JP2016193002A - Clip device for endoscope and clip - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a clip device for endoscopes facilitating coupling operation between a clip and an operation wire and capable of swiftly performing a procedure by reducing exchange frequency of a treatment instrument body, and to provide the clip.SOLUTION: A clip device 100 for an endoscope comprises: a clip 110 including a plurality of arm portions 120 for holding a biological tissue, and a locking portion 130; and a treatment instrument body including a long sheath 10, and an operation wire 20 having a lump-like tip coupling portion 50. When the operation wire 20 is pulled towards an advance/retreat-direction proximal side with the tip coupling portion 50 received in a reception part 134, the arm portions 120 are closed to hold the biological tissue. When the operation wire 20 is further pulled towards the proximal side from a state where the arm portions 120 are closed, the tip coupling portion 50 outwardly deforms a projection portion 140 to open the reception part 134, thereby allowing the tip coupling portion 50 to be pulled out from the reception part 134.SELECTED DRAWING: Figure 9

Description

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

  2. Description of the Related Art There is provided a clip device that excises a living tissue in a body cavity under an endoscope and ligates the excised site to stop bleeding. With regard to this type of endoscope clip device and a medical clip used in the device (hereinafter abbreviated as a clip), Patent Document 1 discloses an arrowhead hook at the tip of an operation wire provided in a treatment instrument body. It is described that the clip is inserted and connected to a connecting member at the base end of the clip. When the operation wire is pulled while the arrowhead hook is inserted into the connecting member, the living tissue is ligated. When the operating wire is further pulled strongly from this state, the small-diameter portion of the connecting member is broken, and the clip is placed in the body cavity with the living tissue ligated. The connecting member has a pair of opposed half-cylindrical through holes, and the arrowhead hooks are pushed into the connecting member and connected so as to expand the through holes.

JP 2004-121485 A

  However, in the endoscope clip device of Patent Document 1, it is necessary to collect the broken connecting member, remove it from the arrowhead hook and dispose it, and the procedure is complicated, and problems such as infection may occur. .

  On the other hand, it is common for the excised portion of the living tissue to stop bleeding using a number of clips. Therefore, the operation wire is connected to the clip, inserted into the body cavity through the endoscope, the living tissue is ligated, the clip is left in place, and the operation wire is further pulled out of the body to connect the next clip again. It is required to perform a series of procedures quickly. In addition, in order to eliminate the time for replacing the treatment instrument body when performing ligation and indwelling operations on a large number of clips, the treatment instrument body needs to be durable enough to be used repeatedly many times. It is done.

  The present invention has been made in view of the problems as described above, and it is easy to connect the clip and the operation wire, and the procedure can be quickly performed by reducing the replacement frequency of the treatment instrument body. An endoscopic clip device and a clip are provided.

  An endoscope clip device according to the present invention includes a clip having a plurality of arms for grasping a living tissue and a locking portion provided on a proximal end side of the arms, a long sheath, and the sheath A treatment instrument body having an operation wire inserted into the inside thereof so as to be movable forward and backward, and provided with a lump-shaped tip connecting portion at the distal end, and the locking portion of the clip receives the tip connecting portion A receiving portion having a space inside, and a protruding portion projecting inwardly on the proximal end side of the receiving portion, and pressing the distal end connecting portion against the protruding portion from the proximal end side The protruding portion is elastically deformed outwardly, and the receiving portion is opened so as to be able to receive the tip connecting portion in the advancing / retracting direction of the operation wire, and the tip connecting portion displaces the protruding portion in the forward / backward direction The protrusions elastically recover inward by passing to the side And pulling the operation wire to the proximal side in the advancing / retreating direction in a state in which the distal end coupling portion is received by the receiving portion, whereby the arm portion is closed to grip the living tissue, and further, the operation wire By pulling the proximal end to the proximal side, the tip connecting portion deforms the protrusion outward so that the receiving portion is opened, and the tip connecting portion can be pulled out from the receiving portion. .

  The clip of the present invention is used in the above-described endoscope clip device, and has a plurality of arm portions for gripping a living tissue and a locking portion provided on the proximal end side of the arm portions, The locking portion includes a base portion connected to a base end of the arm portion, a plurality of projecting pieces formed to protrude from the base portion to the base end side, and a receiving portion having a space therein, and the protrusion And a projecting portion formed inwardly projecting from the proximal end portion of the one portion.

  According to the endoscope clip device and the clip of the present invention, the receiving portion is opened by pressing the lump-like tip connecting portion at the distal end of the operation wire against the protruding portion of the clip from the proximal end side, thereby the tip connecting portion. On the contrary, by pulling the operation wire from the state where the tip connecting portion is received by the receiving portion, the projection portion is deformed, the receiving portion is opened again, and the tip connecting portion can be pulled out. For this reason, the attachment / detachment operation of the tip connecting portion and the clip can be easily performed by the operation wire advance / retreat operation. Further, the distal end connecting portion is in the form of a lump, and the clip engaging portion is exclusively deformed to perform the attaching / detaching operation, so that wear of the distal end connecting portion is suppressed, and the treatment instrument main body is excellent in durability. For this reason, it is possible to reduce the replacement frequency of the treatment instrument body, and the procedure can be performed quickly.

It is a perspective view which shows an example of the clip apparatus for endoscopes concerning embodiment of this invention. It is a side view of a clip. (A) is a side view which shows the clip of a closed arm state, (b) is a top view of (a). It is explanatory drawing which shows the front-end | tip part of a treatment tool main body. (A) is explanatory drawing which shows the state which pushes and connects a front-end | tip connection part to the latching | locking part of a clip. (B) is the enlarged view of (a) regarding the vicinity of a front-end | tip connection part. It is explanatory drawing which shows the state in which the clip was accommodated in the sheath. It is explanatory drawing which shows the state which protruded the clip from the sheath and opened the arm. It is explanatory drawing which shows the ligation state of a clip. (A) is explanatory drawing which shows the state which extracts the front-end | tip connection part from the latching | locking part of a clip. (B) is the enlarged view of (a) regarding the vicinity of a front-end | tip connection part.

  Hereinafter, embodiments of the present invention will be described with reference to the drawings. In each drawing, corresponding constituent elements are denoted by common reference numerals, and redundant description is omitted as appropriate.

  FIG. 1 is a perspective view showing an example of an endoscopic clip device (hereinafter sometimes abbreviated as a clip device) 100 according to an embodiment of the present invention. FIG. 2 is a side view of the clip 110. 3A is a side view showing the clip 110 in the closed arm state, and FIG. 3B is a plan view thereof. FIG. 4 is an explanatory view showing the distal end portion of the treatment instrument main body 90, and is a schematic longitudinal sectional view of the treatment instrument main body 90 cut along the axial direction.

