JP2019177054A - Placement clip within living body - Google Patents

Abstract

To provide a placement clip within a living body capable of easily increasing a contact area of a fluorescent material to a lumen organ inner wall, and allowing easily visual recognition of emission of the fluorescent material from the outside of the lumen organ.SOLUTION: A placement clip within a living body 1 comprises a clip body 2 comprising: a pair of arm plate parts 22 which are opened into an almost V-shape by resilience; a pawl part 23 formed on a tip part of each arm plate part 22; a fastening ring 24 attached to the arm plate parts 22 movably along a longitudinal direction of the pair of arm plate parts 22, the fastening ring being moved in a direction of the pawl parts 23 for closing the pair of arm plate parts 22. To the arm plate part 22, a fluorescent material 3 is coupled so as to swing freely, the fluorescent material including a fluorescent dye for emitting red light or near infrared light by radiation of excitation ray.SELECTED DRAWING: Figure 1

Description

  The present invention relates to an in-vivo indwelling clip that can be inserted into a lumen using an endoscope, for example, and can be used as a marker whose position is visible from the outside of the lumen.

  In general, diseases such as cancer of the digestive tract such as the esophagus, stomach, and large intestine mainly occur from the mucous membrane of the digestive tract and progress. Similarly, lung cancer arises primarily from the tracheal mucosa, and bladder cancer arises and progresses primarily from the bladder mucosa. Therefore, in order to confirm the diagnosis of diseases of luminal organs such as the digestive tract, trachea, and bladder, it is essential to insert an endoscope into the luminal organ, observe the mucosa, and biopsy the affected tissue. It has become. Based on the confirmed diagnosis, the affected tissue is surgically removed as necessary.

  However, in surgical resection, the surgeon approaches from the outside of the luminal organ, so the affected area cannot be directly seen. That is, under thoracotomy, laparoscopic surgery, or laparoscopic surgery, when the gastrointestinal tract, lung, or bladder is observed with the naked eye or laparoscope, it is not the mucosa that is visible, but the gastrointestinal serosal surface, tracheal serosal surface, bladder peritoneal surface It is. Therefore, it is necessary to attach a marker to the inside of the luminal organ so that the excision area can be determined even when observed from the outside of the luminal organ.

  As such a marker, there has been proposed a surgical marker composed of a light emitting body formed of an LED or a fluorescent light emitting substance that is placed in the vicinity of a clip to be locked to a mucous membrane in the body and emits near infrared light ( Patent Document 1).

  However, in the above-described surgical marker, the marker using the LED as the light emitter requires a power supply, so that the device configuration is complicated, and the marker can be passed through the treatment instrument guide tube of the endoscope. It is difficult to form a compact. Moreover, in the above-mentioned surgical markers, those using a luminescent material formed of a fluorescent luminescent substance are said to emit fluorescence by irradiating excitation light from the outside of the luminal organ, and emit fluorescence. However, the intensity of the fluorescence emitted to the outside (serosa side) of the luminal organ is weak, and it is practically difficult to visually recognize the luminescent site from the outside of the luminal organ. .

  In order to improve the disadvantages of the surgical marker as described above, Patent Document 2 includes a clip body having an arm portion and a cylindrical member fastened to the clip body so that the arm portion can be closed. There has been proposed a living body compression clip provided with a pressing portion including a fluorescent dye that compresses a mucous membrane (inner wall of a luminal organ) on a cylindrical member and emits red or near-infrared light. In this clip, since the pressing part containing the fluorescent dye is attached to the inner wall of the luminal organ while compressing the luminal organ wall, the fluorescence is attenuated when it passes through the luminal organ wall (especially hemoglobin contained in blood). As a result of being kept to a minimum, even when the fluorescence is observed from the outside of the luminal organ, it is said that the luminescent site can be seen well. However, in the clip shown in Patent Document 2, the cylindrical member (clamping ring) is provided with a pressing portion containing a fluorescent dye, so that the contact area of the pressing portion with the inner wall of the luminal organ is limited, and still outside the luminal organ. In some cases, it is difficult to visually recognize the light emitting part.

JP 2005-218680 A International Publication No. WO2015 / 182737

  The present invention has been made in view of the above points, and it is easy to increase the contact area of the phosphor to the inner wall of the luminal organ, and it is easy to visually recognize the luminescence from the outside of the luminal organ. An object is to provide an indwelling clip.

