JP3523712B2 - Ligation device - Google Patents

Description

Description: BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to
TECHNICAL FIELD The present invention relates to a ligating device that is inserted into a ligature to ligate an affected part. 2. Description of the Related Art Such a ligating device is used for biopsy, grasping and the like.
Has a ligating part at the tip, and this ligating part
It has a structure that expands using a mechanism and spring properties. I
However, tissue or foreign matter that should undergo biopsy or grasp
The ligature cannot be expanded in the optimal direction,
There is a problem that the object cannot be ligated well.
Was. Accordingly, Japanese Utility Model Laid-Open No. 55-109501 discloses
Then, for example, inserted into the forceps channel of the endoscope and
The sheath portion connected to the ligating part may be a multi-coil or a multi-coil.
Formed by an il and rotate the sheath part at hand
This allows the ligature to rotate in the desired direction
The disclosed ligating device is disclosed. [0004] However, the sheath
Rotate the part through the forceps channel of the endoscope, for example.
The outer circumference of the sheath and the inner wall of the forceps channel.
Rotational jumps etc. occur due to frictional resistance,
Indeed, the rotational force cannot be transmitted to the ligature, which is the tip
There are cases. [0005] Further, the sheath portion is formed of a multi-coil or a multi-coil.
When formed with a sheath, the flexibility of the sheath part is reduced
When pursuing rotation, the forceps channel
Results in significantly worsening the penetration of the sheath
And it is difficult to obtain a desired rotation property. In particular,
In the case of an
Have a point. [0006] In addition, a multiple coil has several layers of coils.
It is formed by combining
Thus, there is a disadvantage that the diameter becomes large. Endoscope forceps channel
And the sheath part using the limited space
Considering the introduction of the distal end ligature into the body cavity,
It is problematic to form the base part with multiple coils.
You. Further, the operating wire is moved forward and backward,
In the configuration that opens and closes the ligating part of the locking mechanism,
The operation wire is under tension in the expanded state.
If you try to ligate while maintaining this state
If you do, this tension will help
Not transmitted to the ligature, rotate the ligature in the desired direction
May not be possible. The present invention has been made by paying attention to the above circumstances.
The purpose is to make the sheath thicker.
Place the ligature without harming other functions.
Provide a ligation device that can be easily rotated in the desired direction.
To provide. [0009] In order to solve the above problems,
In particular, the present invention provides an introduction tube that can be inserted into a body cavity,
A tubular operating member inserted into the irrigation tube so as to be able to advance and retreat,
The advance of the operating member with respect to the introduction pipe connected to the proximal end of the operating member
A first slider that performs a retreat operation, and
Retractably inserted operation wire having torque transmitting property
And the first slurry connected to the proximal end of the operation wire.
The first engagement with the ratchet mechanism
Movement of the operation wire while moving back and forth with respect to the slider
And a second slider for performing
It has a pair of grips that are worn and ligate living tissue.
The gripping part is separated by the pulling operation of the operation wire.
Ligating device having a ligating portion that can be expanded in the direction in which
In this case, the operation wire can be rotated at the hand side.
Operating means, the first slider and the second slider
While holding the ratchet engagement, move the second slider
The tension of the operation wire is adjusted by moving the slider
With tension release means capable of releasing
is there. The ligating apparatus having the above structure rotates the operation wire.
Since the ligature is rotated by operating
Due to the frictional resistance between the inner wall of the forceps channel and the introduction tube.
There is no rotation jump etc.
Torque can be reliably transmitted to the ligature at the tip
You. Also, the first slider, the second slider,
While maintaining the ratchet engagement state of
Move the wire forward and backward with respect to the first slider to adjust the tension of the operation wire.
Can be released, changing the current state of the ligated part
Without increasing the torque transmission.
You. An embodiment of the present invention will be described below with reference to the drawings.
explain about. FIG. 1 shows a clip device as a ligating device.
FIG. 2 shows the hand-side operation unit 4.
You. As shown in FIG. 1, this clip device
The device body 1 and the clip device body 1 are detachably mounted.
And a cassette type clip unit 2 to be attached.
ing. In the figure, reference numeral 3 denotes an introduction pipe of the clip device main body 1.
You. The introduction pipe 3 is made of, for example, tetrafluoroethylene resin or the like.
Formed of a flexible tube made of
Can be inserted into the body cavity using the forceps channel of the endoscope
It has become so. As shown in FIG. 2, the clip device body 1
The operation unit 4 includes an operation unit main body 5 and the operation unit main body 5.
A first slide mounted slidably in the axial direction
Ratchet mechanism for the slider 13 and the first slider 13
A second slider 36 slidable in the axial direction through
It is composed of And the base end of the introduction pipe 3 is
It is connected to the operation unit main body 5 as described above. As shown in FIG. 1, inside the introduction pipe 3,
Connection ring 2 made of stainless steel short tube at the tip
The flexible operation tube 28 with the 9 attached and fixed can move forward and backward
It has been inserted. This operation tube 28 is an example as described later.
For example, it is formed by tightly winding a stainless wire.
Is connected to the first slider 13 of the operation unit 4,
By operating the first slider 13, the inside of the introduction pipe 3 is
It can move forward and backward, and it can freely protrude and retract
is there. The operation tube 28 has a torque transmitting property.
