JP2017176670A - Clip removing device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To facilitate the removal of a clip placed inside a body through an operation from outside the body.SOLUTION: A clip removing device removes a clip 1 placed inside a living body through an operation from outside the body in a state of gripping an inner tissue between the tips of a pair of arm parts 11 and 12 brought close to each other. The device includes: a first member 21 capable of being inserted and positioned in a part between the pair of arm parts; and a second member 24 to be positioned on an opposite side to the first member by clipping one of the arm parts 12 at a position different from a position of the first member in the extension direction of the one arm part with the first member inserted and positioned in a part between the pair of arm parts. At least one of the first member and the second member is moved to a direction crossing the one extension direction of the arm part, and the one arm part is folded.SELECTED DRAWING: Figure 9

Description

  The present invention relates to a clip removing device used for removing a clip placed in a living body while grasping a body tissue by an operation from outside the body.

  An endoscope clip used for treatment such as hemostasis, marking or stitching using an endoscope, for example, as shown in Patent Document 1, by moving (sliding) a tightening ring, In this medical instrument, a pair of arm plate portions are brought close to each other, and a body tissue is grasped at or near the distal end portion of the arm plate portion.

  Such an endoscope clip is attached to the distal end of a catheter tube (clip device) that is passed through the treatment instrument guide tube of the endoscope, guided to the body tissue to be treated, and then the catheter tube By the operation from the operation unit provided at the proximal end, the body tissue (mucosa) is grasped and removed from the catheter tube and placed in the body.

  After achieving the purpose of treatment such as hemostasis, there is a case where the grasp of the body tissue by the clip placed in the living body is released and the clip is taken out of the body, and as a release device therefor, Patent Document 2 and Patent A clip removing device as disclosed in Document 3 has been proposed. In these techniques, a clip is opened by its own elasticity and detached from the body tissue by sliding a clamping ring that closes the clip toward the base end side of the clip.

  However, in the conventional clip removing device, it is necessary to hold a very small clamping ring and slide it relative to the clip. Further, the fastening ring cannot be slid unless the posture of the distal end portion of the clip removing device is accurately set with respect to the posture of the clip. As described above, the operation of moving the tightening ring is not easy, and there is a problem that a long time may be required for work.

JP 2009-189705 A JP 2007-125264 A JP2015-192724A

  This invention is made | formed in view of such a point, and it aims at providing the clip removal apparatus which can remove easily the clip indwelled in the body by operation from the outside of a body.

The clip removing device according to the present invention is:
A clip detaching device that removes a clip placed in the body in a state where the distal ends of the pair of arm parts are close to each other and grips the body tissue, from the outside of the body,
A first member that can be inserted and disposed in a portion between the pair of arm portions;
In a state in which the first member is inserted and disposed in a portion between the pair of arm portions, the arm member is located at a position different from the first member in one extending direction of the arm portion and sandwiches one of the arm portions. And a second member disposed on the opposite side of the first member;
A moving mechanism that moves at least one of the first member and the second member in a direction intersecting one extending direction of the arm portion.

  According to the clip detaching device according to the present invention, when the first member is inserted and disposed in a portion between the pair of arm portions, the second member is located at a position different from the first member in one extending direction of the arm portions. The arm portion is disposed on the opposite side to the first member with the one side interposed therebetween. Therefore, in this state, the moving mechanism is operated to move at least one of the first member and the second member in a direction crossing one extending direction of the arm portion, and bend one of the arm portions. . Thereby, the holding | grip of the body tissue by a clip can be cancelled | released.

  Therefore, unlike the prior art, it is not necessary to hold a very small clamping ring and slide it relative to the clip, and the posture of the distal end portion of the clip removing device with respect to the posture of the clip can be changed. It is not necessary to set it so strictly. Therefore, the operation is easy, and the clip can be removed in a short time.

One of the first member and the second member has a pair of support portions that can come into contact with each other at different positions in one extending direction of the arm portion,
The other of the first member and the second member may be disposed in a portion between the pair of support portions in one extending direction of the arm portion.