In vivo indwelling clip according to the present invention,
A pair of arm plates that elastically open in a substantially V shape;
A claw portion formed at each tip of the arm plate portion;
A clip having a fastening ring that is attached to the arm plate part so as to be movable along the longitudinal direction of the pair of arm plate parts, and that moves the pair of arm plate parts in the direction of the claws, thereby closing the pair of arm plate parts. An in vivo indwelling clip having a body,
At least one of the arm plate portions,
A phosphor containing a fluorescent dye that emits red or near-infrared light when irradiated with excitation light is connected in a freely swingable manner.

  The in-vivo indwelling clip of the present invention is transported into the luminal organ using, for example, an endoscope and a clip device, and attached to the inner wall of the luminal organ. At this time, since the phosphor is attached to the arm plate portion of the clip body so as to be swingable, the phosphor can be accommodated in a clip device or the like even if the phosphor is long. And if a part of the phosphor different from the part connected to the arm plate part of the clip body is gripped by another clip and attached to the inner wall of the luminal organ, the phosphor will be the luminal organ over its entire length. It will be pressed against the inner wall.

  Therefore, according to the in-vivo indwelling clip of the present invention, it is easy to increase the contact area of the phosphor with the inner wall of the luminal organ, and it is easy to visually recognize the luminescence from the outside of the luminal organ. Note that the light emission of the phosphor from the outside of the luminal organ may be visually recognized by image recognition using an imaging device such as a laparoscope or the like, depending on the wavelength of light.

  Preferably, one end of the phosphor is connected to the arm plate portion, and the other end of the phosphor is provided with an engaging member that can be engaged with another clip. By providing the engaging member on the phosphor, it becomes easy to hold the phosphor by another clip, and the mounting workability is improved.

  Preferably, one end of the phosphor is connected to a through hole formed in the arm plate portion. With this configuration, the phosphor can be easily attached to the arm plate so as to be swingable. The through hole preferably extends to the vicinity of the tip of the arm plate portion.

  Preferably, the tightening ring is made of metal. Since the fastening ring is made of metal, the fastening of the clip is rarely loosened, and the attachment stability of the clip is improved. The arm plate portion to which the tightening ring is attached is also preferably made of metal. Furthermore, the phosphor may be formed of a polymer material composition containing a fluorescent dye.

FIG. 1 is a perspective view showing an entire configuration in a state where an arm plate portion of an in-vivo indwelling clip according to an embodiment of the present invention is opened. FIG. 2A is a front view of the clip shown in FIG. 1 in a state where the arm plate portion is opened. FIG. 2B is a side view of the clip of FIG. 2A. FIG. 2C is a front view in a state where the arm plate portion of the clip shown in FIG. 1 is closed. FIG. 3A is a diagram illustrating an appearance of the clip device. 3B is a cross-sectional view taken along line IIIB-IIIB in FIG. 3A. 4A is a view showing a state in which the clip of FIG. 1 is protruded from the distal end of the clip device of FIG. 3A. 4B is a diagram illustrating a state in which the clip of FIG. 1 is accommodated in the distal end portion of the clip device of FIG. 3A. FIG. 5A is a diagram schematically showing a state in which the clip of FIG. 1 is placed in a luminal organ. FIG. 5B is an enlarged schematic view of the main part of FIG. 5A. FIG. 6 is a diagram schematically showing another example of how to stop the clip in FIG. 1. FIG. 7A is a front view showing an overall configuration in a state where an arm plate portion of an in-vivo indwelling clip according to another embodiment of the present invention is opened. FIG. 7B is a side view of the clip of FIG. 7A. FIG. 7C is a front view in a state where the arm plate portion of the clip shown in FIG. 7A is closed. FIG. 8 is a front view showing an overall configuration in a state where an arm plate portion of an in-vivo indwelling clip according to another embodiment of the present invention is opened.

  Embodiments of the present invention will be specifically described below with reference to the drawings.

(First embodiment)
First, a first embodiment of the present invention will be described with reference to FIGS. As shown in FIG. 1, the in-vivo indwelling clip 1 of the present embodiment is used as a marker that can be attached to the inner wall (mucosa, etc.) of a luminal organ in the living body and the position can be visually recognized from the outside of the luminal organ. And has a clip body 2 and a phosphor 3.

  The clip body 2 includes a connecting plate portion 21, a pair of arm plate portions 22, and a tightening ring 24. The connecting plate portion 21 has a shape bent in a substantially U shape, and is continuous with each end portion of the U shape, and the arm plate so as to open in a substantially V shape toward the tip side. The parts 22 and 22 are integrally formed.

