JP2019162259A - Endoscopic traction clip - Google Patents

Abstract

To provide an endoscopic traction clip capable of reducing cost required for treatment.SOLUTION: An endoscopic traction clip 1 has: a clip body 2 having a pair of arm parts 22 arranged with a tip side open-legged while an external force does not act, and a tightening ring 24 externally fitted to a connecting plate part 21 of the base end side of the arm parts 22, and making the arm parts 22 close legs by sliding them to the tip side; an ended circular member 4 with a loop part 41 formed so that a portion 41a of one end 4a side and a portion 41b of the other end 4b side of an elastic wire rod may come close or come in abutment with each other in a separable manner from the side, while the external force does not act; and a traction spring 3 where one end is connected to the clip body 2, and the other end is connected to the ended circular member 4.SELECTED DRAWING: Figure 1A

Description

  The present invention relates to an endoscope pulling clip that is used to pull a part of a body tissue by being inserted into a body using an endoscope.

  In endoscopic submucosal dissection (ESD), in order to facilitate excision of lesions and improve certainty, the excised lesions continue when a part of the lesion is incised and removed. In some cases, a technique of incising the entire lesioned part while applying a traction force to the lesioned part in advance and lifting the detached lesioned part may be performed so as not to interfere with the incision performed. As endoscope clips used for such procedures, for example, traction clips (lifting clips, spring-loaded clips) as described in Patent Document 1 and Patent Document 2 are known.

  The lifting clip described in Patent Document 1 includes a clip having a pair of gripping claws (claws), an elastic member made of string-like rubber, and a ring-shaped member (engaging member). Has been. One end of the elastic member is connected to the base portion of the clip via a string-like connecting member, and a ring-shaped member is attached to the other end of the elastic member.

  When excising the lesioned part, grip the part of the lesioned part with a tow clip, and use a pair of claws on another clip (a normal clip that does not have an elastic member or ring-shaped member). In the meantime, the ring-shaped member is scooped up and the elastic member is elastically deformed (stretched), and a part of the mucous membrane (for example, a part of the mucous membrane facing the lesioned part) is gripped by the other clip. As a result, a traction force acts on the lesion part by the elastic force (tension) of the elastic member, so that the lesion part peeled off by the incision is lifted. Therefore, the surgical field can be secured without the visual field being obstructed by the peeled lesion part, so that the entire circumference of the lesion part can be incised easily and reliably.

  Although details of the ring-shaped member are not specifically described in Patent Document 1, in order to collect a lesioned part after incision, a thinness that can be easily cut by a loop cutter (endoscopic forceps), etc. There is a description that the material is desirable. Further, Patent Document 2 describes that a surgical suture can be used as a string member corresponding to a ring-shaped member.

  Conventionally, cutting of a ring-shaped member is performed by inserting a cutting instrument such as an endoscopic scissors forceps or an electric scalpel for an endoscope through a treatment instrument guide tube of the endoscope. However, it is not preferable to separately prepare a cutting instrument that is used only for cutting a ring-shaped member such as an endoscopic scissors forceps because the cost for the treatment increases. In addition, the cutting of the ring-shaped member with the electric knife for endoscope is not preferable because there is a possibility that the body tissue adjacent to the ring-shaped member may be injured unexpectedly.

Japanese Patent Laid-Open No. 2008-62004 JP2015-192726A

  This invention is made in view of such a point, and it aims at providing the traction clip for endoscopes which does not need to prepare a cutting instrument separately and can reduce the cost which a treatment requires. To do.

The endoscope pulling clip according to the present invention includes:
Tightening that is externally fitted to a pair of arm parts that are arranged with the front end opened with no external force applied, and a connecting part on the base end side of the arm part, and that closes the arm part by sliding to the front end side A clip body having a ring;
In a state where no external force is applied, a part of one end side of the elastic wire and a part on the other end side are formed so as to come close to or come into contact with each other (including pressure contact) so that they can be separated from each other. An end ring member;
A traction spring having one end connected to the clip body and the other end connected to the end ring member.

  In the following, for the sake of simplicity, a part formed so that a part on one end side and a part on the other end side of the elastic wire are separated from each other so as to be separated from each other or contact each other is referred to as an overlapping part. There is a case.

  For example, when excising a lesioned part using the endoscope pulling clip according to the present invention, a part of the lesioned part is clipped by a clip body using a clip device (detailed later), One end of the pair of arms of another clip (a normal clip that does not have a traction spring or an end ring-shaped member) is lifted up and the traction spring is elastically deformed (stretched) ), Clipping the other clip to a part of the mucous membrane (for example, a part of the mucous membrane facing the lesion). Thereby, the traction force acts on the lesioned part by the elastic force (tension) of the elastic member, and the lesioned part peeled off by the incision is lifted, so that the field of view can be secured without being blocked by the peeled lesioned part, The entire circumference of the lesion can be incised easily and reliably.

