JP2012065835A - Ligature device and clip unit used therein - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a ligature device facilitating bending of an insertion part in which respective clip units are aligned and accommodated in a row, by shortening the length of a squeezing ring in the axial direction, improving flexibility of the insertion part, and improving bendability during insertion into body cavities and conformability to ducts in body cavities; and to provide a clip unit used therein.SOLUTION: The clip unit 13 includes: a clip body 35 having a pair of arms 41 capable of ligating somatic tissue, and a base end 39 that connects the base ends of the arms 41; and a squeezing ring 37 that accommodates the clip body 35. A plurality of clip units are disposed in series inside the distal end of an outer sheath member 19. The base end 39 of the clip body 35 of the leading clip unit 13A which, of the plurality of clip units 13, is at the distal end of the outer sheath part 19 is inserted into the arms 41 and 41 of the clip body 35 of the adjacent rearward clip unit 13B so as to be mutually overlapping.

Description

  The present invention relates to a ligation apparatus for ligating a living tissue and a clip unit used therefor.

  As a ligation apparatus for ligating a living tissue, for example, an insertion part is inserted from a forceps port of an endoscope and guided into a body cavity, and a clip disposed at the distal end of the insertion part is expanded to a desired part. A device that closes the arm portion of the clip and ligates the living tissue by pulling the operation wire connected to the clip in accordance with the position of the living tissue is known (see, for example, Patent Document 1).

The living tissue ligation apparatus of Patent Document 1 includes a plurality of insertion portions that are inserted into a body cavity, an operation wire that is inserted into the insertion portion so as to be able to advance and retreat, and a plurality of devices that are connected to the operation wire and are loaded on the distal end portion of the insertion portion. And a clip. This ligation device has a mechanism in which the clip is placed in the body cavity with the living tissue sandwiched by pulling the operation wire, and enables continuous ligation to be sequentially ligated from the top clip. .
In a ligation apparatus that performs this type of continuous ligation, a plurality of clips are arranged in a line in the insertion portion, so that the axial length of the area in which the clips are accommodated inevitably increases. Therefore, since the bending rigidity increases in the region of the insertion portion where the clip exists, the bending property in the body cavity decreases. Further, the plurality of clips arranged in the insertion portion are arranged in contact with the inner wall of the insertion portion. When the insertion portion is inserted into the body cavity while curving the insertion portion, the clip receives external force from the inner wall of the insertion portion. There is a risk of damage. Therefore, it is desired that a plurality of clips be accommodated in a region where the axial length of the insertion portion is as short as possible.

Japanese Patent No. 4059656

  The present invention shortens the axial length of the tightening ring so that the insertion portions in which the clip units are aligned and accommodated can be easily bent, and the flexibility of the insertion portions is improved. It is an object of the present invention to provide a ligation apparatus and a clip unit used therefor, which are capable of improving the bending operability when inserted into the body and the shape following ability to the body cavity duct.

The present invention has the following configuration.
A ligation device for ligating living tissue,
A tubular outer sheath member having flexibility;
A tubular inner sheath member provided in the outer sheath member so as to freely advance and retract, and having a contact surface at the tip;
An operation wire provided in the inner sheath member so as to freely advance and retract;
A plurality of clip units arranged in series inside the distal end of the outer sheath member;
With
The clip unit has a pair of arm portions that are expanded and biased to each other, and a clip body that has a base end portion that connects the base ends of the arm portions and ligates a living tissue;
A clamping ring for inserting a base end portion of the clip body into the cylindrical body and closing the pair of arms,
The clamping ring has a plurality of slits formed along the axial direction,
Of the plurality of clip units, a pair of arm portions of the clip body of the rear clip unit adjacent to the front clip unit on the distal end side of the outer sheath member is inserted into the slit,
The ligation apparatus in which the base end portion of the clip body of the head clip unit is inserted into the arm portion of the clip body of the rear clip unit adjacent to the head clip unit so as to overlap each other.

  According to the ligating apparatus and the clip unit used therefor according to the present invention, the endoscope insertion portion in which the clip units are accommodated in a line can be easily obtained by reducing the axial length of the fastening ring. It becomes possible to bend, and the flexibility of the endoscope insertion portion can be improved. As a result, it is possible to improve the bending operability when inserted into the body cavity and the shape following ability to the body cavity duct.

BRIEF DESCRIPTION OF THE DRAWINGS It is a figure for describing embodiment of this invention, and is the whole block diagram of the ligation apparatus shown by notching a part. It is sectional drawing of the hand operation part of the ligation apparatus shown in FIG. It is a disassembled perspective view of the clip unit shown in FIG. (A) is a side view of the clip main body shown in FIG. 3, and (B) is a plan view. (A) is the sectional view on the AA line of FIG. 3, (B) is the sectional view on the BB line. (A) is a cross-sectional view of the main part of the clip body, the tightening ring, and the operation wire before assembly, (B) is a cross-sectional view of the main part of the clip body inserted into the tightening ring, and (C) is a clip of the operation wire. FIG. 4D is a cross-sectional view of a main part in the middle of being engaged with the wire locking means of the main body, and FIG. (A) is a cross-sectional view of the main part of the clip unit mounted in the introduction pipe, (B) is a cross-sectional view of the main part in which the arm part of the clip body is opened by retreating the introduction pipe, and (C) is a drawing operation of the operation wire. FIG. 5 is a cross-sectional view of the main part showing a state where the arm part of the clip body is opened and closed by a pulling operation. They are a vertical sectional view (A) and a horizontal sectional view (B) of a ligating apparatus in which a plurality of clip units are loaded in the outer sheath member. It is a perspective view of the ligation apparatus of FIG. 8 shown except an outer sheath member. (A) is a perspective view of a ligation apparatus before ligation, (B) is a perspective view showing a state in which an arm portion of a clip main body which is pulled by an operation wire and is arranged at the distal end is closed, and (C) is a clip at the distal end. The perspective view which shows the state from which the latching claw of a main body starts plastic deformation, (D) is a perspective view which shows the state which the latching claw plastically deformed and the latching | locking of a clip main body and a loop part was cancelled | released, (E ) Is a perspective view showing a state in which the loop portion is guided by the retaining portion of the next clip body and guided to the wire locking means, and (F) is a wire locking means of the next clip body where the loop portion of the operation wire is guided. And is a perspective view showing a state in which the clip unit at the tip is separated. It is principal part sectional drawing which shows the state by which the base end part of the clip body of the front end pulled by the operation wire was inserted between a pair of arm parts of the clip body of a back | latter stage. It is principal part sectional drawing which shows the dimensional relationship between the opening width of the arm part of the clip main body inserted in the clamping ring, and the width | variety of the base end part of a clip main body. It is a principal part expansion perspective view of the clip unit of FIG. (A) is a cross-sectional view of the clip body housed in the outer sheath member and the arm portion is closed, (B) is a cross-sectional view showing a state where the outer sheath member is retracted and the arm portion of the clip body is opened, (C) is sectional drawing which shows the state which the outer sheath member moved forward and the biological tissue was temporarily fixed by a pair of arm part. It is an external appearance perspective view of a clip unit. It is CC sectional view taken on the line of FIG. It is a figure for demonstrating another structural example, and is a top view which shows the several clip unit arranged in series except an outer sheath member. It is a top view which shows the state which the ligation apparatus of FIG. 17 bends. FIG. 6 is a perspective view of clip units arranged with the bending directions of the fastening rings being alternately changed by 90 degrees. It is a perspective view which shows the state which changed the expansion direction of the arm part of a some clip unit 90 degrees, and was arranged in a line. FIG. 21 is a perspective view of the fastening ring and clip body of FIG. 20. 21A is a plan view of the clip body, FIG. 21B is a front view, and FIG. 21C is a side view.

Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings.
FIG. 1 is a diagram for explaining an embodiment of the present invention. FIG. 2 is an overall configuration diagram of a ligation apparatus shown with a part cut away, and FIG. 2 is a sectional view of a hand operating unit.
The ligating apparatus 100 includes a clip operating device 11 and a clip unit 13 loaded in the clip operating device 11. The clip operation device 11 includes an insertion portion 15 that is inserted into a channel of an endoscope (not shown) and inserted into a body cavity, and a proximal operation portion 17 on the proximal end side of the insertion portion 15. The insertion portion 15 includes an outer sheath member 19 that is an introduction tube made of a high-density polyethylene tube, an inner sheath member 21 that is inserted into the outer sheath member 19 so as to be able to advance and retract, and an advancement and retraction within the inner sheath member 21. And an operation wire 23 to be inserted into the cable.

  The inner sheath member 21 is configured by a flexible coil sheath in which a wire having spring properties is tightly wound. The operation wire 23 is formed of a twisted metal wire having moderate elasticity such as stainless steel or NiTi alloy, and the outer periphery thereof may be coated with high-density polyethylene as necessary, and is slidable with the inner sheath member 21. You may apply the silicone oil for improving. An annular loop portion 71 is provided at the distal end of the operation wire 23 on the side opposite to the hand operation portion 17 side.

  The clip unit 13 includes a tightening ring 37 formed in a tubular body, and a clip body 35 inserted into the tubular body of the tightening ring 37, and is axially extended from the distal end of the outer sheath member 19. Are arranged in series along. The plurality of clip units 13 are arranged such that the terminal clip unit on the opposite side to the distal end has the rear end opposite to the insertion side of the clip body 35 of the fastening ring 37 as the distal end of the inner sheath member 21. It is abutted against the tip of the.

  The hand operating portion 17 is movable forward and backward with respect to the operating portion main body 27, an outer sheath connecting body 25 that fixes the proximal end side of the outer sheath member 19, an operating portion main body 27 that fixes the proximal end side of the inner sheath member 21. And a slider 29 connected to the operation wire 23, and a finger ring 33 connected to the operation unit main body 27. The hand operating section 17 adjusts the relative position of the outer sheath member 19 and the inner sheath member 21 by relatively moving the outer sheath connector 25 and the operating section main body 27, and the operating section main body 27 and the slider 29. The relative position between the inner sheath member 21 and the clip unit 13 connected to the operation wire 23 is adjusted.

  When the clip operating device 11 pushes the operating portion main body 27 forward with the outer sheath connector 25 fixed, the outer sheath member 19 moves rearward relative to the inner sheath member 21 at the distal end, Conversely, when the operation portion main body 27 is pulled backward, the outer sheath member 19 moves forward relative to the inner sheath member 21 at the distal end. Further, when the slider 29 is moved away from the finger ring 33, the operation wire 23 moves from the inner sheath member 21. On the contrary, when the slider 29 is moved closer to the finger ring 33, the operation wire 23 is moved into the inner ring. It moves in the direction of being drawn into the sheath member 21. The clip unit 13 loaded on the distal end of the outer sheath member 19 is held by an operation wire 23, and will be detached from the clip operation device 11 by pulling of the operation wire 23 as will be described in detail later. .

<Clip unit>
Next, the configuration of the clip unit 13 will be described in detail.
FIG. 3 shows an exploded perspective view of the clip unit. The clip unit 13 includes a tightening ring 37 and a clip body 35 that is inserted into the cylindrical body of the tightening ring 37. The clip main body 35 has a pair of arm portions 41 that are urged to expand and a base end portion 39 that connects the base ends of the arm portions 41, and grips the living tissue by the arm portions 41. The clip body 35 is formed by bending a belt-like metal plate material having a spring property such as stainless steel into a substantially U shape. The fastening ring 37 is a cylindrical member made of a metal material such as stainless steel, and the operation wire 23 is inserted through the inside thereof. The base end side of the clip body 35 is accommodated in the fastening ring 37 in a state where the loop portion 71 of the operation wire 23 is locked to a part of the clip body 35.

<Clip body>
The clip main body 35 is shown in FIG. 4A as a side view of the clip main body, and in FIG. The clip main body 35 has wire locking means including a locking claw 43 and a retaining portion 45 at the base end portion 39. The wire locking means locks the loop portion 71 of the operation wire 23. The locking claws 43 are respectively inclined and extended so as to extend outward from the width direction both sides of the arm portion 41 at the bottom 39 a of the base end portion 39 toward the arm portion 41. That is, the latching claw 43 is inclined and extended outward in the radial direction of the clamping ring 37 in the direction opposite to the insertion direction from the proximal end 39 of the clip body 35 to the clamping ring 37. . The locking claw 43 is a plate-like body narrowed so that the force required to plastically deform the locking claw 43 is larger than the force that pulls the clip body 35 into the fastening ring 37.

  The retaining portion 45 is a protrusion projecting toward the locking claw 43 from a position spaced from the connecting portion with the locking claw 43 at the proximal end portion 39 of the clip body 35 toward the arm portion 41 side. There is an inclined surface 45a whose protruding height toward the pawl 43 gradually increases in the direction of insertion of the clip body 35 into the fastening ring 37. Thus, a gap 47 for locking the loop portion 71 of the operation wire 23 is defined by the locking claw 43, the side surface 45b of the base end portion 39 side of the retaining portion 45, and the side surface in the width direction of the base end portion 39. Is done. The gap between the protruding tip of the retaining portion 45 and the locking claw 43 is made smaller than the diameter of the operation wire 23, and details will be described later, but the loop portion 71 of the operation wire 23 elastically deforms the locking claw 43. When entering the gap 47, the loop portion 71 of the operation wire 23 is prevented from falling out of the gap 47.

