention, the skirt portion is formed by cutting the peripheral surface of the connecting ring into a substantially U shape, leaving an end extending in the axial direction, and the skirt portion rotates around the end side. It is preferable to rotate as a moving shaft and spread outward in the radial direction or close inward.

Moreover, in this invention, it is preferable that each clip of the said clip row | line | column is connected so that the closing direction of the said arm part may correspond.
Furthermore, in the present invention, it is preferable that the surface of the opening of the case aligns with a side extending in the axial direction of the connection ring of the skirt portion, and is configured by an inclined surface.
Furthermore, in this invention, it is preferable that the said case has a fitting part which the sheath which loads the said clip and the said connection ring fits in a rear-end part.
Furthermore, in the present invention, it is preferable that the case and the clip body are rotated by 90 ° relative to each other.

According to a third aspect of the present invention, there is provided a clip loading method for loading the clip body of the clip package of the first aspect or the second aspect into a sheath of an endoscopic clip treatment instrument, A step of connecting a distal end of an operation wire for pulling the clip row disposed on the connecting member attached to the last clip in the case; and a distal end of the sheath and a rear end of the case A step of rotating the operation wire by a predetermined angle, rotating the clip row by a predetermined angle, closing the skirt portion to a position of the inner surface of the case, and a tip of the operation wire. And a step of storing the clip row in the sheath by moving in a direction of moving toward the proximal end side of the sheath. .
In the present invention, the operation wire is preferably rotated by 90 °.

According to the clip package of the present invention, in a natural state in which no external force is applied to the connection ring of the clip body, the body body serves as a rotation shaft and projects outwardly in the radial direction and is pressed inward in the radial direction. When the case and the clip body are relatively rotated by a predetermined angle, the skirt portion is pressed by the inner surface of the case and closed to the position of the inner surface of the case. Thereby, a clip row | line | column can move to the longitudinal direction of a case. For this reason, if the clip row is pulled out in the longitudinal direction, the clip row can be taken out.
Thus, when taking out the clip row, a special jig or the like is unnecessary, the structure can be simplified, and the cost of the clip package can be reduced. In addition, since the clip row is simply rotated and pulled out, the existing operation part for the endoscope can be applied, so that the development man-hours for developing the operation part become unnecessary and the development cost is reduced. Can do.

  Further, according to the clip loading method of the present invention, the case and the clip row are relatively rotated by a predetermined angle, the skirt portion is closed to the inner surface position of the case, and the distal end of the operation wire is fixed to the sheath base. Since the clip row can be accommodated in the sheath by moving in the direction of movement toward the end side, the clip row can be accommodated in the sheath by a simple operation without using a special jig or the like.

It is a typical perspective view which shows the clip treatment tool used in the 1st Embodiment of this invention. (A) is typical sectional drawing which shows the structure of the front-end | tip part of the clip treatment tool used in the 1st Embodiment of this invention, (B) is seen from the angle which differs 90 degrees from FIG. 2 (A). It is a typical sectional view. It is a perspective view which shows schematic structure of the clip used for the clip treatment tool used in the 1st Embodiment of this invention. (A) is a front view which shows an example of the connection ring used with the clip of the clip treatment tool used in the 1st Embodiment of this invention, (B) is the A1-A1 line | wire of FIG. 4 (A). FIG. 4C is a cross-sectional view taken along line B1-B1 of FIG. 4A, and FIG. 4D is a cross-sectional view of the connecting ring inserted into the sheath. It is sectional drawing by the B1-B1 line, (E) is a bottom view of FIG. 4 (A). It is typical sectional drawing which shows the operation part of the operation handle of the clip treatment tool used in the 1st Embodiment of this invention. It is a typical perspective view which shows the state which removed the slider guide from the operation part shown in FIG. (A) is a typical perspective view which shows the slider guide of the operation handle of the clip treatment tool used by the 1st Embodiment of this invention, (B) is the model which expand | deploys and shows the guide part of an operation handle. FIG. It is a typical perspective view which shows the rotation position control member of the operation part of the operation handle of the clip treatment tool used in the 1st Embodiment of this invention. (A) is typical sectional drawing which shows the clip package of the 1st Embodiment of this invention, (B) is typical sectional side view which shows the case of the clip package shown to FIG. 9 (A). . 9A is a schematic perspective view of the case shown in FIG. 9B, FIG. 9B is a cross-sectional view taken along line C1-C1 in FIG. 9B, and FIG. It is sectional drawing by the C2-C2 line of B). (A) And (B) is typical sectional drawing explaining the removal method of a clip row | line from a clip package in order of a process. It is a schematic diagram which expand | deploys and shows the slider guide of the clip treatment tool used in the 1st Embodiment of this invention. (A)-(C) are typical sectional drawings explaining the loading method of the clip row | line | column from a clip package to a sheath in order of a process. (A)-(E) are typical sectional drawings which show the stepped state in clipping operation of a clip treatment tool. It is typical sectional drawing which shows the structure of the front-end | tip part of the clip treatment tool used in the 2nd Embodiment of this invention. It is a perspective view which shows schematic structure of the clip used for the clip treatment tool used in the 2nd Embodiment of this invention. (A) is a front view which shows an example of the connection ring used with the clip of the clip treatment tool used in the 2nd Embodiment of this invention, (B) is the A2-A2 line | wire of FIG. 17 (A). (C) is a sectional view taken along line B2-B2 of FIG. 17 (A), and (D) is a bottom view of FIG. 17 (A). (A)-(C) are model perspective views which show an example of the connection member used with the clip of the clip treatment tool used in the 2nd Embodiment of this invention. It is a schematic diagram which expand | deploys and shows the guide part of the operation handle of the clip treatment tool used in the 2nd Embodiment of this invention. It is a typical disassembled perspective view which shows the clip package of the 2nd Embodiment of this invention. (A) is typical sectional drawing which shows the clip package of the 2nd Embodiment of this invention, (B) is typical sectional drawing which shows the case of the clip package shown to FIG. 21 (A). (C) is sectional drawing by the C3-C3 line | wire of FIG.21 (B). It is a schematic diagram which expand | deploys and shows the slider guide of the clip treatment tool used in the 2nd Embodiment of this invention. (A)-(C) are typical sectional drawings explaining the loading method of the clip row | line | column from a clip package to a sheath in order of a process. (A)-(E) are typical sectional drawings which show the stepped state in clipping operation of a clip treatment tool.

Hereinafter, a clip package and a clip loading method of the present invention will be described in detail based on preferred embodiments shown in the accompanying drawings.
FIG. 1 is a schematic perspective view showing a clip treatment tool used in the first embodiment of the present invention. FIG. 2 (A) is a schematic cross-sectional view showing the configuration of the distal end portion of the clip treatment tool used in the first embodiment of the present invention, and FIG. 2 (B) is 90 ° with FIG. 2 (A). It is typical sectional drawing seen from a different angle.

The clip treatment tool 10 used in the present embodiment is a repetitive type, and, for example, three clips 12 (12A) are attached to the distal end portion of the sheath 16 of the clip treatment tool operation handle 48 (hereinafter referred to as the operation handle 48). , 12B and 12C) and a clip row A (FIG. 2 (A), (C) including a dummy clip 18 connected to the rearmost clip 12C of the clips 12A to 12C and a connecting member 19 connected to the dummy clip 18. B) and the like are stored.
Note that the distal end portion is an end portion on the distal end side that is inserted into a living body when a treatment with the clip treatment tool 10 is performed using an endoscope. Hereinafter, the distal end portion is referred to as the distal end side, and the opposite side to the distal end portion (operation handle 48 side) is referred to as the proximal end side.

  In the present embodiment, the operation handle 48 includes an operation unit (handle unit) 50, a sheath 16, an operation wire 20 (see FIGS. 2A, 2B, etc.) and the like.

  The sheath 16 is a normal long tube-shaped sheath used in a clip treatment tool for an endoscope, and is, for example, a flexible coil sheath in which a metal wire is tightly wound. As will be described later in detail, the sheath 16 has a clip 12 movably fitted in the distal end thereof, and an operation wire 20 connected to the clip 12 via a dummy clip 18 and a connecting member 19. It is to be stored and is connected to the operation unit 50 on the base end side.

  The operation wire 20 is, for example, a metal wire, and is inserted into the sheath 16 from the operation unit 50, and will be described later. The dummy clip 18 on the most proximal side of the clip 12 housed in a connected state at the distal end portion of the sheath 16 will be described later. To the connecting member 19. A connecting member 21 that is engaged with and connected to the connecting member 19 of the dummy clip 18 is provided at the distal end portion of the operation wire 20.

  As shown in FIGS. 2A and 2B, the clip treatment tool 10 used in the embodiment of the present invention includes, for example, three clips 12 (12A, 12B, and 12C) connected as a clip row A. It is accommodated in the sheath 16. The clip treatment device 10 used in the embodiment of the present invention is a three-time clip treatment device 10 that can perform clipping three times without pulling the sheath 16 out of the patient's body.

  The clip treatment device is not limited to the one loaded with the three clips 12, but may be loaded with two clips, or may be loaded with four or more clips. Also good.

Each clip 12 is connected by a connection ring 14 (14A, 14B, 14C) that covers the engaging portions of the front and rear clips 12 and maintains the connection state of the clips 12. In addition, a dummy clip 18 that is engaged with the operation wire 20 is connected to the most proximal end clip 12C.
As will be described in detail later, the operation wire 20 is inserted into the sheath 16 and inserted into a handle operation unit 48 described later, and is connected to a slider 54 that performs clipping preparation and clipping operation.
In the present embodiment, the distal end side is also referred to as “front”, and the proximal end side with respect to the distal end side portion is also referred to as “rear” or “next”. Also, with respect to a certain clip 12, the immediately preceding clip is also referred to as “front clip 12”, and similarly, the immediately subsequent clip 12 is also referred to as “next clip 12” or “rear clip 12”.

2A and 2B show an initial state (standby state) immediately before the start of the clip treatment operation by the first clip 12A.
2 (A) and 2 (B), one clip 12 and one connecting ring 14 including one fastening ring 40 to be described later are one hemostatic clip body B for endoscope (hereinafter, clip body). B)). In the form of a clip body B, a plurality of clips 12 are loaded inside the distal end of a long sheath 16.

  2A and 2B show a state in which the leading first clip 12A protrudes from the distal end of the sheath 16, but is loaded into the sheath 16 of the three clips 12A to 12C. The first clip 12A at the head is completely stored inside the sheath 16.

FIG. 3 is a perspective view showing a schematic configuration of a clip used in the clip treatment instrument shown in FIG.
The clip 12 is a claw portion 22 formed by bending a single long thin plate having a spring property by 180 ° to form a closed end, intersecting both pieces, and bending the two open ends toward each other. , 22 are 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 (base end portion) 24. The arm portions 28 and 28 are provided at predetermined angles so as to intersect each other with respect to the intersecting portion 26 at each end on the opening side of the turn portion 24 and gradually increase the distance therebetween. Yes. For example, the turn part 24 is formed by molding one member into a substantially U shape, and the tail part 24a is rounded. For example, the turn portion 24 is open in a direction perpendicular to the closing direction C of the arm portion 28.

Convex portions 30 and 30 that are partially widened are formed in the central portion of the arm portions 28 and 28, and each arm portion 28 intersects the tip portion 28 a on the claw portion 22 side by the convex portion 30. It is divided into a base part 28b on the part 26 side.
In the arm portions 28 and 28, a notch 31 for securely fitting the fastening ring 40 is formed on the intersecting portion 26 side of the convex portions 30 and 30.
The clip 12 has a claw portion 22 while 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 in a direction facing each other. , 22 (the convex portions 30, 30) by moving a predetermined amount, the arm portions 28, 28 and the claw portions 22, 22 are closed, and a predetermined cusp fitting force ( Demonstrate gripping force).