  After incision of the lesioned part, a part of the end ring-shaped member (a part other than the overlapping part) is gripped using, for example, a clip device used for clipping the clip body. And a part of one arm part of the other clip passed through the end ring-shaped member passes through between the overlapping parts of the end ring-shaped member while elastically deforming them, and the end ring-shaped By changing and adjusting the position and orientation of the member, the end ring-shaped member can be removed from the other clip. Therefore, unlike the prior art, it is not necessary to prepare a separate cutting instrument for cutting the ring-shaped member, and the cost required for the treatment can be reduced.

Drawing 1A is a figure showing the whole composition in the state where the arm part of the clip main part of the pulling clip for endoscopes of the embodiment of the present invention was opened. FIG. 1B is a diagram showing the clip body constituting the pulling clip of FIG. 1A with the orientation changed. FIG. 1C is a diagram showing a state where the arm portion of the clip body of the pulling clip of FIG. 1A is closed. 2A is a view showing a coil spring of the traction clip of FIG. 1A. FIG. 2B is a view of the coil spring of FIG. 2A as viewed from the end ring-shaped member mounting side. FIG. 3A is a plan view of an end ring member of the pulling clip of FIG. 1A. FIG. 3B is a front view of FIG. 3A. FIG. 4A is a plan view showing a modification of the end ring-shaped member of FIG. 3A. 4B is a plan view showing another modification of the end ring-shaped member of FIG. 3A. FIG. 4C is a plan view showing still another modified example of the end ring-shaped member of FIG. 3A. FIG. 4D is a front view of FIG. 4C. FIG. 4E is a plan view showing still another modified example of the end ring-shaped member of FIG. 3A. FIG. 4F is a front view of FIG. 4E. FIG. 5A is a diagram illustrating an appearance of the clip device. 5B is a cross-sectional view taken along line Vb-Vb in FIG. 5A. FIG. 5C is a perspective view showing a configuration of an opening / closing hook and its vicinity of the clip device of FIG. 5A. FIG. 6A is a diagram illustrating a state in which the pulling clip of FIG. 1A is protruded from the tip of the clip device. FIG. 6B is a diagram showing a state in which the tow clip of FIG. 1A is stored at the tip of the clip device. FIG. 7A is a diagram schematically illustrating a state in which a part of a lesioned part is incised while the lesioned part is pulled using the pulling clip of FIG. 1A. FIG. 7B is a diagram schematically illustrating a state in which the incision of the continuation of the lesioned part of FIG. 7A is completed and the distal end of the clip device is brought close to remove the end ring member. FIG. 8A is a diagram illustrating a process of removing the end ring-shaped member of the tow clip of FIG. 1A, and shows a state in which the tip of the clip device is arranged in the vicinity of the end ring-shaped member and the open / close hook is opened. It is. FIG. 8B is a diagram showing a continuation process of FIG. 8A, and shows a state in which the sheath is pushed out to close the open / close hook and a part of the end ring-shaped member is gripped by the open / close hook. FIG. 8C is a diagram showing a continuation process of FIG. 8B, where the position and posture of the clip device that grips a part of the end ring-shaped member is appropriately changed and adjusted, and the arm portion of the other clip is in the end ring shape. It is a figure which shows a mode that it pushes and spreads between the duplication parts of a member, and enters between these duplication parts. FIG. 8D is a diagram showing a continuation process of FIG. 8C, where the position and posture of the clip device that holds a part of the end ring-shaped member is appropriately changed and adjusted, and the arm portions of the other clips are in the end ring-shape. It is a figure which shows a mode that it pushes and spreads between the duplication parts of a member, and is moving between the duplication parts. FIG. 8E is a diagram showing a continuation process of FIG. 8D, where the position and posture of the clip device that holds a part of the end ring-shaped member is appropriately changed and adjusted so that the arm portion of the other clip is a ring end. It is a figure which shows a mode that the end ring-shaped member was removed from the arm part after passing through the duplication part of a member.

  Embodiments of the present invention will be specifically described below with reference to the drawings. As shown in FIGS. 1A and 1B, the endoscope pulling clip 1 according to the present embodiment includes a clip body 2, a coil spring 3, and an end ring member 4. 2 is a clip with a spring that uses a coil spring 3 as a traction spring that connects the end member 2 and the end ring member 4.