The operating wire 33 is inserted so as to be able to advance and retreat. this
The operation wire 33 has excellent slipperiness over almost the entire length.
Coated with fluorinated resin, etc.
The operability of the wire 33 is improved. As shown in FIG. 1, the tip of the operation wire 33
Is attached to the connecting plate 37 of the cassette type clip unit 2.
A hook 30 for detachably locking is attached. Figure
3 is a perspective view showing the hook 30 in an enlarged manner. Figure
As shown, the hook 30 is attached to one side of the tip of the cylindrical body.
A notch surface 30a is formed, and this notch surface 30a
A pin 42 stands perpendicular to the longitudinal direction of the hook 30.
Is established. This pin 42 has a circular head 42a
And a neck 42b smaller in diameter than the head 42a. At the base end of the hook 30, the length of the hook 30 is
A hole 40 coaxial with the central axis is formed. In this hole 40
Is inserted with the operation wire 33 and fixed with a fixing material etc.
Is done. The hook 30 is a metal injection mode.
Molded by metal. This is a metal injector
Surface mold is superior in toughness compared to the shaved product
Even in the event that excessive force is applied, deformation
Just do it and it will not be destroyed and fall off
That's why. The introduction pipe 3 is inserted into the introduction pipe 3.
The operation tube 28 is transparent so that it can be seen through the endoscope.
Is desirable. Clearer between introduction pipe 3 and operation pipe 28
The distance should be about 0.1 to 0.5 mm over the entire circumference.
Is preferred. This is because if the clearance is too large,
These tubes 3 and 28 will deform and buckle, resulting in clearance
Is small, the sliding resistance increases. As shown in FIG. 4, the operation tube 28 has a square cross section.
Stainless steel wire and the hook 30
A tip side coil 31 having an inside diameter that can be inserted,
Connected to the side coil 31 by laser welding, etc.
Proximal coil formed by tightly winding a cross-section stainless steel wire
32. In this way, the tip side
Make sure the inner diameter of the file 31 is such that the hook 30 can be inserted.
It is a flat coil because it needs to be kept, but it is a flat coil
This makes it thinner, but more resistant to stretching and strength.
Is obtained. The proximal coil 32 of the operation tube 28 and the inside thereof
The clearance with the operation wire 33 through which
It is set small. This clearance is 0.05 ~
It is preferably about 0.2 mm. This is the operation wire 33
Meanders in the proximal coil 32, and the transmitted force is
This is to prevent damage. As shown in FIG. 5, the clip unit 2
Is detachably engaged with the clip 45.
A connecting plate 37 as a connecting member to be combined and a clip tightening
And a use ring 46. The clip 45 is a thin stainless steel plate.
Is bent at the center, and the bent portion is used as the base end 47.
Therefore, the clip tightening ring 46 is
A pair of fitting portions 48a, 48b having a wider interval than the inner diameter extend.
And these fitting portions 48a and 48b are extended.
By making both arms 49a and 49b cross each other,
It consists of. And further, each arm 49a,
The tip of 49b is bent to face each other
The holding parts 50a and 50b are formed. And click
Arm 45 so as to open the holding portions 50a and 50b.
a, 49b is provided with open learning. On the other hand, the connecting plate 37 is made of a thin stainless steel.
It is formed by punching a strip,
As shown in FIG.
A J-shaped hook 51 is formed to be detachably engaged.
The hook 30 (FIG. 1 and FIG.
An engagement hole 52 detachably engaged with the pin 42 of FIG. 3).
Is formed. This engagement hole 52 extends in the longitudinal direction.
A long hole 52a, and an end of the long hole 52a in the hook 51 direction.
And the large-diameter hole 52b formed. And hook 30
The head 42a of the pin 42 in FIG.
Formed smaller than hole 52b and larger than width of long hole 52a
The neck 42b of the pin 42 is a long hole of the engagement hole 52.
The diameter is smaller than the width of 52a. The clip tightening ring 46 is an operation pipe.
It is detachably attached to the connecting ring 29 at the tip of 28,
Fits and attaches to the arms 49a and 49b of the clip 45
As a result, the holding portions 50a and 50b of the clip 45 are closed.
Is what it does. As shown in FIG. 5, a clip tightening ring
A step is formed on the outer peripheral surface of 46. And this
Operated by the narrow part of the clip tightening ring 46
Smaller than the inside diameter of the connecting ring 29 of the tube 28 (see FIG. 1)
A connecting portion 46a is formed. Note that this click
The large-diameter portion of the clamping ring 46 is the connecting ring 29.
Is larger than the inner diameter of Then, as shown in FIG.
The lip unit 2 is connected to the base end 47 of the clip 45 by a connecting plate.
Hook 51 of hook 37, and in this state, clear connecting plate 37.
Insert the pipe outer diameter into the
In this state, the inside of the clip tightening ring 46 is compared.
Filling with a fixing agent 90 such as silicone,
And the connecting plate 37 are temporarily fixed in the clip tightening ring 46.
It was done. Next, referring to FIG. 6 to FIG.
The details of the operation unit 4 of the installation main body 1 will be described. As shown in FIG.
As shown, the operation unit 4 includes an operation unit main body 5 and this operation unit book.
A first slidably mounted axially relative to the body 5
A ratchet for the slider 13 and the first slider 13
Second slider 3 slidable in the axial direction via a mechanism
6 is comprised. The operation section main body 5 has a distal opening 10 and a proximal opening.