The nail | claw parts 22 and 22 are formed in the V-shaped male type | mold and female type | mold which mutually engage, 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 clip 12 is preferably made of a biocompatible metal. For example, SUS630 and SUS631 that are precipitation hardening stainless steels can be used.

The clip 12 is pulled into a connecting ring 14 to be described later, whereby the gap between the arm portions 28 is narrowed, and the living tissue is clipped by the claw portion 22.
Here, the convex portion 30 has a width wider than the inner diameter of the opening (hole 41 of the tightening ring 40) and the proximal end opening (hole 43 of the holding portion 42) of the connecting ring 14 described later. . Thus, in the clip treatment instrument 10, the clip 12 allows the portion other than the convex portion 30 of the clip 12 to enter the inside of the connecting ring 14, but the convex portion 30 is also proximal from the distal end side of the connecting ring 14. Even from the side, it cannot enter the interior.

In this embodiment, as shown to FIG. 2 (A) and (B), the 1st clip 12A and the 2nd clip 12B are the arms of the 2nd clip 12B on the turn part 24 of the 1st clip 12A. The claw portion 22 is engaged with the portion 28 closed, and the engaging portion is covered and held by the connecting ring 14A to be connected.
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 coupled to each other. The clips 12B are connected in a direction different by 90 °. Hereinafter, the third clip 12C is also connected to the second clip 12B in a direction different by 90 °. In the clip row A, the clips 12A to 12C are connected with their orientations alternately changed by 90 °.

The connection ring 14 acts as a fastening member for the arm portion 28 when clipping, and is inserted so as to be able to advance and retreat in the longitudinal direction of the sheath 16 with the clip 12 stored. That is, the connection ring 14 has an outer diameter that is substantially equal to the inner diameter of the sheath 16, and can smoothly move forward and backward in the sheath 16 and rotate as the clip 12 moves.
FIG. 4A is a front view showing an example of a connection ring used together with the clip of the clip treatment tool used in the embodiment of the present invention, and FIG. 4B is a view taken along line A1-A1 in FIG. It is sectional drawing, (C) is sectional drawing by the B1-B1 line | wire of FIG. 4 (A), (D) is B1 of FIG. 4 (A) which shows the state of the connection ring inserted in the sheath. It is sectional drawing by -B1 line, (E) is a bottom view of FIG. 4 (A).

As shown in FIGS. 4A and 4B, the connection ring 14 includes a tightening ring 40 and a holding portion 42. The connecting ring 14 has a metal clamping ring 40 fixed to the tip of a resin-made holding portion 42, and the two members have an integral structure.
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.

The hole 43 can accommodate the turn portion 24 of the clip 12 and the base portions 28 b and 28 b of the arm portions 28 and 28, and is a circular hole larger than the hole 41 of the fastening ring 40.
A stepped portion 32b for fitting the tightening ring 40 is formed on the peripheral surface 32a of the distal end portion of the first region 32. The tightening ring 40 and the holding portion 42 are in a state of being loaded on the sheath 16 and clipping It is fitted with an interference fit that does not come off during operation.

In the connection ring 14, in a natural state where no external force is applied to the first region 32, a skirt that protrudes radially outward from the peripheral surface 32 a of the first region 32 with the body 42 a of the holding portion 42 as a rotation axis. A portion 38 is formed.
As shown in FIG. 4 (A), the skirt portion 38 is formed with a notch 39 in a substantially U shape in a side view on the body 42a of the holding portion 42 of the connecting ring 14. Of the four sides of the rectangle, the side 38 a extending in the axial direction of the connection ring 14 is connected to the body 42 a of the connection ring 14. In this way, the rectangular skirt portion 38 is formed. The skirt portion 38 can spread outward in the radial direction with the side 38a as a rotation axis, and can enter the inner side in the radial direction.

  As shown in FIG. 4C, for example, two skirt portions 38 are formed at rotationally symmetric positions, that is, the skirt portions 38 are formed at positions rotated by 180 ° with respect to each other. Further, the skirt portion 38 is formed at the same position in the pulling direction of the clip 12, that is, the vertical direction in FIG.

In a natural state where no external force is applied, the skirt portion 38 is in a state of opening outward in the radial direction with the side 38a as a rotation axis, as shown in FIG. As a result, the connection ring 14 cannot enter the sheath 16 and the inside of the first region 32 of the holding portion 42 becomes a cylindrical space as shown in FIG. 4B.
On the other hand, when the connection ring 14 is loaded into the sheath 16, for example, as shown in FIG. 4D, the end portion 38 b of the skirt portion 38 is pushed into the hole 43 and enters. As a result, the end portion 38 b of the skirt portion 38 presses the side surface (edge portion) of the turn portion 24 of the clip 12 held in the first region 32. For this reason, the clip 12 is held so as not to move in the rotational direction and the forward / backward direction in the connecting ring 14.
The skirt portion 38 may press and hold the rear clip 12 held in the second region 34.

  As shown in FIG. 4 (C), the skirt portions 38, 38 are moved in the radial direction as shown in FIG. The first clip 12A is released, and the width of the first clip 12A is wider than the inner diameter of the sheath 16 to prevent the connecting ring 14A from retracting into the sheath 16. In this state, the operation wire 20 is pulled, and the first clip 12A is retracted, whereby the connecting ring 14A moves forward relative to the first clip 12A, and the tightening ring 40 at the tip of the connecting ring 14A. Thus, the first clip 12A is tightened.

  Therefore, the skirt portion 38 can be closed inward inside the sheath 16 and needs to have elasticity so as to spread in the radial direction when it is released from the distal end of the sheath 16 and released from the external force. At the same time, the skirt portion 38 needs to have a rigidity capable of holding the clip 12 inside the sheath 16 and a rigidity capable of resisting the reaction force of the clamping 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. In this second region 34, the next clip 12 that engages with the clip 12 held in the first region 32, specifically, the claw portions 22 and 22 and the tip portions 28a and 28a of the arm portions 28 and 28 are provided. The claw portions 22 are held in a closed state 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.

As shown in FIG. 4B, a hole 43 having the same inner diameter penetrating from the first region 32 is formed in the second region 34.
As shown in FIG. 4E, in the second region 34, two grooves (concave portions) 43 a are formed on the inner surface of the hole 43 of the holding portion 42 so as to face each other. The groove 43 a is formed on the same side as the skirt portion 38.

Further, as shown in FIGS. 4B and 4E, the second region 34 is formed with slits 46 that are rotated by 90 ° with respect to the opposing direction of the groove 43a and cut from the base end at two opposing locations. Has been.
In the holding part 42, an extension part 44 is provided at a position where each groove 43a is provided so as to extend a part of the base end side. That is, two extension portions 44 are provided opposite to each other in the same manner as the groove 43a. The extension portion 44 is configured by a plate-like member that is curved along the outer periphery of the holding portion 42.

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 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 follow the inner walls of the grooves 43a, 43a. Also, it abuts against the inner walls of the extension portions 44 and 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 (see FIG. 9) can be maintained.

  The engaging portions of the two clips 12 and 12 are located in a region near the boundary between the second region 34 and 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 in FIG. 2B) differs from the previous clip by 90 ° due to the groove 43a in the second region 34. By being held in the direction, 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 slit 46 is formed 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 ° from the expanding 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.

  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 B 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 or the like, the operation unit 50 (to be described later) can be further protruded from the standard protruding position, but the extended portions 44 and 44 can be protruded. By providing this, it is possible to reliably prevent the clip 12 from falling off at the distal end of the sheath 16.

  Further, when the clip 12 is rotated in order to change the spreading direction (closing direction C) of the clip 12, the protrusion 30 of the clip 12 and the extension 44 of the connecting ring 12 come into contact with each other. It is possible to transmit the direction force with higher efficiency.

  As shown in FIGS. 2A and 2B, a dummy clip 18 that is not used for clip treatment is engaged with the last third clip 12C. The dummy clip 18 has a spring-like portion having a shape similar to that of the half of the open end side from the intersection portion 26 of the clip 12 at the tip, and the third clip with the claw portion closed. Engage with the turn part of 12C and open the claw part to release the third clip 12C. 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 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 configuration of the operation handle 48 of the clip treatment tool 10 used in the embodiment of the present invention will be described.
In the present embodiment, the operation handle 48 includes the sheath 16, the operation wire 20, the connection member 21 at the distal end of the operation wire 20, and the operation unit 50 as described above.

FIG. 5 is a schematic cross-sectional view showing the operation portion of the operation handle of the clip treatment tool according to the embodiment of the present invention. FIG. 6 is a schematic perspective view showing a state in which the slider guide is removed from the operation unit shown in FIG.
As shown in FIG. 5, the operation unit 50 of the operation handle 48 includes a handle main body 52, a slider 54, a slider guide 56, a rotation position regulating member 58, an urging spring 60, and a finger hooking member 62.

  As shown in FIGS. 5 and 6, the handle main body 52 is formed of a stepped cylindrical member having three cylindrical portions having different outer diameters, and the large diameter portion 52a, in order from the base end side, A medium diameter part 52b and a small diameter part 52c are formed.

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

In the handle main body 52, the sheath 16 is fixed to the distal end of the small diameter portion 52c on the most distal end side so as to communicate with the through hole 52d of the handle main body 52.
The operation wire 20 is inserted through the sheath 16, protrudes from the proximal end portion of the sheath 16, is inserted through the small diameter portion 52 c and the medium diameter portion 52 b of the handle main body 52, and is inserted into the slider 54 via a slider pin 70 described later. Connected.

The slider 54 is disposed on the outer periphery of the handle body 52 so as to cover a part of the handle body 52 (and a slider guide 56 described later). The slider 54 is a substantially cylindrical member that can move in the axial direction of the handle main body 52 (same as above).
In the present embodiment, the slider 54 has a disc-shaped flange portion 54a that protrudes outward at two positions in the middle of the base end side of the cylinder and the axial direction. When performing a treatment using the clip treatment instrument 10, a doctor puts a finger on the concave portion 55 between the flange portions 54a to easily move the slider 54 in the axial direction.
For example, the doctor puts the thumb into the ring of the finger-holding member 62, puts the index finger and the middle finger in the recess 55 between the flange portions 54a, and moves the slider 54 in the axial direction so that the slider 54 is sandwiched between the index finger and the middle finger.

The slider 54 has a slider pin 70 attached so as to protrude toward the central axis of the handle body 52. The slider pin 70 passes through the engagement groove 68 and reaches the center line of the through hole 52d of the handle body 52. An operation wire 20 inserted through the small diameter portion 52c and the medium diameter portion 52b of the handle main body 52 is fixed near the lower end portion of the slider pin (on the center line side of the through hole 52d).
As described above, the slider 54 is movable in the axial direction of the handle main body 52, and by moving the slider 54, the operation wire 20 inserted through the sheath 16 is moved forward and backward (moved toward the distal end side and the proximal end side). be able to. That is, the operation wire 20 can be moved to the distal end side and the proximal end side.
In the clip treatment instrument 10, the clip wire A at the distal end portion of the sheath 16 is advanced and retracted by the advancement and retraction of the operation wire 20 by the slider 54 to prepare for clipping and perform clipping.
Further, the clip 12 is loaded by rotating the operation wire 20 about the axis of rotation by the slider 54.