The moving mechanism is
A tubular sheath;
A wire inserted movably along the axial direction with respect to the sheath;
An operating portion provided at a proximal end of the sheath so as to move the wire along the axial direction in the sheath;
One of the first member and the second member is provided at a distal end of the sheath;
The other of the first member and the second member may be connected to the distal end of the wire.

It is a top view which shows the structure in the open leg state of the clip for endoscopes as a removal object of a clip removal apparatus. It is a top view which shows the structure in the closed leg state of the clip for endoscopes as a removal object of a clip removal apparatus. It is a top view which shows the whole structure of the clip removal apparatus of 1st Embodiment of this invention. FIG. 4 is a cross-sectional view taken along line IV-IV in FIG. 3. It is the top view which expanded the principal part of the clip removal apparatus shown in FIG. 3, and is a figure which shows the state which retracted the punch member. It is the top view which expanded the principal part of the clip removal apparatus shown in FIG. 3, and is a figure which shows the state which extruded the punch member. It is a figure which shows the clip removal process using the clip removal apparatus shown in FIG. 5 and FIG. It is a figure which shows the removal process of the clip following FIG. It is a figure which shows the removal process of the clip following FIG. It is a perspective view which shows the modification of the clip removal apparatus of 1st Embodiment of this invention. It is the partial cross section perspective view which looked at the clip removal apparatus shown in FIG. 10 from a different angle. It is the perspective view which expanded the principal part of the clip removal apparatus of 2nd Embodiment of this invention. It is a partially broken perspective view of the clip removal apparatus shown in FIG. It is the perspective view which expanded the principal part of the clip removal apparatus of 3rd Embodiment of this invention. It is a perspective view which shows the motion of the clip removal apparatus shown in FIG.

  Hereinafter, a clip removing apparatus according to an embodiment of the present invention will be described in detail with reference to the drawings.

[Medical clip]
First, an endoscope clip (medical clip) as an object to be removed from the clip removal device will be described with reference to FIGS. 1 and 2. In the following description, a clip having an arm plate portion formed in a plate shape as an arm portion will be described. However, an endoscope clip as an object to be removed from a clip removal device is a plate-like one. However, the present invention is not limited thereto, and may have a rod-like (columnar, prismatic, etc.) arm portion.

  The clip 1 includes a pair of arm plate portions (arm portions) 11 and 12 and a connecting plate portion 13 bent into a substantially U shape. A tightening ring 14 for opening and closing the pair of arm plate portions 11 and 12 is slidably fitted to the connecting plate portion 13.

  The pair of arm plate portions 11 and 12 are arranged so that the distance between the arm plate portions 11 and 12 increases toward the tip portion in a state where no external force is applied (opens in a substantially V shape toward the tip portion) One end (base end) of the base end portion 11 b of the arm plate portion 11 is at one end of the connecting plate portion 13, and one end (base end) of the base end portion 12 b of the arm plate portion 12 is at the end of the connecting plate portion 13. Each of the other ends is integrally connected.

  Claw portions 11a and 12a are integrally provided at the distal ends of the arm plate portions 11 and 12, respectively. The claw portions 11a and 12a are formed by being bent toward the inner side (that is, the closing direction) at the tips of the arm plate portions 11 and 12. Each nail | claw part 11a, 12a has a notch part (not shown) recessed in the intermediate part of the front-end | tip.

  The connecting plate portion 13, the pair of arm plate portions 11 and 12, and the pair of claw portions 11 a and 12 a that constitute the endoscope clip 1 are formed by bending a single plate material. Although the board thickness of the board | plate material which comprises the clip 1 for endoscopes is not specifically limited, Preferably it is 0.10-0.30 mm. As the plate material, a metal plate having elasticity is preferable, for example, stainless steel is used.

  The arm plate portions 11 and 12 have base end portions 11b and 12b and gripping portions 11c and 12c, respectively. Protruding portions and wide portions are provided as locking portions for preventing further sliding of the ring 14 toward the gripping portions 11c and 12c on the boundary portions 11d and 12d between the base end portions 11b and 12b and the gripping portions 11c and 12c. May be. The tightening ring 14 is composed of a substantially cylindrical ring member. However, the tightening ring 14 may be composed of a spring formed by winding a wire in a coil shape.

