JP2012200518A - Endoscopic treatment tool - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an endoscopic treatment tool which can be easily cleaned without damaging operability.SOLUTION: The endoscopic treatment tool includes: an outer sheath part including a tubular outer sheath 124; a tubular inner sheath 122 inserted to the outer sheath 124; a drive wire 123 inserted to the inner sheath 122; a connection hook connected to the distal end of the drive wire 123 and capable of holding a clip; a base part connected to the proximal end of the inner sheath 122; and a slider part to which the proximal end of the drive wire 123 is connected and which is slidably held to the base part. As the inner sheath 122, a wire tube formed by spirally twisting a plurality of wires is used.

Description

  The present invention relates to an endoscope treatment tool that performs hemostasis and the like using an endoscope.

  A clip device as a treatment instrument for an endoscope is configured to stop hemostasis by operating a clip disposed at a distal end of a sheath that is passed through a treatment instrument guide tube of an endoscope from an operation unit attached to a rear end of the sheath. It is an apparatus used for indwelling a body tissue for gripping or marking. The clip is configured to be separable from the sheath, and generally, a connecting hook that is detachable with respect to a connecting portion formed at the rear end portion of the clip is attached to the tip of the drive wire passed through the sheath. It is attached.

  Various types of connection hooks that have been engaged with and disengaged from the connection portion of the clip have been devised so far, but are urged to open in a generally C shape toward the front due to their own elasticity. Thus, the one having a shape whose tip is bent inward is often used because of its simple structure and reliable performance of connection and separation with the clip.

  As such a clip device, for example, a device described in Patent Document 1 below is known. The coupling hook for gripping the clip is connected to the distal end of the drive wire (operation wire), the drive wire is inserted through the inner sheath, and the proximal end thereof is connected to the slider portion (first operation portion). The inner sheath is inserted through the outer sheath, and its proximal end is connected to the base portion (second operation portion).

  By sliding the first operation portion in the distal direction of the second operation portion and setting it to the clip open position, the connecting hook protrudes from the tip of the inner sheath and is in a state of being opened in a substantially C shape. From this state, the coupling hook enters the inner sheath by sliding the first operation section by a predetermined amount in the direction approaching the second operation section (retraction direction) to set the clip coupling position (neutral position). The connecting hook can be closed and the clip can be connected (gripped). From this state, the first operating portion is further slid in the direction closer to the second operating portion and set to the clip fastening position, so that the connecting hook that grips the clip further enters the inner sheath, and the tip of the inner sheath A fastening ring provided on the clip is slid to the distal side, and the clip can be in a fastening state with the closed leg fixed. After that, by setting the first operation unit to the clip release position again, it is possible to release the grip of the clip in the fastening state by the connection hook.

  As the drive wire, a wire rope made of a single wire or a stranded wire formed by spirally winding a plurality of wires (element wires) is used. A hollow tube made of resin is used as the inner sheath through which the drive wire is inserted and the outer sheath through which the inner sheath is inserted. Patent Document 2 below describes that a hollow tube made of a resin such as polyethylene is used as an outer sheath, and a densely wound coil sheath is used as an inner sheath.

  By the way, from the viewpoint of cost reduction, resource saving, etc., such an endoscope treatment tool is cleaned by using an ultrasonic cleaning method in which it is cleaned by immersing it in a cleaning agent and ultrasonically oscillating a plurality of times. Although it is preferably used, the prior art uses a hollow tube made of a resin that is difficult to clean.

JP 2009-189704 A Japanese Patent No. 4388324

  In the device as disclosed in Patent Document 1, the inner sheath and the outer sheath are hollow tubes made of resin, and the cleaning liquid does not permeate into such a tube. Therefore, a special jig or the like is required for cleaning the device. However, there are problems such as the operator being confused due to the complexity of the operability, and the apparatus being damaged by the jig.

  Here, as the inner sheath and the outer sheath, if a tightly wound coil sheath such as that used in the inner sheath in Patent Document 2 is used, the cleaning liquid can be penetrated. An ultrasonic cleaning method for cleaning becomes possible, which may improve cleaning workability. However, such a coil sheath is highly stretchable in the axial direction, and the relative position of the distal end of the inner sheath and the distal end (connecting hook) of the drive wire varies depending on the shape of the sheath (such as the degree of bending). Accordingly, the responsiveness and followability in operations such as opening and closing of the connecting hook are deteriorated, so that it cannot be adopted from the viewpoint of operability.

  The present invention has been made in view of these points, and an object of the present invention is to provide an endoscope treatment tool that can be easily washed without impairing operability.

  An endoscope treatment instrument according to the present invention includes an outer sheath portion including a tubular outer sheath, a tubular inner sheath inserted through the outer sheath, a drive wire inserted through the inner sheath, A connection hook connected to the distal end of the drive wire and capable of gripping a clip, a base portion connected to the proximal end of the inner sheath, and a proximal end of the drive wire are connected to the base portion. And a wire tube formed by twisting a plurality of wire strands spirally as the inner sheath.

  In the endoscope treatment tool according to the present invention, a wire tube or a wire rope formed by spirally twisting a plurality of wire strands as the drive wire, and the winding direction of the inner sheath and the winding of the drive wire are used. The directions can be set opposite to each other. In addition, as the outer sheath, a coil sheath formed by spirally winding a single long material or a wire tube formed by spirally twisting a plurality of wire strands, the winding direction of the inner sheath and the outer sheath are used. The winding direction can be set opposite to each other.

  In the endoscope treatment tool according to the present invention, from the clip opening position where the connection hook is opened toward the clip fastening position where the clip is connected to the clip connected to the connection hook, the slider part is moved to the base part. The slide control means may further comprise a slide restricting means for closing the connecting hook and releasably stopping the clip at a clip connecting position for connecting the clip when slid.

  In the case where the slide restricting means is provided, the slide restricting means includes a rotation base provided on the base portion so as to be rotatable in a range from a first angular position (regulated position) to a second angular position (non-regulated position) When the rotation base is at the first angular position, a part of the rotation base comes into contact with the slide portion to stop sliding at the clip coupling position with respect to the base portion, and the rotation base is at the second angular position. In this case, it is possible to use one having a contact portion provided in the slider portion so that contact with a part of the rotating base is released. In this case, when the rotation base is positioned at the second angular position, one of the protrusion and the receiving portion that are engaged with each other can be provided on the base portion, and the other can be provided on the rotation base.

  In the case of including the slide restricting means, the inner sheath is rotatably connected to the base portion, the slider portion is rotatably held with respect to the outer sheath portion, and the base portion is attached to the slider portion. Rotating the connecting hook via the drive wire without rotating the inner sheath by holding and rotating the slider portion with respect to the outer sheath portion. It can be configured to control the orientation of the direction.

  In the endoscope treatment tool according to the present invention, the clip includes a pair of arm portions formed in a substantially C shape toward the distal end thereof, and the connection provided on the proximal end side of the arm portion. It is possible to use one having a connecting portion gripped by a hook and a fastening ring for fixing the arm to a closed leg.

