JP4591433B2 - 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 incision, etc., so there is a demand for a clip device using an endoscope that can be easily and quickly handled and treated, and has a low 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 is housed in a long tubular body 430 and a distal end side in the tubular body 430 , and a flange 320 is provided at the distal end, and the inner diameter of the distal end side inner wall surface is reduced. A locking member 330 formed of an elastic body formed with a step 322 and reduced in diameter by an external force, a stretchable member 420 connected to the rear end of the locking member 330 in a natural length state, and the inside of the cylindrical body 430 reciprocating a freely inserted into, provided with a wire 410 having a first engagement means 332 for engaging the clip 110 to the tip, the clip 110 and the proximal end 500, extends from the proximal portion 500 a clip body 200 having a double-arm section 220 that Hirakiude by automatically opening that issued, the clamping member 300 which is retractably inserted in the clip body 200 comprises, on the base end portion 500, the Second engagement hand 334 is provided, the locking of the first engagement means 332 to regulate the axial movement of the member 330 that is protruded from the engaging member 330, and the first engagement means 332, the a second engagement means 334, and with but is engageable, in a state where the engagement not work stop member 330 is an external force, the tip of the first engagement means 332, of the locking member 320 Located proximal to the tip,
By moving the wire (410) to the proximal end side, the locking member 330 is locked at the distal end portion of the cylindrical body 430 by the flange 320 , and the fastening member 300 is locked at the step 322 . By stopping, the clip body 200 moves to the base end side to close the both arm portions 220 that have been opened, and further, the wire 410 moves to the base end side, thereby The engagement is released when the engaging means 334 is deformed.

  According to the present invention, the hook is provided at the distal end portion, and the locking member having the step with the reduced inner diameter is provided on the inner wall surface on the distal end side. Thereby, it becomes possible to engage with a clip, without using the other cylindrical body penetrated by the cylindrical body cavity like the past.

  Further, the locking member may be an expandable / contractable member and may be connected to the wire in a natural length state at a predetermined position. Further, the distal end of the first engaging portion may be located closer to the proximal end side than the distal end of the locking member in a state where no external force acts on the locking member. Thus, even when the clip and the first engagement means are engaged and moved to the tip side, the engagement portion is surrounded by the engagement member, so that the clip is prevented from falling off. be able to.

  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.

  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. 13 is an overall schematic view showing an embodiment of a clip device according to the present invention. The clip device 100 includes a long tubular body 430, a wire 410 having a first engagement means 332 that is inserted into the tubular body 430 so as to be able to advance and retreat, and engages the clip 110 at the distal end, and a tubular body. An operation unit 460 that is provided on the proximal end side of the shape body 430, is connected to the wire 410, and operates to open and close the clip 110.

  FIG. 1 is a cross-sectional view showing an embodiment of the tip side of the clip device with the clip 110 attached thereto.

The clip device 100 is a long tubular body 430, and is housed on the distal end side in the tubular body 430. The clip device 100 is provided with a flange 320 at the distal end portion, and a step 322 whose inner diameter is reduced on the distal end side inner wall surface. And a wire 410 having first engagement means 332 that is inserted into the cylindrical body 430 so as to be able to advance and retreat and engages the clip 110 at the distal end.
The clip 110 includes a clip main body 200 having a base end portion and both arm portions 220 extending from the base end portion and opened by self-expanding, and a tightening member 300 inserted through the clip main body 200 so as to be able to advance and retreat. Including.

A second engagement means 334 is provided at the proximal end portion, and the wire 410 is moved to the proximal end side in a state where the first engagement means 332 and the second engagement means 334 are engaged. By doing so, the locking member 330 is locked at the tip of the cylindrical body 430 by the flange 320.
Further, the fastening member 300 is locked at the step 322, thereby closing both arms 220 which are opened by further moving the clip body 200 to the proximal end side, and further moving the wire 410 to the proximal end side. By moving, the second engaging means 334 is deformed, so that the engagement is released.

  Further, as shown in FIG. 4, the locking member 330 is connected to the wire 410 at a predetermined position by a member 420 that can be expanded and contracted to form a fixed portion 412. And the front-end | tip part of the wire 410 and the front-end | tip part of the latching member 330 are substantially the same positions.

  Hereinafter, each component will be described in detail.

  FIG. 2 is a front view, a plan view, and a left side view showing an embodiment of the clip. FIG. 3 is a perspective view showing an embodiment of the clip. The clip 110 has a base end portion 500 and a clip main body 200 having both arm portions 220 extending from the base end portion 500 and opened by self-expanding, and a fastening member 300 inserted through the clip main 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 300 is also referred to as a tightening ring.