  The fastening ring 14 is inserted into the guide hole inside thereof, and the connecting plate portion 13 is inserted therethrough, and the space between the outer periphery of the connecting plate portion 13 and the outer periphery of the base end portions 11b and 12b of the arm plate portions 11 and 12 is axial. It is attached (externally fitted) so that it can move (slide). When the tightening ring 14 is slid from a position (release position) externally fitted to the connecting plate portion 13 to a position (holding position) externally fitted to the base end portions 11b and 12b of the arm plate portions 11 and 12 The base end portions 11b and 12b of the pair of arm plate portions 11 and 12 are drawn into the inside (guide hole) of the tightening ring 14, and these arm plate portions 11 and 12 are closed, that is, the arm plate portions 11 and 12 Each is designed to be close to each other.

  As shown in FIG. 1, the arm plate portions 11, 12 are opened (opened) by their own elasticity when the clamping ring 14 is disposed rearward (connecting plate portion 13). ing. If necessary, as shown in FIG. 2, the arm plates 11 and 12 can be gradually closed by moving (sliding) the tightening ring 14 to a position closer to the front. Then, by moving the tightening ring 14 to the base end portions 11b and 12b, the arm plate portions 11 and 12 can be maintained in a closed (closed leg) state.

  Such an endoscope clip 1 is a catheter tube that is passed through a treatment instrument guide tube of an endoscope in a state in which a fastening ring 14 is disposed on a connecting plate portion 13 and arm plate portions 11 and 12 are opened. It is attached to the distal end of the (clip device). Then, after being guided to a body tissue to be treated, such as hemostasis, through the treatment instrument guide tube of the endoscope, the tightening ring 14 is moved by the operation from the operation portion provided at the proximal end of the catheter tube. The body tissue (mucosa) is grasped by sliding to the end portions 11b and 12b and closing the arm plate portions 11 and 12, and in this state, the tissue is removed from the catheter tube and placed in the body.

  After achieving the purpose of treatment such as hemostasis, a clip removal device (clip remover) is used to release the clip from the body by releasing the grasp of the body tissue by the clip placed in the body.

[Clip removal device]
First Embodiment Hereinafter, a clip removing apparatus according to a first embodiment of the present invention will be described with reference to FIGS. As shown in FIGS. 3 to 6, the clip removing device 2 includes a die member (first member) 21 that is a support member, a sheath 22, a drive wire 23, and a punch member (second member) that is a pressurizing member. Member) 24, a lock mechanism having a base side lock member 25 and a sheath side lock member 26, and an operation part having a base part 27 and a slider part 28.

  The sheath 22 and the drive wire 23 constitute a part of a moving mechanism that moves the punch member 24 with respect to the die member 21 in a direction substantially orthogonal to (intersects) one extending direction of the arm plate portions 11 and 12. The moving mechanism includes an operation unit having a base portion 27 and a slider portion 28.

  The sheath 22 is a tubular member. The sheath 22 is desirably flexible, and a simple tube made of resin or the like may be used as the sheath 22, but in this embodiment, a coil tube is used. As the coil tube, a flat wire coil tube formed by spirally winding a long flat plate made of metal (stainless steel) or the like can be used. However, a round wire coil tube or an inner flat coil tube may be used. Note that a wire tube may be used as the sheath 22. The wire tube is a tube made of a hollow stranded wire formed by twisting a plurality of wires (cables) made of, for example, metal (stainless steel) in a spiral shape so as to be hollow.

  Such a coil tube (or wire tube) is used as the sheath 22 when the holding release device 2 is ultrasonically cleaned using a cleaning liquid, so that the cleaning liquid sufficiently penetrates the inside of the tube. This is so that it can be washed well.

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

  The drive wire 23 is inserted into the sheath 22 so as to be movable along the axial direction. A punch member (second member) 24 is integrally fixed to the tip (distal end) of the drive wire 23. The punch member 24 comes into contact with an intermediate portion of one of the arm plate portions 11 and 12 of the endoscope clip 1 to be released from the body tissue to be bent (hereinafter referred to as the arm plate portion 12). It is a member. The punch member 24 is a substantially cylindrical member, and the outer diameter of the punch member 24 is set to a value slightly smaller than the inner diameter of the sheath 22.

