JP2016002392A - Treatment instrument for endoscope - Google Patents

Abstract

PROBLEM TO BE SOLVED: To enable a clip, which is connected to a tip of a sheath, to be arbitrarily rotated on an axis line of the sheath during a clipping operation, and prevent rotation of the clip during a clip release operation.SOLUTION: A connection hook 11 is attached via clutch means 3 to a distal end of a drive wire 13 inserted through a sheath 12. The clutch means is actuated to make the connection hook connected to the drive wire when the connection hook is pulled inward from the distal end of the sheath to bring about a leg-closed state, and to make the connection hook disconnected from the drive wire when the connection hook is pushed out from the distal end of the sheath to bring about a leg-opened state.

Description

  The present invention relates to an endoscope treatment tool for performing a treatment on a body tissue by an operation outside the body using an endoscope.

  The clip device as one of the endoscope treatment tools is operated by operating the clip connected to the distal end of the sheath that is passed through the endoscope treatment instrument guide tube from the operation unit attached to the rear end of the sheath. Thus, the device is used for indwelling the body tissue in order to stop bleeding or mark the bleeding from the defect in the body tissue that occurs when the polyp is excised. Therefore, the clip is configured to be separable with respect to 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 provided on the driving wire passed through the sheath. It is attached to the tip (distal end).

  The connecting hook is urged to open in a generally C-shape toward the front by its own elasticity, and its tip is bent inward. This is often used because the operation of connecting and separating is surely performed and the performance is good. The base end portions of the connecting hooks are integrated with each other and fixed to the distal end of the drive wire (see, for example, Patent Document 1 below).

JP 2012-200158 A

  By the way, when performing an operation of grasping a defect or the like of a body tissue with a clip, it is necessary to adjust the rotation position (posture) around the sheath axis of the clip, but the connection hook that connects the clip is a drive wire. Therefore, the adjustment can be performed by rotating the drive wire and the sheath as a whole. However, when the clip after grasping the body tissue is released from the distal end of the sheath, if the drive wire and the sheath are rotated as a whole, the clip rotates and the clip is detached from the body tissue, There was a problem that the organization might be torn off.

  The present invention has been made in view of the above points. When closing the opening / closing portion, the opening / closing portion is coupled to the drive wire, and when opening / closing, the opening / closing portion is coupled to the drive wire. An object of the present invention is to provide an endoscopic treatment tool that can be released.

An endoscopic treatment tool according to the present invention includes:
A tubular sheath;
A drive wire inserted through the sheath;
An operating portion provided at a proximal end of the sheath and sliding the drive wire with respect to the sheath;
Attached to the distal end of the drive wire, the legs are opened by sliding the sheath proximally with respect to the drive wire, and the sheath is slid distally with respect to the drive wire. And an opening / closing part that closes the leg,
When the opening / closing part is closed, the opening / closing part is coupled to the drive wire, and when the opening / closing part is opened, the opening / closing part is operated to be decoupled from the driving wire. A clutch means is interposed between the opening / closing portion and the distal end of the drive wire.

  In the endoscope treatment instrument according to the present invention, the sheath includes an elastic body having a pair of arm portions arranged so that the opening and closing portion is opened in a substantially C shape as it goes to a distal end thereof. Is slid toward the proximal end side with respect to the drive wire, protrudes from the distal end of the sheath and is opened by its own elasticity, and the sheath is slid toward the distal end side with respect to the drive wire. Thereby, it is buried in the distal end of the sheath and closed, and it can be a connecting hook that releasably connects an endoscopic clip that is held by holding a body tissue.

In the endoscope treatment tool according to the present invention,
As the clutch means,
An external tooth member having external teeth connected to the proximal end of the opening and closing part;
An internal tooth member having internal teeth connected to the distal end of the drive wire;
The external tooth member meshes with the internal teeth when the sheath is slid to the distal end side with respect to the drive wire, and the sheath is slid to the proximal end side with respect to the drive wire. In this case, it is possible to adopt a slidably held member so that the engagement with the internal teeth is released.