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

FIG. 7A is a schematic perspective view showing a slider guide of the operation handle of the clip treatment tool used in the first embodiment of the present invention, and FIG. 7B is a developed view of the guide portion of the operation handle. It is a schematic diagram shown.
The slider guide 56 is a member that regulates the amount of movement of the slider 54 in the axial direction, that is, the amount of advancement / retraction of the operation wire 20 in the longitudinal direction of the sheath 16, as shown in FIGS. 5 and 7A. Is a substantially cylindrical member.
The slider guide 56 is pivotally supported on the outer peripheral surface of the handle body 52 so as to be rotatable in the circumferential direction and movable in the axial direction.

As shown in FIG. 7A, the slider guide 56 includes a joining portion 56a, a gripping portion 56b, and a guide portion 56c.
The joining portion 56a, the gripping portion 56b, and the guide portion 56c are all substantially cylindrical portions, and in the order of the joining portion 56a, the gripping portion 56b, and the guide portion 56c from the distal end side to the proximal end side, It is integrally formed so as to constitute one cylinder.

The joint portion 56a is a substantially cylindrical portion having an inner diameter substantially the same as the outer diameter of the small diameter portion 52c of the handle body 52, and the convex tip portion restricts the rotational position of the slider guide 56, which will be described later. Is inserted into a joint 58 a formed on the rotational position regulating member 58.
At the front end of the joint portion 56a, for example, four, 60 degrees are formed at equal intervals in the circumferential direction (rotating direction around the axis), and one is formed at different 90 degrees intervals. A convex portion 57a and five concave portions 57b between the convex portions 57a are formed. The five convex portions 57a have the same shape and have a sawtooth shape, that is, a tapered shape having a gentle inclination angle of one tooth surface, and a triangular cross section in which the inclination angle of the other tooth surface forms a substantially right-angled step. It is a convex part.

The rotational position restricting member 58 is a member disposed on the most proximal side of the operation unit 50, and is a cylindrical member having a cylindrical region and a substantially hemispherical region and having a through hole in the center. .
The rotational position restricting member 58 is fixed to the small diameter portion 52c of the handle body in the through hole with the cylindrical region facing the front end side.

As shown in FIG. 8, the rotational position restricting member 58 has a concave joint 58a on the base end side. As described above, the convex joint portion 56a on the distal end side of the slider guide 56 is inserted into the concave joint portion 58a in a rotatable state.
Similar to the convex joint portion 56a on the distal end side of the slider guide 56, the joint portion 58a has four convex portions 59a having the same shape and projecting toward the proximal end and having different inclination angles of the two tooth surfaces with respect to the contact surface. Are formed in the circumferential direction, for example, at equal intervals of 60 ° and one convex portion 59a at different intervals of 90 °. The convex portion 59a is a sawtooth shape, that is, a convex portion having a triangular cross section in which the inclination angle of one tooth surface is a gentle taper and the inclination angle of the other tooth surface forms a substantially right-angled step. Moreover, between the adjacent convex part 59a and the convex part 59a, it becomes the recessed part 59b, and this recessed part 59b is also formed five.

  The convex portion 57a of the joint portion 56a of the slider guide 56, the concave portion 59b of the joint portion 58a of the rotational position restricting member 58, the concave portion 57b of the joint portion 56a of the slider guide 56, and the convex portion 59a of the joint portion 58a of the rotational position restricting member 58 Are in mesh with each other. Further, the convex portion 57 a of the joint portion 56 a of the slider guide 56 and the concave portion 59 b of the joint portion 58 a of the rotational position restricting member 58 and the convex portion of the concave portion 57 b of the joint portion 56 a of the slider guide 56 and the joint portion 58 a of the rotational position restricting member 58. Four portions 59a are formed at equal intervals of 60 °, and one is formed at a different 90 °, for a total of five. For this reason, the slider guide 56 is positioned by the rotational position restricting member 58 at intervals of 90 ° and 60 ° in the rotational direction.

  The gripping part 56b is a part for gripping when the doctor rotates the slider guide 52 to perform clipping as will be described later.

  The guide portion 56c has an inner diameter that is substantially the same as the outer diameter of the middle diameter portion 52b of the handle body 52, and an outer diameter that is substantially the same as the inner diameter of the slider 54 and the outer diameter of the large diameter portion 52a of the handle body 52. This is a substantially cylindrical portion. Accordingly, the slider 54 is guided in the outer periphery of the large diameter portion 52a and the guide portion 56c of the handle main body 52 and moves in the axial direction.

The clip treatment tool 10 used in the embodiment of the present invention is a treatment tool that can be clipped three times without loading the sheath 16 from the body, for example, by loading three clips 12. Correspondingly, as shown in FIG. 7B, the guide portion 56 has four guide grooves 66A to 66D for guiding the slider 54 (slider pin 70) extending in the axial direction. The loading groove 67 is formed extending in the circumferential direction.
The guide grooves 66A to 66D are all simple straight grooves. A loading groove 67 is connected to the tip of the guide groove 66A. The loading groove 67 is a substantially L-shaped groove, and includes a first groove portion 67a extending in the circumferential direction and a second groove portion 67b extending in the axial direction from an end portion of the first groove portion 67a.

For example, the guide groove 66A and the loading groove 67 are used when the clip row is loaded, the guide groove 66B is used for the first clipping, the guide groove 66C is used for the second clipping, and the guide groove 66D is used for the third clipping. In addition, each is used.
The groove length of the guide groove 66A is the longest, and thereafter, the groove length is short in the order of the guide groove 66D, the guide groove 66C, and the guide groove 66B.
Each of the guide grooves 66A to 66D is formed, for example, at an equal interval of 60 ° in the circumferential direction of the guide portion 56c, and the interval between the guide groove 66A and the second groove portion 67b is formed at 90 °.

  In the present invention, as described above, the number of clips that can be loaded (successively) is not limited to three. Therefore, in the guide portion 56c of the slider guide 56, when the number of clips 12 that can be loaded into the clip treatment tool (operation handle) is n, the number n of clips is loaded according to the number n of clips. “N + 1” guide grooves to which 1 is added are formed.

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

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

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

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

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

Next, the clip package 80 of this embodiment will be described.
The clip package 80 stores a clip body B (a clip 12 fitted with a connection ring 14) used in the above-described clip treatment instrument 10 in a case 82 with a predetermined number of clip rows A connected in a case 82, It is a packaged linked clip package. However, in the clip package of the present invention, the clip body B used in the single-shot clip treatment tool may be one.

9A is a schematic cross-sectional view showing the clip package of the first embodiment of the present invention, and FIG. 9B shows the case of the clip package shown in FIG. 9A. It is a typical sectional side view. 10A is a schematic perspective view of the case shown in FIG. 9B, FIG. 10B is a cross-sectional view taken along line C1-C1 in FIG. 9B, and FIG. It is sectional drawing by the C2-C2 line of 9 (B).
9A, 9B, and 10A, the left side in the figure, that is, the upper cap 84 side is referred to as the tip, and the right side in the figure, that is, the lower cap 86 side is designated. It is called the rear end.

As shown in FIG. 9A, the clip package 80 includes a case 82, an upper cap 84, a lower cap 86, and a cover 88. Note that the cover 88 is not shown in FIGS. 9B and 10A to 10C.
The case 82 is cylindrical and stores the clip row A therein.
As shown in FIG. 9B, the case 82 is substantially semi-cylindrical, and includes two semi-cylindrical case parts that are symmetrical about the central axis of the cylinder, that is, an upper half 82a and a lower half 82b. It is configured.
In the case 82, the upper cap 84 is fitted to the front ends of the upper half 82a and the lower half 82b, and the lower cap 86 is fitted to the rear end, so that the case 82 is kept closed.

An opening 90 is formed in the case 82 at a position aligned with the skirt portion 38 of the connecting member 14 of the clip row A to be stored.
In the clip row A of the present embodiment, the clips 12A, 12B, and 12C are coupled with a 90 ° offset, and therefore the opening 90 has an axis (not shown) of the case 82 as shown in FIG. It is formed with a 90 ° offset.

The opening 90 has a size that allows the skirt portion 38 to naturally spread outward in the radial direction of the connecting ring 14 without applying an external force to the skirt portion 38 of the connecting portion 14. For example, the opening 90 is rectangular, and the size thereof is larger than the outer edge of the notch 39 formed in the holding part 42.
With this opening 90, the clip row A is held inside the case 82 in a state where no external force is applied to the skirt portion 38. Further, since the skirt portion 38 protrudes from the opening 90, the movement of the clip row A stored in the case 82 in the longitudinal direction of the case 82 is restricted.

  In addition, among the four sides of the opening 90, the side 90 a that faces the side 38 a that serves as the rotation axis of the skirt portion 38 is configured as a slope as shown in FIGS. 10B and 10C. . Thus, by making the side 90a opposite to the side 38a of the skirt portion 38 into an inclined surface, when the clip row A is rotated, the contact resistance between the skirt portion 38 and the opening 90 can be reduced. Thereby, the rotational resistance of the clip row A can be reduced.

  The case 82, that is, the upper half 82a and the lower half 82b are preferably transparent or semi-transparent so that the inside can be seen. The case 82 is preferably formed of a resin that does not change in the fluctuation range of the ambient temperature (for example, 5 ° C. to 38 ° C.) in terms of impact resistance, ease of handling, and ease of molding. In the present embodiment, the outer shape of the case 82 is not particularly limited.

  In the case 82, the outer surfaces of the upper half 82a and the lower half 82b are covered with a cover 88 made of transparent resin. A region corresponding to the opening 90 is not covered with the cover 88. By covering the outer surfaces of the upper half 82a and the lower half 82b with the cover 88, the upper half 82a and the lower half 82b are prevented from being separated. The case 82 may be bonded to the upper half 82a and the lower half 82b with an adhesive or the like.

  The upper cap 84 and the lower cap 86 may be made of rubber or resin as long as they seal the leading and trailing ends of the upper half 82a and the lower half 82b. Moreover, the lower cap 86 is removable. When the clip row A (a plurality of clip bodies B) in the case 82 is loaded into the sheath 16, the lower cap 86 is removed and the internal clip body B is pulled out while being connected. The top cap 84 may or may not be removable. Moreover, it is good also as a structure which obstruct | occludes the front-end | tip part of case 82, and does not provide the upper cap 84. FIG.

As shown in FIG. 9A, the case 82 is slightly larger than the outer diameter of the connecting ring 14 when the upper half 82a and the lower half 82b are combined, and the sheath 16 (FIG. 2) is loaded with the clip body B. A hole 92 having an inner diameter substantially equal to the inner diameter of the case 82 is formed through the entire case 82. In the hole 92, the clips 12A to 12C, the connecting member 15, and the dummy clip 18 are accommodated.
The tip of the top clip 12A is protected by a portion protruding from the upper cap 84 into the case 82. Further, the connecting member 19 at the rear end of the dummy clip 18 connected to the rearmost clip 12 </ b> C is held by the lower cap 86.

The inner diameters of the rear end portions of the upper half 82a and the lower half 82b are enlarged, and the sheath 16 can be inserted into the rear end portion of the case 82 when the upper half 82a and the lower half 82b are combined. A sheath fitting portion 94 is configured.
The sheath fitting portion 94 has a diameter substantially equal to the outer diameter of the sheath 16 into which the clips 12A to 12C, the connection rings 14A to 14C, and the connection member 15 are loaded. Since the diameter of the sheath fitting portion 94 is about the thickness of the sheath 16 than the diameter of the hole 92 of the case 82, a step corresponding to that is formed at the tip of the sheath fitting portion 94. When the clip body in the case 82 is loaded into the sheath 16, the sheath 16 is inserted to the tip of the sheath fitting portion 94 (see FIG. 13B).

