JP4394634B2 - Endoscope clip removal device - Google Patents

Description

  The present invention relates to an endoscope clip removing device for removing a clip placed in a state of being bitten by a living tissue in a body through a treatment instrument insertion channel of the endoscope.

Endoscopic clips used for hemostasis, etc. from living tissue in the body are generally formed in a shape that opens in a bowl shape toward the front by a material having a spring property, and is a cylindrical shape covered from the rear. By sliding the tightening ring forward, the tightening ring is placed in a state of being constricted and biting into the living tissue (for example, Patent Documents 1 and 2).
JP 2002-330972 A Reality 4-26091

  By using the endoscope clip device described in Patent Documents 1 and 2, etc., the clip is placed in a state of being bitten by a living tissue in the body through the treatment instrument insertion channel of the endoscope to perform hemostasis and other treatments. This can be done effectively endoscopically.

  However, in such a conventional endoscopic clip device, the operation of removing the clip that has been placed in the body for a certain period of time and has achieved the purpose of hemostasis or the like has not been considered at all, so the clip is removed from the body tissue. At this time, the entire clip is held and pulled by holding forceps or the like inserted into the body through the treatment instrument insertion channel of the endoscope, and the clip is removed and collected outside the body so as to tear the living tissue.

  However, if you forcibly pull the clip that has bitten into the living tissue in this way, it may bleed again from the affected area that has been stopped by the corner clip, and the clip will bite deeply into the living tissue and work well. If it cannot be removed, it must be left in place for a long time, which may cause damage to the mucosal surface of the body.

  Accordingly, an object of the present invention is to provide an endoscopic clip removing device that can safely and reliably remove a clip placed in a state of being bitten by a living tissue in the body through a treatment instrument insertion channel of the endoscope. And

  In order to achieve the above object, an endoscope clip removing device according to the present invention is a clip formed in a shape opened in a bowl shape toward the front by a material having a spring property, and is a cylinder covered from the rear. Clip removing device for removing from a living tissue through a treatment instrument insertion channel of an endoscope, which has been squeezed by sliding a cylindrical tightening ring forward and held in a state of being bitten into the living tissue A flexible outer tube that can be inserted into and removed from the treatment instrument insertion channel of the endoscope, and a tightening ring that is provided at the distal end portion of the outer tube and is operated from the proximal end side of the outer tube. A plurality of clamping ring holding arms that open and close to hold, and a clip to push forward relative to the clamping ring held by the clamping ring holding arm A lip extruding member is provided, and the clip is pushed out of the tightening ring by the clip extruding member in a state where the tightening ring is held by the tightening ring holding arm, so that the clip is opened due to its own elasticity and is released from the living tissue. It is intended to come off.

  In addition, the plurality of tightening ring holding arms are formed of a spring-like material in a shape that opens in a bowl shape toward the front in a state where no external force is applied, and protrudes from the tip of the mantle tube You may make it open and close toward the front by elastic deformation.

  Further, each tip portion of the plurality of tightening ring holding arms may be formed with a claw-like portion that is bent toward the closing direction, and the tightening ring is closed by closing the tip portions of the plurality of tightening ring holding arms. You may make it hold | grip and hold the side surface of from the side. Moreover, you may enable it to close to the state which the front-end | tip part of a some clamping ring holding arm engages with the front-end edge of a tightening ring in the position ahead of the front-end edge of a tightening ring.

  A plurality of tightening ring holding arms are attached to the distal end of a flexible sheath disposed in the outer tube so as to be movable forward and backward in the axial direction, and operate to advance the outer tube relative to the flexible sheath. As a result, the distal end of the outer tube covers the tightening ring holding arm to close the plurality of tightening ring holding arms, and the distal end of the outer tube is moved to the flexible sheath by retreating the outer tube. The plurality of tightening ring holding arms may be opened by retracting from the tightening ring holding arms.