  According to the endoscope treatment tool of the present invention, since the clutch means is interposed between the opening / closing part and the distal end of the drive wire, when the opening / closing part is closed, the opening / closing part is placed against the drive wire. When coupling and opening the opening / closing part, the coupling of the opening / closing part to the drive wire can be released. As a result, when the present invention is applied to a clip device for placing an endoscope clip in the body, the clip connected to the distal end of the sheath can be arbitrarily rotated around the axis of the sheath at the time of clipping work. There is an effect that the clip can be prevented from rotating during the release operation.

It is a figure showing the whole endoscope treatment instrument composition of an embodiment of the present invention. It is sectional drawing along the AA line of FIG. It is a figure which shows the state which attached the connection hook via the clutch means to the distal end of the drive wire of the treatment tool for endoscopes of embodiment of this invention. It is a figure which shows the state which attached the connection hook via the clutch means to the distal end of the drive wire of the treatment tool for endoscopes of embodiment of this invention. It is sectional drawing which shows the structure at the time of the cancellation | release of the coupling | bonding of the clutch means of the treatment tool for endoscopes of embodiment of this invention. It is sectional drawing which shows the structure at the time of the coupling | bonding of the clutch means of the treatment tool for endoscopes of embodiment of this invention. It is a figure which shows the structure at the time of coupling | bonding release of the clutch means of the treatment tool for endoscopes of embodiment of this invention, Comprising: It is the perspective view cut | disconnected in the surface which passes along a substantially central axis. It is a perspective view which shows the structure of the loop member of the treatment tool for endoscopes of embodiment of this invention. It is a perspective view which shows the structure of the external tooth member of the clutch means of the treatment tool for endoscopes of embodiment of this invention. It is a perspective view which shows the structure of the internal tooth member of the clutch means of the treatment tool for endoscopes of embodiment of this invention. It is a disassembled perspective view which shows the structure of the attaching part of the drive wire with respect to the clutch means of the treatment tool for endoscopes of embodiment of this invention. It is a figure which shows the state which made the external-tooth member and internal-tooth member of the clutch means of the treatment tool for endoscopes of embodiment of this invention mesh. It is a figure which shows the structure at the time of cancellation | release of coupling | bonding of the clutch means of the treatment tool for endoscopes of embodiment of this invention, Comprising: It is the perspective view cut | disconnected by the surface parallel to a substantially central axis. It is a figure which shows the structure at the time of the coupling | bonding of the clutch means of the treatment tool for endoscopes of embodiment of this invention, Comprising: It is the perspective view cut | disconnected by the surface substantially parallel to a central axis. It is a top view which shows the structure of the clip of embodiment of this invention. It is a side view which shows the structure of the clip of embodiment of this invention. It is a figure which shows the state which protruded the connection hook of the treatment tool for endoscopes of embodiment of this invention from the distal end of the inner sheath, and opened the connection hook. It is a figure which shows the state which connected the clip to the distal end of the inner sheath of the treatment tool for endoscopes of embodiment of this invention, and accommodated in the outer sheath. It is a figure which shows the state just before sliding the inner sheath of the treatment tool for endoscopes of embodiment of this invention to a distal end side, and closing a clip. It is a figure which shows the state which slid the inner sheath of the treatment tool for endoscopes of embodiment of this invention to the distal end side, and completed the leg closure of the clip. It is a figure which shows the state which slid the inner sheath of the treatment tool for endoscopes of embodiment of this invention to the proximal end side, and opened the connection hook.

  Hereinafter, referring to the drawings, as an embodiment of the treatment instrument for an endoscope according to the present invention, an endoscope clip for performing hemostasis or the like is connected via an endoscope and conveyed to the inside of the body, and the body tissue A clip device for gripping (clipping) will be described.