A through hole 12 opening with the mouth 11 extends over the entire length thereof.
Is formed. This through hole 12 is located at the tip of the operation section main body 5.
Communicates with the inner hole of the introduction pipe 3 connected to the end opening 10
ing. Further, the operation unit main body 5 is extended from the outer periphery of the base end of the introduction pipe 3.
Over the outer periphery of the tip base 5a of
The heat-shrinkable tube 27 made of soft material is covered
(See also FIG. 2). This is the introduction pipe 3 and the operation unit main body 5
The hardness changes drastically at the connection with the
This is to prevent the inlet pipe 3 from buckling.
The head 27 is provided with a change in hardness from the introduction pipe 3 to the operation section main body 5.
It acts as a reinforcing member to make the formation gentle. The through hole 12 has a small-diameter portion 12a on the tip side and
And a large-diameter portion 12b occupying most of the other portion, and a small-diameter portion
12a and large diameter portion 12b are connected via tapered hole 12c
Consisting of The large-diameter portion 12b has the tip of the first slider 13
It is formed with an insertable inner diameter. The operation unit body 5
In addition, a not-shown syringe is detachable and the
A luer lock base 14 communicating with the large diameter portion 12b is provided.
ing. The operation unit main body 5 has a flange 15 at its base end.
have. As shown in FIG.
The lid member 6 shown in FIG.
A mounting portion 94 to be formed is formed.
Are provided with engagement grooves 16, 16 with which the lid member 6 can engage.
Have been killed. The base end face of the mounting portion 94 is shown in FIG.
An engagement portion 17 with which the fixing release button 7 can be engaged is protruded.
The outer surface of the engaging portion 17 has the same shape as the grooves 16, 16.
The side hole 18 communicating with the large diameter portion 12b of the through hole 12 in the direction
Is formed. As shown in FIG.
In addition, a large-diameter hole 18a and a small-diameter hole 18b are provided. In addition,
The joint 17 is located at the center of the flange 15 (operating unit main body).
5), and a base end opening of the through hole 12 at a base end surface thereof.
The part 11 is open. As shown in FIG. 7B, the lid member 6 is substantially
It has a disk-like shape and is attached to one end of the lid member 6.
A groove 95 capable of accommodating the portion 94 and the engaging portion 17 is formed.
ing. The groove 95 extends to the periphery of the lid member 6.
are doing. In addition, the lid member 6 is directed toward the inside of the groove 95.
And a pair of
Protrusions 22, 22 are provided. Further, the lid member 6
Is connected to the groove 95 and engages with the engaging portion 17
A possible opening 21 is formed. Also, as shown in FIG.
7 shows a state in which the operation section main body 5 and the lid member 6 are assembled (FIG.
9) is formed between the engaging portion 17 and the lid member 6
A rectangular frame 25 that slides in the space, and the inside of the frame 25
And a pin 26 protruding toward. pin
26 is fitted in the large-diameter hole 18a of the side hole 18 of the engaging portion 17.
Fit into the large-diameter portion 26a and the small-diameter hole 18b of the side hole 18.
And a small-diameter portion 26b which is fitted to the engaging portion 17.
In the state, the inside of the large diameter portion 12b of the through hole 12 of the operation portion main body 5
The total length is set to protrude about
I have. Assembling the lid member 6 to the operation section main body 5
First, assemble the fixing release button 7 to the engaging portion 17.
The outer peripheral surface of the small diameter portion 26b of the pin 26 and the
The O-ring 9 is interposed between the peripheral surface of the diameter hole 18a. Next
And a spring device formed on the bottom surface of the large-diameter portion 26a of the pin 26.
The spring 8 is attached to the attachment hole 97 (see FIG. 9), and in this state,
The cover member 6 is fitted into the operation section main body 5. Below, this fitting
The procedure will be described. First, the lids are inserted into the grooves 16, 16 of the operation section main body 5.
Position the protruding portions 22, 22 of the material 6 and set the arrows in FIG.
Therefore, slide the lid member 6 on the operation unit main body 5 from above.
I'll let you. As a result, the protrusions 22 are formed in the grooves 16, 16.
Mesh with each other. In this case, as shown in FIG.
Distance L from the base end surface of the jaw 15 to the base end surface of the engagement portion 17
From the tip of the lid member 6 to the tip of the opening 21 (of the groove 95).
The relationship with the distance L 'to the end face) is L>L'.
L is set to be longer by about 0.5 mm.
Therefore, this dimension setting, the grooves 16, 16 and the projection 2
Chamfers provided at the beginning of each engagement with
The lid member 6 is attached to the operation section main body 5 by the
Cover member 6 is deformed as
Good. In this state, the lid member 6 is further moved to the operation section main body 5.
To slide, the center of the flange 15 and the lid member 6
When the center coincides with the center, the engaging portion 17 of the operation portion main body 5 is
It fits into the opening 21 of the lid member 6, whereby the lid
The deformation of the member 6 is eliminated, and the lid member 6
The grooves 16, 16 engage with the projections 22, 22
In the radial direction, the engaging portion 17 and the opening 2
1 is firmly attached to the operation portion main body 5 by the engagement of
Fixed to. In this assembled state,
All parts between the operation unit main body 5 and the lid member 6 have a minimum size.
There is play and no residual stress is generated by assembly.
