JP4598181B2 - Endoscopic clip device - Google Patents

Endoscopic clip device Download PDF

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JP4598181B2
JP4598181B2 JP2005000334A JP2005000334A JP4598181B2 JP 4598181 B2 JP4598181 B2 JP 4598181B2 JP 2005000334 A JP2005000334 A JP 2005000334A JP 2005000334 A JP2005000334 A JP 2005000334A JP 4598181 B2 JP4598181 B2 JP 4598181B2
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clip
endoscope
clips
sheath
tip
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JP2006187391A (en
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博朗 柴田
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Hoya Corp
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Hoya Corp
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/128—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips
    • A61B17/1285—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/08—Wound clamps or clips, i.e. not or only partly penetrating the tissue ; Devices for bringing together the edges of a wound
    • A61B17/083—Clips, e.g. resilient
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/122—Clamps or clips, e.g. for the umbilical cord
    • A61B17/1227—Spring clips

Description

この発明は、生体内等において止血やマーキング等を行うために内視鏡の処置具挿通チャンネルに通して使用される内視鏡用クリップ装置に関する。   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.

管腔臓器内等において止血やマーキング等を行うためのクリッピング処置が、クリップ装置を内視鏡の処置具挿通チャンネルに通して行われているが、クリッピング処置を一回行う毎にクリップ装置を内視鏡の処置具挿通チャンネルから引き出してクリップを装填し直すのでは操作があまりに煩雑になってしまう。   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.

そこで、内視鏡の処置具挿通チャンネルに挿脱されるシースの先端内に複数のクリップを各々窄まった状態に直列に配置し、シース内に軸線方向に進退自在に配置された操作ワイヤで複数のクリップをシースの先端から順次押し出して、各クリップを一旦開いた後に閉じることができるように構成された内視鏡用クリップ装置が案出されている（例えば、特許文献１）。
特開２００２−３３０９７２ 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

しかし、特許文献１に記載されているような従来の内視鏡用クリップ装置においては、シースの先端内に配置される複数のクリップが操作ワイヤの先端と個別に結紮ワイヤ等で連結されているので、後方に位置するクリップになればなるほど多くの結紮ワイヤと干渉してしまう配置状態になり、構造的に雑然としたものになって円滑に動作しない場合が少なくなかった。   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.

そこで本発明は、シースの先端内に複数のクリップを整然かつ簡潔に配置することができて、連続的なクリッピング処置を円滑な動作で行うことができる内視鏡用クリップ装置を提供することを目的とする。   Accordingly, 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 operation. Objective.

上記の目的を達成するため、本発明の内視鏡用クリップ装置は、嘴状に開閉させることができる複数のクリップが、内視鏡の処置具挿通チャンネルに挿脱されるシースの先端内に各々窄まった状態で直列に配置されて、シース内に軸線方向に進退自在に配置された操作ワイヤにより複数のクリップがシースの先端から順次押し出されて、各クリップが一旦開いた後に閉じることができるように構成された内視鏡用クリップ装置において、各クリップの先端部分に各クリップの閉じ方向に向かって折れ曲がった先端爪部が形成されると共に、先端爪部を差し込み係合自在な連結孔が、嘴状に開閉動作をするクリップの開閉動作面に対し直交する向きに各クリップの後端部分に形成され、隣り合うクリップの先端爪部と連結孔とを係合させることにより、複数のクリップがシース内において軸線周り方向に９０°ずつ交互に向きを変えて直接連結されるようにしたものである。 In order to achieve the above object, the clip device for an endoscope according to the present invention has a plurality of clips that can be opened and closed in a hook shape in the distal end of a sheath that is inserted into and removed from the treatment instrument insertion channel of the endoscope. A plurality of clips are sequentially pushed out from the distal end of the sheath by an operation wire that is arranged in series in a constricted state and can be moved forward and backward in the axial direction in the sheath, and each clip can be closed once opened. In the endoscope clip device configured to be able to be formed, a distal end claw portion that is bent toward the closing direction of each clip is formed at the distal end portion of each clip, and the distal end claw portion can be inserted and engaged freely. but it is formed on the rear end portion of each clip in the direction orthogonal to the opening and closing surface of the clip to the opening and closing operation beak, to engage the a tip claw portion of the adjacent clip connecting hole More, in which a plurality of clips has to be connected directly with different orientations alternately 90 ° around the axis direction within the sheath.