  However, the present invention is not limited to the clip device, and the leg is opened by sliding the sheath toward the proximal end side with respect to the drive wire, and the sheath is slid toward the distal end side with respect to the drive wire. Therefore, the present invention can be widely applied to an endoscope treatment tool including an opening / closing part that closes a leg. More specifically, for example, an endoscopic snare ligation apparatus including a connection hook for connecting an indwelling snare and ligating a body tissue as the opening / closing section, and an internal forceps for grasping or incising the body tissue as the opening / closing section. The present invention can be applied to an endoscopic forceps treatment instrument, a high-frequency treatment instrument including a high-frequency electrode that opens and closes as the opening / closing portion.

  First, refer to FIG. 1 and FIG. The clip device 1 includes a connection hook 11, an inner sheath (inner tube) 12, a drive wire 13, an outer sheath (outer tube) 14, a reinforcing tube 15, a slider 16, a base portion 17, and an operation portion 18. ing.

  Similarly, a tubular inner sheath 12 is inserted through the tubular outer sheath 14, and a drive wire 13 is inserted through the inner sheath 12. The inner sheath 12 is slidable within the outer sheath 14, and the drive wire 13 is slidable within the inner sheath 12.

  The outer sheath 14 is made 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 12 is made of a flexible hollow tube, and a wire tube is used in this embodiment. The wire tube is a tube made of a hollow stranded wire formed by spirally twisting a plurality of wires (cables) made of, for example, metal (stainless steel) or the like. In addition, as the inner sheath 12, a wire tube may be mainly used, and only a part on the tip side may be a coil tube.

  The drive wire 13 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.

  A wire tube made of such a coil tube or a stranded wire is used as the outer sheath 14 or the inner sheath 12 when the clip device 1 is ultrasonically cleaned with a cleaning liquid, and there is sufficient cleaning liquid inside the tube. 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 14 and the winding direction of the inner sheath 12 from the viewpoint of reducing the sliding resistance generated between them. For example, when the outer sheath 14 is Z-winding, the inner sheath 12 is S-winding. When a wire rope or wire tube made of a stranded wire is used for the drive wire 13, it is also preferable that the winding direction is opposite to the winding direction of the inner sheath 12.

  As shown in FIGS. 3 and 4, the connecting hook 11 disposed at the sheath distal end of the clip device 1 is a pair of arm portions made of an elastic body disposed in a substantially C shape toward the distal end. 11a and 11a, and can cooperate with the inner sheath 12 to take two states, an open leg (open) state and a closed leg (closed) state. Claw portions 11b and 11b are formed at the front end portions of the arm portions 11a and 11a of the connecting hook 11 by being bent inward (sides facing each other), and hold the connecting portion 21 of the clip 2 described later. It can be connected.

  The base end portion of the connecting hook 11 is a U-shaped portion 11c formed in a substantially U shape continuously to the base end portions of the pair of arm portions 11a and 11a. The arm portions 11a and 11a and the U-shaped portion 11c including the claw portions 11b and 11b can be formed by appropriately bending (plastically deforming) one elongated plate made of an elastic body. Although not specifically limited, the plate | board thickness of the board | plate material which comprises the connection hook 11 is about 0.20-0.30 mm, and a width | variety is about 0.6 mm. As the plate material, for example, stainless steel is used.

  A loop member 19 is attached to the tip (distal end) of the drive wire 13 slidably inserted into the inner sheath 12 via the clutch means 3 (see FIGS. 3 to 6 and FIG. 8). The loop member 19 has an annular part (annular part) 19a formed in a substantially annular shape and a rod-like part 19b formed integrally with the annular part 19a. The outer diameter of the annular portion 19a is about 1.2 mm, and the inner diameter is about 0.8 to 1.0 mm. The cross section of the annular portion 19a is rectangular in this embodiment, but may be circular or semicircular. The rod-shaped portion 19b is a rod-shaped member having a rectangular cross section, and a fitting portion 19c to be fitted and fixed in a fitting hole 33a of the external tooth member 33 described later is formed on the base end side thereof ( (Refer FIG. 8, FIG. 9). The clutch means 3 will be described later in detail.

