JP4274524B2 - Endoscopic clip device - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to an endoscope clip device that is used through a treatment instrument insertion channel of an endoscope to perform hemostasis, ligation, marking, or the like in the body.
[0002]
[Prior art]
In general, the clip device for an endoscope has a configuration in which a clip disposed at the distal end of a flexible sheath is detachably connected to the distal end of an operation wire that is inserted into the flexible sheath so as to be movable forward and backward in the axial direction. The clip is held in the closed state by pulling the operation wire from the operation unit side connected to the proximal end of the flexible sheath, and the clip thus held in the closed state is The flexible sheath and the operation wire can be separated from each other.
[0003]
In such an endoscopic clip device, it is difficult to perform accurate clipping when the affected area to be clipped is contaminated with blood or sewage and cannot be clearly observed with an endoscope. There is.
[0004]
Therefore, a water injection port is provided in the operation unit connected to the proximal end side of the flexible sheath so that the inside of the flexible sheath can be used as a water supply path so that washing water or the like can be sent out from the distal end of the flexible sheath. (For example, Patent Document 1).
[0005]
[Patent Document 1]
Japanese Utility Model Publication No. 7-1905 [0006]
[Problems to be solved by the invention]
As described above, by allowing cleaning water or the like to be sent out from the distal end of the flexible sheath, the mucosal surface of the affected area is washed and the clipping treatment is accurately performed while clearly observing with an endoscope. Can do.
[0007]
However, when the inside of the flexible sheath is used as the water supply path, the inside of the flexible sheath may be contaminated by the backflow of the body sewage, etc., so it is necessary to completely clean the water supply path after use.
[0008]
For this purpose, it is desirable to brush the cleaning channel through the cleaning brush over the entire length, but the brush interferes with the operation wire inserted in the flexible sheath that is the water channel, so the inner circumference of the water channel Brushing all over the surface is extremely difficult.
[0009]
In addition, in the operation unit for moving the operation wire forward and backward, the water inlet is inevitably disposed sideways by providing a finger hook at the end of the axial line position. It is difficult to insert a cleaning brush into
[0010]
Then, an object of this invention is to provide the clip apparatus for endoscopes which can carry out the brushing washing | cleaning all over the full length inside the water supply path arrange | positioned in a flexible sheath.
[0011]
[Means for Solving the Problems]
In order to achieve the above object, the clip device for an endoscope of the present invention has an operation motion in which a clip disposed at the distal end of the flexible sheath is inserted and disposed in the flexible sheath so as to be movable forward and backward in the axial direction. The clip is held in a closed state by pulling the operating motion transmitting member from the operating portion side connected to the distal end of the transmitting member in a separable manner and connected to the proximal end of the flexible sheath, and so on. In an endoscopic clip device configured to be able to separate a clip held in a closed state from a flexible sheath and an operation motion transmission member, the clip is passed through the operation motion transmission member in the axial direction. A water channel is formed over the entire length, and both ends of the water channel are each opened straight in the axial direction.
[0012]
In addition, when the pipe material which has flexibility is used as an operation movement transmission member and the inner space of the pipe material is a water supply channel, cleaning by brushing the inner peripheral surface of the water supply channel is easy.
[0013]
In addition, the operation portion is provided with a rotation operation wheel for rotating the base end portion of the flexible sheath and the base end portion of the operation motion transmitting member relative to each other in the axial direction by rotating around the axis. Is passing through the rotary operation wheel, it is easy to insert the cleaning brush into the water supply channel.
[0014]
Further, the base end side portion of the clip is formed in a cylindrical shape with the rear opened, and a connecting member that engages and disengages with respect to the rear end cylindrical portion of the clip is provided at the distal end portion of the operation motion transmitting member. And the front-end | tip opening of a water supply path can be easily arrange | positioned in the axial line position of the front end surface of a connection member.
[0015]
DETAILED DESCRIPTION OF THE INVENTION
Embodiments of the present invention will be described with reference to the drawings.
FIG. 4 shows the overall configuration of the endoscope clip device. For example, a flexible sheath 2 formed by tightly winding a stainless steel wire with a constant diameter, such as a tetrafluoroethylene resin tube, is used. An outer tube 6 made of a flexible tube is loosely coated.
[0016]
And the operation part 20 is connected with the base end side, and the closed cylindrical receptacle 3 for mounting | wearing the indwelling clip unit 10 is arrange | positioned at the front end side. The flexible sheath 2 and the outer tube 6 may be formed of a superelastic alloy pipe or the like. Reference numeral 10 denotes an indwelling clip unit.
