JP4960424B2 - Closely wound coil and medical treatment tool using the closely wound coil - Google Patents

Description

  The present invention relates to a closely wound coil formed by densely winding an element wire spirally over a predetermined length, and a medical treatment instrument using the closely wound coil.

  A medical treatment instrument introduced into the body through an endoscope channel generally includes a treatment portion provided at a distal end, an operation portion provided at a proximal side proximal end portion, and an operation force of the operation portion. A force transmission member for transmitting to the portion.

  Since the force transmission member is inserted into a long channel of an endoscope introduced into a torsional lumen in the body, it can withstand bending, compression, and the like, and the operation force from the operation unit side is ensured. Is required to be transmitted to the treatment unit.

  For this reason, a closely wound coil formed by densely winding a strand having a circular cross section in a spiral shape over a predetermined length is widely used as the force transmission member (see, for example, Patent Document 1). .

  FIG. 42 shows a conventional example of a medical treatment instrument including such a closely wound coil as a force transmission member. As shown in the figure, this medical treatment instrument 100 includes a treatment unit 102 provided at the distal end, an operation unit 106 provided at the proximal end on the proximal side, and a close winding that connects the operation unit 106 and the treatment unit 102. A coil 104. The endoscope 200 for introducing the medical treatment instrument 100 into the body includes an insertion unit 202 and a proximal side operation unit 206 that are inserted into a lumen of the body. Is formed with a channel 208 through which the medical treatment tool 100 is inserted. Further, a bending portion 204 that is bent by an operation knob (not shown) provided in the operation portion 206 is provided at the distal end of the insertion portion 202.

JP 56-111221 A

  By the way, in the conventional closely wound coil, there is one big problem. That is, as shown in FIG. 42, when the endoscope 200 is introduced into, for example, a tortuous lumen in the body and the insertion portion 202 of the endoscope 200 is bent in a complicated manner, the channel of the insertion portion 202 is The tightly wound coil 104 of the medical treatment instrument 100 inserted through 208 is also bent in a complicated manner over a long distance. At this time, for example, the operation unit 106 is rotated to change the posture of the treatment unit 102, Even if the rotational force is transmitted to the treatment unit 102 via the densely wound coil 104, the treatment unit 102 may not rotate as intended due to various factors associated with the closely wound coil 104. In particular, in a state where the bending portion 204 is bent at a sharp angle, it is very difficult to linearly transmit the rotational force to the treatment portion 102 ahead of the bending portion 204.

  The rotation transmission performance of the conventional closely wound coil in the bent state as shown in FIG. 42 is schematically shown in FIG. As shown by a solid line in FIG. 43, in the conventional closely wound coil, even if the operation unit 106 is rotated in a bent state as shown in FIG. Occurs and the treatment unit 102 cannot follow the rotation of the operation unit 106 well. That is, as indicated by a broken line in FIG. 43, it is ideal that the rotation angle (input angle) of the operation unit 106 appears as it is as the rotation angle (output angle) of the treatment unit 102 (input angle = output angle). However, in reality, as indicated by the solid line in FIG. 43, a delay or the like occurs between the input angle and the output angle due to the rotation delay or the rotation skip of the closely wound coil 104 (input angle− (Delay angle = output angle), rotation output is not constant, and fine adjustment to the target rotation angle is difficult.

  The present invention has been made by paying attention to the above circumstances, and an object of the present invention is to provide a closely wound coil having good rotation transmission performance and a medical treatment instrument using the closely wound coil. .

In order to solve the above problems, a medical treatment instrument of the present invention includes a sheath-like force transmission member having a distal end and a proximal end, an arm capable of performing a gripping operation, and a proximal end of the arm. A clip provided on the side and urged in a direction to close the arm in a state in which the arm is retracted inside, and a clip provided detachably with respect to a distal end of the force transmission member; An operation wire that is inserted into the force transmission member and is provided on the proximal end side of the clip so as to be separable from the clip; a first engagement portion provided at a distal end of the force transmission member; A second engaging portion provided on the presser tube of the clip, and the first engaging portion and the second engaging portion engage with each other, whereby the force transmission member for the clip is engaged . to regulate the rotation, to follow the clip to rotational movement of said force transmitting member Characterized in that it and a rotation regulating portion for rotating.

  ADVANTAGE OF THE INVENTION According to this invention, the medical treatment instrument using the close winding coil which has favorable rotation transmission performance, and this close winding coil can be provided.

