JP2016123805A - Treatment tool for endoscope - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a treatment tool for an endoscope comprising an inner sheath in which two tubes having a rigidity different from an outer sheath are connected, in which operation failure in the treatment tool for an endoscope which may occur in a case where relative movement in the outer sheath and the inner sheath is no smooth is solved.SOLUTION: As an inner sheath 12 which is inserted into an outer sheath 14 and into which a driving wire in which an action part is attached on its tip is inserted, the tool comprises a tip tube 12a arranged at a tip end part and a main tube 12b in which the distal end of the tip tube is connected to the proximal end. The rigidity of the tip tube is designed to be smaller than that of the main tube. A small diameter part 12c having a smaller outer diameter than a section other than a predetermined section at the distal end of the main tube is used for the predetermined section of the main tube such that the rigidity of the predetermined section of the main tube is larger than that of the tip tube and smaller than that of a section other than the predetermined section of the main tube.SELECTED DRAWING: Figure 18

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.

  Endoscopic treatment tools are those whose distal end is inserted into the body through an endoscope, and perform various treatments on tissues in the body by operations outside the body. Widely used. Various types of endoscope treatment tools are known according to the intended treatment, and one of the forms is an endoscope treatment tool having a double tube structure. it can. An endoscope treatment instrument having a double tube structure is inserted into a coaxially arranged double tube and a tube inside the double tube, and performs treatment on a body tissue at a distal end. The operation unit is attached to the operation wire, and the operation unit is protruded from each sheath by relatively moving each tube (sheath) and the operation wire along the axial direction, or It is buried in each sheath and causes the operation section to perform a desired operation according to the target treatment.

  As an example of the endoscope treatment tool having a double tube structure, a clip device described in Patent Document 1 can be cited. The clip device is a device used to pass through a treatment instrument guide tube of an endoscope, insert it into the body, hold a body tissue with a clip for hemostasis, marking, etc., and place the clip in the body. It is.

  In the clip device described in Patent Document 1, a connection hook that is detachable with respect to a connection portion formed at a rear end portion of a clip placed in the body is provided in a sheath (inner sheath) inside the double tube. It is attached to the tip (distal end) of the threaded drive wire. This connecting hook is urged by its own elasticity to open in a generally C shape toward the front, and has a shape whose tip is bent inward, and when it is pulled into the inner sheath The substantially C-shaped part is closed and can be connected to the rear end part of the clip. And the clip connected to the connection hook can be accommodated in a closed state in the outer sheath (outer sheath) of the double tube, and when the outer sheath is drawn into the inner sheath and the drive wire, The clip protrudes from the outer sheath and is opened. When the clip that has been opened is brought close to the tissue to be grasped and the inner sheath is pushed out against the drive wire, the fastening ring provided on the clip is pushed out by the inner sheath and slides to the distal side. Thus, the clip is closed and the body tissue can be grasped (clipped).

JP 2012-200158 A

  By the way, the distal end portion of the endoscope is appropriately curved for convenience of treatment, but passes through this portion when it is curved relatively large (when curved so as to have a relatively small curvature). In doing so, the tip side portion of the clip device is also bent following the bending of the endoscope. Accordingly, a certain degree of flexibility is required for the tip side portion of the clip device. On the other hand, when the outer sheath is retracted to open the clip, if the rigidity of the inner sheath is insufficient, the outer sheath is not retracted well, and the clip is not developed properly (the clip does not open, or (A phenomenon that the leg of the clip becomes insufficient) may occur. Further, when the fastening ring is pushed out by the inner sheath to close the clip, if the rigidity of the inner sheath is insufficient, the force for sliding the fastening ring is insufficient, and clipping may not be performed well. Therefore, the inner sheath needs to have sufficiently high rigidity.

  In order to meet such a contradicting demand, in the clip device described in Patent Document 1, an inner sheath is disposed at a distal end portion (a portion corresponding to a curved distal end portion of an endoscope), Two tubes, the main tube arranged across the proximal end of the tip tube and the operation unit, are connected and fixed continuously, and the rigidity of the tip tube is set smaller than the rigidity of the main tube. In other words, the above-mentioned contradictory requirements are solved in a compatible manner by softening the distal end portion of the inner sheath and increasing the rigidity of the remaining portion on the proximal end side.

