JP4491589B2 - Endoscopic clip device - Google Patents

Description

  The present invention relates to an endoscope clip device that is passed through a treatment instrument guide tube of an endoscope and used for hemostasis treatment or the like in the body.

In general, the clip device for an endoscope is a distal end of a sheath in which a cylindrical clip fastening ring is fitted to a clip formed of a material having a spring property and passed through a treatment instrument guide tube of the endoscope. When the tip of the operation wire inserted in the sheath is engaged with the rear end of the clip and pulled, the clip tightening ring abuts on the tip of the sheath and is pushed out toward the clip in the distal direction. The clip is forcibly placed in the closed state, and then the clip between the operation wire and the clip is disengaged so that the clip tightening ring is fitted and the closed clip is placed in the body. (For example, Patent Documents 1 and 2).
Japanese Utility Model Publication 4-26091 JP 2002-191609 A

  When performing clipping operation in the body under endoscopic observation, the clip in the opened state is brought close to the affected part by remote control, and the affected part is clamped with the clip, and then the clip tightening ring is pushed forward with the sheath. Although an operation for closing the clip is performed, it may be better to repeat the clipping operation during the clipping operation because the orientation and position of the clip are insufficient.

  However, in many conventional clip devices for endoscopes, once the clip tightening ring is pushed forward by the sheath, the clip is plastically deformed and the clipping operation cannot be redone. The doctor operating on the hand side does not know the boundary between the reversible motion area where the clip reopens and the clipping operation can be redone, and the irreversible motion area where the clip is no longer open and cannot be redone, so it is an irreversible motion area It took a lot of time to redo the clipping operation, or it was a reversible motion area, but the clipping operation was completed in an inadequate state without performing the clipping operation again.

  The present invention has been made to solve such a problem, and in the middle of a clipping operation, the operator clearly understands the boundary between the reversible motion region where the clipping operation can be redone and the irreversible motion region where the clipping operation cannot be redone. Then, it aims at providing the clip apparatus for endoscopes which can perform suitable clipping operation.

The clip device for an endoscope of the present invention includes a clip formed of a material having a spring property in a shape that expands forward when no external force is applied, and a rear side of the clip that is fitted to the clip. A cylindrical clip clamping ring that forcibly closes the clip by moving it from the front to the front, and advancing the clip clamping ring toward the front of the clip by abutting the clip clamping ring at the tip And a clip holding member that is inserted and disposed in the sheath so as to be movable in the axial direction relative to the sheath and that is detachably connected to the rear end portion of the clip in the vicinity of the distal end of the sheath. in endoscopic clip device provided, clips, press the clip tightening ring from the rear side of the clip by a sheath halfway position of the moving range of the front side After that, when the sheath is retracted to the rear side of the clip, the clip tightening ring is retracted to the rear side and the clip is opened again, and the clip tightening ring is returned from the rear side of the clip by the sheath. There is an irreversible operation area where the clip clamping ring does not retract backward even if the sheath is retracted backward after being pushed forward to the middle position of the moving range, and the boundary position between the reversible motion area and the irreversible motion area In addition, a step that is overcome when the clip tightening ring moves from the reversible operation region to the irreversible operation region is formed by changing the width of the clip.

The may be the forward stopper for preventing further advancement of the clip tightening ring to the front end of the irreversible operation region of the clip is formed, the forward stopper but it may also be formed by changing the width of the clip .

The width of the clip in the irreversible operation area may be gradually larger width to reversibly operation area side, by the length of the irreversible operation region of the clip are longer than the length of the clip tightening ring, The clip may be pressed against the ridge line portion of the rear end portion of the inner peripheral surface of the clip tightening ring .

  According to the endoscope clip device of the present invention, when a clip that has been closed is reopened and moved from a reversible operation region where the clipping operation cannot be redone to an irreversible operation region where the clip can no longer be opened and cannot be redone. By forming a step in the clip over the clip tightening ring, the operator can clearly grasp the boundary between the reversible operation region and the irreversible operation region in the middle of the clipping operation, and perform an appropriate clipping operation.