The clip package 80 of the present invention is configured as described above.
In the clip row A stored in the clip package 80, as shown in FIG. 11A, the skirt portion 38 extends outward from the peripheral surface of the connection ring 14 with respect to the opening 90 of the case 82.
In this state, when the clip row A is rotated by 90 ° in the rotation direction ω, the clip row A is pushed inward in the radial direction along the inclined surface 90a of the skirt portion 38, and as shown in FIG. The end portion 38 b of the stubby can enter the inside of the hole 43 and the skirt portion 38 can be closed. Although the next clip 12 is shifted by 90 ° in the expanding direction (closing direction C) of the claw portion 22, the skirt portion 38 is similarly closed. In this state, the clip row A can move in the longitudinal direction of the case 82. Thereafter, the clip row A is pulled out from the case 82 and can be loaded into the sheath 16.

The clip row is stored in the case 82 as follows.
First, the connection rings 14A to 14C are fitted to the clips 12A to 12C from the turn part 24 side.
Next, the tail portion 24a of the turn portion 24 of the clip 12A is sandwiched by the claw portion 22 of the clip 12B from the opening side, and while maintaining this state, the connecting ring 14A is shifted and the engaging portion is moved by the connecting ring 14A. The tail part 24a of the turn part 24 of the cover clip 12A is housed inside the holding part 42.
Next, the tail part 24a of the turn part 24 of the clip 12B is sandwiched by the claw part 22 of the clip 12C from the opening side, and while maintaining this state, the connecting ring 14B is shifted and the engaging part is moved by the connecting ring 14B. The tail part 24a of the turn part 24 of the cover clip 12B is housed inside the holding part 42.
Next, the tail portion 24a of the turn portion 24 of the clip 12C is sandwiched between the claw portions of the dummy clip 18 from the opening side, and while maintaining this state, the connecting ring 14C is shifted, and the engaging portion is moved by the connecting ring 14C. The tail part 24a of the turn part 24 of the cover clip 12C is housed inside the holding part 42. In this way, the clip row A is obtained.
Next, the clip row A is stored in the lower half 82 b of the case 82 with the skirt portion 38 aligned with the opening 90.

  Next, the upper half 82a is put on the lower half 82b from above. As a result, the clip row A is accommodated in the case 82 without applying an external force to the skirt portion 38. In this way, the clip package 80 is obtained.

In this way, the connected clip package 80 can be distributed and stored in a state where the plurality of clips 12 are connected, and can be loaded into the sheath 16 by a simple operation while maintaining the connected state. Therefore, the work burden on the operator is small, and a plurality of clip bodies B, that is, the clip row A can be easily loaded in a short time.
Further, since the connection clip package 80 can be stored with the skirt portion 38 of the connection ring 14 open, it is possible to prevent the elasticity of the skirt portion 38 from being damaged, and the clip 12 can be used when the clip 12 is used (during clip treatment). And the connection ring 14 can exhibit sufficient performance.

Further, in the connection clip package 80, the clip row A is rotated by 90 °, for example, and the operation wire 20 is drawn to close the skirt portion 38 protruding from the opening 90, and the sheath 16 is loaded. Therefore, the loading operation is easy.
Further, when the clip row A is inserted into the sheath 16, the skirt portion 38 is closed by applying an external force along the closing direction of the skirt portion 38 without applying a load opposite to the moving direction of the skirt portion 38. Therefore, an unnecessary load is not applied to the skirt portion 38, and the skirt portion 38 can be prevented from being damaged when loaded into the sheath 16.

Next, using FIG. 12, FIG. 13 (A) to (C) and FIG. 14 (A) to (E), the clipping operation in the clip treatment instrument 10 used in the embodiment of the present invention will be described.
FIG. 12 is a schematic view showing a developed slider guide of the clip treatment tool used in the embodiment of the present invention. In FIG. 12, the position of the slider pin 70 is represented by a circle.
FIGS. 13A to 13C are schematic cross-sectional views illustrating a method of loading a clip row from a clip package to a sheath in the order of steps. 14A to 14E are schematic cross-sectional views showing a stepped state in the clipping operation of the clip treatment tool by the clip treatment tool used in the embodiment of the present invention.
In the description using FIG. 12, such as moving the slider pin 70 to the position P1 shown in FIG. 12, the slider pin 70 is omitted, and simply “move the slider guide to the position P1” and “slider guide 70”. “Move to HP”.

In the present embodiment, the clip row A including the three clips 12 </ b> A to 12 </ b> C is loaded from the clip package 80 into the sheath 16 prior to the clipping operation.
A loading method from the clip package 80 into the sheath 16 of the clip row A will be described.
First, the lower cap 86 of the clip package 80 is removed, and the connection member 21 at the distal end of the operation wire 20 projected from the distal end 16a of the sheath 16 is connected to the dummy clip 18 in the case 82 as shown in FIG. It connects to the connecting member 19 of the rear end part.
In this case, the distal end 16a of the sheath 16 is moved by moving the slider 54 of the operation unit 50 shown in FIG. 5 along the guide groove 66A and the loading groove 67 and moving the slider pin 70 to the position P2 shown in FIG. The connecting member 21 of the operation wire 20 is protruded by a predetermined amount.

Next, as shown in FIG. 13B, the sheath 16 is inserted to the tip of the sheath fitting portion 94 and fitted with the case 82.
After the operator holds the sheath 16 and the case 82 and inserts the distal end 16a of the sheath 16 into the sheath fitting portion 94 of the case 82, the slider 54 of the operation portion 50 (see FIG. 6) is moved to the wire operation portion 52. By pulling the sheath 16 against the operation wire 20, the sheath 16 can be inserted up to the distal end of the sheath fitting portion 94.
In a state where the sheath 16 is fitted to the sheath fitting portion 94 of the case 82, the inner diameter of the straight portion 96 of the case 82 and the inner diameter of the sheath 16 are substantially equal.

  Next, the slider pin 70 is moved along the second groove portion 67b and the first groove portion 67a to move to the position P3. At this time, since the operation wire 20 is rotated by 90 °, the clip row A rotates by 90 ° in the rotation direction ω. Thereby, the skirt part 38 of each clip 12A-12C is closed, and it accommodates in the inside of each connection ring 14A-14C. At this time, the clips 12A to 12C inside the connection rings 14A to 14C are fixed by pressing the side surfaces (edge portions) of the turn portion 24 by the skirt portions 38, respectively.

  Next, the position of the sheath 16 remains the same, the slider 54 is pulled, and the slider pin 70 is moved from the position P3 to the position P4 along the guide groove 66A. Thereby, the operation wire 20 is pulled in the longitudinal direction of the sheath 16, and the clip row A (the clips 12A to 12C, the connection rings 14A to 14C, the connection member 15, and the dummy clip 18) in the case 82 is sequentially arranged from the rear end side. The clip row A is loaded as shown in FIG. Thereby, the clip treatment tool 10 is configured.

Next, the clipping operation by the clip treatment tool 10 will be described.
The slider pin 70 is moved to the HP that contacts the end surface on the rear end side of the guide groove 66A, and is at the position P4. This state is an initial state of treatment in the clip treatment instrument 10.

Thereafter, the sheath 16 is inserted into a forceps port (not shown) of an endoscope (not shown) inserted into the living body, and the distal end of the sheath 16 reaches the distal end of the insertion portion of the endoscope. Project from the tip of the endoscope.
Further, if necessary, the distal end 16a of the sheath 16 of the clip treatment device 10 is moved to a target position by operating an insertion portion or an angle portion of the endoscope.

After the necessary operation is completed, the slider guide 56 is rotated by 60 ° to align the guide groove 66B with the engagement groove 68 (see FIG. 6). Thereby, the position of the slider 54 (slider pin 70) moves to HP corresponding to the guide groove 66B indicated by position P5 in FIG. This state is, for example, the state of the clip 12A shown in FIG.
The base end side of the slider guide 56 is spaced from the base end portion 52 c of the handle main body 52, and when the slider guide 56 is rotated, the convex portion 57 a of the slider guide 56 is protruded from the position regulating member 58. In order to get over the portion 59a, that is, to get over the lock claw, a slider claw ride height that allows the slider guide 56 to move slightly to the base end side is secured.

Next, the slider 54 is moved to the front end side along the guide groove 66B, and the slider pin 70 is moved to a position where it abuts on the end portion 69B on the front end side of the guide groove 66B. That is, it is moved to the maximum protruding position P6 shown in FIG.
By pushing out the slider 54, that is, pushing out the operation wire 20, the clip row A moves to the distal end side, and as shown in FIG. 14B, from the distal end 16a of the sheath 16, the leading clip 12A and the connecting ring 14A. The first region 32 protrudes. Thereby, the arm part 28 of the clip 12A is opened, and the claw part 22 is automatically separated by a predetermined distance. Furthermore, the skirt portion 38 of the connection ring 14 </ b> A opens outward from the inner diameter of the sheath 16. As a result, the clip 12 </ b> A does not return into the sheath 16 and is held at the distal end 16 a of the sheath 16 by the second region 34.

Here, the clip 12 and the connecting ring 14 have dimensional variations due to manufacturing errors. Further, in the clip treatment tool 10 inserted through the endoscope (its insertion portion), the protruding amount of the operation wire 20 may decrease due to differences in inner and outer circumferences due to bending and bending of the operation wire 20 and the sheath 16. .
For this reason, in the clip treatment instrument 10, the end portion 69B on the distal end side of the guide groove 66B is securely connected regardless of the manufacturing error of the clip 12 or the like, the state of the sheath 16, and the like. The ring 14A is formed so that the skirt portion 38 of the ring 14A is at the maximum protruding position (clip standby position) P6.
Therefore, normally, in a state where the slider 54 is pushed out to the maximum projecting position P6, the skirt portion 38 of the connecting ring 14A is positioned ahead of the distal end portion of the sheath 16, and the skirt portion 38 and the sheath 16 are located. Is separated from

  In this regard, the same applies to the configuration of the guide groove 66C corresponding to clipping by the second clip 12B and the guide groove 66D corresponding to clipping by the third clip 12C.

  Next, for example, while viewing the image of the endoscope, the slider 54 is pulled back to the HP side, and the clip row reaches the standard protruding position (clip start position) P7 where the skirt portion 38 of the connecting ring 14A abuts against the distal end 16a of the sheath 16. Pull A back. That is, the clip row A is pulled back to the sheath 16. Thereby, the preparation for the first clipping, that is, the clipping by the first clip 12 is completed. As a result, the clip is ready for clipping.

  After the slider 54 is returned to the standard protruding position P7 to prepare for clipping, the endoscope is operated to press the claw portion 22 of the expanded clip 12A to the position of the living body b to be clipped. It is moved to the base end side by the clip stroke, that is, pulled back to the position P8 (clip completion position).

  At this time, the skirt portion 38 of the connection ring 14A that has come out to the distal end 16a of the sheath 16 is open, and the pressing and holding of the first clip 12A by the skirt portion 38 is released. Further, the connecting ring 14A is prevented from retreating into the sheath 16 because the skirt portion 38 is opened at the distal end 16a of the sheath 16. Therefore, the first first clip 12A moves backward with respect to the connection ring 14A. When the fastening ring 40 at the tip of the connecting ring 14A is pushed along the base portion 28b of the arm portion 28 of the first clip 12A from the intersecting portion 26 side to just below the convex portion 30, the claw portions 22 and 22 are diseased. The part is clipped, and the fastening of the first clip 12A by the fastening 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 extensions 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 and 44 of the connecting ring 14A, the arm portion 28 is expanded until the arm portion 28 hits the inner surface of the sheath 16 by the spring force of the second clip 12B. Then, the gap between the claw portions 22 and 22 opens wider than the width of the turn portion 24 of the first clip 12A, and the connection between the first clip 12A and the second clip 12B is released.
As a result, as shown in FIG. 14D, the first clip 12A and the connection ring 14A that clip the living body b are detached from the distal end 16a of the sheath 16, and the first clip 12A and the distal end of the connection ring 14A. The clip treatment of the diseased part by the fastening ring 40 is completed.