  According to the endoscope treatment tool according to the present invention, as the inner sheath, a hollow wire tube formed by twisting a plurality of wire strands in a spiral shape is used, and the wire tube penetrates the cleaning liquid. It can be cleaned by immersing it in a cleaning agent and vibrating it ultrasonically. Therefore, the work man-hour accompanying cleaning can be reduced. In addition, such a wire tube has a property that a plurality of wire strands are spirally twisted, and when a force is applied in a direction in which the wire tube extends, the strands interfere with each other and are difficult to extend. In other words, since the extensibility in the axial direction is small, the relative position between the distal end of the inner sheath and the distal end (connecting hook) of the drive wire does not vary depending on the shape of the sheath (degree of bending, etc.). Therefore, responsiveness and followability in operations such as opening and closing of the connecting hook are high, and high operability can be realized.

  Further, when the slide restricting means is provided, the slide restricting means is set to stop at the clip connecting position in the state where the slider portion is slid with respect to the base portion and set to the clip open position. On the other hand, the slider portion can be reliably stopped at the clip connecting position by simply sliding the slider portion toward the clip fastening position. At this time, it is not necessary to strictly adjust the sliding force, and the work is extremely easy. As a result, the clip can be easily and reliably connected. Moreover, it is possible to prevent the slider portion from unintentionally sliding during the treatment, and trouble during the treatment can be reduced. If the setting of the slide restricting means is canceled from this state, it can be further slid to the clip fastening position.

It is a front view showing the appearance of the treatment tool for endoscopes of a 1st embodiment of the present invention. It is sectional drawing along the AA line of FIG. It is sectional drawing of the operation part of the treatment tool for endoscopes of 1st Embodiment of this invention. It is a figure which shows the position setting of the rotation base when not stopping the slide of the base part of 1st Embodiment of this invention in a clip connection position. It is a figure which shows the position setting of the rotation base in the case of stopping the slide of the base part of 1st Embodiment of this invention in a clip connection position. It is a figure which expands and shows the principal part of the base part of 1st Embodiment of this invention. It is a figure which shows the structure of the clip of the open leg state of embodiment of this invention. It is a figure which shows the structure of the clip of the closed leg state of embodiment of this invention. It is sectional drawing of the operation part of the treatment tool for endoscopes of 1st Embodiment of this invention, Comprising: It is a figure which shows the case where a base part is slid so that it may become a clip open position. FIG. 10 is a front view showing a state of a distal end portion of the endoscope treatment tool in the case of FIG. 9. It is sectional drawing of the operation part of the treatment tool for endoscopes of 1st Embodiment of this invention, Comprising: It is a figure which shows the case where a rotation part is set to a control position and a base part is slid. It is a front view which shows the mode of the front-end | tip part of the endoscope treatment tool in the case of FIG. It is a side view which shows the mode of the front-end | tip part of the endoscope treatment tool in the case of FIG. It is sectional drawing of the operation part of the treatment tool for endoscopes of 1st Embodiment of this invention, Comprising: The figure which shows the case where an outer receptacle is slid so that the clip connected with the connection hook may be accommodated in an outer sheath. It is. It is a front view which shows the mode of the front-end | tip part of the endoscope treatment tool in the case of FIG. It is a side view which shows the mode of the front-end | tip part of the endoscope treatment tool in the case of FIG. It is sectional drawing of the operation part of the treatment tool for endoscopes of 1st Embodiment of this invention, Comprising: It is a figure which shows the case where a rotation base is set to the non-restriction position in a clip connection position. It is sectional drawing of the operation part of the treatment tool for endoscopes of 1st Embodiment of this invention, Comprising: It is a figure which shows the case where a base part is slid so that it may become a clip fastening position. It is a front view which shows the mode of the front-end | tip part of the endoscope treatment tool in the case of FIG. It is a side view which shows the mode of the front-end | tip part of the endoscope treatment tool in the case of FIG. It is a figure which shows the structure of 2nd Embodiment of this invention, Comprising: It is a front view which shows the principal part structure of a base part. It is a perspective view which shows the external appearance of the operation part of the treatment tool for endoscopes of 3rd Embodiment of this invention. It is a perspective view which shows the state which cut | disconnected the operation part of the treatment tool for endoscopes of 3rd Embodiment of this invention in half. It is sectional drawing of the operation part of the treatment tool for endoscopes of 3rd Embodiment of this invention, Comprising: It is a figure which shows the case where a base part is slid so that it may become a clip open position. It is a perspective view which shows the mode of the front-end | tip part of the treatment tool for endoscopes in the case of FIG. It is a perspective view which shows the state which cut | disconnected FIG. 25 in half. It is sectional drawing of the operation part of the treatment tool for endoscopes of 3rd Embodiment of this invention, Comprising: It is a figure which shows the case where a base part is slid so that it may become a neutral position. It is a perspective view which shows the mode of the front-end | tip part of the treatment tool for endoscopes in the case of FIG. It is a perspective view which shows the state which cut | disconnected FIG. 28 in half. It is sectional drawing of the operation part of the treatment tool for endoscopes of 3rd Embodiment of this invention, Comprising: The figure which shows the case where an outer receiver is slid so that the clip connected with the connection hook may be accommodated in an outer sheath. It is. It is a perspective view which shows the mode of the front-end | tip part of the treatment tool for endoscopes in the case of FIG. It is a perspective view which shows the state which cut | disconnected FIG. 31 in half. It is sectional drawing of the operation part of the treatment tool for endoscopes of 3rd Embodiment of this invention, Comprising: The figure which shows the case where an outer receiver is slid so that the clip connected with the connection hook may be accommodated in an outer sheath. It is. It is a perspective view which shows the principal part of the inner sheath of the treatment tool for endoscopes of 3rd Embodiment of this invention. It is a perspective view which shows the structure of the sheath part of the treatment tool for endoscopes of 3rd Embodiment of this invention.

  Hereinafter, the clip device as the endoscope treatment tool according to the first embodiment of the present invention will be specifically described with reference to FIGS.

  First, reference will be made to FIGS. Hereinafter, for convenience, a direction in which an outer support 26, a slider portion 27, and a base portion 28, which will be described later, slide relative to each other may be referred to as a slide direction.

  The clip device 20 includes a connecting hook 21, an inner sheath (inner tube) 22, a drive wire (operation wire) 23, an outer sheath (outer tube) 24, a reinforcing pipe 25, an outer receptacle 26, a slider portion 27, a base portion 28, And a rotary ring (second operation unit) 29 is generally provided. The slider part 27 includes a base outer cylinder 27a and a slider (first operation part) 27b, and the base part 28 includes a fixed base 28a and a rotating base 28b.

  Similarly, a tubular inner sheath 22 is inserted through the tubular outer sheath 24, and a drive wire 23 is inserted through the inner sheath 22. The inner sheath 22 is slidable within the outer sheath 24, and the drive wire 23 is slidable within the inner sheath 22.

  The outer sheath 24 is formed of a flexible hollow tube, and a coil tube is used in this embodiment. As the coil tube, a flat wire coil tube formed by spirally winding a long flat plate made of metal (stainless steel) or the like can be used. However, a round wire coil tube or an inner flat coil tube may be used.

  The inner sheath 22 is made of a flexible hollow tube, and a wire tube is used in this embodiment. A wire tube is a tube which consists of a hollow twisted wire formed by spirally twisting a plurality of wires (cables) made of, for example, metal (stainless steel) or the like. As an example, using about 8 to 10 wires with a diameter of 0.4 mm and twisting so that the outer diameter is 1.5 to 1.7 mm and the inner diameter is 0.7 to 1 mm, It has become clear from experiments by the present inventors that a wire tube that can sufficiently withstand the compressive force generated in the sheath can be obtained. It has been found that a wire tube similarly obtained using a cable having a diameter of 0.3 mm is insufficient for the compressive force generated in the inner sheath during operation. In addition, as the inner sheath 22, a wire tube may be mainly used, and only a part on the tip side may be a coil tube.