なお、先端爪部が連結孔内に緩く差し込まれて回動自在な状態に係合していてもよく、クリップを閉じたときに、そのクリップの先端に形成されている一対の先端爪部どうしが食い違うように構成されていてもよい。   The tip claw portion may be loosely inserted into the coupling hole and engaged in a freely rotatable state. When the clip is closed, the pair of tip claw portions formed at the tip of the clip May be configured to conflict.

また、各クリップの先端爪部とその前側に隣接するクリップの連結孔とが係合して二つのクリップが連結された状態のときに、前側のクリップの後端面に緩く当接する当接片が各クリップに設けられていてもよい。   In addition, when the front end claw portion of each clip and the connection hole of the clip adjacent to the front side are engaged and the two clips are connected, a contact piece loosely contacting the rear end surface of the front side clip is provided. Each clip may be provided.

また、各クリップが、一枚のバネ性のある板材を折り曲げて形成されていてもよく、その場合に、連結孔が板材を環状に曲げて形成されていてもよく、当接片が板材をクリップの側面位置で折り曲げて形成されていてもよい。   In addition, each clip may be formed by bending a single spring-like plate material, and in that case, the connection hole may be formed by bending the plate material in an annular shape, and the contact piece may be formed by bending the plate material. You may bend and form in the side surface position of a clip.

本発明によれば、隣り合うクリップの先端爪部と連結孔とを係合させることにより複数のクリップが直接連結されるので、連結のための別部材を全く必要とせず、シースの先端内に複数のクリップを整然かつ簡潔に配置することができて連続的なクリッピング処置を円滑な動作で行うことができ、複数のクリップがシース内において軸線周り方向に９０°ずつ交互に向きを変えて連結されるので、内視鏡の湾曲部内を通過する際等に屈曲させられる状態になってもそのカーブに沿ってクリップ装置が屈曲して湾曲部内等をスムーズに通過することができる。   According to the present invention, since the plurality of clips are directly connected by engaging the front end claw portion of the adjacent clip and the connection hole, no separate member for connection is required, and the distal end of the sheath Multiple clips can be arranged in an orderly and concise manner, allowing continuous clipping procedures to be performed smoothly, and multiple clips connected to each other by turning around the axis 90 degrees alternately in the sheath. As a result, even when it is bent when passing through the bending portion of the endoscope, the clip device can be bent along the curve and smoothly pass through the bending portion.

嘴状に開閉させることができる複数のクリップが、内視鏡の処置具挿通チャンネルに挿脱されるシースの先端内に各々窄まった状態で直列に配置されて、シース内に軸線方向に進退自在に配置された操作ワイヤにより複数のクリップがシースの先端から順次押し出されて、各クリップが一旦開いた後に閉じることができるように構成された内視鏡用クリップ装置において、各クリップの先端部分に各クリップの閉じ方向に向かって折れ曲がった先端爪部が形成されると共に、先端爪部を差し込み係合自在な連結孔が、嘴状に開閉動作をするクリップの開閉動作面に対し直交する向きに各クリップの後端部分に形成され、隣り合うクリップの先端爪部と連結孔とを係合させることにより、複数のクリップがシース内において軸線周り方向に９０°ずつ交互に向きを変えて直接連結されるようにする。 A plurality of clips that can be opened and closed in a bowl shape are arranged in series in a state where each clip is constricted in the distal end of the sheath inserted into and removed from the treatment instrument insertion channel of the endoscope, and advances and retracts in the axial direction in the sheath. In an endoscopic clip device configured such that a plurality of clips are sequentially pushed out from the distal end of a sheath by an operation wire that is freely arranged, and each clip can be closed once opened. The front end claw part bent toward the closing direction of each clip is formed, and the connecting hole into which the front end claw part can be inserted and engaged is perpendicular to the opening and closing operation surface of the clip that opens and closes like a bowl. 90 formed at the rear end portion of each clip, by engaging the coupling with the distal end claw portion of the adjacent clip holes, about the axial line direction a plurality of clips in the sheath Each to be connected directly to change the direction alternately.