  The front end portion of the punch member 24 has a shape that is cut by two symmetrical slopes that are oblique to the central axis so that a pressing portion 24a that forms a linear ridge line such as a minus driver is formed. Yes. As will be described in detail later, the pressing portion 24a is a portion that presses the arm plate portion 12 in order to bend the arm plate portion 12 of the clip 1.

  The pressing portion 24a of the punch member 24 does not have to be linear, and may be concave or concave arc shape. When the pressing portion 24a is concave, the width of the concave portion is set to be slightly larger than the width of the arm plate portions 11 and 12 of the clip 1.

  The punch member 24 moves in the sheath 22 along the axial direction of the drive wire 23, so that the punch member 24 is pulled into the sheath 22 at the distal end of the sheath 22 and protrudes from the distal end of the sheath 22. It is possible to move (slide) so as to be in the state. As the punch member 24, metal such as stainless steel can be used. The base end portion of the punch member 24 can be fixed to the distal end of the drive wire 23 by welding or the like.

  The die member (first member) 21 is a member that abuts from the opposite side of the punch member 24 across the arm plate portion 12 at a position different from the contact position by the punch member 24 in the extending direction of the arm plate portion 12. It is. The die member 21 has a total cylindrical portion 21a, a partial cylindrical portion 21b, and a pair of support arm portions (support portions) 21c and 21d. The support arm portions 21 c and 21 d are portions that come into contact with different positions in the extending direction of the arm plate portion 12.

  The die member 21 is cut in a substantially half shape while leaving a substantially half on the base end side and a part on the tip end side of the substantially cylindrical member, and the part cut in the half shape is a partial cylindrical portion 21b. The remaining base end portion is defined as the entire cylindrical portion 21a. A part of the remaining tip end side is notched to form a notch portion 21e, which becomes a pair of substantially C-shaped support arm portions (support portions) 21c and 21d. The base end portion of the entire cylindrical portion 21 a is fixed to the distal end of the sheath 22. As will be described in detail later, the support arm portions 21c and 21d are portions that support the arm plate portion 12 at two points when being pressed by the pressing portion 24a in order to bend the arm plate portion 12 of the clip 1.

  Note that the entire cylindrical portion 21 a may be omitted, and in this case, the base end portion of the partial cylindrical portion 21 b is fixed to the distal end of the sheath 22. Moreover, the partial cylindrical part 21b does not need to be halved, and may be circular arc shape larger or smaller than half.

  In the present embodiment, the corresponding tip portions of the support arm portions 21c and 21d are separated by forming the notch portion 21e. However, as will be described later, this is because the arm plate portion 12 of the clip 1 is separated. This is because there is an advantage that it can be easily hooked to the arm plate portion 12 when it is bent, but it does not necessarily have to be separated.

  The inner diameter of the die member 21 (all cylindrical portions 21 a) is substantially the same as the inner diameter of the sheath 22, and the die member 21 has an inner wall that continues to the inner surface of the distal end portion of the sheath 22 without a step. It is fixed to the tip. As the die member 21, one made of a metal such as stainless steel can be used. The die member 21 can be fixed to the sheath 22 by, for example, welding.

  When the punch member 24 is pushed out from the distal end of the sheath 22, the inner wall of the die member 21 (partial cylindrical portion 21 b) guides the movement of the punch member 24 in the direction along the central axis of the sheath 22. The leading end portion including the pressing portion 24a of the member 24 is guided so as to be inserted into a portion between the support arm portions 21c and 21d of the die member 21.

  The proximal end (base end portion) of the sheath 22 through which the drive wire 23 is inserted has a base portion via a luer lock mechanism having a base side lock member 25 having a male screw portion and a sheath side lock member 26 having a female screw portion. 27 is connected and fixed to the distal end of 27.

  A slider portion 28 is slidably attached to the base portion 27, and the proximal end of the drive wire 23 passes through the respective through holes of the sheath side lock member 26 and the base side lock member 25, and the slider portion 28, and is releasably fixed to the slider portion 28 via a lock screw 29.