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 22 is engaged with the second claw of the coupling rings 14B and 14C by the force (biasing force) of the claw 22 of the third clip 12C and the claw of the dummy clip 18 that are engaged with the clips 12B and 12C. It is pressed against the inner wall of the region 34, and 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 move forward and backward integrally with respect to the sheath 16, and the connection state of the clips 14B and 14C and the dummy clip 18 is maintained by the connection rings 14B and 14C. .

  After the clip treatment by the first clip 12A is completed, the slider 54 is moved to HP as shown in FIG. That is, the slider pin 70 is moved to the position P9 in FIG. Thereby, as shown in FIG. 12D, the clip 12 </ b> B and the clip 12 </ b> C are drawn into the sheath 16.

  The slider pin 70 may be moved from the standard protruding position P6 through the clip completion position P8 to the position P9 (home position) by a series of operations. Further, for example, when the first clip 12A at the head is firmly held at the maximum protruding position and there is no possibility of dropping (very low), from the maximum protruding position P6 to the standard protruding position P7, The clip treatment may be performed by pulling back the slider 54 from the maximum projecting position P6 to the position P9 (home position) without performing the operation of returning the slider 54 once.

  Next, the slider guide 56 is rotated by 60 ° so that the guide groove 66C and the engagement groove 68 are aligned. Thereby, the position of the slider 54 (slider pin 70) moves to HP corresponding to the guide groove 66C indicated by position P10 in FIG. At this time, the position of the second clip 12B remains at the position shown in FIG.

  Then, the slider 54 is moved along the guide groove 66C, and the slider pin 70 is moved to a position where it comes into contact with the end portion 69C on the distal end side of the guide groove 66C. That is, it is moved to the maximum protruding position P11 shown in FIG. At this time, when it is moved to the position P11, as shown in FIG. 11E, the connection ring 14B of the clip 12B protrudes from the tip 16a of the sheath 16, and the skirt portion 38 is opened.

Thereafter, with respect to the clip 12B, the slider 54 is pulled back to the HP side, the clip row A is pulled back to the standard protruding position P12 where the skirt portion 38 of the connecting ring 14B contacts the tip 16a of the sheath 16, and the clip 12B is set to the clip start position. To do. As a result, the clip 12B is ready for clipping.
Thereafter, the claw portion 22 of the expanded second clip 12B is pressed against the position of the living body b to be clipped, and the slider 54 is moved to the proximal end side by the clip stroke, that is, to the position P13 (clip completion position). Pull back to complete clipping. Then, the slider 54 is moved to the proximal end side, and the slider pin 70 is moved to the position P14.

  Next, the slider guide 56 is rotated by 60 ° so that the guide groove 66D and the engagement groove 68 coincide with each other. Thereby, the position of the slider 54 (slider pin 70) moves to HP corresponding to the guide groove 66D indicated by position P15 in FIG. At this time, the position of the clip 12C at the tip of the clip row is the position when the clip row A is loaded.

Then, the slider 54 is moved to the distal end side along the guide groove 66D, and the slider pin 70 is moved to a position where it abuts on the end portion 69D on the distal end side of the guide groove 66D. That is, it is moved to the maximum protruding position P16 shown in FIG. At this time, when moved to the position P16, the connection ring 14C of the clip 12C protrudes from the tip 16a of the sheath 16, and the skirt portion 38 is opened.
Thereafter, also in the clip 12C, the slider 54 is pulled back to the HP side, the clip row A is pulled back to the standard protruding position P17 where the skirt portion 38 of the connecting ring 14C contacts the tip 16a of the sheath 16, and the clip 12C is set to the clip start position. To do. As a result, the clip 12C is ready for clipping.

  Thereafter, the claw part 22 of the expanded clip 12C is pressed against the position of the living body b to be clipped, and the slider 54 is moved to the proximal end side by the clip stroke, that is, pulled back to the position P18 (clip completion position). To complete. Then, the slider 54 is moved to the proximal end side, and the slider pin 70 is moved to the position P19. Thereby, clipping by the clip treatment instrument 10 is completed.

When clipping by the three clips 12A to 12C is completed, the slider 54 is rotated 180 ° toward the guide groove 66A to return to the position P1 in FIG. 12, that is, the HP corresponding to the guide groove 66A. Thereafter, the sheath 16 of the clip treatment instrument 10 is pulled out from the endoscope.
After pulling out the sheath 16, the slider 54 is moved along the guide groove 66A and the loading groove 67 and pushed out to the position P2, and the connecting member 21, the dummy clip 18 and the connecting member 19 are projected from the distal end 16a of the sheath 16, The dummy clip 18 and the connecting member 19 are removed from the connecting member 21 at the tip of the operation wire 20.
Further, when clipping is performed, the connecting member 21 is connected to the connecting member 19 of the clip row A of the clip case 80 and loaded as described above.

  As described above, by using the clip case 80 of the present embodiment, in the clip treatment instrument 10, the operation wire 20 is rotated or the operation wire 20 is moved along the longitudinal direction of the sheath 16. A can be loaded into the sheath 16, and clipping can be performed a plurality of times without pulling out the sheath 16.

Next, a second embodiment of the present invention will be described.
FIG. 15 is a schematic cross-sectional view showing the configuration of the distal end portion of the clip treatment tool used in the second embodiment of the present invention. FIG. 16: is a perspective view which shows schematic structure of the clip used for the clip treatment tool used in the 2nd Embodiment of this invention. FIG. 17A is a front view showing an example of a connection ring used together with the clip of the clip treatment tool used in the second embodiment of the present invention, and FIG. 17B is a front view of A2- in FIG. It is sectional drawing by A2 line, (C) is sectional drawing by the B2-B2 line | wire of FIG. 17 (A), (D) is a bottom view of FIG. 17 (A).

  In this embodiment, the same components as those of the clip treatment tool used in the first embodiment shown in FIGS. 1 to 14 and the clip case of the first embodiment are denoted by the same reference numerals, and the details thereof are described. The detailed explanation is omitted. This embodiment can obtain the same effects as those of the first embodiment.

The clip treatment instrument 100 and the clip case 85 used in this embodiment are configured and connected to the clip 112 as compared with the clip treatment instrument 10 used in the first embodiment and the clip case 82 of the first embodiment. 114 is different, and further, the clip 112 is connected by the connecting member 15, and the clip row A is different in that the claw portions 22 are aligned in the expanding direction (closing direction C). Since the configuration is the same as that of the clip treatment instrument 10 (see FIGS. 2A and 2B) used in the first embodiment, detailed description thereof is omitted.
An operation handle 48 of the clip treatment device 10 used in the first embodiment is used for the clip treatment device 100 used in the present embodiment.

Compared with the clip 12 (see FIG. 3) of the first embodiment, the clip 112 of the present embodiment has no notch 31 (see FIG. 3) and has a turn portion (base end portion), as shown in FIG. ) The length of 25 is short. The connecting member 15 is engaged with the tail portion 25 a of the turn portion 25 of the clip 112.
Moreover, the connection ring 114 of this embodiment differs in the structure of the holding | maintenance part 45 compared with the connection ring 14 of 1st Embodiment, the length of the 2nd area | region 34a is short, and there is no groove | channel.
The holding portion 45 of the connection ring 114 is a first region 32 that accommodates the turn portion 25 of the previous clip 12 and a second portion that stays on the sheath 16 so that the clip 112 does not come off when the clip 12 protrudes from the sheath 16. It is comprised from the area | region 34a. A slit 46 is formed in the second region 34a.
Also in the connection ring 114, the skirt portion 38 opens and closes in the radial direction of the holding portion 45 with the side 38a (torso) as a rotation shaft in the same manner as in the first embodiment. The skirt portion 38 opens outward in the radial direction.

  In the present embodiment, on the other hand, in a state where the connecting ring 114 is housed in the sheath 16, for example, the end portion 38 b of the skirt portion 38 is pushed inward to enter the internal space of the cylindrical connecting ring 114, and the end The edge of the portion 38 b presses the turn portion 25 of the clip 112 held in the first region 32, and the clip 112 moves in the rotation direction and the forward / backward direction (longitudinal (extending) direction of the sheath 16) in the connection ring 114. Do not hold.

  As shown in the leading coupling ring 114A in FIG. 15, the skirt portion 38 opens from the distal end 16a of the sheath 16 and at the same time opens by its own elasticity. Accordingly, the holding of the clip 112 by the connecting ring 114 is released, and the width of the clip 112 is wider than the inner diameter of the sheath 16, and the intrusion (retreat) of the connecting ring 114 into the sheath 16 is prevented.

Also, as shown in FIGS. 17B and 17C, a hole 43 that penetrates the first region 32 and the second region 34 is formed in the holding portion 45 of the connection ring 114.
In the connecting ring 114, the second region 34 has two positions shifted from the skirt portion 90 by 90 ° in the circumferential direction (90 ° from the closing direction C of the clip 112) from the upper end of the second region 34 from the base end. The slit 46 is formed to a shallow position.
By providing the slit 46, the flexibility of the connection ring 114 can be improved, that is, the flexibility of the clip row can be improved. Therefore, even when the angle part of the endoscope is greatly curved, the clip treatment tool 100 can pass while maintaining the connection of the clip rows.

The connecting member 15 connects the two clips 112. One end portion of the connecting member 15 is engaged with the tail portion 25a of the turn portion 25 of the front clip 112, and the other end portion is sandwiched between the claw portions of the rear clip 112.
FIGS. 18A to 18C are schematic perspective views illustrating an example of a connecting member used together with a clip of the clip treatment tool used in the embodiment of the present invention.

For example, as illustrated in FIG. 18A, the connecting member 15 illustrated in FIG. 15 includes a flat plate member 200, and a groove 202 is formed on one end side of the flat plate member 200 from the side surface 200 a side.
On the other end side of the flat plate member 200, an opening 204 through which the claw portion 22 can be inserted is formed on the surface 200b. The groove 202 and the opening 204 extend in the same direction.
In the connecting member 15, the groove 202 is engaged with the tail portion 25 a of the turn portion 25 of the front clip 112, the claw portion 22 of the rear clip 112 is inserted into the opening 204, and the claw portions 22 are substantially in contact with each other. As a result, the connecting member 15 is clamped. In the present embodiment, the closing direction C (see FIG. 15) of the arm portion 28 between the front clip 112 and the rear clip 112 coincides by setting the groove 202 and the opening 204 of the connecting member 15a in the same direction. Can be made. That is, the spreading direction (blocking direction C) of the arm portion 28 can be matched. Thereby, at the time of clipping, the surgeon can perform clipping without worrying about the direction of clip expansion (blocking direction C). For this reason, an operator's workability | operativity can be made high.

Further, since the connecting member 15 has an opening 204 for holding the claw portion 22 on the other end side, the clip 112A is protruded from the distal end 16a of the sheath 16 as shown in FIG. The second region 34 has a length that protrudes from the other end.
In connection members 15a and 15b shown in FIGS. 18B and 18C which will be described later, even when the clip 112A protrudes from the distal end 16a of the sheath 16, the other end protrudes from the second region 34. Have
18A to 18C are arranged in the second region 34, the width thereof is shorter than the inner diameter of the hole 43.