  The drive wire 23 is made of a flexible wire, and a wire rope is used in this embodiment. The wire rope is a rope made of a stranded wire formed by twisting a plurality of wires (cables) made of, for example, metal (stainless steel) or the like. However, a wire tube similar to the inner sheath 22 may be used as the drive wire 23.

  A wire tube made of such a coil tube or a stranded wire is used as the outer sheath 24 or the inner sheath 22 when the clip device 20 is subjected to ultrasonic cleaning using a cleaning liquid. This is to allow the inside and outside to be cleaned well by penetrating into the water.

  In addition, it is preferable to use the opposite direction for the winding direction of the outer sheath 24 and the winding direction of the inner sheath 22 from the viewpoint of reducing the sliding resistance generated between them. For example, when the outer sheath 24 is Z-winding, the inner sheath 22 is S-winding. When a wire rope or wire tube made of a stranded wire is used for the drive wire 23, it is also preferable that the winding direction is opposite to the winding direction of the inner sheath 22.

  The connecting hook 21 arranged at the sheath distal end of the clip device 20 has a pair of arm portions made of an elastic body arranged in a substantially C shape toward the distal end, and in cooperation with the inner sheath 22, Two states, an open leg (open) state and a closed leg (closed) state, can be taken. The distal end portion of the arm portion of the connection hook 21 is bent inward (towards each other) and serves as a grip portion for gripping and connecting a connection portion 11a of the clip 10 described later. The proximal end portion of the connection hook 21 is fixed to the distal end of the drive wire 23.

  A proximal end of the outer sheath 24 is connected to an outer receiver 26 via a reinforcing pipe 25. That is, the vicinity of the proximal end of the outer sheath 24 is inserted into the reinforcing pipe 25 and is integrally fixed to the reinforcing pipe 25, and the base end portion of the reinforcing pipe 25 is attached to the vicinity of the distal end portion of the outer receiver 26. The reinforcement pipe 25 is supported by the outer receptacle 26 so as to be rotatable about the central axis of the pipe, and when the outer receptacle 26 is slid in the sliding direction, the outer reinforcement pipe 25 is slid integrally. Supported by the receiver 26.

  The outer receiver 26 is formed of a substantially cylindrical member, and a pair of spring accommodating portions are provided on the base end side, and the plate springs 31 are accommodated in the pair of spring accommodating portions, respectively.

  The proximal end of the drive wire 23 is integrally connected and fixed to a slider 27 b constituting the slider portion 27 through a lead pipe receiver 30 by a pair of screws (not shown) or fitting. Therefore, the drive wire 23 rotates integrally when the slider 27b is rotated about its central axis, and is slid integrally when the slider 27b is slid in the sliding direction.

  The slider 27b is formed in a substantially cylindrical shape. The slider 27b has flange portions 27c projecting outward at both ends in the sliding direction, and a portion between the flange portions 27c can be sandwiched between, for example, an index finger and a middle finger. Yes. Here, when a finger is placed and operated in the space between the two flange portions 27c, the slider 27b is formed in a substantially cylindrical shape, so that the finger is placed in the hole formed in the slider as in the prior art. The operator can easily operate the slider without worrying about the direction (position, posture) of the slider, as compared with the case where the operator is operated by inserting. Further, a pair of spring accommodating portions are formed inside the slider 27b, and the plate springs 32 are accommodated in these spring accommodating portions, respectively.

  A base outer cylinder 27a is attached to the slider 27b, and the base outer cylinder 27a is formed of a substantially cylindrical member. Since the base outer cylinder 27 a is slidably inserted into the outer receiver 26, the slider portion 27 is slidably held with respect to the outer receiver 26. The base outer cylinder 27a is supported (coupled) by the slider 27b so as to be rotatable about its central axis, and when the slider 27b is slid in the sliding direction, the slider is also slid integrally. 27b is supported.

  The outer receiver 26 can slide with respect to the slider portion 27 so that it can be positioned between two positions, ie, a position moved to the distal end side and a position moved to the proximal end side. That is, the base outer cylinder 27a is formed with a positioning groove 31a in the vicinity of the base end portion and a positioning groove 31b in the vicinity of the distal end portion, and the leaf spring 31 accommodated in the spring accommodating portion of the outer receptacle 26 is The positioning groove 31a or 31b is elastically engaged.

  When the outer receiver 26 is slid with respect to the slider portion 27 so that the base outer cylinder 27a is pulled out of the outer receiver 26, the leaf spring 31 is elastically engaged with the positioning groove 31b. When the base outer cylinder 27a is slid in a direction to be pushed into the outer receptacle 26 at a position moved to the tip end side (position separated from the slider 27b), a leaf spring is inserted into the positioning groove 31a. Positioning is performed at a position (position close to the slider 27) moved to the base end side by elastically engaging 31.

  The proximal end of the inner sheath 22 is connected to the approximate center of the distal end portion of the fixed base 28 a constituting the base portion 28. The inner sheath 22 is integrally formed by being supported by the fixed base 28a so as to be rotatable about its central axis.

  A rotary base 28b is rotatably supported by a shaft portion 28c provided integrally with the fixed base 28a, and a rotary ring 29 as a second operation portion rotates at an end portion on the base end side thereof. Supported as possible. The slider 27 can be easily slid with one hand by inserting the thumb into the rotating ring 29 with the index finger and the middle finger sandwiched between the pair of collars 27c of the slider 27b. It can be done.

  The base portion 28 is inserted and held in the fitting hole of the slider 27b so that the slider 27b can slide in the sliding direction. At least a part of the fixed base 28a of the base portion 28 is always inserted into the fitting hole of the slider 27b. The rotary base 28b is selectively inserted into the fitting hole depending on the slide position of the base portion 28. The outer shape of the fixed base 28a and the inner shape of the fitting hole of the slider 27b are such that the cross-sectional shape is a perfect circle, an ellipse, a rectangle, or the like. In the present embodiment, the shape is a combination of an arc and a pair of straight lines (see FIG. 4). The outer shape of the rotation base 28b is substantially the same as the outer shape of the fixed base.

  Positioning grooves are formed in the fixed base 28a or the rotating base 28b at different positions in the sliding direction. In the present embodiment, positioning grooves 32a and 32b are formed in the fixed base 28a, and a positioning groove 32c is formed in the rotating base 28b. The pair of leaf springs 32 accommodated in the spring accommodating portion of the slider 27b are elastically engaged with any one of the positioning grooves 32a, 32b, 32c according to the slide position of the slider 27b with respect to the base portion 28, whereby the base The slider portion can be positioned with respect to the portion 28 at three positions (a clip opening position, a clip coupling position, and a clip fastening position).

  The clip opening position is a position where the connecting hook 21 is opened (opened), and is the position where the slider part 27 is most pulled out from the base part 28. The clip fastening position is a position where the fastening ring 12 is slid onto the clip 10 gripped by the connecting hook 21 to perform a fastening operation, and is the position where the slider part 27 is pushed most into the base part 28. The clip connecting position is a position where the connecting hook 21 is closed without connecting the clip 10 and the clip 10 is connected (gripped), and is a position set between the clip opening position and the clip fastening position.