Embodiments of the present invention will be specifically described below with reference to the drawings.
FIG. 5 is a side sectional view of the distal end portion of the endoscope clip device in a state where the clip 1 is opened, and FIG. 6 is a plan sectional view.
The clip 1 is used to clamp the tip portion 1a in a state of being bitten into the living tissue in order to stop hemostasis and the like, and a clip tightening ring 2 for maintaining the clip 1 in a closed state It is attached so as to cover a portion closer to the rear than the middle portion of 1.

  The clip tightening ring 2 is formed in a short cylindrical shape by a rigid body such as a stainless pipe material or hard plastic and is fitted to the clip 1, that is, the clip 1 is passed through the clip tightening ring 2. The clip tightening ring 2 is disposed so as to surround the portion near the rear end of the clip 1. In this state, the clip 1 expands to a state where the tip is opened by its own elasticity, and a portion near the rear end of the clip 1 protrudes rearward from the rear end of the clip tightening ring 2. As shown by 12 etc., the clip 1 can be forcedly closed by moving the clip tightening ring 2 from the rear side to the front side of the clip 1. Note that the clip tightening ring 2 may be formed of a tightly wound metal coil or the like.

  Returning to FIGS. 5 and 6, 3 indicates that the clip clamping ring 2 is placed at the tip of the clip 1 so that the tip abuts against the rear end of the clip clamping ring 2 and the clip 1 is forcibly closed. A clip-holding wire 4 (clip-holding member), which is a flexible sheath for pushing forward in the direction and is detachably connected to the rear end portion 1b of the clip 1 by the clip-connecting member 4A. It is slidably inserted in the axial direction. The proximal end portions of the flexible sheath 3 and the clip holding wire 4 reach an operation unit (not shown) and are relatively advanced and retracted in the operation unit.

  The flexible sheath 3 is formed of, for example, a coil pipe in which a stainless steel wire having a flat cross-sectional shape is tightly wound. Therefore, it has the characteristic that it has soft flexibility but is hardly compressed by external force. However, it may be formed of a coil pipe having a circular cross section or a synthetic resin tube such as a strong fluororesin tube or PEEK (polyether ether ketone) resin.

  A cylindrical clip holding base 10 formed of a rigid body such as a stainless steel pipe material or a hard plastic material is brazed to the distal end of the flexible sheath 3 in series with the flexible sheath 3, and laser A fastening ring holding hole 11 for holding the clip fastening ring 2 in a loosely surrounding state is formed at the most distal end portion of the clip holding base 10 by being fixed integrally by welding or adhesion. . The clamping ring holding hole 11 is formed in a circular cross-sectional shape with a diameter into which the clip clamping ring 2 is loosely inserted, and the innermost end of the clamping ring holding hole 11 has a slightly narrower diameter. The contact surface 11a with which the rear end surface of the clip tightening ring 2 contacts is formed facing forward.

  The clip holding base 10 is formed with a clip holding hole 12 that is connected to the rear side of the fastening ring holding hole 11 and holds a portion near the rear end of the clip 1. The clip holding hole 12 holds the clip 1 so as to loosely surround the vicinity of the rear end 1b of the clip 1 protruding rearward from the clip tightening ring 2 in a state where the clip 1 is expanded. The clip connecting member 4A connected to the tip of the clip holding wire 4 by the connecting ring 4B is formed of a material having spring property in a tweezers shape whose tip is bent inward, and the flexible sheath 3 (and the clip holding member). In the base 10), it is elastically deformed in a constricted state and engaged with the rear end 1b of the clip 1, but when it protrudes from the tip of the clip holding base 10, it expands as shown in FIG. Thus, the engagement with the clip 1 is released.