It has become. As described above, the operation unit body 5
In a state where the lid member 6 is assembled, it is engaged with the engaging portion 17.
Part of the fixing release button 7 is
Of the lock release button 7 and the lid
The spring 8 is held in a compressed state with the member 6. This ba
The end 8 of the pin 8 is inserted into the large diameter portion 12 b of the through hole 12.
The fixing release button 7 is urged in the direction in which the fixing release button 7 is projected. did
Therefore, press the release button 7 against this urging force.
As a result, the pin 26 is inserted into the large diameter portion 12b of the through hole 12.
The protrusion amount can be set to 0 mm. Next, a first slider constituting the operation unit 4
The thirteenth and second sliders 36 will be described. FIG.
As shown in FIG.
The first slider 13 is inserted so as to be able to move forward and backward. Introduction
The operation tube 28 inserted through the tube 3 is a distal end of the operation portion main body 5.
Screwed to the tip of the first slider 13 through the opening 10
To the tip of the metal connection member 59
The connection is fixed. The logic using such a connection method
The reason is that the operation tube 28 is a coil and is fixed with an adhesive.
If the coil expands and contracts,
And shrink, causing the adhesive to peel off.
In addition, the first slider 13 has a resin mode.
The operation pipe 28 is directly connected to the first slide.
This is because it is impossible to braze to the die 13.
Therefore, the operation pipe 28 is temporarily connected to the metal connecting member 5.
9 by brazing or the like.
The portion 60 can be screwed and adhered to the first slider 13.
This is the best solution. Further, the screw portion 60 of the connecting member 59 and the operating portion
A compression spring 62 is interposed between the main body 5 and the compression spring 62. this
The compression spring 62 is connected to the connecting member 59 on the distal end side of the screw portion 60.
It is screwed into a spiral groove 61 formed on the outer peripheral surface.
You. Therefore, according to this configuration, the connecting member 59 and the
Spiral groove at the time of screwing adhesion with the slider 13
Applying an adhesive also to the compression spring 62 arranged at 61
Thereby, the work of bonding the compression spring 62 and the connecting member 59 and
Simultaneous bonding of the connecting member 59 and the first slider 13
Can be done. The outer peripheral surface on the tip end side of the first slider 13
Two guide grooves 64, 64 are provided along the longitudinal direction.
ing. These two guide grooves 64, 64
It is provided at an angular interval of 180 degrees in the direction. Each mo
The guide groove 64 is provided with a fixing release button mounted on the operation section main body 5.
Width slightly larger than the diameter of the small diameter portion 26b of the pin 26 of the pin 7
And the step part 99 provided in the middle is
On the other hand, a first guide groove 64a having a shallow groove on the distal end side is formed,
The base end forms a second guide groove 64b having a deep groove.
You. In this configuration, the pin 26 of the release button 7 is
The first guide groove 64a of the guide groove 64 and the second guide
By operating in the groove 64b, operation beyond that position
The protrusion of the pipe 28 with respect to the introduction pipe 3 is regulated,
In addition, the rotation of the first slider 13 is restricted.
You. The compression spring 62 is such that the pin 26 is in the second stage.
When the operation unit main body 5 is located in the second guide groove 64b of the
And the first slider 13 so as to maintain the compressive force.
The dimensions are set, and the pin 26 is the first guide of the first stage.
When located at the tip of the groove 64a, the compression force is released.
Dimensioned. Also, a pin is inserted into the second guide groove 64b of the second stage.
When the inlet 26 is located, the operation is performed from the distal end opening of the introduction pipe 3.
The tube 28 protrudes, and the fixing release button 7 is pressed from this state.
To pull the pin 26 into the side hole 18 of the operation section body 5.
Then, the engagement between the pin 26 and the second guide groove 64b is released.
The operation tube 28 is automatically operated by the urging force of the compression spring 62.
Is drawn into the introduction pipe 3. The guide groove 64 is formed in the first slider 13.
Are provided because the protrusion 7a of the fixing release button 7
Although the pin 26 is located 180 ° on the opposite side of the structure
On the other hand, the user
To the operation unit body 5
There is a possibility that the slider 13 may be inserted 180 °
Because there is. As shown in FIG. 2, a first slider
13 is a first slit along its longitudinal direction on the base end side.
56 are formed. The first slit 56
The first slider 13 is provided at both ends of the first slider 13 on both sides of the first slider 13.
Overhangs substantially perpendicular to the longitudinal direction of the rider 13
A bulging portion 13a is provided. In this bulging portion 13a
Is perpendicular to the first slit 56 and the second slit 5
7 are formed. Then, the second slider 36
1 so as to be movable along the slit 56,
A rotation operation unit, which will be described later, fixed to the base end of the operation wire 33
The material 55 is rotatably disposed in the second slit 57
I have. This configuration will be described in more detail with reference to FIG.
I will tell. As shown in FIG. 6, at the tip of the connecting member 59,
From the base end opening of the operation tube 28 which is connected and fixed, the operation
The extension wire 33 extends, and the extended operation wire 33
The second slider 36 is rotatably connected to the second slider 36. Ma
The operation wire 3 extending from the base end opening of the operation tube 28
A plurality of tubular members 34 and 53 are fitted on the outer peripheral portion of
Have been. That is, as shown in FIG.
