JP2011078592A - Clip, clip unit and clip device - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To sufficiently secure the rigidity of a clip and to favorably reopen the clip for ligating again. <P>SOLUTION: This clip includes: a body 4 having arm parts 2, 3 opened from the proximal end toward the proximal end; and a fastening member (e.g. a fastening ring 6) inserted to the outside of the body 4 and moved toward the distal end to fasten the arm parts 2, 3, the tips 5 of which can be closed. In the arm parts 2, 3, the tips 5 thereof are closed to ligate biological tissue by the tips 5. The arm parts are configured to repel each other against the external force applied in the direction of making the tips 5 close to each other. In the respective arm parts 2, 3, a partial section in the direction pointing from the proximal end toward the distal end constitutes a fastening receiving part 7 fastened by the fastening member. The outer peripheral shape of the fastening receiving part 7 at least in one of the arms 2, 3 is formed like a reverse projected curved surface to the other of the arm parts 2, 3. <P>COPYRIGHT: (C)2011,JPO&INPIT

Description

  The present invention relates to a clip, a clip unit, and a clip device.

  Various clips have been proposed for ligating living tissue.

  Patent Document 1 discloses a clip, a fastening ring that fits and attaches to the clip, closes the clip, and a connecting member that can be inserted into the fastening ring and engages with the clip. An introduction pipe capable of accommodating the clip and the tightening ring, an operation member inserted in the introduction pipe so as to freely advance and retract, and provided in at least one of the tightening ring or the introduction pipe. A living body comprising: an engaging means for engaging the introduction tube and the clamping ring when the projection protrudes forward of the introduction tube and prohibiting the clamping ring from being stored again in the introduction tube; A tissue clip device is disclosed. According to this biological tissue clip device, it is possible to store the clip in the introduction tube and insert the clip into the living body cavity only by advancing and retracting the operation member, and further, the clip stored only by the advance and retreat operation of the operation member At the same time as it is released from the body, it can be engaged and the living tissue can be ligated.

  However, in the clip device of Patent Document 1, once the clip is closed, it is difficult to reopen and ligate again. When the ligation treatment fails, it is necessary to try again with a new clip.

  In view of such a problem, Patent Documents 2 and 3 describe clips that can be reopened until an optimum ligation can be confirmed.

  Among them, the clip of Patent Document 2 includes a main body having both arm portions extending from the base end portion and opening by self-expanding property, and a tightening member attached to the main body so as to be able to advance and retreat. Each of the arm portions includes a curved portion extending from the proximal end portion and a substantially linear gripping portion extending from the curved portion toward the distal end side. This clip is configured such that both arms open when the tightening member moves toward the base end, and both arms close when the tightening member moves toward the bending portion. And the constriction part is provided in the curved part of both arm parts, respectively.

  Moreover, the clip of patent document 3 has at least 1 control part which controls the approach by the force below predetermined of a fastening member instead of the constriction part of the clip of patent document 2. FIG. The restricting portion includes a protrusion having a substantially hemispherical outer surface. This protrusion abuts against the tightening member and restricts the approach of the both end portions of the tightening member to the tip side.

JP 2007-222649 A JP 2007-159794 A JP 2009-66226 A

  The clips of Patent Documents 1 to 3 are configured by bending a flat plate-like member. For this reason, in order to ligate living tissue with a sufficient force, it is necessary to ensure the rigidity of the clip by setting the plate-like member to a sufficient plate thickness. If the plate thickness and rigidity are insufficient, the clip may be deformed during ligation and become unusable.

  Further, in the clips of Patent Documents 2 and 3, due to the self-expanding nature of the main body, both the arm portions are reopened by pushing the fastening member back to the base end side with a flat plate-like member. . For this reason, it is necessary to set the plate-like member to a sufficient plate thickness and rigidity in order to push back the fastening member to the base end side with a sufficient force. If the plate thickness and rigidity are insufficient, the plate-like material is deformed, so that the fastening member cannot be pushed back to the base end side with a sufficient force, and it is difficult to suitably reopen both arms.

  The present invention has been made in view of the above problems, and has a clip that can sufficiently ensure the rigidity of the clip and that can suitably reopen the clip for religation. It is an object to provide a clip unit and a clip device having the clip.

The present invention includes a main body having a pair of arms that open from the proximal side toward the distal side,
A clamping member that is extrapolated to the main body and moved to the distal end side, thereby tightening the pair of arms and closing the distal ends;
Have
The pair of arms are configured to ligate living tissue at the distal ends when the distal ends are closed, and repel each other against an external force acting in a direction to bring the distal ends closer together. Configured,
In each arm portion, a part of the section in the direction from the base end side to the tip end side constitutes a tightening receiving portion that is tightened by the tightening member,
The outer peripheral shape of the tightening receiving portion in at least one of the arm portions is formed in a curved surface that is convex in the opposite direction with respect to the other arm portion,
The tightening receiving portion has first to third sections in this order in the direction from the proximal end side to the distal end side, and the first and second sections expand in diameter toward the distal end side. ,
In a state where the tightening member tightens the third section of the pair of arm portions, the tightening member is fixed to the pair of arm portions with the tip portions closed, and the repulsive force causes the tightening member to be Configured not to move to the second and first sections,
In a state in which the tightening member tightens the second section of the pair of arm portions, the distal end portions are closed, and in this state, the force to move the tightening member toward the distal end side or an attempt to hold the position is held. When the force to release is released, the tightening member moves to the first section of the pair of arm portions as the pair of arm portions open using the repulsive force, There is provided a clip characterized in that the distal ends are opened to such an extent that the living tissue can be ligated again.

According to this clip, the outer peripheral shape of the clamping receiving portion in at least one of the arm portions is formed in a curved surface that is convex in the opposite direction with respect to the other arm portion. Compared with the case where it is comprised in, the rigidity of a clamping receiving part can be improved.
Further, the pair of arm portions are configured to repel each other against an external force acting in a direction in which the distal end portions are brought closer to each other, and the tightening receiving portion has a distal end in the first and second sections. The diameter is expanded toward the side. For this reason, even after the second section of the pair of arm portions is tightened by the tightening member and the distal end portions are closed, that is, after the living tissue is ligated, the rebounding force of the pair of arm portions is used to tighten the tightening member. By pushing back from the second section to the first section, the distal ends can be opened to such an extent that the living tissue can be ligated again. Such a reopening operation of the tip can be more suitably performed by increasing the rigidity of the tightening receiving portion as described above.
As described above, according to the clip of the present invention, it is possible to sufficiently ensure the rigidity of the clip and to suitably reopen the clip for religation.
Note that when the tightening member is moved to the third section located before the second section and the third section is tightened by the tightening member, the tightening member is fixed to the pair of arm portions in a state where the distal ends are closed. The tightening member is prevented from moving to the second and first sections by the repulsive force of the pair of arms. For this reason, the clip which has a main body and a fastening member can be maintained in the state which tied the biological tissue by fastening a 3rd area with a fastening member.

The present invention also includes a clip of the present invention,
A connecting portion detachably connected to the body of the clip;
When the main body moves toward the base end side as the connecting portion is pulled, the movement of the tightening member is restricted, and the movement of the tightening member relative to the main body moves toward the distal end side. The regulatory department,
A clip unit is provided.

The present invention also includes a clip of the present invention,
A sheath capable of accommodating the clip;
An operation transmission wire inserted into the sheath;
A connecting portion that connects the operation transmission wire and the main body of the clip to each other, and is separable from the main body;
An operation portion capable of performing an operation of pushing the clip out of the sheath and an operation of pulling the main body into the sheath by advancing and retracting the operation transmission wire in the sheath;
A movement restricting portion that restricts movement of the tightening member when the main body is drawn into the sheath and moves the tightening member relative to the main body toward the distal end; and
A clip device is provided.

  According to the present invention, it is possible to sufficiently secure the rigidity of the clip, and it is possible to suitably reopen the clip for religation.

