JP4575763B2 - Endoscopic clip device - Google Patents

Description

  The present invention relates to an endoscope clip device that is used through a treatment instrument insertion channel of an endoscope in order to perform hemostasis or marking in a living body or the like.

  Clipping treatment for hemostasis and marking in a luminal organ etc. is performed by passing the clip device through the treatment instrument insertion channel of the endoscope. If it is pulled out from the treatment instrument insertion channel of the endoscope and reloaded with a clip, the operation becomes too complicated.

Therefore, an operation wire arranged in series in a state where a plurality of clips are constricted in the distal end of the sheath inserted into and removed from the treatment instrument insertion channel of the endoscope, and is movable in the axial direction in the sheath. An endoscopic clip device has been devised that is configured so that a plurality of clips can be sequentially pushed out from the distal end of the sheath and each clip can be opened once and then closed (for example, Patent Document 1).
JP 2002-330972 A

  However, in the conventional endoscope clip device described in Patent Document 1, a plurality of clips arranged in the distal end of the sheath are individually connected to the distal end of the operation wire by a ligation wire or the like. Therefore, the more the clip is located at the rear, the more the ligating wire is in an arrangement state, and the structure becomes cluttered and the smooth operation is not the case.

  Therefore, the present invention provides an endoscopic clip device in which a plurality of clips can be arranged in an orderly and concise manner within the distal end of a sheath, and a continuous clipping procedure can be performed with a smooth and reliable operation. For the purpose.

  In order to achieve the above object, the clip device for an endoscope of the present invention is arranged in series in a state where a plurality of clips are respectively constricted in the distal end of a sheath inserted into and removed from the treatment instrument insertion channel of the endoscope. Endoscopic clips constructed such that a plurality of clips can be sequentially pushed out from the distal end of the sheath by an operation wire disposed in the sheath so as to be movable back and forth in the axial direction, and each clip is opened once and then closed. In this device, each clip is formed by a pair of leaf spring pieces arranged facing each other in the opening / closing direction, and a connecting claw bent outward is formed at the rear end portion of each leaf spring piece. At the end of each leaf spring piece, when the clip is in a squeezed state, the clip connecting claw located adjacent to the front side of the leaf spring piece is locked in a state where it is inserted and the clip spreads. When a pair of leaf spring pieces constituting the clip is not applied with an external force in an engagement hole that is disengaged and a plurality of clips are directly connected by the connection claw and the engagement hole. Is a state in which the front part is in a state of opening in a bowl shape, and the front part can be closed by applying an external force, and is fixed at the intermediate part.

  In addition, the clip is provided with a fastening ring that engages with an intermediate portion of the pair of leaf spring pieces with a size that fits in the sheath, and the pair is moved by moving the fastening ring toward the front side of the pair of leaf spring pieces. The leaf spring piece may be forcibly closed by a ring.

  According to the present invention, since the plurality of clips are directly connected in series in the distal end of the sheath and no separate member is required for connection, the plurality of clips are arranged in an orderly and concise manner in the distal end of the sheath. It is possible to perform a continuous clipping procedure with a smooth operation, and the pair of leaf spring pieces constituting the clip are fixed to each other at the middle portion, thereby opening and closing the pair of leaf spring pieces. Therefore, it is possible to perform smooth clipping by operating smoothly without causing misalignment or the like.

  Each clip is formed by a pair of leaf spring pieces arranged facing each other in the opening / closing direction, and a connecting claw bent outward is formed at the rear end portion of each leaf spring piece, and each leaf spring When the clip is in a squeezed state, the connection claw of the clip located adjacent to the front side is locked in a state where the clip is expanded and the engagement with the connection claw is released when the clip spreads. In the case where a hole is formed and a plurality of clips are directly connected by a connecting claw and an engaging hole, when a pair of leaf spring pieces constituting the clip does not act, The intermediate portion is fixed to each other so that the front portion can be closed by applying an external force.

