JP2015157019A - Clip device for endoscope and clip device kit for endoscope - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a clip device for an endoscope which has a diameter reduction sleeve that can be housed in a sheath body due to diameter reduction and improves the movability of the diameter reduction sleeve in the forward and backward directions of an operation wire, and a clip device kit for an endoscope.SOLUTION: A clip device for an endoscope 100 includes a long sheath 10, an operation wire 20, and a diameter reduction sleeve 70 housed in a distal end part of the sheath 10. The diameter reduction sleeve 70 includes a tubular sleeve body 122 which can transit to a projecting state and a housing state in linkage with forward and backward movements of the operation wire 20 with the operation wire 20 inserted thereinto, and has a guide part 120 extending from a distal end part of the sleeve body 122 toward a distal side and having an outer diameter larger than the outer diameter of the sleeve body 122 and the inner diameter of the sheath 10 in a projecting state. An outer surface of the guide part 120 is parallel with the axial direction of the sheath 10 or inclined inwardly toward the distal side in the housing state.

Description

  The present invention relates to an endoscope clip device and an endoscope clip device kit.

  In recent years, along with the development of endoscopic technology, cases of performing medical procedures such as excision of an affected area under an endoscope are increasing along with observation in a body cavity by an endoscope. Along with this, there is an increasing demand for an endoscopic clip device capable of ligating a post-treatment excision part and the like to stop bleeding.

  For example, Patent Document 1 discloses an invention of a clip device (hereinafter also referred to as Prior Art 1) capable of mounting a clip for ligation. As a clip used in the device, a clip body having a base end portion provided with a second engagement means, and both arm portions extending from the base end portion and opened by self-expanding, and the clip body And a fastening member that is inserted so as to be able to advance and retreat.

The prior art 1 includes a cylindrical body, a locking member housed on the distal end side of the cylindrical body, and a wire that is inserted into the cylindrical body so as to freely advance and retract. A first engagement means that engages with the second engagement means is provided at the tip of the wire.
The locking member is provided with a flange at the distal end portion, and a step having a reduced inner diameter is formed on the inner wall surface on the distal end side. The flange is a radially outward projection provided at the tip of the locking member (see paragraph [0025] of Patent Document 1 and FIG. 8B). A retractable member is provided at the rear end of the locking member. The locking member and the wire are linked via the expandable member.

  In the prior art 1, when the first engaging means and the second engaging means are engaged, the wire moves to the proximal end side. It is locked and retreat is restricted. When the locking member is restrained from moving backward, the clamping member is locked to the step, and the wire moves to the proximal end side, whereby both arms of the clip are clamped by the clamping member and closed. Arm When the arm is closed, the wire further moves toward the proximal end, so that the engagement state between the first engagement means and the second engagement means is released, and the clip is left in the body.

  In Patent Document 1, the prior art 1 provides a clip device that can reliably clip without increasing the number of parts compared to a conventional clip device by providing the locking member. It is explained that it is possible.

JP 2008-113673 A

As described above, the related art 1 including the locking member restricts the clip protruding from the cylindrical body from being accommodated in the cylindrical body again, and the first engaging means and the second engaging means. The engagement state can be released. However, the prior art 1 has the following problems.
The problem of the prior art 1 will be described with reference to FIG. FIG. 6 is a cross-sectional explanatory view showing a distal end portion of the locking member 900 in the prior art 1 and a part of the sheath 10 that is a cylindrical body formed by winding a linear member such as a wire in a closely wound shape. is there. FIG. 6 shows a cut surface cut along the central axis of the sheath 10. FIG. 6 shows a state in which coil cross sections 11, which are cross sections of continuous coils, observed on the cut surface are arranged in a substantially horizontal direction on the paper surface.
In FIG. 6, the locking member 900 is housed inside the sheath 10. Although not shown, the locking member 900 is linked to an operation wire provided in the endoscope clip device, and is configured to be able to move forward and backward in conjunction with the advance and retreat movement of the operation wire.

The flange 920 provided at the distal end portion of the locking member 900 is a protrusion protruding outward in the radial direction as described above. The collar 920 is housed inside the sheath 10 in a reduced diameter state. In this state, when the locking member 900 is moved forward, the outer edge of the collar 920 comes into contact with the inner surface of the sheath 10 as shown in FIG. The coil cross section 11B, which is the coil cross section 11 located at the location where the flange 920 abuts, can be pushed outward in the radial direction of the sheath 10. In other words, the outer edge of the collar 920 may be immersed in the inner surface of the sheath 10. In such a case, when an operation wire (not shown) is pushed into the distal side and a force for moving forward is applied to the locking member 900, the coil cross section 11A that is the coil cross section 11 that contacts the distal end surface of the flange 920 is It is pushed distally (in the direction of the arrow z in the drawing). Since a different coil cross-section 11 exists further on the distal side than the coil cross-section 11A, the coil cross-section 11A is unlikely to escape the external force, and there is a possibility that the hook 920 is caught on the coil cross-section 11A. Therefore, there is room for improvement with respect to the operability of the locking member 900 and the operation wire linked thereto.
The “coil cross section 11” described with reference to FIG. 6 is either a coil cross section in a plurality of loops in one linear member or a different coil cross section in a plurality of loops in two or more linear members. Including.

  In the above description, the example of the coil in which the sheath 10 is formed by closely winding a linear member is used with respect to the problem of the related art 1. However, the same problem may occur when the sheath 10 is a tubular tubular body formed using a resin member. In other words, the resin flexible tube may be elastically deformed so that the inner side surface locally protrudes outward when an external force is applied to the inner side surface. Therefore, the same problem as the case where the sheath 10 which is the coil mentioned above is used may arise.

  The present invention has been made in view of the above problems. That is, the present invention is an endoscopic clip device having a reduced diameter sleeve that can be accommodated in a sheath body by reducing the diameter, and the clip for an endoscope in which the mobility of the operation wire in the advancing and retracting direction is improved. An apparatus and an endoscopic clip device kit are provided.

  An endoscope clip device according to the present invention is provided with a clip including a base end portion and a plurality of arm portions that extend from the base end portion and open by self-expanding force and can be closed by external force. A clip device for an endoscope used for a long time, a long sheath, an operation wire inserted in the sheath so as to be movable forward and backward, and housed in a distal end portion of the sheath, the operation wire The distal end protrudes from the sheath in conjunction with the movement of the distal end, and the distal end which is interlocked with the retreating movement of the operation wire and the protruding distal end is reduced in diameter by an external force. A diameter-reduced sleeve capable of transitioning to a housed state in which the part is housed in the sheath, and a locking part provided at a distal end of the operation wire for engaging with the base end of the clip And the reduced diameter sleeve is A tubular sleeve body through which the working wire is inserted, and extends from the distal end of the sleeve body toward the distal side, and is larger than the outer diameter of the sleeve body and the inner diameter of the sheath in the protruding state A guide portion having an outer diameter, and the outer surface of the guide portion is parallel to the axial direction of the sheath or inclined inward toward the distal side in the retracted state. It is characterized by being.

  The endoscope clip device kit of the present invention can be closed by an external force while being opened by a self-expanding force extending from the proximal end portion and the base end portion of the endoscope clip device of the present invention. And a clip including a plurality of arms.

  The reduced diameter sleeve provided in the endoscope clip device of the present invention has a protruding state that protrudes from the distal end of the sheath, and the distal end is contracted by an external force so that the distal end is accommodated in the sheath. Transition to the storage state. A guide extending from the distal end of the sleeve body toward the distal side on the distal end side of the reduced diameter sleeve and having an outer diameter larger than the outer diameter of the sleeve body and the inner diameter of the sheath in the protruding state A part. In the storage state, the outer surface of the guide portion is parallel to the inner surface of the sheath or inclined inward toward the distal side. Therefore, even when the guide portion is in contact with the inner side surface of the sheath in the sheath, it is difficult to be caught on the inner side surface of the sheath, and the forward and backward movement is good. In addition, the operation wire that moves forward and backward in conjunction with the guide portion is also good in forward and backward movement.

  The endoscopic clip device kit of the present invention enjoys the excellent effects of the above-described endoscopic clip device of the present invention, and the operability of the clip is good.