図面を参照して本発明の実施例を説明する。
図１は内視鏡用クリップ装置の先端付近の側面断面図、図２は平面断面図であり、１は、図示されていない内視鏡の処置具挿通チャンネルに挿脱される可撓性のシースである。シース１は、例えばステンレス鋼線を一定の径で密着巻きしたコイルパイプ１ａに四フッ化エチレン樹脂チューブ１ｂを外装して形成されており、その直径は２〜３ｍｍ程度、長さは１〜２ｍ程度である。 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 by packaging a tetrafluoroethylene resin tube 1b on a coil pipe 1a in which, for example, a stainless steel wire is tightly wound with a constant diameter, and has a diameter of about 2 to 3 mm and a length of 1 to 2 m. Degree.

シース１内には、基端側から軸線方向に進退操作自在な操作ワイヤ２が挿通配置されており、シース１の図示されていない基端側に連結された操作部からの操作により操作ワイヤ２が進退操作される。   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.

そのようなシース１の先端部分内には、嘴状に開閉させることができる複数の（この実施例では３個の）クリップ３（３Ａ，３Ｂ，３Ｃ）が各々窄まった状態で直列に配置されており、操作ワイヤ２により複数のクリップ３をシース１の先端から順次押し出して、クリップ３を一旦開いた後に閉じることができるように構成されている。   A plurality of (three in this embodiment) clips 3 (3A, 3B, 3C) that can be opened and closed in a hook shape are arranged in series in the distal end portion of such a sheath 1 in a constricted state. The plurality of clips 3 are sequentially pushed out from the distal end of the sheath 1 by the operation wire 2, and the clips 3 are once opened and then closed.

操作ワイヤ２の先端には、最後端のクリップ３Ｃと係脱可能に連結された連結部材５が連結パイプ６を介して固定的に連結されている。また、シース１の最先端部分には金属製又はプラスチック製の筒状の先端チップ７が固定的に取り付けられている。   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.

各クリップ３は、外力が作用していない状態が図３に単体で示されるように、例えばステンレス鋼板等のようなバネ性のある一枚の板材を後端側で曲げ戻して形成されていて、その後寄りの部分３１では、曲げ戻されて二枚になっている板材の板面どうしが密接している。   Each clip 3 is formed by bending back one plate material having a spring property such as a stainless steel plate at the rear end side so that a state in which no external force is applied is shown in FIG. In the portion 31 closer to the rear side, the plate surfaces of the two plate members bent back are in close contact with each other.

そして各クリップ３は、後寄りの部分３１と中間部分３２との間で外方に折り曲げられて中間部分３２は嘴状に前方に向かって広がり、中間部分３２と先寄りの部分３３との間でさらに外方に向かって大きく広がっている。なお、後寄りの部分３１と中間部分３２は後述する締め環４内に通る程度に細幅に形成され、先寄りの部分３３は締め環４内に通らない程度に幅広に形成されている。   Each clip 3 is bent outward between the rear portion 31 and the intermediate portion 32, and the intermediate portion 32 spreads forward in a bowl shape, between the intermediate portion 32 and the front portion 33. And it spreads further outward. Note that the rear portion 31 and the intermediate portion 32 are formed to be narrow enough to pass through a later-described fastening ring 4, and the front portion 33 is formed to be wide enough not to pass through the fastening ring 4.

クリップ３の最先端部分（嘴状に開閉する最先端部分の双方）にはクリップ３の閉じ方向に向かって突出する一対の先端爪部３４が折り曲げ形成されている。また、クリップ３の後端曲げ戻し部分は環状に膨らんだ形状に形成されていて、それによって先端爪部３４を差し込み係合自在な連結孔３６が形成されている。その結果、連結孔３６は、図５等に示されるように、嘴状に開閉動作をするクリップ３の開閉動作面に対し直交する向きに形成されている。 A pair of front-end claw portions 34 projecting in the closing direction of the clip 3 are formed by bending at the most distal portions of the clip 3 (both the most distal portions that open and close like a bowl). Further, the rear end bent back portion of the clip 3 is formed in an annularly bulging shape, thereby forming a connection hole 36 into which the front end claw portion 34 can be inserted and engaged. As a result, as shown in FIG. 5 and the like, the connecting hole 36 is formed in a direction perpendicular to the opening / closing operation surface of the clip 3 that opens and closes in a bowl shape.