On the outer periphery of the extension of the wire 33, a second
To prevent buckling near the slider 36, a stainless steel
Operation pipe 34 made of pipe material such as stainless steel
I have. Further, a stainless steel is provided on the outer periphery of the base end of the operation pipe 34.
A cylindrical wire receiver 35 made of a material such as
ing. Then, in this state, the outer periphery of the wire receiver 35
By caulking as shown in FIGS. 11 and 12.
, Wire receiver 35, operation pipe 34, and operation wire
33 are integrally fixed. In addition, such fixation,
Of course, soldering is also possible. However, due to soldering
Then, the operation wire 33 is caused by the remaining flux and the like.
It may be corroded and cut, and extra solder
Cleaning process to remove sanding, flux, etc.
There are many problems, such as the need for a process. Therefore,
Considering this point, fixing by swaging is still preferable.
It can be said that it is. In this case, the caulking is fixed by the caulking shown in FIG.
This is performed by a caulking device having the caulking unit 102.
The caulking portion 102 includes a concave receiving portion 100 and a convex portion 101.
, The side surface of the wire receiver 35 is convex with the receiving portion 100.
It can be crimped by being sandwiched between the portion 101 and the portion 101. Mosquito
In the crimped state, as shown in the vertical sectional view of FIG.
The wire 33 and the operation pipe 34 are received by the caulking section 102.
It has a shape that is deviated toward the locking part 100 side. As shown in FIG.
The caulking is the side of the wire receiver 35 shifted in the longitudinal direction.
At two locations. These two caulking are caulking
This is performed by changing the direction of the unit 102. That is, in FIG.
As shown, the operation pie is
The loop 34 and the operation wire 33 form a wavy shape and
Is increased. In addition, outside the wire receiver 35
The diameter is about 2mm and the outer diameter of the operation pipe 34 is about 0.8mm
In the case of degrees, the interval between the two caulking parts 91, 91 is
It is preferably about 0.5 mm. This is two
If the distance between the caulking portions 91 and 91 is too short, the operation pie
Step 34 is too tight and breaks from the bent part
Because it may lead to Conversely, the operation pipe 34
When the degree of undulation of the operation wire 33 is loose, the fixed strength
Is not so high. Of course, there are three caulking points
More than a place is fine. However, in this case as well,
The female parts 91, 91 need to reverse the direction of caulking
(This caulking method is limited to the clip device of this embodiment.
However, the present invention is also applicable to other endoscope treatment tools. ). The outer periphery of the operation pipe 34 has a wire
-The rotating pipe 53 is covered with a certain distance from the receiver 35.
It is fitted. This rotating pipe 53 is a pipe made of brass or the like.
And a flat portion 54 is provided over substantially the entire length thereof.
Have been. That is, the rotating pipe 53 has a sectional shape
Has a D shape. Also, on the outer periphery of the rotating pipe 53
The disk-shaped rotary operation member 55 is slidably fitted.
ing. In this case, the rotation operation member 55
The rotation of the rotation operation member 55 is controlled by the rotation pipe 53 (and thus the operation
Rotating path so that it can be transmitted to wire 33)
A D-shaped through hole 58 having the same cross-sectional shape as Ip 53 is formed.
Have been. Therefore, the rotation operation member 55 is
Cannot rotate with respect to the pump 53. Note that the rotary
The cross-sectional shape of Ip 53 is not a D shape but a square or hexagon
In some cases, of course, the through hole 58 of the rotary operation member 55
It goes without saying that the shape is also a square or a hexagon. The surface of the rotary pipe 53 is made of nickel.
・ Plating such as chrome is applied. And the rotating pie
The operation pipe 53 is formed by caulking its base end.
34. Of course, the rotating pipe 53 and the operation
The fixing to the pipe 34 may be performed by brazing or the like. As described above, the operation pipe 34 and the rotary
The base of the operation wire 33 configured by fitting the
The end side allows the inner hole 120 of the first slider 13 to freely advance and retreat.
It is inserted and protrudes into the first slit 56, and its base end is
Along the first slit 56 via the wire receiver 35
It is fixed to a movable second slider 36. Ma
In addition, the rotation operation member 5 fitted to the outer circumference of the rotation pipe 53
5 is provided on the bulging portion 13a of the first slider 13
It is arranged in the second slit 57. Rotating operation member
55 is slidable on the outer periphery of the rotating pipe 53 (but
(Rotation is impossible as described above).
In any state in which the transfer pipe 53 moves forward and backward, the rotation operation unit
The rotation of the member 55 can be transmitted to the rotating pipe 53. This rotation
The force is the rotation operation member 55 → the rotation pipe 53 → the operation pipe 3
4 → Operation wire 33 → Hook 30 → Cassette type click
It will be transmitted to step 2. In other words, through the clip device
With the rotation operation member 55 inserted into the body cavity endoscopically,
By rotating, the cassette type clip 2
The opening direction of the loop 45 can be remotely controlled from outside the body
ing. As shown in FIG. 6, the rotary operation member 55 is
The second slider 36 is provided in front of a sliding portion.
However, this is the operation of the second slider 36 with the right hand
Suppose that you perform the rotation operation with your left hand.
It is intended to make operation easier, but of course, rotation
The operation member 55 may be provided at another position. As shown in FIG. 6, the second slider 36
Is a wire attached to the base end of the operation wire 33
Two holding members 65 that sandwich and fix the receiver 35,
65 and these pressing members 65, 65 are integrated from the outside.