  In the illustrated example, the upper and lower pairs of locking claws 43 and retaining portions 45 are formed, but they may be formed only on one side. In addition, as shown in the example, a pair of upper and lower locking claws 43 and retaining portions 45 are formed on the clip main body 35, and two loop portions 71 of the operation wire 23 are further formed, and two loop portions are It is good also as a structure each latched to the one latching claw 43 separately. In that case, the clip body 35 can be stably moved without the traction force of the operation wire 23 being biased.

  The pair of arm portions 41 are symmetrically arranged oppositely and are band-shaped metal plate members having spring properties, and have a predetermined width in a direction orthogonal to the expanding direction of the pair of arm portions 41 in order from the base end portion 39. A plate-like piece portion 51, a wide portion 53 wider than the plate-like piece portion 51, and a tissue gripping portion 55 capable of sandwiching a living tissue. The pair of arm portions 41 are urged so as to expand each other by the spring property of the material of the clip body 35. The pair of arms 41 includes a wide portion 53 formed gradually wider from the plate-like piece portion 51, a step portion 57 formed between the wide portion 53 and the plate-like piece portion 51, and a tip of the wide portion 53. A tissue gripping portion 55 formed on the side is provided.

  The pair of arm portions 41 is bent so as to expand outward at a first bending point 41 a provided on the base end portion 39 side of the plate-like piece portion 51, and is provided at a middle position of the plate-like piece portion 51. It is bent inward at a point 41b. Further, the tissue gripping portion 55 is formed by being bent inward at a third bending point 41 c on the distal end side of the wide portion 53.

  When the pair of arm portions 41 are opened due to the spring property of the clip body 35, the pair of tissue gripping portions 55 are spaced apart from each other to form a sandwiching gap 73 between the pair of tissue gripping portions 55. When the arm portion 41 is closed, the tips can come into contact with each other to sandwich the living tissue. It should be noted that the tip of the tissue gripping portion 55 may be linear as shown in the figure, or may be formed in an uneven shape that meshes with each other so that the living tissue can be securely sandwiched.

<Tightening ring>
5A is a cross-sectional view taken along the line AA in FIG. 3, and FIG. 5B is a cross-sectional view taken along the line BB. As shown in FIGS. 3, 5 </ b> A, and 5 </ b> B, the tightening ring 37 includes a hollow cylindrical portion 61, a pair of clip contact portions 63, and a pair of clip retaining pieces 65.

  The fastening ring 37 closes the pair of arm portions 41 by inserting the proximal end portion 39 of the clip body 35 into the cylindrical body. The pair of clip contact portions 63 and the pair of clip retaining pieces 65 are formed by bending each pair of protrusions protruding in the axial direction from one end of the cylindrical portion 61 to the inside of the fastening ring 37 in the radial direction. is doing. The clip retaining piece 65 extends from the end of the tightening ring 37 on the clip body insertion side so as to incline toward the inside of the ring in the insertion direction of the clip body 35. The pair of clip contact portions 63 and the pair of clip retaining pieces 65 are arranged at circumferential positions different from each other by 180 °, and the clip contact portion 63 and the clip retaining pieces 65 are different from each other by 90 °. It is formed at a circumferential position.

  The pair of clip contact portions 63 has a flat surface parallel to the axis of the tightening ring 37 by bending a protrusion protruding from one end of the cylindrical portion 61. A pair of guide pieces 69 projecting inward in the radial direction of the fastening ring 37 are formed on both sides of the clip contact portion 63. The distance between the pair of guide pieces 69 is set to be larger than the width W1 (see FIG. 4) of the plate-like piece portion 51 of the clip body 35 and smaller than the width W2 of the wide portion 53.

  Thereby, when the clip main body 35 is inserted into the fastening ring 37, the flat surfaces of the clip abutting portion 63 abut against both outer side surfaces of the arm portion 41 to guide the clip main body 35, and the center of the fastening ring 37 While restricting the rotation of the clip body 35 relative to the shaft, the stepped portion 57 of the wide portion 53 and the plate-like piece portion 51 comes into contact with the pair of guide pieces 69, and the insertion length of the clip body 35 into the fastening ring 37 is Limit.

  Further, when the clip main body 35 is inserted into the fastening ring 37 from the base end portion 39 side, both outer side surfaces of the pair of arm portions 41 are pressed by the flat surfaces of the clip abutting portions 63, and the arm portions 41. Is closed. The flat surface of the clip abutting portion 63 with which both outer surfaces of the arm portion 41 abut is not particularly limited to a flat surface as long as the rotation of the clip body 35 with respect to the central axis of the fastening ring 37 can be restricted. A plurality of protrusions that are in point contact with both outer side surfaces of the arm portion 41 or protrusions that are in line contact can also be used.

  The pair of clip retaining pieces 65 are provided at one end of the cylindrical portion 61, and from the end on the clip body insertion side of the tightening ring 37 to the front of the clip body 35 in the insertion direction and radially inward of the tightening ring 37. It is inclined and extends in a substantially V-shaped cross section. The pair of clip retaining pieces 65 are latched by the latching claws 43 (see FIG. 3) of the clip body 35 inserted into the tightening ring 37, and the clip body 35 once inserted comes out of the tightening ring 37. To prevent.

<Connection between clip unit and operation wire>
The clip main body 35 and the tightening ring 37 having the above-described configuration become the clip unit 13 when the clip main body 35 is inserted into the tightening ring 37. A plurality of clip units 13 are loaded in the outer sheath member 19 of the clip operating device 11 (see FIG. 1), and the leading clip unit 13 is locked by the operation wire 23. FIGS. 6A to 6D show the procedure for assembling the leading clip unit 13 to the clip operating device. In the figure, the clip operation device is omitted.

  First, as shown in FIG. 6A, the loop portion 71 formed at the tip of the operation wire 23 is inserted into the fastening ring 37, and the locking claw 43 of the clip body 35 is inserted into the loop portion 71 of the operation wire 23. 6B, the clip main body 35 is inserted into the tightening ring 37 from the base end 39 side. Then, the locking claw 43 abuts against the pair of retaining pieces 65 and elastically deforms inward in the radial direction of the fastening ring 37 to get over the retaining pieces 65. Then, when the pair of latching claws 43 pass through the clip retaining piece 65, the pair of latching claws 43 are elastically restored by a spring force, and the tip ends abut against the inner peripheral surface 37 a of the fastening ring 37. Thereby, the latching claw 43 is latched from the inner side to the clip retaining piece 65, and is prevented from coming off from the tightening ring 37. Although details will be described later, in the ligating apparatus of this configuration, a plurality of clip units 13 are loaded in the outer sheath member 19 in series.

