JP2024045534A - Clipping device - Google Patents

Abstract

[Problem] To provide a clip device that has a reduced number of parts, is inexpensive, and can be easily made disposable. [Solution] The clip device comprises a sheath (12) made of a single tubular body, a drive wire (13) inserted into the sheath (12), an operation section (16) provided at the proximal end of the sheath (12) for sliding the drive wire (13) relative to the sheath (12), and a clip (20) made of an elastic body that is detachably connected to the distal end of the drive wire (13) and can be stored in the sheath (12), and an elastic engagement section (33) is provided at an opening on the distal end side of the sheath (12) for allowing the clip (20) to slip out of the sheath (12) to the distal end side by elastic deformation when an external force is applied from the clip (20), and for engaging with a fastening ring (29) that has slipped out of the sheath (12) to the distal end side, thereby sliding the fastening ring (29) to the distal end side to close the clip (20). [Selected Figure] Figure 7

Description

The present invention relates to a medical clipping device that is used with an endoscope to perform hemostasis, marking, suturing, etc. on internal tissue.

When performing endoscopic procedures such as hemostasis in bleeding areas of internal tissue or suturing defects, medical clipping devices are used. This type of clipping device generally comprises a sheath that is passed through the endoscope and a clip that is attached to the distal end of the sheath. With such clipping devices, the distal end of the sheath is guided to the vicinity of the area to be treated, and then an operating section attached to the proximal end of the sheath outside the body is operated to grasp the internal tissue with the clip, and the clip is retained in that state while being placed inside the body.

A conventional clip device includes a sheath with a double tube structure in which an inner sheath is inserted into an outer sheath, a drive wire is inserted into the inner sheath, and a clip made of an elastic body is connected to the tip of the drive wire via a connecting hook. It is known that these are removably connected (for example, Patent Document 1, etc.).

In the clip device described in Patent Document 1, the base end of the clip is connected to a connecting hook connected to the tip of a drive wire, and the clip is stored in a closed state within an outer sheath. When the outer sheath is retracted from this state toward the proximal end relative to the inner sheath and drive wire, the clip is released from the constraint of the outer sheath and opens. When the inner sheath is then pushed toward the distal end relative to the drive wire, the clamping ring fitted on the clip is pushed by the inner sheath and slides toward the distal end, closing the clip and enabling the internal tissue to be grasped. When the inner sheath is then retracted toward the proximal end relative to the drive wire, the connecting hook opens and the connection with the clip is released, and the clip is placed in the body by retracting the sheaths and drive wire.

Japanese Patent Application Publication No. 2016-123805

Incidentally, in recent years, medical instruments have become increasingly disposable in order to improve hygiene and eliminate the complexity of cleaning, and the demand for clip devices has also increased. One of the factors that makes it possible to make it disposable is to reduce the cost by reducing the number of parts, but in the conventional clip device mentioned above, the double-tube structure sheath in particular causes an increase in cost. , it was difficult to make it disposable.

The present invention was made in consideration of the above circumstances, and aims to provide a clipping device that has a reduced number of parts, is inexpensive, and can be easily made disposable.

The clip device according to the present invention includes a sheath made of one tubular body, a drive wire inserted into the sheath, and a clip device provided at a proximal end of the sheath, and the drive wire is connected to the sheath. an operating section that slides along the axial direction; and a clip made of an elastic body that is removably connected to the distal end of the drive wire and can be stored in the sheath, the clip being The distal end side of the clip opens due to its own elasticity when the distal end is pulled out from the distal end, and the distal end side of the clip main body is configured such that when it is stored in the sheath, the clip main body is configured to be closed by being restrained by the sheath. a fastening member that is slidably provided at least partially between the proximal end and the distal end, closes the clip main body by sliding toward the distal end, and is elastic when receiving an external force from the clip. The deformation allows the clip to come out from within the sheath toward the distal end, and engages with the fastening member that has come out from within the sheath toward the distal end, thereby causing the fastening member to move toward the distal end. The sheath is characterized in that an elastic engagement portion that can be slid sideways is provided at the opening on the distal end side of the sheath.