  The proximal end portion 500 has the second engaging means 334, and the wire 410 is connected to the operation portion 460 in a state where the first engaging means 332 and the second engaging means 334 are engaged. By moving it to the proximal end side, both the arm portions 220 opened by the tightening member 300 moving to the distal end side are closed, and further, the wire 410 is further moved to the proximal end side by using the operation portion 460. By moving, the second engaging means 334 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 334 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 base end side at positions facing the axis of the wire 410. As a result, when the wire 410 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. 4, the front-end | tip part of the clip apparatus 100 of this embodiment is shown. At the tip of the clip device 100, a cylindrical body 430, a locking member 330 inserted in the cylindrical body 430 so as to be able to advance and retreat, and a telescopic member connected to the locking member 330 and sliding freely. It is comprised by 420. And a wire 410 having first engagement means 332 at the tip. The first engaging means 332 is formed so as to be engageable with the second engaging means 334. Although not particularly limited, the first engagement means 332 and the clip base end portion 500 are arranged around the wire 410 in the direction in which the first engagement means 332 and the second engagement means 334 are engaged. If at least one or more abutment portions are provided on the first engagement means 332 and the clip base end portion 500 to regulate the rotation of the clip 110, the grip 110 is determined by rotating the clip 110. In this case, the rotation operation force generated by operating the clip rotation operation member (not shown) is reliably transmitted to the clip via the wire 410 and the first engagement means 332, so that the clip can be rotated. . Further, the shape of the contact between the first engaging means 332 and the clip proximal end connecting portion 221 or the second engaging means 334 is not particularly limited as long as the rotation of the wire 410 in the direction around the axis can be restricted. The contact between the surfaces may be sufficient, or the contact due to the unevenness provided on one or both sides may be possible.

  Further, a restricting portion having a rotationally symmetrical polygonal shape that restricts the rotation of the clip body 200 when engaged with the second engaging means 334 is provided on the distal end side of the first engaging means 332. Also good. 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 locking member 330 is inserted through the cylindrical body 430 so as to be able to advance and retract. The locking member 330 is made of an elastic body that is reduced in diameter by an external force, and has a radially outward projection at the tip that engages with the tip of the cylindrical body 430. By applying an external force to the locking member 330 and reducing the outer diameter on the distal end side of the locking member 330, the locking member 330 is allowed to move into the cylindrical body 430. As long as the locking member is a member that can be reduced in diameter by an external force, the material may be a metal, an elastomer such as a resin, rubber, etc. In order to give flexibility to the tip, there is no particular limitation. However, as shown in FIG. 4, a plurality of slits may be formed at the tip, or a plurality of plates It may be formed by welding to a pipe shape.

  When the locking member 330 is protruded from the cylindrical body 430, the movement of the locking member 330 into the cylindrical body 430 can be restricted by increasing the diameter of the distal end side of the locking member 330. When it is desired to store again, as described above, it is possible to apply an external force to the notch 324 to reduce the outer diameter of the distal end portion of the locking member 330. A step 322 is formed on the inner wall of the locking member 330 so as to come into contact with the fastening member 300 inserted on the proximal end side of the clip 110.

A retractable member 420 is attached to the rear end of the locking member 330 and is fixed to the wire 410 at an arbitrary position to form a fixed portion 412. As long as the expandable member 420 is a stretchable member, the material may be an elastomer such as metal, resin, rubber, and the like. The coil is preferably a coil in which fine wires of stainless steel or tungsten are wound at an equal pitch or a variable pitch.
It is preferable that the connecting portion between the expandable member 420 and the wire 410 is connected so as to be free in the rotation direction. The length of the expandable member 420 and the connection position of the fixing portion 412 are expanded and contracted so that the first engagement means 332 at the distal end of the wire 410 does not protrude from the distal end of the locking member 330 in a no-load state (natural length). The length of the possible member 420 and the connection position of the fixing part 412 are adjusted. Even if the wire 410 further protrudes to the distal end side from the state of FIG. 4, the locking member 330 is also pushed out together via the extendable member 420 connected to the wire 410. The positional relationship between the tips of the first engaging means 332 is not changed. However, when the movement of the locking member 330 in the protruding direction of the distal end is restricted by an external force, when the wire 410 is pushed to the distal end side, the expandable member 420 contracts and the distal end of the wire 410 protrudes from the locking member 330. As a result, the first engagement means 332 protrudes from the locking member 330, and as a result, can engage with the second engagement means 334 on the proximal end side of the clip 110. When the wire 410 is pulled to the proximal end side, the expandable member 420 extends, and the distal end of the wire 410 moves to the proximal end side with respect to the locking member 330 and is stored in the cylindrical body 430.

  Next, a method for attaching the clip 110 will be described.