  Next, a description will be given of a slide restricting means that stops the releasable stop at the clip connecting position when the slider portion 27 is slid from the clip opening position toward the clip fixing position. The slide restricting means of the present embodiment includes a rotation base 28b that constitutes the above-described base portion 28, and an abutment surface (abutment portion) 27d that is provided on the slider 27c that constitutes the slider portion 27. Yes.

  As shown in FIGS. 4 and 5, the rotary base 28b is supported by the shaft portion 28c of the fixed base 28a so as to be rotatable around an axis substantially along the slide direction. On the contact surface of the fixed base 28a with the rotating base 28b, a protrusion 33a protruding in the sliding direction is integrally provided. On the other hand, a substantially arc-shaped guide groove 33b in which the protrusion 33a of the fixed base 28a is loosely fitted is formed on the contact surface of the rotation base 28b with the fixed base 28a. These protrusions 33a and guide grooves 33b are means for defining an angular range of rotation of the rotation base 28b with respect to the fixed base 28a.

  As shown in FIG. 4, when the rotary base 28b is rotated counterclockwise with respect to the fixed base 28a (the direction of the arrow A1 in the figure), the protrusion 33a moves along the guide groove 33b, and the guide groove The side portion of the projection 33a abuts on one end of 33b, so that the predetermined second angular position is set. The second angular position is a non-regulating position that does not restrict the sliding of the slider part 27 with respect to the base part 28. In this non-regulated position, the outer shape of the rotating base 28b and the outer shape of the fixed base 28a overlap to form substantially the same shape, and are fixed when slid in the direction in which the slider portion 27 is pushed into the base portion 28. Not only the base 28a but also the rotating base 28b can enter the fitting hole of the slider 28b. That is, the slide of the slider portion 27 is not restricted.

  On the other hand, as shown in FIG. 5, when the rotary base 28b is rotated clockwise with respect to the fixed base 28a (in the direction of arrow A2 in the figure), the projecting portion 33a moves along the guide groove 33b and guides. The side of the protrusion 33a contacts the other end of the groove 33b, so that the predetermined first angular position is set. The first angular position is a restriction position that restricts the sliding of the slider part 27 with respect to the base part 28. In the state set to this restricting position, the outer shape of the rotating base 28b and the outer shape of the fixed base 28a do not overlap each other, and a part (corner portion 28d) of the rotating base 28b is in relation to the fixed base 28a. When the slider portion 27 is slid in the direction in which the slider portion 27 is pushed into the base portion 28, the fixed base 28a can enter the inside of the fitting hole of the slider 27b. The corner portion 28d contacts the contact surface 27d of the slider 27b. That is, the slide of the slider 27b is restricted. From this state, as shown in FIG. 4, if the rotary base 28 b is rotated counterclockwise (in the direction of arrow A <b> 1 in the figure) and set to the non-restricted position, the slider portion 27 is further pushed into the base portion 28. To be able to slide.

  In the present embodiment, as shown in FIG. 6, when the projection 33a is set at the second angular position (non-regulatory position) of the guide groove 33b, the projection 33a is engaged (or fitted). A portion 33c is provided. In order to constitute the receiving portion 33c, a pair of locking portions 33d are provided so as to protrude inside the guide groove 33b. The fact that the protrusion 33a has reached the second angular position of the guide groove 33b can be perceived by a slight resistance (click feeling) when the protrusion 33a passes through the locking portion 33c, and the rotation base 28b. Can be stably held in a state where is set to the non-regulating position.

  Here, the protrusion 33a is provided on the fixed base 28a and the guide groove 33b is provided on the rotary base 28b. On the contrary, a guide groove similar to the guide groove 33b is provided on the fixed base 28a. It is good also as a structure which provides the projection part similar to the projection part 33a.

  Here, a schematic configuration of the clip used in the present embodiment will be described. FIG. 7 is a diagram showing the configuration of the clip in the open leg state, and FIG. 8 is a diagram showing the configuration of the clip in the closed leg state.

  The clip 10 includes a pair of arm portions 11 and a fastening ring (clip fastening ring) 12. The arm portion 11 is formed of an elastic metal plate material or the like, and is configured to be opened and arranged in a substantially C shape as it goes to the tip. A connecting portion 11a for connecting to the connecting hook 21 is disposed on the base end side of the arm portion 11, and the distal end portion of the arm portion 11 is bent inward (that is, in the closing direction) to It is a gripping part 11b for gripping and the like.

  The connecting portion 11a is formed in a substantially U shape (or may be annular or the like), and an annular fastening ring 12 is slidably fitted on the connecting portion 11a. The fastening ring 12 is formed of a short metal pipe material, a coil material, or the like, and, as shown in FIG. If necessary, as shown in FIG. 8, the arm portion 11 is forcibly closed by moving the fastening ring 12 to a position closer to the front (front end).

  Next, the operation of the clip device 20 will be described with reference to FIGS. First, the outer receiver 26 is slid to the side close to the slider portion 27, and the leaf spring 31 is elastically engaged with the positioning groove 31a. Thereby, although illustration is abbreviate | omitted, the inner sheath 22 will be extruded with respect to the outer sheath 24, and the front-end | tip of the inner sheath 22 will protrude from the front-end | tip of the outer sheath 24. FIG.

  Next, for example, the right thumb is inserted into the annular ring 29, and the slider 27b is operated so as to be separated from each other in a state where the portion between the pair of hooks 27c of the slider 27b is sandwiched between the right index finger and the middle finger, for example. Is set to the position where the base part 28 is most pulled out (position on the front end side). This position is the above-described clip opening position. Here, the description will be mainly given of the case where the operation is performed with one hand. For example, the slider part 27 or the vicinity thereof is grasped with the left hand, and the annular ring 29 or the vicinity thereof is grasped with the right hand and the operation is performed with both hands. Of course.

  In the state set to the clip open position, as shown in FIG. 9, the leaf spring 32 is elastically engaged with the positioning groove 32a of the fixed base 28a, and this state is maintained. Although illustration is omitted, in this state, a part of the fixed base 28a abuts a part of the slider 27b, so that further sliding (drawing) of the slider part 27 with respect to the base part 28 is restricted. It has become so.

  By this operation, as shown in FIG. 10, the connecting hook 21 at the distal end of the drive wire 23 is pushed out of the inner sheath 22 and protrudes from the distal end of the inner sheath 22, and is opened in a substantially C shape by its own elasticity. . In this state, as shown in FIG. 9, the rotation base 28b is rotated in the direction of arrow A3 in the figure, and the rotation base 28b is set to the restriction position (first angle position) shown in FIG.

  Next, the sheath tip (connection hook 21) of the clip device 20 is arranged so that the connection portion 11a of the clip 10 to be connected thereto can be gripped. In addition, when performing this clip connection operation | work, if the clip attachment tool etc. which were described in the said patent document 1 are used, the attachment operation | work can be performed easily and reliably.

  In this state, for example, the right thumb is inserted into the annular ring 29, and the portion between the pair of collars 27c of the slider 27b is operated so as to be close to each other with the right index finger and the middle finger sandwiched therebetween, for example. The slider part 27 is slid with respect to 28 in the direction (arrow A4 direction in FIG. 11). Since the rotation base 28b is set at the restricting position, as shown in FIG. 11, the corner portion 28d of the rotation base 28b contacts the contact surface 27d of the slider 27b, and the slide is forcibly stopped. This stopped position is the above-described clip connecting position. Therefore, the setting operation (sliding) to the clip connecting position can be performed at once without strictly adjusting the sliding force and without worrying about the stop position.