  In the present specification, the “axial direction” means the forward / backward direction of the operation wire 20 unless otherwise specified. Further, the “cross section” means a longitudinal section obtained by cutting the endoscope clip device 100 in the axial direction unless otherwise specified.

  In FIG. 4, for convenience, the sheath 10, the reduced diameter sleeve 70, and the expansion / contraction part 80 are illustrated in cross section and hatched, and the operation wire 20, the tip connection part 50, the column part 56, and the centering part 60 are illustrated in a side view. Show. The same applies to the explanatory diagrams of FIG. 6 to 9, only the end face of the stretchable part 80 is shown, and the windings appearing behind each figure are not shown.

  The clip device 100 is used by being inserted into a forceps hole (not shown) of an endoscope. Specifically, the sheath 10 of the clip device 100 is inserted from the proximal side into the forceps hole of the endoscope placed in the body cavity, and the distal end of the sheath 10 is protruded from the distal opening of the forceps hole. Further, the living body tissue can be ligated by exposing the clip 110 from the sheath 10. Examples of the living tissue to be ligated include a mucous membrane wall such as a site to be treated by endoscopic submucosal dissection (ESD) and a body tube such as a blood vessel.

  The “distal side” refers to a side far from the operator of the endoscopic clip device 100 in the endoscopic clip device 100 or the clip 110 attached thereto, unless otherwise specified. Specifically, the side where the arm part 120 of the clip 110 exists is said. The “proximal side” means a side closer to the operator in the endoscope clip device 100 and the clip 110 unless otherwise specified. Further, the movement of the components of the endoscope clip device 100 to the distal side may be referred to as advancement, and conversely, the movement to the proximal side may be referred to as retraction.

  The endoscope clip device 100 includes a clip 110 and a treatment instrument main body 90. As shown in FIGS. 2 and 3, the clip 110 has a plurality of arm portions 120 for grasping a living tissue and a locking portion 130 provided on the proximal end side of the arm portions 120. ing. On the other hand, as shown in FIG. 4, the treatment instrument main body 90 includes a long sheath 10 and an operation wire that is inserted into the sheath 10 so as to be capable of moving forward and backward, and is provided with a lump-like tip connecting portion 50 at the distal end. 20.

  Here, the tip connecting portion 50 is “lumped” means that the tip connecting portion 50 is thicker than the locking portion 130, the tip connecting portion 50 is connected to the locking portion 130, and the tip connecting portion. When 50 is removed from the locking portion 130, the displacement of the tip connecting portion 50 is sufficiently smaller than the displacement of the locking portion 130. The specific shape of the lump-shaped tip connecting portion 50 is not particularly limited, and may be a bullet shape that is reduced in diameter toward the distal side as shown in FIG.

  The specific structure of the treatment instrument main body 90 provided in the clip device 100 is not particularly limited. FIG. 1 illustrates a treatment instrument main body 90 including a finger ring 92, a slider 94, and a main body shaft 96. The user of the clip device 100 inserts a finger (for example, thumb) into the finger ring 92 and moves the slider 94 relative to the main body shaft 96 with the slider 94 held between the other fingers (for example, the index finger and the middle finger). To operate. As a result, the operation wire 20 connected to the slider 94 moves forward and backward within the sheath 10. Further, by rotating the entire treatment instrument main body 90 about the axis, the operation wire 20 is rotated together with the slider 94. When the sheath 10 is in close contact with the wall surface of the forceps hole of the endoscope, the operation wire 20 rotates around the inside of the sheath 10. Hereinafter, the axial rotation of the treatment instrument main body 90, the operation wire 20, and the clip 110 may be referred to as “torque rotation”.

  The clip 110 ligates a living tissue, and by ligating the living tissue with the arm portion 120, for example, a treatment such as hemostasis treatment, sewing and marking can be performed. The arm portion 120 has a self-expanding force, and as will be described later, by projecting the arm portion 120 in a closed arm state from the sheath 10, the arm portion 120 naturally expands to be in an open arm state. Here, “self-expanding” means repelling an external force to close and trying to open itself.

  The arm part 120 and the locking part 130 are integrally formed of one material. More specifically, the arm portion 120 and the locking portion 130 can be created by punching, pressing and bending a metal plate material. Examples of the metal material include stainless steel, titanium, and a titanium alloy, but are not limited thereto. The metal material may be subjected to a corrosion-resistant coating treatment.

  The pair of opposing arm portions 120 in the clip 110 according to the present embodiment has a base end portion 122 projecting from the locking portion 130 toward the distal side (left side in FIG. 2), and the base end portion 122. The arm main body 124 is provided on the distal side. The proximal end portion 122 is curved outward toward the distal side.

  Here, “outward” means a direction away from the axis of the operation wire 20 or an extension line of the axis, and is, for example, a radially outward direction. “Inward” means a direction approaching the axis of the operation wire 20 or an extension line of the axis, for example, an inward direction in the radial direction.

  The arm main body 124 has a linear shape, and a claw 126 is formed at the tip of the arm main body 124. The arm main body portion 124 and the claw portion 126 are gripping regions that mainly grip biological tissue. The nail | claw part 126 protrudes inward from a pair of arm main-body part 124, and improves the holding | grip force of the clip 110 by biting into a biological tissue. The arm portion 120 is bent at the boundary between the base end portion 122 and the arm main body portion 124, and a narrow width portion 123 in which the width dimension of the arm portion 120 is locally reduced is formed at the boundary.

  The clip 110 (except for the fastening member 150) of the present embodiment is made of a single material, that is, one claw portion 126, the arm main body portion 124 and the base end portion 122, and the other claw portion 126, The arm main body portion 124 and the base end portion 122 are formed seamlessly and continuously via the locking portion 130.

  The arm main body 124 has a reinforcing portion 125 formed by pressing (embossing) a part of the center in the width direction. By forming the reinforcing portion 125, the thickness dimension of the arm main body portion 124 is increased, and the bending rigidity of the arm main body portion 124 is improved. Thereby, a high gripping force for the living tissue can be obtained. In the clip 110 of this embodiment, the reinforcing portion 125 is continuously formed from the distal end portion of the arm main body portion 124 excluding the claw portion 126 to the proximal end portion that reaches the narrow width portion 123.

  The clip 110 further includes an annular fastening member 150 attached to the outer periphery of the plurality of arm portions 120. The fastening member 150 is attached to the arm portion 120 so as to be able to advance and retract. By moving the tightening member 150 distally relative to the arm portion 120, the arm portion 120 in the open arm state (see FIG. 2) is tightened by the tightening member 150 against the self-expanding force. be able to. Thereby, the arm part 120 will be in a closed arm state (refer each figure of FIG. 3). Further, by retracting the tightening member 150 relative to the arm portion 120, the arm portion 120 is opened by the self-expanding force. The annular tightening member 150 may be an all-circular shape in which the entire circumferential surface is continuous in the circumferential direction, or a partial annular shape in which a notch or a slit is provided in a part of the circumferential direction.