The sheath of the present invention has a tip end that is placed inside the body as the distal end, and a base end that is placed outside the body as the proximal end. The distal end and proximal end described in association with each component of the present invention refer to the ends corresponding to the distal end, i.e., the tip side, and the proximal end, i.e., the base side, of the sheath, respectively.

Due to the above configuration, the clip device according to the present invention is configured with only one sheath without having a double-tube structure sheath, so the sheath configuration is simpler than before and the number of parts can be reduced. As a result, it becomes possible to make the product disposable as the cost decreases.

The clip device according to the present invention is also characterized in that the elastic engagement portion is formed in a cylindrical shape with multiple elastic pieces that elastically deform when subjected to an external force from the clip, allowing the clip to pass through its interior.

With this configuration, the clip device according to the present invention can have a simple configuration for the elastic engagement portion, and therefore can promote disposability due to cost reduction. In addition, the clip is surrounded by the cylindrical elastic engagement part and is restricted from coming out of the sheath, and when the clip slides against the sheath and passes through the elastic engagement part, multiple elastic pieces The clip is elastically deformed and comes out of the sheath. Therefore, it is possible to prevent the clip stored in the sheath from accidentally passing through the elastic engagement part and coming out of the sheath, ensuring safety when used inside the body. .

The clip device according to the present invention is also characterized in that the elastic engagement portion is formed in a cone shape that narrows toward the distal end.

With this configuration, the clip device according to the present invention can be easily inserted into an endoscope, and the distal end provided with the elastic engagement portion can be placed with high precision at the site to be treated inside the body.

The clip device according to the present invention is also characterized in that the distal end surface of the elastic piece is configured to abut and engage with the proximal end of the fastening member.

With this configuration, in the clip device according to the present invention, the portion of the elastic engagement portion that engages with the fastening member of the clip can be configured by the tip end surface of the elastic piece, so the configuration of the elastic engagement portion is simplified. It is possible to further promote disposable products due to lower prices.

The clip device according to the present invention may also be configured so that the elastic engagement portion is integrally molded with the sheath.

According to this configuration, the number of parts of the clip device according to the present invention is further reduced, so that it is possible to further promote disposability due to cost reduction.

According to the present invention, it is possible to provide a clip device that has a reduced number of parts, is inexpensive, and is easily disposable.

FIG. 1 is a side view showing a clip device according to an embodiment of the present invention. 2 is a sectional view taken along line II-II in FIG. 1. FIG. 1A and 1B are perspective views of a clip constituting a clip device according to one embodiment of the present invention, in which FIG. 1A shows a state in which the clip is opened and FIG. FIG. 2 is a side view showing a portion of a connecting hook and a drive wire that constitute a clip device according to an embodiment of the present invention. 1 is a perspective view showing a gate member constituting a clip device according to an embodiment of the present invention; 1A and 1B are diagrams showing a gate member constituting a clip device according to one embodiment of the present invention, in which FIG. 1A is an oblique view explaining the function of a clip constituting a clip device according to one embodiment of the present invention, in which (a) shows the clip stored in a sheath, (b) shows the clip with its legs open, and (c) shows the clip with its legs closed outside the sheath. 5A to 5D are cross-sectional views showing the action of a clip in a clip device according to one embodiment of the present invention in a step-by-step manner. FIG. 7 is a cross-sectional view showing a modified example in which the sheath and the gate member are integrally molded in the clip device according to the embodiment of the present invention.

One embodiment of the present invention will be described below with reference to the drawings.

(Embodiment)
First, the configuration of one embodiment will be described.

As shown in FIGS. 1 and 2, the clip device 1 according to the present embodiment includes a sheath 12 made of one tubular body, a drive wire 13 inserted into the sheath 12, and a proximal end of the sheath 12 (see FIG. 1 (upper end), and includes an operating section 16 that slides the drive wire 13 relative to the sheath 12 along the axial direction of the sheath 12, and a connecting hook 11.

Further, the clip device 1 according to this embodiment includes a clip 20 shown in FIG. 3. The clip 20 is removably connected to the distal end (the lower end in FIG. 1) of the drive wire 13 via the connecting hook 11, and can be stored in the sheath 12 together with the connecting hook 11.

