JP4360383B2 - Clip device - Google Patents

Description

  The present invention relates to a clip device.

  With the development of endoscopic treatment methods in recent years, the number of sites that can be treated under the endoscope has increased. In early cancer treatment, large lesions can be removed together by ESD (endoscopic submucosal dissection), The recurrence rate after treatment is decreasing. However, on the other hand, there are an increasing number of cases where bleeding or perforation occurs due to excessive incisions, etc., so there is a demand for clip devices that use endoscopes that can be easily and quickly handled and treated, and have little risk of tissue destruction. Has been increasing.

  As a clip device, the clip and the operation wire are engaged with each other through a claw projecting from the base end of the clip having a clamping portion at the tip and a hook provided at the tip of the operation wire, and then fitted to the arm of the clip. Then, with the base end of the attached clip tightening ring engaged with the distal end of the operation tube inserted into the introduction tube so as to be able to advance and retreat, the operation wire is pulled to place the clip in the tightening ring. A clip device that pulls in and closes the distal end clamping portion has been introduced (Patent Document 1), but after the tissue is grasped by the clip, the clip is detached from the clip by operating the operation wire. It is necessary to push out the engaging portion between the claw and the operation wire tip hook from the operation tube, and to swing the operation wire to release the engagement, which is somewhat complicated.

  Therefore, as means for solving the above-mentioned problems, a coupling member that can be engaged with the operation wire distal end hook is engaged with a claw provided at the base end of the clip while being inserted into the fastening ring, and the clip is cassette-type. And a clip device that attaches the clip by engaging the connecting member of the cassette type clip and the operation wire distal end hook. By pulling the operation wire, the clip proximal end claw is deformed to remove the clip from the clip device. A clip device (Patent Document 2) for detachment and a clip device (Patent Document 3) for detaching the clip from the clip device by deforming the connecting member clip connecting end claw by pulling the operation wire are introduced. Both devices use connecting members, which increases the number of parts, increases manufacturing costs, and increases the operating cost of the clip device after the clip is placed. The tip, since there remains a connecting member of the clip which is placed, when mounting the new clip to the clip device, the operation was necessary to remove the coupling member. There is also a risk that the connecting member may fall into the body by mistake.

JP 60-103946 A Japanese Utility Model Publication No. 62-170010 Japanese Utility Model Publication No. 2-6011

  The present invention has been made in view of the above circumstances, and it is an object of the present invention to provide a clip device that can reliably clip without increasing the number of parts of the clip device.

The clip device according to the present invention includes a long cylindrical body, a wire that is inserted through the cylindrical body so as to be freely advanced and retracted, and has a first engaging means that engages with a clip at a distal end, and the cylindrical body. An operating portion that is connected to the wire and operates to open and close the clip, and the clip extends from the proximal end portion and is opened by self-expanding. A clip body having both arms, and a fastening member inserted through the clip body so as to be able to advance and retreat. The base end portion has a pair of claws at a position facing the axis of the wire. And a second engagement means for engaging with the first engagement means is provided on the distal end side of the first engagement means when the second engagement means is engaged. A rotationally symmetric polygonal restriction is provided to restrict the rotation of the clip body in the direction around the wire axis. , Said first engagement means and second engagement means, but in engagement, by moving the wire proximally using the operation unit, the clamping member is distally By moving the both arms that have been opened, the arms are closed, and further, the second engagement means is deformed by moving the wire to the proximal end side using the operation portion, The engagement is released.

  In this clip device, the first engagement means provided at the distal end portion of the wire and the second engagement means provided at the proximal end portion of the clip are directly engaged with each other. This eliminates the need for a member for connecting the wire and the clip to each other as in the prior art, and makes it possible to provide a clip device that can perform reliable clipping without increasing the number of parts.

  Further, a rotationally symmetric polygonal restricting portion that restricts the rotation of the clip body when engaged with the second engaging means is provided on the distal end side of the first engaging means. Good. As a result, the polygonal shape is engaged with the space on the proximal end side of the clip, and the clip also rotates in accordance with the rotation of the operation unit. For this reason, when the affected part is gripped, the clip does not rotate against the movement of the operation part, so that the affected part can be accurately visually recognized and gripped.

  Further, a restricting means for restricting the movement of the tightening member to the lumen of the cylindrical body may be provided on the inner wall surface on the distal end side of the long cylindrical body. Thereby, when the wire is moved to the proximal end side, the tightening member comes into contact with the restricting means, and the clip can be closed.