  The arm main body portion 124 of the arm portion 120 is formed wider than the base end portion 122 and the narrow width portion 123, and the fastening member 150 can move over the narrow width portion 123 and advance to the arm main body portion 124. prohibited. Further, the base end portion 122 is formed with a thick portion 121 that is partially formed with a large width. The inner diameter of the fastening member 150 on the proximal side is smaller than the width dimension of the thick portion 121, that is, the fastening member 150 is prohibited from moving over the thick portion 121 to the proximal side of the clip 110. . The tightening member 150 moves forward and backward with respect to the arm portion 120 in a length region between the wide width portion 121 and the arm main body portion 124. Then, when the fastening member 150 is fitted into the narrow width portion 123, the fastening member 150 is locked to the arm portion 120, and the clip 110 is locked in a closed arm state.

  As shown in FIGS. 2 and 3, the locking portion 130 of the clip 110 includes a receiving portion 134 having a space 132 for receiving the distal end connecting portion 50 therein, and an inward direction toward the proximal end side of the receiving portion 134. And a projecting portion 140 formed to project. The clip 110 and the operation wire 20 are connected to each other by receiving the tip connecting portion 50 in the space 132.

  The protrusion 140 is a claw portion that is elastically deformed and opened so as to be spread by the tip connecting portion 50, and that engages and holds the tip connecting portion 50 by being elastically restored.

  The protruding portion 140 is a portion that is disposed on the proximal side of the receiving portion 134 and closes part or all of the space 132 so as to be openable. The shape, position, and size of the protrusion 140 are not particularly limited. For example, the receiving part 134 may be formed in an annular shape, and the protrusion 140 may be formed so as to protrude radially inward from the peripheral surface of the annular receiving part 134. Alternatively, as described below, the receiving portion 134 is configured by a base portion 136 such as an annular shape and a protruding piece portion 142 that protrudes proximally from the base portion 136, and the protruding portion 140 is formed at the tip of the protruding piece portion 142. May be.

  The locking part 130 includes a base part 136 connected to the base end of the arm part 120, and a plurality of projecting piece parts 142 that project from the base part 136 toward the base end side and constitute the receiving part 134. . The protrusions 140 are respectively formed on the proximal end portion of the protrusion piece 142.

  The distal end connecting portion 50 of the operation wire 20 is accommodated in a space 132 surrounded by the base portion 136, the protruding piece portion 142, and the protruding portion 140. The inner diameter of the base portion 136 is smaller than the maximum outer diameter of the tip connecting portion 50, and the base portion 136 restricts the forward movement of the tip connecting portion 50. The protrusion 140 restricts the tip connecting part 50 accommodated in the space 132 from moving backward. The distal end coupling portion 50 accommodated in the space 132 may be restrained in the distal proximal direction by the base portion 136 and the projection portion 140, and the forward / backward movement inside the space 132 may be prohibited. The part 50 may be movable back and forth in the axial direction slightly.

  The projecting piece 142 of the present embodiment has a plate shape that is narrower than the diameter of the tip connecting portion 50. The cross-sectional shape of the tip connecting portion 50 is a polygon, preferably a regular polygon cross section. The tip connecting portion 50 of the present embodiment has a regular hexagonal cross section, that is, the tip connecting portion 50 has six outer peripheral planes. A plurality of protruding piece portions 142 are arranged to face the locking portion 130. The number of projecting piece portions 142 is not limited, but is preferably smaller than the number of outer peripheral planes of tip connecting portion 50 having a polygonal cross section. Specifically, the locking portion 130 of this embodiment has two protruding piece portions 142.

  The two projecting piece portions 142 are provided at positions where they can face each other on the outer peripheral flat surface of the tip connecting portion 50. More specifically, the two projecting piece portions 142 are provided at positions facing each other by 180 degrees in the base portion 136 of the locking portion 130. Instead of this embodiment, the three projecting piece portions 142 may be arranged to be evenly opposed at intervals of 120 degrees. The facing interval between the projecting piece portions 142 is set to a dimension that allows the projecting piece portions 142 to be in close contact with or close to the outer peripheral plane of the tip connecting portion 50.

  When the tip connecting portion 50 is connected to the clip 110, the plurality of projecting piece portions 142 are arranged in close contact with or close to the tip connecting portion 50 so as to surround the outer peripheral plane of the tip connecting portion 50 received by the receiving portion 134. The As a result, when the tip connecting portion 50 is torque-rotated, the outer peripheral plane of the tip connecting portion 50 rotates the projecting piece 142 around the axis and applies torque to the clip 110 through the locking portion 130.

  The protrusion 140 formed at the tip on the proximal side of the protruding piece 142 is disposed on a circumference concentric with the base 136 and has a partial arc shape. Each protrusion 140 has a partial arc shape with a central angle of about 120 degrees, and is formed so that the two protrusions 140 can hold about two thirds of the circumference. .

  The base 136 has a ring shape formed by bending a plate material such as a metal material and abutting the end edges 138 with each other. The plurality of projecting piece portions 142 are spaced from each other around the annular base portion 136. As shown in FIG. 2 and FIG. 3A, the seam of the abutted end edge 138 is disposed at an intermediate position between the adjacent projecting piece portions 142.

  As a result, as will be described later with reference to FIGS. 5B and 9B, when the tip connecting portion 50 is inserted into the receiving portion 134 or removed from the receiving portion 134, The bending stress transmitted to the projecting piece 142 is transmitted to the annular base 136 as a deformation force in a direction to open the joint of the end edge 138. For this reason, the bending stress is consumed as an elastic force for expanding the diameter of the base portion 136, and the protruding piece portion 142 is suppressed from being plastically deformed.

  The specific shape of the annular base 136 is not particularly limited, and examples thereof include a cylindrical shape, a rectangular tube shape, or a combination thereof. The base 136 may be a full ring in which the joints of the end edges 138 are in contact with each other, or may be a partial ring in which the joints of the end edges 138 are separated at a predetermined interval.

  As shown in FIG. 3B, a plurality of recesses 137 that are recessed toward the distal side are formed on the periphery of the base end side of the base portion 136. The projecting piece 142 is formed to project from the bottom 139 of the recess 137 toward the base end. This makes it possible to form the protruding piece 142 long while suppressing the dimension of the locking portion 130 in the axial direction, and to protrude when the distal end connecting portion 50 of the operation wire 20 is fitted or removed from the receiving portion 134. The piece 142 can be flexibly deformed.