It is a perspective view of the clip device for endoscopes which illustrates the first embodiment of the present invention, and shows the state where a clip was attached. FIG. 2 is an enlarged explanatory view of an end region on a distal side of the endoscope clip device shown in FIG. 1. It is explanatory drawing which shows the diameter reduction sleeve and 2nd latching | locking part in the clip apparatus for endoscopes shown in FIG. 1, and the one aspect | mode of the clip which can be mounted | worn with the clip apparatus for endoscopes. (4a) and (4b) are explanatory views showing a contact state between the sheath and the reduced diameter sleeve in the endoscope clip device of the present invention. (5a) is explanatory drawing which shows the state by which the whole clip with which the clip apparatus for endoscopes which is one embodiment of this invention was mounted | worn was accommodated in the sheath, (5b) is one implementation of this invention It is explanatory drawing which shows the state with which the clip with which the clip device for endoscopes which is an aspect was projected protruded from the distal end of a sheath, and opened an arm, (5c) is an endoscope which is one embodiment of the present invention. It is explanatory drawing which shows the state which the clip with which the clip apparatus mounted | worn was clamp | tightened by the fastening member, and closed. It is explanatory drawing which shows the contact state of the sheath and diameter-reduction sleeve in the conventional clip apparatus for endoscopes.

Hereinafter, embodiments of the present invention will be described with reference to the drawings. In all the drawings, the same components are denoted by the same reference numerals, and redundant description will be appropriately omitted.
In the present embodiment, there are cases where the left and right directions are defined and illustrated as shown. However, this is provided for convenience in order to simply explain the relative relationship of the components, and does not limit the direction during the manufacture or use of the product implementing the present invention.
The various components of the endoscopic clip device of the present invention do not have to be individually independent, but a plurality of components are formed as a single member, and a single component is a plurality of members. It is allowed that a certain component is a part of another component, a part of a certain component overlaps a part of another component, and the like.

The terms in the present invention or terms used in describing the present invention are defined as follows unless otherwise specified.
In this specification, the “proximal side” means a side close to a side operated by an operator operating the endoscope clip device (hereinafter simply referred to as “operator”) unless otherwise specified. In this specification, the “distal side” refers to a side far from the side operated by the operator unless otherwise specified.
The “proximal end portion” is a predetermined length that can include a proximal end portion (proximal end) in an endoscopic clip device, a member provided in the device, or a clip attached to the device. This is the area. Similarly, the “distal end” refers to a predetermined length region that may include a distal end (distal end).
In the present invention, “advance and retreat” refers to movement on the proximal side and the distal side of the endoscope clip device. “Progressive movement” means a movement toward the distal side among the forward and backward movements. The “regression movement” means a movement toward the proximal side among the advancing and retreating movements.
In the description of the present invention, unless otherwise specified, the “inward direction” means the direction toward the axis of the operation wire or an extension line of the axis in the endoscope clip device, and the inner direction in the radial direction. Including orientation. The “outward direction” means a direction away from the axis of the operation wire or an extension line of the axis, and includes a radially outward direction.
In the description of the present invention, unless otherwise specified, the “axial direction” means the axial direction of the operation wire.

(First embodiment)
Hereinafter, a configuration of an endoscope clip device 100 (hereinafter also simply referred to as “clip device 100”) according to a first embodiment of the present invention will be described with reference to the drawings.
As shown in FIG. 1, the clip device 100 can mount a clip 200. FIG. 1 is a perspective view of a clip device 100 illustrating a first embodiment of the present invention, and shows a state in which a clip 200 is mounted.
The clip device 100 includes, for example, a finger ring 500, a drive unit 510, and an operation unit body 520 from the proximal side. When the operator operates the drive unit 510 relative to the operation unit main body 520, the operation wire 20 inserted through the sheath 10 moves forward and backward in the extending direction of the sheath 10. In addition, the finger ring 500 is fixed with a finger, and the entire operation unit main body 520 is rotated about the axis. Thereby, the operation wire 20 and the clip 200 can be rotated. However, the configuration related to the operation of the clip device 100 and the description of the operation of the operation described above are examples of the clip device 100 according to the present embodiment, and do not limit the present invention.

  Next, details of the clip device 100 will be described with reference to FIG. FIG. 2 is an enlarged explanatory view of the distal end region indicated by a broken-line circle on the distal side of the clip device 100 shown in FIG. FIG. 2 shows a cross section of the sheath 10, the reduced diameter sleeve 70, the reinforcing layer 75, and the extension 80 cut in the axial direction along the slit 146, and the other configuration shows the side surface. The clip apparatus 100 is shown typically. Similarly in FIG. 5 described later, the present invention is schematically illustrated together with the cross section and the side surface.

The clip device 100 includes a first locking portion 50 that is a base end portion and a plurality of arms that extend from the first locking portion 50 that is a base end portion and open by self-expanding force and can be closed by external force. The clip 200 provided with the part 40 is used.
The clip device 100 includes a long sheath 10, an operation wire 20 that is inserted in the sheath 10 so as to be capable of moving forward and backward, and a reduced diameter sleeve 70 that is housed in a distal end portion of the sheath 10. A distal end portion of the operation wire 20 is provided with a second locking portion 30 that is a locking portion for engaging with the first locking portion 50 that is the base end portion of the clip device 100. FIG. 2 shows a state in which the first locking portion 50 and the second locking portion 30 are engaged and the clip 200 is attached to the clip device 100.
The diameter-reduced sleeve 70 can transition between a protruding state (FIG. 2) and a storage state (FIG. 5a).
The protruding state is a state in which the distal end portion of the reduced diameter sleeve 70 protrudes from the sheath 10 in conjunction with the traveling movement of the operation wire 20. The retracted state is interlocked with the retreating movement of the operation wire 20 and the distal end portion of the protruding reduced diameter sleeve 70 is reduced in diameter by an external force, so that the distal end portion of the reduced diameter sleeve 70 is moved to the sheath 10. It is in a state of being stored.
The reduced diameter sleeve 70 has a tubular sleeve main body 122 through which the operation wire 20 is inserted, and a guide portion 120.
As shown in FIG. 2, the guide portion 120 extends from the distal end portion of the sleeve body 122 toward the distal side, and from the outer diameter C of the sleeve body 122 and the inner diameter B of the sheath 10 in the protruding state. Has a large outer diameter A. In the stored state, the outer surface of the guide portion 120 is parallel to the axial direction of the sheath 10 (FIG. 4a) or inclined inward (FIG. 4b) toward the distal side.

  The clip device 100 according to this embodiment is inserted into a channel (not shown) of an endoscope (not shown), for example, and the clip 200 is protruded from the distal end portion of the channel, so that the living tissue in the body cavity is obtained. It can be used as a long medical instrument for ligating.

In the reduced diameter sleeve 70 according to the present embodiment, an effect exerted by providing the guide portion 120 will be described with reference to FIG.
FIG. 4 is an explanatory view showing a contact state between the sheath 10 which is a coil formed by closely winding a linear member in the clip device 100 and the reduced diameter sleeve 70. FIG. 4 schematically shows a partial cut surface obtained by cutting the clip device 100 along the central axis of the sheath 10 at the slit 146. Coil cross sections 11 constituting the sheath 10 are adjacent to each other in the left-right direction on the paper surface. The coil cross section 11 shown in FIG. 4 is the same as the “coil cross section 11” described with reference to FIG.
The diameter-reduced sleeve 70 is linked to the operation wire 20 (FIG. 2), and moves forward and backward in the same direction in conjunction with the forward and backward movement of the operation wire 20.
The reduced diameter sleeve 70 is provided with a slit 146 from the guide portion 120 to the distal end portion of the sleeve main body 122. As shown in FIGS. 4a and 4b, the diameter-reduced sleeve 70 is reduced in diameter as the width dimension of the slit 146 is reduced. Further, the rigidity of the sleeve main body 122 changes near the end of the slit 146 in the sleeve main body 122. Thus, the diameter-reduced sleeve 70 is bent and diameter-reduced in the sheath 10 such that the distal end side bends radially inward from the vicinity of the terminal end of the slit 146.