It is a schematic diagram which shows the state by which the closely wound coil was penetrated in the channel of the endoscope which bends complicatedly. FIG. 3 is a half cross-sectional view of a closely wound coil made of a strand having a circular cross section. (A) is a conceptual diagram showing a bending state of a portion of a strand forming a bending beam when the closely wound coil of FIG. 2 is twisted in a direction opposite to the winding direction, and (b) is a dense diagram of FIG. It is a conceptual diagram which shows the bending state of the site | part of the strand which forms the bending beam at the time of twisting a winding coil in the winding direction. (A) is a conceptual diagram showing the twisted state of the strand when the closely wound coil of FIG. 2 is bent, and (b) is a strand when a twisting torque acts on the strand as shown in (a). It is a stress distribution figure in a line. 1 is a half cross-sectional view of a closely wound coil according to a first embodiment of the present invention. FIG. 5A is a conceptual diagram showing a bent state of a portion of a strand forming a bending beam when the closely wound coil of FIG. 5 is twisted in a direction opposite to the winding direction, and FIG. It is a conceptual diagram which shows the bending state of the site | part of the strand which forms the bending beam at the time of twisting a winding coil in the winding direction. (A) is a conceptual diagram showing the twisted state of the strand when the closely wound coil of FIG. 5 is bent, and (b) is a strand when a twisting torque acts on the strand as shown in (a). It is a stress distribution figure in a line. It is a side view which shows an example which applied the closely wound coil of FIG. 5 to the medical treatment tool. (A) is sectional drawing which shows the winding number per unit length of the closely wound coil of FIG. 5, (b) is sectional drawing which shows the winding number per unit length of a reference | standard densely wound coil. (A) is sectional drawing which shows the malfunctioning of the closely wound coil which consists of the strand of the conventional circular section, (b) is sectional drawing which shows the malfunctioning deformation of the densely wound coil which consists of the strand of the conventional rectangular section, (C) is sectional drawing which shows the deformation | transformation state of the closely wound coil of FIG. (A) is the schematic which shows the state which pressed the medical treatment tool provided with the closely wound coil which concerns on the 1st Embodiment of this invention to a body tissue transendoscopically, (b) is a figure of (a) It is sectional drawing which shows the straight state of the closely wound coil in a condition. (A) is the schematic which shows the state which pressed the medical treatment tool provided with the closely wound coil which consists of a conventional circular cross-section strand to a body tissue endoscopically, (b) is the situation of (a) It is sectional drawing which shows the buckled state of the closely wound coil in. It is a side view of the closely wound coil which has high straightness. (A) is a side view of a tightly wound coil with a curved beak, (b) is a schematic diagram showing how vibration is generated when the closely wound coil with a curved beak is rotated, and (c) is an endoscope channel insertion It is sectional drawing for showing the bad influence by the shake below. It is a half sectional view of a closely wound coil according to a second embodiment of the present invention. FIG. 16 is a perspective view illustrating a part of the manufacturing method of the closely wound coil of FIG. 15. (A) is a sectional side view of FIG. 16, (b) is a sectional side view corresponding to (a) at the time of manufacturing the closely wound coil of FIG. (A) is sectional drawing which shows the 1st example of the usage pattern of the closely wound coil of FIG. 15, (b) is sectional drawing which shows the 1st example of the usage pattern of the closely wound coil of FIG. (A) is sectional drawing which shows the 2nd example of the usage pattern of the closely wound coil of FIG. 15, (b) is sectional drawing which shows the 2nd example of the usage pattern of the closely wound coil of FIG. It is a half cross-sectional view of a closely wound coil according to a third embodiment of the present invention. It is a conceptual diagram which shows the bending state of the site | part of the strand which forms the bending beam at the time of twisting the closely wound coil of FIG. 20 in the direction opposite to the winding direction. (A) is a conceptual diagram showing the twisted state of the strand when the closely wound coil of FIG. 20 is bent, and (b) is a strand when twisting torque acts on the strand as shown in (a). It is a stress distribution figure in a line. It is a half cross-sectional view of a closely wound coil according to a fourth embodiment of the present invention. It is a conceptual diagram which shows the bending state of the site | part of the strand which forms the bending beam at the time of twisting the closely wound coil of FIG. 23 in the direction opposite to the winding direction. It is a conceptual diagram which shows the twisted state of the strand at the time of bending the closely wound coil of FIG. FIG. 24 is a half cross-sectional view according to a modification of the closely wound coil of FIG. 23. It is a perspective view which shows the state which welds strands. It is a half cross-sectional view of a closely wound coil according to a fifth embodiment of the present invention. FIG. 28A is a conceptual diagram showing a bending state of a portion of a strand forming a bent beam when the closely wound coil of FIG. 28 is twisted in a direction opposite to the winding direction, and FIG. It is a conceptual diagram which shows the bending state of the site | part of the strand which forms the bending beam at the time of twisting a winding coil in the winding direction. It is a conceptual diagram which shows the twisted state of the strand at the time of bending the closely wound coil of FIG. It is a half sectional view of a closely wound coil according to a sixth embodiment of the present invention. (A) is a conceptual diagram showing a bending state of a portion of a strand forming a bending beam when the closely wound coil of FIG. 31 is twisted in a direction opposite to its winding direction, and (b) is a conceptual diagram showing the dense state of FIG. It is a conceptual diagram which shows the bending state of the site | part of the strand which forms the bending beam at the time of twisting a winding coil in the winding direction. It is a conceptual diagram which shows the twisted state of the strand at the time of bending the closely wound coil of FIG. It is a half cross-sectional view of a closely wound coil according to a seventh embodiment of the present invention. (A) is a conceptual diagram showing a bending state of a portion of a strand forming a bending beam when the closely wound coil of FIG. 34 is twisted in a direction opposite to its winding direction, and (b) is a dense diagram of FIG. It is a conceptual diagram which shows the bending state of the site | part of the strand which forms the bending beam at the time of twisting a winding coil in the winding direction. (A) is a conceptual diagram showing the twisted state of the strand when the closely wound coil of FIG. 34 is bent, and (b) is a strand when a twisting torque acts on the strand as shown in (a). It is a stress distribution figure in a line. It is a fragmentary sectional side view which shows the 1st example of the medical treatment tool which used the closely wound coil which concerns on 1st thru | or 7th embodiment as a force transmission member. It is a perspective view of the front end side of the treatment tool of FIG. FIG. 38 is a partial side cross-sectional view showing the operation of the treatment instrument of FIG. 37 in stages. It is the schematic which shows the state which penetrated the treatment tool of FIG. 37 in the channel of an endoscope. (A) is a fragmentary sectional side view which shows the 2nd example of the medical treatment tool which used the closely wound coil which concerns on 1st thru | or 7th embodiment as a force transmission member, (b) is a treatment tool of (a). FIG. It is the schematic which shows the state which penetrated the conventional treatment tool in the channel of the endoscope. It is a graph which shows the rotation transmission performance on the predetermined conditions of the closely wound coil which consists of a strand of a circular cross section.

  Before describing specific embodiments of the present invention, the basic concept of the present invention will be described first.

  In the conventional closely wound coil, there are mainly two causes for causing a delay or the like between the input angle and the output angle (see FIG. 43).

  The first cause is accumulation of stress due to torsional deformation of the closely wound coil due to the fact that the closely wound coil is not a rigid body. That is, when a rotational force is input to one end of the closely wound coil, if the closely wound coil undergoes torsional deformation, a part of the rotational force is accumulated in the closely wound coil as an internal stress. The rotation angle output at the other end of the coil does not match the rotation angle input at one end of the closely wound coil. Accordingly, when the torsional rigidity of the densely wound coil is large, the accumulation of stress in the closely wound coil is small, so that delay and jumping are unlikely to occur, and therefore the rotation transmission performance is high. On the other hand, when the torsional rigidity of the closely wound coil is small, accumulation of stress in the closely wound coil increases, so that a delay or jump is likely to occur in the rotation, and therefore the rotation transmission performance is deteriorated.