It is a side view showing a clip concerning an embodiment. It is a figure which shows the main body of the clip concerning embodiment. It is a perspective view of the main body of the clip concerning an embodiment. It is a front view which shows the front-end | tip part of the main body of the clip concerning embodiment. It is a side view which shows the state which a clamping ring (tightening member) clamps the 1st area of the clamping receiving part of a main body. It is a side view which shows the state which a clamping ring (tightening member) clamps the 2nd area of the clamping receiving part of a main body. It is a side view which shows the state by which the clamp ring (tightening member) was fixed to the 3rd area of the clamp receiving part of a main body. It is a figure which shows the clamp | tightening ring (tightening member) of the clip concerning embodiment. It is a mimetic diagram showing the whole clip device composition concerning an embodiment. It is a figure which shows the front-end | tip part of the clip apparatus which concerns on embodiment. It is a disassembled perspective view which shows the connection unit of the clip unit which concerns on embodiment. It is a top view which shows the state which connected the operation transmission wire and the main body with the connection unit. It is a perspective view which shows the reduced diameter tube of the clip unit which concerns on embodiment. It is a plane sectional view of the important section showing the state where the diameter-reduced tube is engaged with the tip ring provided at the tip of the sheath. It is a plane sectional view showing a cartridge which has a clip unit concerning an embodiment. FIG. 16 is a plan sectional view for explaining an operation of accommodating the clip unit of the cartridge of FIG. 15 in the sheath of the clip device. It is a plane sectional view of the important section showing the state where the clip concerning this embodiment was stored in the sheath of a clip device. It is a plane sectional view showing a tip part of a clip device in the state where a clamp ring (tightening member) clamps the 3rd section of a clamp receiving part of a main part. It is a front view of the front-end | tip part which shows the other example of a nail | claw-shaped part.

  Hereinafter, embodiments of the present invention will be described with reference to the drawings. In all the drawings, the same components are denoted by the same reference numerals, and the description thereof is omitted as appropriate.

  Drawing 1 is a side view showing clip 1 concerning an embodiment. FIG. 2 is a view showing the main body 4 of the clip 1 according to the embodiment, in which (a) is a plan view and (b) is a side view. FIG. 3 is a perspective view of the main body 4 of the clip 1 according to the embodiment. FIG. 4 is a front view showing the distal end portion 5 of the main body 4 of the clip 1 according to the embodiment. FIG. 5 is a side view showing a state in which the tightening ring 6 tightens the first section 11 of the tightening receiving portion 7 of the main body 4. FIG. 6 is a side view showing a state in which the fastening ring 6 fastens the second section 12 of the fastening receiving portion 7 of the main body 4. FIG. 7 is a side view showing a state in which the tightening ring 6 is fixed to the third section 13 of the tightening receiving portion 7 of the main body 4. FIG. 8 is a view showing a fastening ring (clamping member) 6 of the clip 1 according to the embodiment, in which (a) is a perspective view, (b) is a side view, and (c) is an arrow A direction of (b). The front view seen from (d) is the rear view seen from the arrow B direction of (b). FIG. 9 is a schematic diagram illustrating the overall configuration of the clip device 100 according to the embodiment. FIGS. 10A and 10B are views showing the tip of the clip device 100 according to the embodiment, in which FIG. 10A is a plan sectional view and FIG. 10B is a side sectional view. 11 is an exploded perspective view showing the connecting unit 50 of the clip unit 110 according to the embodiment, FIG. 12 is a plan view showing a state where the operation transmission wire 42 and the main body 4 are connected by the connecting unit 50, and FIG. 13 shows the embodiment. It is a perspective view which shows the reduced diameter tube 70 of the clip unit 110 which concerns. FIG. 15 is a plan sectional view showing a cartridge 150 having the clip unit 110 according to the embodiment.

  In addition, in the clip 1, the clip unit 110 and the clip device 100 according to the embodiment, and their respective components, in FIGS. 1, 2, 5 to 7, 10, 12, 12, and 14 to 18. The left end is called the tip, and the right end is called the base end. Similarly, in the operation unit 80 of the clip device 100, the left end in FIG. 9 is referred to as the distal end, and the right end is referred to as the proximal end.

The clip 1 according to this embodiment includes a main body 4 having a pair of arm portions 2 and 3 that open from the proximal end side toward the distal end side. Further, a tightening member (for example, a tightening ring 6) that can be externally inserted into the main body 4 and moved to the distal end side to tighten the pair of arm portions 2 and 3 and close the distal end portions 5 to each other. Have. The pair of arms 2 and 3 ligate the living tissue at the distal end 5 when the distal ends 5 close to each other, and resist each other against an external force acting in a direction to bring the distal ends 5 closer together. It is configured to repel each other. In each of the arm portions 2 and 3, a part of the section in the direction from the proximal end side to the distal end side constitutes a tightening receiving portion 7 that is tightened by the tightening member. The outer peripheral shape of the fastening receiving portion 7 in at least one of the arm portions (both arm portions 2 and 3 in the case of the present embodiment) is formed in a curved surface that is convex in the opposite direction with respect to the other arm portion. The tightening receiving portion 7 has first to third sections 11, 12, and 13 in this order in the direction from the proximal end side to the distal end side, and the first and second sections 11 and 12 expand toward the distal end side. It has a diameter. In a state in which the tightening member tightens the third section 13 in the tightening receiving portion 7 of the pair of arm portions 2 and 3, the tightening member is fixed to the pair of arm portions 2 and 3 with the distal end portions 5 closed, and the repulsion The clip 1 is configured so that the tightening member does not move to the first and second sections 11 and 12 with this force. In a state where the tightening member tightens the second section 12 in the tightening receiving portion 7 of the pair of arm portions 2 and 3, the distal end portions 5 are closed, and in this state, the force or position for moving the tightening member to the distal end side is applied. When the force to be held is released, the tightening member is a tightening receiving portion of the pair of arm portions 2 and 3 as the pair of arm portions 2 and 3 are opened using the repulsive force. 7 is moved to the first section 11 so that the distal end portions 5 are opened to the extent that the living tissue can be ligated again.
The clip unit 110 according to the present embodiment includes the clip 1 according to the present embodiment and a connecting portion (for example, a connecting unit 50) that is detachably connected to the main body 4 of the clip 1. Further, when the main body 4 moves to the base end side as the connecting portion is pulled, the movement of the tightening member (for example, the tightening ring 6) is restricted, and the tightening member is relatively distal to the main body 4. It has a movement restricting portion (for example, a reduced diameter tube 70) that moves to the side.
The clip device 100 according to the present embodiment includes the clip 1 according to the present embodiment and a sheath 41 that can accommodate the clip 1. Further, an operation transmission wire 42 inserted into the sheath 41, a connection portion (for example, a connection unit 50) that connects the operation transmission wire 42 and the main body 4 of the clip 1 to each other and is separable from the main body 4. Have. Furthermore, the operation transmission wire 42 is advanced and retracted in the sheath 41 to have an operation portion 80 capable of pushing the clip 1 out of the sheath 41 and pulling the main body 4 into the sheath 41. Furthermore, it has a movement restricting portion (for example, a reduced diameter tube 70) that restricts the movement of the tightening member when the main body 4 is drawn into the sheath 41 and moves the tightening member to the distal end side relative to the main body 4.
Details will be described below.

  First, the configuration of the clip 1 according to this embodiment will be described.

  The clip 1 according to the present embodiment is suitably used for an endoscope, for example, and has, for example, a main body 4 and a tightening ring 6 as shown in FIG.

  As shown in FIGS. 1 to 3, the main body 4 has a pair of arm portions 2 and 3. The arm portions 2 and 3 are formed vertically symmetrical with each other in FIG. The main body 4 is configured, for example, by bending a single plate-like member formed with a pair of arm portions 2 and 3 at the center. That is, the pair of arm portions 2 and 3 are connected to each other at the base end portion 4b so as to be integrated. And a pair of arm parts 2 and 3 are mutually opened toward the front end side from the base end side. The arm portions 2 and 3 ligate a living tissue (not shown) at the distal end portion 5 when the distal end portions 5 are closed to each other. By this ligation, treatment such as hemostasis treatment, mucosal stitching and marking is possible. Among these, examples of hemostasis include hemostasis of exposed blood vessels or bleeding points. In addition, examples of mucosal sutures include ulcer stitches and perforation closure after EMR (endoscopic mucosal resection) or ESD (endoscopic submucosal dissection). The marking is to use the clip 1 as various marks.

  1 shows a state in which the pair of arm portions 2 and 3 of the main body 4 are naturally opened by their repulsive force, and in FIGS. 2 and 3, the pair of arm portions 2 and 3 of the main body 4 are closed by an external force. Shows the state.

  In the arms 2 and 3, a part of the section in the direction from the proximal end side to the distal end side constitutes a tightening receiving portion 7 that is tightened by the tightening ring 6. The outer peripheral shape of the distal end side portion 8 including the tightening receiving portion 7 in the arm portion 2 is formed in a curved surface convex in the opposite direction to the arm portion 3. Similarly, the outer peripheral shape of the distal end side portion 8 including the tightening receiving portion 7 in the arm portion 3 is formed in a curved surface shape convex in the opposite direction to the arm portion 2. The distal end portion 8 may be hollow inside or may not be hollow inside.

  The tightening receiving portion 7 has first to third sections 11, 12, and 13 in this order in the direction from the proximal end side to the distal end side of the arm portions 2 and 3.