And a cover member 122 that covers the main body.
You. The holding members 65, 65 reduce the product cost.
To use two identical parts. Each holding member
65 is inside the first slit 56 of the first slider 13
And a plate-shaped sliding portion 65a that slides
And a crescent-shaped portion 65b located on the base end side.
Since the notch 69 is provided in the sliding portion 65a,
The two holding members 65, 65 are notched 69, 6
9 Comrades are joined to face each other and
In the closed space formed by the notches 69, 69,
When the wire receiver 35 is disposed, the operation wire 33 is
Rotatably fixed to the second slider 36 via the receiver 35
Is done. At the tip of the sliding portion 65a, there is an escape portion 7 inside.
0 is formed on the outer peripheral surface of the tip.
A claw portion 71 is formed. Cover member 122 and two
The fixing of the holding members 65 and 65 is performed by two holding members.
65, the base end of the cover member 122
The claws 71 of the holding members 65, 65 are removed from the cover member 122.
Along the inner hole groove 72 (see FIG. 15) provided in the inner hole.
And push it. At this time, the escape portion 70 makes the sliding portion 65a
The fact that the tip bends is used. Then, the holding members 65, 6
When the cover 5 and the cover member 122 come to a predetermined position, the claw 71
To the locking portion 73 provided at the tip of the cover member 122.
The two are fixed. The crescent-shaped portion 65b of the holding member 65 has a half-moon
Rectangular penetrating vertically through the crescent-shaped portion 65b from the flat surface portion 74
There is a through hole 75 having a ratchet shape.
The release button 68, the locking means 66, and the spring 67 are slidably arranged.
Is established. The spring 67 is provided between the locking means 66 and the second slide.
It is arranged in a compressed state between the inner wall of the
In the normal state, the locking means 66 is connected to the first slider 13.
Is pressed against the locking claw 76 of the first
Of the second slider 36 with respect to the
It regulates movement and forms a ratchet mechanism.
The ratchet release button 68 is connected to the through hole 75 and the through hole.
75 through the communication hole 77 of the cover member 122 communicating with
When the ratchet release button 68 is pressed, the
The means 66 is pushed up, and the locking means 66 and the locking pawl 76
Is released. Further, the laser beam located in the first slit 56
A rod-shaped sliding portion 68a at the tip of the chest release button 68
There is almost no clearance between through hole 75
Is defined. The clearance in this case is about 0.01 ~
It is preferably about 0.2 mm. This is
It depends. That is, in the present clip device,
As described above, pull the second slider 36
Extend the J-shaped hook 51 of the socket type clip 2 and
Type clip 2 and the clip device body 1
The clip-type clip 2 is placed in the affected area, and at this time, the second
The force applied to the slider 36 is released, and the second slider
The rider 36 suddenly moves to the near side, and the second slider
-36 and the first slit 5 of the first slider 13
6 hits the base end violently. At this time, the ratchet solution
The clearance between the sliding portion 68a of the release button 68 and the through hole 75
If the clearance is large, the holding members 65, 65
The base end is plastically deformed, the through hole 75 is crushed,
The sliding means 68 of the locking means 66 and the ratchet release button 68
a cannot be slid. So, like this
In order to prevent accidents, the clearance was almost eliminated.
To provide space for the holding members 65, 65 to plastically deform.
Even if a sudden collision occurs, the holding member 6
5, 65 absorb the impact by elastic deformation, and the locking means 6
6 and the sliding portion 68a of the ratchet release button
It is a movement that can be performed. Also two pushes
The surrounding members 65, 65 are surrounded by a cylindrical cover member 122.
As a result, the pressing members 65, 65
It is possible to prevent loosening beforehand. By the way, as shown in FIG.
Release button 68 is extended toward the button 68b.
The stopper 7 has a space 78 inside the stopper 78.
9 is bent, so that the pressing members 65
The ratchet release button 68 is fitted into the hole 75
It is possible. Also, after being fitted, the retaining 7
8 is hooked on the step portion 80 of the through hole 75 and does not come off.
Swelling. The first and second sliders 13, 36
The length of the locking means 66 in the longitudinal direction of the
It is about 5 mm shorter than the length in the longitudinal direction.
Even if the ratchet mechanism is engaged, the second slide
The slider 36 is preferably 3 to 10 mm with respect to the first slider 13.
More preferably, it can move about 5 mm. As shown in FIG. 6B, the first
A ring-shaped handle 105 is provided at the base end of the slider 13.
Have been. Next, the operation of the clip device having the above configuration will be described.
I will tell. First, the first slider 13 of the operation unit 4 is moved to the front end side.
The pin 26 to the first slider 13
The operation tube 28 is guided to the second guide groove 64b of the
Let it protrude from the inlet tube 3. Then, in this state,
A cassette type clip unit is attached to the hook 30 on the main body 1 side.
Install 2. The method of mounting the clip unit 2 is as follows.
Slide the second slider 36 of the operation unit 4 toward the distal end side.
The hook 30 at the tip of the operation wire 33 is
Protrude outward. Next, the connecting plate of the clip unit 2
The head 42 of the pin 42 of the hook 30 is inserted into the large-diameter hole 52b of 37.
a, and in this state, the clip unit 2 is
To pull. Then, the long hole 52a of the engagement hole 52 of the connecting plate 37 is formed.