[0017]
FIG. 5 shows an indwelling clip unit 10. In this embodiment, for example, three clip claws 11 made of a superelastic alloy, a stainless steel material having a spring property, etc. are elastically deformed in the vicinity of their rear end portions A. As a result, it is arranged in a shape extending at intervals of about 120 ° around the central axis so as to open and close with the vicinity of the rear end A as a base point, and is connected to each other at a cylindrical connecting portion 12 provided at the rear end. ing. The rear end portion of the cylindrical connecting portion 12 is open.
[0018]
Reference numeral 13 denotes an engagement click part for engaging with a connecting member 5 described later, and the cylindrical connecting part 12 is cut from the rear side by a pair of parallel slits so as to form a leaf spring. It is integrally formed with the shape connecting portion 12 and the clip claw 11. An inward protrusion 13 a that protrudes inward is formed near the rear end of the engagement click portion 13.
[0019]
A clip closing cylinder 15 made of, for example, a stainless steel pipe, which is another component constituting the indwelling clip unit 10, is fitted to the cylindrical connecting portion 12 from the rear so as to be slidable in the axial direction. On the outer peripheral surface of the clip closing cylinder 15, a circumferential groove 15 a for engaging with the inner surface convex portion 3 a of the closing cylinder receiver 3 is formed.
[0020]
The cylindrical connecting portion 12 and the clip closing cylinder 15 are elastically frictionally engaged so that a certain amount of force needs to be applied to slide relatively, and the clip closing cylinder 15 is cylindrical. By moving the clip claw 11 from the connecting portion 12 side so as to cover the clip claw 11, the clip claw 11 is elastically deformed and held in a closed state.
[0021]
In this way, the clip closing cylinder 15 is fitted from the rear to the cylindrical connecting part 12 that connects all the three clip claws 11 in a continuous manner on the rear end A side, and the indwelling clip A unit 10 is configured.
[0022]
Returning to FIG. 4, the closed cylinder receiver 3 attached to the distal end of the flexible sheath 2 is formed in a shape obtained by cutting off a cylindrical member fitted to the clip closed cylinder 15 by a half circumference, On the inner peripheral surface of the distal end portion of the closed cylinder receiver 3, an inner surface convex portion 3 a that engages with the circumferential groove 15 a on the outer peripheral surface of the clip closed cylinder 15 is formed so as to protrude halfway.
[0023]
As a result, the clip closing cylinder 15 can be engaged with and disengaged from the side with respect to the closing cylinder receiver 3, and the inner surface convex portion 3 a of the closing cylinder receiver 3 is fitted into the circumferential groove 15 a of the clip closing cylinder 15. As shown in FIG. 6 and the like, which will be described later, the clip closing cylinder 15 is engaged with the closing cylinder receiver 3 in a state where it cannot move in the axial direction.
[0024]
FIG. 1 shows a ready-to-use state in which the indwelling clip unit 10 is loaded on the distal end portion of the endoscope clip device, and the outer tube 6 is fitted to the clip claw 11 portion.
[0025]
The closed cylinder receiver 3 is fixed to the distal end of the flexible sheath 2 by brazing or the like, and the flexible sheath 2 has flexibility such as a superelastic alloy pipe or a plastic pipe. An operation connected to the base end of the flexible sheath 2 in which an operation motion transmission member 4 having a circular shape in cross section made of a pipe material having a certain level of waist strength is inserted and disposed so as to be movable back and forth in the axial direction. From the portion 20, the operation motion transmitting member 4 can be moved back and forth in the axial direction relative to the flexible sheath 2.
[0026]
At the tip of the operation motion transmitting member 4, a connecting member 5 that can be engaged and disengaged from the rear side with respect to the cylindrical connecting portion 12 when the clip closing cylinder 15 does not cover the engaging click portion 13 is connected and fixed. ing.
[0027]
The connecting member 5 has a front half formed in a columnar shape with a rounded head and is loosely fitted into the cylindrical connecting portion 12. A constricted portion 5a with which the protrusion 13a is engaged is formed.
[0028]
As a result, when the engagement click portion 13 is covered with the clip closing cylinder 15, the engagement click portion 13 and the constricted portion 5 a are not disengaged, and the clip closing cylinder 15 is not covered. The inward projection 13a and the constricted portion 5a can be engaged and disengaged by elastically deforming the engagement click portion 13 outward.
[0029]
The hollow portion of the operation motion transmitting member 4 located substantially at the axial line portion of the flexible sheath 2 is a water supply passage 4a through which the cleaning liquid and the like can be passed from the proximal end side. The water supply port 41 is opened at the axial position of the distal end surface of the connecting member 5.