  The tightening receiving portion 7 is expanded in diameter toward the distal end side of the arm portions 2 and 3 in the first and second sections 11 and 12. That is, the portion from the first section 11 to the second section 12 in the tightening receiving portion 7 forms a series of slopes having a convex curved surface shape.

  The outer peripheral shape of the tightening receiving portion 7 from the first section 11 to the second section 12 is a shape obtained by dividing the cone shape in parallel with the axis. More specifically, the outer peripheral shape from the first section 11 to the second section 12 of the clamping receiving portion 7 is, for example, two structures obtained by cutting a conical structure along a plane parallel to the cone axis. Of these, it has a shape like a curved surface on the outer periphery of the structure not including the conical axis.

  2 and 3, when the distal end portion 5 is closed, the outer periphery of the first and second sections 11 and 12 of one arm portion 2 and the first and second of the other arm portion 3 are provided. The outer peripheries of the two sections 11 and 12 are positioned along a conical outer peripheral surface. In the state in which the distal end portion 5 is closed in this way, for example, an interval 29 is generated between the linear portion 15 of the arm portion 2 and the linear portion 15 of the arm portion 3.

  Further, the third section 13 of the tightening receiving portion 7 has a larger diameter than the second section 12. Specifically, for example, a step 14 that makes the third section 13 larger in diameter than the second section 12 is formed at the boundary between the second section 12 and the third section 13 in the tightening receiving portion 7. In addition, you may form this level | step difference 14 as an inclined surface where inclination is steeper than the 1st and 2nd area 11 and 12, as shown in FIG.2 (b), for example.

  A concave portion 17 that engages with a convex portion 16 (to be described later) of the tightening ring 6 is formed at an end portion on the distal end side in the third section 13 of the tightening receiving portion 7.

  The arm portions 2 and 3 are configured to repel each other against an external force acting in a direction in which the distal end portions 5 are brought closer to each other. Specifically, for example, the arm portions 2 and 3 have a leaf spring portion 9 configured in a leaf spring shape on the proximal end side with respect to the tightening receiving portion 7. The base end portions of the leaf spring portions 9 are the base end portions 4b. On the other hand, these leaf spring portions 9 are warped in a bow shape so that the tip portions of the leaf spring portions 9 are separated from each other. For this reason, the arm portions 2 and 3 are repelled against each other against an external force acting in a direction in which the distal end portions 5 are brought closer to each other by the elastic force of the leaf spring portion 9. As shown in FIG. 1, the leaf spring portions 9 of the arm portions 2 and 3 face each other diagonally when the arm portions 2 and 3 are open, as shown in FIGS. As shown, one side faces each other with the arms 2 and 3 closed (specifically, facing each other).

  Further, as shown in FIGS. 2A and 3, an arc-shaped (preferably arc-shaped) cutout portion 25 is formed in the base end side portion 4 a of the main body 4. Here, if the direction along the plate surface direction of the leaf spring portion 9 and perpendicular to the longitudinal direction of the arm portions 2 and 3 is referred to as the left-right direction, the notch portion 25 specifically includes, for example, These are formed at both ends in the left-right direction of the base end side portion 4a of the main body 4, respectively.

  Further, the portion adjacent to the rear side of the cutout portion 25 in the base end side portion 4 a constitutes a pair of overhang portions 26 that protrude relative to the cutout portion 25 in the left-right direction.

  Further, the portion adjacent to the rear side of the overhanging portion 26 in the base end side portion 4a is formed so that the left and right widths gradually become smaller toward the base end side, and constitutes the connecting sliding portion 27. Yes.

  Further, a portion of the base end side portion 4 a adjacent to the rear side of the connecting sliding portion 27 has a diameter equal to the base end portion of the connecting sliding portion 27, that is, the smallest diameter portion of the connecting sliding portion 27. A small-diameter portion 28 is configured.

  In addition, the leaf | plate spring part 9 becomes a substantially constant width | variety from the base end side of this leaf | plate spring part 9 to a front end side except the formation location of the notch part 25, the sliding part 27 for connection, and the small diameter part 28, for example. ing. However, you may form the leaf | plate spring part 9 so that it may become a little small diameter toward a base end side.

  Moreover, in the arm parts 2 and 3, the intermediate part of the front-end | tip part 5 and the clamping receiving part 7 comprises the linear part 15 extended linearly from the base end side to the front end side, for example. At the boundary between the linear section 15 and the third section 13, a step 18 is formed that makes the linear section 15 larger in diameter than the third section 13.

  The outer peripheral shape from the 3rd section 13 of the front end side part 8 to the linear part 15 is each formed in the half cylinder shape, for example. Specifically, the outer peripheral shape from the third section 13 of the distal end side portion 8 to the linear portion 15 is, for example, two structures obtained by cutting a cylindrical structure along a plane parallel to its central axis. Of these, it has a shape like a curved surface on the outer periphery of the structure not including the central axis.

  And in the state which the front-end | tip part 5 closed as shown in FIG.2 and FIG.3, the outer periphery from the 3rd area 13 to the linear part 15 of the front end side part 8 of one arm part 2, and the other arm part The outer periphery from the third section 13 of the three distal end side portions 8 to the linear portion 15 is positioned along one cylindrical outer peripheral surface.

  Further, the distal end portions 5 of the arm portions 2 and 3 are continuous with the distal end of the linear portion 15 so as to bend or bend with respect to the linear portion 15 so as to approach each other toward the distal ends of the distal end portions 5. Provided.

  As shown in FIG. 4, for example, a plurality of claw-like portions 31 and 32 for ligating living tissue are formed at the distal end portion 5 of the arm portions 2 and 3. These claw-shaped portions 31 and 32 are configured by alternately forming a plurality of mountain shapes 31a and 32a and valley shapes 33 each having a hem. The plurality of mountain shapes 31a and 32a include mountain shapes having different heights. That is, in the case of the present embodiment, for example, there are two peak shapes 31a and 32a included in one tip portion 5, and the heights of these two peak shapes 31a and 32a are different from each other. Further, the claw-like portions 31 and 32 of the one end portion 5 and the claw-like portions 31 and 32 of the other end portion 5 are point-symmetrical with the symmetry center point 34 as the center.

  The main body 4 having such a configuration is preferably made of, for example, metal, more preferably made of, for example, stainless steel, and particularly preferably made of SUS304 or SUS301.

  As shown in FIG. 1, the tightening ring 6 is extrapolated from the base end side of the main body 4 with respect to the main body 4. The tightening ring 6 is configured to be able to close the tip portions 5 by tightening the arm portions 2 and 3 by moving to the tip side of the arm portions 2 and 3 relative to the main body 4. ing.

  That is, when the tightening ring 6 is moved toward the distal end side of the main body 4 against the repulsive force due to the elasticity of the leaf spring portion 9, the opening angle between the arms 2 and 3 gradually decreases, and eventually the distal ends 5 Closes.

  As shown in FIG. 5, in a state where the tightening ring 6 tightens the first section 11 in the tightening receiving portion 7 of the arm portions 2 and 3, the distal end portions 5 are still open, and ligation of the living tissue is started from this state. Is possible.

  As shown in FIG. 6, when the tightening ring 6 tightens the second section 12 in the tightening receiving portion 7 of the arm portions 2 and 3, the distal end portions 5 are closed. In this stage, it is a preferable example that the tip portions 5 are in contact with each other, but the tip portions 5 are closed to such an extent that living tissue can be ligated by the pair of tip portions 5 even if they are not in contact. Just do it.

  Here, in a state where the tightening ring 6 tightens the second section 12 in the tightening receiving portion 7 of the arm portions 2 and 3, a force for moving the tightening ring 6 toward the distal end side, or the tightening ring 6 at the position. Assume that the force to be held is released. In this case, as the arms 2 and 3 open according to the repulsive force due to the elasticity of the leaf spring portion 9, the tightening ring 6 is connected to the first section 11 or the first section in the tightening receiving portion 7 of the arm portions 2 and 3. It moves to the base end side (leaf spring part 9 grade | etc.) Rather than the area 11. FIG. As a result, as shown in FIG. 5, for example, the distal end portion 5 is opened to such an extent that the living tissue can be ligated again.

  Further, as shown in FIG. 7, in a state where the tightening ring 6 tightens the third section 13 in the tightening receiving portion 7 of the arm portions 2 and 3, the tightening ring 6 is in the state in which the tip portions 5 are closed. 3 is fixed. In this state, the clip 1 is configured so that the tightening ring 6 does not move to the first and second sections 11 and 12 by the repulsive force due to the elasticity of the leaf spring portion 9.