  Here, as shown in FIG. 6C, when the operation wire 23 is pulled in the insertion direction of the clip main body 35 (the right direction in the figure), the loop portion 71 includes the retaining piece 65 of the fastening ring 37 and the clip. It is guided by the inclined surface 45 a of the retaining portion 45 of the main body 35 and comes into contact with the inner surface of the locking claw 43. Then, as shown in FIG. 6D, the locking claw 43 is elastically deformed radially outward of the fastening ring 37, so that the loop portion 71 of the operation wire 23 is detached from the locking claw 43. The operation wire 23 is locked to the locking claw 43 by being inserted into a gap 47 defined by the locking portion 45 and the end surface in the width direction of the base end portion 39.

  Since the loop portion 71 of the operation wire 23 is inserted into the gap 47 due to the elastic deformation of the locking claw 43, once inserted into the gap 47, the loop chamfer 43 can be removed from the gap 47 unless the locking claw 43 is deformed. Absent. Thereby, the clip unit 13 is assembled to the clip operating device 11. The operation wire 23 is locked only on one side (upper side in the figure) of the clip body 35 in the illustrated example, but is locked on both sides (upper and lower sides in the figure) of the clip body 35 by the two operation wires 23. It is good also as a structure.

<Basic ligation procedure with ligation device>
As shown in FIG. 7A, the clip unit 13 assembled to the clip operating device 11 as described above extends the outer sheath member 19 that is an introduction tube to the front, so that the distal side of the outer sheath member 19 Housed in the tip. This is a state in which the outer sheath connection body 25 shown in FIG. 1 is fixed at a position away from the operation portion main body 27. At this time, the proximal end side of the clip unit 13 abuts on the distal end of the inner sheath member 21. Further, the pair of arm portions 41 of the clip main body 35 are in contact with the inner peripheral surface of the extended outer sheath member 19 and are accommodated in the outer sheath member 19 in a state of being elastically deformed in a direction approaching each other. With the outer side of the clip unit 13 covered with the outer sheath member 19 as described above, the insertion portion 15 of the ligating apparatus 100 is inserted into the body cavity from a forceps hole of an endoscope (not shown) that has been previously inserted into the body cavity. And while observing the inside of a body cavity with an endoscope, the front-end | tip of the insertion part 15 is guide | induced to the ligation target site | part of a biological tissue.

  Next, when the outer sheath connector 25 shown in FIG. 1 is moved to the operating portion main body 27 side until the clip located at the head is exposed, the outer sheath member 19 is fixed as shown in FIG. 7B. The clip unit 13 is moved forward (distal end side) by being pressed by the inner sheath member 21 relatively moving inside, and the pair of arm portions 41 of the clip body 35 protrudes from the outer sheath member 19. Since the pair of arm portions 41 are released from the restraint by the outer sheath member 19, the pair of arm portions 41 are expanded by the spring force of the clip body 35, and a sandwiching gap 73 is formed between the tissue gripping portions 55 and 55. In this state, the clip body 35 is positioned so that a desired living tissue is disposed in the holding gap 73.

  Then, in a state where the position of the tissue gripping portion is optimum, the slider 29 shown in FIG. 1 is moved in a direction to approach the finger ring 33 and the operation wire 23 is pulled into the inner sheath member 21, thereby causing the operation wire 23 to move. Pull relative to the inner sheath. Then, as shown in FIG. 7C, the loop portion 71 of the operation wire 23 pulls the locking claw 43 and the clip main body 35 is pulled into the tightening ring 37. At this time, the pair of arm portions 41 that are in contact with the flat surface of the clip contact portion 63 of the tightening ring 37 are closed by the clip contact portion 63 as indicated by a solid line in the drawing.

  Further, when the slider 29 shown in FIG. 1 is moved away from the finger ring 33 and the operation wire 23 is moved out relative to the inner sheath, the clip body 35 is pushed out from the tightening ring 37, and the clip is pressed. Since the restraint of the pair of arm portions 41 by the flat surface of the contact portion 63 is released, the pair of arm portions 41 expands as shown by a broken line in the figure.

  That is, the pair of arm portions 41 is closed by pulling the operation wire 23 relative to the inner sheath, and the pair of arm portions 41 is opened by extending the operation wire 23 relatively. During the above operation, both the outer surfaces of the arm portion 41 are in contact with the flat surface of the clip contact portion 63, so that the clip body 35 does not rotate with respect to the central axis of the fastening ring 37. The pair of arms 41 is stably opened and closed by protruding from the tightening ring 37.

  By the above closing and opening operations, the biological tissue can be re-gripped by a simple operation. That is, it is possible to re-grip only by operating the operation unit main body 27 and the finger ring 33, and the operation of the operator can be simplified.

<Continuous configuration of clip unit>
A plurality of clip units having the above configuration are loaded in series in the outer sheath member. Hereinafter, the interrelationship between the plurality of clip units will be described in detail.
FIG. 8A is a vertical sectional view of the ligating apparatus in which a plurality of clip units are loaded in the outer sheath member, FIG. 8B is a horizontal sectional view, and FIG. 9 is a perspective view of the main part of the ligating apparatus except for the outer sheath member. FIG. In the following description, the same members as those shown in FIGS. 1 to 7 are denoted by the same reference numerals, and redundant description is omitted.

  As shown in FIGS. 8A, 8 </ b> B, and 9, the ligating apparatus 100 of this configuration includes a plurality of clip units 13 including a clip main body 35 and a fastening ring 37 in a row in the outer sheath member 19. Inserted in an aligned state. In each clip unit 13, the rotation position within the outer sheath member 19 is restricted by the catch claw 43 of the clip body 35 being sandwiched between the loop portions 71 of the operation wire 23. In the illustrated example, all the clip units 13 are loaded in the outer sheath member 19 in series with the same rotational posture.

  The operation wire 23 is inserted through each of the plurality of tightening rings 37, and the loop portion 71 of the operation wire 23 has an overall length corresponding to the length of the plurality of clip units 13 arranged and arranged in at least one row. . The distal end of the loop portion 71 is the width of the locking claw 43, the retaining portion 45, and the proximal end portion 39 of the clip main body 35 shown in FIG. 3 of the clip unit 13 </ b> A located at the distal end of the outer sheath member 19. It is inserted into a gap 47 defined by the direction end face. That is, the operation wire 23 is locked to the locking claw 43 of the leading clip unit 13A. Further, the locking claws 43 of the rear clip units 13B, 13C, and 13D are in contact with the inner peripheral surface 37a of the tightening ring 37 in a state of entering the loop portion 71.