[0030]
FIG. 2 shows a configuration of the operation unit 20. The operation unit main body 21 is rotatable around the axis with respect to the operation motion transmission member 4 but integrally moves in the axial direction. The external thread part 21a is formed in the outer peripheral part of the intermediate part connected with the base end.
[0031]
The operation motion transmission member 4 is disposed in a state of penetrating the axial position of the operation unit 20, and the water supply path 4a opens straight outward in the axial direction. The operation knob 31 fixed to the end of the operation motion transmitting member 4 is formed by integrally screwing an insertion section 31a positioned in the operation section main body 21 and a knob section 31b positioned outside the operation section main body 21. It is configured. A water inlet 42 that communicates straight with the end opening of the water passage 4 a is formed at the axial position of the outer end surface of the operation knob 31.
[0032]
Therefore, it is possible to inject cleaning water or the like from the water injection port 42 into the water supply channel 4a and to send out the cleaning water from the water supply port 41 at the tip, and insert a wire-like member or the like into the water supply channel 4a from the water injection port 42. It is also possible to project from the water supply port 41 at the tip. Further, if the operation knob 31 is rotated around the axis, the indwelling clip unit 10 can be rotated around the axis at the tip via the operation motion transmission member 4.
[0033]
The sheath base end cap 24 fixed to the base end of the flexible sheath 2 is formed in a cylindrical shape in which the front half of the operation portion main body 21 is loosely inserted, and a male portion is provided on the outer peripheral portion of the intermediate portion. A screw portion 24a is formed, and a flange portion 24b is formed at the protruding end portion.
[0034]
The first rotary operation wheel 22 that is independently arranged to be rotatable around the axis line includes a female screw portion 22 a that is screwed with the male screw portion 21 a of the operation portion main body 21, and a collar portion of the sheath base end cap 24. The operation wheel portion 22b that is rotatable around the axis line in a state in which the movement in the axial direction is restricted with respect to 24b is integrally screwed and connected.
[0035]
The outer tube base end cap 27 fixed to the base end of the outer tube 6 is formed in a cylindrical shape in which the front half of the sheath base end cap 24 is loosely inserted, and a flange portion 27b is formed at the protruding end portion. Has been. 28 is a flexible anti-folding tube.
[0036]
The second rotation operation wheel 23, which is arranged so as to be rotatable around the axis alone, has a female screw portion 23 a screwed with the male screw portion 24 a of the sheath base end cap 24, and an outer tube base end cap 27. An operation wheel portion 23b that is rotatable around the axis line in a state in which movement in the axial direction is restricted with respect to the flange portion 27b is integrally connected with a screw.
[0037]
Further, as shown in FIG. 3 illustrating the III-III cross section, the operation portion main body 21 and the sheath base end cap 24, and the sheath base end cap 24 and the outer tube base end cap 27 are non-circular such as a regular hexagon. They are fitted in a cross-sectional shape so that they cannot rotate about the axis relatively.
[0038]
As a result, the operation unit main body 21 and the sheath base end cap 24 are held by holding the operation unit main body 21 (or the outer tube base end cap 27 or the like) and rotating the first rotation operation wheel 22 around the axis. The operation motion transmitting member 4 and the flexible sheath 2 are relatively advanced and retracted in the axial direction while relatively moving in the axial direction without rotating around the axial line.
[0039]
In addition, by holding one or both of the operation unit main body 21 and the first rotation operation wheel 22 (or the outer tube base end cap 27 and the like), the second rotation operation wheel 23 is rotated around the axis, thereby enabling the sheath The base end cap 24 and the sheath tube base end cap 27 relatively advance and retract in the axial direction without rotating around the axis, and the flexible sheath 2 and the sheath tube 6 relatively advance and retract in the axial direction.
[0040]
6 to 8 show a procedure for attaching the indwelling clip unit 10 until the clip apparatus for endoscope is put into the use ready state shown in FIG. 1, and before that, it is shown in FIG. Thus, on the indwelling clip unit 10 side, the clip closing cylinder 15 is slid forward so that the engagement click portion 13 is exposed, and the clip claw 11 is thereby closed.
[0041]
Then, as shown in FIG. 6, the inner surface convex portion 3a of the closed cylindrical body receiver 3 is fitted into the circumferential groove 15a of the clip closed cylindrical body 15 from the side, and is possible from the proximal end side as shown in FIG. When the operation motion transmission member 4 is relatively pushed into the flexible sheath 2, the inward protrusion 13 a interferes with the outer peripheral surface of the connecting member 5, but the engagement click portion 13 is elastically pushed outward. By deforming, the connecting member 5 enters the cylindrical connecting portion 12.