  The clip body 2 includes a connecting plate portion (connecting portion) 21, a pair of arm portions 22, and a tightening ring 24. The connecting plate portion 21 has a shape that is bent into a substantially U shape, and is continuous with each end portion of the U shape so that the distal end side is opened in a substantially V shape without external force acting. The arm portion 22 is integrally formed.

  The fastening ring 24 is a member formed in a ring shape that is slidably fitted to the connecting plate portion 21 on the proximal end side of the arm portion 22. The fastening ring 24 is disposed so as to be movable forward and backward with respect to the inner sheath 52 and the inner sheath 52, and has a clip device 5 having an opening / closing hook 51 that is detachably connected to the connecting plate portion 21 (see FIGS. 5A to 5C, details). And a member to be slid. The tightening ring 24 is pushed and slid at the distal end portion of the inner sheath 52 by pulling the open / close hook 51 from the distal end portion of the inner sheath 52 in a state where the open / close hook 51 is coupled to the coupling plate portion 21. The part 22 is closed.

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

  The connecting plate portion 21, the pair of arm portions 22, and the pair of claw portions 23 constituting the clip body 2 are formed by bending a thin and long plate member. Although the plate | board thickness of the board | plate material which comprises the clip main body 2 is not specifically limited, Preferably it is 0.10-0.30 mm. As the plate material, a plate material having elasticity is preferable, and for example, stainless steel is used.

  As shown in FIG. 1B, each of the arm portions 22 has a base end portion 22a and a grip portion 22b. A penetrating portion 22 c is formed in the grip portion 22 b of each arm portion 22. These penetration parts 22c are formed without impairing the desired strength of the arm part 22 (gripping part 22b). These penetrating portions 22 c are formed from the viewpoint of adjusting elasticity (repulsive force) when the arm portion 22 is closed by the tightening ring 24. One of these penetrating portions 22 c is used to connect the coil spring 3 to the clip body 2, as will be described in detail later.

  A tightening ring 24 is slidably fitted into the connecting plate portion 21. The fastening ring 24 is composed of a substantially cylindrical ring member. However, the tightening ring 24 may be configured by a spring formed by winding a wire rod in a coil shape. The fastening ring 24 is inserted into the guide hole on the inner side thereof, and the connecting plate portion 21 is inserted therein, so that it can move (slide) in the axial direction between the outer periphery of the connecting plate portion 21 and the outer periphery of the base end portion 22a of the arm portion 22. Attached (externally fitted). The material of the tightening ring 24 is preferably a metal, for example, stainless steel.

  As shown in FIG. 1A or FIG. 1B, when the tightening ring 24 is disposed closer to the rear (the connecting plate portion 21), the arm portion 22 is opened (opened) by its own elasticity. If necessary, as shown in FIG. 1C, the arm portion 22 is closed (closed leg) by moving (sliding) the tightening ring 24 to a position closer to the distal end (base end portion 22a). )) State.

  The coil spring 3 is a tension coil spring formed by winding a metal wire such as stainless steel. As shown in FIGS. 2A and 2B, the coil spring 3 includes a clip hook portion 32 that is connected to the clip body 2 at one end of a body portion 31 formed by winding a metal wire. The other end has a hook portion 33 for the end ring-shaped member for mounting (attaching) the end ring-shaped member 4. The clip hook portion 32 has a portion corresponding to approximately one turn (may be one turn or more) of one end of a metal strand (main body portion 31) wound in a substantially cylindrical shape. It is formed by being bent at approximately 90 degrees with respect to a plane orthogonal to the axis of. Alternatively, the clip hook portion 32 may be separately prepared and welded to one end of a wound metal wire.

  The end ring-shaped member hook portion 33 is formed by bending a part of the other end of the main body portion 31 inward so as to draw a substantially D-shape and forming it in a straight line. From the viewpoint of preventing the end ring-shaped member 4 from coming off when the end portion 33a of the end ring-shaped member hook section 33 formed in a straight line is connected to the end ring-shaped member 4 described later. It is preferable to reach to the wound metal strand (main body portion 31) as shown in FIG. However, when the end ring-shaped member 4 is connected and fixed by bonding or the like, the tip of the linear portion formed into the linear shape does not reach the wound metal wire (main body portion 31). Also good.

  As shown in FIGS. 3A and 3B, the end ring-shaped member 4 is a member that is attached to a part of the clip body 2 via the coil spring 3, and a part of the end ring-like member 4 is opened and closed by the opening / closing hook 51 of the clip device 5. Are provided with a loop portion 41 formed in an end loop shape that can be gripped (connectable), and an adapter portion 42 for connecting to the coil spring 3.