The clip device 1 according to this embodiment is used by inserting the sheath 12 through an endoscope (not shown) and inserting it into the body together with the endoscope. The distal end of the sheath 12, which is disposed inside the body when in use, is the distal end, and the proximal end is the proximal end, which is disposed outside the body. The distal end and proximal end in the following description refer to the ends corresponding to the distal end and proximal end of this sheath 12.

The sheath 12 according to this embodiment is configured as a flexible hollow tubular body. The sheath 12 is configured as, for example, a wire tube. The wire tube is made of a hollow stranded wire in which multiple wires (cables) made of a metal such as stainless steel are twisted in a spiral shape to form a hollow space. The sheath 12 may also be configured by molding a flexible resin (such as a polyamide resin or a polyamide-based elastomer) into a tubular body.

As shown in FIG. 1, the opening on the distal end side of the sheath 12 is provided with a gate member 30 having an elastic engagement portion 33, which will be described later.

The drive wire 13 according to the present embodiment is made of a flexible wire, such as a wire rope made of a stranded wire formed by spirally twisting a plurality of wires (cables) made of metal such as stainless steel. is used. Moreover, as the drive wire 13, a wire tube may be used similarly to the sheath 12, and further, a single wire may be used.

As shown in FIG. 4, the connecting hook 11 according to the present embodiment has a pair of arm portions 11a made of an elastic body and arranged in a substantially V-shape toward the tip thereof. The connecting hook 11 can take two states, an open state and a closed state, by cooperating with the sheath 12.

The tips of the arms 11a of the connecting hook 11 are bent inwardly toward each other to form claws 11b. The connecting hook 11 grips the connecting plate 22 of the clip body 21 that constitutes the clip 20 (described later) and engages with the claws 11b, thereby detachably connecting the clip 20 and the drive wire 13.

The connecting hook 11 has a U-shaped portion 11c at its base end that is connected to the base end of each arm portion 11a and is formed in a roughly U-shape.

Each arm portion 11a including the claw portion 11b and the U-shaped portion 11c are formed by suitably bending and plastically deforming one elongated plate made of an elastic body. Although not particularly limited, the thickness of the plate material constituting the connecting hook 11 is about 0.20 to 0.24 mm, and the width is about 0.6 mm. For example, stainless steel is used as the plate material.

A hook-side annular portion 11d is provided at the base end of the U-shaped portion 11c of the connecting hook 11. The hook-side annular portion 11d is fixed integrally to the connecting hook 11 by fixing a pair of open ends of the U-shaped member to the outer surface of the base end of the U-shaped portion 11c. The hook-side annular portion 11d is fixed to the U-shaped portion 11c by means of, for example, laser welding, adhesives, or other means.

As shown in FIG. 4, a wire-side annular portion 19 is provided at the distal end of the drive wire 13 (the end on the left side in FIG. 4). The wire-side annular portion 19 is fixed integrally to the drive wire 13 by sandwiching the distal end of the drive wire 13 between a pair of open ends of a U-shaped member and joining the inner surfaces of the open ends to the sides of the drive wire 13. The wire-side annular portion 19 is fixed to the drive wire 13 by means of, for example, laser welding, adhesive bonding, or other means.

The U-shaped members constituting the hook side annular portion 11d and the wire side annular portion 19 may be made of a plate material similar to that constituting the connecting hook 11, which has been appropriately bent. The material for the U-shaped members constituting the annular portions 11d and 19 may be, for example, stainless steel. The semicircular arc portions of the annular portions 11d and 19 have an outer diameter of, for example, about 1.0 to 1.2 mm and an inner diameter of, for example, about 0.8 to 1.0 mm, and the cross-sectional shape may be, for example, rectangular, circular, or semicircular.

The hook side annular portion 11d and the wire side annular portion 19 are connected to each other in a chain shape, so that the connecting hook 11 is attached so as to be able to pivot relative to the distal end of the driving wire 13. By allowing the connecting hook 11 to pivot relative to the distal end of the driving wire 13, this portion is prevented from becoming rigid within the sheath 12, and the sheath 12 can be smoothly passed through the curved portion of the endoscope inserted into the digestive tract.