[0042]
As shown in FIG. 8, when the inward projection 13a reaches the position of the constricted portion 5a as shown in FIG. 8, the engagement click portion 13 returns to the original unexpanded shape by its own elasticity, and the inward projection 13a Engage in a state of falling into the constricted portion 5a.
[0043]
Therefore, by pushing the mantle tube 6 forward from the proximal end side, as shown in FIG. 1, the mantle tube 6 is fully covered and ready for use, and in this state, the manipulator tube is inserted into the treatment instrument insertion channel of the endoscope. Passed.
[0044]
9 to 14 show the state of use in the body. The distal end portion of the endoscope clip device protrudes from the treatment instrument insertion channel of the endoscope, and as shown in FIG. The clip nail 11 is directed to the affected area 100.
[0045]
Then, by pushing the operation motion transmission member 4 forward with respect to the flexible sheath 2 (or by pulling the flexible sheath 2 proximally with respect to the operation motion transmission member 4), the clip claw 11 is clipped. It comes out of the closed cylinder 15 and becomes an open shape by its own elasticity. At the same time, the engagement click portion 13 is covered with the clip closing cylinder 15 so that the engagement with the connecting member 5 is not released.
[0046]
Therefore, when the affected area 100 is contaminated with blood or the like, if the cleaning liquid or the like is injected into the water supply channel 4a from the water injection port 42 on the operation unit 20 side, as shown in FIG. Then, the cleaning liquid is sprayed to wash away blood and the like, and the mucosal surface of the affected area 100 can be clearly observed with an endoscope.
[0047]
Further, if a wire-like member 200 such as a guide wire or a puncture needle is inserted from the water injection port 42, as shown in FIG. 11, the wire-like member may be pressed against the affected area 100 for positioning. it can.
[0048]
Further, if the operation knob 31 is rotated around the axis on the operation unit 20 side, the three clip claws 11 are rotated around the axis via the operation motion transmitting member 4, so that the three clip claws for the affected area 100 are provided. 11 can be easily corrected to an appropriate state.
[0049]
In this manner, when the affected part 100 is surrounded by the tips of the three clip claws 11, as shown in FIG. 12, the operation movement transmitting member 4 is pulled from the rear with respect to the flexible sheath 2 (or The flexible sheath 2 is pushed into the operation motion transmission member 4).
[0050]
As a result, the clip claw 11 is fitted from the rear end side into the clip closed cylinder 15 pressed by the closed cylinder receiver 3 so that the clip claw 11 is narrowed, and the affected part 100 can be clipped. Further, in accordance with the operation, the engagement click portion 13 moves to a position where it has come out of the rear end of the clip closing cylinder 15.
[0051]
However, if the clipping state at that time is incomplete, the operation motion transmitting member 4 is pushed forward again to the flexible sheath 2 (or the flexible sheath is pressed against the operation motion transmitting member 4). 2), the clip claw 11 is opened by its own elasticity.
[0052]
In addition, when the operation motion transmission member 4 is pushed in, the connecting member 5 at the tip thereof is formed on the outer peripheral surface of the connecting member 5 so that the cylindrical connecting portion 12 is not pushed out from the inside of the clip closing cylinder 15. The stepped portion comes into contact with the rear end of the clip closing cylinder 15 to stop the advancement of the connecting member 5.
[0053]
In this manner, when a satisfactory clipping state is obtained with respect to the affected area 100, the operation motion transmitting member 4 is strongly pulled backward with respect to the flexible sheath 2 (or the flexible sheath 2 is strongly pushed in). ) And the click portion 13 of the engagement click portion 13 is not covered with the clip click cylinder 13, so that the engagement click portion 13 is elastically deformed outward as shown in FIG. The engagement between the constricted portion 5a of the member 5 and the inward projection 13a of the engagement click portion 13 is released.
[0054]
Then, as shown in FIG. 14, the indwelling clip unit 10 is placed in the body in a state where the affected part 100 is clipped, and is rubbed from the outside by shaking the distal end portions of the flexible sheath 2 and the outer tube 6 slightly to the left and right. The clip claw 11 pressed by the engaging clip closing cylinder 15 is kept closed.
[0055]
When the clipping treatment for the affected area 100 is finished in this manner and the endoscope clip device is pulled out from the treatment instrument insertion channel of the endoscope, the cleaning brush is straightened from the water injection port 42 on the operation section 20 side into the water supply path 4a. By inserting 300, as shown in FIG. 15, the tip of the cleaning brush 300 can be protruded from the water supply port 41 formed in the connecting member 5, and the inner peripheral surface of the water supply path 4a is spread over the entire length. Can be brushed. Further, depending on the situation, the cleaning brush 300 can be inserted into the water supply path 4a from the water supply port 41 side at the tip.