  As shown in FIG. 8, the tightening ring 6 is formed, for example, in a cylindrical shape (specifically, for example, a cylindrical shape). The inner diameter of the tightening ring 6 is, for example, the base ends of the arm portions 2 and 3 rather than the inner diameter φ1 of the large diameter portion 22 located at the end of the arm portions 2 and 3 on the distal end side (left side in FIG. 8B). The small-diameter portion 23 located at the end portion on the side (the right side in FIG. 8B) is formed so that the inner diameter φ2 is smaller.

  A convex portion 16 that engages with the concave portion 17 of the third section 13 of the arm portions 2 and 3 is formed on the inner periphery of the end portion on the distal end side of the tightening ring 6, for example. Specifically, the convex portion 16 is formed in an annular shape, for example. The convex portion 16 constitutes the large diameter portion 22. The inner diameter of the intermediate portion 24 located between the large-diameter portion 22 (convex portion 16) and the small-diameter portion 23 in the tightening ring 6 is larger than the large-diameter portion 22 by the height of the convex portion 16. ing.

  Since the convex portion 16 is formed on the tightening ring 6 as described above, and the above-described step 14 is formed on the tightening receiving portion 7, the tightening ring 6 acts on the main body 4 with a strong force of a certain level or more. As long as it does not move forward relatively, it is not fitted on the third section 13.

  Here, the manufacturing method of such a fastening ring 6 is demonstrated. First, a plate material (not shown) having a rectangular and belt-like planar shape is prepared. This plate material has a linear convex portion (not shown) that later becomes the convex portion 16 along one side of the plate material. In addition, the extending direction of this convex part is a strip | belt direction of this board | plate material. Next, an engagement piece 19a is formed at one end in the band direction of the plate material, and a notch 19b engaged with the engagement piece 19a is formed at the other end by punching or the like. On the other hand, in this plate material, a plurality of notches 20 are intermittently formed along a side parallel to the side having the convex portion. The remaining piece 21 remaining between the notches 20 is bent so as to face the center of the tightening ring 6 as shown in FIG. In such a folded state, the shape of the end surface 21a of the residual piece 21 is appropriately determined by punching or the like so that the inner periphery of the annular frame constituted by the aggregate of the end surfaces 21a of the residual pieces 21 has a circular cross section. Process. In addition, illustration of the notch part 20 and the residual piece 21 is abbreviate | omitted in FIG.8 (b). Next, the plate material is bent into a cylindrical shape so that the convex portion is on the inside and looped, and the engagement piece 19a is engaged with the notch portion 19b. Next, the fastening pieces 6 shown in FIG. 8 are obtained by bending the remaining pieces 21 between the notches 20 inward. That is, in this state, as shown in FIG. 8C and FIG. 8D, the projecting portion becomes the annular projecting portion 16 and the annular frame configured by the aggregate of the end faces 21 a of the remaining pieces 21. That is, the inner circumference of the small diameter portion 23 is circular in cross section. The tightening ring 6 may be manufactured by turning a rod-shaped member.

  Such a tightening ring 6 is preferably made of metal, for example. More specifically, the tightening ring 6 is more preferably made of, for example, stainless steel, and particularly preferably made of SUS304 or SUS303.

  Next, the configuration of the clip device 100 according to the present embodiment will be described.

The clip device 100 according to the present embodiment is suitably used for an endoscope, for example. For example, as shown in FIGS. 9 to 10, the clip 1, the sheath 41, and the operation transmission wire 42 described above are used. The connecting unit 50, the reduced diameter tube (movement restricting portion) 70, and the operation portion 80 are included.
Such a clip device 100 is a suitable example of a catheter.

  The sheath 41 is a long and flexible sheath-like member. The sheath 41 can accommodate the clip 1, the operation transmission wire 42, the connecting unit 50, and the reduced diameter tube 70 therein. As for the inner peripheral shape of the sheath 41, the cross section orthogonal to the longitudinal direction is circular.

  The operation transmission wire 42 is inserted into the sheath 41 so that it can advance and retreat with respect to the sheath 41. In other words, the operation transmission wire 42 advances and retreats in the longitudinal direction with respect to the sheath 41 as the operation unit 80 is operated. Further, the operation transmission wire 42 rotates around an axis with the longitudinal direction of the operation transmission wire 42 as an axis in accordance with an operation on the operation unit 80.

  As shown in FIG. 10B, a torque transmission portion 43 is fixed to the distal end portion of the operation transmission wire 42. The torque transmission unit 43 is for transmitting the rotation operation of the operation transmission wire 42 to the clip 1 via the connection unit 50. In order to suitably perform this transmission, at least a part of the torque transmission portion 43 is a polygonal shape (for example, an octagon) in which the cross-sectional shape of the outer peripheral surface 43a around the axis about the longitudinal direction of the operation transmission wire 42 is rotationally symmetrical It is said that.

  Further, in the operation transmission wire 42, the centering unit 44 is connected to the operation transmission wire 42 at a rear position that is spaced from the torque transmission unit 43 by a predetermined distance (the same distance as a distance D <b> 1 (FIG. 11B) described later). It is extrapolated and fixed to it. The outer diameter of the centering portion 44 is such that the centering portion 44 can smoothly move in the longitudinal direction of the sheath 41 in the sheath 41 even when the sheath 41 is bent, and the operation transmission wire 42 is moved by the centering portion 44. The dimension is set such that the sheath 41 can be positioned substantially at the center. The outer peripheral shape of the centering portion 44 is circular in cross section.

  10A, illustration of the operation transmission wire 42, the torque transmission part 43, and the centering part 44 is abbreviate | omitted, and the shape of the connection members 51 and 52 which the connection unit 50 mentions later is shown.

  11A and 11B are exploded perspective views of the connecting unit 50. FIG.

  As shown in FIG. 11, the connecting unit 50 has a pair of connecting members 51 and 52.

  The connecting members 51 and 52 connect the operation transmission wire 42 and the main body 4 of the clip 1 to each other in a state of being assembled to each other. However, the connecting members 51 and 52 and the main body 4 can be separated at a later stage after the fastening ring 6 is fixed to the third section 13 of the arm portions 2 and 3 of the main body 4 (details will be described later).

  For example, each of the connecting members 51 and 52 includes a half columnar portion 54 and a half square columnar portion 55 that extends in a straight bar shape from one end of the half columnar portion 54. . For example, as shown in FIG. 11A, the connecting member 51 and the connecting member 52 are joined separately from the connecting recesses 59 formed in the connecting members 51 and 52 and the connecting members 51 and 52, respectively. This is performed by closely fitting the attachment member 53. Alternatively, the joining of the connecting member 51 and the connecting member 52 is performed, for example, as shown in FIG. 11B, with a joining concave portion 59 formed in the connecting member 51 and a joint convex portion 64 formed in the connecting member 52. This is done by tightly fitting. In the connecting members 51 and 52, the butting surfaces 56 that are opposed to and in contact with each other in the assembled state are flat.

  The half-cylindrical cylindrical portion 54 is formed with an accommodation concave chamber 57 for accommodating and positioning the torque transmission portion 43 therein, and an introduction notch 58 for introducing the torque transmission portion 43 into the accommodation concave chamber 57. ing.

  The housing concave chambers 57 of the connecting members 51 and 52 are formed so as to face each other. When the connecting member 51 and the connecting member 52 are assembled, the pair of receiving concave chambers 57 form a hollow for storing the torque transmitting portion 43. For example, one accommodation concave chamber 57 accommodates the left half of the torque transmission portion 43, and the other accommodation concave chamber 57 accommodates the right half of the torque transmission portion 43. Thus, in a state in which the torque transmission part 43 is accommodated in the pair of accommodating concave chambers 57, the connecting unit 50 cannot rotate around the axis of the torque transmission part 43 with respect to the torque transmission part 43. The shape of the internal space of the accommodating concave chamber 57 corresponds to the outer shape of the torque transmitting portion 43, and specifically, for example, an octagonal prism is divided into two along its height direction.

  The introduction cutout 58 is formed at the base end portion of the half columnar portion 54 continuously with the receiving concave chamber 57. When the connecting member 51 and the connecting member 52 are assembled, the pair of introduction cutouts 58 form a cylindrical hollow that accommodates and positions the vicinity of the torque transmitting portion 43 in the operation transmitting wire 42 therein.

  The connecting members 51 and 52 are made of an elastic material. When the tip of the torque transmission part 43 is inserted into the hollow formed by the pair of introduction notches 58 of the connection unit 50, the introduction notch 58 is pushed to both sides while the tip of the torque transmission part 43 slides. As a result, the pair of halved columnar portions 54 are elastically deformed in a direction away from each other, and the distance between the pair of introduction cutouts 58 opens to a distance that allows the torque transmission portion 43 to pass. When the torque transmitting portion 43 is further inserted into the hollow, the torque transmitting portion 43 is accommodated in the pair of accommodating concave chambers 57. In this state, the pair of half-cylindrical portions 54 are closed, and the connection between the connecting unit 50 and the torque transmitting portion 43 is completed.