  ADVANTAGE OF THE INVENTION According to this invention, the clip apparatus which can clip reliably can be provided, without increasing the number of parts of a clip apparatus.

  Preferred embodiments of the present invention will be described below with reference to the drawings. In all the drawings, common constituent elements are denoted by the same reference numerals, and detailed description thereof will be appropriately omitted in the following description.

  FIG. 11 is an overall schematic view showing an embodiment of a clip device according to the present invention. The clip device includes a long cylindrical body 420, a wire 430 that is inserted into the cylindrical body 420 so as to freely advance and retreat, and has a first engagement means 440 that engages with the clip 1 at the tip, and a cylindrical shape. Provided on the proximal end side of the body 420, is connected to the wire 430, and includes an operation unit 460 that operates opening and closing of the clip 1.

  FIG. 1 is a front view, a plan view, and a left side view showing an embodiment of a clip. FIG. 2 is a perspective view showing an embodiment of the clip. The clip 1 includes a clip body 200 having a base end portion 500 and both arm portions 220 extending from the base end portion 500 and opened by self-expanding, and a tightening member 300 inserted through the clip body 200 so as to be able to advance and retreat. Including.

  Both arm portions 220 are a curved portion 600 extending from the base end portion 500, a substantially linear gripping portion 700 extending from the curved portion 600 to the distal end side, and a clip body distal end provided at the distal end of the gripping portion 700. The base end portion 500 is provided with a base end connection portion 221 and a convex portion 223, and the grip portion 700 is provided with an engagement portion 224, an enlarged diameter portion 225, and an arm reinforcing member 227. In addition, a restricting portion 226 is provided near the base end side boundary of the engaging portion 224, and when the fastening member 300 moves to the base end portion 500 side, the arm is opened and when it moves to the bending portion 600 side. Both arm portions 220 are configured to be closed. Hereinafter, the tightening member is referred to as a tightening ring.

  The proximal end portion 500 has the second engaging means 222. With the first engaging means 440 and the second engaging means 222 engaged, the wire 430 is connected to the operating portion 460. By moving it to the proximal end side, both arms 220 opened by the tightening member 300 moving to the distal end side are closed, and further, the wire 430 is further moved to the proximal end side using the operation portion 460. By moving, the second engaging means 222 is deformed and the engagement is released. The process of releasing the engagement will be described later.

The clip body front end claw portion 210 facing each other is opened by self-expanding property, and a fastening ring 300 is attached to the front end side of the convex portion 223 of the base end portion 500 so as to be able to advance and retreat. The convex portion 223 is formed to have a width that the tightening ring 300 cannot pass through. When the fastening ring 300 is mounted from the base end portion 500 side, the base end portion 500 is closed in the direction of closing the arm, and is passed as close to the center as possible so that a large diameter portion of the fastening ring 300 can be used. As a result, after the fastening ring 300 is mounted, after the proximal end portion 500 is restored to a predetermined width, the fastening ring 300 is not easily dropped from the proximal end side.
Further, the self-expanding property of the curved portion 600 is formed stronger than the weight of the fastening ring 300. Therefore, the tightening ring 300 does not move the distal end side by deforming the bending portion 600 and does not narrow the claw opening width L.

  Further, the base end connecting portion 221 is formed by bending in a substantially U shape, and the second engaging means 222 is a claw formed by bending a part of the base end portion 500 in a substantially L shape. May be. A pair of claws may be provided on the clip proximal end side at positions facing the axis of the wire 430. Thus, when the wire 430 is pulled, the pulling operation force is easily transmitted to the clip body 200, and the opening and closing can be performed smoothly.

  In FIG. 3, the front-end | tip part of the clip apparatus 100 of this embodiment is shown. The distal end portion 2 of the clip device 100 includes an outer tube 410, an operation member 420 (a long cylindrical body) that is inserted into the outer tube 410 so as to be able to advance and retract, and an operation member 420 that is inserted into the operation member 420 so as to advance and retract. And an operation wire 430 (wire) having first engagement means 440. The operation wire distal end hook 440 (first engagement means) is formed so as to be engageable with the clip proximal end claw 222 (second engagement means). Although not particularly limited, in a state where the operation wire distal end hook 440 and the clip proximal end claw 222 are engaged, the operation wire distal end hook 440 and the clip proximal end portion 500 restrict the rotation in the direction around the operation wire axis. When at least one or more abutment portions are provided at the operation wire distal end hook 440 and the clip base end portion 500, the grip 1 is not shown when the clip 1 is rotated to determine the gripping direction. Since the rotation operation force by operating the clip rotation operation member is reliably transmitted to the clip via the operation wire 430 and the operation wire tip hook 440, the clip can be rotated. Further, the shape of the contact between the operation wire distal end hook 440 and the clip proximal end coupling portion 221 or the clip proximal end claw 222 is not particularly limited as long as the rotation restriction in the direction around the operation wire 430 is possible. The contact by mutual may be sufficient and the contact by the unevenness | corrugation provided in one or both may be sufficient.