  The connecting hook 11 is inserted into the annular portion 19a and is disposed so that the U-shaped portion 11c is loosely fitted to the annular portion 19a, so that the connecting hook 11 is swingably attached to the distal end of the drive wire 13. By attaching the connecting hook 11 to the distal end of the drive wire 13 via the annular portion 19a and the U-shaped portion 11c loosely fitted to the annular portion 19a, the connecting hook 11 is shown in FIG. It can be freely rotated in the direction of arrow B in the direction of arrow C in FIG.

  Returning to FIGS. 1 and 2, the vicinity of the proximal end (proximal end) side of the outer sheath 14 is inserted into the reinforcing tube 15 and is integrally fixed to the reinforcing tube 15. The reinforcing tube 15 is made of a highly rigid hollow tube, and a coil tube is used in this embodiment. The reinforcing tube 15 is integrally fixed to the slider 16, and a portion on the distal end side of the base portion 17 is inserted and arranged inside the slider 16. The slider 16 can be slidably positioned relative to the base portion 17 between a position moved toward the distal end (distal end) and two positions moved toward the proximal end (proximal end). It has become.

  An operating portion 18 is slidably held on the base portion 17, and a proximal end of the inner sheath 12 is fixed to a distal end portion of the base portion 17. The proximal end of the drive wire 13 is fixed to the operation unit 18.

  Next, the clutch means (clutch device) 3 will be described in detail with reference to FIGS. The clutch means 3 includes an outer cylinder member 31, an inner cylinder member 32, an outer tooth member 33, and an inner tooth member 34. Although not particularly limited, these are formed of a metal such as stainless steel. The loop member 19 will be described as a constituent member different from the clutch means 3 here, but may be a constituent member of the clutch means 3.

  As shown in FIG. 11, the outer cylinder member 31 and the inner cylinder member 32 are substantially cylindrical members, respectively. The inner cylinder member 32 has a distal end of the drive wire 13 fitted therein. While being fixed integrally with each other, it is fitted into one end side of the outer cylinder member 31 and fixed integrally with each other. Note that these members may be fixed by laser welding or the like.

  As shown in FIG. 9, the external teeth member 33 is arranged so as to project outward toward the outside at a substantially rectangular fitting hole 33 a formed in the central portion and radially at equal angular intervals. It is a member having the provided external teeth 33b. As shown in FIG. 10, the internal tooth member 34 is a member having a circular through hole 34 a formed in the center and internal teeth 34 b that mesh with the external teeth 33 b of the external tooth member 33. In the present embodiment, the external tooth member 33 is provided with four external teeth 33b radially at intervals of 90 degrees, and the internal tooth member 34 is provided with four internal teeth 34b that respectively mesh with the external teeth 33b. However, the number of the outer teeth 33b and the inner teeth 34b is not particularly limited.

  As shown in FIGS. 5 to 7, the fitting portion 19 c of the rod-shaped portion 19 b is connected to the external tooth member 33 in a state where the rod-shaped portion 19 b of the loop member 19 is inserted into the through hole 34 a of the internal gear member 34. The loop member 19 and the external tooth member 33 are integrally fixed to each other by being inserted into the fitting hole 33a.

  The inner tooth member 34 is integrally fixed to the outer cylinder member 31 by fitting a protrusion for forming the inner teeth 34 b into the other end of the outer cylinder member 31. The loop member 19 and the outer tooth member 33 and the inner tooth member 34 and the outer cylinder member 31 may be fixed by laser welding or the like.

  With such a configuration, the base end surface of the loop member 19 to which the external tooth member 33 is fixed (the open end surface of the fitting portion 19c) and / or the base end surface of the external tooth member 33 (the annular portion 19a of the loop member 19). The surface opposite to the distal end surface of the drive wire 13 is in contact with or separated from the distal end surface of the drive wire 13, and the loop member 19 faces the clutch means 3 along the central axis of the outer cylinder member 31. It is held by the clutch means 3 so that it can slide.