[0056]
【The invention's effect】
According to the present invention, a water supply passage penetrating in the axial direction is formed in the operation motion transmission member over the entire length, and both ends of the water supply passage are opened straight in the axial direction, thereby allowing the flexible sheath to By inserting a cleaning brush into the arranged water supply channel, the entire water supply channel can be brushed and washed all over the length.
[Brief description of the drawings]
FIG. 1 is a side sectional view of a distal end portion of an endoscope clip device according to an embodiment of the present invention in a ready state for use.
FIG. 2 is a side sectional view of an operation unit of the endoscope clip device according to the embodiment of the present invention.
FIG. 3 is a cross-sectional view taken along the line III-III in FIG. 2 of the endoscope clip device according to the embodiment of the present invention.
FIG. 4 is a perspective view showing the overall configuration of the endoscope clip device according to the embodiment of the present invention.
FIG. 5 is a side partial sectional view of an indwelling clip unit according to an embodiment of the present invention.
6 is a side cross-sectional view showing a procedure for attaching an indwelling clip unit until the endoscope clip device according to the embodiment of the present invention is in a ready state for use shown in FIG. 1; FIG.
7 is a side cross-sectional view showing a procedure for attaching an indwelling clip unit until the endoscope clip device according to the embodiment of the present invention is in a ready state for use shown in FIG. 1; FIG.
8 is a side cross-sectional view showing a procedure for attaching an indwelling clip unit until the endoscope clip device according to the embodiment of the present invention is in a ready state for use shown in FIG. 1; FIG.
FIG. 9 is a side sectional view showing a state of a distal end portion when the endoscope clip device according to the embodiment of the present invention is used.
FIG. 10 is a side sectional view showing a state of a distal end portion when the endoscope clip device of the embodiment of the present invention is used.
FIG. 11 is a side sectional view showing a state of a distal end portion when the endoscope clip device of the embodiment of the present invention is used.
FIG. 12 is a side sectional view showing a state of a distal end portion when the endoscope clip device of the embodiment of the present invention is used.
FIG. 13 is a side sectional view showing a state of a distal end portion when the endoscope clip device of the embodiment of the present invention is used.
FIG. 14 is a side sectional view showing a state of a distal end portion when the endoscope clip device according to the embodiment of the present invention is used.
FIG. 15 is a side sectional view showing a state of a distal end portion when the endoscope clip device according to the embodiment of the present invention is cleaned after use.
[Explanation of symbols]
2 Flexible sheath 4 Operation motion transmission member 4a Water supply path 5 Connection member 6 Mantle tube 10 Indwelling clip unit 11 Clip claw 12 Cylindrical connection part 15 Clip closing cylinder 20 Operation part 31 Operation knob 41 Water supply port 42 Water supply port 200 Wire Shaped member 300 Brush for cleaning

Claims (4)

A clip disposed at the distal end of the flexible sheath is detachably coupled to a distal end of an operation motion transmitting member that is inserted and disposed in the flexible sheath so as to be movable forward and backward in the axial direction. The clip is held in a closed state by pulling the operation movement transmitting member from the operation unit side connected to the base end, and the clip thus held in the closed state is connected to the flexible sheath. In the endoscope clip device configured to be separable from the operation motion transmission member,
The clip is configured by connecting the proximal end portions of a plurality of clip claws that open and close forward to the distal end portion of the cylindrical portion penetrating in the axial direction,
The aforementioned operation motion transmission member, with feed water channel that penetrates in the axial direction is formed over the entire length, both ends of the water supply channel is provided with straight open each axially,
The tip of the wire-like member inserted from the base end side into the water supply channel can be further passed from the tip of the water supply channel through the open clip and projected to the front. Endoscopic clip device. The endoscope clip device according to claim 1, wherein a pipe material having flexibility is used as the operation motion transmission member, and an inner space of the pipe material is the water supply path. The operation portion is provided with a rotation operation wheel that relatively rotates in the axial direction between the proximal end portion of the flexible sheath and the proximal end portion of the operation motion transmission member by rotating around the axis. The endoscope clip device according to claim 1 or 2, wherein a water supply passage passes through the rotary operation wheel. A portion of the base end side of the clip is formed in a cylindrical shape with the rear opened, and a distal end portion of the operation motion transmitting member is provided with a connecting member that engages and disengages with respect to the rear end cylindrical portion of the clip. The endoscope clip device according to claim 1, 2, or 3, wherein a distal end opening of the water supply passage is formed on a distal end surface of the connecting member.

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