  When the clip 110 is mounted, the first engaging means 332 needs to protrude from the locking member 330. First, when the wire 410 is pushed out to the distal end side in a state where movement of the locking member 330 to the distal end side in the axial direction is restricted by a cartridge or the like (not shown) containing the clip 110, The engaging means 332 protrudes from the front end of the locking member 330. At this time, the expandable member 420 is in a contracted state as compared with the unloaded state.

Next, the clip 110 is mounted by engaging the first engaging means 332 protruding from the locking member 330 and the second engaging means 334 (FIG. 5). In addition, in the clip cartridge that stores the clip 110 in advance,
Means for fixing the position of the locking member 330, guiding means for the first engaging means 332 to the second engaging means 334, means for reducing the diameter of the locking member 330 for storing the clip 110 in the cylindrical body 430 Is preferably provided.

  With a clip cartridge or the like, a radially inward force is applied to the distal end of the locking member 330 and the distal end of the locking member 330 is contracted in the radial direction, that is, the cylindrical body 430 inner diameter> the locking member 330 outer diameter. Then, the wire 410 is pulled to the proximal end side, and the locking member 330, the fastening member 300, and the clip 110 are accommodated in the cylindrical body 430 (FIG. 6).

In a state where the locking member 330, the fastening member 300, and the clip 110 are housed in the cylindrical body 430, the distal end inner diameter of the locking member 330 is smaller than the outer diameter of the fastening member 300, and the distal end outer diameter of the locking member 330 is Since the outer diameter of the locking member 330 is larger than the outer diameter of the locking member 330> the outer diameter of the tightening member 300> the inner diameter of the leading end of the locking member 330, the tightening member 300 is not housed in the locking member 330. The locking member 330 is not accommodated in 300.
Further, when being accommodated in the cylindrical body 430, the fastening member 300 may move toward the distal end side of the clip 110 due to sliding with the inner wall of the tubular body 430. Since the restricting portion 226 that temporarily prevents the engagement is provided, the fastening member 300 does not engage with the clip 110 and the clip 110 cannot be reopened.

  Next, a method for gripping a part with the clip 110 will be described.

  First, the wire 410 is pushed out to the distal end side. The clip 110 and the fastening member 300 protrude from the tip of the cylindrical body 430, and the clip 110 naturally expands to the maximum opening width by spring elasticity (FIG. 7). Even if the tightening member 300 moves to the distal end side of the clip 110, it is pushed back to the proximal end side by self-expanding property with the opening of the clip 110.

Next, the locking member 330 tip protrudes from the cylindrical body 430 tip, and the locking member 330 tip expands to the original diameter. Since the protrusion at the distal end of the locking member 330 engages with the distal end of the cylindrical body 430 and the movement of the locking member 330 toward the proximal end in the axial direction is restricted, the locking member 330 is again cylindrical even when the wire 410 is pulled. It is not housed in the body 430 (FIG. 8A).
For example, even if the wire 410 is further protruded toward the distal end side, the extensible member 420 connected to the wire 410 in a natural length state by the fixing portion 412 is used as long as no external force is applied. Since the locking member 330 provided in the portion is also pushed out to the distal end side, the positional relationship between the first engaging means 332 and the locking member 330 does not change (FIG. 8B). Therefore, the base end portion of the clip 110 and the engaging portion of the first engaging means 332 are in the locking member 330, and there is no possibility that the clip 110 is detached from the first engaging means 332.

Next, the clip 110 is positioned with respect to the site. The rotation of the clip 110 is performed by transmitting torque from the operation unit 460 to the clip 110 via the wire 410. With the tip of the clip 110 pressed against the affected part, the wire 410 is pulled to the proximal end side (FIG. 9). Since the tightening member 300 abuts on the step 322 in the locking member 330 and the movement of the tightening member 300 toward the proximal end side in the axial direction is restricted, the tightening member 300 exceeds the receiving member 300 in the locking member 330. It will not be pulled to the proximal side. Further, since the tightening member 300 is housed in the locking member 330, contraction of the distal end diameter of the locking member 330 due to an external force is suppressed, and the locking member 330 is brought into the cylindrical body 430 even when the wire 410 is pulled with a large force. It will not be easily pulled in.
In addition, since the wire 410 and the locking member 330 are connected by the extendable member 420, the base end is further increased by the extension of the expandable member 420 even after the locking member 330 is engaged with the cylindrical body 430. It is possible to pull in to the side.

Next, as shown in FIG. 9, when the wire 410 is further pulled in a state where the proximal end side of the fastening member 300 and the step 322 are in contact with each other and the movement of the fastening member 300 toward the axial proximal end side is restricted, the clip 110 is pulled. Is pulled into the fastening member 300 from the proximal end side, and the clip 110 is closed.
However, as shown in FIG. 10, the clip 110 can be reopened unless it is pulled into the fastening member 300 beyond the restriction portion 226 provided on the clip 110. Therefore, the clip 110 is re-gripped until the optimum ligation position is found. The operation can be performed.