  However, even if such a structure is adopted, if the degree of bending of the distal end portion of the endoscope is large (the curvature is small), the unfolded clip may still occur. Therefore, the inventor of the present application repeatedly performed a simulation experiment and the like, and when there is a steep rigidity difference at the connection portion between the tip tube and the main body tube, when the inner sheath is bent, this connection portion Is deformed so as to be bent with respect to the remaining portion, and this portion interferes with the inner surface of the outer sheath (such as being caught), and hinders the smooth relative movement between the outer sheath and the inner sheath. I found out that this was happening.

  The present invention has been made in view of the above points, and in an endoscope treatment instrument including an outer sheath and an inner sheath formed by connecting two tubes having different rigidity, the outer sheath and the inner sheath An object of the present invention is to solve a malfunction of an endoscopic treatment tool (for example, a poor deployment of a clip in a clip device) that may occur when the relative movement of the endoscope is not smooth.

An endoscopic treatment tool according to the present invention includes:
A tubular outer sheath;
A tubular inner sheath inserted through the outer sheath;
A drive wire inserted through the inner sheath;
An operating part attached to the distal end of the drive wire,
The inner sheath is
A tip tube disposed at the tip, and a body tube having a distal end connected to the proximal end of the tip tube;
The rigidity of the tip tube is set to a value smaller than the rigidity of the main body tube,
The predetermined section on the distal end side of the body tube, the rigidity of the predetermined section is larger than the rigidity of the tip tube, and smaller than the rigidity of the section other than the predetermined section of the body tube, The main body tube is a narrow-diameter portion having an outer diameter smaller than a section other than the predetermined section.

  In the present invention, a wire tube formed by spirally twisting a plurality of wire strands is used as the main body tube, and a coil tube formed by spirally winding a single long material is used as the tip tube. Can do.

  In the present invention, the narrow diameter portion can be formed by polishing the predetermined section of the main body tube.

  In the present invention, the operating part has a pair of arm parts arranged so as to open in a substantially C shape as it goes to the tip thereof, and the arm part has the drive wire connected to the inner sheath. By sliding with respect to the inner sheath, it is possible to use one that protrudes from the distal end of the inner sheath and opens, and is embedded in the distal end of the inner sheath to close the leg. In this case, the arm portion can be a connection hook that releasably connects a clip that is held by grasping a body tissue.

  In the present invention, an operation having a base portion connected to the proximal end of the inner sheath and a slider portion connected to the proximal end of the outer sheath and slidably held with respect to the base portion A part can be further provided. In this case, the operation unit may further include a wire operation unit that is connected to a proximal end of the drive wire and is slidably held with respect to the base unit.

  According to the endoscope treatment tool of the present invention, in the inner sheath, the predetermined section on the distal end side of the main body tube has a rigidity of the predetermined section larger than the rigidity of the tip tube, and the predetermined section of the main body tube Since the small-diameter portion having an outer diameter smaller than that of the section other than the predetermined section of the main body tube is set to be smaller than the rigidity of the section other than the section, the main tube having high rigidity and the tip tube having low rigidity are provided. In the meantime, the small diameter part with medium rigidity is interposed (arranged), and the bending caused by the sudden change in the rigidity of the connection part between the main tube and the tip tube is suppressed and smoother. Therefore, the interference with the inner surface of the outer sheath is reduced. Accordingly, the relative movement between the outer sheath and the inner sheath becomes smooth, and the occurrence of malfunction of the endoscope treatment instrument (for example, poor deployment of the clip in the clip device) can be reduced. Therefore, treatment can be performed smoothly.