  The tightening 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 plate 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 shown in FIG. 3A to be described later, and is connected (engaged) to the connecting plate portion 21 so as to be detachable (detachable). It is a member slid by using the clip device 5 having 1 and 2A to 2C, the coupling ring 51 is connected to the distal end portion of the inner sheath 52 as shown in FIG. 4B in a state where the coupling hook 51 shown in FIG. By pulling in from the inside, the arm plate portion 22 is closed by being pushed and slid at the distal end of the inner sheath 52.

  As shown in FIG. 1, a claw portion 23 is integrally formed at the distal end portion of each arm plate portion 22. The claw portion 23 is bent toward the inside (that is, the closing direction) at the tip of the arm plate portion 22. Each nail | claw part 23 has the notch part 23a recessed in the intermediate part of the front-end | tip.

  The connecting plate part 21, the pair of arm plate parts 22, and the pair of claw parts 23 are formed by bending a single thin and long plate material. Although the board thickness of the board | plate material which comprises these is not specifically limited, Preferably it is 0.10-0.30 mm. As the plate material, a metal plate having elasticity is preferable, and for example, a stainless steel plate is used. In the present embodiment, the fastening ring 24 is also made of metal, and the material thereof is not particularly limited, and may be made of the same metal (for example, stainless steel) as the plate material constituting the arm plate portion 22 and the like. Alternatively, it may be made of a metal different from the plate material constituting the arm plate portion 22 or the like, for example, titanium alloy, gold, aluminum or the like.

  Each arm plate portion 22 has a base end portion 22a and a gripping portion 22b. A through hole 22 c is formed in each gripping portion 22 b of each arm plate portion 22. These through holes 22c are formed without impairing the desired strength of the arm plate portion 22 (gripping portion 22b). These through-holes 22 c are formed from the viewpoint of adjusting elasticity (repulsive force) when the arm plate portion 22 is closed by the fastening ring 24. The through hole 22c is formed up to the vicinity of the distal end portion of the grip portion 22b (near the claw portion 23).

  The fastening ring 24 fitted to the connecting plate portion 21 so as to be slidable 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 coupling ring 21 is inserted into the inner guide hole of the tightening ring 24, and can be moved (slid) in the axial direction between the outer periphery of the connection plate 21 and the outer periphery of the base end 22 a of the arm plate 22. Is attached (externally fitted). As shown in FIG. 2B, the connecting plate portion 21 is formed with a stopper convex portion 21 a so that the tightening ring 24 does not come outside the connecting plate portion 21.

  As shown in FIG. 1, in a state where the tightening ring 24 is disposed closer to the rear of the arm plate portion 22 (connection plate portion 21), the arm plate portion 22 is opened (opened) by its own elasticity. It has become. If necessary, as shown in FIG. 2C, the arm plate portion 22 is closed (closed leg) by moving (sliding) the tightening ring 24 to a position closer to the distal end of the proximal end portion 22a (closer to the gripping portion 22b). )) State.

  As shown in FIG. 1, a string-like annular member (connecting member) 35 is passed through the through hole 22 c of at least one of the arm plate portions 22. The annular member 35 is provided at one end of the phosphor 3 and may be integrally formed of the same material as the phosphor 3, or may be formed separately from the phosphor 3 and bonded to one end of the phosphor 3. It may be joined by such means. Since the annular member 35 is fixed to the through hole 22c of the arm plate portion 22, the phosphor 3 is attached to the grip portion 22b of the arm plate portion 22 so as to be swingable.

  In the present embodiment, the phosphor 3 has an elongated shape in the longitudinal direction, and the outer diameter thereof is preferably equal to or less than the outer diameter of the tightening ring 24. This is because, as shown in FIG. 4B, the phosphor 3 can be accommodated inside the outer sheath 54 of the clip device described later together with the tightening ring 24. The cross-sectional shape of the phosphor 3 is not particularly limited, and may be a substantially circular shape or an elliptical shape, or may be a polygonal shape of a triangle or more. The diameter of the maximum circumscribed circle in the cross section of the phosphor 3 is not particularly limited, but is preferably 100 to 2000 μm. The length of the phosphor 3 in the longitudinal direction is, for example, 10 to 500% of the length of the arm plate portion, and preferably 0.5 to 35 mm.

  At the other end in the longitudinal direction of the phosphor 3, for example, a loop member 37 as an engaging member that can be engaged with the auxiliary clip 7 shown in FIG. 5B is joined by an adapter member 36. Instead of using the adapter member 36, the loop member 37 may also be integrally formed with the polymer material composition constituting the phosphor 3. The loop member 37 is preferably formed of a flexible string-like member having a restoring force for returning to the original shape (or a shape close to the original shape) when bent. The maximum loop outer diameter of the loop member 37 is preferably larger than the maximum outer diameter of the cross section of the phosphor 3. This is because the auxiliary clip 7 shown in FIG.