各クリップ３の先寄りの部分３３の先端に形成された一対の先端爪部３４は、クリップ３を閉じきった状態にしたときに互いにぶつかり合わずに食い違うように、折り曲げ位置を僅かに前後方向にずらして形成されており、連結孔３６は、そのような一対の先端爪部３４が緩く通されて内部で回動することができる程度の大きさに形成されている。   The pair of tip claws 34 formed at the tip of the tip portion 33 of each clip 3 is slightly bent in the front-rear direction so that the clips 3 do not collide with each other when the clip 3 is closed. The connecting hole 36 is formed in such a size that the pair of tip claw portions 34 can be loosely passed and rotated inside.

図４は、クリップ３を強制的に閉じ状態にするための締め環４を示しており、締め環４は、外面が円形の断面形状で先側に次第に径が小さくなるテーパ状に形成され、内面４ａはそこに通されるクリップ３の断面形状に合わせて矩形状の断面形状に形成されている。   FIG. 4 shows a fastening ring 4 for forcibly closing the clip 3, and the fastening 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. The inner surface 4a is formed in a rectangular cross-sectional shape in accordance with the cross-sectional shape of the clip 3 passed therethrough.

図５と図６は、最先端のクリップ３Ａと２番目のクリップ３Ｂとが連結された状態の側面断面図と平面断面図であり、図示されていないシース１内に収容されることにより閉じた状態になっている２番目のクリップ３Ｂの一対の先端爪部３４が最先端のクリップ３Ａの連結孔３６内に緩く差し込まれて、最先端のクリップ３Ａと２番目のクリップ３Ｂとが直接連結された状態になっている。このとき、一対の先端爪部３４が食い違った状態に噛み合っているので、連結孔３６と安定した状態に係合する。   FIGS. 5 and 6 are a side sectional view and a plan sectional view showing a state in which the most advanced clip 3A and the second clip 3B are connected to each other, and are closed by being accommodated in the sheath 1 (not shown). The pair of tip claws 34 of the second clip 3B in the state is loosely inserted into the connecting hole 36 of the most advanced clip 3A, and the most advanced clip 3A and the second clip 3B are directly connected. It is in the state. At this time, since the pair of front end claw portions 34 are engaged with each other, they engage with the connection hole 36 in a stable state.

そのような連結構造により、最先端のクリップ３Ａと２番目のクリップ３Ｂとはシース１内においてシース１の軸線周り方向に９０°向きを変えて連結され、３番目のクリップ３Ｃは、さらに２番目のクリップ３Ｂに対して９０°向きを変えて連結されて最先端のクリップ３Ａと１８０°反転した向き（又は最先端のクリップ３Ａと同じ向き）になり、各クリップ３がシース１内において軸線周り方向に９０°ずつ交互に向きを変えて連結される。なお、図５に二点鎖線で示されるように、締め環４をクリップ３の先寄りの位置に移動させることにより、クリップ３が強制的に閉じられた状態になる。   With such a connecting structure, the most advanced clip 3A and the second clip 3B are connected to each other in the sheath 1 while changing the direction around the axis of the sheath 1 by 90 °, and the third clip 3C is further connected to the second clip 3C. The clip 3B is connected to the clip 3B by changing the direction by 90 ° to be turned 180 ° with the most advanced clip 3A (or the same direction as the most advanced clip 3A). The direction is alternately changed by 90 ° and connected. Note that, as indicated by a two-dot chain line in FIG. 5, the clip 3 is forcibly closed by moving the fastening ring 4 to a position closer to the tip of the clip 3.

図７は、２番目のクリップ３Ｂに対して最先端のクリップ３Ａが向きを変えた状態を示しており、２番目のクリップ３Ｂの一対の先端爪部３４が最先端のクリップ３Ａの連結孔３６内に緩く差し込まれているので、最先端のクリップ３Ａは２番目のクリップ３Ｂに対して連結孔３６の軸線周り方向に回動自在であり、２番目のクリップ３Ｂは図示されていない３番目のクリップ３Ｃに対して最先端のクリップ３Ａと９０°相違する方向に回動自在である。また、３番目のクリップ３Ｃはその後側の連結部材５に対して１番目のクリップ３Ａと同方向に回動自在である。   FIG. 7 shows a state in which the most advanced clip 3A changes its orientation with respect to the second clip 3B, and the pair of tip claws 34 of the second clip 3B are connected to the connecting hole 36 of the most advanced clip 3A. Since it is loosely inserted in the clip 3A, the most advanced clip 3A is rotatable in the direction around the axis of the coupling hole 36 with respect to the second clip 3B, and the second clip 3B is the third clip not shown. The clip 3C is rotatable in a direction different from the most advanced clip 3A by 90 °. The third clip 3C is rotatable in the same direction as the first clip 3A with respect to the connecting member 5 on the rear side.