  Returning to FIGS. 5 and 6 again, reference numeral 5 denotes a flexible outer tube made of, for example, a fluororesin tube or the like loosely fitted on the flexible sheath 3. The distal end of the outer tube 5 is usually at a position slightly retracted from the distal end of the flexible sheath 3. However, if the outer tube 5 is pushed forward by the operation portion on the hand side, as shown in FIG. The tip of the outer tube 5 is covered with the clip 1, and the clip 1 can be elastically deformed so that the clip 1 is retracted. If the outer tube 5 is retracted rearward, the clip 1 is shown in FIG. Return to the expanded state.

  2 and 1 are a side view and a plan view of only the clip 1 in a state where the clip fastening ring 2 is mounted. However, the clip fastening ring 2 is shown in cross section. The clip 1 is formed by bending a plate material having a spring property such as a stainless steel plate for a spring by pressing or the like, and a developed view (half) before bending is shown in FIG. . As shown in FIG. 2, the clip 1 has a rear end portion 1 b bent back in a substantially U shape in parallel, and when the external force is not applied, the leading arm portion 1 c is “C” toward the front. It is formed in a shape that is in a state of expanding into a shape.

  The portion behind the step A formed in the substantially middle portion of the clip 1 is a reversible operation region 1d in which the fitted clip fastening ring 2 can move relatively freely, and the reversible operation region 1d. In the portion near the rear end, there is formed a retraction stopper R for slightly expanding the width of the clip 1 to the left and right evenly than the width Wd of the reversible operation region 1d and restricting the clip tightening ring 2 from retreating further. . That is, Wd <WR. Note that the width Wd of the reversible operation region 1d of the clip 1 is such that the clip 1 bent back in a substantially U shape in parallel at the rear end 1b as shown in FIG. 10 illustrating the AA cross section in FIG. The clip 1 is formed to have the narrowest width within the entire clip 1 so that the clip tightening ring 2 is slightly inscribed to the retreat stopper R position. As shown in FIG. 2, such a reversible motion region 1 d is a smooth rounded curved surface that gradually goes outward from the parallel portion formed toward the rear end portion 1 b when viewed from the side. Has reached step A.

  When the clip tightening ring 2 is engaged (that is, fitted into the clip tightening ring 2), the clip tightening ring 2 is retracted to the reversible operation region 1d side. As shown in FIG. 1, the width WA of the irreversible motion area 1e is more evenly spread left and right than the width Wd of the reversible motion area 1d as shown in FIG. The difference in width is a step A. Further, an advance stopper F for completely preventing the clip tightening ring 2 from moving further forward is provided at the boundary portion with the arm portion 1c which is the foremost portion of the irreversible operation region 1e. Is spread evenly on the left and right sides. The width of the forward stopper F portion is the width Wc itself of the rear end portion of the arm portion 1c. However, the forward stopper F is formed by a 45 ° chamfered slope with the width of the clip 1 gradually increased so that the outer tube 5 and the like are not caught.

  As shown in FIG. 2, the irreversible motion region 1e is a plane that is straight with respect to the arm portion 1c, and the curve of the reversible motion region 1d is at the boundary with the reversible motion region 1d where the step A is formed. It is bent in the closing direction slightly from the tangential direction, for example, inward by about 30 °. With such a shape, the clip 1 can be kept tightly closed when the clip clamping ring 2 is engaged with the irreversible operation region 1e.

  Although the width of the clip 1 in the irreversible motion region 1e is substantially uniform, strictly speaking, the width WA of the step A portion which is the rear end of the irreversible motion region 1e is slightly smaller than the width We near the front end of the irreversible motion region 1e. Widely formed (for example, less than 0.1 mm). In FIG. 1 and the like, the width difference is slightly exaggerated. The relationship of the width of the clip 1 is Wd << We << WA << Wc. Further, the step A formed by the change of the width of the clip 1 is rounded, and the clip clamping ring 2 is caught by the step A and cannot move from the reversible operation region 1d to the irreversible operation region 1e side. Does not occur.