  The loop part 41 of the end ring-shaped member 4 is a member having a shape similar to that of a station clip, and a part 41a on the one end 4a side and the other end of an elastic wire (elementary wire) in a state where no external force is applied. A part 41b on the 4b side is a member formed so as to be close to or in contact (including pressure contact) so as to be separated from the side in opposite directions. In the following, for the sake of simplicity, a part of one end 4a side and a part of the other end 4b side of the wire rod having elasticity of the end ring member 4 are formed so as to be close to or in contact with each other so as to be separated from each other. The part which was made is called the overlapping part 41a, 41b, the part on the one end 4a side of the wire may be called the one end side overlapping part 41a, and the part on the other end 4b side may be called the other end side overlapping part 41b. .

  In the present embodiment, the loop portion 41 of the end ring-shaped member 4 has a substantially oval shape in which semicircular arc portions are arranged at both ends of the pair of linear portions, and the overlapping portions 41a and 41b are formed of the pair of linear portions. It is provided in one part of one of the straight portions. Note that the overlapping portions 41a and 41b may be provided on the entire one of the pair of linear portions, or part or all of the overlapping portions 41a and 41b may be provided on the semicircular arc portion. .

  In the present embodiment, the one end side overlapping portion 41a reaches the one end 4a, the other end side overlapping portion 41b does not reach the other end 4b, and the other end 4b side is further different from the other end side overlapping portion 41b. The end-side overlapping portion 41b extends continuously in a straight line. In addition, the part of the other end 4b side further than the other end side overlapping part 41b may be provided along a part of a corresponding semicircular arc part as a circular arc shape instead of a linear shape. Further, the other end side 4b side may be omitted from the other end side overlapping portion 41b, that is, the other end side overlapping portion 41b may reach the other end 4b.

  In this embodiment, the one end side overlapping portion 41a and the other end side overlapping portion 41b are in contact with each other (including pressure contact), but as shown in FIG. 4A, they are close to each other, that is, slightly separated from each other. You may do it. Further, as shown in FIG. 4B, the guide portion is bent by folding the portion on the one end 4a side further than the one end side overlapping portion 41a without reaching the one end side overlapping portion 41a to the one end 4a. It may be formed. By providing the guide portion, the arm portion of the clip can easily enter between the overlapping portions 41a and 41b, and the removal work from the clip (detailed later) can be easily performed.

  Further, in the present embodiment, the one end side overlapping portion 41a and the other end side overlapping portion 41b are in contact with each other as shown in FIGS. 3A and 3B, that is, in a direction parallel to the paper surface in FIG. 3A ( (Vertical direction) from the side in the direction orthogonal to the paper surface in FIG. 3B, but from the side as shown in FIGS. 4C and 4D, that is, orthogonal to the paper surface in FIG. 4C. The direction may be abutted from the side in a direction (vertical direction) parallel to the paper surface in FIG. 4D. Furthermore, these may be contacted in an oblique direction.

  The loop portion 41 is flexible enough to be housed in the distal end portion of the outer sheath 54 of the clip device 5 described later. In this embodiment, the cross-sectional shape of the loop portion 41 is a substantially circular shape that is uniform over the entire length, but the cross-sectional shape of the loop portion 41 is an ellipse, an oval, a rectangle, or other polygons. There may be.

  Further, in the present embodiment, the shape of the loop portion 41 in plan view is a substantially oval shape, but may be an ellipse, a circle, a rectangle, or other polygons, and some of these may be used. It may be cut out and combined into two or more to form a substantially loop shape. For example, a semi-oval shape and a semi-elliptical shape that are bisected at the center in the major axis direction may be joined at their corresponding open ends.

  In this embodiment, the adapter portion 42 is a substantially rectangular plate-like portion formed integrally with the loop portion 41, and is formed with a spring through-hole 42a penetrating in a direction substantially perpendicular to the plate surface. The spring through hole 42a is a substantially circular hole into which the hook portion (straight portion) 33 for the end ring member of the coil spring 3 can be fitted. The inner diameter of the spring through-hole 42 a is set to a value that is equal to or slightly larger than the outer diameter of the end ring-shaped member hook part (straight line part) 33 of the coil spring 3.

  The end ring member 4 is connected to the coil spring 3 by connecting the end ring member hook part (straight line part) 33 of the coil spring 3 to the outside (in the direction in which the tip part 33a is separated from the end part of the main body part 31). Inserted so that the open end side of the adapter part 42 is positioned inside the coil spring 3 (main body part 31) while being elastically deformed and fitted (inserted) so as to pass through the spring through hole 42a of the adapter part 42. -Dispose and release the elastic deformation of the hook portion 33 for the end ring member. Thereby, the end ring-shaped member 4 is connected (attached) to the coil spring 3. As described above, the operation for connecting the adapter portion 42 to the coil spring 3 is easy, and the adapter portion 42 is also prevented from falling off the coil spring 3. In addition, in order to prevent the adapter part 42 from falling off from the coil spring 3 more reliably, a contact part between the hook part 33 for the end ring member and the spring through hole 42a of the adapter part 42b may be adhered. .