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 sectional drawing of the main body tube which comprises the inner sheath of embodiment of this invention. It is sectional drawing of the small diameter part of the main body tube which comprises the inner sheath of embodiment of this invention. It is a perspective view which shows the structure of the coil tube of embodiment of this invention. It is a perspective view which shows the structure of the wire tube of embodiment of this invention. It is a side view which shows the structure of the inner sheath of embodiment of this invention. It is a side view which shows the structure after grinding | polishing of the wire tube of embodiment of this invention. It is a figure which shows the structure of the connection hook of embodiment of this invention. It is a perspective view which shows the structure of the connection hook of embodiment of this invention. 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 side view which shows the state which protruded the connection hook of embodiment of this invention from the distal end of the inner sheath, and opened the connection hook. It is a side view which shows the state which connected the clip to the distal end of the inner sheath of embodiment of this invention, and accommodated in the outer sheath. It is a top view which shows the state which connected the clip to the distal end of the inner sheath of embodiment of this invention, and accommodated in the outer sheath. It is a top view which shows the state which protruded the clip from the distal end of the outer sheath of embodiment of this invention, and expand | deployed the clip (open leg). It is a figure which shows the problem when not providing a thin diameter part in an inner sheath. It is a figure which shows the effect at the time of providing a thin diameter part in the inner sheath of embodiment of this invention.

  Hereinafter, referring to the drawings, as an embodiment of an endoscopic treatment tool according to the present invention, a clip for performing hemostasis or the like (hemostatic clip) is connected via an endoscope and transported into the body, and tissue in the body. A clip device for gripping (clipping) will be described.

  However, the present invention is not limited to such a clip device, and can be widely applied to an endoscope treatment instrument having a structure having an outer sheath and an inner sheath (double tube structure).

  More specifically, for example, the present invention can be applied to a snare ligation device that links an indwelling snare to ligate a body tissue, a forceps device that includes forceps that grip the body tissue, a bipolar high-frequency device that includes a high-frequency electrode that opens and closes, and the like. it can.

  First, FIG. 1 and FIG. 2 will be referred to. The clip device 1 includes a connection hook (operation unit) 11, an inner sheath 12, a drive wire 13, an outer sheath 14, a reinforcing coil 15, and an operation unit. The operation unit includes a slider unit 16, a base unit 17, and a wire operation unit 18.

  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 for example, a coil tube can be used as the outer sheath 14. A coil tube is a hollow tube formed by spirally winding a single wire. As the coil tube, for example, as indicated by reference numeral 31 in FIG. 5, a flat plate formed by spirally winding a single long flat plate 31a having a rectangular cross section made of metal (stainless steel) or the like is in close contact. A wire coil tube can be used. A round wire coil tube having a circular cross section or an inner flat coil tube having a substantially semicircular cross section (the inner surface is a flat surface and the outer surface is an arc shape) may be used. The coil tube has a characteristic that the rigidity can be set relatively small (low).

  Further, as the outer sheath 14, a simple tube made of resin or the like may be used, and a wire tube 32 as shown in FIG. 6 is used in the same manner as the main body tube 12 a of the inner sheath 12 described in detail later. It may be used.

  In the present invention, rigidity refers to the degree of difficulty of dimensional change (deformation) with respect to a bending load, and is expressed as rigidity k = F / δ where F is the bending load and δ is the amount of bending deformation. Large (high) means that the deformation is small with respect to the force, and low rigidity (low) means that the deformation is large with respect to the force.

  The inner sheath 12 is composed of a flexible hollow tube, and as shown in FIG. 7, a tip tube 12a disposed at the tip (distal end) and a proximal end and a base of the tip tube 12a The main body tube 12b disposed over the portion 17 can be integrally connected and fixed so as to be continuous with each other. The rigidity of the tip tube 12a is set to a value smaller than the rigidity of the main body tube 12b.

  Adopting such a structure in which tubes having different rigidity are connected is caused by poor deployment of the clip 2 (details will be described later) due to insufficient rigidity of the inner sheath 12 (the clip does not open or the legs of the clip are insufficient). In order to suppress the occurrence of clipping failure, the inner sheath 12 as a whole is secured with sufficient rigidity, and the distal end portion is secured with flexibility for smoothly bending following the bending of the endoscope. Because. Note that the length of the distal tube 12a is set to a length corresponding to the distal end movable portion of the endoscope (portion that can be freely bent according to the operation).