As shown in FIG. 1, the operating section 16 according to this embodiment has a cylindrical slider section 17 and a base section 18 inserted into the slider section 17 from the proximal end side so as to be relatively slidable and rotatable about the axis. A reinforcing coil 15 is fixed to the distal end of the slider section 17 so as to extend coaxially. The proximal end of the sheath 12 is inserted into the reinforcing coil 15 and fixed integrally to this reinforcing coil 15. In other words, the sheath 12 is integrated with the slider section 17 via the reinforcing coil 15.

The slider portion 17 is slidably supported on the distal end of the base portion 18. The proximal end of the drive wire 13 is fixed to the base portion 18 inside the slider portion 17. Therefore, the drive wire 13 is integral with the base portion 18 and can slide relative to the slider portion 17.

A pair of flanges 17a are formed at the proximal end of the slider 17, spaced apart in the sliding direction, and the circumferential groove 17b between the flanges 17a can be held between the index finger and middle finger, for example.

Further, a ring portion 18a is supported at the proximal end of the base portion 18 so as to be rotatable around an axis. As described above, by inserting the thumb into the ring part 18a while holding the circumferential groove part 17b of the slider part 17 between the index finger and the middle finger, the operation of sliding the slider part 17 relative to the base part 18 can be smoothly performed with one hand. is now possible. Further, when the ring portion 18a is rotated, the drive wire 13 rotates together with the drive wire 13, so that a clip 20, which will be described later, can also be rotated together with the drive wire 13.

Next, the clip 20 will be explained with reference to FIG. 3.

As shown in FIG. 3, the clip 20 has a clip body 21 and a tightening ring 29. The tightening ring 29 constitutes the fastening member of the present invention. The tightening ring 29 is provided slidably relative to an arm plate portion 23 of the clip body 21, which will be described later. The clip 20 is configured such that when the tightening ring 29 slides toward the proximal end, the clip body 21 opens as shown in FIG. 3(a), and when the tightening ring 29 moves toward the distal end, the clip body 21 closes as shown in FIG. 3(b).

The clip body 21 has a connecting plate portion 22 that is bent into a generally U-shape. A pair of arm plate portions 23 that open out into a generally V-shape toward the tip of the connecting plate portion 22 are integrally formed on both ends of the connecting plate portion 22. The connecting plate portion 22 is formed on the proximal end side of the arm plate portion 23.

A claw portion 24 is integrally formed at the distal end of each arm plate portion 23. Each claw portion 24 is formed by bending inwardly, facing each other, at the tip of the arm plate portion 23. A concave cutout portion 24a is formed in the center of the tip edge of each claw portion 24.

The connecting plate portion 22, the pair of arm plate portions 23, and the pair of claw portions 24 that constitute the clip body 21 are formed by bending and plastically deforming one thin and elongated plate made of an elastic body. Although not particularly limited, the thickness of the plate material constituting the clip body 21 is preferably 0.10 to 0.30 mm. For example, stainless steel is used as the plate material.

Each arm plate 23 has a base end 23a and a gripping portion 23b formed on the distal end side, continuous with the base end 23a. The claw portion 24 is formed at the tip of each gripping portion 23b. Each arm plate 23 is curved so that it moves away from the gripping portion 23b. The base end 23a has a uniform width, but the gripping portion 23b is formed in an elongated trapezoidal shape that becomes wider toward the distal end side where the claw portion 24 is formed. In addition, a through hole 23c is formed in the gripping portion 23b to reduce the weight of the clip body 21.

The U-shaped connecting plate 22 has a wide portion 22a at each end on the distal end side. The width of the base end 23a of each arm plate 23 is slightly smaller than the width of the wide portion 22a and the grip portion 23b of the connecting plate 22. Due to this shape, as shown in FIG. 3(b), a pair of locking steps 25a are formed on both ends of the width direction at the edge of the distal end side (the base end 23a side of the arm plate 23) of the wide portion 22a of the connecting plate 22. Also, as shown in FIG. 3(a), a pair of locking steps 25b are formed on both ends of the width direction at the edge of the proximal end side (the base end 23a side of the arm plate 23) of the grip portion 23b.

Further, as shown in FIG. 3(a), the base end portion 23a of each arm plate portion 23 has a ring locking portion 26 formed with a large width at the end portion on the grip portion 23b side.