したがってクリップ装置は、内視鏡の湾曲部内を通過する際等に屈曲させられる状態になっても、そのカーブに沿って無理なく屈曲して内視鏡の湾曲部内等をスムーズに通過することができる。   Therefore, even when the clip device is bent when passing through the bending portion of the endoscope, the clip device can be bent easily along the curve and pass smoothly through the bending portion of the endoscope. it can.

各クリップ３の先端部分の先端爪部３４と先寄りの部分３３との間には、各図に示されるように、二つのクリップ３Ａ，３Ｂが連結された状態のときに、その前側のクリップ３Ａの後端面に緩く当接する（即ち、常態では前側のクリップ３Ａの後端面との間に僅かに隙間があく程度になっていて、後側のクリップ３Ｂに後方から推進力が作用すると前側のクリップ３Ａの後端面に押し付けられる）当接片３５が、クリップ３を構成する板材を側面位置で折り曲げて形成されている。   As shown in each figure, when the two clips 3A and 3B are connected between the tip claw portion 34 and the tip portion 33 of the tip portion of each clip 3, the clip on the front side thereof 3A is loosely abutted on the rear end surface (that is, there is usually a slight gap between the rear end surface of the front clip 3A and a forward thrust is applied to the rear clip 3B from the rear side. A contact piece 35, which is pressed against the rear end surface of the clip 3 </ b> A, is formed by bending a plate material constituting the clip 3 at a side surface position.

したがって、操作ワイヤ２が手元側から押し込み操作されると、各クリップ３の当接片３５がその前側に隣接するクリップ３を前方へ押す状態になるので、先端爪部３４が連結孔３６内にきつく食い込んだ状態にならず、各クリップ３が連結部で円滑に回動することができる。   Therefore, when the operation wire 2 is pushed in from the hand side, the contact piece 35 of each clip 3 is in a state of pushing the clip 3 adjacent to the front side forward, so that the tip claw portion 34 enters the connection hole 36. Each clip 3 can be smoothly rotated at the connecting portion without being in a state of being bitten.

シース１の最先端部分に取り付けられた筒状の先端チップ７は、図１等に示されるように、内径が先細りのテーパ筒状に形成されて、その最先端部分の内径が締め環４の後端外径より小さく形成されている。   As shown in FIG. 1 and the like, the cylindrical tip 7 attached to the most distal portion of the sheath 1 is formed in a tapered cylindrical shape having an inner diameter that is tapered. It is formed smaller than the rear end outer diameter.

また、図８に単体で示されるように、締め環４が後方から押し込まれたときそれによって径が押し広げられる状態に弾性変形するよう、先端チップ７の先寄りの部分は軸線と平行方向に複数のスリット７ｂで分断された形状に形成されている。なお、この実施例ではスリット７ｂが１２０°間隔に３個設けられているが、９０°間隔に４個或いはそれ以上の個数設けてもよい。   Further, as shown in FIG. 8 alone, when the fastening ring 4 is pushed in from the rear, the tip portion of the tip 7 is in a direction parallel to the axis so that it is elastically deformed so that its diameter is expanded. It is formed in a shape divided 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 °.

このように構成された内視鏡用クリップ装置が使用される際には、図１に示されるように、各クリップ３がシース１内で窄まって連結された状態で、図示されていない内視鏡の処置具挿通チャンネルに通される。   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.

体内でシース１の先端を目標とする患部に向けたら、操作ワイヤ２を基端側から強く押し込む操作をすることにより、図９に示されるように、一連に繋がっている三つのクリップ３Ａ，３Ｂ，３Ｃがシース１内で前方に移動して、締め環４が先端チップ７を押し広げる状態に弾性変形させて先端チップ７の先端から前方に飛び出し、クリップ３がシース１の前方で最大限に広がった状態になる。   When the distal end of the sheath 1 is directed to the target affected part in the body, the operation wire 2 is pushed strongly from the proximal end side, thereby three clips 3A and 3B connected in series as shown in FIG. , 3C moves forward in the sheath 1 and elastically deforms so that the fastening ring 4 pushes and expands the distal tip 7 and jumps forward from the distal end of the distal tip 7 so that the clip 3 is maximized in front of the sheath 1. It becomes in a spread state.