  In this case, the outer tube may be a flexible tube, and the flexible sheath may be a coiled coil that is tightly wound. The clip pushing member is attached to the tightening ring holding arm by an operation from the proximal end side of the outer tube. An operation wire for relatively moving back and forth in the axial direction may be inserted and disposed in the flexible sheath so as to freely move back and forth.

  In addition, the clip push-out member may be formed in a bar shape that comes into contact with the rear end portion of the clip from the rear, and in this case, the clip push-out member may come into contact with the rear end surface of the clip at its front end surface. And the recessed part engaged with the rear-end surface of a clip may be formed in the front end surface of a clip extrusion member.

  Further, the clip push-out member may be a pair of clip engagement arms that open and close like a hook so as to engage with the vicinity of the rear end of the clip from a direction that does not interfere with the tightening ring holding arm. The portion may be formed in a loop shape, and a clip engagement claw that engages with the loop may be formed protruding from the tip of the clip engagement arm in the closing direction.

  The pair of clip engagement arms are formed of a spring-like material in a shape that opens in a hook shape toward the front when no external force is applied, and is formed near the base of the tightening ring holding arm. It may be configured to open and close by being elastically deformed by moving back and forth while passing through the guide hole.

  According to the present invention, by holding the tightening ring at the distal end portion of the tightening ring holding arm that is opened and closed by an operation from the base end side, by pushing the clip relatively forward from the tightening ring by the clip pushing member, Since the clip opens by its own elasticity and disengages from the living tissue, the clip placed in a state of being bitten by the living tissue in the body can be safely and reliably removed through the treatment instrument insertion channel of the endoscope.

  A clip formed in a shape that opens in a bowl shape toward the front by a material having a spring property, and is squeezed by sliding forward a cylindrical fastening ring covered from the rear and bites into a living tissue. An endoscopic clip removing device for removing an object placed in a state from a living tissue through a treatment instrument insertion channel of an endoscope, and is flexible to be inserted into and removed from the treatment instrument insertion channel of the endoscope An outer tube, a plurality of tightening ring holding arms which are provided at the distal end portion of the outer tube and which open and close to hold the tightening ring by the operation from the proximal end side of the outer tube, and a tightening ring holding arm A clip push-out member is provided to push the clip forward relative to the clamp ring that is held. By extruding the clamping clip ring clip pushing member forward relative while holding the ring, the clip is so out of the opening by the elastic self biological tissue.

Embodiments of the present invention will be described with reference to the drawings.
FIG. 1 is a side sectional view of a distal end portion of an endoscope clip removing device, and FIG. 2 is a perspective view.
Reference numeral 1 denotes a flexible outer tube that is an exterior member of a portion that is inserted into and removed from a treatment instrument insertion channel of an endoscope, and is formed of a flexible tube such as a tetrafluoroethylene resin tube, for example. Yes.

  Reference numeral 2 denotes a pair of (that is, two) tightening ring holding arms that are elastically deformed by projecting forward from the tip of the outer tube 1 to open and close like a bowl, and are formed of, for example, a stainless steel plate for a spring. The flexible sheath 3 inserted and disposed in the outer tube 1 is connected and fixed. Three or more tightening ring holding arms 2 may be provided at substantially equal intervals.

  The flexible sheath 3 is formed of, for example, a coil pipe or a flexible tube formed by tightly winding a stainless steel wire with a constant diameter, and the fastening ring holding arm 2 connected to the tip of the flexible sheath 3 is In a natural state in which no external force is applied, as shown in FIGS. 1 and 2, it is formed in a shape that opens forward in a bowl shape as shown in FIGS.

  Therefore, when the outer tube 1 is moved forward with respect to the flexible sheath 3, as shown by a two-dot chain line in FIG. When retracted backward with respect to the flexible sheath 3, the tightening ring holding arm 2 returns to its original open state by its own elasticity. A claw-like portion 2a that is bent in the closing direction is formed to protrude from the tip portion of each tightening ring holding arm 2.

  Reference numeral 4 denotes a clip push-out member for pushing a clip, which will be described later, forward relative to the clip tightening ring. In this embodiment, the clip push-out member is formed into a long and narrow bar shape by a stainless steel bar or the like.