  The base portion on the distal side of the projecting piece 142 is gradually formed wider toward the bottom 139 of the recess 137 and is smoothly connected to the bottom 139. Thereby, when the distal end connecting portion 50 of the operation wire 20 urges the protruding portion 140 and bending stress is applied to the protruding piece portion 142, the stress concentration on the root portion of the protruding piece portion 142 is alleviated, It is suppressed that the protruding piece part 142 is plastically deformed.

  More specifically, the joint of the end edge 138 in the locking portion 130 is disposed at a position where the recess 137 is not formed in the base portion 136. Thereby, the length of the joint of the end edge 138 can be made the full length of the dimension of the base 136 in the axial direction. For this reason, when the clip 110 is formed by bending a plate material such as a metal material, the annular base portion 136 can be accurately formed in a desired shape.

  The sheath 10 shown in FIG. 4 is a long and flexible tubular member. The sheath 10 is longer than the forceps hole of the endoscope used with the clip device 100. The sheath 10 can be composed of, for example, a coil layer (not shown) in which a metal wire is wound long. An inner layer (not shown) made of a fluorine-based polymer may be provided on the inner peripheral surface of the coil layer. The sheath 10 may be a coil layer formed by winding a resin wire, or may be a flexible resin tube.

  The inner diameter dimension of the sheath 10 is a size that slidably accommodates a centering portion 60 (described later) provided at the distal end of the operation wire 20. In the sheath 10 of the present embodiment, the clip 110 in the closed arm state can be accommodated in the sheath 10 (see FIG. 6A). Specifically, the inner diameter of the sheath 10 is, for example, not less than 100 μm and not more than 2400 μm. Moreover, the thickness dimension of the sheath 10 is 100 micrometers or more and 350 micrometers or less, for example. 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. Examples of the metal material constituting the metal plate 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.

  At the distal end of the operation wire 20, a centering portion 60, a column portion 56 and a tip connecting portion 50, an expansion / contraction portion 80 and a reduced diameter sleeve 70 are provided. The centering portion 60 has a larger diameter than the operation wire 20 and is fixed to the distal end of the operation wire 20. The centering portion 60 includes a cylindrical portion (cylindrical portion), and the outer diameter of the cylindrical portion is equal to and slightly smaller than the inner diameter of the sheath 10. As the operation wire 20 is moved back and forth inside the sheath 10, the centering portion 60 slides and moves back and forth inside the sheath 10. At this time, since the outer diameter of the centering portion 60 is substantially the same as the inner diameter of the sheath 10, the operation wire 20 moves forward and backward while being positioned in the vicinity of the axial center of the sheath 10. Even when the sheath 10 is inserted into a forceps hole of a curved endoscope (not shown), the operation wire 20 is positioned substantially on the center line of the forceps hole, so that the path length of the operation wire 20 does not change. It is suppressed that the front-end | tip connection part 50 and the clip 110 protrude from the sheath 10 unexpectedly.

  A support column 56 is formed on the distal side of the operation wire 20 so as to protrude coaxially with the operation wire 20. A lump-shaped tip connecting portion 50 is integrally formed at the distal end of the column portion 56. A bend portion 51 is formed between the column portion 56 and the tip connecting portion 50 (see FIG. 5B). The expansion / contraction part 80 is provided around the support part 56 so as to accommodate the support part 56, and the tip connecting part 50 is positioned inside the reduced diameter sleeve 70 in a natural state shown in FIG.

  A second inclined surface 54 is provided at the distal portion of the tip connecting portion 50. The normal direction of the second inclined surface 54 is obliquely outward toward the distal side (left side in FIG. 4). As a result, as will be described later with reference to FIGS. 5A and 5B, the second inclined surface 54 elastically projects the protrusion 140 outward by pressing the distal end connecting portion 50 against the protrusion 140 from the base end side. Deform.

  A first inclined surface 52 is provided at the proximal portion of the tip connecting portion 50. The normal direction of the first inclined surface 52 is obliquely outward toward the proximal side. Accordingly, as will be described later with reference to FIGS. 9A and 9B, the first inclined surface can be obtained by pulling the operation wire 20 proximally in the advancing / retreating direction in a state where the distal end connecting portion 50 is received by the receiving portion 134. 52 deforms the protrusion 140 outward.

  One or both of the first inclined surface 52 and the second inclined surface 54 may be a flat surface or a curved surface. In the case of a curved surface, it may be a convex surface that bulges outward in the radial direction so that 140 can be suitably spread outward.

  At least one of the first inclined surface 52 and the second inclined surface 54 has a weight surface shape. Although the specific shape of the weight surface is not particularly limited, it can be, for example, a truncated cone or a truncated pyramid. Since the first inclined surface 52 or the second inclined surface 54 has a weight surface shape, when the tip connecting portion 50 is removed from the locking portion 130 or inserted into the locking portion 130, the orientation of the tip connecting portion 50 is adjusted. It becomes unnecessary, or the angle which should be faced can be reduced.

  In particular, the first inclined surface 52 and the second inclined surface 54 of the present embodiment are both conical. More specifically, the first inclined surface 52 is a truncated cone surface that decreases in diameter toward the proximal side, and the second inclined surface 54 is a conical surface that decreases in diameter toward the distal side. As a result, the tip connecting portion 50 can be inserted into and removed from the locking portion 130 without causing the tip connecting portion 50 to face the locking portion 130.

  As shown in FIG. 4, a distal end portion of the operation wire 20 is provided with a cylindrical sleeve (a reduced diameter sleeve 70) that can be accommodated in the sheath 10 and that accommodates the tip connecting portion 50. The inner diameter of at least a part of the reduced diameter sleeve 70 is smaller than the outer diameter of the locking portion 130 when the tip connecting portion 50 can be pulled out from the receiving portion 134 as shown in FIG.

  The reduced diameter sleeve 70 is a member for restricting the backward movement of the tightening member 150 with respect to the sheath 10 and causing the clip 110 (see FIG. 7) in the open arm state to transition to the closed arm state (see FIG. 8). As shown in FIG. 6, the reduced diameter sleeve 70 can be accommodated inside the sheath 10, and a part of the reduced diameter sleeve 70 (the enlarged diameter portion 72) protrudes from the sheath 10 by advancing the operation wire 20. (See FIGS. 7 to 9).

  The sleeve (the reduced diameter sleeve 70) of the present embodiment includes an enlarged diameter portion 72, a reduced diameter step portion 74, and a sleeve main body 76. The enlarged diameter portion 72 is provided on the distal side of the reduced diameter sleeve 70 and can elastically self-expand. The reduced diameter step portion 74 is provided on the proximal side of the expanded diameter portion 72. The sleeve main body 76 is provided on a more proximal side than the reduced-diameter stepped portion 74, and has a higher radial rigidity than the enlarged-diameter portion 72. The inner diameter of the sleeve body 76 is smaller than the outer diameter of the locking portion 130 when the tip connecting portion 50 can be pulled out from the receiving portion 134 as shown in FIG. 9B. Accordingly, by retracting at least a part of the projecting portion 140 and the projecting piece portion 142 from the sleeve main body 76, the projecting piece portion 142 is sufficiently deformed and the tip connecting portion 50 can be pulled out from the receiving portion 134. In other words, in a state where the projection 140 and the projecting piece 142 are accommodated in the sleeve main body 76, since the sleeve main body 76 restrains the outward deformation of the projecting piece 142, the distal end connecting portion 50 is separated from the receiving portion 134. Detachment is prevented.