  In the present embodiment, the end ring-shaped member 4 is made of an injection molded product of a thermoplastic polymer material. However, the end ring-shaped member 4 may be formed of a metal such as stainless steel. When a thermoplastic polymer material is used as the material of the end ring member 4, specifically, a thermoplastic resin such as polypropylene, polyethylene, polyamide, polystyrene, or the like, a polyolefin-based elastomer, a polyamide-based elastomer, a polystyrene-based elastomer, or a polyurethane-based material. A thermoplastic elastomer such as an elastomer can be exemplified.

  The major axis (dimension in the major axis direction) of the loop part 41 is about 5 to 10 mm, the minor axis (dimension in the minor axis direction) is about 2 to 5 mm, and the diameter of the cross section of the loop part 41 is about 0.2 to 0.5 mm. can do. The diameter of the spring through hole 42a can be about 0.1 to 0.3 mm.

  In this embodiment, the adapter part 42 is formed by injection molding together with the loop part 41. However, the adapter part 42 may be configured as a separate member and fixed to the loop part 41 by adhesion or the like. Good. The adapter unit 42 may be omitted. In this case, as shown in FIGS. 4E and 4F, the substantially plate-shaped adapter member 34 having a through hole 34 a through which the loop portion 41 can be inserted (freely fitted) is connected to the end of the coil spring 3. The loop portion 41 can be connected to the coil spring 3 by being attached to the ring-shaped member hook portion 33 and inserting the loop portion 41 into the through hole 34a of the adapter member 34 (free fitting). Moreover, the looped portion 41 may be connected to the coil spring 3 by inserting the looped portion 41 into the ring-shaped member hook portion 33 of the coiled spring 3 in the same ring shape as the clip hooked portion 32. .

  The endoscope pulling clip 1 as described above is attached to and stored in the distal end portion (distal end portion) of the clip device 5 as shown in FIGS. 5A and 5B, for example. The parts (inner sheath 52 and outer sheath 54) are inserted into the treatment instrument guide tube of the endoscope and guided to the mucosa (living tissue) to be treated.

  As shown in FIG. 5A or 5B, the clip device 5 includes an opening / closing hook 51, an inner sheath 52, a drive wire 53, an outer sheath 54, a reinforcing coil 55, an outer sheath operating portion 56, an inner sheath operating portion 57, The wire operation unit 58 is generally provided.

  Similarly, a tubular inner sheath 52 is inserted through the tubular outer sheath 54, and a drive wire 53 is inserted through the inner sheath 52. The inner sheath 52 is slidable (slidable) within the outer sheath 54, and the drive wire 53 is slidable (slidable) within the inner sheath 52.

  The outer sheath 54 is formed of a flexible hollow tube, and a coil tube is used in this embodiment. As the coil tube, a flat wire coil tube formed by spirally winding a long flat plate made of metal (stainless steel) or the like can be used. However, a round wire coil tube or an inner flat coil tube may be used. The inner diameter of the outer sheath 54 is about 2.0 to 3.0 mm.

  The inner sheath 52 is made of a flexible hollow tube, and a wire tube is used in this embodiment. The wire tube is a tube made of a hollow stranded wire formed by spirally twisting a plurality of wires (cables) made of, for example, metal (stainless steel) or the like. In addition, as the inner sheath 52, a wire tube may be mainly used, and only a part on the tip side may be a coil tube. The inner diameter of the inner sheath 52 is about 1.5 to 2.5 mm.

  The drive wire 53 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, a wire tube similar to the inner sheath 52 may be used as the drive wire 53.

  As shown in FIG. 5C, the opening / closing hook 51 disposed at the sheath distal end of the clip device 5 includes a pair of arm portions 51a and 51a made of an elastic body disposed in a substantially V shape toward the distal end. And in cooperation with the inner sheath 52, it can take two states, an open leg (open) state and a closed leg (closed) state. Claw portions 51b and 51b are formed at the front end portions of the pair of arm portions 51a and 51a of the opening / closing hook 51 by being bent inwardly (sides facing each other), and grip the connection portion 21 of the clip body 2. Can be connected.

  The base end portion of the opening / closing hook 51 is a U-shaped portion 51c formed in a substantially U shape continuously to the base end portions of the pair of arm portions 51a, 51a. The pair of arm portions 51a and 51a and the U-shaped portion 51c including the claw portions 51b and 51b can be formed by appropriately bending (plastically deforming) one elongated plate made of an elastic body. Although not particularly limited, the thickness of the plate material constituting the opening / closing hook 51 is about 0.20 to 0.24 mm, and the width is about 0.6 mm. As the plate material, for example, stainless steel is used.