  The second cause of delay between the input angle and the output angle is a frictional resistance generated between the endoscope channel and the closely wound coil. That is, as shown in FIG. 1, in a state where the densely wound coil 4 is inserted into the channel 2 of the endoscope that is bent in a complicated manner, the densely wound coil 4 is channeled by a plurality of portions P located near the bent portion. 2 is brought into pressure contact with the inner surface, thereby generating a frictional resistance. In this case, when the bending stiffness of the densely wound coil 4 is small, the surface pressure at the contact point P between the densely wound coil 4 to be bent and the channel 2 is small, so that the frictional resistance is also small. However, when the tightly wound coil 4 has a high bending rigidity, the surface pressure at the contact point P between the tightly wound coil 4 and the channel 2 to be bent also increases, and the frictional resistance also increases.

  Considering the above two causes, in order to improve the rotation transmission performance of the closely wound coil, the accumulation of stress due to torsional deformation of the closely wound coil is reduced, and the endoscope channel and the closely wound coil are It is necessary to reduce the frictional resistance generated during That is, if the torsional rigidity of the closely wound coil is increased and the bending rigidity of the closely wound coil is decreased, the rotation transmission performance of the closely wound coil can be improved.

  By the way, it can be considered that the torsional rigidity and bending rigidity of the closely wound coil respectively correspond to the bending rigidity and torsional rigidity of the strands forming the closely wound coil. That is, as shown in FIG. 2, when considering a closely wound coil 10 formed by densely winding a strand 8 having a circular cross section spirally over a predetermined length, the twist of the closely wound coil 10 is considered. This corresponds to the bending of the wire 8 as shown in FIG. Specifically, when the closely wound coil 10 is twisted in the winding direction, the portion of the strand 8 forming the bending beam is bent inward as shown in FIG. In addition, when the closely wound coil 10 is twisted in the direction opposite to the winding direction, the portion of the wire 8 forming the bent beam is bent outward as shown in FIG. become. Therefore, it can be said that the torsional rigidity of the closely wound coil 10 corresponds to the bending rigidity of the wire 8 forming the closely wound coil 10.

  On the other hand, the bending of the closely wound coil 10 corresponds to twisting of the wire 8 as shown in FIG. This is because when the densely wound coil 10 is bent, the wire 8 is deformed so that the adjacent winding portions are separated from each other, and receives a force in the twisting direction. Therefore, it can be said that the bending rigidity of the closely wound coil 10 corresponds to the torsional rigidity of the wire 8 forming the closely wound coil 10. 4B shows a stress distribution in the strand 8 when a torsional torque is applied to the strand 8 as shown in FIG. 4A.

To summarize the above points, in order to improve the rotation transmission performance of the closely wound coil 10, it is necessary to increase the torsional rigidity of the closely wound coil 10 and to reduce the bending rigidity of the closely wound coil 10. For this purpose, it is necessary to increase the bending rigidity of the wire 8 forming the closely wound coil 10 and to reduce the torsional rigidity of the wire 8.

  However, the conventional closely wound coil 10 cannot easily satisfy this condition. Because, in the conventional densely wound coil 10, the cross-sectional shape of the strand 8 is circular, so when the outer diameter of the strand 8 is increased to improve the torsional rigidity of the closely wound coil 10, This is because the bending rigidity of the closely wound coil 10 is also increased. Therefore, when the strand 8 has a circular cross section, it is difficult to improve the rotational performance of the closely wound coil 10 simply by changing the outer diameter.

  The present inventor has considered all the points described above, and as a result, has found that, under certain conditions, the mutual relationship between the secondary moments of the cross section of the strands is greatly involved in the above conditions. Further, it has been found that, under certain conditions, the above conditions can be easily satisfied even if the strand has a circular cross section.

Hereinafter, specific embodiments based on such knowledge (concept of the present invention) will be described.

  5 to 7 show a first embodiment of the present invention.

As shown in FIG. 5, the closely wound coil 20 of the present embodiment is formed by densely winding the wire 18 in a spiral shape over a predetermined length around a predetermined first axis O1. Yes. Wire 18, in a cross section perpendicular S with respect to the wire axis O2, the second moment I ₁ relating to the second axis O3 center O2 street and perpendicular to the first axis O1 of the cross-section S, section S Is formed so as to be smaller than the cross-sectional secondary moment I _{2 with} respect to the third axis O4 passing through the center O2 and perpendicular to the second axis O3. Specifically, the cross section S of the strand 18 has a substantially rectangular shape in which the dimension Y along the second axis O3 is larger than the dimension X along the third axis O4 (vertical / horizontal of the cross section S). The ratio S is larger than 1 and arcs with large curvatures are formed at both ends along the second axis O3). The closely wound coil 20 is formed in such an arrangement state (state of FIG. 5). Such a cross-sectional shape of the strand 18 is formed at low cost by rolling a strand having a circular cross section in a direction along the third axis O4, for example.

Further, in the present embodiment, the strand 18 has a torsional rigidity equivalent to (substantially the same as that of a strand having a perfect circle with a diameter d having a cross-sectional shape (hereinafter referred to as a first reference strand). ), The dimension of the cross section S is set. Specifically, when the wire 18 is approximated to a rectangular shape with a vertical dimension Y and a horizontal dimension X, the relationship between Y, X and d is
d = (32ξ ₁ YX ³ / π) ^1/4 (1)
It is set to become.

Here, ξ ₁ is a constant determined by Y / X.

Incidentally, Formula (1) is derived as follows.