  As shown in FIGS. 5 and 13, when the loop member 19 is slid so that the base end surface thereof is in contact with the distal end surface of the drive wire 13, the engagement of the external tooth member 33 with the internal tooth member 34 is released. Thus, the loop member 19 is rotatable about the central axis of the outer cylinder member 31 with respect to the drive wire 13 (clutch means 3). On the contrary, as shown in FIGS. 6 and 14, when the loop member 19 is slid so that its proximal end face is separated from the distal end face of the drive wire 13, the external tooth member 33 becomes the internal tooth member. 34, the loop member 19 is unable to rotate relative to the drive wire 13 (clutch means 3), and when the drive wire 13 is rotated, the loop member 19 is also integrally rotated.

  Next, the endoscope clip 2 that holds the body tissue using the clip device 1 will be described. As shown in FIGS. 15 and 16, the clip 2 includes a connecting plate portion 21 that is bent into a substantially U shape. A pair of arm plate portions 22 are formed integrally with each of the U-shaped end portions of the connecting plate portion 21 so as to be opened (opened) in a substantially square shape toward the tip. ing.

  A claw portion 23 is integrally formed at the distal end portion of each arm plate portion 22. The claw portion 23 is formed by being bent toward the inner side (that is, the closing direction) at the tip of the arm plate portion 22. Each nail | claw part 23 has a notch part (not shown) recessed in the intermediate part of the front-end | tip.

  The connecting plate portion 21, the pair of arm plate portions 22, and the pair of claw portions 23 that constitute the clip 2 are formed by bending (plastically deforming) a single plate material made of a thin and long elastic body. Can do. Although the board thickness of the board | plate material which comprises the clip 2 is not specifically limited, Preferably it is 0.10-0.30 mm. As the plate material, for example, stainless steel is used.

  As shown in FIG. 16, each of the arm plate portions 22 has a base end portion 22a and a grip portion 22b. A penetrating portion 22 c is formed in the grip portion 22 b of each arm plate portion 22. These through portions 22c are formed to adjust the rigidity of the arm plate portion 22 while maintaining a desired strength (thickness) of the arm plate portion 22 (gripping portion 22b).

  A tightening ring 24 is slidably fitted into the connecting plate portion 21. The fastening ring 24 is composed of a substantially cylindrical ring member. However, the tightening ring 24 may be configured by a spring formed by winding a wire in a coil shape. The coupling ring 21 is inserted into the inner guide hole of the tightening ring 24, and can be moved (slid) in the axial direction between the outer periphery of the connection plate 21 and the outer periphery of the base end 22 a of the arm plate 22. Is attached (externally fitted).

  As shown in FIG. 15 or FIG. 16, when the tightening ring 24 is disposed rearward (connecting plate portion 21), the arm plate portion 22 is opened (opened) by its own elasticity. If necessary, the arm plate portion 22 can be closed (closed) by moving (sliding) the tightening ring 24 to a position closer to the distal end (base end portion 22a).

  Next, the usage method of the clip apparatus 1 mentioned above is demonstrated with reference to FIGS. First, as shown in FIG. 17, the slider 16 is slid to the position on the proximal end side with respect to the base portion 17 so that the distal end of the inner sheath 12 protrudes from the distal end of the outer sheath 14. State. Further, the base portion 17 is slid toward the proximal end side with respect to the operation portion 18, the inner sheath 12 is drawn into the drive wire 13, and the connecting hook 11 at the distal end of the drive wire 13 is moved away from the inner sheath 12. It protrudes from the end and is opened in a substantially C shape by its own elasticity.

  In this state, since the inner sheath 12 is drawn into the drive wire 13 (that is, the drive wire 13 is pushed out with respect to the inner sheath 12), the clutch means 3 is shown in FIG. 5 or FIG. As shown, the coupling is released, and the connecting hook 11 is rotatable around the central axis.