FIG. 4 a shows a mode in which the outer surface of the guide portion 120 provided in the reduced diameter sleeve 70 is parallel to the axial direction of the sheath 10 in the stored state stored in the sheath 10. Here, “parallel” may be an aspect in which the outer surface of the guide portion 120 is substantially flat and parallel to the axial direction of the sheath 10. Or the said parallel is uneven | corrugated in the range which does not deviate from the meaning of this invention in the outer surface of the guide part 120, The said outer surface when the outer surface containing the said unevenness | corrugation is seen macroscopically, and the sheath 10 The aspect which is parallel to an axial direction may be sufficient.
The guide portion 120 in the housed state is reduced in diameter as compared with the protruding state, and has a force to spread outward in the radial direction. Therefore, the coil cross section 11 </ b> B, which is the coil cross section 11 that contacts the outer surface of the guide portion 120, can be pushed outward in the radial direction of the sheath 10.
As a result, as shown in FIG. 4 a, the tip of the guide portion 120 abuts on the lower end side from the center of the coil cross section 11 </ b> A that is distal to the tip. In this state, when a force that moves forward is applied to the reduced diameter sleeve 70, a force that is directed obliquely outward (in the direction of the arrow z in the drawing) toward the distal side is applied to the coil cross section 11A. As a result, the coil cross section 11A slightly shifts outward, and the reduced diameter sleeve 70 moves forward by a distance substantially equal to the diameter of the coil cross section 11. The coil cross section 11A shifted outwardly rides on the outer surface of the guide portion 120 (not shown). The guide portion 120 whose outer side surface is parallel to the axial direction of the sheath 10 sequentially pushes the coil 11 at the front, and the movement of the reduced diameter sleeve 70 is continuously performed as the operation wire 20 moves forward. That is, the reduced diameter sleeve 70 advances and moves well, and the operation wire 20 linked to the reduced diameter sleeve 70 also advances and moves well.

FIG. 4 b shows a mode in which the outer surface of the guide portion 120 provided in the reduced diameter sleeve 70 is inclined inward toward the distal side in the housed state housed in the sheath 10.
The guide portion 120 in the housed state is reduced in diameter as compared with the protruding state, and has a force to spread outward in the radial direction. Therefore, the distal end portion of the guide portion 120 may come into contact with the coil cross section 11 and may enter between the coil cross section 11A and the coil cross section 11B as shown in FIG. 4b. The coil cross section 11A is located on the distal side of the coil cross section 11B and is adjacent to the coil cross section 11B in the axial direction.
At this time, the outer surface of the guide part 120 inclined inward toward the distal side is in contact with the coil cross section 11A. As a result, when a force that moves forward is applied to the reduced diameter sleeve 70, a force in the normal direction (direction of the arrow z in the drawing) is applied to the coil cross section 11A with respect to the tangent line between the coil cross section 11A and the guide portion 120. As a result, the coil cross section 11A slightly shifts outward, and the reduced diameter sleeve 70 moves forward by a distance substantially equal to the diameter of the coil cross section 11. The movement of the diameter-reducing sleeve 70 described above is continuously performed as the operation wire 20 moves forward. That is, the reduced diameter sleeve 70 advances and moves well, and the operation wire 20 linked to the reduced diameter sleeve 70 also advances and moves well.

As described above, the diameter-reducing sleeve 70 provided in the clip device 100 is restrained from being caught on the inner surface of the sheath 10 when moving forward in the sheath 10. Therefore, the diameter-reducing sleeve 70 and the operation wire 20 linked to the sleeve 70 advance and move well.
In particular, in the mode shown in FIG. 4B, a part of the force for moving forward is smoothly released outward by the coil cross-section 11A contacting the inclined surface of the guide part 120, so that the moving forward is good.

  In the above description, the case where the diameter-reducing sleeve 70 and the operation wire 20 are moved forward has been described. Similarly, the clip device 100 is also good in the backward movement of the diameter-reducing sleeve 70 and the operation wire 20. In particular, as shown in FIG. 4, when the stepped portion 124 has a tapered shape with a diameter decreasing toward the proximal side, the description regarding FIG. 4 b is also applied to the backward movement as appropriate. That is, when the stepped portion 124 is tapered, the backward movement is particularly good.

  In the above, the effect of the guide part 120 was demonstrated regarding the aspect using the sheath 10 which is the said coil. The same explanation is applied to an embodiment using the sheath 10 made of a flexible resin tube. That is, the effect of the present invention that makes the forward and backward movement of the diameter-reduced sleeve 70 and the operation wire 20 good can be similarly exerted in the clip device 100 using the sheath 10 made of a resin tube.

Each structure of the clip apparatus 100 is demonstrated using FIG.
The long sheath 10 is a long and flexible tubular member.
As shown in FIG. 2, for example, the sheath 10 in the present embodiment is a long coil in which a linear member is wound in a tightly wound shape. Although not shown, the sheath 10 may be a tubular tubular member made of a flexible resin member.

The linear member is a long member having a small diameter such as a wire. A typical example of the linear member is a wire mainly made of stainless steel or steel, but is not limited thereto.
In the present specification, the closely wound shape means a state in which one loop that is wound and adjacent in the axial direction and another loop are in contact with each other in the natural state, or are adjacent to each other with a small distance. The coil made of a linear member forming the sheath 10 is one in which one linear member is wound in the circumferential direction, and two or more linear members are wound in multiple directions in the circumferential direction. including.
The coil forming the sheath 10 is a coil in which a linear member is tightly wound to such an extent that the operation wire 20 can be operated with the operation wire 20 inserted therethrough. An inner layer (not shown) made of a fluorine-based polymer may be appropriately provided on the inner peripheral surface of the coil.

The sheath 10 made of the coil has good bendability and strength, and can be easily bent in any direction following the operation of the operation wire 20 inserted therein. Therefore, the clip device 100 including the sheath 10 made of the coil has good operability.
The above-described problem of the related art 1 can occur in both cases where the sheath 10 is made of a coil and a resin tube. However, in the sheath 10 made of a coil, in particular, the tendency of the advancement / retraction movement of the locking member 900 due to the hook 920 to be caught was remarkable. Therefore, the clip device 100 of the present invention in which the problem is improved is particularly effective in the aspect including the sheath 10 that is the coil.

  The inner diameter of the sheath 10 is at least large enough to slide the operation wire 20. The inner diameter of the sheath 10 may be secured so that the clip 200 can be stored. In the present embodiment, the clip 200 including the arm portion 40 in the closed state can be stored in the sheath 10 (FIG. 5a). Specifically, the inner diameter of the sheath 10 is, for example, not less than 100 μm and not more than 2.4 mm. Further, the thickness of the sheath 10 is, for example, 100 μm or more and 350 μm or less. Thereby, the flexibility of the sheath 10 can be improved.

  The operation wire 20 is inserted through the inside of the sheath 10 so as to advance and retract in the axial direction. The operation wire 20 is made of, for example, a highly rigid metal material such as stainless steel, a steel wire coated with corrosion resistance, titanium, or a titanium alloy.

  The distal end portion of the operation wire 20 is provided with a second locking portion 30 that is a locking portion for engaging with the first locking portion 50 that is the base end portion of the clip 200. FIG. 2 shows a state where the first locking portion 50 and the second locking portion 30 are engaged. The engagement can be released by operating the operation wire 20.

As shown in FIG. 3, the second locking portion 30 in the present embodiment extends in the axial direction of the operation wire 20 from the proximal end portion 32 located on the proximal side and the proximal end portion 32 toward the distal side. And three or more claw portions 34 to be operated. For example, the claw portion 34 can be provided so as to extend substantially parallel to the axial direction, but the extension angle is not limited thereto.
The proximal end portion 32 is linked to the proximal end of the claw portion 34 and is connected to the distal end portion of the operation wire 20. For example, the base end portion 32 is a cylindrical body, and has a connection bottom surface 116 connected to the operation wire 20 on the bottom surface on one side of the cylindrical body. As shown in FIG. 3, the base end portion 32 in the present embodiment has a cylindrical shape, and the proximal end face is closed by a connection bottom face 116 and the distal end face is open. Examples of the metal material constituting the second locking portion 30 include, but are not limited to, stainless steel, titanium, or a titanium alloy. The metal member may be appropriately subjected to a corrosion-resistant coating treatment.