That is, the twist angle φ when a torsional moment of T is applied to a rod of length L is
(I) When the cross section is circular
φ _R = 32TL / πd ⁴ G (G is transverse elastic modulus (a constant determined by the material))
And
(Ii) For a rectangular cross section,
φ _L = TL / ξ ₁ YX ³ G (Y> X)
And
The fact that the torsional rigidity is equivalent means that the torsion angle (deformation amount) when the same torsional moment is applied is the same.
φ _R = φ _L
And therefore
32TL / πd ⁴ G = TL / ξ ₁ YX ³ G
And as a result,
d = (32ξ ₁ YX ³ / π) ^1/4
Get.

  In the present embodiment, the material of the wire 18 is preferably a material that can withstand bending deformation, tensile load, and compressive load and has high corrosion resistance. Examples of such materials include stainless steel wires for springs (SUS304-WPB, SUS316-WPA, SUS301, SUS302-WPB, SUS631J1-WPC), nickel-titanium alloy (having superelastic characteristics), piano wire, oil A tempered wire, a tungsten wire, etc. can be mentioned.

Thus, in densely wound coil 20 of this embodiment, the wire 18, than the second moment I ₁ relating to the third section 2 about axis O4 of moment I ₂ is the second axis O3 as described above It is formed to be large. Therefore, the bending in the direction along the second axis O3 of the wire 18 forming the bending beam (see FIG. 6 (the state in which the bending force F1 is applied to the wire 18 is shown in FIG. 6)) is formed. The rigidity can be increased. Therefore, the torsional rigidity of the densely wound coil 20 can be increased as compared with that of the closely wound coil made of a conventional wire having a circular cross section, and as a result, the rotation transmission performance (rotation followability) is higher than that of the conventional. It becomes possible to improve.

In particular, the close-wound coil 20 of the present embodiment has the torsional rigidity of the strand 18 in addition to the mutual relationship between the sectional moments I ₁ and I ₂ of the strand 18 itself. The dimension of the cross section S of the strand 18 is set so as to be equivalent to the torsional rigidity of the reference strand (FIG. 7 shows a state in which the twisting force F2 is applied to the strand 18. Have been). Accordingly, the bending stiffness of the closely wound coil 20 is equivalent to the corresponding bending stiffness of the closely wound coil formed by the first reference strand (hereinafter referred to as the first reference closely wound coil).

Further, in this way, when the torsional rigidity of the strand 18 is set to be equal to the torsional rigidity of the first reference strand, the bending rigidity of the strand 18 inevitably becomes the first toughness. It becomes larger than that of the reference strand. For example, the torsional rigidity is equal for a rectangular cross-section wire (element wire 18) having a vertical dimension Y and a horizontal dimension X (Y = 1.5X) and a circular cross-section element wire (first reference element wire) having a diameter d. the case where each of the second moment _I L, calculating the _{I R,}
(I) second moment _{I L} of the rectangular cross section wire (the wire 18) of the vertical dimension Y and the transverse dimension X (Y = 1.5X), the
I _L = Y ³ X / 12
= (1.5X) ³ X / 12
= 0.2812X ⁴
(Ii) second moment _{I R} of circular cross-section wire of a diameter d (first reference wire) is
I _R = πr ^4/4
= (Π / 4) (d / 2) ⁴ (2)
It becomes.

Here, substituting equation (1) into equation (2) based on the condition that the torsional rigidity is equivalent,
I _R = (π / 64) (32ξ ₁ YX ³ / π)
It becomes.

Also, when Y = 1.5X, ξ ₁ = 0.1958, so
I _R = (π / 64) (32 × 0.1958 × 1.5X ⁴ / π)
= 0.1468X ⁴
It becomes.

Therefore, I _L / I _R = 1.91, and the bending stiffness (EI _L (E is an elastic modulus)) of the strand 18 that is a rectangular section wire is the bending stiffness of the first reference strand (circular section). (EI _R ) is approximately twice (thus, the torsional rigidity of the closely wound coil 20 is twice that of the first reference closely wound coil).

That is, the tightly wound coil 20 of this embodiment has a torsional rigidity larger than that of the first reference densely wound coil and a bending rigidity equivalent to that of the first reference closely wound coil. Yes. Therefore, the rotation transmission performance (rotation followability) of the closely wound coil 20 of this embodiment is improved as compared with that of the first reference closely wound coil.

  Moreover, the densely wound coil 20 of the present embodiment can obtain various functions and effects as described below by forming the characteristics and forms described above.

  That is, as shown in FIG. 10A, when the cross-sectional shape of the strands is circular as in the prior art, the strands 8 of the coil 10 contact each other at a point, so that the coil 10 is curved. When a strong force F in the compression direction is applied to both ends in the state, the strands 8 are likely to be displaced from each other and to be permanently deformed. Further, as shown in FIG. 10B, even when the cross-sectional shape of the wire 8A is not circular but rectangular, the horizontal dimension (longitudinal direction of the coil 10A) of the cross-section is larger than the vertical dimension. If the length is too long, the wires 8A overlap each other in the radial direction due to slight deviation, the coil length shrinks, and further severe deformation occurs. Therefore, there is a problem that permanent deformation is more likely to occur.

On the other hand, the close-wound coil 20 of the present embodiment has an aspect ratio of the section S of the strand 8 greater than 1, and the section of the strand 8 is substantially rectangular. They are in contact with each other, and the strands 8 are not easily displaced ((c) in FIG. 10). Further, since there is a margin in the length of the contact surface between the strands 8 in the vertical direction, the strands 8 have a diameter even if they are displaced by the same amount T (see (b) and (c) in FIG. 10) as before. Hard to overlap in direction. Therefore, permanent deformation hardly occurs and the compression resistance is improved.

  Further, conventionally, as shown in FIG. 42, the distal end of the closely wound coil 104 has a high flexibility so that the treatment instrument 100 can smoothly pass through the curved portion 204 at the distal end of the endoscope 200. However, if the separate flexible coil 112 is interposed between the treatment portion 102 and the densely wound coil 104, the torsional rigidity of the densely wound coil as a whole is connected. However, the rotation transmission performance is further deteriorated as compared with the case of the densely wound coil 104 alone.