The tightening ring 29 is made of a substantially cylindrical member and is attached to the base end 23a of each arm plate 23 of the clip body 21 so as to be slidable along the direction in which the base end 23a extends. The tightening ring 29 may also be made of a coil spring made of a wire wound into a coil shape.

The clamping ring 29 has an internal space through which the base end 23a of the arm plate 23 is inserted, and is fitted onto the base end 23a so as to slide between the wide portion 22a of the connecting plate 22 and the gripping portion 23b.

As shown in FIG. 3(a), when the tightening ring 29 is slid toward the proximal end side, that is, the connecting plate portion 22 side, the tightening ring 29 comes into contact with each of the locking step portions 25a and stops. Sliding toward the proximal end is restricted. At this time, the clip main body 21 becomes in a state where each arm plate part 23 is spaced apart from each other due to its own elasticity, and the legs are opened.

On the other hand, as shown in FIG. 3(b), when the tightening ring 29 is slid toward the distal end side, that is, the gripping section 23b, against the elasticity of each arm plate section 23, the tightening ring 29 is moved to each locking stage. It comes into contact with the portion 25b and stops, and further sliding toward the distal end side is restricted. As the tightening ring 29 is slid toward the grip portion 23b, each arm plate portion 23 is pressed closer to each other by the tightening ring 29 and elastically deforms, and when the tightening ring 29 comes into contact with each locking step portion 25b, the clip is released. The main body 21 is completely closed. When the clip main body 21 is closed in this manner, the respective claw portions 24 overlap each other.

The clip 20 is configured such that each ring locking portion 26 is press-fitted into the tightening ring 29 when the tightening ring 29 is in contact with each locking step portion 25b and the clip body 21 is closed. . As a result, the tightening ring 29 is locked to each ring locking portion 26, and the closed state of the clip body 21 is maintained.

The clip 20 is connected to the connecting hook 11 within the sheath 12 by inserting each claw portion 11b of the connecting hook 11 that closes its legs into the connecting plate portion 22 of the clip body 21. When the connecting hook 11 is pulled toward the proximal end side with respect to the clip 20 in this connected state within the sheath 12, each claw portion 11b rides on the connecting plate portion 22, the arm portion 11a opens slightly, and the connecting hook 11 can be detached from the clip 20 to release the connection.

Next, the gate member 30 provided at the opening at the distal end of the sheath 12 will be explained.

The gate member 30 is shown in FIGS. 5 and 6. The gate member 30 according to the present embodiment allows the clip 20 to come out from inside the sheath 12 toward the distal end by being elastically deformed in response to an external force from the clip 20, and also allows the clip 20 to come out from inside the sheath 12 toward the distal end. It has an elastic engagement portion 33 that can engage with the tightening ring 29 that has come out and slide the tightening ring 29 toward the distal end.

The elastic engagement portion 33 according to this embodiment has four elastic pieces 33b that are elastically deformed when subjected to an external force from the clip 20. The elastic engagement portion 33 is formed into a cylindrical shape by the elastic pieces 33b so that the clip 20 can pass through its interior.

The gate member 30 is made of a member formed into a cylindrical shape, and from the proximal end to the distal end, has a fixed portion 31, an intermediate cylindrical portion 32, and an elastic engagement portion 33.

The fixing portion 31 of the gate member 30 is a portion that is fixed to the opening on the distal end side of the sheath 12. As shown in FIG. 7, the gate member 30 is configured such that the distal end of the sheath 12 is inserted into the fixing portion 31 and fixed to the opening on the distal end of the sheath 12. . The fixing portion 31 is fixed to the sheath 12 by, for example, adhesive bonding.

The intermediate cylindrical portion 32 is formed with an outer diameter slightly smaller than that of the fixed portion 31. The elastic engagement portion 33 is formed in a cone shape that continues from the intermediate cylindrical portion 32 and decreases in diameter toward the distal end. Therefore, the opening diameter on the distal end side of the elastic engagement portion 33 is smaller than the inner diameter of the sheath 12.