  Further, on the distal end side of the operation wire distal end hook 440, a restricting portion that is a rotationally symmetrical polygonal shape that restricts the rotation of the clip main body 1 when engaged with the clip proximal end claw 222 may be provided. As a result, the clip body 1 is rotated only when the operation unit 460 is used to perform the rotation operation. Therefore, it is possible to accurately align the clip body 1 with the gripped portion.

  The operation wire distal end hook is pulled by pulling the operation wire 430 in a state in which the operation wire distal end hook 440 is fitted from the side surface of the clip proximal end coupling portion 221 formed by bending in a substantially U shape. 440 and the clip base end claw 222 engage with each other, and are pulled into the operation member 420 so that the clip 1 is attached to the distal end 2 of the clip device 100 as shown in FIG. In addition, the tightening ring 300 is pulled into the operation member 420 together with the clip body 200 by pulling the operation wire 430, but is not pulled into the clip device operation unit side beyond the operation member tip tightening member receiver 450. Is formed. Although not particularly limited, for example, a cartridge (not shown) may be used as a mounting jig so that the operation wire distal end hook 440 can be smoothly guided to the side of the clip proximal end connecting portion 221 without a wall when mounting the clip. You may make and use.

  The clip device is inserted into the endoscope forceps hole as shown in FIG. 5 by pushing the outer tube 410 toward the distal end and covering the clip 1 with the outer tube 410. This prevents the inner wall of the endoscopic forceps hole from being damaged by rubbing with the clip 1, and enables smooth insertion and removal. In addition, after the clip device distal end portion 2 protrudes from the distal end of the endoscope, by pulling the outer tube 410 back to the proximal end side, the clip body 200 is in a state where both arms 220 are firmly opened by self-expanding (see FIG. Returning to 4), the clip treatment is possible.

  The opening and closing operation of the clip arms 220 for grasping the tissue is performed by moving the operation wire 430 back and forth in the axial direction. By pulling the operation wire 430, the clip main body 200 is gradually drawn into the inner cavity of the tightening ring 300 from the proximal end side of the clip main body 200, and the clip both arms 220 are closed (FIG. 6). When the clip main body 200 is drawn into the fastening ring 300 to the front end side boundary of the bending portion 600, the front end claw portion 210 is fitted and fitted, and a living tissue (not shown) is gripped as shown in FIG. . However, in the state where the tip of the tightening ring 300 is at the curved portion 600 (FIG. 6), the contact area between the inner wall of the tightening ring 300 and the clip body 200 is very small, and the position of the tightening ring 300 is fixed by friction. Therefore, when released from the tension state by the operation wire 430, the clamping ring 300 is pushed back to the clip body proximal side 500 by the self-expanding force of the clip body 200, and the clip body 200 has both arms before the arm closing operation. It returns to the state (FIG. 4) which the part 220 opened. In the state of FIG. 6, since the clip tip claws are in contact with each other and the tissue is firmly gripped, it is possible to confirm gripping effects such as hemostasis and sewing by this clip closing arm operation. If the clip is not in an optimal gripping state, the clip is opened by the self-expanding performance by releasing the clip from the tensioned state by the operation wire 430, and the tissue can be gripped again. In addition, although not particularly limited, when the arm reinforcing member 227 is provided in the grasping portion, the deformation of the arm can be suppressed even when the hard tissue is grasped, so that the tissue can be surely grasped.

A restricting portion 226 is provided in the vicinity of the base end side boundary of the engaging portion 224, and the restricting portion 226 is formed so as to protrude outwardly of the opposing arm portions 220 so as to come into contact with the distal end side of the fastening ring 300. Has been. When the minimum traction force necessary to pull the clip main body 200 into the fastening ring 300 to the front end side boundary of the curved portion 600 is the first external force, both the clip arm portions 220 are bent inward, and the fastening ring 300 is The minimum traction force (second external force) necessary for moving over the restricting portion 226 to the front end side is larger than the first external force.
After confirming the optimum gripping, when the operation wire 430 is pulled with a force equal to or greater than the second external force, the clip body 200 is pulled into the fastening ring 300 up to the engaging portion 224 (FIG. 7). At this time, the contact area between the inner wall of the tightening ring 300 and the clip body 200 is large in the engagement portion 224 in the inner cavity of the ring (not shown). There is no return to the end 500 side.
Further, since the enlarged diameter portion 225 is processed to have a width wider than the inner diameter of the tightening ring 300, the clip body 200 is not drawn into the tightening ring 300 beyond the enlarged diameter portion 225.