  The reduced-diameter stepped portion 74 is formed in a tapered shape that decreases in diameter toward the proximal side between the sleeve main body 76 and the enlarged-diameter portion 72. The constituent material of the reduced diameter sleeve 70 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, an elastomer such as a metal material, a resin, or rubber can be used.

  The diameter-reduced sleeve 70 of the present embodiment is a cylindrical body (pipe) made of a metal material such as stainless steel, and is one or more notched from the distal end of the diameter-expanded portion 72 toward the proximal side. Slit (not shown). The slit may be formed with a length reaching the reduced diameter step portion 74. By having such a slit, at least the diameter-expanded portion 72 of the diameter-reduced sleeve 70 is configured to be capable of being expanded or deformed. As shown in FIG. 6, in the state where the diameter-reduced sleeve 70 is accommodated in the sheath 10, the diameter-expanded portion 72 is deformed and deformed smaller than the natural state (see FIG. 4), and the outer diameter is smaller than the inner diameter of the sheath 10. It has become.

  Then, as shown in FIGS. 7 to 9, the enlarged diameter portion 72 of the reduced diameter sleeve 70 protrudes distally from the sheath 10 so that the enlarged diameter portion 72 is elastically restored to a natural state. The enlarged diameter portion 72 is larger in diameter than the inner diameter of the sheath 10 in a natural state. Further, the sleeve main body 76 is naturally smaller in diameter than the inner diameter of the sheath 10, and the reduced diameter step portion 74 has a portion having a larger diameter and a smaller diameter than the inner diameter of the sheath 10 in the natural state.

  As shown in FIG. 8, the fastening member 150 can be accommodated in the enlarged diameter portion 72. In other words, the inner diameter of the enlarged diameter portion 72 in the natural state is slightly larger than the outer diameter of the tightening member 150. Then, accommodating the tightening member 150 restricts the diameter-enlarged portion 72 from being deformed and prevents the diameter-enlarged portion 72 from entering the sheath 10. That is, since the retracting movement of the diameter-reducing sleeve 70 is restricted by locking the diameter-reduced stepped portion 74 to the distal end of the sheath 10, the arm of the clip 110 is pulled by pulling the clip 110 using the operation wire 20. The portion 120 can be retracted relative to the enlarged diameter portion 72 and the fastening member 150. As a result, the arm 120 of the clip 110 can be closed as will be described later, and the operation wire 20 can be removed from the clip 110.

  When the tightening member 150 is not accommodated in the enlarged diameter portion 72, when the operation wire 20 is retracted, the enlarged diameter portion 72 is re-accommodated in the sheath 10 while being reduced in diameter.

  The expansion / contraction part 80 is a member that connects the centering part 60 and the reduced diameter sleeve 70, and is configured to be expandable / contractible in the axial direction.

  The stretchable part 80 can be made of a coil in which a metal or resin wire is spirally wound, or an elastomer such as rubber. As the wire, a metal wire such as stainless steel or tungsten can be preferably used. The stretchable portion 80 of the present embodiment is wound at an unequal pitch in which the winding pitch at both ends fixed to the stretchable portion 80 and the reduced diameter sleeve 70 is reduced and the winding pitch at the intermediate portion is larger than both ends. It is a turned coil. More specifically, both ends of the expansion / contraction part 80 are wound in a tight winding where adjacent winding loops are in contact with each other, and an intermediate part of the expansion / contraction part 80 is a pitch where adjacent winding loops are separated from each other. It is wound by winding.

  The diameter-reducing sleeve 70 is a cylindrical member fixed to the expansion / contraction part 80, and the operation wire 20, the expansion / contraction part 80 and the diameter-reducing sleeve 70 are arranged coaxially with the sheath 10. The sleeve main body 76 of the reduced diameter sleeve 70 is accommodated in the expansion / contraction part 80 (coil). The distal end of the expansion / contraction part 80 is in contact with the proximal side of the reduced diameter step part 74. The distal portion of the expansion / contraction part 80 includes a fixing wire 82 fixed around the sleeve body 76, and a non-fixing wire 84 positioned on the distal side of the fixing wire 82 and fixedly mounted around the sleeve body 76. And including. The fixing wire 82 is fixed around the sleeve body 76 by an adhesive, metal wax such as solder, or welding.

  A series of procedures from connecting the tip connecting portion 50 of the operation wire 20 to the clip 110, closing the clip 110, and further releasing the tip connecting portion 50 from the clip 110 will be described with reference to FIGS. To do.

  FIG. 5A is an explanatory view showing a state in which the tip connecting portion 50 is pushed into and connected to the locking portion 130 of the clip 110. FIG. 5B is an enlarged view of FIG. 5A regarding the vicinity of the tip connecting portion 50. FIG. 6 is an explanatory view showing a state in which the clip 110 is accommodated in the sheath 10. FIG. 7 is an explanatory view showing a state in which the clip 110 protrudes from the sheath 10 and is opened, and FIG. 8 is an explanatory view showing a ligated state of the clip 110. 9A is an explanatory view showing a state in which the tip connecting portion 50 is pulled out from the locking portion 130 of the clip 110, and FIG. 9B is an enlarged view of the vicinity of the tip connecting portion 50 in FIG. 9A. It is.

  The clip 110 is provided by being accommodated in a cartridge (not shown) in a state where the fastening member 150 is mounted on the outer periphery of the arm portion 120 (see each drawing in FIG. 3). The cartridge may be provided with an opening for externally accessing the accommodating portion of the clip 110 and the locking portion 130 of the clip 110 accommodated in the accommodating portion. And the operation wire 20 and the clip 110 are connected by pressing the front-end | tip connection part 50 of the operation wire 20 with respect to the latching | locking part 130 of the clip 110 accommodated in the cartridge from the base end side.

  Specifically, as shown in FIG. 5A, the protrusion 140 is outwardly moved by pressing the distal end connecting portion 50 of the operation wire 20 against the protrusion 140 of the locking portion 130 from the proximal end side. Due to elastic deformation, the receiving portion 134 is opened so as to be able to receive the distal end connecting portion 50 in the advancing and retracting direction of the operation wire 20. At this time, the slider 94 (see FIG. 1) of the treatment instrument main body 90 is moved forward so that the distal end connecting portion 50 protrudes from the distal end of the sheath 10 as shown in FIG. From the state in which the protrusion 140 is elastically deformed outward and the receiving part 134 is opened, the tip connecting part 50 moves the protrusion 140 to the distal side in the forward / backward direction as indicated by an arrow in FIG. By passing, the protrusion 140 is elastically restored inward (see FIG. 6). As a result, the protrusion 140 is engaged with the distal end connecting portion 50 and the distal end connecting portion 50 and the engaging portion 130 are connected.