  When the base portion 17 is slid to the distal end side with respect to the operation portion 18 from this state, the inner sheath 12 is pushed out with respect to the drive wire 13, and the connection hook 11 at the distal end of the drive wire 13 is moved to the inner side. The legs are gradually closed while entering the sheath 12, so that the connecting plate portion 21 of the clip 2 is positioned so as to be gripped by the connecting hook 11, buried in the inner sheath 12, and completely closed. 2 can be connected to the distal end of the inner sheath 12.

  In this state, since the drive wire 13 is drawn into the inner sheath 12 (that is, the inner sheath 12 is pushed out with respect to the drive wire 13), the clutch means 3 is shown in FIG. As shown in FIG. 2, the coupling hook 11 is in a coupled state, and the coupling hook 11 cannot rotate relative to the drive wire 13.

  Next, the slider 16 is slid to the position on the distal end side with respect to the base portion 17, and the distal end of the inner sheath 12 to which the clip 2 is connected is housed (embedded) in the outer sheath 14 together with the clip 2. (See FIG. 18). In this state, the fastening ring 24 of the clip 2 remains positioned on the connecting plate portion 21, and the arm plate portion 22 is closed by the inner wall of the outer sheath 14.

  Next, although illustration is omitted, the distal ends of the sheaths 12 and 14 of the clip device 1 to which the clip 2 is connected are positioned in the vicinity of a body tissue to be treated such as hemostasis via an endoscope. . Thereafter, the clip 16 is protruded from the distal end of the outer sheath 14 by sliding the slider 16 to a position on the proximal end side with respect to the base portion 17 and sliding the outer sheath 14 to the proximal end side. Thereby, the arm board part 22 of the clip 2 will be in the state opened by self elasticity (refer FIG. 19).

  In a state where the arm plate portion 22 is opened, the arm plate portion 22 is positioned in the vicinity of a portion to be grasped of the mucous membrane (internal tissue). At this time, as shown in FIG. 6 or FIG. 14, the clutch means 3 remains in the coupled state, so that the coupling hook 11 is not rotatable relative to the drive wire 13. Therefore, by rotating the clip device 1 (the base portion 17 and the operation portion 18) around the central axis, the clip 2 also rotates integrally, so that the rotation position of the clip 2 (attitude around the sheath central axis) is arbitrary. Can be adjusted.

  Next, the inner ring 12 is slid to the distal end side with respect to the drive wire 13, so that the tightening ring 24 is slid to the distal end side of the arm plate portion 22. As a result, the arm plate portion 22 is gradually closed (approached to each other), and the mucous membrane on one side and the mucous membrane on the other side are pulled together while sandwiching the body tissue.

  By further sliding the inner sheath 12 to the distal end side with respect to the drive wire 13, the tightening ring 24 moves to the grasping portion 22b side of the arm plate portion 22, and the grasping of the body tissue by the clip 2 is completed (see FIG. 20). In this state, the inner sheath 12 is slid toward the proximal end side with respect to the drive wire 13, whereby the connecting hook 11 is pushed out from the distal end of the inner sheath 12 and opened as shown in FIG. The clip 2 is released from the gripping (engagement) of the clip 2 by the connecting hook 11 and the clip 2 is released, and the clipping of the clip 2 to the body tissue is completed.

  At this time, the clutch means 3 is shown in FIG. 5 or FIG. 13 because the inner sheath 12 is drawn into the drive wire 13 (that is, the drive wire 13 is pushed out with respect to the inner sheath 12). As shown, the coupling is released, and the connecting hook 11 can rotate around the central axis with respect to the drive wire 13. Therefore, even if the clip device 1 is rotated as a whole during the release operation of the clip 2, the drive wire 13 or the like does not rotate around the connection hook 11, and the connection hook 11 does not rotate. The gripping of the clip 2 by the connecting hook 11 can be safely released without adversely affecting the rotation position of the clip 2 (posture around the sheath central axis).