  When the slide operation unit 82 (FIG. 9) is slid back and forth in the state of being connected in this way, the connection unit 50 also moves forward and backward with respect to the sheath 41 along with the operation transmission wire 42. That is, it is possible to pull (retract) and push (forward) the connection unit 50 by operating the slide operation unit 82.

  Here, for example, the distance D1 (FIG. 11B) from the base end of the housing concave chamber 57 of the connecting members 51, 52 to the base end of the connecting members 51, 52, the torque transmission unit 43, and the centering unit 44 Is set to be approximately equal to the distance. For this reason, in the state where the connecting unit 50 is connected to the operation transmission wire 42, the tip of the centering portion 44 is in contact with the base ends of the connecting members 51 and 52 as shown in FIG.

  Next, a configuration that enables connection and separation between the connection unit 50 and the main body 4 of the clip 1 will be described.

  As shown in FIG. 11, the base end side portion 4 a including the notch portion 25 and the base end portion 4 b in the main body 4 enters the half split columnar portion 55 in the half prismatic portion 55 of the connecting members 51 and 52. A slit 60 to be engaged, a protrusion 61 that engages with the notch 25, and a hole 62 into which the overhang 26 of the main body 4 enters are formed.

  The slit 60 is formed at the distal end portion of the half prismatic portion 55. The slit 60 is for inserting the base end side portion 4 a of the main body 4 into the half prismatic portion 55 from the front side of the half prismatic portion 55. The slits 60 are respectively opened on the front surface side and the butting surface 56 side of the half prismatic portion 55. Further, as described above, the connecting member 51 and the connecting member 52 are plane-symmetric with each other. Therefore, in a state where the connecting members 51 and 52 are assembled to each other, the slit 60 of the connecting member 51 and the slit 60 of the connecting member 52 are integrated with each other and opened to the front side of the half-divided columnar portion 55. One insertion hole is formed. The base end side portion 4a of the main body 4 can be inserted from the front side into the insertion hole formed by the pair of slits 60 in this way.

  The protrusion 61 is disposed facing the internal space of the slit 60. In a state in which the connecting members 51 and 52 are assembled to each other, the protrusion 61 of one half prismatic part 55 and the protrusion 61 of the other half prismatic part 55 face each other through the internal space of the slit 60. And the protrusion 61 is formed so that it may protrude in the direction of each other. Then, by inserting the proximal end portion 4a of the main body 4 into the insertion hole formed by the pair of slits 60, each protrusion 61 engages with the corresponding notch 25 of the proximal end portion 4a. It is supposed to be. For example, the protrusion 61 is formed in a semicircular shape so as to abut along the notch 25.

  The hole 62 is formed continuously with the base end of the slit 60. For example, the internal space of the slit 60 communicates with the outside of the half-square columnar portion 55 via the hole 62. And when the base end side part 4a of the main body 4 is inserted into the insertion hole formed by the pair of slits 60, the corresponding overhanging part 26 of the base end side part 4a is inserted into each hole 62. Each comes in.

  In the slit 60, the projection 61 and the cutout portion 25 are engaged, and the protruding portion 26 is inserted into the hole portion 62, and the small diameter portion 28 in the base end side portion 4 a of the main body 4 is also in the insertion hole. It has enough depth to accommodate. However, in this state, it is preferable that movement of the base end of the main body 4 (base end of the small diameter portion 28) to the rear (base end side) is restricted by the wall surface of the rear end of the slit 60.

  As described above, the connecting members 51 and 52 are made of an elastic material. In the process in which the base end side portion 4a of the main body 4 is inserted into the insertion hole formed by the pair of slits 60, the connecting sliding portion 27 of the base end side portion 4a hits the protrusion 61, and further insertion proceeds. The left and right side surfaces of the connecting sliding portion 27 slide against the protrusion 61 and push the protrusion 61 to the side. As a result, the pair of halved prisms 55 are elastically deformed in a direction away from each other, and the distance between the pair of protrusions 61 opens to a distance through which the overhanging portion 26 can pass. When the proximal end portion 4a is further inserted into the insertion hole, the overhanging portion 26 enters the hole portion 62 of the half prismatic portion 55, and the notch portion 25 and the protrusion 61 engage with each other. In this state, the pair of half prismatic portions 55 are closed, and the connection between the connection unit 50 and the main body 4 is completed.

  Further, when the connecting unit 50 is strongly pulled backward relative to the main body 4, the pair of halved columnar portions 55 are elastically deformed in a direction away from each other and connected to the base end side portion 4 a of the main body 4. The connection state with the unit 50 is released. That is, first, the protrusion 61 is pushed by the inner peripheral surface of the notch portion 25, and the pair of half prismatic portions 55 are elastically deformed in a direction away from each other. As a result, the engagement state between the cutout portion 25 and the protrusion 61 is released, and the overhang portion 26 comes out of the hole portion 62. Further, when the connecting unit 50 is pulled rearward relative to the main body 4, the base end side portion 4a of the main body 4 comes out of the insertion hole. Thereby, the connection unit 50 and the main body 4 are separated.

  Here, the external dimensions of the pair of half prismatic portions 55 can be inserted into the reduced diameter tube 70 from the rear in a state where the pair of half prismatic portions 55 are assembled as the connecting unit 50. The dimensions are set.

  Further, the tip 63 of the half prismatic part 55 is tapered or chamfered so that the tip of the aggregate of the pair of half prismatic parts 55 is tapered.

  In addition, it is an example that it is preferable that such connection members 51 and 52 are made of resin, for example, and it is preferable that the connection members 51 and 52 be made of, for example, polyethersulfone.

  FIG. 13 is a perspective view of the reduced diameter tube 70. FIG. 14 is a plan sectional view of the main part showing a state in which the reduced diameter tube 70 is engaged with a distal end ring 75 provided at the distal end of the sheath 41.

  As shown in FIGS. 13 and 14, the reduced diameter tube 70 is formed in a cylindrical shape with both ends opened. The opening of the distal end 70a of the reduced diameter tube 70 is set to such a dimension that the fastening ring 6 cannot enter into the opening.

  In the reduced diameter tube 70, a pair of split groove portions 71 extending in the axial direction are formed so as to cut from the distal end 70 a of the reduced diameter tube 70 toward the proximal end 70 b side. The pair of split groove portions 71 are arranged so as to face each other. These split groove portions 71 have a smaller diameter from the distal end 70a toward the proximal end 70b. In the reduced diameter tube 70, the portions divided into the left and right sides by the pair of split grooves 71 constitute a pair of divided portions 72.

  A first diameter-expanded portion 73 is formed on the outer surface at the tip of the pair of divided portions 72. Further, a second enlarged diameter portion 74 is formed at a rear position (a base end side position) of the first enlarged diameter portion 73 on the outer side surface of the pair of divided portions 72 so as to be separated from the first enlarged diameter portion 73. Yes. The locations where the first and second enlarged diameter portions 73 and 74 are formed in the reduced diameter tube 70 are formed larger in diameter than the inner diameter of the sheath 41. On the other hand, the rear portion 70 c of the reduced diameter tube 70 is set to have an outer diameter substantially equal to the inner diameter of the sheath 41.

  The reduced diameter tube 70 is made of an elastic material. When the pair of divided portions 72 are pushed from both sides, the reduced diameter tube 70 is elastically deformed so that the pair of divided portions 72 approach each other. As a result, the diameter of the portion of the reduced diameter tube 70 on the distal end 70 a side is reduced, and the entire reduced diameter tube 70 can enter the sheath 41.

  A cylindrical tip ring 75 is fixed to the tip of the sheath 41 so as to be coaxial with the tip of the sheath 41. The inner diameter of the tip ring 75 is substantially equal to the inner diameter of the sheath 41. However, on the inner peripheral surface of the tip ring 75, an engagement recess 76 that engages with the second diameter-expanded portion 74 of the reduced diameter tube 70 is formed in an annular shape, and the tip ring at the position where the engagement recess 76 is formed. The inner diameter of 75 is larger than the inner diameter of the sheath 41.