  A wire tube can be used as the main body tube 12b. The wire tube is, for example, a hollow stranded wire formed by spirally twisting a plurality of wires (cables) 32a made of metal (stainless steel) or the like so as to be hollow, as indicated by reference numeral 32 in FIG. It is the tube which consists of. Since the wire tube has a characteristic that the rigidity can be set to be relatively high, the wire tube is preferably used for the main body tube 12b that requires a sufficiently high rigidity. Due to the high rigidity of the main body tube 12b, when the base portion 17 is slid to the distal end side with respect to the wire operation portion 18, the distal end portion of the inner sheath surely pushes up the ring 24 of the clip 2 with the operated force. It can be a (sliding) force.

  A coil tube can be used as the tip tube 12a. As the coil tube used for the distal end tube 12a, for example, a flat wire coil tube 31 as shown in FIG. 5 can be used similarly to the outer sheath 14 described above. However, as in the case of the outer sheath 14 described above, a round wire coil tube having a circular cross section or an inner flat coil tube having a substantially semicircular cross section (inner surface is flat and outer surface is arc-shaped) may be used. It is. Since the coil tube has a characteristic that the rigidity can be set to be relatively low, the coil tube is preferably used for the distal end tube 12a in which flexibility (low rigidity) is required.

  When both the outer sheath 14 and the inner sheath 12 are constituted by a coil tube or a wire tube, when the clip device 1 is subjected to ultrasonic cleaning, the cleaning liquid sufficiently permeates the inside of the tube and cleans both inside and outside. The effect that it becomes possible can be produced.

  When both the outer sheath 14 and the inner sheath 12 are constituted by a coil tube or a wire tube, the winding direction of the outer sheath 14 and the winding direction of the inner sheath 12 may be opposite to each other. It is preferable from the viewpoint of reducing the sliding resistance generated between each other. For example, when the outer sheath 14 is Z-winding, the inner sheath 12 is S-winding.

  In the present embodiment, as shown in FIG. 7, a small diameter portion having a smaller outer diameter than the other part (section) of the main body tube 12b is provided on the distal end side (distal end side) of the main body tube 12b. 12c is formed. The rigidity of the small diameter portion 12c is larger than the rigidity of the distal end tube 12a, and is smaller than a portion (section) other than the small diameter portion 12c of the main body tube 12b. In the present embodiment, the small-diameter portion 12c has a tapered portion 12d having a tapered outer diameter that decreases toward the distal end side (distal end side), and a distal end side (distal end side) of the tapered portion 12d. The constant diameter portion 12e is continuous and has a substantially constant outer diameter in the longitudinal direction. In the present embodiment, polishing is used to form the small diameter portion 12c. Although it does not specifically limit as a grinding | polishing process, For example, a centerless grinding | polishing process can be used. Here, FIG. 3 shows a cross-sectional shape of a portion to be the narrow diameter portion 12c of the main body tube 12b before polishing or a portion other than the portion to be the thin diameter portion 12c, and FIG. 4 shows the main body tube 12b after the polishing processing. The cross section of the small diameter part 12c is shown.

  The method for manufacturing the inner sheath 12 is not particularly limited, but the tip tube 12a and the main body tube 12b may be manufactured as separate members and connected and fixed integrally so as to be continuous with each other by laser welding or the like. Processing such as polishing for forming the small diameter portion 12c of the main body tube 12b may be performed before or after the tip tube 12a and the main body tube 12b are connected. From the viewpoint of easiness, it is preferable to perform it before connecting the tip tube 12a and the main body tube 12b.

  When the distal end tube 12a and the main body tube 12b are connected after the small diameter portion 12c is formed in the main body tube 12b, as shown in FIG. 8, the distal end side of the small diameter portion 12c of the main body tube 12b. It is preferable to form a connecting small diameter portion 12f having an outer diameter smaller than that of the small diameter portion 12c on the (distal end side). Providing this connecting small diameter portion 12f makes it easy to connect the leading end tube 12a and the main body tube 12b by inserting the connecting small diameter portion 12f into the lumen of the tip tube 12a. For example, if the connecting small diameter portion 12f is inserted into the lumen of the tip tube 12a and the tip tube 12a existing outside the connecting thin diameter portion 12f is irradiated with a laser beam from the laser welding machine, the tip tube 12a at that portion is removed. Since it melts and is welded to the outer peripheral surface of the connecting small diameter portion 12f, the welded portion 12g shown in FIG. 7 can be formed. Note that the method of forming the connection small diameter portion 12f is not particularly limited, and may be formed by polishing or the like. However, when the thin diameter portion 12c is formed by centerless polishing, a connection fine diameter having a good shape is formed. From the viewpoint of forming the portion 12f, it is preferable to perform a polishing process separate from the centerless polishing process. For example, a polishing process using a small electric grinder is preferable.