The elastic engagement portion 33 has a plurality of slits 33a formed therein, which extend in the axial direction of the gate member 30. Each slit 33a is formed so as to penetrate into a portion of the intermediate cylindrical portion 32. In this embodiment, each slit 33a is formed at four locations that divide the circumference equally, but the number of slits 33a formed may be any number. The elastic engagement portion 33 is divided into four elastic pieces 33b between the slits 33a by forming the four slits 33a. In other words, the elastic engagement portion 33 has four elastic pieces 33b whose cross sections are formed in an approximately quarter-circular arc shape. The number of elastic pieces 33b, i.e., the number of slits 33a formed, may be any number, as described above.

The outer diameter of the tip surface of the elastic engagement portion 33, i.e., the annular tip surface formed by the tip surfaces 33c of each elastic piece 33b, is set to approximately the same dimension as the outer diameter of the tightening ring 29. This allows the tip surface 33c of each elastic piece 33b to abut against the annular end surface 29c on the proximal end side of the tightening ring 29 (see FIG. 8(d)).

In an unloaded state in which each elastic piece 33b is not subjected to external force, the elastic engagement portion 33 maintains a conical shape and is in a closed state, as shown in FIGS. 5 and 6(a). As shown in FIGS. 8(a) to 8(d), when the clip 20 housed in the sheath 12 slides toward the distal end of the sheath 12 and enters the elastic engagement portion 33, the clip body Each elastic piece 33b is pushed open radially by the gripping part 23b of the arm plate part 23 of 21 and the tightening ring 29, allowing the clip 20 to come out from inside the sheath 12 to the outside on the distal end side. When the clip 20 comes out of the sheath 12, the clip main body 21 elastically returns to a fully open state.

From the state where the clip 20 including the tightening ring 29 comes out from the gate member 30 toward the distal end side and the clip body 21 is opened, the drive wire 13 is drawn toward the proximal end side with respect to the sheath 12, and the sheath 12 is moved relative to the sheath 12. When the elastic pieces 33b of the closed elastic engagement section 33 are slid toward the distal end, the distal end surface 33c of each elastic piece 33b of the closed elastic engagement section 33 comes into contact with the proximal end surface 29c of the tightening ring 29, and the elastic engagement section 33 closes the tightening ring. 29 is pushed and slid toward the distal end along each proximal end 23a of the clip main body 21. The tightening ring 29 slides toward the distal end until it comes into contact with each of the locking step portions 25b and is locked with the ring locking portion 26. Thereby, the clip main body 21 can be closed by the tightening ring 29.

The clip 20 connected to the drive wire 13 via the connection hook 11 is housed in the sheath 12 by sliding the drive wire 13 toward the proximal end or distal end with respect to the sheath 12 using the operating section 16. The clip body 21 is positioned in three positions: a storage position where the clip body 21 is opened from the gate member 30 toward the distal end, an open leg position where the clip body 21 is opened by slipping out from the gate member 30 toward the distal end, and a clip position where the clip body 21 is closed by the tightening ring 29. It looks like this. FIGS. 7A, 7B, and 7C show the clip 20 in the storage position, leg open position, and clip position, respectively.

The operating section 16 is equipped with a click mechanism (not shown) that can accurately position the clip 20 at the three positions described above. The click mechanism can be configured, for example, as a combination of grooves formed in three axially spaced locations on the base section 18 and a spring member provided on the slider section 17 that elastically engages with these grooves.

The fixing portion 31, the intermediate cylindrical portion 32, and the elastic engagement portion 33 that constitute the gate member 30 are integrally molded. The gate member 30 is made of a material that can be elastically deformed when each elastic piece 33b of the elastic engagement part 33 receives an external force from the clip 20 passing through the inside thereof, and is pushed open, such as stainless steel. Metals such as are preferred. In addition, resins can also be used.

Next, we will explain how to use the clipping device 1 according to the present embodiment to clip the internal tissue to be treated.

First, the clip 20 is connected to the connecting hook 11, and the clip 20 and the connecting hook 11 are stored inside the distal end side of the sheath 12. To do this, for example, the elastic engagement portion 33 of the gate member 30 is held open using a jig (not shown), and the sheath 12 is slid toward the proximal end side with respect to the drive wire 13 using the operating portion 16 to hook the connecting hook. 11 is made to protrude from the gate member 30 toward the distal end side, and the legs are opened. Further, the clip 20 is prepared in a state where the legs are opened as shown in FIG. 3(a).