  As the loop member 37, for example, a surgical bioabsorbable thread (suture thread) made of a polymer material that is biodegraded or absorbed can be used. The loop member 37 may be a thread or a wire that does not have bioabsorbability. Instead of the loop member 37, for example, an engagement member formed in an annular shape (annular, elliptical, oval, etc.) made of a thermoplastic polymer material or the like may be provided.

  The phosphor 3 is a phosphor containing a fluorescent dye that emits red or near-infrared light when irradiated with excitation light, and is preferably formed of a polymer material composition containing the fluorescent dye. As the fluorescent dye, those that emit fluorescence in the red to near-infrared wavelength region of 600 to 1400 nm are preferable. Light in such a wavelength band is highly permeable to human tissues such as skin, fat and muscle, and can reach well to about 5 mm to 20 mm below the tissue surface of the living body.

  Examples of fluorescent dyes that emit fluorescence in the above-described wavelength range include water-soluble dyes such as riboflavin, thiamine, NADH (nicotinamide adenine dinucleotide), indocyanine green (ICG), and azo-boron described in JP2011-162445A. Oil-soluble dyes such as complex compounds can be mentioned. Among them, a dye having high compatibility with a polymer material is preferable because it is stably retained in the polymer material without being eluted in vivo, and in particular, an azo-boron complex compound described in JP2011-162445A Are preferable in that they have excellent fluorescence emission intensity and are excellent in compatibility with polymer materials such as polyurethane, light resistance, and heat resistance.

  Although the preferable density | concentration of the fluorescent dye in the polymeric material composition containing a fluorescent dye is based also on the kind of fluorescent dye or polymeric material, it is preferable to set it as 0.1-0.001 mass% normally.

  As the polymer material containing the fluorescent dye, polyurethane, polypropylene, polyethylene, polyvinyl chloride, polyamide, polyamide elastomer, or the like may be blended with a curing agent as necessary.

  Examples of the method of incorporating the fluorescent dye into the polymer material include a method of kneading the fluorescent dye into the polymer material using a biaxial kneader. Then, the fluorescent substance 3 can be obtained by shape | molding in a predetermined shape by extrusion molding or injection molding, and post-processing as needed. The phosphor 3 is connected to the arm plate portion 22 by a connecting member such as an annular member 35 so as to be swingable.

  In addition, you may add contrast agents, such as barium sulfate, to the polymeric material composition containing a fluorescent dye as needed. As a result, even if the in-vivo indwelling clip 1 holding the inner wall of the luminal organ in the living body is detached from the inner wall of the luminal organ or the phosphor 3 is detached from the clip body 2, the in-vivo phosphor 3 Can be tracked by photographing using X-rays.

  The phosphor 3 may be a polymer material or a metal rod whose surface is coated with a paint containing a fluorescent dye. Alternatively, the phosphor 3 may be a polymer material composition rod containing a fluorescent dye, the outer surface of which is coated with a transparent material not containing the fluorescent dye, or two layers. Further, the fluorescent dye may be fixed with gelatin or the like on the surface of a bar made of a material not containing the fluorescent dye.

  In the present embodiment, for example, using the endoscope shown in FIG. 5A and the clip device 5 shown in FIG. 3A, the in-vivo indwelling clip 1 is transported to the inside of the luminal organ 4 shown in FIG. It is attached to a specific position on the inner wall of the hollow organ 4. For example, it attaches around the tumor 4b generated in a part of the mucous membrane (luminal organ inner wall) 4a existing on the inner wall of the luminal organ 4 in order to identify its position. Although the clip 1 attached to the inner wall of the luminal organ 4 may be single or plural, it is preferable that plural.

  Here, the in-vivo indwelling clip 1 is transported to the luminal organ through the treatment instrument guide tube of the endoscope 6 shown in FIG. 5A, and the inner wall of the luminal organ is grasped and placed (clipping). The clip device 5 shown in FIG.

  The clip device 5 includes a connecting hook 51, an inner sheath 52, a drive wire 53, an outer sheath 54, a reinforcing coil 55, a first slider portion 56, a base portion 57, and a second slider portion 58.

  As shown in FIG. 3B, a tubular inner sheath 52 is similarly 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 distal end portion of the outer sheath 54 is about 2 to 3 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 distal end portion 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.