  If the tip tube 12a with low rigidity and the main body tube 12b with high rigidity are simply connected and fixed, there is a steep difference in rigidity at the connection between the tip tube 12a and the main body tube 12b. As shown in the figure, when bent, deformation occurs so as to be bent at the connecting portion X, and this connecting portion (bent portion) X interferes with the inner surface of the outer sheath 14 (such as being caught) and slides. The resistance increases, and the relative movement between the outer sheath 14 and the inner sheath 12 is not smoothly performed. Therefore, even if the outer sheath 14 is slid toward the proximal end side with respect to the inner sheath 12 by operating the operation portion, the sliding amount is insufficient, and the clip 2 is sufficient from the distal end of the outer sheath 14. As a result, the clip 2 may develop poorly (the arm plate portions 22 and 22 may not be opened or the legs may be insufficiently opened).

  On the other hand, by forming the small-diameter portion 12c in the vicinity of the distal end of the main body tube 12b by the above-described polishing or the like, the rigidity of the small-diameter portion 12c is the remaining portion of the main body tube 12b. As a result, the inner sheath 12 is located between a portion (section) other than the small-diameter portion 12c of the main tube 12b having relatively high rigidity and the tip tube 12a having relatively low rigidity. In addition, the small-diameter portion 12c having a medium rigidity is arranged, and the rigidity changes stepwise. For this reason, for example, as shown in FIG. 18, deformation such as bending at the connection portion X between the main body tube 12b (the small diameter portion 12c) and the distal end tube 12a is reduced, and a smoother curve is obtained. Therefore, interference with the inner surface of the outer sheath 14 is reduced, and sliding resistance is reduced. Thereby, the relative movement of the outer sheath 14 and the inner sheath 12 is performed smoothly, and the clip 2 protrudes sufficiently from the distal end of the outer sheath 14, thereby preventing the deployment failure of the clip 2.

  Further, since the distal end side of the main body tube 12b is reduced in diameter by polishing or the like, the rigidity of the small diameter portion 12c can be arbitrarily changed and adjusted by appropriately adjusting the diameter of the small diameter portion 12c. The rigidity of the diameter portion 12c can be easily changed and adjusted to an optimum value in accordance with the relationship between the rigidity of the distal tube 12a and the rigidity of the portion (section) other than the narrow diameter portion 12c of the main body tube 12b.

  Here, the tapered portion 12d and the constant-diameter portion 12e are provided, and the narrow-diameter portion 12c having substantially the same length is provided. However, the tapered portion 12d and the constant-diameter portion 12e have their lengths. May be different, and either the tapered portion 12d or the constant diameter portion 12e may be lengthened. In addition, the small diameter portion 12c may be configured by only one of the tapered portion 12d and the constant diameter portion 12e. However, from the viewpoint of making the change in rigidity more gradual, the small diameter portion 12c is It is preferable to have a tapered portion 12d having a tapered outer diameter that decreases toward the distal end. The length of the small-diameter portion 12c is not particularly limited, but is set within a range of 10 to 120 mm from the viewpoint of sufficiently exerting the effect of providing the small-diameter portion 12c and ensuring the rigidity of the inner sheath 12. Is preferred.