  As shown in FIG. 14, the reduced diameter tube 70 is engaged with the tip ring 75. Here, the base end face of the first enlarged diameter portion 73 is a stepped portion 73b. When the stepped portion 73 b abuts against the distal end surface of the distal end ring 75, the reduced diameter tube 70 is restricted from moving rearward relative to the distal end ring 75. Further, the inner wall surface at the tip of the engaging recess 76 is a stepped portion 76a, and the tip surface of the second enlarged diameter portion 74 is a stepped portion 74a. When the stepped portion 74a hits the stepped portion 76a, the diameter-reduced tube 70 is restricted from moving forward relative to the tip ring 75. Further, an inclined surface 73 a is formed at the distal end portion of the first enlarged diameter portion 73, and an inclined surface 74 b is formed at the proximal end portion of the second enlarged diameter portion 74.

  For example, the reduced diameter tube 70 is preferably made of a resin, and is preferably made of, for example, polyethersulfone.

  As shown in FIG. 9, the operation unit 80 includes a tubular operation unit main body 81 and a slide operation unit 82. The operation portion main body 81 integrally has a finger ring 84 at a base end portion thereof. The slide operation unit 82 is externally fitted to the operation unit main body 81, and is slidable in the longitudinal direction of the operation unit main body 81 with respect to the operation unit main body 81. For example, the slide operation unit 82 is configured as a cylindrical body having front and rear collars, and the slide operation unit 82 can be easily slid by placing a finger between the front and rear collars. ing. The proximal end portion of the operation transmission wire 42 is connected to the slide operation unit 82 inside the operation unit main body 81. Therefore, when the slide operation unit 82 is slid back and forth with respect to the operation unit main body 81, the operation transmission wire 42 advances and retreats with respect to the sheath 41. Further, when the operation portion main body 81 is rotated with respect to the sheath 41, the operation transmission wire 42 is also rotated with respect to the sheath 41.

  FIG. 15 is a plan sectional view showing a cartridge 150 having the clip unit 110 according to the embodiment.

  Each clip unit 110 is provided as a cartridge 150, for example. The cartridge 150 is configured by arranging a set of clip units 110 in a container 151. The set of clip units 110 includes, for example, a reduced diameter tube 70 and a connecting unit 50 in addition to the main body 4 and the fastening ring 6.

  The container 151 is formed with a hollow housing chamber 152 that houses a set of clip units 110. The storage chamber 152 has a large-diameter portion 153, a tapered portion 154, a first linear portion 155, and a second linear portion 156 in this order. A central portion in the longitudinal direction of the first linear portion 155 constitutes a connection operation portion 158 formed with a diameter slightly larger than both sides thereof. The storage chamber 152 is open on one end side of the second linear portion 156.

  The base end side of the main body 4 is inserted into the fastening ring 6, and the reduced diameter tube 70 is arranged so that the proximal end of the fastening ring 6 and the distal end of the reduced diameter tube 70 are connected. Further, the distal end portion of the connecting unit 50 (that is, the half-divided columnar portion 55) is inserted into the reduced diameter tube 70 from the proximal end side of the reduced diameter tube 70, and the proximal end side portion 4 a of the main body 4 inside the reduced diameter tube 70. Are connected to the half prismatic portion 55 of the connecting unit 50. Specifically, for example, the pair of arm portions 2 and 3 of the main body 4 are accommodated in the large diameter portion 153, and the fastening ring 6 is accommodated in the tapered portion 154. Further, the reduced diameter tube 70 has a pair of divided portions 72 accommodated in a portion from the tapered portion 154 to the first linear portion 155. The half columnar part 54 on the proximal end side of the connection unit 50 is accommodated in the connection operation part 158.

  The tapered portion 154 is reduced in diameter toward the opening side of the storage chamber 152, and reduces the diameter of the reduced diameter tube 70 when the clip unit 110 is removed from the container 151. The first linear portion 155 is set to have an inner diameter that is substantially equal to the inner diameter of the sheath 41. The sheath 41 of the clip device 100 is inserted into the second linear portion 156 adjacent to the first linear portion 155 from its distal end side. At the boundary between the second linear portion 156 and the first linear portion 155, a step 157 that makes the second linear portion 156 larger in diameter than the first linear portion 155 is formed.

  Next, an operation for accommodating the clip 1 of the cartridge 150 in the sheath 41 of the clip device 100 will be described.

  FIG. 16 is a plan sectional view of the cartridge 150 for explaining the operation of housing the clip unit 110 of the cartridge 150 in the sheath 41 of the clip device 100. FIG. 17 is a plan cross-sectional view of the main part showing a state in which the clip unit 110 is housed in the sheath 41 of the clip device 100.

  In order to accommodate the clip unit 110 in the sheath 41, first, the sheath 41 is inserted into the second linear portion 156 from the distal end side. This insertion is performed until the tip of the tip ring 75 hits the step 157.

  Next, by operating the slide operation unit 82 to move forward with respect to the operation unit main body 81, the torque transmission unit 43 protrudes forward from the distal end ring 75, and the torque transmission unit 43 is introduced to the proximal end side of the connection unit 50. The connection unit 50 and the torque transmitting portion 43 are connected by entering the receiving recess 57 through the notch 58. The connection unit 50 and the torque transmission unit 43 are connected by a connection operation unit 158 in the cartridge 150. The connecting operation portion 158 has an inner diameter larger than that of the other portions of the first linear portion 155, and when the connecting unit 50 and the torque transmitting portion 43 are connected, the pair of half cylindrical portions 54 of the connecting unit 50 are mutually connected. It can be elastically deformed in the separating direction. In FIG. 12, the diameter-reduced tube 70 and the tightening ring 6 are not shown.

  When the connection unit 50 and the torque transmission unit 43 are connected in this manner, an operation of moving the slide operation unit 82 backward relative to the operation unit main body 81 is performed. By this operation, the operation transmission wire 42 is retracted relative to the sheath 41, and the clip unit 110 is also retracted accordingly. In this retreat, the main body 4 pushes the tightening ring 6 rearward by the tightening receiving portion 7, for example, and the tightening ring 6 pushes the reduced diameter tube 70 rearward by the base end. Further, during the retreat, the pair of arms 2 and 3 are closed by the tapered portion 154. Further, the diameter-reduced tube 70 is reduced in diameter by the taper-shaped portion 154 by elastically deforming the pair of divided portions 72 toward each other. In addition, since the inclined surface 74b is formed in the rear part of the 2nd diameter expansion part 74 of the diameter reduction tube 70 as mentioned above, the diameter reduction operation | movement by the taper-shaped part 154 can be performed suitably. When the clip unit 110 is further retracted, the clip unit 110 enters the sheath 41 via the first linear portion 155 (see FIG. 17). In the sheath 41, the reduced diameter tube 70 is still reduced in the compressed state. In addition, since the above-described convex portion 16 is formed on the tightening ring 6 and the above-described step 14 is formed on the tightening receiving portion 7, the tightening ring 6 is fitted on the third section 13 at this stage. Not.

  Next, an operation for ligating a living tissue with the clip 1 will be described.

  In order to ligate a living tissue with the clip 1, first, the distal end portion of the sheath 41 of the clip device 100 is advanced into the body cavity. Note that the clip device 100 is introduced into a body cavity through a forceps hole of an endoscope, for example. The operator can guide the distal end of the sheath 41 protruded from the forceps hole toward the distal end side near the ligation position in the body cavity while visually confirming with a monitor.

Next, the operator performs an operation of engaging and positioning the reduced diameter tube 70 of the clip unit 110 with the tip ring 75.
That is, the operator advances the clip unit 110 via the operation transmission wire 42 by moving the slide operation unit 82 forward relative to the operation unit main body 81. At the time of this advancement, the connecting unit 50 pushes the main body 4 forward by the half-divided columnar portion 55 at the tip thereof. Further, the pair of half prismatic portions 55 enter the reduced diameter tube 70 up to their roots, and the connecting unit 51, 52 is connected to the connecting unit by a step at the boundary between the half prismatic portion 55 and the half cylindrical portion 54. 50 pushes the reduced diameter tube 70 forward (see FIG. 17). Further, the diameter-reduced tube 70 pushes the clamping ring 6 forward by its tip 70a. Therefore, the entire clip unit 110 moves forward.
Eventually, when the first diameter-expanded portion 73 of the diameter-reduced tube 70 protrudes in front of the tip ring 75, the diameter-reduced tube 70 is released from the compressed state, and the divided portions 72 are elastically deformed in a direction away from each other. Due to this elastic deformation, the stepped portion 73 b of the proximal end surface of the first enlarged diameter portion 73 engages with the distal end surface of the distal end ring 75, and the second enlarged diameter portion 74 engages with the engaging recess 76 of the distal end ring 75. . Thereby, the diameter-reduced tube 70 will be in the state by which movement control was carried out to the front and back with the front-end | tip ring 75 (refer FIG.10 and FIG.14). Thus, the reduced diameter tube 70 is engaged and positioned with respect to the tip ring 75.