  An annular member 53a formed in a substantially annular shape is integrally fixed to the tip (distal end) of the drive wire 53 slidably inserted into the inner sheath 52 by laser welding or the like. The outer diameter of the annular member 53a is about 1.2 mm, and the inner diameter is about 0.8 to 1.0 mm.

  The opening / closing hook 51 is inserted into the annular member 53a and is disposed so that the U-shaped portion 51c is loosely fitted to the annular member 53a, so that the opening / closing hook 51 is swingably attached to the distal end of the drive wire 53. . By attaching the opening / closing hook 51 to the tip of the drive wire 53 via such an annular member 53a and a U-shaped portion 51c loosely fitted to the annular member 53a, the opening / closing hook 51 is shown in FIG. It can be freely rotated in the a1 direction.

  Returning to FIGS. 5A and 5B, the vicinity of the proximal end (proximal end) side of the outer sheath 54 is inserted into the reinforcing coil 55 and is integrally fixed to the reinforcing coil 55. The reinforcing coil 55 is integrally fixed to the outer sheath operating portion 56, and the distal end side portion of the inner sheath operating portion 57 is inserted and arranged inside the outer sheath operating portion 56. The outer sheath operation unit 56 can be positioned between the position moved to the distal end (distal end) side and the two positions moved to the proximal end (proximal end) side with respect to the inner sheath operation unit 57. It can be slid.

  A wire operation unit 58 is slidably held by the inner sheath operation unit 57, and an inner sheath 52 is fixed to the inner sheath operation unit 57. The proximal end of the drive wire 53 is fixed to the wire operation unit 58.

  When the wire operation part 58 is slid to the distal end side (distal end side) with respect to the inner sheath operation part 57, the inner sheath 52 is drawn into the drive wire 53, and the opening / closing hook 51 at the distal end of the drive wire 53 is moved. It protrudes from the tip of the inner sheath 52 and opens with its own elasticity. When the wire operation portion 58 is slid to the proximal end side (proximal end side) with respect to the inner sheath operation portion 57, the drive wire 53 is drawn into the inner sheath 52, and the opening / closing hook 51 at the distal end of the drive wire 53. While entering the inner sheath 52, the legs are gradually closed and buried in the inner sheath 52 so that the legs are completely closed.

  When the outer sheath operating portion 56 is slid to the position on the proximal end side with respect to the inner sheath operating portion 57, the inner sheath 52 can be protruded from the distal end of the outer sheath 54, and conversely, the outer sheath operating portion 56 is moved to the inner sheath. By sliding to the position on the distal end side with respect to the operation portion 57, the distal end of the inner sheath 52 can be stored (embedded) in the outer sheath 54.

  Next, a method of using the endoscope pulling clip 1 will be described with reference to FIGS. 6A, 6B, 7A, 7B, and 8A to 8E.

  In the clip body 2, in the state where the fastening ring 24 is fitted on the outer periphery of the connection plate portion 21 near the base end portion 22 a, a connection hole 25 is formed in the connection plate portion 21 having a U-shaped cross section (see FIG. 1A, see FIG. 6A). The opening / closing hook 51 of the clip device 5 shown in FIG. 5A is engaged with the connecting hole 25 and the opening / closing hook 51 is pulled into the inner sheath 52, whereby the opening / closing hook 51 is closed and the endoscope pulling clip 1. The clip body 2 is attached to the tip of the inner sheath 52 (see FIG. 6A).

  In this state, the distal end portion of the inner sheath 52 to which the endoscope pulling clip 1 (the clip body 2, the coil spring 3, and the end ring member 4) is connected is drawn into the outer sheath 54, and is shown in FIG. 6B. As described above, the entire endoscope pulling clip 1 (the clip body 2, the coil spring 3, and the end ring member 4) is housed inside the distal end portion of the outer sheath 54.

  In this state, the tightening ring 24 of the clip body 2 remains positioned on the connecting plate portion 21, and the arm portion 22 is closed by the action of the inner wall of the outer sheath 54. Further, the loop portion 41 of the end ring-shaped member 4 is housed in the outer sheath 54 in an elastically deformed state by the action of the inner wall of the outer sheath 54.

  The distal end portion of the sheath portion of the clip device 5 to which the endoscope pulling clip 1 is attached should be subjected to excision (peeling) treatment through a treatment instrument guide tube of an endoscope (not shown) inserted into the body. Located in the vicinity of the mucous membrane. Next, the outer sheath 54 is slid to the proximal end side, thereby causing the endoscope pulling clip 1 to protrude from the distal end of the outer sheath 54. As a result, as shown in FIG. 6A, the arm portion 22 is in a state of being opened by its own elasticity, and the loop portion 41 of the end ring member 4 is restored to its original shape by its own elasticity.