Embodiments of the present invention will be described with reference to the drawings.
FIG. 1 is a side sectional view of the vicinity of the distal end of an endoscope clip device, FIG. 2 is a plan sectional view, and 1 is a flexible member that is inserted into and removed from a treatment instrument insertion channel of an endoscope (not shown). Sheath. The sheath 1 is formed of, for example, a coil pipe in which a stainless steel wire is closely wound with a constant diameter, and has a diameter of about 2 to 3 mm and a length of about 1 to 2 m.

  An operation wire 2 that can be moved back and forth in the axial direction from the proximal end side is inserted in the sheath 1, and the operation wire 2 is operated by an operation from an operation unit that is connected to the proximal end side (not shown) of the sheath 1. Is moved forward and backward.

  A plurality (three in this embodiment) of the clips 3 (3A, 3B, 3C) are arranged in series in the distal end portion of the sheath 1 in such a manner that they are constricted. A plurality of clips 3 are sequentially pushed out from the distal end of the sheath 1 so that the clips 3 can be once opened and then closed.

  A connecting member 5 that is detachably connected to the rearmost clip 3 </ b> C is fixedly connected to the distal end of the operation wire 2 via a connecting pipe 6. Further, a metal or plastic cylindrical tip 7 is fixedly attached to the most distal portion of the sheath 1.

  Each clip 3 is composed of a pair of leaf spring pieces 30 made of, for example, a stainless steel plate for springs, which are arranged facing each other in the opening and closing direction, and a fastening ring 4 for forcibly closing the clip 3. Has been.

  FIG. 3 shows a pair of leaf spring pieces 30 in an unloaded state to which no external force is applied. Each leaf spring piece 30 has an intermediate portion 32 formed in a flat shape elongated in the front-rear direction. Are fixed to each other by silver brazing or the like. In the figure, the portion is indicated by XXX.

  The rear portion 31 of each leaf spring piece 30 is formed in a loose arc shape that slightly bulges outward so as not to pass through the ring 4, and the front portion 33 is opened in a bowl shape. Further, it is formed in a shape bent outwardly in two stages at the boundary portion with the intermediate portion 32.

  Further, the intermediate portion 32 of the leaf spring piece 30 is formed with a narrow width so that it can move in the fastening ring 4, and the tip portion 33 is fitted in the fastening ring 4 except for the vicinity of the boundary with the intermediate portion 32. It is formed wide so that it cannot get stuck. The rear portion 31 is formed narrow, but may be formed wide.

  A connecting claw 34 that is bent outward is formed at the rear end portion of each leaf spring piece 30. In this embodiment, the connecting claw 34 is bent at an angle of about 45 ° obliquely rearward to have a narrow width. Yes. An engagement hole 37 into which the coupling claw 34 of the leaf spring piece 30 located adjacent to the front side is inserted and engaged is formed in the vicinity of the tip of each leaf spring piece 30.

  A clip claw 35 is formed at the foremost portion of each leaf spring piece 30 so as to be bent toward the inside in order to eat the living tissue at the time of clipping. However, the folding positions of the clip claws 35 are slightly shifted in the pair of leaf spring pieces 30 so that the clip claws 35 of the pair of leaf spring pieces 30 do not collide with each other when the clip 3 is closed.

  Further, each clip claw 35 interferes with the rear portion 31 of the leaf spring piece 30 located adjacent to the front side when the leaf spring piece 30 is constricted in the sheath 1. A cutout 36 for avoiding is formed, whereby the clip claw 35 has a gate shape.

  FIG. 4 shows a clamp ring 4. The clamp ring 4 is formed in a tapered shape with an outer surface having a circular cross-sectional shape and gradually decreasing in diameter toward the front side, and an inner surface 4a is passed through a pair of leaf spring pieces. It is formed in a rectangular cross-sectional shape according to the cross-sectional shape of 30.

  FIG. 5 shows a state in which the intermediate portion 32 of the leaf spring piece 30 is passed through the fastening ring 4. In this state where no external force acts on the leaf spring piece 30, the clip 3 has a shape of the pair of leaf spring pieces 30. It is in a state of being wide open as it is.