  In the state set to the clip coupling position, as shown in FIG. 11, the leaf spring 32 is elastically engaged with the positioning groove 32b of the fixed base 28a, and this state is maintained.

  By this operation, as shown in FIGS. 12 and 13, the drive wire 23 is drawn into the inner sheath 22, and the connecting hook 21 at the tip of the drive wire 23 is buried in the tip of the inner sheath 22 to close the leg. The clip 10 is connected to the distal end of the sheath 20. As shown in FIG. 13, in this state, the fastening ring 12 of the clip 10 is not slid, and the pair of arm portions 11 of the clip 10 are in a state of being opened by their own elasticity.

  Next, as shown in FIG. 14, the outer receiver 26 is slid in the direction away from the slider portion 27 (in the direction of arrow A5 in FIG. 14), and the leaf spring 31 is elastically engaged with the positioning groove 31b. State. As a result, as shown in FIGS. 15 and 16, the outer tube 24 is pushed out against the inner sheath 22 and the drive wire 23, and the connecting hook 21 and the clip 10 to which the clip 10 is connected are buried in the outer sheath 24. Then, the clip 10 is accommodated in the distal end portion of the outer sheath 24 with the legs closed. In this state, the fastening ring 12 of the clip 10 maintains the previous position, and the fastening operation of the clip 10 is not performed.

  In this state, the clip device 20 is inserted into a treatment instrument guide tube (not shown) of the endoscope, and is introduced to the affected area where hemostasis or the like is to be performed by clipping the clip 10. When the distal end of the outer sheath 24 reaches the affected part, as shown in FIG. 17, the outer receiver 26 is slid again in the direction approaching the slider part 27 (in the direction of the arrow A6 in FIG. 17) to enter the positioning groove 31a. The leaf spring 31 is in an elastically engaged state. Accordingly, as shown in FIGS. 12 and 13, the outer tube 23 is pulled into the inner sheath 22, and the clip 10 connected to the connecting hook 21 protrudes from the distal end of the outer sheath 24. It is returned to the state where the legs are opened.

  Next, when adjusting the posture of the clip 10 connected to the connection hook 21 in the rotation direction, the slider portion 27 with respect to the outer receiver 26 (when the slider portion 27 is rotated, the base portion 28 is also rotated integrally). It can be adjusted by rotating. At this time, since the proximal end of the inner sheath 22 is rotatably supported by the tip of the fixed base 28a, only the drive wire 23 can be rotated without rotating the inner sheath 22.

  When the clip 10 is introduced into an appropriate position in the body cavity of the patient and the posture adjustment and the like have been completed, the rotation base 28b is rotated in the direction of arrow A7 in the drawing as shown in FIG. The non-regulated position (second angle position) is set. At this time, the protruding portion 33a of the fixed base 28a engages (or fits) with the receiving portion 33c of the guide groove 33b of the rotating base 28b so that the state can be recognized and the position is maintained.

  As a result, the restriction of sliding that pulls the slider portion 27 to the position on the proximal side of the base portion 28 is released, and the slider portion 27 can be further pulled in the direction of arrow A8 in FIG. Pull it further and slide it to the most retracted position (most proximal position). This position is the above-described clip fastening position.

  In the state set to the clip fastening position, as shown in FIG. 18, the leaf spring 32 is elastically engaged with the positioning groove 32c of the rotation base 27b, and this state is maintained. In this state, a part of the portion of the rotary base 28b to which the rotary ring 29 is attached comes into contact with the contact surface 27d of the slider portion 27, so that further sliding of the slider portion 27 with respect to the base portion 28 is restricted. It has come to be.

  Accordingly, as shown in FIGS. 19 and 20, the drive wire 23 is further drawn into the inner sheath 22, that is, the connecting hook 21 is further drawn into the inner sheath 22, and is clipped by the distal end portion of the inner sheath 22. Ten fastening rings 12 are pushed out and slid to the fastening position, and the clip 10 is closed and fixed in a state where the affected part is gripped.

  When the clipping of the clip 10 to the affected part is completed, the slider part 27 is slid to the clip opening position (see FIGS. 9 and 10), which is the position on the most distal side of the base part 28, and the clip 10 by the connecting hook 21 is removed. The grip is released and a series of work is completed.

  FIG. 21 is a front view showing the configuration of the main part of the second embodiment of the present invention, and shows the configuration of the base portion 28. In addition, the same number is attached | subjected to the component substantially the same as 1st Embodiment mentioned above, and the description is abbreviate | omitted. In the first embodiment described above, as shown in FIGS. 4 to 6, the rotation angle range of the rotation base 28b with respect to the fixed base 28a is defined by the protrusion 33a and the guide groove 33b, and the non-regulated position (first In order to create and position a click feeling when set to the (two-angle position), receiving portions 33c (a pair of locking portions 33d) into which the protruding portions 33a are fitted are provided in the guide grooves 33.

  On the other hand, in the second embodiment, instead of the receiving portion 33c, a protrusion 34a having a head is provided on the inner surface of the rotation base 28b, and corresponds to the protrusion 34a of the shaft portion 28c of the fixed base 28a. The portion is provided with a receiving portion 34b into which the protruding portion 34a is releasably engaged or fitted. The receiving portion 34b is a thin plate having elasticity and has a pair of engaging plates 34c facing each other, and the rotation base 28b is rotated in the direction of arrow A9 in the drawing so as to be in the non-restricting position (second angular position). In this case, the head of the projection 34a enters between the pair of locking plates 33c and is locked. If the rotation base 28b is rotated in the opposite direction to the restriction position (first angle position), the locking of the protrusion 34a to the locking plate 33c is released.

  The fact that the rotation base 28b is set to the non-restricted position can be perceived by a slight resistance (clicking) when the protrusion 34a is press-fitted between the pair of locking plates 33c of the receiving portion 34b. The rotation base 28b can be stably held in a state where the rotation base 28b is set to the non-restricted position.

  Here, the protrusion 34a is provided on the rotating base 28b, and the receiving portion 34b (locking plate 34c) is provided on the fixed base 28a (shaft portion 28c). Conversely, the fixed base 28a (shaft portion 28c) is provided. It is also possible to provide a protrusion similar to the protrusion 34a and a receiving portion similar to the receiving portion 34b (locking plate 34c) on the rotary base 28b.

  According to the first embodiment or the second embodiment described above, when the clip 10 is connected (gripped) to the connection hook 21, the slider portion 27 is slid in the direction of pushing out toward the distal end side of the base portion 28. To set the clip open position to open the connecting hook 21, and then move the slider 27 to the proximal side of the base 28 in a state where the rotary base 28 b is rotated to the restricted position (first angular position). When it is slid in the retracting direction, it is forcibly stopped at an optimal position for connecting the clip 10. Therefore, unlike the prior art, it is not necessary to perform the slide operation to set the clip connection position by adjusting the slide force, and the clip is set to a position before the clip connection position due to insufficient slide amount. 10 cannot be accurately connected (gripped), or the slide amount is too large, and the clip is further pushed in than the clip connecting position, and the fastening ring 12 of the clip 10 is slid, and the clip is brought into a fastening state. It is possible to reduce the occurrence of failure.