  By sliding the slider portion 28 to the distal end side with respect to the base portion 27, the drive wire 23 moves to the distal end side with respect to the sheath 22, and a punch member provided at the distal end of the drive wire 23 24 is pushed out from the distal end of the sheath 22 and moves to the distal end side along the inner wall of the die member 21 (full cylindrical portion 21a, partial cylindrical portion 21b), and a pair of support arm portions 21c of the die member 21 , 21d. On the contrary, by sliding the slider portion 28 toward the proximal end side with respect to the base portion 27, the punch member 24 provided at the distal end of the drive wire 23 is proximal along the inner wall of the die member 21. It moves to the end side and is drawn into the distal end of the sheath 22.

  Next, the usage method of the clip removal apparatus 2 mentioned above is demonstrated with reference to FIGS. Although not shown in FIGS. 7 to 9, the clip 1 is slid from the release position where the ring 14 is positioned on the connecting plate portion 13, and the base end portions 11 b of the pair of arm plate portions 11, 12. It is assumed that the body tissue (mucosa) is held in the body with the gripping portions 11c and 12c of the pair of arm plate portions 11 and 12 in a state where the holding position is set at 12b.

  First, the sheath 22 of the clip removal device 2 is inserted through the treatment instrument guide tube of the endoscope, and the distal end (die member 21) of the sheath 22 is inserted into the body as shown in FIG. The clip 1 to be released from being held is positioned in the vicinity of the arm plate portion 12 as a target of bending of the clip 1. Before and after this operation, the slider portion 28 is slid toward the proximal end side with respect to the base portion 27 of the clip removing device 2, and the punch member 24 provided at the distal end of the drive wire 23 is attached to the die member 21. It is made to evacuate from the inside and to be accommodated in the distal end portion of the sheath 22.

  In this state, the base portion 27 and the slider portion 28 are integrally rotated, and the line connecting the tip ends of the pair of support arm portions 21c and 21d of the die member 21 is the extending direction of the arm plate portion 12 of the clip 1. The posture of the die member 21 is adjusted so as to roughly follow the above.

  Next, as shown in FIG. 8, the pair of support arm portions 21 c and 21 d of the die member 21 are inserted between the pair of arm plate portions 11 and 12 of the clip 1 from the lateral direction, and the partial cylindrical portion The die member 21 is arranged so that the side portion of the arm plate portion 12 of the clip 1 is brought into contact with the edge portion of 21b.

  Next, the slider portion 28 is slid to the distal end side with respect to the base portion 27 of the clip removing device 2, and the punch member 24 provided at the distal end of the drive wire 23 is moved from the distal end of the sheath 22 to the die. Project into the member 21. As a result, the pair of support arm portions 21c and 21d of the die member 21 abut on the arm plate portion 12 of the clip 1 from the inside, and the pressing portion 24a at the tip of the punch member 24 contacts the arm plate portion 12 of the clip 1 from the outside. Abut. At this time, in the extending direction of the arm plate portion 12 of the clip 1, the one support arm portion 21 c is different from the position where the pressing portion 24 a of the punch member 24 is in contact with the base end portion side of the clip 1. The other support arm portion 21d abuts at a different position shifted to the tip end side of the clip 1.

  Thereafter, the slider portion 28 is further slid toward the distal end side with respect to the base portion 27 of the clip removing device 2, whereby the pressing portion 24 a of the punch member 21 is moved to the arm plate portion as shown in FIG. 9. 12 is pressed between the pair of support arm portions 21c and 21d. As a result, the arm plate portion 12 is bent into a substantially V shape, and the claw portion 12a of the one arm plate portion 12 is separated from the claw portion 11a of the other arm plate portion 11 of the clip 1, and these By spreading the gap, the grip of the clip 1 on the body tissue is released. Note that the clip 1 whose grip has been released is separately taken out of the body.