  The connection hook 51 disposed at the distal end of the clip device 5 shown in FIG. 3A has a pair of arm portions 51a, 51a made of an elastic body disposed in a substantially V shape toward the tip, and has an inner sheath. By cooperating with 52, two states, an open leg (open) state and a closed leg (closed) state, can be taken. A claw portion is formed at the distal end portion of the arm portions 51a and 51a of the connection hook 51 by being bent inwardly (sides facing each other) so that the connection plate portion 21 of the clip body 2 can be gripped and connected. It has become.

  The base end portion of the connecting hook 51 is a U-shaped portion that is formed in a substantially U shape continuously to the base end portions of the pair of arm portions 51a and 51a. The connecting hook 51 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 connection 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.

  The proximal end portion of the connection hook 51 is fixed to the distal end (distal end) of the drive wire 53 slidably inserted into the inner sheath 52 by laser welding or the like. A substantially annular ring member is fixed to the distal end of the drive wire 53 by laser welding or the like, and the U-shaped portion of the connection hook 51 is passed through the ring member, whereby the connection hook 51 is attached to the drive wire 53. It may be possible to swing.

  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 first slider portion 56, and a portion on the distal end side of the base portion 57 is inserted and arranged inside the first slider portion 56. The first slider portion 56 slides relative to the base portion 57 so as to be positionable between a position moved to the distal end (distal end) side and two positions moved to the proximal end (proximal end) side. To get.

  A second slider portion 58 is slidably held on the base portion 57, and the inner sheath 52 is fixed to the base portion 57. The proximal end of the drive wire 53 is fixed to the second slider portion 58.

  When the second slider portion 58 is slid to the distal end side (distal end side) with respect to the base portion 57, the inner sheath 52 is drawn into the driving wire 53, and the connecting hook 51 at the distal end of the driving wire 53 is moved to the inner side. It protrudes from the tip of the sheath 52 and opens with its own elasticity. When the second slider portion 58 is slid to the base end side (proximal end side) with respect to the base portion 57, the drive wire 53 is drawn into the inner sheath 52, and the connecting hook 51 at the distal end of the drive wire 53 is moved. 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 first slider portion 56 is slid to the position on the proximal end side with respect to the base portion 57, the inner sheath 52 can be protruded from the distal end of the outer sheath 54, and conversely, the first slider portion 56 is moved to the base portion 57. On the other hand, when the slide is made to the position on the distal end side, the distal end of the inner sheath 52 can be stored (embedded) in the outer sheath 54.

  Next, an example of a method for using the in-vivo indwelling clip 1 will be described with reference to FIGS. 4A, 4B, 5A, and 5B. The connecting hook 51 of the clip device 5 is engaged with the connecting hole 25 formed inside the connecting plate portion 21 of the clip body 2, and the connecting hook 51 is pulled into the inner sheath 52, so that the connecting hook 51 is closed. Then, the clip body 2 of the in-vivo indwelling clip 1 is attached to the tip of the inner sheath 52 (see FIG. 4A).

  In this state, the distal end portion of the inner sheath 52 to which the in-vivo indwelling clip 1 (the clip body 2 and the phosphor 3) is connected is drawn into the outer sheath 54, and the entire in-vivo indwelling clip 1 is removed from the outer sheath 54. Housed inside the distal end (see FIG. 4B). In this state, the tightening ring 24 of the clip body 2 is positioned on the connecting plate portion 21, and the arm plate portion 22 is closed by the action of the inner wall of the outer sheath 54. The phosphor 3 connected to the arm plate portion 22 so as to be swingable is drawn into the outer sheath 54 together with the clip body 2. In other words, the clip body 2 and the phosphor 3 are housed in the outer sheath 54 in the order from the distal end of the outer sheath 54.

  Using the endoscope 6 shown in FIG. 5A, the distal end portion of the outer sheath 54 of the clip device 5 to which the in-vivo indwelling clip 1 is attached is inserted into the lumen organ 4. Next, the outer sheath 54 shown in FIG. 3A is slid to the proximal end side to cause the clip 1 to protrude from the distal end of the outer sheath 54. Thereby, as shown in FIG. 4A, the arm plate portion 22 is in a state of being opened by its own elasticity.

  In a state where the arm plate portion 22 is open, for example, the arm plate portion 22 is positioned around a lesion portion such as the tumor 4b shown in FIG. 5A. Next, the inner sheath 52 shown in FIG. 4A is slid to the distal end side with respect to the drive wire 53, so that the tightening ring 24 slides to the distal end side of the arm plate portion 22. As a result, the pair of arm plate portions 22 are gradually closed (approached to each other), and a part Y of the mucous membrane 4a is sandwiched between the clips 1 as shown in FIG. 5B, for example.