  On the other hand, since the tightly wound coil 20 of the present embodiment has a lower bending rigidity than the conventional one as described above, it can smoothly pass through the bending portion of the endoscope. Therefore, since it is not necessary to connect separate coils having high torsional rigidity (high flexibility), the rotational performance does not deteriorate.

In the densely wound coil 20 of the present embodiment, the torsional rigidity of the strand 18 is equal to the torsional rigidity of the reference strand, but is higher than the torsional rigidity of the reference strand. It may be smaller. Thereby, the rotation transmission performance of the closely wound coil 20 can be further improved.

As shown in FIG. 8, when the tightly wound coil 20 of the present embodiment is applied to the medical treatment instrument 30, for example, a treatment portion (end effector) 22 is fixed to the distal end of the closely wound coil 20. The operation unit 24 is fixed to the proximal end of the closely wound coil 20. Further, an operation wire is inserted into the inner hole of the closely wound coil 20, and a movable element of the end effector 22 is connected to the distal end of the operation wire, and the operation portion 24 is movably provided at the proximal end of the operation wire. The handle 25 is connected. Therefore, in such a configuration, when the handle 25 is moved back and forth with respect to the operation portion, the operation wire moves back and forth with respect to the closely wound coil 20 and the end effector 22 operates. When the entire operation unit 24 is rotated, torsional torque is transmitted to the closely wound coil 20 and the end effector 22 at the tip of the closely wound coil 20 is rotated. The rotational transmission at that time is very good for the reasons described above. The end effector 22 may employ various forms such as a biopsy forceps, a grasping forceps, a strut that can pass a high-frequency current, and a basket forceps.

In addition, when the tightly wound coil 20 according to the present embodiment is applied to a medical treatment instrument, the end effector 22 is exposed from the channel 2 of the endoscope as shown in FIG. Assuming that the end effector 22 is pressed against the tissue X in order to treat the tissue X, the distal side portion 20A of the closely wound coil 20 exposed from the channel 2 is different from the proximal side portion 20B inside the channel 2. There is no restriction in the radial direction by channel 2. In such a case, in the conventional closely wound coil 10 formed of the strand 8 having a circular cross section, when the end effector 22 is pressed against the tissue X as shown in FIG. The intermediate portion P of the tip-side portion 10A of the closely wound coil 10 exposed between the two may buckle (a force in the compression direction acts and curves in the lateral direction). This is because, in the conventional wire 8 having a circular cross section, the wires 8 are in contact with each other at a point, so that the force in the compression direction easily escapes in the lateral direction (see FIG. 12B). On the other hand, in the closely wound coil 20 of the above-described embodiment, since the strands 18 are in contact with each other on the surface, the force in the compression direction is difficult to escape in the lateral direction (see FIG. 11B), and therefore buckling occurs. (Refer to FIG. 11A).

Further, as shown in FIG. 13, as a precaution for manufacturing the closely wound coil 20 (which is applicable not only to the closely wound coil of the present embodiment but also to the closely wound coil in general), the completed densely wound coil is shown. It is important that the coil 20 has “high straightness”. “High straightness” has linearity such that when one end is rotated, as shown in FIG. 13, each part of the closely wound coil 20 is not shaken and rotates while maintaining a straight state. Say that.

  On the other hand, if there is a bending wrinkle in a part of the closely wound coil 20 (see FIG. 14A), vibration occurs in each part when one end is rotated (see FIG. 14B). In particular, if there is a curl at the other end (distal end: the side on which the end effector 22 is provided) of the closely wound coil 20, the effect becomes very large. This is because, when the vibration occurs, a frictional resistance is generated between the outer surface of the coil and the inner surface of the channel 2 due to the bending wrinkles even though the endoscope is not curved.

Further, in the first embodiment described above, the torsional rigidity of the strand 18 is equal to the torsional rigidity of the first reference strand, but the bending stiffness of the strand 18 has a diameter d ′. (I.e., the second reference element wire) (hereinafter, referred to as a second reference element wire). The dimension of the cross section S of the strand 18 may be set so that the moment I ₂ is equivalent to that of the second reference strand. Also in this case, the rotation transmission performance (rotation followability) of the closely wound coil 20 is based on the rotation transmission performance of the closely wound coil (hereinafter referred to as the second reference closely wound coil) formed by the second reference strand. improves. Specifically, when the wire 18 is approximated to a rectangular shape having a vertical dimension Y and a horizontal dimension X, the relationship between Y, X and d ′ (Y> X, Y = 1.5X) is
d ′ = (16Y ³ X / 3π) ^1/4 (3)
Set to be.

Incidentally, Formula (3) is derived as follows.

That is, the wire 18 and the second cross-sectional secondary moment of the reference wire _I L, _{I R} are each,
I _L = Y ³ X / 12
^{_{I R = πr 2/4 =}} πd '4/64
And
Based on the condition that the bending stiffness is the same, I _L = I _R
Then,
^{Y 3 X / 12 = πd '} 4/64
From this equation, d ′ = (16Y ³ X / 3π) ^1/4
It becomes.

  In addition, when the bending stiffness of the strand 18 is set to be equal to the bending stiffness of the second reference strand, the torsional stiffness of the strand 18 is inevitably set to the second reference strand. Smaller than that of wire.

That is, the twist angle φ when a torsional moment of T is applied to a rod of length L is
(I) In the case of a circular cross section,
φ _R = 32TL / πd ′ ⁴ G (4)
And substituting equation (3) into equation (4) based on the condition that the bending stiffness is equivalent,
φ _R = (32TL / πG) (3π / 16Y ³ X)
= 6TL / 1.5 ³ X ⁴ G
= 1.78 (TL / X ⁴ G)
And again
(Ii) In the case of a rectangular cross section,
φ _L = TL / ξ ₁ YX ³ G
= (1 / (0.1958 × 1.5)) (TL / X ⁴ G)
= 3.40 (TL / X ⁴ G)
It becomes.

Therefore, φ _R / φ _L = 0.52, and the torsional rigidity of the strand 18 is about ½ of the torsional rigidity of the second reference strand.