すると、締め環４の後端部の外径が先端チップ７の先端内径より大きいため、締め環４は逆行して先端チップ７内に戻ることができなくなり、大きく開いた最先端のクリップ３Ａをこの状態で目標患部に押しつけることができる。   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.

そこで、図１０に示されるように、操作ワイヤ２を基端側に牽引操作すると、締め環４の後端が先端チップ７の先端面に当接した状態で、最先端のクリップ３Ａの後半部分がシース１内に引き込まれ、それに伴って締め環４が相対的にクリップ３の先寄りの位置に移動することになって、最先端のクリップ３Ａが締め環４により強制的に閉じられて目標患部をきつく挟み付けた状態になり、操作ワイヤ２をそれ以上牽引操作することができなくなる。   Therefore, as shown in FIG. 10, when the operation wire 2 is pulled toward the proximal end side, the latter half of the most advanced clip 3 </ b> A with the rear end of the fastening ring 4 in contact with the distal end surface of the distal end tip 7. Is pulled into the sheath 1, and the fastening ring 4 moves to a position closer to the leading end of the clip 3, and the cutting-edge clip 3 A is forcibly closed by the fastening ring 4, The affected area is tightly clamped, and the operation wire 2 cannot be further pulled.

そのようになったら、図１１に示されるように、操作ワイヤ２を再び先端側に押し込み操作し、図１２に示されるように、２番目のクリップ３Ｂを先端チップ７の先端から押し出せば、２番目のクリップ３Ｂが開くことにより最先端のクリップ３Ａと２番目のクリップ３Ｂとの連結が外れて、最先端のクリップ３Ａが目標患部をクリッピングした状態で体内に留置され、同時に、２番目のクリップ３Ｂによって次の目標患部に対するクリッピング操作を行うことができる状態になる。   When that happens, as shown in FIG. 11, the operation wire 2 is pushed again into the distal end side, and as shown in FIG. 12, 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 left 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.

そして、２番目のクリップ３Ｂによるクリッピング操作が終わったら、同様にして３番目のクリップ３Ｃによるクリッピング操作を連続して行うことができる。   When the clipping operation by the second clip 3B is finished, the clipping operation by the third clip 3C can be continuously performed in the same manner.

本発明の実施例の内視鏡用クリップ装置の先端付近の側面断面図である。It is side surface sectional drawing of the front-end | tip vicinity of the clip apparatus for endoscopes of the Example of this invention. 本発明の実施例の内視鏡用クリップ装置の先端付近の平面断面図である。It is a plane sectional view near the tip of the clip device for endoscopes of the example of the present invention. 本発明の実施例の内視鏡用クリップ装置のクリップの単体斜視図である。It is a single-piece | unit perspective view of the clip of the clip apparatus for endoscopes of the Example of this invention. 本発明の実施例の内視鏡用クリップ装置の締め環の単体斜視図である。It is a single-piece | unit perspective view of the fastener ring of the clip apparatus for endoscopes of the Example of this invention. 本発明の実施例の内視鏡用クリップ装置の二つのクリップが連結された状態の側面断面図である。It is side surface sectional drawing of the state which two clips of the clip apparatus for endoscopes of the Example of this invention were connected. 本発明の実施例の内視鏡用クリップ装置の二つのクリップが連結された状態の平面断面図である。It is a plane sectional view in the state where two clips of an endoscope clip device of an example of the present invention were connected. 本発明の実施例の内視鏡用クリップ装置のクリップが連結部で屈曲した状態の側面図である。It is a side view of the state where the clip of the clip device for endoscopes of the example of the present invention bent in the connecting part. 本発明の実施例の内視鏡用クリップ装置の先端チップの単体斜視図である。It is a single-piece | unit perspective view of the front-end | tip tip of the clip apparatus for endoscopes of the Example of this invention. 本発明の実施例の内視鏡用クリップ装置の使用時の動作を示す側面断面図である。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. 本発明の実施例の内視鏡用クリップ装置の使用時の動作を示す側面断面図である。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. 本発明の実施例の内視鏡用クリップ装置の使用時の動作を示す側面断面図である。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. 本発明の実施例の内視鏡用クリップ装置の使用時の動作を示す側面断面図である。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.