  The inner sheath 52 is further slid to the distal end side with respect to the drive wire 53, the clamping ring 24 is moved to the distal end side of the arm plate portion 22, and the clip body 2 of the in-vivo indwelling clip 1 is completely closed. In this state, the inner sheath 52 is slid to the proximal end side with respect to the drive wire 53, the connecting hook 51 is pushed out from the distal end of the inner sheath 52, and the leg is gripped by the connecting hook 51 of the clip body 2. Release (engage). As a result, as shown in FIG. 5B, clipping of a part (gripping part) Y of the mucous membrane 4a by the in-vivo indwelling clip 1 is completed.

  Next, once the clip device 5 shown in FIG. 3A is removed from the endoscope 6 shown in FIG. 5A, another auxiliary clip 7 separately prepared is configured in the same manner as the clip device 5 (or the clip device 5). Attach to the distal end of a separately prepared clip device). Next, the distal end portion of the clip device 5 to which the auxiliary clip 7 is attached is held on the opposite side of the gripping part Y across the phosphor contact part X (from the phosphor contact part X to the phosphor 3). It is transported to the vicinity of the opposite portion (Z) which is about ½ of the longitudinal dimension and is located on the opposite side of the gripping portion Y. As the auxiliary clip 7, a clip having the same configuration as that of the clip main body 2 in which the phosphor 3 including the annular member 35, the adapter member 36 and the loop member 37 is removed from the in-vivo indwelling clip 1 shown in FIGS. , The in-vivo indwelling clip 1 and the auxiliary clip 7 can be handled by the same clip device 5.

  Next, one of the pair of arm plate portions 72, 72 of the auxiliary clip 7 is passed through the inside of the loop member 37, and a part of the loop member 37 is positioned at a portion between the pair of arm plate portions 72, 72. Thus, a slight tension is applied to the phosphor 3 as appropriate, and the auxiliary clip 7 is clipped to the grip portion Z in the same manner as the grip portion Y is gripped by the clip body 2. As a result, the phosphor 3 is accurately positioned at the phosphor contact site (abutting or approaching position) X.

  If these operations are repeated around the tumor 4b shown in FIG. 5A, the plurality of phosphors 3 can be pressed against the mucous membrane 4a around the tumor 4b. As described above, in this embodiment, the portion Y of the mucous membrane 4a that is the inner wall of the luminal organ 4 is gripped by the clip body 2 of the in-vivo indwelling clip 1 of this embodiment, and the loop member 37 is separately attached by another auxiliary clip 7. After scooping up, the other part Z of the mucous membrane 4a which is the inner wall of the luminal organ 4 is gripped, whereby the phosphor 3 can be pressed against an arbitrary position (site X) of the mucous membrane 4a. That is, the pressing position of the phosphor 3 can be arbitrarily adjusted, and the phosphor 3 can be pressed against the mucous membrane 4 a at a portion between the clip body 2 and the auxiliary clip 7.

  In the holding part Y of the in-vivo indwelling clip 1, the holding part Z of the auxiliary clip 7, and the part X on which the phosphor 3 is pressed, the blood vessel network under the mucous membrane 4a is compressed, and blood is excluded from the blood vessel. can do. As a result, when the excitation light is irradiated from the outside (serosa side) to the inside (mucosal side) of the luminal organ 4 under thoracotomy or laparoscopic surgery or laparoscopic surgery, the excitation light is emitted from the submucosal vascular network. It becomes difficult to be absorbed by hemoglobin contained in blood, and excitation light easily reaches the phosphor 3.

  The phosphor 3 contains a fluorescent dye that emits red or near-infrared light when irradiated with excitation light. Therefore, the excitation light irradiated from the outside of the luminal organ 4 is hardly absorbed by hemoglobin, but is efficiently absorbed by the fluorescent dye of the phosphor 3, thereby causing the fluorescence emitted from the fluorescent dye of the phosphor 3. It is emitted outside the luminal organ 4 with almost no absorption by hemoglobin. Therefore, the light emission of the phosphor 3 attached to the mucous membrane 4 a of the luminal organ 4 can be viewed well from the outside of the luminal organ 4. Further, since the tightening ring 24 is made of metal, tightening of the in-vivo indwelling clip 1 is rarely loosened, and attachment stability of the clip 1 is also improved. It should be noted that the light emission of the phosphor 3 from the outside of the luminal organ 4 can be visually recognized by selecting a means for easily viewing the fluorescence without being influenced by the excitation light, according to the wavelength of the excitation light and the wavelength of the fluorescence. For example, it may be performed by image recognition by an imaging device such as a laparoscope provided with a near infrared light camera or a medical near infrared light camera system, or may be performed by visual observation.