  When the endoscopic clip device using the clip 1 configured as described above is passed through the treatment instrument guide tube of the endoscope to perform a transendoscopic clipping operation, first, as shown in FIG. Then, the rear end 1b of the clip 1 is engaged with the clip connecting member 4A, the outer tube 5 is pushed forward, the clip 1 is squeezed and inserted into a treatment instrument guide tube of an endoscope (not shown). . Then, in the body, the tip of the clip device protrudes from the tip of the endoscope, and the outer tube 5 is retracted rearward as shown in FIGS. To face the affected area.

  Then, by a remote operation from an operation unit (not shown) connected to the proximal end of the flexible sheath 3, as shown in FIG. The clip clamping ring 2 is pushed forward from the rear toward the front with respect to the clip 1, and the tip end portion of the clip clamping ring 2 comes into contact with the step A of the clip 1. In this state, the clip 1 is considerably closed and the curved portions of the pair of reversible motion regions 1d are in contact with each other. Then, as shown in FIG. 8 which shows an enlarged view of the state near the step A at that time, the clip fastening ring 2 in contact with the step A moves over the step A and moves to the irreversible operation region 1e side. Since the amount of operation force on the hand side suddenly increases, the operator can clearly grasp that the clip fastening ring 2 is now hitting the step A with a sense of hand. Since the clip fastening ring 2 is engaged with the reversible operation region 1d of the clip 1 until that state, if the flexible sheath 3 is retracted backward with respect to the clip holding wire 4, At the same time, the clip tightening ring 2 retracts to the rear side of the clip 1 and returns to the original state shown in FIG. Therefore, if there is a possibility that the previous clipping operation is not sufficient, the clipping operation can be immediately redone. The step A may be subjected to a three-dimensional bending process such as bending outward or inward in order to optimize the contact state with the clip fastening ring 2.

  If it is determined that the clipping operation is properly performed, the clip holding wire is detected with a stronger operating force after detecting that the tip of the clip tightening ring 2 is in contact with the step A of the clip 1. 4 to push the flexible sheath 3 forward. As a result, as shown in FIG. 9, the tip of the clip fastening ring 2 moves over the step A and moves toward the irreversible motion region 1e. The operator can clearly grasp the moment when the clip tightening ring 2 gets over the step A with a sense of hand. Then, the clip 1 is tightened inward of the clip tightening ring 2 from the state of FIG. 10 illustrating the AA cross section in FIG. 7 to the state of FIG. 11 illustrating the BB cross section in FIG. At the same time that the clip 1 is almost closed, the frictional resistance between the clip clamping ring 2 and the clip 1 is increased, and the flexible sheath 3 is retracted rearward. Even if this is done, the clip tightening ring 2 is not retracted to the rear side, and the clip 1 is kept in the closed state.

  Further, as shown in FIG. 12, when the flexible sheath 3 is pushed to a position where the clip clamping ring 2 hits the advance stopper F, further advancement of the clip clamping ring 2 is completely prevented. Thus, the clip 1 is tightly closed, and the affected mucous membrane can be clipped at the distal end portion 1a of the clip 1 by positioning the affected mucous membrane and the like between the pair of arms 1c. Subsequently, as shown in FIG. 13, the flexible sheath 3 is retracted to the rear side, and the clip connecting member 4A is removed from the rear end 1b of the clip 1, whereby the irreversible operation region 1e is formed as described above. The condition that the clip tightening ring 2 is forcibly closed by the clip tightening ring 2 without detaching from the clip 1 due to resistance due to the formation of We <WA and gradually wider toward the rear side. The clip 1 can be securely placed in the body.

  14 and 15 are a side sectional view and a plan view of the clip 1 according to the second embodiment of the present invention, in which the length Le of the irreversible operation region 1e is formed longer than the length L2 of the clip tightening ring 2. ing. That is, Le> L2. As a result, as shown in an enlarged view in FIG. 16, the clip 1 is pressed against the ridge line portion P at the rear end portion of the inner peripheral surface of the clip fastening ring 2 in the indwelling state in the body. The tightening ring 2 becomes more difficult to retract. Further, in this second embodiment, the clip 1 is formed in a shape that intersects in an α shape in the reversible operation region 1d. Thus, the specific shape of the clip 1 can take various forms. .