In the connecting member 15, it is preferable to record, for example, a number or symbol indicating the number of clips, a manufacturing control number or manufacturing control symbol of the clip, or a size of the clip on the surface 200b of the flat plate member 200, for example. Thereby, the operator can grasp the remaining number of clips, the size of the clip, and the like from the observation image of the clip.
Furthermore, by forming the connecting member 15 with a magnetic material, it is possible to specify the position where clipping is performed from outside the body after clipping.

Further, when the rear clip 112 is moved to the claw portion 22 side by using the connecting member 15, a force acts on the front clip 112 through the flat plate member 200, and the front clip 112 can be pushed out. . Further, when the rear clip 112 is moved to the turn part 25 side, a force acts on the front clip 112 via the flat plate member 200, and the front clip 112 can be pulled.
Further, when the rear clip 112 is rotated in the sheath, a force acts on the front clip 112 via the connecting member 15, and the front clip 112 can be rotated.

The connecting member 15 remains in the body together with the clip 112. For this reason, the material constituting the flat plate member 200 is a biocompatible material, and the groove 202 and the opening 204 are deformed by the force acting at the time of clipping, so that the front clip 112 and the rear clip There is no particular limitation as long as the connection with 112 is not disengaged. For example, SUS630 and SUS631 which are precipitation hardening stainless steels can be used.
Further, as the material of the flat plate member 200, PPSU (polyphenylsulfone), PSU (polysulfone), PEI (polyetherimide), PEEK (polyetheretherketone), PPS (polyphenylene sulfide), PES (polyethersulfone). ), PASF (polyallyl sulfone), and the like may be a resin suitable for sterilization.

In the present invention, the configuration of the connecting member 15 is not particularly limited. For example, as shown in FIG. 18B, the first connecting portion 206, the second connecting portion 208, and the first connecting portion 15 The connecting member 15a having the connecting portion 210 that connects the first connecting portion 206 and the second connecting portion 208 may be used.
In the connecting member 15 a, the first connecting portion 206 is engaged with the tail portion 25 a of the turn portion 25 of the clip 112. The first connecting portion 206 is made of, for example, a substantially pentagonal flat plate material, and a groove 212 is formed from the side surface 206a side. At the end of the groove 212 on the opening side, a flange 214 is formed so as to close the opening. The tail portion 25a of the turn portion 25 is fitted into a region 215 surrounded by the flange portion 214 and the groove 212. Since there is the collar portion 214, the first coupling portion 206 is difficult to come off from the clip 112.
In addition, in the connection member 15 shown in FIG.

The 2nd connection part 208 is comprised by the substantially triangular flat plate material, for example. The second connecting portion 208 is formed with an opening 204 through which the claw portion 22 of the clip 112 is inserted and clamped.
In the connecting member 15a, the first connecting portion 206 and the second connecting portion 208 may be made of the same material or different materials. The first connecting part 206 and the second connecting part 208 are made of the same material as the flat plate member 200 of the connecting member 15.

The connecting portion 210 connects the first connecting portion 206 and the second connecting portion 208, and is composed of a member that is narrower than the width of the opening 204 and has a shorter length. The connecting portion 210 is a joint portion when the first connecting portion 206 and the second connecting portion 208 are integrally formed.
The connecting portion 210 may be made of the same material as the first connecting portion 206 and the second connecting portion 208, but is preferably made of a material having a lower strength than the first connecting portion 206 and the second connecting portion 208. In this case, the first connecting part 206 and the second connecting part 208 are relatively easily moved by the connecting part 210. Thereby, compared with the connection member 15, followability with respect to the bending of the sheath 16 is good. That is, the sheath 16 can be bent with a small curvature.
Further, when the rear clip 112 is moved forward or backward using the operation wire 20, the front clip 112 is also easily moved by following the first connecting portion 206.
Furthermore, when the rear clip is rotated using the operation wire 20, the front clip 112 is easily rotated following the rear clip by the first connecting portion 206.

Further, the connecting member 15a shown in FIG. 18 (B) may have a long connecting portion 216 like the connecting member 15b shown in FIG. 18 (C). In this case, since the connecting portion 216 is long, followability is good with respect to the bending of the sheath 16 as compared with the connecting member 15a shown in FIG. 18B, that is, the sheath 16 can be bent with a small curvature. . It is preferable that the connection part 216 is also made of a material having a lower strength than the first connection part 206 and the second connection part 208. Thereby, followability is better with respect to the bending of the sheath 16. That is, the sheath 16 can be bent with a smaller curvature.
The connecting member 15b shown in FIG. 18C is also made of the same material as that of the connecting member 15a shown in FIG.
Further, in any of the connecting members 15, 15a, and 15b shown in FIGS. 18A to 18C, the color may be changed depending on how many times the clip is generated.

  In the present embodiment, as shown in FIG. 15, the connecting member 15 is provided in the turn part 25 of the most advanced clip 112 </ b> A, and the claw part 22 of the next clip 112 </ b> B holds the connecting member 15. Furthermore, the connecting member 15 is provided in the turn part 25 of the clip 112B, and the claw part 22 of the next clip 112C sandwiches the connecting member 15 to connect the three clips 112A to 12C. Further, a connecting member 15 is also provided on the turn part 25 of the rearmost clip 112C, and the dummy clip 18 holds the connecting member 15 therebetween. As described above, the clips 112 </ b> A to 12 </ b> C are all connected in the same direction in the closing direction C using the connecting member 15.

Further, in the clip 112B, the clip 112C, and the dummy clip 18, the arm portion 28 is pressed by the inner surface of the sheath 16, and the closed state of the arm portion 28 for connection with the previous clip 112 is maintained, so that the claw portion The connecting member 15 is clamped by 22 and the connected state is maintained.
When the pressure on the inner surface of the sheath 16 is released, the arm portion 28 of the clip 112 expands in the direction opposite to the closing direction C, and the claw portions 22 are automatically separated from each other by a predetermined distance.
In the clip treatment instrument 100, for example, a clip row A formed by connecting three clips 112 </ b> A to 12 </ b> C and one dummy clip 18 via a connecting member 15 is stored at the distal end portion of the sheath 16 of the operation handle 48. Is done.

The dummy clip 18 that sandwiches the connecting member 15 of the clip 112C at the rearmost end (most proximal end) has the same configuration as the dummy clip 18 of the first embodiment, and the connecting member 19 is attached to the proximal end side. And is not used for clipping.
The dummy clip 18 holds the connecting member 15 of the rearmost clip 112C with the claw closed, and releases the connecting member 15 when the claw is opened.
Further, a connecting member (hook) 21 at the tip of the operation wire 20 is attached to and detached from the connecting member 19.
Further, the connecting member 19 at the rear end portion of the dummy clip 18 and the connecting member 21 at the front end of the operation wire 20 are configured not to be disengaged by the forward / backward movement of the operation wire 20.

In the present embodiment, a state in which the connection ring 114 is inserted into the clip 112 and the connection member 15 is engaged with the tail portion 25 a of the turn portion 25 of the clip 112 is also referred to as a clip body B.
In the present embodiment, the clip row A is inserted into the sheath 16 so as to be capable of moving forward and backward in the longitudinal direction. The operation wire 20 is inserted through the sheath 16 and connected to the slider 54 of the operation unit 50 on the proximal end side of the operation handle 48. The operation wire 20 is connected to the dummy clip 18 via the connecting member 2 at the distal end. Joined with.
Also in the clip treatment device 100, the operation wire 20 is pushed or pulled (moved in the longitudinal direction of the sheath 16) in the sheath 16 by the operation of the slider 54, and is connected to the distal end portion of the sheath 16 and accommodated. Clipping operation is performed by moving the clip row forward or backward.

Further, the clip treatment tool 100 used in the present embodiment differs from the clip treatment tool 10 used in the first embodiment in the pattern of grooves formed in the guide portion 56c.
In the guide portion 56c of the present embodiment, as shown in FIG. 19, four guide grooves 120A to 120D for guiding the slider 54 (slider pin 70) are formed extending in the axial direction. A loading groove 122 is formed extending in the circumferential direction. These four guide grooves 120 </ b> A to 120 </ b> D are communicated by a common groove 124.
The guide grooves 120A to 120C are all simple straight grooves. A loading groove 122 is connected to the tip of the guide groove 120A. The loading groove 122 is a substantially L-shaped groove, and includes a first groove 122a extending in the circumferential direction and a second groove 122b extending in the axial direction from an end of the first groove 122a. Further, the guide groove 120D has a straight groove with an end portion extending obliquely.

For example, the guide groove 120A and the loading groove 122 are used when the clip row is loaded, the guide groove 120B is used for the first clipping, the guide groove 120C is used for the second clipping, and the guide groove 120D is used for the third clipping. In addition, each is used.
Note that the length of the guide groove 120A is the longest, and the remaining guide grooves 120B to 120D are shorter than the guide groove 120A, but the lengths thereof are the same.
Each of the guide grooves 120A to 120D is formed, for example, at an equal interval of 60 ° in the circumferential direction of the guide portion 56c, and the interval between the guide groove 120A and the second groove portion 67b is formed at 90 °.

Next, the clip package of this embodiment will be described.
In the clip package 80a of the present embodiment, the clip body B used in the above-described clip treatment device 100 (with the coupling ring 114 fitted to the clip 112 and provided with the coupling member 15) is connected in a predetermined number in advance. Although the clip package is housed in a case and packaged, the clip package of the present invention may of course be a single clip body B used in a single-shot clip treatment device.

FIG. 20 is a schematic exploded perspective view showing a clip package used in the continuous clip treatment device of the present invention. FIG. 21A is a schematic cross-sectional view showing a clip package used in the clip treatment instrument used in the embodiment of the present invention, and FIG. 21B shows a case of the clip package shown in FIG. It is typical sectional drawing, (C) is sectional drawing by the C3-C3 line | wire of FIG. 21 (B).
20 and FIGS. 21A and 21B, the left side in the figure, that is, the upper cap 84 side is referred to as the front end, and the right side in the figure, that is, the lower cap 86 side is referred to as the rear end.
In FIG. 20 and FIGS. 21B and 21C, the cover 88 is not shown.

Compared with the clip package 80 of the first embodiment (see FIGS. 9A and 9B), the clip package 80a of the present embodiment has a case 85 as shown in FIGS. 20 and 21A. The positions of the openings 90 formed in the second embodiment are different, and the other configuration is the same as that of the clip package 80 of the first embodiment, and thus detailed description thereof is omitted.
Also in this embodiment, the case 85 has a cylindrical shape and houses the clip row A therein. As shown in FIG. 20, the case 85 has a substantially semicylindrical shape and a symmetrical shape about the central axis of the cylinder. The upper half 85a and the lower half 85b are combined.

  When combined, the upper half 85a and the lower half 85b of the case 85 are formed with openings 90 facing each other in the diameter direction of the case 85. The opening 90 is formed at a position aligned with the skirt portion 38 of the connecting member 114 to be accommodated, and is formed in a line at a predetermined interval. Other than that, it is the same structure as the opening part 90 of the case 82 of the clip package 80 of 1st Embodiment. Also in the opening 90, the side 90a opposite to the side 38a serving as the rotation axis of the skirt portion 38 is formed of an inclined surface.

Also in the case 85, the upper cap 84 is fitted to the tips of the two upper halves 85a and the lower half 85b, and the lower cap 86 is fitted to the rear end to keep the case 85 closed.
In this embodiment, since the direction of the clip 112 can be made the same, the openings 90 need only be formed on the same row with a predetermined interval, so the case 85 can be easily formed.

  The case 85 is preferably transparent or translucent so that the inside can be seen, like the case 82 of the first embodiment. The case 85 is preferably formed of a resin that does not change in the fluctuation range of the ambient temperature (for example, 5 ° C. to 38 ° C.) in terms of impact resistance, ease of handling, and ease of molding.