  Further, it is no longer possible to unintentionally slide from the clip connection position during the procedure, and the occurrence of the trouble that the fastening ring 12 of the clip 10 is slid and the clip 10 is brought into the fastening state can be reduced. it can.

  For this reason, the clip 10 is erroneously fixed to the closed leg, and there is no need to perform the troublesome work for wasting the clip 10 or returning it to the unused state, thereby suppressing waste of resources and time. .

  Next, a clip device as an endoscope treatment tool according to a third embodiment of the present invention will be specifically described with reference to FIGS. 22 to 35.

  First, FIG. 22 to FIG. 26 will be referred to. Hereinafter, for convenience, a direction in which an outer support 126, a slider portion 127, and a base portion 128, which will be described later, slide relative to each other may be referred to as a slide direction.

  The clip device 120 includes a connecting hook 121, an inner sheath (inner tube) 122, a drive wire (operation wire) 123, a sheath portion having an outer sheath (outer tube) 124, an outer receiver 126, and a slider portion 127 (127a, 127a, 127b), a base portion 128, and an operation portion having a rotary ring (second operation portion) 129. The slider portion 127 includes a base outer cylinder 127a and a slider (first operation portion) 127b, and the base portion 128 includes a fixed base 128a and a tip base 128b.

  Similarly, a tubular inner sheath 122 is inserted through the tubular outer sheath 124, and a drive wire 123 is inserted through the inner sheath 122. The inner sheath 122 is slidable within the outer sheath 124, and the drive wire 123 is slidable within the inner sheath 122.

  The outer sheath 124 is made of a flexible hollow tube, and for example, a coil tube can be used. A coil tube is a hollow tube formed by spirally winding a single wire. In the present embodiment, as a coil tube constituting the outer sheath 124, as shown in an enlarged view in FIG. 35, a spiral long plate having a rectangular cross section made of metal (stainless steel) or the like is brought into close contact with each other. A coiled flat wire coil tube is used. However, a round wire coil tube having a circular cross section or an inner flat coil tube having a substantially semicircular cross section (inner surface is flat and outer surface is arc-shaped) may be used. The coil tube has the characteristics that flexibility and stretchability are relatively high, and torque (rotational force) transmission is relatively low (inferior). In the present embodiment, the outer sheath 124 having a total length of 2 m, an outer diameter of 2.6 mm, and an inner diameter of 2.1 mm is used. As the outer sheath 124, a wire tube may be used as in the case of the inner sheath 122 described in detail later, as long as it is technically possible to manufacture a product having such dimensions.

  The inner sheath 122 is made of a flexible hollow tube, and as shown in FIGS. 34 and 35, a wire tube is used in this embodiment. The wire tube is a tube made of a hollow stranded wire formed by twisting a plurality of wire strands made of, for example, metal (stainless steel) in a spiral shape so as to be hollow. In the present embodiment, ten wire strands having a diameter of 0.4 mm are used and twisted so that the outer diameter is 1.7 mm and the inner diameter is 0.9 mm. The wire tube has characteristics of low flexibility and stretchability and high torque transmission (excellent) compared to the coil tube described above. In the third embodiment, the inner sheath 122 mainly uses a wire tube for a total length of 2 m in order to improve (increase) flexibility or flexibility of the distal end portion, and a part of the distal end side thereof. A coil tube made of only (150 mm) is used.

  An annular member 122a is attached to the tip of the inner sheath 122 so as to be rotatable around its central axis. The annular member 122a is rotatably provided because the connecting wire 121 is accommodated at the distal end of the inner sheath 122 and the drive wire 123 is used to adjust the posture of the connecting hook 121 (clip 10). This is because when the ring member 122 is rotated, the annular member 122a rotates integrally with the connecting hook 121, thereby reducing the resistance received from the inner sheath 122.

  The drive wire 123 is made of a flexible wire, and in the third embodiment, a wire rope is used as shown in FIG. The wire rope is a rope made of a non-hollow stranded wire formed by twisting a plurality of wire strands made of, for example, metal (stainless steel) in a spiral shape. However, as the drive wire 123, a wire tube made of a hollow stranded wire similar to the inner sheath 122 may be used. Further, as the drive wire 123, a wire made of a single wire may be used.

  The winding direction of the outer sheath 124 and the winding direction of the inner sheath 122 are preferably opposite to each other from the viewpoint of reducing the sliding resistance generated between them. For example, when the outer sheath 124 is Z-wound (Z twisted), the inner sheath 122 is S-wound (S twisted). In the case where a wire rope or wire tube made of a stranded wire is used for the drive wire 123, it is also preferable that the winding direction is opposite to the winding direction of the inner sheath 122. In this case, the outer sheath 124 and the drive wire 123 are wound in the same direction.

  Reference is again made to FIGS. 22 to 26. The connection hook 121 disposed at the distal end of the sheath portion of the clip device 120 has a pair of arm portions made of an elastic body disposed in a substantially C shape toward the distal end, and cooperates with the inner sheath 122. Thus, two states, that is, an open leg (open) state and a closed leg (closed) state can be taken. The front end of the arm portion of the connection hook 121 is bent inward (towards each other) and grips and connects the connection portion 11a of the clip 10 (see FIGS. 7 and 8) to be connected. It has become. The proximal end portion of the connection hook 121 is integrally fixed to the distal end of the drive wire 123.

  The proximal end of the outer sheath 124 is connected to the tip of the outer receptacle 126. The outer sheath 124 is supported by the outer receptacle 126 so as to be rotatable about its central axis, and when the outer receptacle 126 is slid in the sliding direction, the outer receptacle 126 is slid integrally. It is supported by.

  The outer receptacle 126 is made of a substantially cylindrical member, and a pair of spring accommodating portions are provided on the base end side, and the plate springs 131 are accommodated in the pair of spring accommodating portions, respectively. The outer receptacle 126 is formed of a half member having a shape substantially opposite to each other, and is integrated by fitting a plurality of appropriately arranged fitting holes 126a and a plurality of fitting projections 126b fitted thereto. It has come to be. The halved member of the outer receptacle 126 is formed with a plurality of recessed portions 126c for reducing the weight on the joint surface, and an uneven portion 126d for preventing slipping when operated by hand on the outside thereof. ing.

  The proximal end of the drive wire 123 is integrally connected and fixed to a slider 127 b that constitutes the slider portion 127. Therefore, the drive wire 123 rotates integrally when the slider 127b is rotated about its central axis, and is slid integrally when the slider 127b is slid in the sliding direction.

  The slider 127b has flanges 127c projecting outward at both ends in the sliding direction, and a portion between the flanges 127c can be sandwiched between, for example, an index finger and a middle finger. . The further distal end portion of the flange portion 127c on the distal end side of the slider 127b is an inclined portion that decreases in diameter toward the distal end, and a finger (for example, an index finger and a middle finger) is applied to the inclined portion, The slider portion 127 can be operated also by grasping with.

  A pair of spring accommodating portions are formed inside the slider 127b, and the plate springs 132 are accommodated in these spring accommodating portions, respectively. The slider 127b is formed of a half member having a shape substantially opposite to each other, and is integrated by fitting together a plurality of fitting holes 127e arranged appropriately and a plurality of fitting protrusions 127d fitted therein. It has become so. The halved member of the slider 127b is formed with a plurality of depressions 127f for reducing the weight on the joint surface.