The claw portion 34 extends further to the distal side from the distal end of the base end portion 32. The claw portion 34 includes any one formed by joining the base end portion 32 separately from the base end portion 32, or one formed integrally with the base end portion 32. . The three or more claw portions 34 surround the first locking portion 50 locked to the second locking portion 30 (see FIG. 2). From the viewpoint of favorably preventing the first locking portion 50 from being detached from the second locking portion 30 by surrounding the first locking portion 50 with three or more claw portions 34. Is preferably a plate-like body. In this embodiment, the nail | claw part 34 is a plate-shaped object, Comprising: One main surface has faced the inner direction. Thereby, the area of the claw part 34 surrounding the first locking part 50 is increased, and the first locking part 50 is favorably prevented from being detached from the second locking part 30.
The three or more claw portions 34 described above have a protruding portion 36 protruding inward. A space 150 that includes and locks the first locking portion 50 is defined between the base end portion 32 and the protruding portions 36 provided on the three or more claw portions 34. The distance between one projecting portion 36 and the other projecting portion 36 facing the one projecting portion 36 is configured to be smaller than the outer diameter of the first locking portion 50. The protruding portion 36 is included in the space 150 and can contact the first locking portion 50. When the protruding portion 36 and the first locking portion 50 abut, the relative movement of the first locking portion 50 relative to the second locking portion 30 from the proximal side to the distal side is restricted. The restriction prevents the first locking part 50 from being easily detached from the second locking part 30.
In the nail | claw part 34, the surface which faces the distal side of the protrusion part 36 makes the distal direction inclination surface 38 which inclines inward toward a proximal side. Here, the surface facing the distal side refers to a surface having a directional component in which the normal of the surface is directed toward the distal side. The first locking portion 50 and the distal-facing inclined surface 38 come into contact with each other, and an external force is applied in a direction in which the first locking portion 50 moves relative to the second locking portion 30 from the distal side to the proximal side. When added, the claw portion 34 is pushed outward and tilted. Thus, the first locking portion 50 is smoothly contained in the space 150 and locked to the second locking portion 30.
In the nail | claw part 34, the surface which faces the proximal side of the protrusion part 36 makes the proximal direction inclined surface 37 which inclines outward toward the proximal side. Here, the surface facing the proximal side refers to a surface having a directional component in which the normal of the surface is directed toward the proximal side.
In a state where the proximal-facing inclined surface 37 and the first locking portion 50 included in the space 150 are in contact with each other, an external force is applied in a direction in which the first locking portion 50 moves relatively from the proximal side to the distal side. When added, the claw portion 34 is pushed outward and tilted. As a result, the engagement between the first locking portion 50 and the second locking portion is released without destroying both the first locking portion 50 and the second locking portion 30.
The nail | claw part main body 35 and the protrusion part 36 are comprised integrally from a series of plate-shaped bodies, for example.

In the clip 200 used in the clip device 100 according to the present embodiment, the entire base end portion forms a first locking portion 50 that can be engaged with the second locking portion 30. The first locking part 50 is included in the second locking part 30, whereby the first locking part 50 and the second locking part 30 are engaged. The clip 200 is attached to the clip device 100 by the engagement.
However, the second locking portion 30 and the first locking portion 50 engaged therewith do not limit the present invention. As long as the second locking portion 30 and the first locking portion 50 are engaged with each other, the clip 200 is attached to the clip device 100 and the operation of the operation wire 20 can be transmitted to the clip 200 as appropriate. Can be designed.

Next, the reduced diameter sleeve 70 will be described. As shown in FIG. 3, the diameter-reduced sleeve 70 includes a sleeve main body 122, a guide portion 120, and a step portion 124 provided between the sleeve main body 122 and the guide portion 120.
At least a part of the reduced diameter sleeve 70 is accommodated in the sheath 10 so as to be able to advance and retreat. The diameter of the reduced diameter sleeve 70 is reduced in diameter by the external force. The reduced distal end can be stored in the sheath 10.

As described above, the diameter-reduced sleeve 70 can transition between a protruding state and a stored state.
In the protruding state, when the middle portion of the sleeve body 122 projects from the distal end of the sheath 10 (FIG. 5b), the entire guide portion 120 projects from the distal end of the sheath 10 and the entire sleeve body 122 is accommodated in the sheath 10. (FIG. 5c). The protruding state is a restricted state in which the guide portion 120 having an outer diameter larger than the inner diameter of the sheath 10 is restricted from abutting on the distal end of the sheath 10 and moving relative to the clip device 100 in the proximal direction. Including the case (Fig. 5c).
The housed state includes a state where the distal end of the guide part 120 is housed in the sheath 10 (FIG. 5a) and a state where the middle part of the guide part 120 is housed in the sheath 10 (not shown).
The diameter-reduced sleeve 70 has a characteristic that it can be changed between a storage state and a protruding state, and can be further restricted in the protruding state. Due to the above characteristics, the clip 200 attached to the clip device 100 is housed in the sheath 10, protrudes from the sheath 10, and can be restricted from moving relative to the clip device 100 in a proximal position at a predetermined position. Due to the restriction of the clip 200, the engagement between the first locking portion 50 and the second locking portion 30 can be released. Details of the operation of the clip device 100 including the operation of the clip 200 will be described later.

The diameter of the diameter-reduced sleeve 70 is reduced at the distal end to such an extent that it can be changed from the protruding state to the retracted state. For example, in the reduced diameter sleeve 70 in the present embodiment, the guide portion 120 and the stepped portion 124 are reduced in diameter in addition to the distal end portion of the sleeve body.
The constituent material of the reduced diameter sleeve 70 (particularly, the constituent material of the distal end portion capable of reducing the diameter) is not limited to a specific material as long as it is a member that can be reduced in diameter by an external force. For example, the constituent material may be an elastomer such as rubber, a metal such as stainless steel or steel, or a combination thereof. In consideration of the strength requirements for the reduced diameter sleeve 70, it is preferable that the reduced diameter sleeve 70 is made of a metal material and has a structure allowing the diameter of the distal end portion to be reduced. The structure allowing the diameter reduction is a space provided in the circumferential direction of the diameter-reducing sleeve 70, and can be exemplified by a structure in which the space is reduced in the circumferential direction by an external force, thereby enabling the diameter reduction. As a more specific example, a slit 146 described later can be given. In the present embodiment, the sleeve main body 122, the stepped portion 124, and the guide portion 120 are integrally formed from one material.

  The sleeve body 122 is a tubular body through which the operation wire 20 is inserted. Specific examples of the tubular body include a cylinder, a rectangular tube, a cone, or a pyramid. The sleeve main body 122 may be deformed in a protruding state and a reduced diameter state. For example, the sleeve body 122 may form a cylindrical body when in the protruding state (FIG. 5b). Further, when in the retracted state, the sleeve body 122 may have a gradually narrowing diameter at the distal end portion toward the distal end (FIG. 5a).

The guide portion 120 extends from the distal end portion of the sleeve body 122 toward the distal side. For example, the guide part 120 is a plate-like body, and the outer surface and the inner surface are substantially parallel. However, the guide portion 120 is not limited to this, and is configured to have at least an outer diameter larger than the outer diameter of the sleeve main body 122 and the inner diameter of the sheath 10 in the protruding state. As a result, the restricted state can be realized. The outer diameter of the sleeve main body 122 and the outer diameter larger than the inner diameter of the sheath 10 in the protruding state may be shown in at least a part of the guide portion 120. For example, you may have the area | region where a diameter is smaller than the said outer diameter in the distal end or intermediate part of the guide part 120. FIG.
The guide part 120 in the present embodiment is a cylindrical body in which plate-like bodies divided by the slits 146 are continuously arranged in the circumferential direction with the main surface facing inward. As shown in FIG. 3, the guide portion 120 can be configured to have a substantially equal outer diameter from the distal end to the proximal end. Although not shown in the drawings, the guide portion 120 may be increased in diameter toward the distal side in the protruding state.
As a modification of the guide portion 120 that is not shown, for example, the guide portion 120 may be composed of a plurality of rod-like bodies that are continuous in the circumferential direction. The outer diameter of the guide part 120 is the diameter of the outer periphery shape shown along the outer surface of the member which comprises the guide part 120, and it is not limited whether the said member is one member or several members.

The sheath 10 in this embodiment can be comprised from the coil formed by closely winding a linear member as shown, for example in FIG.
In the relationship between the sheath 10 that is a coil and the guide portion 120, the following aspect is preferable.
That is, in the clip device 100, as shown in FIG. 4, the axial length s of the guide portion 120 is from the cross-sectional center of one of the linear members on the cut surface cut along the central axis of the sheath 10. The distance t is exceeded. In the above aspect, almost the whole or a part of the outer surface of the guide part 120 is not easily caught by the coil constituting the sheath 10, and the guide part 120 moves forward and backward within the sheath 10.
More preferably, the axial length s of the guide part 120 is at least twice the distance t, and more preferably, the axial length s of the guide part 120 is at least three times the distance t.

In particular, in the aspect in which the outer surface of the guide part 120 is parallel to the axial direction of the sheath 10, the axial length s of the guide part 120 exceeds the distance t, so that 1 as shown in FIG. The coil cross section 11B that exceeds the width is preferable because it can ride on the outer surface.
That is, the force in which the guide portion 120 spreads outward in the sheath 10 can be distributed to the plurality of coil cross sections 11B. When the coil cross section 11B exceeding 1 is in contact with the outer surface of the guide portion 120, the pushing distance at which the coil cross section 11B exceeding 1 can be pushed outward in the radial direction of the sheath 10 can be suppressed to be small.
Therefore, as shown in FIG. 4a, the tip of the guide part 120 is likely to come into contact with the lower end side from the center of the coil cross section 11A on the distal side of the tip, and the guide part 120 can easily push the coil 11 on the front side sequentially.