The top view of the clip of the state in which the clip clamping ring of the 1st Example of this invention was mounted | worn. The side view of the clip of the state in which the clip clamping ring of the 1st Example of this invention was mounted | worn. The expanded view of the clip of the 1st Example of this invention. The side sectional view of the tip part of the clip device for endoscopes in the state where the mantle tube of the 1st example of the present invention moved forward. The side sectional view of the tip part of the clip device for endoscopes in the state where the clip of the 1st example of the present invention opened. The top sectional view of the tip part of the clip device for endoscopes in the state where the clip of the 1st example of the present invention opened. The side sectional view of the tip part of the clip device for endoscopes in the state where the clip of the 1st example of the present invention closes and can return to the original. 1 is a partially enlarged perspective view of a distal end portion of an endoscope clip device in a state in which a clip according to a first embodiment of the present invention is closed and can be returned to its original state. The side sectional view of the tip part of the clip device for endoscopes in the state where the clip of the 1st example of the present invention closed, and became unable to return to the former. Sectional drawing of the state cut | disconnected by the AA line of FIG.1 and FIG.7 of the clip apparatus for endoscopes of 1st Example of this invention. Sectional drawing of the state cut | disconnected by the BB line of FIG. 9 of the clip apparatus for endoscopes of 1st Example of this invention. The side sectional view of the tip part of the clip device for endoscopes in the state where the clip of the 1st example of the present invention was closed completely. The side sectional view of the detention state where the clip of the 1st example of the present invention was closed with the clip clamping ring. The side sectional view of the detention state where the clip of the 2nd example of the present invention was closed with the clip clamping ring. The top view of the clip of the 2nd Example of this invention. The partial expansion perspective view in the state where the clip of the 2nd example of the present invention was closed with the clip clamping ring.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 ... Clip 1a ... Front-end | tip part 1b ... Rear-end part 1c ... Arm part 1d ... Reversible operation area | region 1e ... Reversible operation area | region 2 ... Clip clamping ring 3 ... Flexible sheath 4 ... Clip holding wire (clip holding member)
A ... Step F ... Forward stopper R ... Reverse stopper

Claims (2)

A clip formed of a spring material in a shape that expands toward the front when no external force is applied, and the clip is fitted to the clip and moved from the rear side to the front side of the clip. A cylindrical clip clamping ring that forcibly closes the clip; a sheath for abutting the clip clamping ring at the tip portion to push the clip clamping ring forward of the clip; and A clip holding member that is inserted and arranged in the sheath so as to be movable in the axial direction relative to the sheath, and a distal end portion of which is detachably connected to a rear end portion of the clip in the vicinity of the distal end of the sheath; In the endoscope endoscopic clip device,
When the clip pushes the clip tightening ring from the rear side to the front side of the clip to the middle position of the moving range by the sheath and then retracts the sheath to the rear side of the clip, the clip tightening ring is moved along with it. A reversible motion region in which the clip retracts to the rear side and the clip opens, and the sheath pushes the clip clamping ring from the rear side to the front side of the clip to the middle position of the moving range. The clip clamping ring has an irreversible operation area where the clip clamping ring does not retract to the rear side even when the clip clamping ring is retracted rearward, and the clip clamping ring is located at the boundary position between the reversible operation area and the irreversible operation area. a step to overcome the operating area when moving to the irreversible operation region so as to form a change of the width of the clip, The forward stop to prevent further forward movement of the clip tightening ring to the front end portion of the serial irreversible operation region formed by the change of the width of the clip,
The clip device for an endoscope , wherein a width of the clip in the irreversible operation region is gradually increased from the advance stopper side to the reversible operation region side . The endoscopic clip device according to claim 1, wherein the length of the irreversible operation region of the clip is longer than the length of the clip tightening ring. An endoscopic clip device in which the clip is press-contacted to a ridge line portion of a rear end portion of a surface .

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