  The clip push-out member 4 is disposed between the pair of tightening ring holding arms 2 and at a position on an extension line of the outer tube 1 and the axis of the flexible sheath 3. It is connected via a connecting pipe 6 to the tip of an operation wire 5 arranged so as to be able to advance and retract in the direction. Therefore, when the operation wire 5 is moved back and forth in the axial direction in the flexible sheath 3, the clip push-out member 4 moves in the front-rear direction as shown by a two-dot chain line in FIG.

  The front end surface 4a of the clip pushing member 4 that contacts the rear end of the clip has, for example, a V-shaped cross-section so that the rear end of the clip does not slip out when engaged with the rear end surface of the clip. A recess having a shape in which two grooves are orthogonal to each other in a cross shape is formed.

  However, the front end surface 4a of the clip push-out member 4 may be formed with a concave recess as shown in FIG. 3 or a countersunk recess as shown in FIG. It may be formed.

  FIG. 5 shows the overall configuration of the clip removing device. Reference numeral 10 denotes an operation unit provided on the hand side, and a proximal end of the flexible sheath 3 is fixedly connected to a distal end of the operation unit main body 11, and a slide operation member 12 slidable with respect to the operation unit main body 11 is provided. The proximal end of the operation wire 5 is connected.

  In addition, a mantle tube base end cap 13 provided at the base end of the mantle tube 1 can be slidably operated with respect to the operation portion main body 11, and the mantle tube base end cap 13 is operated by sliding operation. The tube 1 advances and retracts in the axial direction with respect to the flexible sheath 3.

  FIGS. 6 to 10 sequentially show the operation of removing the clip 20 placed in the body by the clip removing device of the present invention. First, as shown in FIG. 6, the outer tube 1 is pushed forward to hold the tightening ring. After the arm 2 is constricted, it is passed through the treatment instrument insertion channel 51 of the endoscope 50, and the distal end portion of the clip removing device is fed into the body where the clip 20 is placed.

  The clip 20 is formed of a material having a spring property, and the front half is formed in a shape that opens in a bowl shape toward the front when no external force is applied, and the rear half is bent at the rear end. It is formed in a returned loop shape.

  Then, as shown in FIG. 6, the cylindrical clip tightening ring 21 that covers the clip 20 from the rear is slid to a position closer to the middle using an endoscope clip device (not shown). It is indwelled in a state where it is constricted by and bitten into the living tissue.

  Therefore, when the leading end portion of the clip removing device of the present invention is guided so as to face the rear end portion of the clip 20 straightly, as shown in FIG. The tightening ring holding arm 2 is opened.

  Then, the entire clip removing device is pushed forward to bring the front end surface 4a of the clip pushing member 4 into contact with the rear end surface of the clip 20 from the rear as shown in FIG. In this way, the outer tube 1 is pushed forward to squeeze the pair of tightening ring holding arms 2, and the side surfaces of the clip tightening ring 21 are sandwiched from the side by the claw-like portions 2 a at the tips of the tightening ring holding arms 2.

  However, the clip pusher member 4 may be brought into contact with the clip 20 after the clip clamp ring 21 is first clamped by the clamp ring holding arm 2. Note that the tip of the claw-shaped portion 2a of the tightening ring holding arm 2 may be formed to be a rough surface or a pointed surface so that the clip tightening ring 21 can be clamped more reliably.

  Thus, when the clip clamping ring 21 is firmly held by the claw-like portions 2a of the pair of clamping ring holding arms 2 so as not to move, the operation wire 5 is pushed forward from the operation unit 10 side. As shown in FIG. 10, the clip pushing member 4 is pushed forward relative to the flexible sheath 3.

  Then, the clip 20 moves back relatively forward in the clip tightening ring 21 fixed to the tightening ring holding arm 2 to return to a shape expanded by its own elasticity, and is released from the state of being bitten by the living tissue. The

  At this time, the clip 20 spreads in a state of being released from the living tissue only by moving a small amount with respect to the clip tightening ring 21. In this way, the clip 20 can be safely and reliably removed from the living tissue without tearing the living tissue.