The case 85 is also covered with a cover 88 made of a transparent resin (not shown in FIGS. 20 and 21A) as in the case 82 of the first embodiment. The area corresponding to is not covered with the cover 88. Covering the outer surfaces of the upper half 85a and the lower half 85b with the cover 88 prevents the upper half 85a and the lower half 85b from separating. Moreover, the case 85 may adhere | attach the upper half 85a and the lower half 85b with an adhesive agent.
Further, the tip portion may be closed with the case 85, and the upper cap 84 may not be provided.

As shown in FIG. 21A, the case 85 is slightly larger than the outer diameter of the connection ring 114 when the upper half 85a and the lower half 85b are combined, and the sheath 16 (FIG. 15) into which the clip body B is loaded. A hole 92 having an inner diameter substantially equal to the inner diameter of the case 85 is formed through the entire case 85. In this hole 92, the clips 112A to 12C, the connecting member 15, and the dummy clip 18 are accommodated.
The tip of the top clip 112A is protected by a portion protruding from the upper cap 84 into the case 85. Further, the connecting member 19 at the rear end of the dummy clip 18 connected to the rearmost clip 112 </ b> C is held by the lower cap 86.

The rear end portions inside the upper half 85a and the lower half 85b are expanded in diameter, and when the upper half 85a and the lower half 85b are combined, a sheath fit into which the sheath 16 can be inserted into the rear end portion of the case 85 A joint portion 94 is configured.
The sheath fitting portion 94 has a diameter substantially equal to the outer diameter of the sheath 16 into which the clips 112A to 12C, the connection rings 114A to 14C, and the connection member 15 are loaded. Since the diameter of the sheath fitting portion 94 is larger than the diameter of the hole 92 of the case 85 by the thickness of the sheath 16, a step corresponding to that is formed at the tip of the sheath fitting portion 94. When the clip body in the case 85 is loaded into the sheath 16, the sheath 16 is inserted and connected to the distal end of the sheath fitting portion 94 (see FIG. 23B).

  The clip package 80a of this embodiment is configured as described above. Also in the clip package 80 a of this embodiment, the skirt portion 38 of the clip row A housed inside protrudes from the opening 90 of the case 85. Thereby, the movement of the clip row A in the longitudinal direction is restricted. In this state, when the clip row A is rotated 90 ° in the rotational direction ω, the clip row A is pushed inward in the radial direction along the inclined surface 90 a of the skirt portion 38, and the end portion 38 b of the skirt portion 38 is placed inside the hole 43. The skirt portion 38 can be closed. In this state, the clip row A can move in the longitudinal direction of the case 85. Thereafter, the clip row can be pulled out of the case 85 and loaded into the sheath 16.

The clip body B is stored in the case 85 as follows.
First, the coupling rings 114A to 114C are fitted to the clips 112A to 112C from the turn part 25 side.
Next, the connection ring 15 is attached to the tail portion 25a of the turn portion 25 of each of the clips 112A to 112C, for example, from the slit 46, and the clip body B is obtained.
Next, each clip body B (clips 112 </ b> A to 112 </ b> C) is stored one by one in the lower half 85 b of the case 85 with the skirt portion 38 aligned with the opening 90. At this time, the claw portion 22 of the next clip 112 is passed through the opening portion 204 of the connecting member 15. In the clip 112 </ b> C, the claw portion 22 of the connecting clip 18 is passed through the opening 204 of the connecting member 15.

  Next, the upper half 85a is put on the lower half 85b. Thereby, each arm part 28 of clip 112A-112C is pressed by the inner surface of case 85, the connection member 15 is clamped by the nail | claw part 22, and the three clip bodies B and the dummy clip 18 are connected, It is stored in the case 85. In this way, the clip package 80a is obtained.

In the clip package 80a of this embodiment, when the clip bodies B (clips 112A to 12C) are stored in the lower half 85b on the lower side of the case 85, the claw portion 22 of the next clip is opened to the opening portion 204 of the connecting member 15. By passing the upper case part 82a, the arm part 28 of the clip 112 is pressed by the inner surface of the case 85, and the connecting member 15 is clamped by the claw part 22, so that the three clip bodies B in the case And the dummy clip 18 is accommodated in the case 85 in a connected state. As described above, in order to obtain the clip package 80a, the clip package 80a can be easily assembled without complicated operations.
Moreover, since it is only hooked and engaged with the turn part 25 of the front clip 112, it is easy to attach the connecting member 15 to the clip 112.

Next, with reference to FIGS. 22, 23 (A) to (C) and FIGS. 24 (A) to (E), a clipping operation in the clip treatment tool 100 used in the present embodiment will be described.
FIG. 22 is a schematic diagram showing an unfolded slider guide of the clip treatment tool used in the embodiment of the present invention. In FIG. 22, the position of the slider pin 70 is represented by a circle.

Prior to the clipping operation, the clip row A including the three clips 112A to 112C is loaded into the sheath 16 from the clip package 80a.
The loading method from the clip package 80a of this embodiment into the sheath 16 of the clip row A is the same as the loading method of the first embodiment.
Also in this embodiment, the slider 54 of the operation unit 50 shown in FIG. 22 is moved along the guide groove 120A and the loading groove 122, and the slider pin 70 is moved to the position P21 shown in FIG. The connection member 21 of the operation wire 20 is protruded by a predetermined amount from the tip 16a.
As shown in FIG. 23A, the lower cap 86 of the clip package 80 a is removed, and the connection member 21 at the distal end of the operation wire 20 protruding from the distal end 16 a of the sheath 16 is connected to the rear end of the dummy clip 18 in the case 85. It connects to the connection member 19 of a part.

  Next, as shown in FIG. 23 (B), the sheath 16 is inserted to the distal end of the sheath fitting portion 94 and is fitted to the case 85 to connect the distal end 16a of the sheath 16 and the rear end of the case 82. To do.

Next, the slider pin 70 is moved along the second groove 122b and the first groove 122a to move to the position P22. At this time, since the operation wire 20 is rotated by 90 °, the clip row A is rotated by 90 ° as shown in FIG. Thereby, the skirt part 38 of each clip 112A-112C is closed, and it accommodates in the inside of each connection ring 114A-114C.
Next, the position of the sheath 16 remains the same, the slider 54 is pulled, and the slider pin 70 is moved from the position P22 to the position P20 along the guide groove 66A. Thereby, the operation wire 20 is pulled in the longitudinal direction of the sheath 16, and the clip row A (the clips 112 </ b> A to 112 </ b> C, the connection rings 114 </ b> A to 114 </ b> C, the connection member 15, and the dummy clip 18) in the case 85 is sequentially moved from the rear end side. The clip row A is loaded as shown in FIG. Thereby, the clip treatment tool 100 is configured.
The slider pin 70 is moved to the HP that contacts the end surface on the rear end side of the guide groove 66A, and is at the position P20. This state is an initial state of treatment in the clip treatment device 100.

Thereafter, the sheath 16 is inserted into a forceps port (not shown) of an endoscope (not shown) inserted into the living body, and the distal end of the sheath 16 reaches the distal end of the insertion portion of the endoscope. Project from the tip of the endoscope.
Further, if necessary, the distal end 16a of the sheath 16 of the clip treatment device 10 is moved to a target position by operating an insertion portion or an angle portion of the endoscope.

  After the necessary operation is completed, the slider guide 56 is rotated by 90 ° so that the guide groove 120B and the engagement groove 68 (see FIG. 6) are aligned. Thereby, the position of the slider 54 (slider pin 70) moves to HP corresponding to the guide groove 120B indicated by position P23 in FIG. At this time, the distal end of the clip row A moves to the distal end side of the sheath 16 by a predetermined distance. This state is, for example, the state of the clip 112A shown in FIG.

Next, the slider 54 is moved to the front end side along the guide groove 120B, and the slider pin 70 is moved to a position where it abuts on the end portion 123B on the front end side of the guide groove 120B. That is, it is moved to the maximum protruding position P24 shown in FIG.
By pushing out the slider 54, that is, pushing out the operation wire 20, the clip row A moves to the distal end side, and as shown in FIG. 24B, the leading clip 112A and the connecting ring 114A are moved from the distal end 16a of the sheath 16. The first region 32 protrudes. Thereby, the arm part 28 of the clip 112A is opened, and the claw part 22 is automatically separated by a predetermined distance. Further, the skirt portion 38 of the connecting ring 114 </ b> A opens outward from the inner diameter of the sheath 16. As a result, the clip 112 </ b> A does not return into the sheath 16 and is held by the distal end 16 a of the sheath 16 by the second region 34.

Here, the clip 112, the connecting ring 114, and the connecting member 15 have dimensional variations due to manufacturing errors. Further, in the clip treatment tool 100 inserted through the endoscope (the insertion portion thereof), the amount of protrusion of the operation wire 20 may decrease due to differences in inner and outer circumferences caused by bending or bending of the operation wire 20 and the sheath 16. .
For this reason, in the clip treatment instrument 100, the end portion 123B on the distal end side of the guide groove 120B is securely connected regardless of the manufacturing error of the clip 112 or the like, the state of the sheath 16, and the like. The skirt portion 38 of the ring 114A is formed so as to be at the maximum projecting position (clip standby position) P24.
Therefore, normally, in a state where the slider 54 is pushed out to the maximum projecting position P24, the skirt portion 38 of the coupling ring 114A is positioned ahead of the distal end portion of the sheath 16, and the skirt portion 38 and the sheath 16 are located. Is separated from

  In this regard, the same applies to the configuration of the guide groove 120C corresponding to clipping by the second clip 112B and the guide groove 120D corresponding to clipping by the third clip 112C.

  Next, for example, while viewing the image of the endoscope, the slider 54 is pulled back to the HP side, and the clip row reaches the standard protruding position (clip disclosure position) P25 where the skirt portion 38 of the connecting ring 114A contacts the distal end 16a of the sheath 16. Pull A back. That is, the clip row A is pulled back to the sheath 16. Thus, the preparation for the first clipping, that is, the clipping by the first clip 112 is completed. As a result, the clip is ready for clipping.

  After returning the slider 54 to the standard protruding position P25 to prepare for clipping, the endoscope is operated to press the claw portion 22 of the expanded clip 112A to the position of the living body b to be clipped, and the slider 54 is moved. It moves to the base end side and pulls back to HP, that is, position P26 (clip completion position).

In the ready state, since the skirt portion 38 of the connecting ring 114A is open, the pressing and holding of the clip 112A by the skirt portion 38 in the connecting ring 114A is open. The connecting ring 114 </ b> A is prevented from retreating into the sheath 16 because the skirt portion 38 is open at the distal end of the sheath 16.
Therefore, the leading clip 112A is drawn into the connecting ring 114A by the movement of the slider 54, and the arm portion 28 opened by the tightening ring 40 is closed in the closing direction C, as shown in FIG. Thus, the nail | claw part 22 obstruct | occludes and the biological body b is clipped. Further, when the slider 54 moves from the standard projecting position P25 to the clip completion position P26 (moves by the clip stroke from the standard projecting position P25), as described above, it is drawn into the connecting ring 114A up to just below the convex part 30 of the arm part 28. Clipping is complete.

  Next, the slider guide 56 is rotated by 90 ° so that the guide groove 120C and the engagement groove 68 are aligned. Thereby, the position of the slider 54 (slider pin 70) moves to HP corresponding to the guide groove 120C indicated by position P27 in FIG. At this time, the second clip 112B at the distal end of the clip row moves to the distal end side of the sheath 16 by a predetermined distance.