  As shown in FIG. 2, the step portion 124 is a step formed by the difference between the outer diameter C of the sleeve body 122 and the outer diameter A of the guide portion 120. The step portion 124 is inclined so as to have a small diameter from the guide portion 120 toward the sleeve main body 122. As a result, the reduced diameter sleeve 70 can smoothly transition from the protruding state to the stored state. More specifically, the diameter-reduced sleeve 70 can be shifted to the retracted state by bringing the stepped portion 124 into contact with the distal end of the sheath 10 and pulling the operation wire 20 proximally in the protruding state. By pulling the operation wire 20 proximally, at least a part of the external force that reduces the diameter of the distal end portion of the diameter-reducing sleeve 70 can be generated.

  However, the above description does not exclude the provision of the stepped portion 124 that is a discontinuous step between the sleeve main body 122 and the guide portion 120 in the clip device 100 according to the present embodiment. The diameter-reducing sleeve 70 having the step portion 124 that is a discontinuous step, for example, reduces the diameter of the distal end portion by applying an external force inward from the outside of the sleeve body 122 or the guide portion 120. be able to.

Next, the slit 146 provided in the reduced diameter sleeve 70 will be described.
As shown in FIG. 3, the reduced diameter sleeve 70 is provided with a slit 146 extending from the guide portion 120 to the distal end portion of the sleeve main body 122. For example, the slit 146 is provided from the distal end of the guide portion 120 to the intermediate portion of the sleeve body 122 across the step portion 124.

  The slit 146 is a configuration for enabling the guide portion 120 to be reduced in diameter by an external force. When the end surfaces of the slits facing each other in the width direction of the slit 146 are close to each other, the diameter-reducing sleeve 70 is reduced in diameter. One or more slits 146 can be provided. For example, the slit 146 is a cutout in which the end face and the end face are cut out so as to be close to each other. There may be a substantial space between the end face and the end face. Thereby, the said end surface and the said end surface are easy to adjoin, and the diameter reduction sleeve 70 is easy to reduce a diameter. As another aspect, at least a part between the end face and the end face may be appropriately filled with an elastic member such as rubber. As a result, the diameter of the distal end portion of the reduced diameter sleeve 70 provided with the slit 146 can be reduced and reinforced.

  The slit 146 is provided at the distal end portion of the reduced diameter sleeve 70 having an outer diameter larger than the inner diameter of the sheath 10 and extends to the distal end portion of the sleeve body 122 having an outer diameter that is equal to or smaller than the inner diameter of the sheath 10. Is provided. As a result, the distal end portion having an outer diameter larger than the inner diameter of the sheath 10 can be accommodated in the sheath 10 without difficulty.

  In the clip device 100 including the slit 146 described above, the reduced diameter sleeve 70 may be provided with a reinforcing layer 75 that is continuous in the circumferential direction of the sleeve main body 122 and covers at least a part of the slit 146 provided in the sleeve main body 122. . At least a part of the reinforcing layer 75 is joined to the reduced diameter sleeve 70.

  In the reduced diameter sleeve 70, the region having the slit 146 tends to be weaker than the region not having the slit 146. In particular, in the aspect in which the slit 146 is provided from the sleeve main body 122 to the guide portion 120, the extension distance of the slit 146 tends to be long, and the tendency to become weak is strong. On the other hand, by providing the reinforcing layer 75, the distal end portion of the reduced diameter sleeve 70 having the slit 146 is reinforced, and damage to the distal end portion can be avoided.

  The reinforcing layer 75 may be provided further to the proximal side than the end portion on the proximal side of the slit 146. There is a tendency for the degree of vulnerability to be particularly high around the end portion on the proximal side of the slit 146. Therefore, it is preferable to reinforce the reduced diameter sleeve 70 by providing a reinforcing layer 75 from the proximal side to the distal side via the terminal portion.

On the other hand, in the present embodiment, the distal end portion of the reinforcing layer 75 is located proximal to the guide portion 120.
By terminating the distal end portion of the reinforcing layer 75 in the stepped portion 124 or the sleeve body 122 having a smaller outer diameter than the guide portion 120, the maximum diameter of the reduced diameter sleeve 70 is prevented from being increased by the reinforcing layer 75; The reduced diameter sleeve 70 can be configured compactly.

  For example, it is preferable that the distal end portion of the reinforcing layer 75 is located closer to the proximal side than the proximal end portion of the stepped portion 124 that becomes narrower in diameter toward the proximal side. Thereby, the front-end | tip of the sheath 10 can be contact | abutted to the outer surface of the level | step-difference part 124, and it can slide smoothly.

  The reinforcing layer 75 may be formed of, for example, an elastic member that can expand and contract in the radial direction or an elastic member that can move in the radial direction. Specifically, the reinforcing layer 75 may be a resin member, a linear member such as stainless steel, and a coil spring that is wound in the circumferential direction. In the clip device 100, when the arm portion 40 to which the tissue is ligated from an angle different from the axial direction is operated in that state, a lateral force may be applied to the distal end portion of the reduced diameter sleeve 70. At this time, stress concentrates on the root of the guide portion 120 or the stepped portion 124 exposed in the distal direction from the distal end of the reinforcing layer 75, and the vicinity of the root may be damaged, or may be plastically deformed. On the other hand, when the reinforcing layer 75 is made of a member that can expand and contract in the radial direction, the stress can be released by expanding and contracting in the radial direction in response to the stress.

The reinforcement layer 75 may be comprised from arbitrary members. For example, the reinforcing layer 75 can be formed of a resin member or a metal member such as stainless steel.
As a more specific example, the reinforcing layer 75 may be formed of an elastic member that can expand and contract in the axial direction. For example, the elastic member is made of a member such as a metal, an elastomer such as resin, rubber, or the like. For example, the elastic member is preferably a coil spring in which fine wires of stainless steel or tungsten are wound at an equal pitch or a variable pitch. For example, the coil spring is spirally wound in the circumferential direction of the reduced diameter sleeve 70.
As shown in FIG. 3, the clip device 100 according to the present embodiment has an extension 80 in which the elastic member extends beyond the proximal end of the sleeve body 122 to the proximal side. The extension portion 80 is connected to the intermediate portion of the operation wire 20. The extension part 80 slides in the sheath 10 so as to freely advance and retract, and can extend and contract in the axial direction.

The reinforcing layer 75 and the reduced diameter sleeve 70 are linked together, and the extension portion 80 extending proximally from the reinforcing layer 75 is linked to the operating wire 20, whereby the operating wire 20 and the reduced diameter sleeve 70 are linked. .
The extension 80 forms a linkage member that links the operation wire 20 and the reduced diameter sleeve 70. The extension part 80 which is a linking member and the reinforcing layer 75 which reinforces the reduced diameter sleeve 70 are formed of one material and a series, so that the number of parts inside the sheath 10 can be reduced.
In particular, it is preferable that the reinforcing layer 75 and the extension portion 80 are formed of a member such as a coil spring that is a single material and is a series, is extensible in the axial direction, and is extensible or deformable in the radial direction. As a result, one member constituting the reinforcing layer 75 and the extending portion 80 exhibits an extending action or a deforming action in the radial direction in the region of the reinforcing layer 75, and an extending action in the axial direction in the region of the extending portion 80.
As another aspect, the extension 80 and the reinforcing layer 75 may be formed of different members and may be linked to each other.

  In the clip device 100 according to this embodiment, the proximal end portion of the extension portion 80 is connected to the centering portion 90. The operation wire 20 is inserted and fixed substantially at the center of the centering portion 90. Therefore, the centering part 90 and the extension part 80 connected to the centering part 90 can be operated in the advance / retreat direction in conjunction with the operation of the operation wire 20 in the advance / retreat direction. By providing the centering portion 90, the insertion position of the operation wire 20 is restricted along the central axis in the vicinity of the centering portion 90. That is, the operation wire 20 is centered in the sheath 10 at the center of the cross section of the sheath 10 by the centering portion 90. The operation wire 20 can correct the insertion path inside the sheath 10 by the centering, and can realize a preferable operation planned based on the design. The cross section of the sheath 10 here means a cut surface cut perpendicular to the axial direction of the sheath 10.