  Here, the outwardly elastic deformation of the protrusion 140 is not limited to the complete elastic deformation of the protrusion 140 but includes the elastic deformation of the protrusion 140 accompanied by plastic deformation. In addition, the term “the projection 140 is elastically restored inward” includes not only a state in which the displacement of the projection 140 that is elastically deformed outward is completely restored but also a state in which a part of the displacement of the outward elastic deformation is restored. . When the tip connecting portion 50 is pressed against the protrusion 140 to deform the protrusion 140 outward, the protrusion 140 is elastically deformed so that at least a part of the displacement is restored. That is, the protrusion 140 is urged by the tip connecting portion 50 to release the receiving portion 134, and after the tip connecting portion 50 is received by the receiving portion 134, the protrusion 140 is elastically restored to cause the receiving portion 134 to move. Can be closed. For this reason, according to the endoscope clip device 100 of the present embodiment, the distal end connecting portion 50 is simply moved forward to press the distal end connecting portion 50 against the axial center of the locking portion 130, so that the distal end connecting portion 50 receives the receiving portion 134. To be coupled to the clip 110. In addition, the protrusion 140 is formed in a partial arc shape, and the protrusion 140 is configured so that the pair of protrusions 140 hold the proximal portion of the tip connecting portion 50, specifically, the periphery of the bend portion 51. Locks to the tip connecting portion 50. As a result, the tip connecting portion 50 received by the receiving portion 134 is prevented from wobbling inside the receiving portion 134.

  Specifically, when the second inclined surface 54 of the distal end connecting portion 50 is pressed against the protrusion 140 from the proximal end side, the second inclined surface 54 having a normal line obliquely outward toward the distal side is formed. The protrusion 140 is pressed outward in the radial direction, and the protrusion 142 is bent and deformed outward. Since the second inclined surface 54 has a spindle shape, the protrusion 140 is gradually and strongly biased by moving the second inclined surface 54 forward. For this reason, it is possible to prevent the projecting portion 140 and the projecting piece portion 142 from being impacted and plastically deformed.

  As shown in FIG. 6, the operation wire 20 is further advanced from the state shown in FIG. 5A to completely accommodate the distal end connecting portion 50 in the receiving portion 134 and then the operation wire 20 is retracted. The clip 110 and the reduced diameter sleeve 70 are accommodated in the sheath 10. At this time, an external force is applied to the enlarged diameter portion 72 of the reduced diameter sleeve 70 to reduce the diameter thereof. Such external force can be performed by the cartridge described above. More specifically, when the distal end connecting portion 50 is connected to the locking portion 130 inside the cartridge, and then the operating wire 20 is retracted and the clip 110 is removed from the cartridge, the diameter-expanded portion 72 depends on a specific portion of the cartridge. It is good to urge inward in the radial direction. The outer diameter of the diameter-expanded portion 72 that has been reduced in diameter is smaller than the inner diameter of the sheath 10.

  As shown in FIG. 6, with the clip 110 housed in the sheath 10, the sheath 10 is caused to enter the body cavity through the forceps hole of the endoscope. When the distal end portion of the sheath 10 reaches the vicinity of the living tissue requiring ligation, the operation wire 20 is pushed out to the distal side. Thereby, as shown in FIG. 7, the clip 110 and the fastening member 150 protrude from the distal end of the sheath 10, and the clip 110 naturally expands to the maximum opening width by the self-expanding force.

  At this time, at least the enlarged diameter portion 72 and the reduced diameter stepped portion 74 of the reduced diameter sleeve 70 protrude from the distal opening of the sheath 10 and are expanded and deformed to the natural diameter. That is, the enlarged diameter portion 72 of the reduced diameter sleeve 70 that has been drawn into the sheath 10 and deformed to a reduced diameter is elastically restored to a large diameter by protruding from the distal opening of the sheath 10. Then, the fastening member 150 is fitted inside the enlarged diameter portion 72. Next, the position and orientation of the clip 110 are adjusted with respect to the living tissue to be ligated.

  When the treatment instrument main body 90 (see FIG. 1) is rotated by torque, the operation wire 20 and the distal end connecting portion 50 are rotated by torque in conjunction with each other. As described above, the pair of opposed projecting piece portions 142 are in close contact with or close to the outer peripheral plane of the tip connecting portion 50, and the tip connecting portion 50 transmits torque to the locking portion 130. As shown in FIG. 7, when the treatment instrument main body 90 is torque-rotated in a state where the distal end connecting portion 50 is connected to the engaging portion 130 of the clip 110, torque is transmitted to the engaging portion 130 of the clip 110 through the distal end connecting portion 50. The arm portion 120 of the clip 110 also rotates by torque. Thereby, the arm opening direction of the arm part 120 can be directed to a desired direction with respect to the ligation site | part of a biological tissue.

  After determining the position and orientation of the clip 110, the operation wire 20 is pulled proximally with the tip of the clip 110 pressed against the ligation site. The tightening member 150 abuts on the inner surface of the diameter-reduced stepped portion 74 and is fitted inside the diameter-enlarged portion 72, so that the backward movement with respect to the diameter-reduced sleeve 70 and the sheath 10 is restricted. Further, since the tightening member 150 is fitted in the enlarged diameter portion 72, the diameter reduction portion 72 is prevented from being deformed even when an external force is applied to the enlarged diameter portion 72. Even if it is pulled to the side, the enlarged diameter portion 72 is prevented from being pulled into the sheath 10.

  The operation wire 20 and the reduced diameter sleeve 70 are connected to each other by an expansion / contraction part 80. Therefore, even after the reduced diameter sleeve 70 is restricted from moving relative to the clip device 100 in the proximal direction, the expansion / contraction part 80 is extended by drawing the operation wire 20 in the proximal side, and the distal end connecting part 50 is moved into the sheath 10. It is possible to retract further proximally.

  By pulling the operation wire 20 to the proximal side in the advancing / retreating direction in a state where the distal end connecting portion 50 is received by the receiving portion 134, the arm portion 120 is closed to grip the living tissue as shown in FIG. . More specifically, when the operation wire 20 is further pulled in a state in which the diameter-reducing sleeve 70 and the tightening member 150 are restricted from moving relative to the sheath 10 in the proximal direction, the arm portion 120 becomes the tightening member. The arm is drawn into 150 and closed. However, the arm portion 120 can be expanded again by interrupting the pulling in the middle of the arm portion 120 closing and pushing the operation wire 20 again. After the optimum ligation has been confirmed, when the operation wire 20 is further pulled to the proximal side, the tightening member 150 is fitted into the narrow width portion 123 (see each drawing in FIG. 3) provided on the arm portion 120. Thus, the clip 110 is locked. As a result, the clip 110 is in the closed arm state shown in FIG.