  The outer diameter of the portion (section) other than the small-diameter portion 12c of the main body tube 12b is not particularly limited, but is set in the range of 1.5 to 1.9 mm, for example. The outer diameter of the small-diameter portion 12c of the main body tube 12b is not particularly limited as long as it is smaller than the outer diameter of a portion (section) other than the thin-diameter portion 12c of the main body tube 12b, but the effect of providing the small-diameter portion 12c is sufficient. From the viewpoint of ensuring the rigidity of the inner sheath 12, the outer diameter of the portion with the smallest outer diameter of the thin diameter portion 12c is the portion (section) other than the thin diameter portion 12c of the main body tube 12b. It is preferable to set within a range of 60 to 85% of the outer diameter. The outer diameter of the distal tube 12a is not particularly limited, but is, for example, a range that is 55 to 140% of the outer diameter of a portion (section) other than the narrow diameter portion 12c of the main body tube 12b, and preferably a range that is 65 to 110%. You can set in.

  Returning to FIG. 1 and FIG. 2, the drive wire 13 is made of a flexible wire. In this embodiment, a plurality of wires (cables) made of metal (stainless steel) or the like are twisted in a spiral shape (wires). Rope). As the drive wire 13, a single (single wire) wire or a wire tube similar to the main body tube 12 b of the inner sheath 12 may be used.

  As shown in FIGS. 9 and 10, the connecting hook 11 as the operating portion disposed at the sheath distal end of the clip device 1 is formed of an elastic body disposed in a substantially square shape toward the distal end. It has a pair of arm portions 11a, 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 connection hook 11 by being bent inwardly (sides facing each other), and hold the connection plate portion 21 of the clip 2 described later. 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 with the base end portions of the pair of arm portions 11a and 11a. The arm portions 11a and 11a including the claw portions 11b and 11b and the U-shaped portion 11c can be formed by appropriately bending (plastically deforming) one elongated plate made of an elastic body. Although not particularly limited, the plate thickness of the plate material constituting the connecting hook 11 is about 0.20 to 0.24 mm, and the width is about 0.6 mm. As the plate material, for example, stainless steel is used.

  The tip (distal end) of the drive wire 13 slidably inserted in the inner sheath 12 is formed integrally with the annular portion (annular portion) 19a formed in a substantially annular shape and the annular portion 19a. The loop member 19 having the bar 19b is integrally welded and fixed by laser welding or the like. 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 it may be circular or semicircular.

  The connecting hook 11 is inserted into the annular portion 19a, and is arranged 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. . The connecting hook 11 is attached to the distal end of the drive wire 13 through the annular portion 19a and the U-shaped portion 11c loosely fitted to the annular portion 19a. It can be freely rotated in the direction of arrow B in FIG. 10 and 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 coil 15 and is integrally fixed to the reinforcing coil 15. The reinforcing coil 15 is integrally fixed to the slider portion 16, and a portion on the distal end side of the base portion 17 is inserted and arranged inside the slider portion 16. The slider portion 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.

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

  Next, a clip (hemostatic clip) 2 that holds a body tissue using such a clip device 1 will be described. As shown in FIGS. 11 and 12, the clip 2 has 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. 12, 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 reduce the weight without impairing the desired strength 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. 11 or FIG. 12, 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. First, the slider portion 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 as shown in FIG. Let the state be Further, the base portion 17 is slid toward the proximal end side with respect to the wire operation portion 18, the inner sheath 12 is drawn into the drive wire 13, and the connection hook 11 at the distal end of the drive wire 13 is connected to the inner sheath 12. It protrudes from the distal end and is opened in a substantially C shape by its own elasticity.

  From this state, when the base portion 17 is slid to the distal end side with respect to the wire operating portion 18, 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. The legs are gradually closed while entering the inner 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. Clip 2 can be connected to the distal end of inner sheath 12.

  Next, the slider portion 16 is slid to a position on the distal end side with respect to the base portion 17, and as shown in FIGS. 14 and 15, the distal end of the inner sheath 12 to which the clip 2 is connected. Together with the clip 2 is housed (buried) in the outer sheath 14. 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 projected from the distal end of the outer sheath 14 by sliding the slider portion 16 to the position on the proximal end side with respect to the base portion 17 and sliding the outer sheath 14 to the proximal end side. . As a result, as shown in FIG. 16, the arm plate portion 22 of the clip 2 is in a state of being opened by its own elasticity (a state of being fully deployed).