  A base outer cylinder 127a is attached to the slider 127b, and the base outer cylinder 127a is formed of a substantially cylindrical member. Since the base outer cylinder 127 a is slidably inserted into the outer receiver 126, the slider portion 127 is slidably held by the outer receiver 126. The base outer cylinder 127a is fitted and fixed to the slider 127b, and slides integrally when the slider 127b is slid in the sliding direction.

  The outer receiver 126 is slidable relative to the slider portion 127 so that it can be positioned between two positions: a position moved to the distal end side and a position moved to the proximal end side. That is, the base outer cylinder 127a has a positioning groove 131a in the vicinity of the base end portion thereof and a positioning groove 131b in the vicinity of the distal end portion thereof, and the leaf spring 131 accommodated in the spring accommodating portion of the outer receptacle 126 has these The positioning groove 131a or 131b is elastically engaged.

  When the outer receiver 126 is slid with respect to the slider portion 127 so that the base outer cylinder 127a is pulled out of the outer receiver 126, the leaf spring 131 is elastically engaged with the positioning groove 131b. When the base outer cylinder 127a is slid in the direction to be pushed into the outer receiver 126 when it is moved to the tip end side (position separated from the slider 127b), a leaf spring is inserted into the positioning groove 131a. Positioning is performed at a position (position close to the slider 127b) moved to the base end side by elastically engaging 131.

  The proximal end of the inner sheath 122 is connected to the approximate center of the distal end base 128 b that is fitted and fixed to the distal end of the fixed base 128 a that constitutes the base portion 128. The inner sheath 122 is supported by the distal end base 128b so as to be rotatable about its central axis, and when the base portion 128 is slid in the sliding direction, the distal end is slid integrally therewith. It is supported by the base 128b. A rotating ring 129 is rotatably attached to the base end side of the fixed base 128a.

  For example, the base portion 128 can be easily slid with one hand by inserting the thumb into the rotating ring 129 with the portion between the pair of collars 127c of the slider 127b sandwiched between the index finger and the middle finger. Be able to.

  The base portion 128 is inserted and held in the fitting holes of the slider 127b and the base outer cylinder 127a so as to be slidable in the sliding direction.

  Positioning grooves 132a, 132b, 132c are formed in the fixed base 128a at positions different from each other in the sliding direction. The pair of leaf springs 132 accommodated in the spring accommodating portion of the slider 127b are elastically engaged with any one of the positioning grooves 132a, 132b, and 132c according to the slide position of the base portion 128, whereby the base portion 128 is moved. The slider portion 127 can be positioned at three positions (a clip opening position, a clip coupling position, and a clip fastening position).

  The clip opening position is a position where the connecting hook 121 is opened (opened), and is the position where the base portion 128 is most pulled out from the slider portion 127. The clip fastening position is a position where the fastening ring 12 (see FIGS. 7 and 8) is slid and fastened to the clip 10 (see FIGS. 7 and 8) held by the connecting hook 121, and the base portion 128 is moved to the slider portion. 127 is the position most pushed into 127. The clip connecting position is a position where the connecting hook 121 is closed without connecting the clip 10 and the clip 10 is connected (gripped), and is a position set between the clip opening position and the clip fastening position.

  Note that the clip device 120 of the second embodiment is not provided with the slide restricting means as in the first embodiment, and the elasticity of the positioning grooves 132a, 132b, 132c of the fixed base 128a and the leaf spring 132 is not provided. The base portion 128 is positioned with respect to the slider portion 127 by the effective engagement.

  In addition, the clip used in the second embodiment is the same as the clip 10 described with reference to FIGS. 7 and 8 in the first embodiment described above, and is given the same reference numeral. The description is omitted.

  Next, the operation of the clip device 120 will be described with reference to FIGS. First, as shown in FIG. 24, the slider 127 is slid so that the base outer cylinder 127a is pushed into the outer receptacle 126, and the leaf spring 131 is elastically engaged with the positioning groove 131a. As a result, as shown in FIGS. 25 and 26, the inner sheath 122 is pushed out with respect to the outer sheath 124, and the distal end of the inner sheath 122 protrudes from the distal end of the outer sheath 124.

  Next, for example, the right thumb is inserted into the annular ring 129, and the base portion 128 is operated so as to be separated from each other while the portion between the pair of collars 127c of the slider 127b is sandwiched between the right index finger and the middle finger, for example. Is set to the position where it is most pulled out with respect to the slider portion 127. This position is the above-described clip opening position. Here, the description will be mainly given for the case of operation with one hand. For example, the slider 127 or its vicinity is grasped with the left hand, and the annular ring 129 or its vicinity is grasped with the right hand, and the operation is performed with both hands. Of course.

  In the state set to the clip open position, as shown in FIG. 24, the leaf spring 132 is elastically engaged with the positioning groove 132a of the fixed base 128a, and this state is maintained.

  By this operation, as shown in FIGS. 25 and 26, the inner sheath 122 is drawn into the drive wire 123, and the connecting hook 121 at the tip of the drive wire 123 protrudes from the tip (annular member 122a) of the inner sheath 122. The legs are opened in a generally C shape by their own elasticity.

  Next, although not shown, the distal end of the sheath portion of the clip device 120 (the connection hook 121) is arranged so that the connection portion 11a of the clip 10 (see FIGS. 7 and 8) to be connected thereto can be gripped. . In addition, when performing this clip connection operation | work, if the clip attachment tool etc. which were described in the said patent document 1 are used, the attachment operation | work can be performed easily and reliably.

  In this state, for example, the right thumb is inserted into the annular ring 129, and the portion between the pair of hooks 127c of the slider 128b is operated so as to be close to each other with the right index finger and the middle finger being sandwiched, for example. The part 128 is slid in the direction to be pushed into the slider part 127. As a result, as shown in FIG. 27, the leaf spring 132 is elastically engaged with the positioning groove 132b of the fixed base 128a, and there is a clicking sound or a feeling of stop, so the slide is stopped at that position. Let

  By this operation, as shown in FIGS. 28 and 29, the inner sheath 122 is pushed out with respect to the drive wire 123, and the connecting hook 121 at the tip of the drive wire 123 is buried in the annular member 122a at the tip of the inner sheath 122. Then, the leg is closed and the clip 10 is connected to the sheath tip of the clip device 120. In this state, the fastening ring 12 of the clip 10 is not slid, and the pair of arm portions 11 of the clip 10 is in a state of being opened by its own elasticity.

  Next, as shown in FIG. 30, the slider portion 127 is slid so as to be pulled out from the outer receiver 126, and the leaf spring 131 is elastically engaged with the positioning groove 131b. As a result, as shown in FIGS. 31 and 32, the outer tube 124 is pushed out against the inner sheath 122 and the drive wire 123, and the connection hook 121 and the clip 10 to which the clip 10 is connected are buried in the outer sheath 124. Then, the clip 10 is accommodated in the distal end portion of the outer sheath 124 with the leg closed. In this state, the fastening ring 12 of the clip 10 maintains the previous position, and the fastening operation of the clip 10 is not performed.