  In the process of engaging and positioning the reduced diameter tube 70 with the tip ring 75 in this manner, the fastening ring 6 and the tip side portion 8 of the main body 4 protrude forward of the tip ring 75 as shown in FIG. To do. In this state, the pair of arm portions 2 and 3 are opened to each other by their repulsive force.

  Next, the operator adjusts the arrangement of the sheath 41, the front and rear positions of the arms 2 and 3, and the rotation phase as necessary to align the pair of arms 2 and 3 with respect to the ligation position. The front and rear positions of the arms 2 and 3 are adjusted by adjusting the depth at which the entire operation unit 80 is pushed into the endoscope, and the rotation phase of the arms 2 and 3 is adjusted using the operation unit main body 81 and the slide operation unit 82. This is performed by rotating the sheath 41 and the endoscope.

  Next, the operator performs an operation of closing the pair of arms 2 and 3. That is, the operator moves the main body 4 backward via the operation transmission wire 42 and the connecting unit 50 by moving the slide operation portion 82 backward relative to the operation portion main body 81. At this time, since the reduced diameter tube 70 is positioned with respect to the tip ring 75, the reduced diameter tube 70 and the fastening ring 6 do not retreat. Therefore, the tightening ring 6 is moved toward the distal end side of the arm portions 2 and 3 relative to the main body 4 and tightens the arm portions 2 and 3. As a result, the opening angle between the distal end portions 5 of the arms 2 and 3 is gradually narrowed (see FIG. 5), the distal end portions 5 are eventually closed (see FIG. 6), and the living tissue is ligated between the distal end portions 5. Become.

  However, as shown in FIG. 6, when the tightening ring 6 is tightening the second section 12, the tightening ring 6 is not completely fixed to the main body 4, and the tightening ring 6 is not fixed for re-ligation. It is possible to reopen the end portions 5 by moving to one section 11.

  In order to open the tip portions 5 for re-ligation, the force for moving the fastening ring 6 toward the tip side of the arms 2 and 3 or the force for holding it in that position is released. Specifically, for example, by moving the slide operation unit 82 forward relative to the operation unit main body 81, the force is released. Then, as the arms 2 and 3 are opened using the repulsive force between the arms 2 and 3, the tightening ring 6 is pushed by the slope-shaped outer peripheral surface of the second section 12 and the first section 11. Move to. As a result, the tip portions 5 are opened to such an extent that the living tissue can be ligated again (see FIG. 5).

  By repeating such a ligation operation and an operation of opening the tip portions 5 for re-ligation, the tip portions 5 can be re-opened until an optimum ligation is confirmed.

  In order for the tightening ring 6 to move beyond the second section 12 to the third section 13, a strong force is required so that the tightening ring 6 rides on the step 14. Further, the operator can determine whether or not the tip of the tightening ring 6 has hit the step 14 with a feeling of operating the slide operation unit. Therefore, when the operator performs an appropriate operation, the tightening ring 6 can be repeatedly moved between the second section 12 and the first section 11 without causing the tightening ring 6 to reach the third section 13. .

  In order to perform final ligation, an operation of closing the pair of arms 2 and 3 is performed. That is, as shown in FIG. 6, the main body 4 is further retracted with a strong force of a certain level or more from a state in which the distal ends 5 are closed and the living tissue is ligated. Then, the tightening ring 6 rides on the step 14. When the main body 4 is moved backward, the tip of the tightening ring 6 eventually abuts against the step 18 and the convex portion 16 on the inner periphery of the tightening ring 6 engages with the concave portion 17 before the step 18. In this state, the remaining piece 21 of the tightening ring 6 comes into contact with the step 14, and the small diameter portion 23 of the tightening ring 6 tightens the second section 12.

  Thus, as shown in FIGS. 7 and 18, the tightening ring 6 is fixed to the third section 13 of the tightening receiving portion 7 of the arm portions 2 and 3. In this state, the tightening ring 6 cannot move to the second section 12 by the repulsive force between the arms 2 and 3. Therefore, the distal end portion 5 is maintained in a state where the living tissue is ligated.

  Further, at the stage where the tightening ring 6 is extrapolated to the third section 13 until the convex portion 16 engages with the concave portion 17 as described above, as shown in FIG. 55 is located at or near the position where it has come back to the rear side from the base end 70 b of the reduced diameter tube 70.

  Here, in the reduced diameter tube 70, the pair of halved prismatic portions 55 are restricted from moving to both sides by the inner periphery of the reduced diameter tube 70 and cannot be opened in a direction away from each other. . Therefore, at the stage where the pair of half prismatic portions 55 are positioned in the reduced diameter tube 70, the base end side portion 4a of the main body 4 and the half prismatic portions 55 are maintained in a connected state.

  On the other hand, as described above, the tightening ring 6 is fixed to the third section 13 and the half-divided columnar portion 55 is located at or near the position where it is pulled out from the proximal end 70b of the reduced diameter tube 70. Then, the restriction on the movement of the half-divided columnar portion 55 due to the inner periphery of the reduced diameter tube 70 is released, or the degree of restriction is at least weakened. Further, at this stage, since the step 18 of the main body 4 is in contact with the tip of the tightening ring 6, the main body 4 does not move further back. For this reason, when the connecting unit 50 is further pulled rearward, the pair of halved prismatic portions 55 are elastically deformed in a direction away from each other, and the engagement state between the cutout portion 25 and the protrusion 61 is released. The connection unit 50 and the main body 4 are separated.

  Therefore, the main body 4 and the tightening ring 6 are united and remain in the body cavity while ligating the living tissue.

According to the embodiment as described above, the outer peripheral shape of the distal end side portion 8 including the tightening receiving portion 7 in the pair of arm portions 2 and 3 is a curved surface convex in the opposite direction with respect to the other arm portions 2 and 3, respectively. Therefore, the rigidity of the distal end side portion 8 can be increased as compared with the case where the distal end side portion 8 is formed in a flat plate shape.
Therefore, since the shape retaining property of the distal end side portion 8 against the tightening by the tightening ring 6 can be sufficiently ensured, the force for ligating the living tissue by the distal end portion 5 can be improved, for example, the hemostasis performance by ligation is improved. be able to.
Specifically, for example, since the entire distal end side portion 8 is curved and halved, it is possible to ligate a living tissue not only at the distal end portion 5 but also at the entire distal end side portion 8. is there.
The pair of arm portions 2 and 3 are configured to repel each other against an external force acting in a direction in which the distal end portions 5 are brought close to each other, and the tightening receiving portion 7 includes the first and second arm portions 2 and 3. In the second sections 11 and 12, the diameter is increased toward the tip side. Therefore, even after the second section 12 of the pair of arms 2 and 3 is tightened by the tightening ring 6 and the distal ends 5 are closed, that is, after the living tissue is ligated, the repulsion of the pair of arms 2 and 3 is performed. The clamping ring 6 can be pushed back from the second section 12 to the first section 11 by force, and the distal ends 5 can be opened to the extent that the living tissue can be ligated again. Such reopening operation of the distal end portion 5 can be performed more suitably by increasing the rigidity of the distal end side portion 8 including the tightening receiving portion 7 as described above.
As described above, according to the clip 1 according to the present embodiment, the clip 1 can be sufficiently secured, and the clip 1 for re-ligation can be suitably reopened.
When the tightening ring 6 is moved to the third section 13 positioned ahead of the second section 12 and the third section 13 is tightened by the tightening ring 6, the tightening ring 6 is in a state where the distal ends 5 are closed. The clamp ring 6 is fixed to the pair of arm portions 2 and 3 so that the repelling force of the pair of arm portions 2 and 3 does not move to the second and first sections 12 and 11. For this reason, the clip 1 having the main body 4 and the tightening ring 6 can be maintained in a ligated state by tightening the third section 13 with the tightening ring 6.

  Further, since the outer peripheral surface of the distal end side portion 8 of the arms 2 and 3 is curved, when the clip 1 is accommodated in the sheath 41 and when the clip 1 is pushed out from the sheath 41, the sheath 41 and the clip 1 The sliding resistance can be reduced, and the operation can be made smooth.

  Further, the tightening receiving portion 7 is formed with a step 14 that makes the third section 13 larger in diameter than the second section 12 at the boundary between the second section 12 and the third section 13. It is possible to make the operator feel the feeling that the tip of the butt hits the step 14. Therefore, it is possible to determine whether or not to perform ligation again at the stage of the temporarily fixed state in which the tightening ring 6 tightens the second section 12.

  Further, a recess 17 is formed in the third section 13 of the tightening receiving portion 7, and a protrusion 16 that engages with the recess 17 is formed on the inner peripheral surface of the tightening ring 6. The third section 13 can be fixed.