  Then, as shown in FIG. 6, when the fastening ring 4 is shifted from the intermediate part 32 of the clip 3 toward the front part 33, the pair of leaf spring pieces 30 pushed by the fastening ring 4 from the outside gradually close. Finally, the clip 3 is tightly closed until the clip claws 35 of the pair of leaf spring pieces 30 intersect each other.

  As described above, the leaf spring piece 30 can be opened and closed by moving the fastening ring 4 in the axial direction with respect to the pair of leaf spring pieces 30, but the pair of leaf spring pieces 30 are fixed to each other at the intermediate portion 32. As a result, the pair of leaf spring pieces 30 can be opened and closed in a stable state without any positional deviation.

  FIG. 7 shows the connecting portion between the most advanced clip 3A and the second clip 3B. Each clip 3 is elastically deformed into a constricted state by being housed in the sheath 1, and the most advanced clip. When the connecting claw 34 at the rear end of 3A is inserted into the engagement hole 37 of the second clip 3B, the most advanced clip 3A and the second clip 3B move together in the axial direction of the sheath 1. Linked to the state.

  At this time, since the notch 36 is formed in the clip claw 35 of the second clip 3B, the clip claw 35 of the second clip 3B in the closed state does not interfere with the most advanced clip 3A.

  Further, the connecting claw 34 of the most advanced clip 3A is formed to have a length that does not penetrate outward from the engagement hole 37 of the second clip 3B, and as a result, it moves smoothly without being caught on the inner surface of the sheath 1. can do.

  When the second clip 3B is in an open state, the engagement hole 37 of the second clip 3B is disengaged from the connecting claw 34 of the most advanced clip 3A, and the most advanced clip 3A and the second clip 3B The connection of is released.

  Note that the connecting portion between the second clip 3B and the rearmost clip 3C and the connecting portion between the rearmost clip 3C and the connecting member 5 shown in FIG. 30 are directly connected in series by each connecting claw 34 and the engaging hole 37.

  As shown in FIG. 1, the cylindrical tip 7 attached to the most distal portion of the sheath 1 is formed in a tapered cylindrical shape having a tapered inner diameter. It is formed smaller than the end outer diameter.

  Further, as shown in FIG. 8, the tip portion of the tip 7 is parallel to the axis so that when the fastening ring 4 is pushed from behind, the diameter thereof is easily elastically deformed so as to be expanded. It is formed in a shape divided in the direction by a plurality of slits 7b. In this embodiment, three slits 7b are provided at intervals of 120 °, but four or more may be provided at intervals of 90 °.

  When the endoscope clip device configured as described above is used, as shown in FIG. 1, the clips 3 are squeezed and connected in the sheath 1, and are not illustrated. It is passed through the treatment instrument insertion channel of the endoscope.

  When the distal end of the sheath 1 is directed to the target affected part in the body, the operation wire 2 is pushed from the proximal end side, and as shown in FIG. 9, three clips 3A and 3B connected in series are connected. , 3C moves forward in the sheath 1 and the tip of the most advanced clip 3A passes through the tip 7.

  Further, when the operation wire 2 is further pushed in, as shown in FIG. 10, the distal portion 33 of the most advanced clip 3A is pushed forward from the distal tip 7 and is opened to the maximum. .

  At this time, the fastening ring 4 abuts on the back surface of the tip 7 and stops at the tip 7. However, when the operation wire 2 is pushed in with a larger force, the fastening ring 4 is elastically stretched to push the tip 7. As shown in FIG. 11, the fastening ring 4 jumps out from the tip of the tip tip 7.

  Then, since the outer diameter of the rear end portion of the clamp ring 4 is larger than the tip inner diameter of the tip chip 7, the clamp ring 4 can not go back and return to the tip chip 7, and the cutting edge clip 3A that is wide open can be removed. In this state, it can be pressed against the target affected area.

  Therefore, as shown in FIG. 12, when the operation wire 2 is pulled toward the proximal end side, the pair of cutting-edge clips 3 </ b> A in a state where the rear end of the fastening ring 4 is in contact with the distal end surface of the distal end tip 7. The leaf spring piece 30 is drawn into the sheath 1, and accordingly, the fastening ring 4 moves to a position closer to the tip of the clip 3, and the state-of-the-art clip 3 </ b> A is closed.