Fits into the neck 42b of the pin 42 of the hook 30,
It will not come off easily. In that state, the second
Pull the slider 36 toward the hand side, and
Pull the hook 30 into the connecting ring 29 and insert the cassette
Of the clip tightening ring 46 on the side of the clip unit 2
The connecting portion 46a is fitted and fixed in the connecting ring 29.
You. As a result, the cassette type clip unit 2 is closed.
It is loaded into the lip device main body 1. Next, the first slider 13 of the operation unit 4 is
Introduce the operation tube 28 by sliding to the original side
With the clip 45 closed, the introduction pipe is pulled into the pipe 3.
Put it in 3. Then, the endoscope tube together with the introduction tube 3
After being introduced into the body cavity through the channel,
1 by pushing the slider 13 toward the distal end side.
And pushes the operation tube 28 against the introduction tube 3 and clips
45 is pushed out from the introduction pipe 3. At this time,
The 45 arms 49a and 49b are provided with open learning.
Therefore, the arms 49a and 49b of the clip 45 expand.
You. Thereafter, the second slider 36 of the operation unit 4 is moved
Pull the hook 30 by hand through the operation wire 33
By pulling to the original side, the fitting portion 48a of the clip 45,
48 b is drawn into the clip tightening ring 46. Do
As shown in FIG. 16, the fitting portions 48a and 48b are crushed.
As a result, the arms 49a and 49b of the clip 45
Open greatly. Thus, the arms 49a, 49 of the clip 45
With b fully open, rotate the rotation member 55 in any direction.
And rotate the clip 45 in the desired direction.
I do. At this time, the second slider 36 is moved 3 to 1 to the distal end side.
By moving it by 0 mm, preferably about 5 mm,
Rotation of the rotation operation member 55 (rotation of the operation wire 33)
It can be done smoothly. This is clip 45
Tension on the operation wire 33 to open the leg
This tension is linked with the cassette type clip 2.
With the frictional resistance with the joining ring 29 increased,
The operation wire 33 is fixed by the
8 (a)), the second slider 36 is moved to the distal end side.
By moving about 3 to 10 mm, preferably about 5 mm
(The state shown in FIG. 18B), and the tension is released.
To be able to. In addition, this 3 to 10 mm, preferably 5
mm movement as described in the previous configuration.
It is possible to perform the operation in a state where the automatic mechanism is engaged. By such an operation, the cassette type clip
After adjusting the leg direction to the optimal direction, clipping is necessary.
The clip 45 is pressed against the desired living tissue 108.
Then, again pull the second slider 36 toward the hand
When the operation wire 33 is pulled toward the user, the arm of the clip 45
49a and 49b hit the clip tightening ring 46,
Further, the arms 49a and 49b are provided with the clip tightening ring.
The arm portion of the clip 45 is drawn into the
49a and 49b are closed, and the holding portions 50a and 50b are
Weave 108. Here, the operation wire 33 is further moved to the hand side.
By pulling, the clip 45 is shown in FIG.
Into the living tissue 108 as shown. At this time,
The hooks 51 of the connecting plate 37 are as shown in FIGS.
And the clip 45 comes off the connecting plate 37.
You. Note that the clip tightening ring 46 is
Since the arms 49a and 49b are pressed,
As shown in FIG.
It is left in the body together with 45. As described above, the clip of this embodiment is
The device can be used at the distal treatment section without damaging any mechanism other than rotation.
Can be rotated. In addition, rotation in both directions
Can be performed reliably without skipping rotation. This allows
Ripping can be easily performed. Before rotating, the ratchet is released.
The second slider 36 is moved 3 to 10
mm, preferably about 5 mm, for safe and secure
The tension applied to the wire can be released,
A smooth rotation becomes possible. The operation pipe 34 and the operation wire 33
By crimping the wire receiver 35 so that
Therefore, inexpensive fixing with high fixing strength is possible. What
According to the embodiment described above, various types shown in the following sections
Is obtained. 1. An introduction tube that can be inserted into a living body cavity,
A tubular operating member which is inserted into the introduction pipe so as to be able to advance and retreat,
Of the operating member connected to the proximal end of the operating member
A first slider that moves forward and backward, and
Operation wire having torque transmitting property inserted to be able to move forward and backward
And the first slurry connected to the proximal end of the operation wire.
The first engagement with the ratchet mechanism
Movement of the operation wire while moving back and forth with respect to the slider
And a second slider for performing
It has a pair of grips that are worn and ligate living tissue.
The gripping part is separated by the pulling operation of the operation wire.
Ligating device having a ligating portion that can be expanded in the direction in which
In this case, the operation wire can be rotated at the hand side.
Operating means, the first slider and the second slider
While holding the ratchet engagement, move the second slider
The tension of the operation wire is adjusted by moving the slider
Tension release means capable of releasing the
A ligating device characterized by the following. 2. The ratchet mechanism is connected to the first switch.
A locking claw formed along the longitudinal direction of the rider;
2 which is disposed in the slider and is engageable with the engaging claw.
Means for pressing the locking means against the locking claw.
And the engaging means and the engaging member against the urging force of the spring.
And a release button for releasing the engagement state with the pawl.
The tension releasing means is configured to connect the locking means to a second slide.