In the present embodiment, the reinforcing layer 75 is fixed to the sleeve main body 122 in the circumferential direction of the sleeve main body 122 and fixed to the sleeve main body 122, and is located on the distal side of the fixing portion 75 A and is not in contact with the sleeve main body 122. It has the non-fixed part 75B which is fixed.
The reinforcing layer 75 is provided in the circumferential direction of the sleeve body when the reinforcing layer 75 is continuous over the entire circumference of the sleeve body and when the reinforcing layer 75 is provided intermittently in the circumferential direction of the sleeve body. Any of these are included.

  The reinforcing layer 75 and the sleeve body 122 are linked by the fixing portion 75A. The fixing portion 75A is provided over the circumferential direction of the sleeve main body 122, whereby the strength of the sleeve main body 122 can be improved. The means for forming the fixing portion 75A is not particularly limited. At least one of the bonding means for bonding the reinforcing layer 75 and the sleeve main body 122 using an adhesive, the reinforcing layer 75 and the sleeve main body 122 is melted by heat, and the two are bonded to each other. A welding means for welding can be exemplified.

For example, the reinforcing layer 75 that is a coil shown in FIG. 3 is melted by applying heat to a predetermined region, and is heat-sealed to the outer surface of the sleeve body 122. The fixing portion 75A may be provided so as to cover the proximal end portion of the slit 146 having a high degree of vulnerability. Alternatively, the fixing portion 75 </ b> A may be provided closer to the proximal side than the proximal end portion of the slit 146. As a result, it is possible to avoid the deformation in the width direction of the slit 146 by the fixing portion 75A, and to prevent the degree of freedom of the diameter reduction of the diameter reduction sleeve 70 from being reduced.
By providing the non-fixed portion 75B on the distal side of the fixed portion 75A, the deformation in the width direction of the slit 146 is ensured.
As shown in FIG. 3, when the reduced diameter state is released and in the natural state (relatively expanded diameter state), the outer surface of the reduced diameter sleeve 70 is substantially the inner surface of the coil constituting the non-fixed portion 75B. You may contact | abut. When the distal end portion of the reduced diameter sleeve 70 is accommodated in the sheath 10, the distal end portion of the reduced diameter sleeve 70 is reduced in diameter, and the outer surface of the reduced diameter sleeve 70 is the coil constituting the non-fixed portion 75B. It may be separated from the inner surface (see FIG. 5a).

The clip device 100 can be used with a clip 200 further including a fastening member 60 inserted so as to be able to advance and retract in a region on the proximal end side of the arm portion 40.
The inner surface of the stepped portion 124 forms a restricting portion that restricts the relative movement of the tightening member 60 relative to the reduced diameter sleeve 70 by contacting the tightening member 60.

  The tightening member 60 is a member for closing the arm 40 by tightening the arm 40 in a direction different from the direction in which the arm 40 is expanded. In this embodiment, the example in which the fastening member 60 was provided in the clip 200 was shown. However, this embodiment does not exclude an aspect in which the clip device 100 is provided with a member having the same function as the fastening member 60.

  The inner side surface of the stepped portion 124 forming the restricting portion includes both an aspect configured substantially parallel to the outer surface of the stepped portion 124 and a mode non-parallel to the outer surface of the stepped portion 124. For example, the outer surface may be a discontinuous step, and the inner surface may be inclined inward toward the proximal side. Alternatively, the outer surface and the inner surface may be substantially parallel and may be inclined inward toward the proximal side.

  When the tightening member 60 abuts on the step portion 124, the relative movement toward the proximal side with respect to the reduced diameter sleeve 70 is restricted (hereinafter also referred to as a tightening member restricting state). In the tightening member restricting state, when the operation wire 20 is further pulled to the proximal side, the first locking portion 50 and the arm portion 40 linked thereto are drawn into the tightening member 60 and the arm is closed.

(Second embodiment)
Next, the endoscope clip device kit 300 (hereinafter also referred to as the clip device kit 300) of the present invention will be described.
As shown in FIG. 2, the clip device kit 300 includes the clip device 100 according to the first embodiment described above and the clip 200.
The clip 200 has a base end portion (first locking portion 50) and a plurality of arm portions that extend from the base end portion (first locking portion 50) and open by self-expanding force and can be closed by external force. 40. The “self-expanding force” refers to a force that repels an external force that attempts to close in a direction in which the plurality of arm portions 40 face each other and tries to open in a direction different from the direction in which the arms 40 face each other.

  The clip device kit 300 includes the clip device 100 and the clip 200 that can be attached to the clip device 100, so that the handleability is good. Further, the clip device kit 300 enjoys the effects exhibited by the clip device 100, and the operability of the operation wire 20 is good, and the operability of the clip 200 by the operation of the operation wire 20 is good.

The clip 200 ligates a living tissue, and by ligating the living tissue with the clip 200, for example, a treatment such as hemostasis treatment, sewing and marking can be performed.
The clip 200 shown in the present embodiment is an example, and can be appropriately changed to other aspects of the clip used in the endoscope clip device.

  The clip 200 is attached to the clip device 100. Specifically, the clip 200 is attached to the clip device 100 by the engagement of the first locking portion 50 provided in the clip 200 and the second locking portion 30 provided in the clip device. As an aspect of engagement, the example of the second locking portion 30 including the cylindrical first locking portion 50 has been described above. However, the mode of engagement of the first locking portion 50 and the second locking portion 30 is not limited to this, and the above-described engagement is performed as long as the clip 200 can be attached to the clip device 100. The aspect can be changed as appropriate.

  The clip 200 may have the fastening member 60 as described above. The fastening member 60 is, for example, a ring-shaped member. The arm portion 40 is provided with an enlarged width portion 114 that prohibits passage of the tip of the arm portion in a closed state with respect to the diameter of the tightening member 60 that is a ring-shaped member. The enlarged width part 114 prohibits the relative movement of the fastening member 60 to the distal side with respect to the arm part 40 in a closed state. On the proximal side of the enlarged width portion 114, a regulating portion 115 that is an outer surface of the arm portion 40 and projects outward is provided. The tightening member 60 rides on the restricting portion 115 and moves to the distal end side of the arm portion 40, whereby the arm portion 40 is maintained in the closed state.

As shown in FIG. 2, the clip device kit 300 has a first inclined surface 125 that is inclined inward toward the proximal side on the inner surface of the stepped portion 124.
On the other hand, the fastening member 60 has a second inclined surface 210 inclined inward toward the proximal side at an angle substantially equal to the inclination angle of the first inclined surface 125 with respect to the central axis of the operation wire 20 at the proximal end portion. have.
The first inclined surface 125 and the second inclined surface 210 are in contact with each other, so that the tightening member 60 is restricted from moving relative to the reduced diameter sleeve 70 in the proximal direction.

  By bringing the first inclined surface 125 and the second inclined surface 210 into contact with each other, the contact surface between the reduced diameter sleeve 70 and the fastening member 60 is prevented from being shifted in the direction perpendicular to the axial direction. Therefore, the contact state between the first inclined surface 125 and the second inclined surface 210 is stabilized. Further, by bringing the first inclined surface 125 and the second inclined surface 210 into contact with each other, the central axis of the reduced diameter sleeve 70 is overlapped with the central axis of the tightening member 60 and centered.

In the clip device kit 300 shown in FIG. 2, the reduced diameter sleeve 70 is in a protruding state. The clip device kit 300 is configured such that the inner diameter D of the guide portion 120 in the protruding state and the outer diameter E of the fastening member 60 are substantially equal. That is, the tightening member 60 is fitted inside the guide portion 120, and the posture of the tightening member 60 in the clip device kit 300 is stabilized.
In addition, when the fastening member 60 is fitted inside the guide part 120 in the protruding state, the guide part 120 is reduced in diameter even when an inward external force is applied from the outside of the guide part 120. Is regulated. Therefore, the guide part 120 cannot enter the sheath 10 and the protruding state is maintained.

  A method for attaching the clip 200 to the clip device 100 is not particularly limited. For example, a cartridge filled with a clip 200 (not shown) is prepared. The cartridge is provided with a clip take-out opening for taking out the filled clip 200. The distal end of the sheath 10 is opposed to the clip extraction opening. In this state, the second locking portion 30 is moved to the distal side by pushing the operation wire 20 to the distal side. The clip take-out opening may be provided with a sheath restricting portion that restricts relative movement of the sheath 10 to the distal side with respect to the cartridge. The second locking portion 30 is projected from the sheath 10 whose movement to the distal side is restricted by the sheath restricting portion, and is engaged with the first locking portion 50. While maintaining the engagement, the clip 200 can be extracted from the cartridge opening, and the clip device 100 to which the clip 200 is attached can be formed. When the second locking portion 30 is protruded from the sheath 10, the reduced diameter sleeve 70 can also be in the protruding state.