  In the embodiment described above, all the in-vivo indwelling clips 1 are attached to the mucosa 4a substantially perpendicular to the mucosa 4a, but the present invention is not limited to this. For example, as shown in FIG. 6, at least a part of the clip 1 is attached to the mucous membrane 4a so that a part of the mucous membrane 4a is raised and the pair of arm plate portions 22 of the clip 1 sandwich the mucous membrane 4a. It may be done.

  In the in vivo indwelling clip 1 of the present embodiment, since the phosphor 3 is connected to the arm plate portion 22 so as to be swingable, the phosphor 3 and the clip body 2 are connected to each other as shown in FIG. 4B. In order, they can be accommodated within the outer sheath 54 of the clip device. Therefore, even when the phosphor 3 is long, the clip 1 is excellent in transportability and the clip 1 can be easily attached.

  As shown in FIG. 5B, in the state where the distal ends of the pair of arm plate portions 22 of the in-vivo indwelling clip 1 are attached with the mucosa 4a of the lumen inner wall 4 sandwiched therebetween, the phosphor 3 is attached to the arm plate portion 22. And can be swung freely. Therefore, if the other end of the phosphor 3 different from one end connected to the arm plate portion 22 of the clip 1 is gripped by another auxiliary clip 7 and attached to the mucosa 4a of the luminal organ 4, the phosphor 3 is It will be pressed against the mucous membrane 4a over its entire length.

  In the portion X where the phosphor 3 is pressed, the blood vessel network in the submucosa layer is compressed, and blood can be excluded from the blood vessel. In addition, even in the portion sandwiched between the in-vivo in-dwelling clip 1 and the auxiliary clip 7, the vascular network in the submucosal layer is compressed, and blood can be excluded from the blood vessel. As a result, when the excitation light is irradiated from the outer side (serosa side) to the inner side (mucosal side) of the luminal organ, it is not absorbed by hemoglobin contained in the blood of the vascular network in the submucosal layer, and the phosphor 3 The excitation light can easily reach.

  Further, since the phosphor 3 is attached to the arm plate portion 22 so as to be swingable, the contact area of the phosphor 3 to the mucous membrane 4a of the luminal organ 4 can be reduced by using the auxiliary clip 7 together. It is easy to increase the light emission of the phosphor 3 from the outside of the luminal organ 4.

  If the phosphor 3 emits light by excitation light irradiated from the outside of the luminal organ 4 under thoracotomy or laparoscopic surgery or under laparoscopic surgery, the light emitted from the phosphor 3 is imaged, for example, visually or by an imaging device. Then, the position of the phosphor 3 can be specified from the outside of the luminal organ 4, and the position of the lesioned part such as the tumor 4b can be specified therefrom. Therefore, the luminal organ 4 corresponding to the tumor 4b can be excised from the outside with only a necessary minimum range using a normal scalpel or a high-frequency knife. In addition, the clip 1 can be taken out of the body along with the excision of the tumor 4b.

(Second Embodiment)
Next, a second embodiment of the present invention will be described with reference to FIGS. 7A to 7C. In addition, it demonstrates centering around the change from 1st Embodiment demonstrated with reference to FIGS.

  As shown in FIGS. 7A to 7C, the in vivo indwelling clip 1a of the present embodiment is the same as the in vivo indwelling clip 1 of the first embodiment, except that the shape and configuration of the phosphor 3a are changed. . That is, in this embodiment, the clip body 2 is the same as the clip body 2 of the first embodiment, and only the phosphor 3a is different from the phosphor 3 of the first embodiment.

  A loop member 37 is not provided at the end of the phosphor 3a opposite to the annular member 35. Instead, a grip portion (engagement member) 33 is integrally formed. The grip portion 33 has a shape that can be easily sandwiched between the pair of arm plate portions 72 of the auxiliary clip 7 shown in FIG. 5B.

  Also in this embodiment, using the endoscope 6 shown in FIG. 5A and the clip device 5 shown in FIG. 3A, the in-vivo indwelling clip 1a is transported to the inside of the luminal organ 4, and the clip 1a is attached to a specific position. . Thereafter, the phosphor 3a can be pressed against the mucous membrane 4a by attaching it to the mucosa 4a while grasping the grip portion 33 with another auxiliary clip 7. Other configurations and operational effects are the same as those of the first embodiment described above.

(Third embodiment)
Next, a third embodiment of the present invention will be described with reference to FIG. In addition, it demonstrates centering around the change from 1st Embodiment demonstrated with reference to FIGS.