  According to the above-described embodiment, when the connecting hook 11 is pulled in from the distal end of the inner sheath 12, the connecting hook 11 is coupled to the drive wire 13, and the connecting hook 11 is connected to the distal end of the inner sheath 12. Since the connection hook 11 is attached to the distal end of the drive wire 13 via the clutch means 3 that operates so that the connection hook 11 is released from the connection to the drive wire 13 when pushing out, during the clipping operation (clip 2), the clip 2 connected to the distal end of the inner sheath 12 can be arbitrarily rotated around the axis of the sheath 12, and the clip 2 is released (the gripping of the clip 2 by the connecting hook 11). The clip 2 can be prevented from rotating when the operation is canceled. Therefore, the clipping operation can be performed easily and reliably, and it is possible to reduce damage to the body tissue when the clip is released.

  In the clutch means 3 described above, the external teeth 33b of the external tooth member 33 and the internal teeth 34b of the internal tooth member 34 are provided in order to smoothly engage with the sliding of the external tooth member 33 and the internal tooth member 34. It is preferable that the taper shape is appropriately opposed.

  In the above-described embodiment, the U-shaped portion 11c of the connecting hook 11 is loosely fitted to the annular portion 19a of the loop member 19 that is slidably held by the clutch means 3. This is because it is possible to swing the clutch means 3 to improve the smoothness of the sliding of the connecting hook 11 in the curved inner sheath 12. However, if there is no such need, a rod-like member similar to the rod-like portion 19b of the loop member 19 is provided in place of the loop member 19, and the base end portion of the connecting hook 11 is welded to the tip of the rod-like member. May be integrally fixed.

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

1. Clip device (endoscopic treatment tool)
11. Connection hook (opening / closing part)
DESCRIPTION OF SYMBOLS 11a ... Arm part 11b ... Claw part 11c ... U-shaped part 12 ... Inner sheath 13 ... Driving wire 14 ... Outer sheath 16 ... Slider 17 ... Base part 18 ... Operation part 19 ... Loop member 19a ... Ring-shaped part 19b ... Rod-shaped part 19c ... Fitting part 2 ... Clip 21 ... Connecting plate part 22 ... Arm plate part 22a ... Base end part 22b ... Holding part 23 ... Claw part 24 ... Clamping ring 3 ... Clutch means 31 ... Outer cylinder member 32 ... Inner cylinder member 33 ... External tooth member 33a ... Fitting hole 33b ... External tooth 34 ... Internal tooth member 34a ... Through hole 34b ... Internal tooth

Claims (3)

A tubular sheath;
A drive wire inserted through the sheath;
An operating portion provided at a proximal end of the sheath and sliding the drive wire with respect to the sheath;
Attached to the distal end of the drive wire, the legs are opened by sliding the sheath proximally with respect to the drive wire, and the sheath is slid distally with respect to the drive wire. And an opening / closing part that closes the leg,
When the opening / closing part is closed, the opening / closing part is coupled to the drive wire, and when the opening / closing part is opened, the opening / closing part is operated to be decoupled from the driving wire. A treatment instrument for an endoscope, wherein a clutch means is interposed between the opening / closing part and a distal end of the drive wire.   The opening / closing portion is made of an elastic body having a pair of arm portions arranged so as to open in a substantially C shape as it goes to the tip thereof, and the sheath is located on the proximal end side with respect to the drive wire. By sliding, it protrudes from the distal end of the sheath and opens with its own elasticity, and by sliding the sheath toward the distal end side with respect to the drive wire, it is buried in the distal end of the sheath The endoscopic treatment tool according to claim 1, wherein the endoscopic treatment tool is a connecting hook that releasably connects an endoscopic clip that is placed and closed while grasping a body tissue. The clutch means includes
An external tooth member having external teeth connected to the proximal end of the opening and closing part;
An internal tooth member having internal teeth connected to the distal end of the drive wire;
The external tooth member meshes with the internal teeth when the sheath is slid to the distal end side with respect to the drive wire, and the sheath is slid to the proximal end side with respect to the drive wire. The endoscopic treatment tool according to claim 1 or 2, wherein the endoscopic treatment tool is slidably held so that the engagement with the internal teeth is released when the internal teeth are released.

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