  The pair of arm portions of the clip main body 35 of each clip unit 13A, 13B, 13C, 13D arranged in a line is adjacent to the front of the pair of arm portions 41 of the clip main body 35 positioned at the rear. Housed in a clamping ring 37. Thereby, when the insertion part 15 of the ligation apparatus 100 is introduced into the body cavity, each tightening ring 37 is prevented from acting on the clip body 35 due to an external force generated by the insertion operation. Therefore, even if the insertion portion 15 is bent and the fastening rings 37 are bent and introduced into the body cavity, the clip body 35 is protected by the fastening ring 37 and the clip body 35 is damaged. Can be prevented.

  In addition, since the plurality of clip units 13A, 13B, 13C, and 13D are aligned and arranged in the same rotational posture, the loop portion 71 of the operation wire 23 is released from the engagement with the leading clip unit 13A. It can be locked to the locking claw 43 of the rear clip unit 13B. Similarly, with respect to the rear clip units 13C and 13D, the loop portion 71 can be sequentially locked to the locking claw 43, and continuous ligation can be performed by continuously extending each clip body 35. Become.

<Procedure for continuous feeding of clip unit>
Here, a continuous feeding procedure of the clip unit by the ligating apparatus having the above configuration will be described.
FIGS. 10A to 10F are schematic perspective views showing a continuous ligation procedure by the ligation apparatus. First, the insertion portion 15 is introduced into the body cavity via an endoscope channel previously inserted into the body cavity, and the distal end of the insertion portion 15 is ligated to the ligation site of the living tissue while observing the inside of the body cavity with the endoscope. To be located. Thereafter, as shown in FIG. 10A, the pair of arm portions 41 of the clip unit 13A located at the head of the outer sheath member (not shown) is opened. Note that the operations for opening and closing the arm portion 41 are the same as described above, and thus the description thereof is omitted here.

  Next, as shown in FIG. 10 (B), the operation wire 23 is pulled with respect to the inner sheath member, and via the locking claw 43 of the leading clip unit 13A to which the loop portion 71 of the operation wire 23 is locked. Then, the clip main body 35 of the clip unit 13 </ b> A is pulled into the fastening ring 37. As a result, the pair of arm portions 41 of the clip unit 13 </ b> A is closed by being guided by the clip contact portion 63 of the fastening ring 37, and the living tissue 81 is gripped between the tissue gripping portions 55 and 55. In this state, as shown in FIG. 11, the base end portion 39 of the clip body 35 of the clip unit 13A is inserted into the arm portion 41 of the clip body 35 of the rear clip unit 13B.

  Therefore, as shown in FIG. 12, the maximum width WF of the base end portion 39 in the arm portion 41 expanding direction with respect to the clip main body 35 of the clip unit 13A is elastically biased against the inner peripheral surface 37a of the fastening ring 37. The opening width WR of the pair of arm portions 41 (tissue gripping portion 55) of the clip body 35 of the rear clip unit 13B that is in contact is set. Thus, when the clip main body 35 of the clip unit 13A is pulled into the fastening ring 37, the base end portion 39 of the clip main body 35 of the clip unit 13A overlaps with the arm portion 41 of the clip main body 35 of the rear clip unit 13B. Inserted.

  With this configuration, the axial length of the tightening ring 37 can be shortened, and the insertion portions 15 accommodated in the clip units 13A, 13B, 13C, and 13D aligned in a row can be easily bent. Thus, the flexibility is improved, and the bending operability when inserted into the body cavity and the shape followability to the body lumen are improved. Further, since the flexibility of the insertion portion 15 is improved, the ligation direction at the time of clipping can be adjusted more appropriately. Furthermore, since the overall length of the clip unit is shortened, it is possible to make it difficult to restrict the procedure after the clip operation.

  When the operation wire 23 is pulled as shown in FIG. 10B, the step between the wide portion 53 of the arm portion 41 and the plate-like piece portion 51 in the clip body 35 of the leading clip unit 13A shown in FIG. The portions 57 are in contact with the pair of guide pieces 69, respectively, so that the backward movement of the clip body 35 is restricted. When the operation wire 23 is further pulled from this state as shown in FIG. 10C, the locking claw 43 of the leading clip body 35 starts plastic deformation in the pulling direction of the operation wire 23, and FIG. As shown in FIG. 4, the locking claw 43 is greatly plastically deformed, and the locking claw 43 and the loop portion 71 are unlocked. At this time, the tissue gripping portion 55 of the leading clip body 35 holds the ligation of the living tissue 81.

  As described above, in the ligating apparatus 100 of this configuration, the separation between the operation wire 23 and the clip main body 35 is realized by plastic deformation of the locking claw 43 regardless of the breakage of the member, so that no broken pieces are generated. Thus, damage caused by broken fragments is completely prevented.

  When the operation wire 23 continues to be pulled, as shown in FIG. 10 (E), the loop portion 71 unlocked from the leading clip body 35 is the retaining portion of the clip body 35 disposed on the rear side. It is guided by the inclined surface 45 a of 45 and moves outward in the radial direction of the tightening ring 37 and abuts against the inner surface of the locking claw 43.

  Then, as shown in FIG. 10 (F), by slightly elastically deforming the locking claw 43 by pulling the operation wire 23, the loop portion 71 of the operation wire 23 becomes the locking claw 43, the retaining portion 45, And the gap 47 defined by the end surface in the width direction of the base end portion 39 enters. Thereby, the locking claw 43 of the clip main body 35 of the next-stage clip unit 13B and the operation wire 23 are automatically locked, and preparation for the next living tissue ligation is completed. Further, the clip unit 13A is separated from the ligation apparatus 100 and is left in the body cavity while the living tissue is ligated.

  As described above, according to the ligation apparatus 100 of this configuration, every time the ligation of the living tissue is finished, the insertion unit 15 of the ligation apparatus 100 is continuously inserted into the body cavity without being pulled out of the body cavity. Living tissue can be ligated. Therefore, efficient ligation is possible and the burden on the patient can be reduced.

  In the above description, the pair of arm portions 41 are opened and closed by pulling and feeding the operation wire 23. However, as shown in FIG. 14, the outer sheath member 19 is advanced relative to the inner sheath member 21, By retracting, the pair of arm portions 41 can be opened and closed. Specifically, as shown in FIG. 14A, the pair of arm portions 41 accommodated and closed in the outer sheath member 19 retreats the outer sheath member 19, thereby causing FIG. ), The restraint by the outer sheath member 19 is released to open, and a sandwiching gap 73 is formed between the pair of arm portions 41.