From this state, the sheath 12 is slid toward the distal end relative to the driving wire 13 to retract the driving wire 13 into the sheath 12, and the connecting hook 11 is stored in the gate member 30 to close the legs. At this time, the clip 20 in the closed state is placed in a position where the connecting hook 11 can clamp the connecting plate portion 22 of the clip body 21, and the driving wire 13 is further retracted into the sheath 12. As a result, the connecting hook 11 closes and each claw portion 11b enters the connecting plate portion 22 of the clip body 21, and the clip 20 is connected to the connecting hook 11 as shown in Figure 8.

Next, the drive wire 13 is further drawn toward the proximal end, and the clip 20 is stored in the storage position at the distal end within the sheath 12.

Next, the jig is removed from the gate member 30, and the elastic engagement portion 33 is returned to the closed state. FIG. 7(a) and FIG. 8(a) show this state.

Next, the distal end of the sheath 12 is guided and placed near the tissue to be treated within the body via an endoscope (not shown). From this state, the sheath 12 is slid toward the proximal end side with respect to the drive wire 13 using the operating section 16, and the clip 20 is positioned in the open leg position. At this time, as shown in FIGS. 8(b) to 8(c), the elastic engagement portion 33 of the gate member 30 is pushed open by the clip 20, and the clip 20 is opened from the gate member 30 to the outside of the distal end side. The clip 20 including the tightening ring 29 is positioned in the open position.

Next, the opened clip 20 is placed so that the body tissue to be treated is located between the claws 24 at the tips of the gripping parts 23b of the clip 20. At this time, the clip 20 is rotated around the axis via the drive wire 13 using the ring part 18a of the operating part 16 as needed.

Next, the sheath 12 is slid toward the distal end side with respect to the drive wire 13 using the operation section 16, and the clip 20 is positioned at the clip position. At this time, as shown in FIGS. 8(c) to 8(d), the distal end surface 33c of each elastic piece 33b of the gate member 30 comes into contact with the proximal end surface 29c of the tightening ring 29, and the tightening ring 29 is elastic. It is pushed toward the distal end by the engaging portion 33 and slides until it comes into contact with the locking step portion 25b. As a result, the tightening ring 29 is locked to the ring locking portion 26, the clip body 21 is completely closed, and the pair of claw portions 24 grip the internal tissue.

Next, the drive wire 13 is slid toward the proximal end with respect to the sheath 12 and pulled back. As a result, the connecting hook 11 is pulled toward the proximal end, the claw portion 11b is removed from the connecting plate portion 22 of the clip main body 21, and the connecting hook 11 is removed from the clip 20. At this time, the clip main body 21 is pressed toward the distal end via the tightening ring 29 by the sheath 12 that recoils toward the distal end. Therefore, the stress generated when pulling the connecting hook 11 is not transmitted to the clip main body 21, and there is no fear that the clip main body 21 will be pulled toward the proximal end side together with the connecting hook 11. Therefore, the connecting hook 11 can be removed from the clip main body 21 without damaging the internal tissue held by each claw portion 24.

In addition, instead of pulling the connecting hook 11 toward the proximal end of the clip 20 to release it, the connection between the two may be released by sliding the sheath 12 toward the proximal end relative to the drive wire 13, causing the connecting hook 11 to protrude from within the sheath 12 toward the distal end, and allowing each arm portion 11a to return elastically to its original position and open.

Then, the entire operation section 16 is moved toward the proximal end of the endoscope to retract the sheath 12 and the drive wire 13, and the clip 20 gripping the tissue is placed inside the body. This completes clipping the tissue with the clip device 1.

The following describes the operation of the clip device 1 according to the present embodiment.

The clip device 1 according to the present embodiment is configured with one sheath 12 without having a sheath with a double tube structure. Therefore, the structure of the sheath can be simplified and the number of parts can be reduced compared to the conventional one, and as a result, it is possible to make the sheath disposable at a lower cost.