  Next, after the optimum ligation has been confirmed, when the wire 410 is further pulled to the proximal end side, the clip 110 is pulled into the fastening member 300 beyond the restriction portion 226 provided on the clip 110, and the clip 110 is tightened. The member 300 is engaged and the closed state is maintained. However, the clip 110 has an enlarged diameter portion that is wider than the inner diameter of the tightening member 300, and the clip 110 is not pulled into the tightening member 300 beyond the enlarged diameter portion.

  As shown in FIG. 10, when the wire 110 is further pulled to the proximal end side in a state where the enlarged diameter portion of the clip 110 is in contact with the distal end of the fastening member 300 and the movement of the clip 110 to the proximal end side in the axial direction is restricted The second engaging means 334 is deformed (elongated) under stress, and as shown in FIG. 11, the engagement with the first engaging means 332 is released and the clip 110 is left in the body (FIG. 12). ).

  If necessary, the above method can be repeated by reloading the clip 110. Here, as an advantage of not using the connecting member as in the prior art, the connecting member remains in the cylindrical body 430 and does not hinder the operation of the wire 410. When the clip 110 is reloaded, it is necessary to remove the connecting member. There is no such thing as no connection member falling into the body, no infectious waste.

It is sectional drawing which shows one Embodiment of the clip apparatus front end side with which the clip was mounted | worn. It is the front view which shows one Embodiment of a clip, a top view, and a left view. It is a perspective view which shows one Embodiment of a clip. It is sectional drawing which shows one Embodiment of a clip apparatus front end side. It is the front view which shows a clip mounting state, a top view, and sectional drawing. It is sectional drawing which shows the state in which the clip was accommodated. It is the front view and sectional drawing showing the state which protruded the accommodated clip. It is the front view and sectional drawing which show the state which the locking member front-end | tip part contact | abutted with the cylindrical body front-end | tip part, and the extruded state. It is the front view and sectional view which show the state where the clip was temporarily closed. It is the front view and sectional view which show the state where the clip was fully closed. It is the front view and sectional drawing which show the state by which the engagement of the clip and the wire was cancelled | released. It is the front view and sectional drawing which show the state indwelled. 1 is an overall schematic view showing an embodiment of a clip device according to the present invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 100 Clip apparatus 110 Clip 200 Clip main body 210 Clip main body front-end | tip nail | claw part 220 Both arms (arm part)
221 Base end connecting portion 223 Protruding portion 224 Engaging portion 225 Expanding portion 226 Restricting portion 227 Arm reinforcing member 300 Tightening member (tightening ring)
320 鍔 322 Step 324 Notch 330 Locking member 332 First engagement means 334 Second engagement means 410 Wire 412 Fixing part 420 Extendable member 430 Tubular body 460 Operation part 500 Base end part 600 Bending part 700 Grasping Part L Claw opening width

Claims (2)

A long tubular body 430 ;
The cylindrical body 430 is housed on the distal end side, provided with a flange 320 at the distal end, and formed on the distal end side inner wall surface with a step 322 whose inner diameter is reduced, and is made of an elastic body that is reduced in diameter by an external force. Member 330 ;
A telescopic member 420 connected in a natural length to the rear end of the locking member 330;
A wire 410 that is inserted into the tubular body 430 so as to freely advance and retreat, and has first engagement means 332 that engages with the clip 110 at the tip.
And the clip 110 is proximal portion 500, a clip body 200 having a double-arm section 220 that Hirakiude by automatically opening extending from the proximal end 500, which is retractably inserted in the clip body 200 It includes a fastening member 300, a,
The base end portion 500 is provided with second engagement means 334,
By causing the first engagement means 332 to regulate the axial movement of the locking member 330 protrudes from the locking member 330, and the first engagement means 332, the second engagement and it means 334, and with being engageable, in a state where the locking member 330 does not work force, the tip of the first engagement means 332, proximal to the distal end of the locking member 320 Position to,
By moving the wire (410) to the proximal end side, the locking member 330 is locked at the distal end portion of the cylindrical body 430 by the flange 320 , and the fastening member 300 is locked at the step 322 . By stopping, the clip body 200 moves to the base end side to close the both arm portions 220 that have been opened, and further, the wire 410 moves to the base end side, thereby A clip device, wherein the engagement is released when the engagement means 334 is deformed. Over an external force to the locking member 330, by diameter the distal outer diameter of the locking member 330, to claim 1 where the locking member 330 is allowed to move into the tubular body 430 The clip device as described.

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