  In a state where the engaging portion 224 and the inner wall of the tightening ring 300 are engaged, or in a state where the enlarged diameter portion 225 and the tip of the tightening ring 300 are in contact, the operation wire 430 is pulled by a third external force that is larger than the second external force. When the clip base end claw 222 extends without maintaining a substantially L shape, the engagement between the clip base end claw 222 and the operation wire tip hook 440 is released (FIG. 8), and the clip 1 is Removal from the clip device completes the placement (FIG. 9).

  For example, as a conventional example, Japanese Laid-Open Patent Publication No. 2002-301082 introduces a clip device for living tissue in which a clip and an operation wire are directly engaged. In this, as shown in FIG. 10A, as a means for direct engagement between the clip 900 and the operation wire 910, a closed loop wire 911 is formed at the distal end of the operation wire. A method of engaging with the claw 901 has been introduced. To disengage the clip 900 and the operation wire 910 after grasping the tissue, the operation wire 910 is pulled, and the clip base as shown in FIG. A method has been introduced in which the end J-shaped claw 901 is deformed into a substantially I shape. However, in the method of deforming the nail into an I shape, the number of parts can be reduced, but the nail remains long on the proximal end side of the clip, and the nail may be damaged by the nail.

  As described above, the tightening ring 300 that holds the closed state of the clip body 200 is positioned at the engaging portion 224, and the contact area between the clip body 200 and the inner wall of the tightening ring 300 is large, and the clip body 200 is strongly engaged. Therefore, the clip main body 200 can firmly hold the living tissue, does not come off immediately, and can maintain the holding state of the living tissue for a long period of time.

  As the first external force is smaller, the tissue can be grasped with less force. Although not particularly limited, if the first external force is 15 N or less, the gripping operation may be easily performed. In addition, the larger the difference between the second external force and the first external force, the wider the range of force that can be re-gripped, and it is better to prevent a situation in which it cannot be re-gripped accidentally. Although there is no particular limitation, if the difference between the second external force and the first external force is 10 N or more, it may be difficult to accidentally re-grip. In addition, the smaller the third external force, the easier it is to perform the clip detachment operation when the clip is placed, but in order to maintain the closed state of the clip, the force needs to be greater than the second external force. Although there is no particular limitation, the disengagement operation may be easily performed if the third external force is 50 N or less.

  Further, the clip proximal end claws 222 are formed by bending a part of the clip proximal end portion 500 into a substantially L shape, and at least one pair is provided so as to be substantially symmetric with respect to the operation wire 430 axis. Therefore, even if the claw length 222a is short, the operation wire distal end hook 440 can be reliably engaged, and the axial operation of the operation wire 430 can be transmitted. Although not particularly limited, for example, the claw length 222a is about 0.1 mm to 0.3 mm. Moreover, when it is a J-shaped nail | claw introduced by patent document 2 or patent document 4, since detailed dimension is not described in patent document 2, according to embodiment of the invention of patent document 4, it is J character. The claw 901 protrudes from the proximal end 902 of the clip 900 with a length of about 1 to 3 mm, and the loop wire 911 is described as φ0.2 or more. In order for the loop wire 911 to engage with the J-shaped claw 901 and perform reliable clip rotation operation and clip treatment, the engagement portion length of the J-shaped claw needs to be at least the semicircular circumference of the loop wire 911. Therefore, for example, if the J-shaped claw 901 protrudes 1 mm from the clip base end 902 and is bent and formed in a J-shape along the φ0.2 loop wire 911, In the state of being deformed and extending substantially in an I-shape, it is estimated that it will be 1.2 mm or more even if it is calculated as little as possible. Therefore, according to the clip device according to the present invention, the clip base end claw length can be extremely shortened. Therefore, even when the clip device is extended by the third external force, it is introduced in Patent Document 2 and Patent Document 4 It does not have a shape that protrudes to the extent that normal tissue is damaged like a claw.