That is, when the dimension of the cross section S of the strand 18 is set so that the bending stiffness of the strand 18 is equivalent (substantially the same) as that of the second reference strand, the torsional stiffness of the strand 18 is the second. Is smaller than that of the reference strand. Accordingly, the tightly wound coil 20 has a bending rigidity smaller than that of the second reference densely wound coil and a torsional rigidity equivalent to that of the second reference closely wound coil. The rotation transmission performance (rotation followability) of 20 is improved more than that of the second reference densely wound coil.

From the viewpoint of setting the dimension of the cross section S of the strand 18 so that the bending rigidity of the strand 18 is equivalent (substantially the same) as that of the strand having a predetermined circular cross section, the second axis O3 or the second axis Among the dimensions of the cross section S of the strand 18 along the third axis O4, a third reference strand whose cross section is a perfect circle whose diameter is the longest dimension (dimension Y in the first embodiment) is assumed. Then, the bending rigidity of the strand 18 may be set substantially the same as the bending rigidity of the third reference strand. Also in this case, the rotation transmission performance (rotation followability) of the densely wound coil 20 is improved over that of the closely wound coil (third reference closely wound coil) formed by the third reference strand. That is, if the bending rigidity of the strand 18 is made equal to that of the third reference strand, and the sectional area of the strand 18 is made smaller than the sectional area of the third reference strand, the twist of the strand 18 is reduced. The torsional rigidity becomes smaller than the torsional rigidity of the third reference strand, the bending stiffness of the closely wound coil 20 becomes smaller than the corresponding bending stiffness of the third reference closely wound coil, and the strand 18 When the short-diameter dimension of the cross section S (dimension X in this embodiment) is smaller than the diameter of the circular section of the third reference strand, the number of coil turns per unit length L of the closely wound coil 20 (see FIG. 9 (see (a)) is larger than the number of coil turns per unit length L of the third reference densely wound coil (see (b) in FIG. 9). The load applied to one winding part of the wire 18 is reduced (that is, the coil is folded). Nikuku made), thus, the resistance coming from bending of densely wound coil 20 for a given bend is reduced. Thereby, as a whole, the rotational performance of the densely wound coil 20 is improved as compared with that of the third reference densely wound coil, and the same effects as those of the above-described embodiment can be obtained.

  15 to 17 show a second embodiment of the present invention. In the present embodiment, portions common to the first embodiment are denoted by the same reference numerals and description thereof is omitted.

  As shown in FIG. 15, the cross-sectional shape of the strand 18A of the closely wound coil 20A of the present embodiment is a rectangle in which the dimension Y along the second axis O3 is larger than the dimension X along the third axis O4. is doing. Other characteristics and configurations are the same as those in the first embodiment.

  Thus, since the cross-sectional shape of the strand 18A of the closely wound coil 20A of the present embodiment is a rectangle, an advantageous effect can be obtained in the manufacturing process. That is, when manufacturing the closely wound coil 20A of this embodiment, as shown in FIG. 16, the wire 18A is wound around the cored bar 30 so that the second axis O3 is orthogonal to the first axis O1. However, at this time, as shown in FIG. 17 (a), the wire 18A is abutted against the core 30 in a plane, so that the strand 18A is not easily tilted against the core 30 and stable production is achieved. Is possible.

FIG. 17B shows a state in which the wire 18 falls with respect to the cored bar 30 in the process of manufacturing the closely wound coil 20 of the first embodiment. The wire of the first embodiment is shown in FIG. In the cross-sectional shape applied to the cored bar 30 at the arc portion as in 18, it is conceivable that the wire 18 falls with respect to the cored bar 30 in the manufacturing process. On the other hand, when the wire 18A has a cross-sectional shape that hits the core metal 30 with a flat surface (flat portion) as in the present embodiment, the wire 18A is less likely to fall over the core metal 30. The yield at the time of manufacture becomes good.

Further, the flat portion of the cross section of the strand of the densely wound coil 20A of the present embodiment acts more advantageously than the arc portion of the cross section of the strand of the closely wound coil 20 of the first embodiment. For example, as shown in FIG. 18, when the operation wire 35 is inserted into the closely wound coils 20 and 20A, the closely wound coil 20 of the first embodiment is shown in FIG. As described above, since the operation wire 35 and the densely wound coil 20 are in point contact due to the unevenness (arc portion) on the inner surface of the closely wound coil 20, if the closely wound coil 20 is curved with a large curvature, these point contacts are made. The operation wire 35 is strongly pressed against the portion, and a concentrated load (indicated by an arrow in the drawing) acts on the portion, and the sliding resistance of the operation wire 35 is increased. Therefore, the operation of the operation wire 35, and thus the operation of the end effector operated by the operation wire 35 becomes heavy. On the other hand, in the densely wound coil 20A of the second embodiment, as shown in FIG. 18A, the operation wire 35 and the closely wound coil 20A face each other due to the flat inner surface of the densely wound coil 20A. Therefore, the sliding resistance of the operation wire 35 is low, and the operation of the operation wire 35 and thus the operation of the end effector operated by the operation wire 35 are lightened.

Further, as shown in FIG. 19, when considering the case where the closely wound coils 20 and 20A are inserted into the channel 208 of the endoscope, the closely wound coil 20 of the first embodiment is shown in FIG. As shown in FIG. 5, the inner surface of the endoscope channel 208 and the densely wound coil 20 are in point contact with the unevenness (arc portion) on the outer surface of the closely wound coil 20, so that the endoscope channel 208 is bent with a large curvature. Then, a concentrated load (indicated by an arrow in the figure) acts on these point contact portions, and the sliding resistance of the closely wound coil 20 increases. Therefore, the back-and-forth operation or the rotation operation of the closely wound coil 20 (or the treatment portion provided at the tip of the closely wound coil 20) becomes heavy. On the other hand, in the closely wound coil 20A of the second embodiment, as shown in FIG. 19B, the inner surface of the endoscope channel 208 and the closely wound coil are formed by the flat outer surface of the closely wound coil 20A. 20A is in contact with the surface, so that the sliding resistance of the closely wound coil 20A is low, and therefore the back and forth operation or the rotating operation of the closely wound coil 20A (or the treatment portion provided at the tip of the closely wound coil 20A) is light. Become.