  In the clip removing device according to the first embodiment described above, the pair of support arm portions 21c and 21d of the die member 21 are inserted and disposed in a portion between the pair of arm plate portions 11 and 12. Therefore, the pressing portion 24a of the punch member 24 is at a position (a portion between) different from the support arm portions 21c and 21d in the extending direction of the one arm plate portion 12 to be bent, and the arm plate portion 12 is disposed on the opposite side (outside) of the support arm portions 21c and 21d. In this state, the slider portion 28 is slid to the distal end side with respect to the base portion 27. Thereby, the punch member 24 is pushed out, and the pressing portion 24a is moved in a direction intersecting (substantially orthogonal) to the extending direction of the arm plate portion 12, so that the arm plate portion 12 can be bent. Thereby, the holding | grip of the body tissue by the clip 1 can be cancelled | released.

  As described above, the arm plate portion 12 can be bent simply by inserting and arranging the support arm portions 21c and 21d between the pair of arm plate portions 11 and 12 of the clip 1 and pushing the pressing portion 24. Thus, the grasp of the body tissue by the clip 1 can be released. For this reason, the operation is very easy, and the clip 1 can be removed in a short time.

  In the operation portion, the base portion 27 and the slider portion 28 rotate as a unit in the rotational direction (the rotational direction around the axis of the sheath 22), so a pair of support of the pressing portion 24a of the punch member 24 and the die member 21 is supported. The relative posture in the rotation direction with the arms 21c and 21d is maintained to some extent. However, when the change in the relative posture becomes a problem, as shown in FIGS. 10 and 11, the punch member 24 is formed with a concave groove 24b in the direction along its axis, and the die member 21 What is necessary is just to provide the convex part 21f inserted in this concave groove 24b (free fitting) inside the all cylindrical part 21a. Thereby, the change of the relative attitude | position of the rotation direction of the press part 24a of the punch member 24 and a pair of support arm part 21c, 21d of the die member 21 can be prevented.

Second Embodiment Next, a second embodiment of the present invention will be described with reference to FIGS. In contrast to the first embodiment described above, the second embodiment changes the configuration of the die member and the punch member. In addition, the same number is attached | subjected about the substantially same component as 1st Embodiment mentioned above, and the description is abbreviate | omitted.

  That is, in the second embodiment, the punch member 34 is formed of a substantially rectangular parallelepiped member, and the tip portion thereof is cut by two target slopes so that a pressing portion 34a forming a linear ridge line is formed. It has such a shape. The pressing portion 34 a is a portion that presses the arm plate portion 12 in order to bend the arm plate portion 12 of the clip 1.

  Note that the pressing portion 34a of the punch member 34 does not have to be linear, and may be a concave shape or a concave arc shape, similar to the pressing portion 24a of the first embodiment described above.

  The punch member 34 is moved in the sheath 22 along the axial direction in the sheath 22, so that the punch member 34 is pulled into the sheath 22 and protrudes from the distal end of the sheath 22. It is possible to move (slide) so as to be in the state. As the punch member 34, a metal such as stainless steel can be used. The base end of the punch member 34 is fixed to the distal end of the drive wire 23 by welding or the like.

  The die member 31 is a member that abuts from the side opposite to the punch member 34 across the arm plate portion 12 at a position different from the abutting position by the punch member 34 in the extending direction of the arm plate portion 12. The die member 31 has a rectangular cylindrical portion 31a, a plate-like portion 31b, and a pair of support arm portions 31c and 31d. The support arm portions 31 c and 31 d are portions that come into contact with different positions in the extending direction of the arm plate portion 12.

  In the die member 31, the base end portion of the rectangular tube portion 31 a is fixed to the distal end of the sheath 22. The support arm portions 31c and 31d are portions that support the arm plate portion 12 at two points when being pressed by the pressing portion 34a in order to bend the arm plate portion 12 of the clip 1. As the die member 31, one made of a metal such as stainless steel can be used. The die member 31 can be fixed to the sheath 22 by, for example, welding. Others are the same as in the first embodiment described above.

  In the present embodiment, since the punch member 34 slides along the rectangular tube portion 31a, the pressing portion 34a of the punch member 34 and the punch member 34 can be separated from each other without using a rotation prevention mechanism as shown in FIGS. A change in the relative posture of the die member 31 in the rotation direction with the pair of support arm portions 31c and 31d can be prevented.