  Next, as shown in FIG. 14C, after the sandwiching gap 73 is positioned in the living tissue 81, when the outer sheath member 19 is advanced, the outer surfaces of the pair of arm portions 41 become the inner periphery of the outer sheath member 19. The pair of arms 41 sandwich the living tissue 81 by contacting the surface and closing. Thus, by moving the outer sheath member 19 forward and backward, the pair of arms 41 can be opened and closed to temporarily fix the living tissue 81. Then, after confirming that the target biological tissue 81 is held between the pair of arm portions 41, the biological tissue 81 is ligated by pulling the operation wire 23 as already described with reference to FIG.

<Other examples of tightening rings>
15 is an external perspective view of the clip unit, and FIG. 16 is a cross-sectional view taken along the line CC of FIG.
As shown in FIGS. 15 and 16, in the tightening ring 37 of this configuration example, four slits 48 extending along the axial direction are formed in the cylindrical portion 61 so as to penetrate inside and outside of the cylindrical portion 61. . The four slits 48 are provided at positions corresponding to the width direction outer corners 41 d of the pair of arm portions 41 of the clip main body 35 inserted into the fastening ring 37. As a result, the pair of arm portions 41 are not restrained by the inner peripheral surface 37a of the fastening ring 37, and the width direction outer corner portion 41d enters the slit 48, compared with the case where the slit 48 is not provided. The pair of arm portions 41 are greatly opened. That is, since the opening width WR (see FIG. 12) of the pair of arm portions 41 is increased, interference between the base end portion 39 of the front clip body 35 and the pair of arm portions 41 of the rear clip body is reduced. The mutual overlap length in the arm portion can be further earned. Accordingly, the axial length of the tightening ring 37 can be further shortened by providing the slit 48 in the tightening ring 37.

  In addition, since the clip body 35 has the pair of arm portions 41 guided by the clip contact portion 63 of the fastening ring 37, the rotation of the clip body 35 with respect to the central axis of the fastening ring 37 is restricted. Further, since the pair of arm portions 41 engage with the slits 48 of the tightening ring 37 located at the front stage, the relative rotation between the front stage clip unit 13A and the rear stage clip unit 13B disposed on the rear side adjacent thereto is performed. The position is regulated constant. As a result, the base end portion 39 of the front clip body 35 is reliably inserted between the pair of arm portions 41 of the rear clip body 35.

  With this configuration, the axial length of the tightening ring 37 can be further shortened, and the insertion portion 15 accommodated in each clip unit aligned in a row can be easily bent to improve flexibility. The bending operability when inserted into a body cavity and the shape following ability to the body cavity are improved. Further, the force generated when the insertion portion 15 is introduced into the body cavity is received by each tightening ring 37 and does not act on the clip body 35. Therefore, even if the insertion portion 15 is bent and the fastening rings 37 are bent and introduced into the body cavity, the clip body 35 is protected by the fastening ring 37 and the clip body 35 is damaged. Can be prevented.

<Connection structure between adjacent clip units>
FIG. 17 is a plan view showing a state in which a plurality of clip units are arranged in a straight line, and FIG. 18 is a plan view showing a state in which a plurality of clip units are arranged in a bent and curved state. In the configuration of the clip unit of this configuration, the joining surfaces 37b, 37c between the end surfaces of the adjacent tightening rings 37 are each formed in an arc shape when viewed in the axial direction of the tightening ring 37 (viewed in the direction perpendicular to the paper surface of FIG. 17). Has been. By forming the joint surfaces 37b and 37c between the end faces of the tightening ring 37 into an arc shape when viewed in the axial direction, the tightening ring 37 can be arranged in an inclined state from the axial direction. That is, the adjacent fastening rings 37 can be connected to each other in a plane parallel to the axial direction by the arc-shaped joining surfaces 37b and 37c.

  The joint surfaces 37b and 37c of the tightening ring 37 have a contact area A1 that always contacts at a circumferential position different by at least 180 ° regardless of the bending of the tightening ring 37. Further, it has a contact disengagement region A2 that comes into contact when the tightening rings 37 are arranged in a straight line and does not come into contact when bent.

  At least the joint surfaces 37b and 37c in the contact area A1 are formed in circular arc shapes having the same curvature as viewed in the vertical direction of the fastening ring 37 in the axial direction. For the clip unit of the illustrated example, in the contact area A1, the joining surface 37b on the front side in the axial direction is concave and the joining surface 37c on the rear side in the axial direction is convex, but these joining surfaces 37b, The unevenness of 37c may be reversed.

  Further, on the joint surfaces 37b, 37c of the tightening ring 37, relief portions in which the end portions of the tightening ring 37 are notched in advance may be formed on the concave surface side of the contact disengagement region A2. The escape portion does not come into contact with the facing joint surface 37b and can reliably prevent interference between the side surfaces of the tightening rings 37 when the adjacent tightening rings 37 are bent.

  As a result, the fastening rings 37 can be bent in a plane parallel to the axial direction of the fastening ring 37 by always contacting the concave surface of the joining surface 37b and the convex surface of the joining surface 37c in the contact region A1. It becomes. In addition, the contact area A1 that is always in contact can be made flexible while securing the compression rigidity of the tightening ring 37. As a result, the bending operability when inserted into the body cavity and the shape followability to the body cavity are improved, and the burden on the patient is reduced. In addition, the joint surfaces 37b and 37c of each fastening ring 37 may have, for example, a spherical shape in addition to the above-described configuration having an arc shape when viewed in the axial direction. In this case, the adjacent tightening rings 37 can be bent in any direction.

In addition to the connection configuration of the clip unit that can be bent in one direction, the clip unit can be bent in two different directions.
FIG. 19 is a perspective view of clip units in which the bending directions of the tightening rings are alternately arranged at 90 degrees. In the clip unit of this configuration example, the bending center axes C of the adjacent tightening rings 37 are alternately varied by 90 degrees along the arrangement direction of the clip units. That is, the contact areas A1 of the joint surfaces 37b and 37c between the end surfaces of the adjacent tightening rings 37 are alternately varied by 90 degrees.

  As a result, the connected clip units can be bent in two orthogonal directions by the adjacent tightening rings 37. As a result, the bendability of the clip unit is further improved, and bending operability when inserted into a body cavity, Shape followability to the body cavity duct is further improved.

<Other configuration examples of the clip unit>
Next, another configuration example of the clip unit will be described. FIG. 20 is a perspective view showing a state in which a plurality of clip units are arranged in a line with the opening directions of the arms differing from each other by 90 °, FIG. 21 is an exploded perspective view of the clip unit, and FIG. The top view of a main body, (B) is a front view, (C) is a side view.

  As shown in FIG. 20, in this clip unit configuration, a plurality of clip units 42 each having a clip body 36 inserted into a fastening ring 40 are alternately arranged in the axial direction, and an outer sheath member (not shown) is shown. 19 are aligned in series. In the aligned clip bodies 36, the expanding direction of the arm portion 41 is different by 90 °. The tightening ring 40 is also rotated 90 °.