Then, the slider 54 is moved along the guide groove 120C, and the slider pin 70 is moved to a position where it abuts on the end portion 123C on the distal end side of the guide groove 120C. That is, it is moved to the maximum protruding position P28 shown in FIG. At this time, when moved to the position P28, as shown in FIG. 24D, the second clip 112B moves to the tip side from the position where the clipping of the first clip 112A is completed.
For this reason, when the slider 54 is moved to the maximum projecting position P28, the second clip 112B pushes the first clip 112A outward through the connecting member 15, and the second clip 112B is also connected to the connecting member 15. At the same time, the claw portion 22 protrudes to the outside of the sheath 16. Accordingly, as shown in FIG. 24D, the pressing of the claw portion 22 by the inner surface of the sheath 16 is released, and the clamping of the connecting member 15 is released. Further, when the slider 54 is moved to the maximum projecting position P28, the second clip 112B projects to the outside of the sheath 16 as shown in FIG. At this time, the first clip 112 </ b> A holds the living body b in a state where the arm portion 28 is tightened by the connection ring 114 and the connection member 15 is attached to the turn portion 25. As described above, clipping is performed by the first clip 112A.

Thereafter, with respect to the second clip 112B, the slider 54 is pulled back to the HP side, the clip row A is pulled back to the standard protruding position P29 where the skirt portion 38 of the connecting ring 114B abuts against the distal end 16a of the sheath 16, and the second clip 112B Set 112B to the clip start position. As a result, the second clip 112B is ready for clipping.
Thereafter, the claw portion 22 of the second clip 112B that is expanded is pressed against the position of the living body b to be clipped, the slider 54 is moved to the proximal end side, and pulled back to HP, that is, the position P30 (clip completion position). Complete clipping.

  Next, the slider guide 56 is rotated by 90 ° so that the guide groove 120D and the engagement groove 68 coincide with each other. Thereby, the position of the slider 54 (slider pin 70) moves to HP corresponding to the guide groove 120D indicated by position P31 in FIG. At this time, the third clip 112C at the distal end of the clip row moves to the distal end side of the sheath 16 by a predetermined distance.

Then, the slider 54 is moved to the tip side along the guide groove 120D, and the slider pin 70 is moved to a position where it abuts on the bent portion 67D on the tip side of the guide groove 120D. That is, it is moved to the maximum protruding position (clip standby position) P32 shown in FIG. At this time, if the second clip 112B is moved to the position P32, the third clip 112C moves to the tip side from the position where the clipping of the second clip 112B is completed.
For this reason, when the slider 54 is moved to the maximum projecting position P32, the third clip 112C pushes the second clip 112B outward through the connecting member 15, and the third clip 112C is also connected to the connecting member 15. At the same time, the claw portion 22 protrudes to the outside of the sheath 16. As a result, similarly to the second clip 112B shown in FIG. 24D, the pressing of the claw portion 22 by the inner surface of the sheath 16 is released, and the connection with the connecting member 15 is released. Further, when the slider 54 is moved to the maximum projecting position P32, the third clip 112C projects to the outside of the sheath 16 in the same manner as the second clip 112B shown in FIG. At this time, similarly to the first clip 112A shown in FIG. 24E, the second clip 112B grips the living body b with the connecting member 15 still attached to the turn portion 25.

  Next, when clipping with the third clip 13C, the slider 54 is pulled back to the HP side, and the clip row is pulled back to the standard protruding position P33 where the skirt portion 38 of the connecting ring 114B abuts against the distal end 16a of the sheath 16. The clip 112C is set to the clip start position. As a result, the third clip 112C is ready for clipping. Thereafter, the claw portion 22 of the third clip 112C that has been expanded is pressed against the position of the living body b to be clipped, the slider 54 is moved to the proximal end side, and pulled back to HP, that is, the position P34 (clip completion position). Complete clipping.

  Next, the slider 54 is moved along the guide groove 120D, and the lidar pin 70 is moved to a position where it abuts on the end 123E of the guide groove 120D. That is, it is moved to the position P35 shown in FIG. At this time, when the dummy clip 18 protrudes from the distal end 16a of the sheath 16, the holding of the connecting member 15 of the third clip 112C is released, and the third clip 112C has the connecting member 15 attached to the turn portion 25. The living body b is gripped in the state as it is.

When the clipping by the three clips 112 is completed, the slider 54 is moved to the base end side along the guide groove 120A, and the position of the slider 54 is again set to the position P1, that is, the guide groove in FIG. Return to the HP corresponding to 120A. Thereafter, the sheath 16 of the clip treatment device 100 is pulled out from the endoscope.
After the sheath 16 is pulled out, the slider 54 is pushed out to a position P2 where it abuts on the end portion 123A on the distal end side of the guide groove 120A. The clip 18 and the connecting member 19 are removed from the connecting member 21 at the distal end of the operation wire 20.

In the clip treatment instrument 100 used in the present embodiment, when the rear clip 112 is pushed, the front clip 112 can be pushed through the coupling member 15, and the rear clip 112 is clamped by the coupling member 15. Since the arm portion 28 of the rear clip 112 is automatically expanded when the arm portion 28 of the rear clip 112 protrudes from the distal end 16a of the sheath 16, the connection with the front clip 112 is reliably released. Can be.
Further, in the clip treatment instrument 100 used in the present embodiment, since the expansion direction (occlusion direction C) of the arm portion 28 can be matched, the operator cares about the expansion direction of the clip. Since clipping is possible, workability can be improved.

  Also in the clip treatment device 100, when the slider 54 reaches the positions (clip completion positions) P26, P30, and P34, the concave and convex portions that engage with each other, the energized sphere and the concave portion that engages with this are known. By this means, it is preferable that a small impact (so-called click feeling) is generated so that the doctor performing the treatment can perceive that the clipping is completed.

  In the clip treatment devices 10 and 100, there are three sizes of clips, for example, a standard size (standard type), a short size (short type), and a long size (long type). In order to deal with various clip sizes, a guide portion having guide grooves corresponding to each clip size may be prepared, and the guide portion may be exchanged according to the clip size.

  As described above, the continuous clip treatment device and the clip package of the present invention have been described in detail. However, the present invention is not limited to the above-described embodiment, and various improvements and modifications can be made without departing from the gist of the present invention. Of course, you may do.

  As described above, the clip package and the clip loading method of the present invention have been described in detail. However, the present invention is not limited to the above embodiment, and various improvements and modifications can be made without departing from the gist of the present invention. Of course, you can go.

DESCRIPTION OF SYMBOLS 10 Clip treatment tool 12 Clip 14 Connection ring 15 Connection member 16 Sheath 18 Dummy clip 19 Connection member 21 Connection member 20 Operation wire 22 Claw part 24, 25 Turn part 26 Intersection part 28 Arm part 30 Convex part 32 1st area | region 34, 34a Second region 38 Skirt portion 39 Notch portion 40 Clamping ring 41, 43 Hole 42, 45 Holding portion 46 Slit 48 Clip treatment instrument operation handle (operation handle)
DESCRIPTION OF SYMBOLS 50 Operation part 52 Handle body 54 Slider 56 Slider guide 56a Joint part 56b Holding part 56c Guide part 58 Rotation position control member 60 Energizing spring 62 Finger ring 66A-66D, 120A-120D Guide groove 67 Loading groove 68 Engagement groove 70 Slider Pin 80, 80a Clip package 82, 85 Case 84 Upper cap 86 Lower cap

Claims (12)

There are provided two arm portions each having a claw portion at a base end portion, a clip that closes the arm portion and sandwiches an object with the claw portion, and a connection ring that is fitted to the clip so as to be able to advance and retreat. A clip body comprising,
It has an inner diameter that is slightly larger than the outer diameter of the connecting ring, and the claw portion of the clip of the rear clip body engages with the base end of the clip of the front clip body, and this engaging portion is covered with the connecting ring. A plurality of clip bodies connected to each other, and a cylindrical case containing therein a clip row including a connection member connected to the last clip body,
In the natural state where no external force is applied, the connection ring has a skirt portion that projects outwardly in the radial direction with its body as a rotation axis, and closes inward when pressed inward in the radial direction,
The case has an opening for maintaining the skirt portion in a natural state at a position corresponding to the skirt portion of the connection ring of the clip body accommodated.
The clip row is housed in the case with the skirt portion of the clip body projecting from the opening, and the skirt is rotated when the case and the clip row are relatively rotated by a predetermined angle. The clip package is characterized in that the portion is pressed by the inner surface of the case and closed inward to the position of the inner surface of the case. The skirt portion is formed by cutting out a substantially U-shape with the peripheral surface of the connecting ring leaving an end extending in the axial direction,
2. The clip package according to claim 1, wherein the skirt portion rotates around the end side as a rotation axis and extends outward in the radial direction or closes inward.   3. The clip package according to claim 1, wherein the clips in the clip row are connected by alternately changing the direction in which the arm portion is closed by 90 °.   The clip package according to any one of claims 1 to 3, wherein a surface of the opening of the case that is aligned with a side of the skirt portion that extends in the axial direction of the connection ring is formed by an inclined surface. . Two arms with claw portions are provided at the base end, a clip that closes the arm portion and sandwiches an object with the claw portion, and a connection ring that is fitted to the clip so as to be able to advance and retreat. A clip body including one end portion engaged with a base end portion of the clip, and the other end portion sandwiched between claws of the other clip to connect a plurality of clips;
The rear clip body has an inner diameter slightly larger than the outer diameter of the connection ring, and the other end portion of the connection member of the front clip body is pushed by the claw portion when the arm portion of the clip is pressed against the inner surface of the case. A plurality of clip bodies that are sandwiched and connected, and a cylindrical case that houses therein a clip row including another connection member connected to the connection member of the last clip body;
In the natural state where no external force is applied, the connection ring has a skirt portion that projects outwardly in the radial direction with its body as a rotation axis, and closes inward when pressed inward in the radial direction,
The clip row is housed in the case with the skirt portion of the clip body protruding from the opening, and the skirt is rotated when the case and the clip body are relatively rotated by a predetermined angle. The clip package is characterized in that the portion is pressed by the inner surface of the case and closed inward to the position of the inner surface of the case. The skirt portion is formed by cutting out a substantially U-shape with the peripheral surface of the connecting ring leaving an end extending in the axial direction,
The clip package according to claim 5, wherein the skirt portion rotates around the end side as a rotation axis, spreads outward in the radial direction, or closes inward.   The clip package according to claim 5 or 6, wherein each clip of the clip row is connected so that a closing direction of the arm portion coincides.   The clip package according to any one of claims 5 to 7, wherein a surface of the opening of the case that is aligned with a side of the skirt portion that extends in the axial direction of the connection ring is formed by an inclined surface. .   The clip case according to any one of claims 1 to 8, wherein the case has a fitting portion into which a sheath for loading the clip and the connection ring is fitted at a rear end portion.   The clip package according to any one of claims 1 to 9, wherein the case and the clip body are relatively rotated by 90 °. A clip loading method for loading the clip body of the clip package according to any one of claims 1 to 10 into a sheath of an endoscopic clip treatment tool,
Connecting a distal end of an operation wire disposed in the sheath for pulling the clip row to a connecting member attached to the rearmost clip in the case;
Connecting the tip of the sheath and the rear end of the case;
Rotating the operation wire by a predetermined angle, rotating the clip row by a predetermined angle, and closing the skirt portion to the position of the inner surface of the case;
And a step of storing the clip row in the sheath by moving the distal end of the operation wire in a direction of moving to the proximal end side of the sheath.   The clip loading method according to claim 11, wherein the operation wire is rotated by 90 °.

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