  As the material of the clip body 200, a metal plate such as a leaf spring material rich in elasticity is preferable because it is less deteriorated by digestive juice and must be kept open when no external force is applied. Examples include titanium. The clip body tip claw portion 210 is bent inward so that the living tissue can be firmly grasped, and the bent tip portion is fitted and fitted with no gap when the clip is closed. It is preferable to provide unevenness on the part. Although not particularly limited, the bending angle θ1 of the clip main body front end claw portion 210 is preferably substantially right-angled for marking purposes for maintaining the tissue gripping state of the clip. In the intended use, the clip body tip claw 210 needs to enter the tissue and come close to the tissue surface without slipping, so it is calculated from the contact degree between the clip body tip claw 210 and the tissue and the clip arm opening angle. It is preferable that it is a value obtained.

Further, the opening width L of the claw portion can be freely determined by the length of the clip body arm and the bending strength of the bending portion 600, and is not particularly limited, but from the tip of the fastening ring 300 in the closed state of the clip 1 to the tip of the clip body. 2 times or less of the length M is preferable, and when the width of the arm is open, the approached tissue can be firmly grasped.
The material of the tightening ring 300 is preferably a material that can maintain the clip body 200 in a closed state, and that is less deteriorated by digestive fluid, such as metal or plastic.

It is the front view, top view, and left view of a clip with which the clip apparatus of this invention is mounted | worn. It is a perspective view of the clip with which the clip apparatus of this invention is mounted | worn. It is front sectional drawing of the clip apparatus front-end | tip part of this invention. It is front sectional drawing which shows the state which mounted | wore the clip apparatus of this invention with the clip. It is front sectional drawing which shows the state which can be inserted in the endoscope forceps hole of the clip apparatus of this invention. It is front sectional drawing which shows the state operated in the clip opening / closing operation of the clip apparatus of this invention by more than 1st external force and less than 2nd external force. It is front sectional drawing which shows the state operated by 2nd external force or more and less than 3rd external force in the clip opening / closing operation of the clip apparatus of this invention. It is front sectional drawing which shows the state operated by the 3rd external force or more in the clip opening / closing operation of the clip apparatus of this invention. It is front sectional drawing which shows the state which the clip completed treatment by the clip apparatus of this invention remove | deviated, and the closed arm of a clip arm is maintained. It is the figure which showed the conventional product. It is the schematic which shows the whole clip apparatus of this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Clip 2 Tip part 100 of clip apparatus Clip apparatus 200 Clip main body 210 Clip main body front-end | tip nail | claw part 220 Both arms (arm part)
221 Base end connecting portion 222 Claw (second engaging means)
223 Protruding part 224 Engaging part 225 Expanded diameter part 226 Restricting part 227 Arm reinforcing member 300 Tightening member (tightening ring)
410 Mantle tube 420 Operation member (long cylindrical body)
430 Operation wire (wire)
440 Operation wire tip hook (first engaging means)
450 Clamping member receiver 460 Operation portion 500 Base end portion 600 Bending portion 700 Grip portion 900 Clip 901 J-shaped claw 902 Base end portion 910 Operation wire 911 Loop wire L Claw portion opening width M Tightening ring 300 when the clip is closed Length from tip to clip tip

Claims (3)

A long tubular body;
A wire that is inserted into the cylindrical body so as to be able to advance and retract, and has a first engaging means that engages with a clip at a tip portion;
Provided on the proximal end side of the cylindrical body, connected to the wire, and an operation unit for operating opening and closing of the clip,
The clip includes a clip main body having a base end portion and both arm portions extending from the base end portion and opened by self-expanding, and a fastening member inserted through the clip main body so as to be able to advance and retreat,
The base end portion has a pair of claws at positions facing the axis of the wire, and is provided with second engagement means that engages with the first engagement means ,
A rotationally symmetrical polygonal restricting portion that restricts the rotation of the clip body in the direction around the wire axis when engaged with the second engaging means is provided on the distal end side of the first engaging means. And
With the first engaging means and the second engaging means engaged, the fastening member moves to the distal end side by moving the wire to the proximal end side using the operation portion. As a result, the both arms that have been opened are closed, and further, the second engaging means is deformed by moving the wire to the proximal end side using the operating portion, whereby the engagement A clip device characterized by being released. The clip device according to claim 1 , wherein the claw is integrally formed with the clip body. The clip device according to claim 1 or 2 , wherein a restriction means for restricting movement of the tightening member to a lumen of the cylindrical body is provided on an inner wall surface on a distal end side of the long cylindrical body. .

Images