  Next, the operation of the clip 200 for grasping the ligated site will be described with reference to FIGS. FIG. 5 is an explanatory diagram for explaining a gripping operation of the clip device 100 to which the clip 200 is attached. FIG. 5 a shows a state in which the attached clip 200 is housed in the sheath 10. At this time, the reduced diameter sleeve 70 is in the stored state. FIG. 5 b shows a state in which the clip 200 protrudes from the distal end of the sheath 10 and the arm portion 40 is expanded. At this time, the reduced diameter sleeve 70 is in a protruding state. FIG. 5c shows a state where the clip 200 is closed. At this time, the reduced diameter sleeve 70 is in a protruding state and in a restricted state.

The reduced diameter sleeve 70 that protrudes from the sheath 10 together with the second locking portion 30 is reduced in diameter by applying an external force to the distal end portion, and the operation wire 20 is pulled proximally. It will be changed to a stowed state by being. FIG. 5 a shows a state in which the clip 200 attached to the clip device 100 is housed in the sheath 10 together with the reduced diameter sleeve 70.
In this state, the clip device 100 enters the body cavity.
When the distal end of the sheath 10 reaches the vicinity of the affected part requiring ligation, first, the operation wire 20 is pushed out to the distal side. Thereby, the clip 200 and the fastening member 60 protrude from the distal end of the sheath 10. Further, by pushing the operation wire 20 to the distal side, the guide portion 120 and the stepped portion 124 in the reduced diameter sleeve 70 are exposed from the tip of the sheath 10 and expanded to the original diameter. In other words, the distal end portion of the reduced diameter sleeve 70 is released from the reduced diameter state. The tightening member 60 is fitted inside the guide portion 120 from which the reduced diameter state is released (FIG. 5b). The tightening member 60 is fitted inside the guide portion 120, and the inclined surface of the proximal end portion of the tightening member 60 contacts the inner surface of the stepped portion 124.

Next, the clip 200 is positioned with respect to the ligated site. The rotation operation of the clip 200 is performed by transmitting the rotational driving force by the operation unit main body 520 (FIG. 1) to the clip 200 through the operation wire 20.
After the positioning of the clip 200 is completed, the operation wire 20 is pulled to the proximal side with the tip of the clip 200 pressed against the ligation site.
Since the tightening member 60 is fitted inside the guide portion 120 as described above, the relative movement of the tightening member 60 relative to the reduced diameter sleeve 70 is restricted. For this reason, the fastening member 60 does not pass through the inside of the reduced diameter sleeve 70 and is not drawn into the sheath 10.
Further, since the tightening member 60 is fitted to the guide portion 120, the contraction of the distal end diameter of the reduced diameter sleeve 70 due to an external force is suppressed, and the reduced diameter sleeve is prevented even if the operation wire 20 is pulled to the proximal side with a large force. 70 is not drawn into the sheath 10. The outer diameter of the guide part 120 fitted with the fastening member 60 exceeds the inner diameter of the sheath 10. In FIG. 5 c, the outer diameter of the guide part 120 fitted with the fastening member 60 exceeds the inner diameter of the sheath 10 and is smaller than the outer diameter of the sheath 10. Although not shown, the outer diameter of the guide part 120 fitted with the tightening member 60 may be equal to or larger than the outer diameter of the sheath 10. That is, the relative movement of the reduced diameter sleeve 70 relative to the clip device 100 is restricted. Therefore, relative movement of the tightening member 60 relative to the clip device 100 is also restricted.

  The operation wire 20 and the reduced diameter sleeve 70 are linked by an extension 80. Therefore, even after the reduced diameter sleeve 70 and the fastening member 60 are restricted from moving relative to the clip device 100 in the proximal direction, the extension 80 is extended by pulling the operation wire 20 in the proximal side. At the same time, the second locking portion 30 provided at the distal end of the operation wire 20 and the first locking portion 50 engaged with the second locking portion 30 are further drawn to the proximal side in the sheath 10.

  In this way, when the operation wire 20 is pulled in the proximal side even after the relative movement of the reduced diameter sleeve 70 and the fastening member 60 to the proximal side with respect to the clip device 100 is restricted, the arm portion 40 is It is drawn into the tightening member 60 to close the arm and ligate the ligation site. However, in this state, the arm portion 40 can be expanded by pushing the operation wire 20 to the distal side again, so that it is possible to grasp the ligation site again.

  After the optimum ligation has been confirmed, when the operation wire 20 is further pulled to the proximal side, the tightening member 60 moves relatively to the distal side with respect to the arm portion 40, and the restricting portion 115 provided on the arm portion 40 is moved. Get on. Thereby, the obstruction | occlusion state of the arm part 40 is maintained (FIG. 5c). In addition, the arm portion 40 has an enlarged width portion 114 having a plate width wider than the inner diameter of the fastening member 60, and the arm portion 40 is not drawn into the fastening member 60 beyond the enlarged width portion 114.

  As shown in FIG. 5c, in a state where the clip 200 is restricted from moving relative to the clip device 100 in the proximal direction, the operation wire 20 is further pulled in the proximal side. Thereby, engagement with the 1st latching | locking part 50 and the 2nd latching | locking part 30 is cancelled | released. With the above operation, the clip 200 is detached from the clip device 100 and is left in the body.

  The first embodiment and the second embodiment of the present invention have been described above. The present invention is not limited to the above-described embodiment, and includes various modifications and improvements as long as the object of the present invention is achieved. The matters described in each embodiment are appropriately applied to other embodiments.