2nd slider leaving a certain clearance between
Characterized in that it comprises means for arranging inside
Ligating device. 3. The clearance is 4-6mm
3. The ligating apparatus according to claim 2, wherein: 4. A reinforcement pipe is installed outside the base end of the operation wire.
A cylindrical receiving member is provided on the outer periphery of the reinforcing pipe,
At least two positions different in the longitudinal direction from the side surface of the member
By caulking with the operation wire and reinforcing pipe
And the receiving member are integrally fixed, and the receiving member is
To catch on the locking part provided inside the slider 2
The operation wire and the second slider are fixed,
The two adjacent caulking points are on the side of the receiving member.
Item 1 is characterized by being performed on the opposite side
Ligation device. 5. At least two caulking points
It is performed by caulking means having a convex part.
5. The ligating apparatus according to claim 4, wherein 6. The distance between the ends of adjacent caulking is 0.4 to 0.6
Item 4 or 5 characterized in that it is mm
Ligation device. (Regarding Configurations of Items 4 to 6)
Some conventional ligating devices operate the ligating part via a wire.
Some operations are performed by operating the operation unit. Kaikai
As disclosed in JP-A-5-13409, an operating wire
After installing a reinforcement pipe at the base end of the
Bend the strong pipe together and engage with the wire receiving member
And the wire receiving member
And the operation wire are fixed. However, the operation pipe and the operation wire are broken.
After bending, fix it to the wire receiving member.
Has the disadvantage of requiring a lot of work time.
Was. Therefore, the operation pipe and the operation wire are folded at the same time.
Instead of bending, do not bend and place the receiving member in the wrong orientation.
Caulking at multiple locations from different directions
It is an attempt to solve the problem. Operation pipe and operation
By crimping the wire holder so that the ears undulate
Thus, it is possible to achieve high fixing strength and low-cost fixing. As described above, the ligating apparatus of the present invention
Does not reduce the thickness of the sheath and impair other functions.
The ligature can be easily rotated in the desired direction without
Can be. Particularly, the operating wire is rotated to ligate.
Part is rotated.
Rotational fly due to frictional resistance between the inner wall of the channel and the inlet pipe
No rotation occurs, and the rotational force generated by the rotary operation means
Can be reliably transmitted to the ligating portion at the tip. This
The ligating device improves the ease of the procedure and improves the efficiency of the procedure.
Improvement can be achieved. Further, the first slider, the second slider,
While maintaining the ratchet engagement state of
Move the wire forward and backward with respect to the first slider to adjust the tension of the operation wire.
Can be released, changing the current state of the ligated part
Without increasing the torque transmission.
You.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1A is a longitudinal sectional view of a distal end portion of a clip device according to an embodiment of the present invention, and FIG. 1B is a transverse sectional view of the distal end portion of the clip device. FIG. 2 is a perspective view of an operation unit of the clip device of FIG. 3A is a perspective view of a hook portion, and FIG. 3B is a cross-sectional view taken along line AA in FIG. FIG. 4 is a side sectional view showing a configuration of an operation tube. 5A is a plan view of the clip, and FIG. 5B is a side view of the clip. FIG. 6 is a sectional view of an operation unit of the clip device. FIG. 7 is a perspective view illustrating a configuration of an operation unit main body and a lid member. FIG. 8 is a perspective view of a fixing release button. FIG. 9 is a longitudinal sectional view of a portion of a fixing release button in an assembled state. FIG. 10 is a perspective view showing a configuration of a proximal end side of an operation wire. FIG. 11 is a front sectional view showing a state of a caulked portion at a base end portion of the operation wire. FIG. 12 is a side sectional view showing a state of a caulked portion at a base end portion of the operation wire. FIG. 13 is a view showing a main part of a caulking tool. FIG. 14 is a longitudinal sectional view of a part of a ratchet release button in an assembled state. FIG. 15 is a perspective view of a cover member of the second slider. FIG. 16 is a cross-sectional view showing how a tissue is ligated using a clip device. 17A is a cross-sectional view of a clip placed in a ligated tissue, FIG. 17B is a cross-sectional view of the clip device after placing the clip, and FIG. 17C is a longitudinal section of the clip device after placing the clip. FIG. FIG. 18 is a sectional view of a second slider. [Description of reference numerals] 1 ... main body, 2 ... clip unit, 3 ... introduction pipe, 1
3 first slider, 28 operating tube (operating member), 33
... operation wire, 36 ... second slider, 55 ... rotation operation member.

Claims (1)

(57) [Claims 1] An introduction tube which can be inserted into a living body cavity, a tubular operation member which is inserted into the introduction tube so as to be able to advance and retreat, and which is connected to a base end of the operation member. A first slider for moving the operating member forward and backward with respect to the introduction pipe, an operating wire having a torque transmitting property inserted in the operating member so as to be able to advance and retreat, and the first slider connected to a base end of the operating wire; And the ratchet mechanism
A second slider for moving the operating wire forward and backward while moving forward and backward with respect to the slider, and a pair of grips attached to the distal end of the operating wire and ligating a living tissue, and the pulling operation of the operating wire A ligating device including a ligating portion that can be expanded in a direction in which the grip portion is separated from the ligating device, wherein: a rotating operation unit configured to rotate the operation wire at a hand side; and a first slider and a second slider. A ligating device comprising: tension releasing means for releasing the tension of the operation wire by moving the second slider with respect to the first slider while maintaining the ratchet engagement state.