  Reference is now made to FIG. The clip main body 2 is positioned so that a site (lesion) X to be excised (separated) from the mucous membrane exists between the pair of arm portions 22 in a state where the arm portion 22 is opened. Next, the inner ring 52 is slid toward the distal end side with respect to the drive wire 53, so that the tightening ring 24 is slid toward the distal end side of the arm portion 22. As a result, the arm portion 22 is gradually closed (approached to each other), and the mucous membrane on one side and the mucous membrane on the other side are pulled together with the lesioned portion X interposed therebetween.

  By further sliding the inner sheath 52 toward the distal end side with respect to the drive wire 53, the tightening ring 24 moves to the grip portion 22b side of the arm portion 22 (see FIG. 1C), and the endoscope pull clip 1 (clip body) Grasping of the lesioned part X according to 2) is completed. In this state, the inner sheath 52 is slid to the proximal end side with respect to the drive wire 53, whereby the opening / closing hook 51 is pushed out from the distal end of the inner sheath 52 to open the leg, and the endoscope pulling clip 1 ( The grip (engagement) of the clip body 2) by the opening / closing hook 51 is released, and the clipping of the lesion X of the endoscope pull clip 1 (clip body 2) is completed.

  Next, after removing the clip device 5 from the endoscope, another clip (ordinary clip) 7 prepared separately was prepared separately with the clip device 5 (or the same configuration as the clip device 5). The clip device 5 is attached to the distal end portion of the clip device 5 and the distal end portion of the sheath portion of the clip device 5 to which the normal clip 7 is attached is transported to the vicinity of an appropriate portion (opposing portion) Y that faces (opposite) the lesioned portion X. To do. In addition, as a normal clip 7, the clip of the structure similar to the clip main body 2 which removed the coil spring 3 and the end ring-shaped member 4 from the endoscope pulling clip 1 shown to FIG. 1A-FIG. 1C can be used. .

  Next, the loop portion 41 of the end ring member 4 is scooped up on one of the pair of arm portions 72 of the normal clip 7 (a part of the loop portion 41 is positioned between the pair of arm portions 72), While the coil spring 3 is stretched, the normal clip 7 is clipped to the facing portion Y in the same manner as the above-described gripping of the lesion X by the clip body 2. As a result, the lesioned part X is pulled (lifted) by the elastic force (tension) of the coil spring 3. After this state, the endoscope electric scalpel 8 is inserted through the treatment instrument guide tube of the endoscope, and the outer periphery of the lesion X is incised using the electric scalpel 8 for endoscope. Since the lesioned part X is lifted by the elastic force (tension) of the coil spring 3 from the part peeled off by the incision, the part peeled off by the incision of the lesioned part X does not obstruct the view or disturb the procedure. The entire circumference of the lesion X can be easily and reliably incised.

  When the excision of the lesioned part X is completed, as shown in FIG. 7B, after the electric scalpel 8 for endoscope is removed from the endoscope, the clip is not attached (connected). The distal end portion of the device 5 (or a separately prepared clip device having the same configuration as that of the clip device 5) is positioned in the vicinity of the loop portion 41 of the end ring member 4, and the opening / closing hook 51 is moved from the distal end of the inner sheath 52. Protrude and open legs. In this state, as shown in FIG. 8A, an appropriate part of the loop part 41 (a part other than the overlapping parts 41a and 41b, for example, a part of the linear part facing the overlapping parts 41a and 41b). The position is adjusted so that it can be gripped.

  Next, as shown in FIG. 8B, the inner sheath 52 is pushed out toward the distal end side with respect to the drive wire 53, the opening / closing hook 51 is closed, and a part of the loop portion 41 is gripped by the opening / closing hook 51. The loop portion 41 is brought into contact with the tip of the inner sheath 52. As a result, the loop portion 41 is connected (attached) to the distal end of the inner sheath 52.

  From this state, as shown in FIG. 8C, the position of the distal end of the inner sheath 52 with respect to a portion 72 a passed through the loop portion 41 of one arm portion 72 of the normal clip 7. Then, by appropriately changing and adjusting the posture, the portion 72a of the arm portion 72 enters the portion of the loop portion 41 between the one end side overlapping portion 41a and the other end side overlapping portion 41b while elastically deforming them. To. Next, as shown in FIG. 8D, the distal end portion of the inner sheath 52 is moved so that a portion 72a of the arm portion 72 passes between the overlapping portions 41a and 41b, and all of them are passed. Thus, as shown in FIG. 8E, the loop portion 41 is separated from the arm portion 72, that is, the endoscope pulling clip 1 including the end ring-shaped member 4 is detached from the normal clip 7.