The above embodiment includes the following technical idea.
(1) An endoscope clip used by mounting a clip including a base end portion and a plurality of arm portions that extend from the base end portion and open by self-expanding force and can be closed by external force. A device,
A long sheath,
An operation wire inserted in the sheath so as to be movable back and forth; and
A distal state where the distal end is housed in the distal end of the sheath and protrudes from the sheath in conjunction with advancing movement of the operation wire, and a distal where the distal end is interlocked with and protrudes from the backward movement of the operation wire A diameter-reducing sleeve that is capable of transitioning to a storage state in which the distal end is reduced in diameter by an external force and the distal end is accommodated in the sheath;
A locking portion provided at a distal end portion of the operation wire for engaging with the proximal end portion of the clip,
The reduced diameter sleeve is
A tubular sleeve body through which the operation wire is inserted;
A guide portion extending from a distal end portion of the sleeve body toward the distal side and having an outer diameter larger than an outer diameter of the sleeve body and an inner diameter of the sheath in the protruding state;
Have
The clip device for an endoscope, wherein an outer surface of the guide portion is parallel to the axial direction of the sheath or is inclined inward toward the distal side in the housed state. .
(2) having a step portion which is a step formed by the difference between the outer diameter of the sleeve body and the outer diameter of the guide portion;
The endoscope clip device according to (1), wherein the stepped portion is inclined so as to have a small diameter from the guide portion toward the sleeve main body.
(3) The endoscope clip device according to (1) or (2), wherein the sheath is a long coil in which a linear member is wound in a closely wound shape.
(4) In the above (3), the length of the guide portion in the axial direction exceeds the distance from one cross-sectional center of the linear member to the other cross-sectional center on the cut surface cut along the central axis of the sheath. The endoscope clip device according to the description.
(5) A slit extending from the guide portion to the distal end portion of the sleeve body is provided,
The internal view according to any one of (1) to (4), wherein a reinforcing layer that is continuous in a circumferential direction of the sleeve main body and covers at least a part of the slit provided in the sleeve main body is provided. Mirror clip device.
(6) The endoscope clip device according to (5), wherein the distal end portion of the reinforcing layer is located proximal to the guide portion.
(7) The reinforcing layer is formed of an elastic member that can expand and contract in the axial direction, and the elastic member has an extension portion that extends proximally beyond the proximal end of the sleeve body,
The endoscope clip device according to (5) or (6), wherein the extension portion is connected to an intermediate portion of the operation wire.
(8) The reinforcing layer is fixed to the sleeve body in a circumferential direction of the sleeve body, and is fixed to the sleeve body, and is positioned on the distal side of the fixing part. The clip device for an endoscope according to any one of (5) to (7), including an unfixed portion.
(9) The endoscope clip device used by attaching the clip further having a fastening member inserted so as to be able to advance and retreat in a region on the proximal end side of the arm portion,
The inner surface of the stepped portion is a restricting portion that restricts relative movement of the tightening member to the proximal side with respect to the reduced diameter sleeve by contacting the tightening member. Endoscopic clip device.
(10) The endoscope clip device according to any one of (1) to (9),
An endoscopic clip device comprising: a base end portion; and a clip including a plurality of arm portions that extend from the base end portion and open by self-expanding force and can be closed by external force. kit.
(11) The clip has a fastening member that is inserted so as to be able to advance and retreat in a region on the proximal end side of the arm portion,
The endoscope clip device has a step portion that is a step formed by a difference between an outer diameter of the sleeve body and an outer diameter of the guide portion,
In the protruding state, the inner surface of the stepped portion is a restricting portion that restricts relative movement of the tightening member to the proximal side relative to the reduced diameter sleeve by contacting the tightening member. The clip device kit for endoscopes as described in 10).
(12) The endoscope clip device has a first inclined surface inclined inward toward the proximal side on an inner surface of the stepped portion,
The fastening member has a second inclined surface inclined inward toward the proximal side at an angle substantially equal to an inclination angle of the inclination of the first inclined surface with respect to the central axis of the operation wire at the proximal end portion. Have
The inner surface according to (11), wherein the first inclined surface and the second inclined surface are in contact with each other, and the relative movement of the tightening member relative to the reduced diameter sleeve is restricted. Endoscopic clip device kit.
(13) The endoscope clip device kit according to (11) or (12), wherein an inner diameter of the guide portion is substantially equal to an outer diameter of the fastening member.
(Supplementary Note 1) Inserted to be able to move forward and backward in the base end portion, both arm portions that extend from the base end portion and open by self-expanding ability and can be closed by external force, and the base end side region of the arm portion An endoscopic clip device used by attaching a clip comprising a tightened member,
A long sheath,
An operation wire inserted in the sheath so as to be movable back and forth; and
The entire housing that is housed in the sheath by being housed in the distal end portion of the sheath, the distal end portion projecting from the sheath, and the projecting distal end portion being reduced in diameter by an external force. A diameter-reducing sleeve that is capable of transitioning in conjunction with the forward and backward movement of the operation wire,
A locking portion provided at a distal end portion of the operation wire for engaging with the proximal end portion of the clip,
The reduced diameter sleeve is
A tubular sleeve body through which the operation wire is inserted;
A guide portion extending from the distal end portion toward the distal side and having an outer diameter larger than an outer diameter of the sleeve body and an outer diameter of the sheath in the protruding state;
A restricting portion for restricting relative movement of the tightening member to the proximal side with respect to the reduced diameter sleeve;
The clip device for an endoscope, wherein the outer surface of the guide portion is parallel to the inner surface of the sheath in the fully retracted state or is inclined inward toward the distal side. .
(Additional remark 2) The clip apparatus for endoscopes of the said additional remark 2 which the level | step-difference part which is the level | step difference formed between the said sleeve main body and the said guide part is provided, and the said level | step-difference part is the said control part. .

DESCRIPTION OF SYMBOLS 10 ... Sheath 11 ... Coil 11A ... Coil 11B ... Coil 20 ... Operation wire 30 ... Second locking part 32 ... Base end part 34 ... Claw part 35 .... Claw body 36 ... Projection 37 ... Proximal inclined surface 38 ... Distal inclined surface 40 ... Arm 50 ... First locking part 60 ... Tightening member 70 ... Reduced diameter sleeve 75 ... Reinforcement layer 75A ... Fixed portion 75B ... Non-fixed portion 80 ... Extension portion 90 ... Centering portion 100 ... Endoscope clip Device 114 ... Enlarged width part 115 ... Restriction part 116 ... Connection bottom surface 120 ... Guide part 122 ... Sleeve body 124 ... Step part 125 ... First inclined surface 146 ... Slit 150 ... Space 200 ... Clip 210 ... Second inclined surface 300 ... Endoscope clamp Device kit 500 ... ring 510 ... drive unit 520 ... operation unit main body 900 ... locking member 920 ... 装置 A ... outer diameter B ... inner diameter C ... outer Diameter D ... Inner diameter E ... Outer diameter s ... Axial length t ... Distance

Claims (13)

An endoscopic clip device used by mounting a clip comprising a base end portion and a plurality of arms that extend from the base end portion and open by self-expanding force and can be closed by external force. And
A long sheath,
An operation wire inserted in the sheath so as to be movable back and forth; and
A distal state where the distal end is housed in the distal end of the sheath and protrudes from the sheath in conjunction with advancing movement of the operation wire, and a distal where the distal end is interlocked with and protrudes from the backward movement of the operation wire A diameter-reducing sleeve that is capable of transitioning to a storage state in which the distal end is reduced in diameter by an external force and the distal end is accommodated in the sheath;
A locking portion provided at a distal end portion of the operation wire for engaging with the proximal end portion of the clip,
The reduced diameter sleeve is
A tubular sleeve body through which the operation wire is inserted;
A guide portion extending from a distal end portion of the sleeve body toward the distal side and having an outer diameter larger than an outer diameter of the sleeve body and an inner diameter of the sheath in the protruding state;
Have
The clip device for an endoscope, wherein an outer surface of the guide portion is parallel to the axial direction of the sheath or is inclined inward toward the distal side in the housed state. . Having a step portion which is a step formed by the difference between the outer diameter of the sleeve body and the outer diameter of the guide portion;
The endoscope clip device according to claim 1, wherein the stepped portion is inclined so as to have a small diameter from the guide portion toward the sleeve main body.   The endoscope clip device according to claim 1 or 2, wherein the sheath is a long coil in which a linear member is wound in a closely wound shape.   The internal view according to claim 3, wherein an axial length of the guide portion exceeds a distance from one cross-sectional center of the linear member to another cross-sectional center in a cut surface cut along the central axis of the sheath. Mirror clip device. A slit extending from the guide portion to the distal end of the sleeve body is provided;
The endoscope clip according to any one of claims 1 to 4, further comprising a reinforcing layer that is continuous in a circumferential direction of the sleeve main body and covers at least a part of the slit provided in the sleeve main body. apparatus.   The clip device for an endoscope according to claim 5, wherein a distal end portion of the reinforcing layer is located proximal to the guide portion. The reinforcing layer is formed of a stretchable member that can be stretched in the axial direction, and the stretchable member has an extension that extends proximally beyond the proximal end of the sleeve body,
The endoscope clip device according to claim 5 or 6, wherein the extension portion is connected to an intermediate portion of the operation wire.   The reinforcing layer includes a fixing portion that is joined and fixed to the sleeve body in the circumferential direction of the sleeve body, and a non-fixing portion that is located on the distal side of the fixing portion and is not fixed to the sleeve body. The endoscope clip device according to any one of claims 5 to 7. The endoscope clip device used by attaching the clip further having a fastening member inserted so as to be able to advance and retreat in a region on the proximal end side of the arm part,
The inner surface according to claim 2, wherein the inner surface of the stepped portion is a restricting portion that restricts the relative movement of the tightening member to the proximal side with respect to the reduced diameter sleeve by contacting the tightening member. Endoscopic clip device. An endoscopic clip device according to any one of claims 1 to 9,
An endoscopic clip device comprising: a base end portion; and a clip including a plurality of arm portions that extend from the base end portion and open by self-expanding force and can be closed by external force. kit. The clip has a fastening member inserted so as to be able to advance and retreat in a region on the proximal end side of the arm portion,
The endoscope clip device has a step portion that is a step formed by a difference between an outer diameter of the sleeve body and an outer diameter of the guide portion,
The restricting portion that restricts relative movement of the tightening member to the proximal side with respect to the reduced diameter sleeve by contacting an inner surface of the stepped portion with the tightening member in the protruding state. The endoscope clip device kit according to 10. The endoscope clip device has a first inclined surface inclined inward toward the proximal side on an inner surface of the stepped portion,
The tightening member has a second inclined surface inclined inward toward the proximal side at an angle substantially equal to an inclination angle of the first inclined surface with respect to a central axis of the operation wire at a proximal end portion. ,
The internal view according to claim 11, wherein the first inclined surface and the second inclined surface are in contact with each other, so that the relative movement of the tightening member relative to the reduced diameter sleeve is restricted. Mirror clip device kit.   The endoscope clip device kit according to claim 11 or 12, wherein an inner diameter of the guide portion is substantially equal to an outer diameter of the fastening member.

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