  As shown in FIGS. 21 and 22 (A), 22 (B), and (C), the clip main body 36 has a base end portion 39 on the side inserted into the fastening ring 40, and extends from the base end portion 39. It is formed by bending a belt-shaped metal plate material having a pair of arms 41 and having spring properties such as stainless steel into a substantially U shape.

  A pair of wire locking means of the clip main body 36 including the locking claw 44 and the retaining portion 46 are extended from both sides in the width direction of the base end portion 39 orthogonal to the arm portion expanding direction of the base end portion 39. The parallel part 50 is bent in the plate thickness direction of the clip main body 36 (arm part expanding direction), and is arranged at a diagonal position of the base end part 39.

  The locking claw 44 is inclined and extended so as to extend outward from the position on the bottom 39 a side of the base end 39 toward the arm 41 from the retaining portion 46. The force required for plastic deformation of the locking claw 44 is a plate-like body narrowed to such an extent that the force required to pull the clip main body 36 into the fastening ring 40 is larger.

  The retaining portion 46 is a protruding portion that protrudes toward the locking claw 44 from a position spaced from the locking claw 44 toward the arm portion 41, and the protruding height toward the locking claw 44 has a clip body 36. And an inclined surface 46a that gradually increases in the direction of insertion into the tightening ring 40. The locking claw 44 and the retaining portion 46 are formed by a parallel portion 50 that is bent and erected from the width direction end portion of the base end portion 39. Accordingly, as shown in FIGS. 21 and 22A, a gap for locking the loop portion 71 of the operation wire 23 by the locking claw 44, the retaining portion 46, and the parallel portion 50 of the proximal end portion 39. 47 is defined.

  The force required to plastically deform the locking claw 44 is set to be larger than the force that pulls the clip body 36 into the tightening ring 40. As a result, the clip main body 36 is plastically deformed by pulling the operation wire 23 in a state where the loop portion 71 of the operation wire 23 shown in FIG. Without being retracted into the tightening ring 40.

  As shown in FIG. 21, the tightening ring 40 includes a hollow cylindrical portion 61 and a pair of clip contact portions 63. The pair of clip abutting portions 63 bends the projecting portion projecting from one end portion of the cylindrical portion 61 and has a flat surface parallel to the axis of the fastening ring 40. The clip body 36 is guided by coming into contact with the outer surface, and the rotation of the clip body 36 with respect to the central axis of the tightening ring 40 is restricted.

  A pair of guide pieces 69 are formed on both sides of the clip abutting portion 63 so as to protrude inward in the radial direction of the fastening ring 40. When the clip main body 36 is inserted into the tightening ring 40, the guide piece 69A at the diagonal position where the locking claw 44 abuts is formed so as to be inclined toward the inner side of the ring toward the insertion direction of the clip main body 36. . Thereby, when the clip main body 36 is inserted into the tightening ring 40, the locking claw 44 abuts on the inner side of the guide piece 69 </ b> A to prevent the clip main body 36 from coming out of the tightening ring 40. Further, the distance between the pair of guide pieces 69 is smaller than the width W2 of the wide portion 53 (similar to FIG. 4), and the step portion 57 between the wide portion 53 and the plate-like piece portion 51 abuts against the pair of guide pieces 69. The insertion length of the clip body 36 into the tightening ring 40 is limited.

  Then, when the operation wire 23 is pulled and the clip body 36 is pulled into the fastening ring 40 and the stepped portion 57 of the clip body 36 contacts the fastening ring 40 (a pair of guide pieces 69), the locking claw The plastic deformation 44 starts, and the loop portion 71 of the operation wire 23 and the locking claw 44 are unlocked. As a result, the clip unit 42 can be separated from other clip units.

When the clip main body 36 is inserted into the fastening ring 40, the locking claw 44 is elastically urged against and abuts on the inner peripheral surface of the fastening ring 40. Further, the inclined surface 46a of the retaining portion 46 guides the loop portion 71 and reliably inserts it into the clearance 47 for retaining the operation wire when the operation wire 23 is pulled.
Other configurations and effects are the same as those of the above-described configuration example, and thus description thereof is omitted.

  As described above, the present invention is not limited to the above-described configuration example, and modifications and applications by those skilled in the art based on the description of the specification and well-known techniques are also intended to be covered by the present invention. Is included in the range for which

As described above, the following items are disclosed in this specification.
(1) A ligation apparatus for ligating living tissue,
A tubular outer sheath member having flexibility;
A tubular inner sheath member provided in the outer sheath member so as to freely advance and retract, and having a contact surface at the tip;
An operation wire provided in the inner sheath member so as to freely advance and retract;
A plurality of clip units arranged in series inside the distal end of the outer sheath member;
With
The clip unit has a pair of arm portions that are expanded and biased to each other, and a clip body that has a base end portion that connects the base ends of the arm portions and ligates a living tissue;
A clamping ring for inserting a base end portion of the clip body into the cylindrical body and closing the pair of arms,
The clamping ring has a plurality of slits formed along the axial direction,
Of the plurality of clip units, a pair of arm portions of the clip body of the rear clip unit adjacent to the front clip unit on the distal end side of the outer sheath member is inserted into the slit,
The ligation apparatus in which the base end portion of the clip body of the head clip unit is inserted into the arm portion of the clip body of the rear clip unit adjacent to the head clip unit so as to overlap each other.
According to this ligating apparatus, the base end portion of the clip body of the leading clip unit is inserted into the pair of arms of the clip body of the rear clip unit that is inserted into the slit of the fastening ring of the leading clip unit. Therefore, the base end portion can be easily inserted into the arm portion, and the axial length of the tightening ring can be shortened. As a result, the insertion part that accommodates the clip units arranged in a row can be easily bent to improve flexibility, bend operability when inserted into a body cavity, and follow the shape of the body cavity. Improves.

(2) The ligation apparatus according to (1),
With the arm portion of the clip body of the rear clip unit inserted into the fastening ring of the front clip unit,
A ligating apparatus in which a distal end opening width of the arm portion of the clip body of the rear clip unit is set to a length that allows insertion of a proximal end portion of the clip body of the head clip unit.
According to this ligating apparatus, since the distal end opening width of the arm portion of the rear clip body is larger than the proximal end portion of the leading clip body, the proximal end portion can be securely overlapped with the pair of arm portions and tightened. The axial length of the attached ring can be shortened.

(3) The ligation apparatus according to (1) or (2),
Of the plurality of clip units, a leading clip unit on the distal end side of the outer sheath member is connected to the operation wire, and by pulling the manipulation wire, a terminal clip unit on the side opposite to the leading clip unit is A ligating apparatus that abuts against the abutment surface of the inner sheath member and abuts between the end surfaces of the adjacent tightening rings.
According to this ligating apparatus, since the force generated when the insertion portion is introduced into the body cavity is received by each of the fastening rings with which the end surfaces abut, the clip body does not act on the clip body. To prevent damage.