Third Embodiment Next, a third embodiment of the present invention will be described with reference to FIGS. In these figures, 41 is a die member and 44 is a punch member. The punch member 44 includes a shaft support portion 44a, a wire attachment portion 44b, and an arm portion 44c. The arm portion 44c has a substantially triangular cross section, and the ridge line portion of the arm portion 44c serves as a pressing portion 44d. The die member 41 includes a shaft support portion 41a, a wire attachment portion 41b, and a pair of arm portions 41c and 41d. The arms 41c and 41d have a substantially triangular cross section, and the ridges of the arms 41c and 41d are pressing portions 41e and 41f.

  The punch member 44 has a shaft support portion 44 a rotatably supported on the shaft support portion 41 a of the die member 41 via a rotation shaft 45. For this reason, as shown in FIG. 14, the arm part 44c of the punch member 44 and the arm parts 41c and 41d of the die member 41 can be rotated so as to be separated from each other. Further, as shown in FIG. 15, the arm portion 44 c of the punch member 44 may be rotated so as to enter a portion between the arm portions 41 c and 41 d of the die member 41.

  Although not shown, the rotating shaft 45 is supported by a fixing member provided at the distal end of the sheath (see the sheath 22 in FIG. 3). The wire attachment portion 44b of the punch member 44 and the wire attachment portion 41b of the die member 41 are inserted into the sheath 22 so as to be movable in the axial direction via a pair of flexible sub wires (see FIG. 3 drive wires 23).

  The punch member 44 is operated by operating an operation portion (see the base portion 27, the slider portion 28, etc. in FIG. 3) provided at the proximal end of the sheath and moving the main wire along the axial direction with respect to the sheath. The arm portion 44c and the arm portions 41c and 41d of the die member 41 can be opened and closed.

  When removing the clip 1 placed in the body, the arm portions 41c and 41d of the die member 41 are inserted and disposed between the arm plate portions 11 and 12 of the clip 1, and the arm portion 44c of the punch member 44 is inserted. And the arm portions 41c and 41d of the die member 41 may be operated so as to close (close to each other). Thereby, one arm plate part (12) to be bent of the clip 1 is sandwiched, and the arm part 44c of the punch member 44 enters the portion between the arm parts 41c and 41d of the die member 41, and the arm plate part 12 can be bent to release the grip of the clip 1 from the living tissue.

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

DESCRIPTION OF SYMBOLS 1 ... Endoscope clip 11, 12 ... Arm board part (arm part)
DESCRIPTION OF SYMBOLS 13 ... Connection board part 14 ... Fastening ring 2 ... Clip removal apparatus 21 ... Die member (1st member)
21a ... All cylindrical parts 21b ... Partial cylindrical parts 21c, 21d ... Support arm parts (support parts)
21e ... Notch 22 ... Sheath (movement mechanism)
23 ... Driving wire (moving mechanism)
24 ... Punch member (second member)
24a ... Pressing part 27 ... Base part (operation part, moving mechanism)
28 ... Slider part (operation part, moving mechanism)

Claims (3)

A clip detaching device that removes a clip placed in the body in a state where the distal ends of the pair of arm parts are close to each other and grips the body tissue, from the outside of the body,
A first member that can be inserted and disposed in a portion between the pair of arm portions;
In a state where the first member is inserted and arranged in a portion between the pair of arm portions, the arm portion is sandwiched between one arm portion at a position different from the first member in one extending direction of the arm portion. A second member disposed on the opposite side of the first member;
And a moving mechanism that moves at least one of the first member and the second member in a direction intersecting with one extending direction of the arm portion. One of the first member and the second member has a pair of support portions that can come into contact with each other at different positions in one extending direction of the arm portion,
2. The clip holder according to claim 1, wherein the other of the first member and the second member is disposed in a portion between the pair of support portions in one extending direction of the arm portion. External device. The moving mechanism is
A tubular sheath;
A wire inserted movably along the axial direction with respect to the sheath;
An operation portion provided at a proximal end of the sheath for moving the wire along the axial direction in the sheath;
One of the first member and the second member is provided at a distal end of the sheath;
The clip removing device according to claim 1 or 2, wherein the other of the first member and the second member is connected to a distal end of the wire.

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