  As shown in FIG. 8, the in vivo indwelling clip 1b of the present embodiment is the same as the in vivo indwelling clip 1 of the first embodiment, except that the shape and configuration of the phosphor 3b are changed. That is, in this embodiment, the clip body 2 is the same as the clip body 2 of the first embodiment, and only the phosphor 3b is different from the phosphor 3 of the first embodiment.

  In the present embodiment, a pair of phosphors 3b are provided in the middle of the loop member 38, and one end of the loop member 38 becomes the connecting portion 22 connected to the arm plate portion 22, and the other end is shown in FIG. 5B. The engaging clip 38b engages with the auxiliary clip 7 shown in FIG.

  Also in this embodiment, using the endoscope 6 shown in FIG. 5A and the clip device 5 shown in FIG. 3A, the in-vivo clip 1b is transported to the inside of the luminal organ 4 and the clip 1b is attached to a specific position. be able to. Thereafter, if the engaging portion 38b is attached to the mucous membrane 4a while being gripped by another auxiliary clip 7, the pair of phosphors 3b can be pressed against the mucous membrane 4a. Other configurations and operational effects are the same as those of the first embodiment described above.

  In the present embodiment, each phosphor 3b may be made of a fluorescent material that is more flexible and elastic than the phosphor 3. In that case, the phosphor 3b is attached to the mucous membrane 4a using the in-vivo clip 1 and the auxiliary clip 7 so that the space between the connecting portion 38a and the engaging portion 38b is extended. , Pressed more strongly against the mucous membrane 4a. Further, the shape of the phosphor 3b may be changed in accordance with the surface shape of the mucous membrane 4a. This is the same for the phosphors 3 and 3a, and the phosphors may be made of a flexible and elastic material.

  In addition, this invention is not limited to embodiment mentioned above, It can modify | change variously. For example, the elements disclosed in the above-described embodiments can be modified and combined in various ways.

  The living tissue in which the in-vivo indwelling clip of the above-described embodiment is placed is not particularly limited, and is a luminal organ such as the digestive tract, trachea, bladder, bile duct, pancreatic duct, ureter, renal pelvis, liver, kidney, and lung. Is exemplified. Moreover, the in-vivo indwelling clip of this invention can also be used for uses other than excision surgery of a part of a luminal organ.

DESCRIPTION OF SYMBOLS 1, 1a, 1b ... In-vivo indwelling clip 2 ... Clip main body 21 ... Connecting plate part 21a ... Protruding part for stoppers 22 ... Arm plate part 22a ... Base end part 22b ... Grasping part 22c ... Through-hole 23 ... Claw part 23a ... Notch Portion 24 ... Tightening ring 3, 3a, 3b ... Phosphor 33 ... Grip portion (engaging member)
35 ... annular member (connecting member)
36 ... Adapter member 37 ... Loop member (engaging member)
38 ... Loop member 38a ... Connection part (connection member)
38b ... engaging portion (engaging member)
DESCRIPTION OF SYMBOLS 4 ... Luminal organ 4a ... Mucosa 4b ... Tumor 5 ... Clip apparatus 51 ... Connection hook 51a ... Arm part 52 ... Inner sheath 53 ... Drive wire 54 ... Outer sheath 55 ... Reinforcement coil 56 ... First slider part 57 ... Base part 58 ... 2nd slider part 6 ... Endoscope 7 ... Auxiliary clip 72 ... Arm plate part X ... Phosphor contact part Y ... Holding part Z of in-vivo indwelling clip 1 ... Holding part of auxiliary clip 7

Claims (4)

A pair of arm plates that elastically open in a substantially V shape;
A claw portion formed at each tip of the arm plate portion;
A clip having a fastening ring that is attached to the arm plate part so as to be movable along the longitudinal direction of the pair of arm plate parts, and that moves the pair of arm plate parts in the direction of the claws, thereby closing the pair of arm plate parts. An in vivo indwelling clip having a body,
At least one of the arm plate portions,
An in-vivo indwelling clip, characterized in that a phosphor containing a fluorescent dye that emits red or near-infrared light when irradiated with excitation light is connected so as to be swingable.   The in vivo indwelling device according to claim 1, wherein one end of the phosphor is connected to the arm plate portion, and the other end of the phosphor is provided with an engaging member that can be engaged with another clip. clip.   The in-vivo indwelling clip according to claim 1 or 2, wherein one end of the phosphor is connected to a through hole formed in the arm plate portion.   The in-vivo indwelling clip according to any one of claims 1 to 3, wherein the tightening ring is made of metal.

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