  20 to 22 show a third embodiment of the present invention. In the present embodiment, portions common to the first embodiment are denoted by the same reference numerals and description thereof is omitted.

  As shown in these drawings, in the closely wound coil 20B of the present embodiment, the cross-sectional shape of the wire 18B is elliptical. Other characteristics and configurations are the same as those in the first embodiment. Therefore, the same effect as the first embodiment can be obtained.

  23 to 25 show a fourth embodiment of the present invention. In the present embodiment, portions common to the first embodiment are denoted by the same reference numerals and description thereof is omitted.

  As shown in these drawings, the close-wound coil 20C of the present embodiment has a strand set 18C formed by two radial cross-sections of strands 8 and a predetermined first axis O1. It is formed by densely winding spirally over a predetermined length at the center. A strand set 18C (see FIG. 24) in which two strands 8 having a circular cross section are overlapped in the radial direction has an aspect ratio substantially equal to the section S of the strand 18 of the first embodiment. A large cross section S ′ can be formed. Accordingly, the closely wound coil 20 </ b> C formed by closely winding such a strand set 18 </ b> C can have the same characteristics as the closely wound coil 20 of the first embodiment. In particular, in this embodiment, it is only necessary to use two strands 8 having a circular cross section, and it is not necessary to roll the strand 8 having a circular cross section, so that a coil having a large aspect ratio can be easily manufactured. it can.

  In the present embodiment, as shown in FIGS. 26 and 27, the strands 8 may be welded together. In this case, as shown in FIG. 27, two strands 8 are arranged in parallel and their joints are welded, and the strand set 18C integrated thereby is connected in the vertical direction to form a densely wound coil. Form. In this way, since the two strands 8 are integrated, the bending rigidity of the strand set 18C can be further improved.

  28 to 30 show a fifth embodiment of the present invention. In the present embodiment, portions common to the first embodiment are denoted by the same reference numerals and description thereof is omitted.

  As shown in these drawings, the closely wound coil 20D of the present embodiment has a wire 28 having a circular cross section (a cross-sectional dimension ratio of 1: 1) is set to a predetermined length around a predetermined first axis O1. It is formed by densely winding in a spiral shape. However, the inside of the material of the wire 28 is non-homogeneous, the regions on both sides (regions having a crescent shape in cross section) R1 and R1 have characteristics of low rigidity, and these regions R1 and R1. A region (region having a substantially rectangular cross section) R2 in the vicinity of the central axis O2 sandwiched between the two has a high rigidity characteristic.

  Accordingly, the wire 28 of the present embodiment has a bending rigidity equal to or greater than that of a homogeneous material wire having a circular cross section of the same size, and a torsional rigidity equal to or less than that. 20D has improved torsional rigidity and lower bending rigidity than a closely wound coil formed of the homogeneous material wire, and therefore improved rotation transmission performance.

  As described above, according to the present embodiment, it is possible to improve the rotation transmission characteristic while keeping the wire cross-sectional shape circular. Moreover, the same manufacturing equipment as that of the strand having a circular cross section can be used. Furthermore, since the vertical / horizontal dimension ratio of the wire cross section is 1: 1, compared to the vertically long wire, the collapse is less likely to occur during manufacturing, and the yield is improved.

  31 to 33 show a sixth embodiment of the present invention. In the present embodiment, portions common to the first embodiment are denoted by the same reference numerals and description thereof is omitted.

  As shown in these drawings, the closely wound coil 20E according to the present embodiment has a wire 38 having a circular cross section (a cross-sectional aspect ratio of 1: 1) and a predetermined length around a predetermined first axis O1. It is formed by densely winding in a spiral shape. However, the strand 38 has a non-homogeneous material inside, the central region (region having a circular cross section) R3 has high rigidity, and the peripheral region (the cross section has an annular shape). Region) R4 has a characteristic of low rigidity.

  Therefore, the strand 38 of the present embodiment has a bending rigidity equal to or greater than that of a homogeneous material strand having a circular cross section of the same size and a torsional rigidity equal to or less than that. 20E has improved torsional rigidity and lower bending rigidity as compared with a densely wound coil formed of the homogeneous material wire, so that the rotation transmission performance is improved.

  As described above, also in the present embodiment, the rotation transmission characteristics can be improved while maintaining the cross-sectional shape of the strands in a circular shape. Therefore, the same operational effects as those of the fifth embodiment can be obtained.

  34 to 36 show a seventh embodiment of the present invention. In the present embodiment, portions common to the first embodiment are denoted by the same reference numerals and description thereof is omitted.

  As shown in these drawings, the closely wound coil 20F of the present embodiment has a wire 48 having a circular cross section (a cross-sectional aspect ratio of 1: 1) and a predetermined length around a predetermined first axis O1. It is formed by densely winding in a spiral shape. However, the wire 48 is made of a material having a characteristic that the bending rigidity has anisotropy. That is, this material has high bending rigidity in the first direction and low bending rigidity in the second direction perpendicular to the first direction. In the present embodiment, the first direction with high bending rigidity is set to be orthogonal to the first axis O1 of the closely wound coil 20F.

  Accordingly, the wire 48 of the present embodiment has a bending rigidity equal to or greater than that of a homogeneous material wire having a circular cross section of the same size and a torsional rigidity equal to or less than that. 20F has improved torsional transmission performance and improved torsional rigidity and bending rigidity as compared with a closely wound coil formed of the homogeneous material strand.

  As described above, also in the present embodiment, the rotation transmission characteristics can be improved while maintaining the cross-sectional shape of the strands in a circular shape. Therefore, the same operational effects as those of the fifth embodiment can be obtained.

  37 to 40 show a first example of a medical treatment instrument using any one of the above-described tightly wound coils 20 to 20F as a force transmission member.