  The present invention is not limited to the above-described embodiment. For example, as shown in FIG. 11, the tips of the claw-shaped portions 2 a of the plurality of fastening ring holding arms 2 are ahead of the leading edge of the clip fastening ring 21. You may make it close to the state which engages with the front-end edge of the clip clamping | tightening ring 21 in the position close | similar (namely, it enters into an inner position from the outer diameter of the clip clamping | tightening ring 21).

  In this way, when the clip 20 is pushed forward by the clip push-out member 4, the clip fastening ring 21 can be held so that the clip fastening ring 21 does not move forward.

  Also, as shown in FIGS. 12 and 13, a pair of clips that open and close in a hook shape so that the clip pushing member is engaged with the vicinity of the rear end 20a of the clip 20 from a direction not interfering with the tightening ring holding arm 2 You may form with the engagement arm 104. FIG.

  The pair of clip engaging arms 104 of this embodiment is formed in a shape that opens in a hook shape toward the front in a state where an external force is not applied as shown in FIG. The pair of tightening ring holding arms 2 is opened / closed by being elastically deformed by advancing and retreating in a state of passing through a guide hole 7 formed in the vicinity of the base portion.

  A clip engaging claw 104a that can be engaged in a state of being inserted into the loop-shaped portion of the rear half of the clip 20 is formed at the front end portion of each clip engaging arm 104 so as to protrude in the closing direction. ing.

  Then, as shown in FIG. 13, the clip engagement arm 104 is retracted by pulling the operation wire 5 from the operation unit 10 side, whereby the clip engagement claw 104a at the tip thereof is engaged with the loop-shaped portion of the clip 20. When the clip tightening ring 21 is held by the tightening ring holding arm 2 and the operation wire 5 is pushed forward, the clip 20 opens by moving slightly forward relatively in the clip tightening ring 21. Get out of the body tissue.

It is side surface sectional drawing of the front-end | tip part vicinity of the clip removal apparatus for endoscopes of 1st Example of this invention. It is a perspective view near the front-end | tip part of the clip removal apparatus for endoscopes of 1st Example of this invention. It is side surface sectional drawing of the modification of the front-end | tip part of the clip extrusion member of the clip removal apparatus for endoscopes of 1st Example of this invention. It is side surface sectional drawing of the other modification of the front-end | tip part of the clip extrusion member of the clip removal apparatus for endoscopes of the 1st Example of this invention. 1 is a side view of the vicinity of a distal end portion showing the overall configuration of an endoscope clip removing apparatus according to a first embodiment of the present invention. It is side surface sectional drawing of the tip part vicinity which shows operation | movement of the clip removal apparatus for endoscopes of 1st Example of this invention in order. It is side surface sectional drawing of the tip part vicinity which shows operation | movement of the clip removal apparatus for endoscopes of 1st Example of this invention in order. It is side surface sectional drawing of the tip part vicinity which shows operation | movement of the clip removal apparatus for endoscopes of 1st Example of this invention in order. It is side surface sectional drawing of the front-end | tip part vicinity which shows operation | movement of the clip removal apparatus for endoscopes of 1st Example of this invention in order. It is side surface sectional drawing of the tip part vicinity which shows operation | movement of the clip removal apparatus for endoscopes of 1st Example of this invention in order. It is plane sectional drawing of the front-end | tip part vicinity of the clip removal apparatus for endoscopes of 2nd Example of this invention. It is a perspective view near the front-end | tip part of the clip removal apparatus for endoscopes of the 3rd Example of this invention. It is plane sectional drawing of the tip part vicinity of the clip removal apparatus for endoscopes of the 3rd Example of this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Outer tube 2 Clamping ring holding arm 2a Claw-shaped part 3 Flexible sheath 4 Clip pushing member 4a Front end surface 5 Operation wire 10 Operation part 20 Clip 21 Clip clamping ring 50 Endoscope 51 Treatment instrument insertion channel 104 Clip engagement arm 104a Clip engagement claw