(4) The ligation apparatus according to any one of (1) to (3),
The operation wire has a loop portion at the tip,
A locking claw, wherein the wire locking means is inclined and extended outward from the proximal end portion of the clip body toward the rear in the insertion direction of the clamping ring;
A ligating apparatus comprising: a retaining portion that prevents the loop portion of the operation wire hung on the retaining claw from falling out of the retaining claw.
According to this ligation apparatus, when the living tissue is ligated, the relative position between the clip body and the tightening ring can be changed by pulling and feeding the operation wire, so that the clip can be freely opened and closed. Re-grabbing can be done with a simple operation. In addition, since the clip body and the operation wire are separated due to the deformation of the clip body's latching claw, no fragmentation occurs during the separation, and the fragmentation affects the living tissue or interferes with the ligation operation. There is no fear of it.

(5) The ligation apparatus according to any one of (1) to (4),
The pair of arm portions of the clip body is formed of a plate-shaped piece having a predetermined width in a direction orthogonal to the expanding direction of the arm portions,
The ligating apparatus having a pair of clip abutting portions in which the tightening ring abuts on an outer surface of the arm portion inserted into the tightening ring and restricts rotation of the clip body.
According to this ligating apparatus, the rotation phase between the clip main body and the tightening ring can be maintained constant, and the operability for ligating living tissue can be improved.

(6) The ligation apparatus according to (5),
The ligating apparatus, wherein the clip abutting portion of the tightening ring has a flat surface that abuts against an outer surface of an arm portion of the clip body.
According to this ligating apparatus, since the pair of arm portions abut on the flat surface of the clip abutting surface, the contact area of both increases, and the arm portion can be stably guided, and the rotation of the clip body relative to the tightening ring is restricted. Thus, the pair of arms can be opened and closed smoothly.

(7) The ligation apparatus according to (5) or (6),
The arm portion of the clip body includes a wide end portion that has a stepped portion on the distal end side of the arm portion and is formed wider than the predetermined width,
A pair of guide pieces projecting from the clip abutting portion toward the inside of the clamping ring at intervals between which the clip abutting portion of the clamping ring is wider than the predetermined width and narrower than the width of the wide end portion. Have
A ligating apparatus in which an arm portion of the clip main body is inserted between the pair of guide pieces so as to advance and retreat in the longitudinal direction of the clip, and the stepped portion contacts the guide piece.
According to this ligating apparatus, when the clip main body is inserted into the fastening ring by a predetermined amount, the step formed on the arm portion of the clip main body and the guide piece come into contact with each other. Insertion into can be restricted.

(8) A clip unit used in the ligating apparatus according to any one of (1) to (7).
According to this clip unit, the living tissue can be re-gripped, and the living tissue can be continuously ligated by the plurality of clip bodies.

13, 42 Clip unit 19 Outer sheath member 21 Inner sheath member 23 Operation wire 35, 36 Clip body 37, 40 Clamping ring 37b, 37c Joining surface (end surface of clamping ring)
39 Base end part 41 Arm part 43, 44 Locking claw (wire locking means)
45, 46 Retaining part (wire locking means)
48 slit 53 wide part (wide end part)
57 Step part 63 Clip contact part 69 Guide piece 71 Loop part 81 Biological tissue 100 Ligating device WR width (end opening width of arm part)

Claims (8)

A ligation device for ligating living tissue,
A tubular outer sheath member having flexibility;
A tubular inner sheath member provided in the outer sheath member so as to freely advance and retract, and having a contact surface at the tip;
An operation wire provided in the inner sheath member so as to freely advance and retract;
A plurality of clip units arranged in series inside the distal end of the outer sheath member;
With
The clip unit has a pair of arm portions that are expanded and biased to each other, and a clip body that has a base end portion that connects the base ends of the arm portions and ligates a living tissue;
A clamping ring for inserting a base end portion of the clip body into the cylindrical body and closing the pair of arms,
The clamping ring has a plurality of slits formed along the axial direction,
Of the plurality of clip units, a pair of arm portions of the clip body of the rear clip unit adjacent to the front clip unit on the distal end side of the outer sheath member is inserted into the slit,
The ligation apparatus in which the base end portion of the clip body of the head clip unit is inserted into the arm portion of the clip body of the rear clip unit adjacent to the head clip unit so as to overlap each other. The ligation apparatus according to claim 1,
With the arm portion of the clip body of the rear clip unit inserted into the fastening ring of the front clip unit,
A ligating apparatus in which a distal end opening width of the arm portion of the clip body of the rear clip unit is set to a length that allows insertion of a proximal end portion of the clip body of the head clip unit. The ligation apparatus according to claim 1 or 2,
Of the plurality of clip units, a leading clip unit on the distal end side of the outer sheath member is connected to the operation wire, and by pulling the manipulation wire, a terminal clip unit on the side opposite to the leading clip unit is A ligating apparatus that abuts against the abutment surface of the inner sheath member and abuts between the end surfaces of the adjacent tightening rings. The ligation apparatus according to any one of claims 1 to 3,
The operation wire has a loop portion at the tip,
A locking claw, wherein the wire locking means is inclined and extended outward from the proximal end portion of the clip body toward the rear in the insertion direction of the clamping ring;
A ligating apparatus comprising: a retaining portion that prevents the loop portion of the operation wire hung on the retaining claw from falling out of the retaining claw. The ligation apparatus according to any one of claims 1 to 4,
The pair of arm portions of the clip body is formed of a plate-shaped piece having a predetermined width in a direction orthogonal to the expanding direction of the arm portions,
The ligating apparatus having a pair of clip abutting portions in which the tightening ring abuts on an outer surface of the arm portion inserted into the tightening ring and restricts rotation of the clip body. The ligation apparatus according to claim 5, wherein
The ligating apparatus, wherein the clip abutting portion of the tightening ring has a flat surface that abuts against an outer surface of an arm portion of the clip body. The ligation apparatus according to claim 5 or 6,
The arm portion of the clip body includes a wide end portion that has a stepped portion on the distal end side of the arm portion and is formed wider than the predetermined width,
A pair of guide pieces projecting from the clip abutting portion toward the inside of the clamping ring at intervals between which the clip abutting portion of the clamping ring is wider than the predetermined width and narrower than the width of the wide end portion. Have
A ligating apparatus in which an arm portion of the clip main body is inserted between the pair of guide pieces so as to advance and retreat in the longitudinal direction of the clip, and the stepped portion contacts the guide piece.   The clip unit used for the ligation apparatus of any one of Claims 1-7.

Images