  As a result, the lesioned part X can be extracted outside the body together with the endoscope pulling clip 1 removed from the normal clip 7, so that the clip device 5 or a separately prepared endoscope grip This can be removed outside the body using forceps or the like.

  The end ring-shaped member 4 (loop portion 41) of the endoscope pulling clip 1 according to the above-described embodiment is provided with the clip device 5 that slides the tightening ring 24 to close the pair of arm portions 22 of the clip body 2. Therefore, it is not necessary to separately prepare a cutting instrument such as an endoscopic scissors forceps or an endoscopic scalpel in order to cut the end ring-shaped member 4. Therefore, it is not necessary to separately prepare a cutting instrument used only for cutting the end ring-shaped member 4 such as the scissors forceps for endoscope, and the cost can be reduced. In addition, it is possible to avoid the use of a cutting instrument that may injure a body tissue such as an electric scalpel for an endoscope unexpectedly. Moreover, since the end ring-shaped member 4 of the pulling clip 1 for an endoscope according to the above-described embodiment integrally includes a loop portion 41 and an adapter portion 42, an adapter as described in Patent Document 2 is used. There is no need to use a separate member, and the configuration is simple.

  Although not shown in the figure, for example, in FIG. 7A, when the operator wishes to change the pulling direction of the lesioned part X in the middle of the incision of the lesioned part X or before starting the incision, This can be done with the following procedure. That is, another clip similar to the normal clip 7 is clipped to an appropriate position separated from the normal clip 7. Then, after removing the loop portion 41 from the normal clip 7 by the above procedure shown in FIGS. 8A to 8E, the overlapping portion of the loop portion 41 is performed by a procedure reverse to the above procedure shown in FIGS. 8A to 8E. By passing the arm portion of the another clip while elastically deforming between 41a and 41b, the endoscope pulling clip 1 can be connected to the other clip. Thereby, the pulling direction and pulling force by the pulling clip 1 for endoscope can be changed.

  In particular, in the above-described embodiment, as shown in FIG. 3A, for example, the loop portion 41 has a portion on the other end 4b side continuous with the other end side overlapping portion 41b from the other end side overlapping portion 41b. The loop portion 41 is gradually separated from the arc-shaped portion that continues to the one end-side overlap portion 41a of the loop portion 41. Therefore, when connecting to the other clip, this separated portion is used as a guide portion. Part of the arm portion can be inserted into the overlapping portions 41a and 41b. Therefore, it is possible to easily perform the connecting operation for the another clip.

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

DESCRIPTION OF SYMBOLS 1 ... Endo pulling clip 2 ... Clip main body 21 ... Connection board part (connection part)
DESCRIPTION OF SYMBOLS 22 ... Arm part 22a ... Base end part 22b ... Grasp part 22c ... Through part 23 ... Claw part 24 ... Fastening ring 25 ... Connection hole 3 ... Coil spring (traction spring)
DESCRIPTION OF SYMBOLS 31 ... Main-body part 32 ... Clip hook part 33 ... Ended ring-shaped member hook part 33a ... End part 34 ... Adapter member 34a ... Through-hole 4 ... Ended ring-shaped member 4a ... One end 4b ... Other end 41 ... Loop part 41a ... One end overlapping part (overlapping part)
41b ... other end side overlapping portion (overlapping portion)
DESCRIPTION OF SYMBOLS 42 ... Adapter part 42a ... Spring through-hole 5 ... Clip apparatus 51 ... Opening / closing hook 51a ... Arm part 51b ... Claw part 51c ... U-shaped part 52 ... Inner sheath 53 ... Driving wire 53a ... Ring member 54 ... Outer sheath 55 ... Reinforcing coil 56 ... Outer sheath operating part 57 ... Inner sheath operating part 58 ... Wire operating part 7 ... Normal clip 72 ... Arm part 72a ... Part of arm part 8 ... Endoscopic electrosurgical knife X ... Lesion part Y ... Opposite part

Claims (1)

Tightening that is externally fitted to a pair of arm parts that are arranged with the front end opened with no external force applied, and a connecting part on the base end side of the arm part, and that closes the arm part by sliding to the front end side A clip body having a ring;
In a state where no external force is applied, a part of one end side of the elastic wire and a part on the other end side are formed so as to be close to or abutting from each other so as to be separated from each other,
A traction clip for an endoscope, comprising: a traction spring having one end connected to the clip body and the other end connected to the end ring-shaped member.

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