  Further, the inner diameter of the tightening ring 6 is smaller on the base end side than the distal end side, so that the inner periphery of the tightening ring 6 is in accordance with the shapes of the first and second sections 11 and 12 of the tightening receiving portion 7. Thus, the movement of the tightening ring 6 with respect to the tightening receiving portion 7 can be made smooth. Further, when the tightening ring 6 moves back and forth with respect to the arm portions 2 and 3, the small diameter portion 23 comes into light contact with the slope surfaces of the first and second sections 11 and 12, thereby tilting the tightening ring 6. Therefore, the arms 2 and 3 can be opened and closed smoothly.

  Specifically, for example, the tightening ring 6 is formed in a cylindrical shape, and the notch 20 is intermittently formed along the axial direction of the tightening ring 6 at the proximal end of the tightening ring 6. The residual piece 21 between the cutout portions 20 is formed and bent toward the central axis side of the tightening ring 6, so that the proximal end portion of the tightening ring 6 is a small diameter portion 23. .

Further, as shown in FIG. 4, a plurality of claw-shaped portions 31 and 32 for ligating living tissue are formed at the distal end portion 5 of the arm portions 2 and 3, and the claw-shaped portions 31 and 32 are formed of a plurality of mountain shapes. 31a, 32a and valley shape 33 are formed alternately, and the plurality of mountain shapes 31a, 32a includes mountain shapes 31a, 32a having different heights. For this reason, since the meshing force can be concentrated on the claw-like portion 31 constituted by the higher chevron 31a in the initial stage of the ligation operation of the living tissue, the escape of the living tissue from the distal end portion 5 is suppressed. And ligation of the living tissue can be performed reliably.
In addition, since the plurality of claw-shaped portions 31 and 32 of the one distal end portion 5 and the plurality of claw-shaped portions 31 and 32 of the other distal end portion 5 are point-symmetric with each other, a load is applied to the living tissue in a balanced manner. Can be ligated. In addition, since the plurality of mountain shapes 31a and 32a each have a skirt spread (both skirt spread on both sides), the degree of invasiveness to the living tissue can be reduced.
For example, as shown in FIG. 19 (a), when the heights of the chevron 131a and 132a are the same, there is a high possibility that the nail portions 131 and 132 simultaneously contact the living tissue during ligation. Since it becomes difficult to concentrate the meshing force on one nail-like portion, the possibility that the living tissue escapes from the distal end portion 5 is increased. In the case of FIG. 19A, the positions of the claw-like portions 131 and 132 of the upper and lower tip portions 5 are shifted in the left-right direction, and the load applied to the living tissue is poorly balanced.
Further, for example, as shown in FIG. 19B, when the chevron 132a is not widened (one side is upright), the tip of the claw-shaped portion 132 is sharp. For this reason, there is a possibility that the tip of the claw-like portion 132 is caught by the living tissue during religation or the like, and the living tissue is invaded.

  In each of the above embodiments, the example in which the entire arm portions 2 and 3 and the tightening ring 6 remain integrally with the living tissue has been described. However, the tightening receiving portion 7 extends from the distal end portion 5 of the arm portions 2 and 3. A part including the above part and the tightening ring 6 may be separated from the base end part of the arms 2 and 3 so as to remain integrally with the ecological tissue.

DESCRIPTION OF SYMBOLS 1 Clip 2 Arm part 3 Arm part 4 Main body 4a Base end side part 4b Base end part 5 Tip part 6 Tightening ring 7 Tightening receiving part 8 Tip side part 9 Leaf spring part 11 First section 12 Second section 13 Third section 14 Step 15 Straight portion 16 Convex portion 17 Concave portion 18 Step 19a Engagement piece 19b Notch portion 20 Notch portion 21 Residual piece (tongue piece)
21a End face 22 Large diameter portion 23 Small diameter portion 24 Intermediate portion 25 Notch portion 26 Overhang portion 27 Connecting sliding portion 28 Small diameter portion 29 Distance 31 Claw-shaped portion 31a Mountain shape 32 Claw-shaped portion 32a Mountain shape 33 Valley shape 34 Symmetric center Point 41 Sheath 42 Operation transmission wire 43 Torque transmission part 43a Outer peripheral surface 44 Centering part 50 Connection unit 51 Connection member 52 Connection member 53 Assembly member 54 Half columnar part 55 Half angle columnar part 56 Abutment surface 57 Accommodating concave chamber 58 Notch for introduction 59 Joint recess 60 Slit 61 Protrusion 62 Hole 63 Tip 64 Joint convex 70 Reduced diameter tube 70a Tip 70b Base 70c Rear 71 Split groove 72 Divided part 73 First enlarged part 73a Inclined surface 73b Stepped part 74 Second expanded diameter portion 74a Stepped portion 74b Inclined surface 75 Tip ring 76 Engaging recess 76a Stepped portion 80 Operation portion 81 Operation portion main body 82 Id operation portion 84 Finger ring 100 Clip device 110 Clip unit 131 Claw portion 131a Mountain shape 132 Claw shape portion 132a Mountain shape 150 Cartridge 151 Container 152 Storage chamber 153 Large diameter portion 154 Tapered portion 155 First linear portion 156 Second Linear part 157 Step 158 Connection operation part

Claims (9)

A body having a pair of arms that open from the proximal side to the distal side,
A clamping member that is extrapolated to the main body and moved to the distal end side, thereby tightening the pair of arms and closing the distal ends;
Have
The pair of arms are configured to ligate living tissue at the distal ends when the distal ends are closed, and repel each other against an external force acting in a direction to bring the distal ends closer together. Configured,
In each arm portion, a part of the section in the direction from the base end side to the tip end side constitutes a tightening receiving portion that is tightened by the tightening member,
The outer peripheral shape of the tightening receiving portion in at least one of the arm portions is formed in a curved surface that is convex in the opposite direction with respect to the other arm portion,
The tightening receiving portion has first to third sections in this order in the direction from the proximal end side to the distal end side, and the first and second sections expand in diameter toward the distal end side. ,
In a state where the tightening member tightens the third section of the pair of arm portions, the tightening member is fixed to the pair of arm portions with the tip portions closed, and the repulsive force causes the tightening member to be Configured not to move to the second and first sections,
In a state in which the tightening member tightens the second section of the pair of arm portions, the distal end portions are closed, and in this state, the force to move the tightening member toward the distal end side or an attempt to hold the position is held. When the force to release is released, the tightening member moves to the first section of the pair of arm portions as the pair of arm portions open using the repulsive force, A clip characterized in that the distal ends open to such an extent that the living tissue can be ligated again.   The step of making the third section larger in diameter than the second section is formed at the boundary between the second section and the third section in the tightening receiving portion. Clip as described in.   The concave portion is formed in the third section of the tightening receiving portion, and a convex portion that engages with the concave portion is formed on an inner peripheral surface of the tightening member. clip.   The clip according to any one of claims 1 to 3, wherein an inner diameter of the tightening member is smaller on the base end side than on the distal end side.   The fastening member is formed in a cylindrical shape, and a notch is intermittently formed along the axial direction of the fastening member at the proximal end of the fastening member, and a tongue piece between the notches 5. The clip according to claim 4, wherein the base end side portion of the tightening member has a small diameter by being bent toward the central axis side of the tightening member. A plurality of claw-like portions for ligating living tissue are formed at the distal ends of the pair of arms,
The claw-shaped portion is formed by alternately forming a plurality of mountain shapes and valley shapes,
The clip according to any one of claims 1 to 5, wherein the plurality of mountain shapes include mountain shapes having different heights.   The clip according to claim 6, wherein the plurality of claw-shaped portions of one of the tip portions and the plurality of claw-shaped portions of the other tip portion are point-symmetric with each other. The clip according to any one of claims 1 to 7,
A connecting portion detachably connected to the body of the clip;
When the main body moves toward the base end side as the connecting portion is pulled, the movement of the tightening member is restricted, and the movement of the tightening member relative to the main body moves toward the distal end side. The regulatory department,
A clip unit comprising: The clip according to any one of claims 1 to 7,
A sheath capable of accommodating the clip;
An operation transmission wire inserted into the sheath;
A connecting portion that connects the operation transmission wire and the main body of the clip to each other, and is separable from the main body;
An operation portion capable of performing an operation of pushing the clip out of the sheath and an operation of pulling the main body into the sheath by advancing and retracting the operation transmission wire in the sheath;
A movement restricting portion that restricts movement of the tightening member when the main body is drawn into the sheath and moves the tightening member relative to the main body toward the distal end; and
A clip device comprising:

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