  When the arm 120 closes and grips the living tissue, the protrusion 140 of the locking portion 130 is housed inside the reduced diameter sleeve 70 (sleeve). By further pulling the operation wire 20 to the proximal side from this state, the protrusion 140 protrudes from the sleeve main body 76 of the reduced diameter sleeve 70 to the proximal end side, and can be greatly deformed outward. Here, the large deformation of the protrusion 140 means that the protrusion 140 is deformed to a large diameter until at least the tip connecting portion 50 can be pulled out from the receiving portion 134.

  That is, by further pulling the operation wire 20 from the closed arm state shown in FIG. 8, the protruding portion 140 of the locking portion 130 protrudes more proximally than the sleeve main body 76 corresponding to the proximal portion of the reduced diameter sleeve 70. As a result, the sleeve main body 76 can no longer constrain the diameter expansion of the protrusion 140 and the protrusion piece 142, and the protrusion 140 can be greatly enlarged and deformed beyond the inner diameter of the sleeve main body 76 (FIGS. 9A and 9B). reference).

  For this reason, by further pulling the operation wire 20 to the proximal side from the state in which the arm part 120 is closed, as shown in each drawing of FIG. 9, the tip connecting part 50 deforms the protruding part 140 outward. The receiving portion 134 is opened, and the distal end connecting portion 50 can be pulled out from the receiving portion 134 in the direction indicated by the arrow. Here, the fact that the protrusion 140 is deformed outward may be plastically deformed or elastically deformed.

  More specifically, the first inclined surface 52 of the tip connecting portion 50 urges the protruding portion 140 outward to cause elastic deformation. Since the normal line of the first inclined surface 52 is obliquely outward toward the proximal side, the protrusion 140 is displaced outward by retracting the tip connecting portion 50 (first inclined surface 52) toward the proximal side. The protruding piece 142 is bent and deformed outward.

  The protrusion 140 has a weight shape, and more specifically, has a taper shape with a diameter reduced to the proximal side. For this reason, regardless of the direction of the distal end connecting portion 50 and the protruding portion 140, the protruding end portion 50 is moved backward to gradually bias the protruding portion 140 to move backward from the sleeve main body 76, and the sleeve main body 76. When the protrusion 140 protrudes on the proximal side of the projection, they are deformed outward. For this reason, when the living tissue is ligated, the distal end connecting portion 50 is removed from the locking portion 130 by further retracting the slider 94 continuously with the operation of retracting the slider 94 (see FIG. 1). As a result, the clip 110 is separated from the operation wire 20 and is placed in the body cavity with the living tissue ligated.

  With the above operation, a series of procedures from connecting the tip connecting portion 50 to the clip 110, closing the clip 110, and further detaching the tip connecting portion 50 from the clip 110 is completed. By repeating the above procedure, a living tissue can be ligated with a large number of clips 110.

  As described above, according to the endoscopic clip device 100 of the present embodiment, the distal end connecting portion 50 is massive and does not substantially deform, connects the distal end connecting portion 50 to the clip 110, ligates a living tissue, Further, the wear of the tip connecting portion 50 is also reduced by a series of procedures for removing from the clip 110. Further, since the tip connecting portion 50 (operation wire 20) can be removed without breaking the clip 110, a part of the clip 110 does not remain in the tip connecting portion 50 that has been removed and collected. Since the receiving portion 134 can receive the tip connecting portion 50 in the advancing and retracting direction of the operation wire 20, the tip connecting portion 50 (the operation wire 20) and the clip can be simply moved forward with respect to the receiving portion 134. 110 are connected. The same applies to the removal, and the receiving portion 134 is opened and the tip connecting portion 50 can be pulled out simply by pulling the operation wire 20 to the proximal side in the advancing and retracting direction. For this reason, the procedure is easy and problems such as infection are prevented.

  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.

  Note that the various components of the endoscope clip device 100 and the clip 110 of the present invention do not have to be independent of each other. A plurality of components are formed as one member, a component is formed of a plurality of members, one component is a part of another component, and one component is And a part of other components are allowed to overlap.

The above embodiment includes the following technical idea.
(1) A clip having a plurality of arm portions for grasping a living tissue and a locking portion provided on the proximal end side of the arm portion, a long sheath, and inserted into the inside of the sheath so as to be movable forward and backward A treatment instrument body having an operation wire provided with a lump-shaped tip connecting portion at a distal end thereof, and the locking portion of the clip includes a receiving portion having a space for receiving the tip connecting portion therein A protrusion formed inwardly on the proximal end side of the receiving portion, and the protrusion is outwardly pressed by pressing the distal end connecting portion against the protrusion from the proximal end side. The protrusion is elastically deformed and is opened so as to be able to receive the tip connecting portion in the advancing / retreating direction of the operation wire, and the tip connecting portion passes through the protrusion to the distal side in the advancing / retreating direction. The part is elastically restored inward, and the tip connecting part is By pulling the operation wire to the proximal side in the advancing / retreating direction while being received by the part, the arm portion is closed to grip the living tissue, and further, the operation wire is pulled to the proximal side. Thus, the distal end connecting portion deforms the projection portion outwardly to open the receiving portion, and the distal end connecting portion can be pulled out from the receiving portion.
(2) A first inclined surface is provided at a proximal portion of the tip connecting portion, a normal direction of the first inclined surface is obliquely outward toward the proximal side, and the tip connecting portion is The endoscope according to (1), wherein the first inclined surface deforms the protrusion outward by pulling the operation wire proximally in the forward / backward direction while being received by the receiving portion. Clip device.
(3) A second inclined surface is provided at a distal portion of the tip connecting portion, and a normal direction of the second inclined surface is obliquely outward toward a distal side, and the tip connecting portion is The endoscope clip device according to (2), wherein the second inclined surface elastically deforms the protrusion outward by pressing the protrusion from the base end side.
(4) The endoscope clip device according to (3), wherein at least one of the first inclined surface and the second inclined surface has a weight surface shape.
(5) A cylindrical sleeve that can be housed in the sheath and accommodates the tip connecting portion is provided at a distal portion of the operation wire, and an inner diameter of at least a part of the sleeve is the tip connecting portion. The endoscope clip device according to any one of (1) to (4), wherein the portion is smaller than an outer diameter of the locking portion when the portion can be pulled out from the receiving portion.
(6) The sleeve includes a diameter-expanded portion provided on the distal side and capable of elastically self-expanding, a reduced-diameter step portion provided on the proximal side of the expanded-diameter portion, and the reduced-diameter step portion. A cylindrical sleeve body that is provided more proximally than the enlarged-diameter portion and has a radial rigidity higher than that of the enlarged-diameter portion, and the inner diameter of the sleeve body is such that the distal end connecting portion can be pulled out from the receiving portion. The endoscope clip device according to (5), which is smaller than the outer diameter of the locking portion when
(7) When the arm closes and grips the living tissue, the protrusion is accommodated in the sleeve, and the protrusion is further pulled by pulling the operation wire to the proximal side. The endoscope according to the above (5) or (6), in which the protrusion protrudes from the sleeve to the proximal end side and the protrusion can be deformed outward until the distal end connecting portion can be pulled out from the receiving portion. Clip device.
(8) A clip used in the endoscopic clip device described in any one of (1) to (7) above, wherein a plurality of arms for grasping a living tissue and the arms A locking portion provided on the base end side, and the locking portion includes a base portion connected to the base end of the arm portion and a plurality of projecting piece portions formed to protrude from the base portion to the base end side. A clip comprising: a receiving portion configured to have a space therein; and a protruding portion that protrudes inwardly at a tip portion on the proximal side of the protruding piece portion.
(9) The base portion has an annular shape formed by bending a plate material and abutting edges thereof, and a plurality of the projecting piece portions are spaced apart around the annular base portion, The clip according to (8), wherein a joint line of the end edges is disposed at an intermediate position between the adjacent projecting piece portions.
(10) A plurality of recesses that are recessed toward the distal side are formed on the peripheral edge of the base portion on the base end side, and the protruding piece portion is formed to protrude from the bottom of the recess to the base end side. The clip according to (9) above.
(11) The clip according to (10), wherein the seam of the end edge is disposed at a position where the concave portion is not formed in the base portion.