  Then, as shown in FIG. 13, when the fastening ring 4 is engaged with the further distal portion 33 side of the most advanced clip 3A, the most advanced clip 3A is tightly closed and the operation is performed. The wire 2 can no longer be pulled.

  When that happens, as shown in FIG. 14, the operation wire 2 is pushed again into the distal end side, and as shown in FIG. 15, the second clip 3B is pushed out from the distal end of the distal tip 7. When the second clip 3B is opened, the connection between the cutting edge clip 3A and the second clip 3B is released, and the cutting edge clip 3A is placed in the body with the target affected area being clipped. The clip 3B is in a state where a clipping operation can be performed on the next target affected area.

  When the clipping operation with the second clip 3B is finished, the clipping operation with the last clip 3C can be continuously performed in the same manner.

It is side surface sectional drawing of the front-end | tip vicinity of the clip apparatus for endoscopes of the Example of this invention. It is a plane sectional view near the tip of the clip device for endoscopes of the example of the present invention. It is a perspective view of a pair of leaf | plate spring pieces of the clip apparatus for endoscopes of the Example of this invention. It is a perspective view of a clamp ring of the clip device for endoscopes of the example of the present invention. It is side surface sectional drawing of the state which the clip of the clip apparatus for endoscopes of the Example of this invention opened. It is side surface sectional drawing of the state which the clip of the clip apparatus for endoscopes of the Example of this invention closed. It is side surface sectional drawing which shows the connection state of the clip of the clip apparatus for endoscopes of the Example of this invention. It is a perspective view of the front-end | tip chip | tip of the clip apparatus for endoscopes of the Example of this invention. It is side surface sectional drawing which shows operation | movement at the time of use of the clip apparatus for endoscopes of the Example of this invention. It is side surface sectional drawing which shows operation | movement at the time of use of the clip apparatus for endoscopes of the Example of this invention. It is side surface sectional drawing which shows operation | movement at the time of use of the clip apparatus for endoscopes of the Example of this invention. It is side surface sectional drawing which shows operation | movement at the time of use of the clip apparatus for endoscopes of the Example of this invention. It is side surface sectional drawing which shows operation | movement at the time of use of the clip apparatus for endoscopes of the Example of this invention. It is side surface sectional drawing which shows operation | movement at the time of use of the clip apparatus for endoscopes of the Example of this invention. It is side surface sectional drawing which shows operation | movement at the time of use of the clip apparatus for endoscopes of the Example of this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Sheath 2 Operation wire 3 (3A, 3B, 3C) Clip 4 Fastening ring 5 Connection member 7 Tip tip 7b Slit 30 Leaf spring piece 32 Middle part 33 Leading part 34 Connection claw 35 Clip claw 37 Engagement hole

Claims (2)

A plurality of clips are placed in series in the distal end of the sheath inserted into and removed from the treatment instrument insertion channel of the endoscope, respectively, and the operation wire is disposed in the sheath so as to be movable back and forth in the axial direction. An endoscopic clip device configured to sequentially extrude a plurality of clips from the distal end of the sheath and then close each clip once opened,
Each clip is formed by a pair of leaf spring pieces disposed facing each other in the opening and closing direction, and a connecting claw bent outward is formed at the rear end of each leaf spring piece, and When the clip is in a state where the clip is constricted, the connection claw of the clip located adjacent to the front side of the leaf spring piece is locked in a state where the clip is expanded and the clip expands. An engagement hole for releasing engagement is formed, and the plurality of clips are directly connected by the connection claw and the engagement hole.
When a pair of leaf spring pieces constituting the clip is not applied with an external force, the leading part is opened in a bowl shape, and the leading part can be closed by applying the external force. An endoscopic clip device characterized by being fixed at an intermediate portion.   The clip is provided with a fastening ring that engages with an intermediate portion of the pair of leaf spring pieces so as to fit within the sheath, and moves the fastening ring toward the front side of the pair of leaf spring pieces. 2. The endoscope clip device according to claim 1, wherein the pair of leaf spring pieces are forcibly closed by the fastening ring.

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