In addition, in this embodiment, the elastic engagement portion 33 of the gate member 30 is formed in a cylindrical shape with multiple elastic pieces 33b that elastically deform when subjected to an external force from the clip 20, allowing the clip 20 to pass through its interior.

With this configuration, the clip device 1 according to this embodiment can have a simple elastic engagement portion 33, which can promote disposability through lower costs.

Further, the clip 20 is surrounded by the closed cylindrical elastic engagement part 33 and is restricted from coming out of the sheath 12, and the clip 20 slides with respect to the sheath 12 and passes through the elastic engagement part 33. At this time, the four elastic pieces 33b are elastically deformed and the clip 20 comes out of the sheath 12. Therefore, it is possible to prevent the clip 20 housed in the sheath 12 from accidentally passing through the elastic engagement part 33 and coming out of the sheath 12, and as a result, when used inside the body, Safety can be ensured.

In addition, in the clip device 1 according to this embodiment, the elastic engagement portion 33 of the gate member 30 is formed in a cone shape that narrows toward the distal end. This configuration makes it easier to insert the clip device 1 according to this embodiment into an endoscope, and allows the distal end provided with the elastic engagement portion 33 to be positioned with high precision at the site to be treated inside the body.

In addition, in this embodiment, the four elastic pieces 33b constituting the elastic engagement portion 33 are configured so that the distal end surface 33c thereof abuts and engages with the proximal end surface 29c of the tightening ring 29. This simplifies the configuration of the elastic engagement portion 33, further promoting disposability along with cost reduction.

(Example of change)
In the clip device 1 of the embodiment described above, the gate member 30 including the elastic engagement portion 33 is a separate member from the sheath 12, but the gate member 30 may be formed integrally with the sheath 12.

Figure 9 shows one example of this. In this case, the sheath 12 is made of a flexible resin as described above, and the shape of the gate member 30 including the elastic engagement portion 33 is integrally molded at the tip of the sheath 12, so that the gate member 30 is molded integrally with the sheath 12.

When the sheath 12 and gate member 30 are molded integrally in this way, the number of parts is further reduced, further promoting disposability along with lower costs.

The present invention is useful as a disposable medical clip device.

1 Clip device 12 Sheath 13 Driving wire 16 Operation unit 20 Clip 21 Clip body 29 Fastening ring (fastening member)
30 Gate member 33 Elastic engagement portion 33b Elastic piece 33c Tip surface of elastic piece

Claims (5)

a sheath consisting of one tubular body;
a drive wire inserted into the sheath;
an operating section that is provided at the proximal end of the sheath and slides the drive wire with respect to the sheath along the axial direction of the sheath;
a clip made of an elastic body that is removably connected to the distal end of the drive wire and can be stored in the sheath;
The clip is configured such that when it is pulled out from the distal end of the sheath, its distal end side opens due to its own elasticity, and when it is housed in the sheath, it is closed by being restrained by the sheath. comprising a clip body, and a fastening member that is slidably provided at least partially between the proximal end and the distal end of the clip body, and closes the clip body by sliding toward the distal end;
The clip is elastically deformed by receiving an external force from the clip, thereby allowing the clip to come out of the sheath toward the distal end, and engages with the fastening member that has come out of the sheath toward the distal end. an elastic engagement portion capable of sliding the fastening member toward the distal end side is provided at the opening on the distal end side of the sheath;
The clip main body has a locking step portion that prevents the fastening member from sliding toward the distal end at a distal end side of a range in which the fastening member can slide, and a proximal end of the locking step portion. A wide locking portion is provided on a side of the clip, and the locking portion is press-fitted into the fastening member when the fastening member is in contact with the locking stepped portion and the clip body is closed. A clip device characterized by being in a state. 2. The elastic engagement portion is formed into a cylindrical shape through which the clip passes through a plurality of elastic pieces that elastically deform in response to an external force from the clip. The clip device described in . The clip device according to claim 2, characterized in that the elastic engagement portion is formed in a cone shape that narrows toward the distal end. 4. The clip device according to claim 2, wherein the elastic piece is configured such that a distal end surface of the elastic piece abuts and engages with the proximal end of the fastening member. The clip device according to any one of claims 1 to 4, wherein the elastic engagement portion is integrally molded with the sheath.

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