  In this state, the sheath part of the clip device 120 is inserted into a treatment instrument guide tube (not shown) of the endoscope, and the distal end thereof is introduced to the affected part where hemostasis or the like is to be performed by clipping the clip 10. When the distal end of the outer sheath 124 reaches the affected part, as shown in FIG. 33, the slider part 127 is slid again so that the base outer cylinder 127a is pushed into the outer receptacle 126, and the leaf spring 131 is inserted into the positioning groove 131a. Are in an elastically engaged state. As a result, as shown in FIGS. 28 and 29, the outer tube 124 is drawn into the inner sheath 122 and the drive wire 123, and the clip 10 connected to the connecting hook 121 protrudes from the tip of the outer sheath 124. The leg is returned to the open state by its own elasticity.

  Next, when adjusting the orientation of the clip 10 connected to the connection hook 121 in the rotation direction, the slider portion 127 with respect to the rotating ring 129 (when the slider portion 127 is rotated, the base portion 128 is also rotated integrally). It can be adjusted by rotating. At this time, since the proximal end of the inner sheath 122 is rotatably supported by the tip of the tip base 128b, only the drive wire 123 can be rotated without rotating the inner sheath 122.

  When the clip 10 is introduced to an appropriate position in the patient and the posture adjustment and the like are completed, the base portion 128 is further pushed into the slider portion 127 and is slid to the most pushed position as shown in FIG. . This position is the clip fastening described above.

  In the state set to the clip fastening position, the leaf spring 132 is elastically engaged with the positioning groove 132c of the base portion 128a, and the state is maintained. In this state, a part of the part to which the base part 128a of the rotary ring 129 is attached contacts the slider part 127, and further sliding (pushing) of the base part 128 with respect to the slider part 127 is restricted. It is like that.

  Thereby, the inner sheath 122 is further pushed out with respect to the drive wire 123, that is, the connecting hook 121 is further drawn into the inner sheath 122, and the fastening ring of the clip 10 is caused by the distal end portion (annular member 122 a) of the inner sheath 122. 12 is pushed out and slid to the fastening position, and the clip 10 is closed and fixed in a state where the affected part is gripped.

  When the clipping of the clip 10 to the affected part is completed, the base part 128 is slid to the clip releasing position (see FIGS. 24 to 26) that is most pulled out from the slider part 127, and the gripping of the clip 10 by the connecting hook 121 is released. To complete a series of operations.

  According to the second embodiment described above, a wire tube is used as the inner sheath 122, and the wire tube has a certain gap between the strands, and the cleaning liquid penetrates into the inside during ultrasonic cleaning. The drive wire 123 can be cleaned as a single unit while the drive wire 123 is inserted into the inner sheath 122. In addition, a coil tube is used as the outer sheath 124, and the coil tube has a certain gap in the adjacent portion of the wire, and the cleaning liquid penetrates into the inner sheath 122 during ultrasonic cleaning. It can be washed as a single unit while being inserted into the.

  In particular, in the second embodiment, since a wire tube is used as the inner sheath 122 and a coil tube is used as the outer sheath 124, the inner sheath 122 into which the drive wire 123 has been inserted is inserted into the outer sheath 124. Thus, these can be cleaned as a unit. The same applies when a wire tube is used as the outer sheath 124. As a result, the entire apparatus can be cleaned as a unit without performing any work for disassembling the clip apparatus 120.

  In addition, since the wire tube has low elasticity in the axial direction, the relative position between the distal end of the inner sheath 122 and the distal end of the drive wire 123 (the connecting hook 121) is the shape of the sheath (degree of bending, etc.). ) Will not fluctuate. Therefore, responsiveness and followability in operations such as opening and closing of the connecting hook 121 are high, and high operability can be realized.

  The embodiment described above is described for facilitating the understanding of the present invention, and is not described for limiting the present invention. Therefore, each element disclosed in the embodiment described above is intended to include all design changes and equivalents belonging to the technical scope of the present invention.

DESCRIPTION OF SYMBOLS 10 ... Clip 11 ... Arm part 11a ... Connection part 11b ... Holding part 12 ... Clip clamping ring 20,120 ... Clip apparatus 21, 121 ... Connection hook 22, 122 ... Inner sheath 122a ... Ring member 23, 123 ... Drive wire 24 , 124 ... outer sheath 26, 126 ... outer receptacles 27, 127 ... slider parts 27a, 127a ... base outer cylinders 27b, 127b ... sliders 27c, 127c ... flange parts 27d ... contact surfaces 28, 128 ... base parts 28a, 128a ... Fixed base 28b ... rotating base 28c ... shaft 29, 129 ... rotating rings 31, 32, 131, 132 ... leaf springs 31a, 31b, 32a, 32b, 32c, 131a, 131b, 132a, 132b, 132c ... positioning groove 33a, 34a ... projection 33b ... guide grooves 33c, 34b ... receiving

Claims (8)

An outer sheath portion including a tubular outer sheath;
A tubular inner sheath inserted through the outer sheath;
A drive wire inserted through the inner sheath;
A coupling hook connected to the distal end of the drive wire and capable of gripping a clip;
A base connected to the proximal end of the inner sheath;
A proximal end of the drive wire is connected, and a slider portion slidably held with respect to the base portion, and
A treatment instrument for an endoscope, wherein a wire tube formed by twisting a plurality of wire strands in a spiral shape is used as the inner sheath. As the drive wire, using a wire tube or a wire rope formed by spirally twisting a plurality of wire strands,
The endoscopic treatment instrument according to claim 1, wherein the winding direction of the inner sheath and the winding direction of the drive wire are set to be opposite to each other. As the outer sheath, a coil sheath formed by spirally winding a single long material or a wire tube formed by twisting a plurality of wire strands spirally,
The endoscopic treatment instrument according to claim 1 or 2, wherein the winding direction of the inner sheath and the winding direction of the outer sheath are set to be opposite to each other.   When the slider part is slid with respect to the base part from the clip opening position where the connection hook is opened toward the clip fastening position where the clip connected to the connection hook is fastened, the connection hook The endoscopic treatment tool according to any one of claims 1 to 3, further comprising a slide restricting unit that closes a leg and stops releasably at a clip coupling position where the clip is coupled. The slide regulating means is
A rotation base provided on the base portion so as to be rotatable in a range from a first angular position to a second angular position;
When the rotation base is at the first angular position, a part of the rotation base comes into contact with the slide portion to stop sliding at the clip coupling position with respect to the base portion, and the rotation base is at the second angular position. The endoscopic treatment tool according to claim 4, further comprising: a contact portion provided on the slider portion so that contact with a part of the rotation base is released at a certain time.   6. The projection portion and the receiving portion that are engaged with each other when the rotation base is positioned at the second angular position, wherein one of the protrusion and the receiving portion is provided on the base portion, and the other is provided on the rotation base. Endoscopic treatment tool. The inner sheath is rotatably connected to the base portion,
Holding the slider part rotatably with respect to the outer sheath part;
Holding the base portion on the slider portion so as to be rotatable integrally with the slider portion;
The posture of the connecting hook in the rotation direction is controlled through the drive wire without rotating the inner sheath by rotating and adjusting the slider portion with respect to the outer sheath portion. The endoscope treatment tool according to any one of the above.   The clip has a pair of arm portions formed in a substantially C shape toward the tip, a connecting portion gripped by the connecting hook provided on the base end side of the arm portion, and fixing the arm to a closed leg. The processing tool for endoscopes as described in any one of Claims 1-7 which has a fastening ring to make.

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