  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). 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 grip portion 22 b 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 gripping portion 22 b side of the arm plate portion 22 and reaches the proximal end portion 22 a, and the body tissue by the clip 2. Is completed. In this state, the inner sheath 12 is slid toward the proximal end side with respect to the drive wire 13, so that the connecting hook 11 is pushed out from the distal end of the inner sheath 12 and opened. The connection (engagement) is released, and clipping of the clip 2 to the body tissue is completed.

  According to the above-described embodiment, the rigidity of the predetermined section on the distal end side of the main body tube 12b is larger than the rigidity of the tip tube 12a and the rigidity of the section other than the predetermined section of the main body tube 12b. Since the diameter is reduced so as to be smaller than that of the small-diameter portion 12c, the thin-diameter portion 12c having intermediate rigidity is interposed between the main tube 12b having high rigidity and the tip tube 12a having low rigidity. (Arranged). As a result, as shown in FIG. 17, the bending (bending) caused by a sudden change in rigidity at the connection portion X between the main body tube 12b and the distal end tube 12a when bent relatively rapidly. 18 is suppressed, and as shown in FIG. 18, the outer sheath 14 and the inner sheath 12 are smoothly moved relative to each other, so that the development failure of the clip 2 can be suppressed. .

  In addition, since the small diameter portion 12c can be formed simply by polishing the distal end portion of the main body tube 12b, it is easier and less expensive than a case where another member or the like having an appropriate rigidity is interposed. Can be realized. Furthermore, since the rigidity can be changed and adjusted according to the polishing amount, it can be freely adjusted so as to obtain the optimum rigidity.

  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 ... Connecting hook (operation part)
DESCRIPTION OF SYMBOLS 11a ... Arm part 11b ... Claw part 11c ... U-shaped part 12 ... Inner sheath 12a ... Tip tube 12b ... Main body tube 12c ... Small diameter part (predetermined area)
12d ... Tapered portion 12e ... Constant diameter portion 13 ... Drive wire 14 ... Outer sheath 16 ... Slider portion 17 ... Base portion 18 ... Wire operation portion 19 ... Loop member 19a ... Ring portion 19b ... Stick portion 2 ... Clip 21 ... Connecting plate Part 22 ... Arm plate part 22a ... Base end part 22b ... Grip part 23 ... Claw part 24 ... Tightening ring 31 ... Coil tube 32 ... Wire tube X ... Connection part

Claims (7)

A tubular outer sheath;
A tubular inner sheath inserted through the outer sheath;
A drive wire inserted through the inner sheath;
An operating part attached to the distal end of the drive wire,
The inner sheath is
A tip tube disposed at the tip and a body tube having a distal end connected to the proximal end of the tip tube;
The rigidity of the tip tube is set to a value smaller than the rigidity of the main body tube,
The predetermined section on the distal end side of the body tube, the rigidity of the predetermined section is larger than the rigidity of the tip tube, and smaller than the rigidity of the section other than the predetermined section of the body tube, A treatment instrument for an endoscope, characterized in that the main body tube is a narrow-diameter portion having an outer diameter smaller than a section other than the predetermined section. As the main body tube, using a wire tube formed by twisting a plurality of wire strands in a spiral shape,
The treatment instrument for an endoscope according to claim 1, wherein a coil tube obtained by spirally winding a single long material is used as the distal end tube.   The endoscopic treatment instrument according to claim 1 or 2, wherein the narrow-diameter portion is formed by polishing the predetermined section of the main body tube.   The operating portion has a pair of arm portions arranged so as to open in a substantially C shape as it goes to the tip thereof. The arm portion is configured such that the drive wire is slid with respect to the inner sheath. 4, by projecting from the distal end of the inner sheath, and being embedded in the distal end portion of the inner sheath to close the leg. Endoscopic treatment tool.   The treatment tool for an endoscope according to claim 4, wherein the arm portion is a connection hook that releasably connects a clip placed by holding a body tissue. A base connected to the proximal end of the inner sheath;
The proximal end of the outer sheath is connected, and an operation unit having a slider unit slidably held with respect to the base unit is further provided. The treatment tool for endoscopes described in 1.   The endoscope according to claim 6, wherein the operation unit further includes a wire operation unit connected to a proximal end of the drive wire and slidably held with respect to the base unit. Treatment tool.

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