Claims (14)

A clip formed in a shape that opens in a bowl shape toward the front by a material having a spring property, and is squeezed by sliding forward a cylindrical fastening ring covered from the rear, and bites into a living tissue. An endoscopic clip detaching device for removing what is placed in a state from the living tissue through a treatment instrument insertion channel of the endoscope,
A flexible outer tube that can be inserted into and removed from the treatment instrument insertion channel of the endoscope;
A plurality of tightening ring holding arms provided at the distal end portion of the outer tube and opening and closing so as to hold the tightening ring at the distal end portion by an operation from the proximal end side of the outer tube;
A clip pushing member for pushing the clip forward relative to the clamping ring held by the clamping ring holding arm;
With the clamp ring holding arm holding the clamp ring, the clip pusher member pushes the clip relatively forward from the clamp ring so that the clip is opened by its own elasticity and detached from the living tissue. An endoscope clip detaching device characterized by comprising:   The plurality of tightening ring holding arms are formed of a springy material in a shape that opens in a bowl shape toward the front when no external force is applied, and protrudes from the tip of the mantle tube The endoscope clip removing apparatus according to claim 1, wherein the apparatus is elastically deformed and opens and closes forward.   The endoscope clip detaching device according to claim 1 or 2, wherein a claw-like portion bent in the closing direction protrudes from each tip portion of the plurality of tightening ring holding arms.   The endoscope clip removing device according to claim 1, 2, or 3, wherein the distal end portions of the plurality of tightening ring holding arms are held by sandwiching a side surface of the tightening ring from the side.   4. The inner side according to claim 1, 2, or 3, wherein the front end portions of the plurality of tightening ring holding arms can be closed to engage with the front end edge of the tightening ring at a position closer to the front end edge of the tightening ring. Endoscopic clip removal device.   The plurality of tightening ring holding arms are attached to the distal end of a flexible sheath disposed in the outer tube so as to be movable forward and backward in the axial direction, and an operation of moving the outer tube forward with respect to the flexible sheath. By doing so, the distal end of the outer tube covers the tightening ring holding arm, and the plurality of tightening ring holding arms are closed, and the outer tube is retreated with respect to the flexible sheath. The endoscope clip removal according to any one of claims 1 to 5, wherein a distal end of the outer tube is retracted from the plurality of tightening ring holding arms to open the plurality of tightening ring holding arms. apparatus.   7. The endoscope clip removing device according to claim 6, wherein the outer tube is a flexible tube, and the flexible sheath is a tightly wound coil pipe.   An operation wire for advancing and retracting the clip pushing member relative to the tightening ring holding arm in the axial direction by an operation from the proximal end side of the outer tube is inserted into the flexible sheath so as to freely advance and retract. The endoscope clip removing apparatus according to claim 6 or 7, wherein   The endoscope clip removing device according to any one of claims 1 to 8, wherein the clip push-out member is formed in a rod shape that comes into contact with a rear end portion of the clip from the rear side.   The endoscope clip removing device according to claim 9, wherein the clip pushing member abuts on a rear end surface of the clip at a front end surface thereof.   The endoscope clip removing device according to claim 10, wherein a concave portion that engages with a rear end surface of the clip is formed on a front end surface of the clip push-out member.   9. The clip engaging arm according to claim 1, wherein the clip pushing member is a pair of clip engaging arms that open and close like a hook so as to engage with the vicinity of the rear end of the clip from a direction not interfering with the tightening ring holding arm. The endoscope clip removing apparatus according to the section.   The rear half of the clip is formed in a loop shape, and a clip engagement claw that engages with the loop is formed to protrude toward the closing direction at the tip of the clip engagement arm. Endoscope clip removal device.   The pair of clip engagement arms is formed of a spring-like material in a shape that opens in a hook shape toward the front when no external force is applied, and is formed near the base of the tightening ring holding arm. The endoscope clip removing device according to claim 12 or 13, which is elastically deformed and opened and closed by advancing and retreating in a state of passing through the guide hole.

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