符号の説明Explanation of symbols

１ シース
２ 操作ワイヤ
３（３Ａ，３Ｂ，３Ｃ） クリップ
４ 締め環
５ 連結部材
７ 先端チップ
３４ 先端爪部
３５ 当接片
３６ 連結孔 DESCRIPTION OF SYMBOLS 1 Sheath 2 Operation wire 3 (3A, 3B, 3C) Clip 4 Fastening ring 5 Connection member 7 Tip tip 34 Tip claw part 35 Contact piece 36 Connection hole

Claims (7)

嘴状に開閉させることができる複数のクリップが、内視鏡の処置具挿通チャンネルに挿脱されるシースの先端内に各々窄まった状態で直列に配置されて、上記シース内に軸線方向に進退自在に配置された操作ワイヤにより上記複数のクリップが上記シースの先端から順次押し出されて、上記各クリップが一旦開いた後に閉じることができるように構成された内視鏡用クリップ装置において、
上記各クリップの先端部分に上記各クリップの閉じ方向に向かって折れ曲がった先端爪部が形成されると共に、上記先端爪部を差し込み係合自在な連結孔が、嘴状に開閉動作をする上記クリップの開閉動作面に対し直交する向きに上記各クリップの後端部分に形成され、
隣り合うクリップの先端爪部と連結孔とを係合させることにより、上記複数のクリップが上記シース内において軸線周り方向に９０°ずつ交互に向きを変えて直接連結されるようにしたことを特徴とする内視鏡用クリップ装置。 A plurality of clips that can be opened and closed in a hook shape are arranged in series in a state where each clip is constricted in the distal end of the sheath inserted into and removed from the treatment instrument insertion channel of the endoscope. In the endoscope clip device configured such that the plurality of clips are sequentially pushed out from the distal end of the sheath by an operation wire disposed so as to freely advance and retract, and the clips can be closed once opened.
The clip is formed with a tip claw portion that is bent toward the closing direction of each clip at the tip portion of each clip, and a connecting hole that can be inserted and engaged with the tip claw portion opens and closes like a hook. Formed in the rear end portion of each clip in a direction orthogonal to the opening / closing operation surface of
The plurality of clips are directly connected to each other by changing the orientation by 90 ° in the direction around the axis in the sheath by engaging the leading end claw portion of the adjacent clip and the connecting hole. An endoscopic clip device. 上記先端爪部が上記連結孔内に緩く差し込まれて回動自在な状態に係合している請求項１記載の内視鏡用クリップ装置。   The endoscope clip device according to claim 1, wherein the tip claw portion is loosely inserted into the coupling hole and is engaged in a rotatable state. 上記クリップを閉じたときに、そのクリップの先端に形成されている一対の先端爪部どうしが食い違うように構成されている請求項１又は２記載の内視鏡用クリップ装置。   The endoscope clip device according to claim 1 or 2, wherein when the clip is closed, a pair of distal claw portions formed at the distal end of the clip are different from each other. 上記各クリップの先端爪部とその前側に隣接するクリップの連結孔とが係合して二つのクリップが連結された状態のときに、前側のクリップの後端面に緩く当接する当接片が上記各クリップに設けられている請求項１、２又は３記載の内視鏡用クリップ装置。   The contact piece that loosely contacts the rear end surface of the front clip when the front end claw of each clip and the connection hole of the clip adjacent to the front side are engaged and the two clips are connected. The endoscope clip device according to claim 1, 2 or 3, which is provided in each clip. 上記各クリップが、一枚のバネ性のある板材を折り曲げて形成されている請求項１、２、３又は４記載の内視鏡用クリップ装置。   The endoscope clip device according to claim 1, 2, 3, or 4, wherein each of the clips is formed by bending a single plate having a spring property. 上記連結孔が、上記板材を環状に曲げて形成されている請求項５記載の内視鏡用クリップ装置。   The endoscope clip device according to claim 5, wherein the connection hole is formed by bending the plate member into an annular shape. 上記当接片が上記板材を上記クリップの側面位置で折り曲げて形成されている請求項５又は６記載の内視鏡用クリップ装置。   The endoscope clip device according to claim 5 or 6, wherein the contact piece is formed by bending the plate material at a side surface position of the clip.
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