DESCRIPTION OF SYMBOLS 10 Sheath 20 Operation wire 50 Tip connection part 51 Bending part 52 1st inclined surface 54 2nd inclined surface 56 Support | pillar part 60 Centering part 70 Diameter reduction sleeve 72 Diameter expansion part 74 Diameter reduction level | step difference part 76 Sleeve main body 80 Expansion / contraction part 82 Adherence Wire 84 Non-fixed wire 90 Treatment tool main body 92 Finger ring 94 Slider 96 Main body shaft 100 Endoscopic clip device (clip device)
110 Clip 120 Arm part 121 Wide part 122 Base end part 123 Narrow part 124 Arm main body part 125 Reinforcement part 126 Claw part 130 Locking part 132 Space 134 Receiving part 136 Base part 137 Recessed part 138 Edge part 139 Bottom part 140 Protruding part 142 Projection Single part 150 Tightening member

Claims (11)

A clip having a plurality of arm portions for grasping a living tissue and a locking portion provided on a proximal end side of the arm portions;
A long sheath, and a treatment instrument body having an operation wire that is inserted into the sheath so as to be movable forward and backward and provided with a lump-shaped tip connecting portion at a distal end thereof,
The locking portion of the clip includes a receiving portion having a space for receiving the distal end coupling portion therein, and a protruding portion formed inwardly projecting toward the proximal end side of the receiving portion,
The protrusion is elastically deformed outward by pressing the distal end connecting portion against the protrusion from the base end side, and the receiving portion is opened to accept the distal end connecting portion in the forward / backward direction of the operation wire. And when the tip connecting portion passes through the protrusion to the distal side in the advance / retreat direction, the protrusion is elastically restored inward,
By pulling the operation wire to the proximal side in the advancing / retreating direction with the distal end coupling portion being received by the receiving portion, the arm portion is closed to grip the living tissue, and the operation wire is By pulling the proximal side, the tip connecting portion deforms the protrusion outward so that the receiving portion is opened, and the tip connecting portion can be pulled out from the receiving portion. Endoscopic clip device. A first inclined surface is provided in the proximal portion of the tip connecting portion, and the normal direction of the first inclined surface is obliquely outward toward the proximal side,
2. The first inclined surface deforms the protruding portion outward by pulling the operation wire proximally in the advancing / retreating direction in a state where the distal end coupling portion is received by the receiving portion. Endoscopic clip device. A second inclined surface is provided at the distal portion of the tip connecting portion, and the normal direction of the second inclined surface is obliquely outward toward the distal side,
The endoscope clip device according to claim 2, wherein the second inclined surface elastically deforms the protrusion outward by pressing the distal end connecting portion against the protrusion from the proximal end side.   The endoscope clip device according to claim 3, wherein at least one of the first inclined surface and the second inclined surface has a weight surface shape. At the distal portion of the operation wire, a cylindrical sleeve that can be housed in the sheath and accommodates the tip connecting portion is provided,
The internal view according to any one of claims 1 to 4, wherein an inner diameter of at least a part of the sleeve is smaller than an outer diameter of the locking portion when the tip connecting portion can be pulled out from the receiving portion. Mirror clip device. The sleeve is provided on the distal side and is elastically self-expandable, a reduced diameter step provided on the proximal side of the enlarged diameter portion, and closer to the reduced diameter step. A cylindrical sleeve body provided on the rear side and having a radial rigidity higher than that of the enlarged diameter portion,
The endoscope clip device according to claim 5, wherein an inner diameter of the sleeve body is smaller than an outer diameter of the locking portion when the distal end connecting portion can be pulled out from the receiving portion.   When the arm is closed and grips the living tissue, the protrusion is accommodated in the sleeve, and the protrusion is further pulled by moving the operation wire to the proximal side. The endoscopic clip device according to claim 5 or 6, wherein the protruding portion is deformable outward until the distal end connecting portion can be pulled out from the receiving portion. A clip used for the endoscope clip device according to any one of claims 1 to 7,
A plurality of arms for grasping a living tissue and a locking portion provided on the proximal end side of the arms,
The locking portion includes a base portion connected to a base end of the arm portion, a plurality of projecting pieces formed to protrude from the base portion to the base end side, and a receiving portion having a space therein, and the protrusion And a protruding portion formed inwardly projecting from a distal end portion on the proximal side of the one portion. The base portion is formed by bending a plate material to form an annular shape in which the edges are abutted against each other,
The plurality of protruding piece portions are spaced apart around the annular base portion,
The clip according to claim 8, wherein a seam of the abutted edge is disposed at an intermediate position between adjacent projecting piece portions. A plurality of recesses that are recessed toward the distal side are formed on the periphery of the base end side of the base,
The clip according to claim 9, wherein the protruding piece is formed to protrude from the bottom of the recess toward the proximal end.   The clip according to claim 10, wherein the seam of the end edge is disposed at a position where the concave portion is not formed in the base portion.

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