  As shown in FIGS. 37 and 38, the medical treatment tool 70 according to the first example has a clip 60 that can be placed in a living body cavity as an end effector (treatment portion). A tip coil 53 having a large inner diameter is connected to the tip side of the closely wound coils 20 to 20F. Since the inner diameter of the tip coil 53 is larger than that of the closely wound coils 20 to 20F, the longitudinal / lateral dimension ratio of the cross section of the coil element wire is smaller than 1, and therefore the rotation transmission performance is close to the closely wound coil. It is inferior to that of 20-20F.

  As shown in FIG. 40, at the base end of the closely wound coils 20 to 20F, an operation unit (rotating operation means) for rotating the densely wound coils 20 to 20F around the first axis O1. 106 is provided.

  A hook 55 that can be engaged with the clip 60 is provided at the tip of the operation wire 54 inserted through the closely wound coils 20 to 20F and the tip coil 53. Further, a chip 50 is fixed to the tip of the closely wound coils 20 to 20F, and a notch 52 is formed in the top and bottom of the chip 50 at the top and bottom.

The clip 60 is attached to a hook 55 protruding at the tip. When the hook 55 is pushed into the rear end of the clip 60, the rear end of the clip 60 is deformed and the hook 55 is engaged with the clip 60 (see FIG. 39A).
The clip 60 is provided with a wing 56 that can project and retract (biased toward the projecting side), and the clip 60 can be stored in the tip coil 53 with the wing 56 folded (FIG. 39A). reference). The length of the tip coil 53 is generally set to a length that can accommodate the clip 60.

  As shown in FIG. 40, the medical treatment instrument 70 is inserted into the channel 208 of the endoscope 200 in a state where the clip 60 is housed in the distal coil 53 (the state shown in FIG. 39A). Through the channel 208, the body 208 is guided to a target site (a wound 80). In FIG. 40, the same reference numerals are given to components common to FIG.

  When the clip 60 is projected from the tip of the tip coil 53, the wing 56 protrudes outward, engages with the notch 52 of the tip coil 53, and can receive a traction force acting on the clip 60 (see FIG. 39). (See (b)). Although the hook 55 and the clip 60 can be rotated relative to each other, since the wing 56 of the clip 60 is engaged with the notch 52 of the chip 50, the clip 60 follows the rotating operation of the closely wound coils 20 to 20F. Rotate.

  When the traction force is applied to the clip 60, the prong 62 is pulled into the presser tube 69, the arms of the prong 62 approach each other, and the clip 60 can be completely closed. Therefore, the wound 80 can be closed by pressing the prong 62 against the wound 80 generated in the living body and pulling the clip 60. When the traction force reaches a certain value, the connecting portion 63 located between the clip 60 and the hook 55 breaks and the clip 60 is divided back and forth, so that the clip 60 is left in place with the wound 80 closed. (See (c) and (d) of FIG. 39).

  As described above, the medical treatment instrument 70 can smoothly pass through the bending portion 204 of the endoscope 200 because the tight winding coils 20 to 20F have low bending rigidity. Therefore, the tip coil 53 with inferior rotation transmission performance can be shortened as much as possible, and deterioration of rotation transmission performance can be minimized.

  FIG. 39 shows a second example of a medical treatment instrument using any one of the closely wound coils 20 to 20F described above as a force transmission member.

  As shown in the drawing, in the medical treatment instrument 90 according to the second example, a binding device (snare) 92 as an end effector is fixed to the tips of the closely wound coils 20 to 20F. A flexible outer tube 94 is provided outside the densely wound coils 20 to 20F. The outer tube 94 and the closely wound coils 20 to 20F are relatively movable in the axial direction, and are also relatively rotated. Is possible. In the figure, reference numeral 96 denotes an extension regulating member for preventing the closely wound coils 20 to 20F from extending.

  The snare 92 is reduced in diameter when housed in the outer tube 94 and is inserted into the body through the endoscope channel in the housed state. When the closely wound coils 20 to 20F are pushed out in the body and the snare 92 is protruded from the outer tube 94, the snare 92 expands. In this state, when the densely wound coils 20 to 20F are rotated via the operation unit 106 provided on the proximal side of the closely wound coils 20 to 20F, the snare 92 is moved together with the densely wound coils 20 to 20F with respect to the outer tube 94. The snare 92 can be hooked on a lesion such as a polyp by rotating and aligning with the affected part. When the closely wound coil 20 to 20F is pulled with respect to the outer tube 94 in the hooked state, the polyp is bound by the snare 92, and in this state, a high frequency current is applied to the snare 92 via the closely wound coil 20 to 20F. When flowed, the polyp is excised.

  In addition, according to the technical content demonstrated above, the various structures as shown below are obtained.

1. In a close-wound coil formed by winding a strand densely in a spiral shape over a predetermined length around a predetermined first axis,
In the cross section perpendicular to the element wire axis, the element wire passes through the center of the cross section, and the second moment of section with respect to the second axis perpendicular to the first axis passes through the center of the cross section and A densely wound coil, characterized in that the coil is formed so as to be smaller than a second moment of section with respect to a third axis perpendicular to the second axis.

2. In a close-wound coil formed by winding a strand densely in a spiral shape over a predetermined length around a predetermined first axis,
A cross section perpendicular to the element wire axis of the element wire passes through the center of the cross section and is perpendicular to the first axis, and passes through the center of the cross section and is relative to the second axis. A third axis that is vertical,
The bending rigidity of the strand is greater than the bending stiffness of a reference strand having a cross-sectional shape of a perfect circle whose diameter is the longest dimension among the cross-sectional dimensions of the strand along the second axis or the third axis. Big
The closely wound coil according to claim 1, wherein the torsional rigidity of the strand is substantially the same as the torsional rigidity of the reference strand.

3. In a close-wound coil formed by winding a strand densely in a spiral shape over a predetermined length around a predetermined first axis,
A cross section perpendicular to the element wire axis of the element wire passes through the center of the cross section and is perpendicular to the first axis, and passes through the center of the cross section and is relative to the second axis. A third axis that is vertical,
The bending rigidity of the strand is the bending stiffness of a reference strand having a perfect circle having a longest diameter as a cross-sectional shape among the cross-sectional dimensions of the strand along the second axis or the third axis. Almost the same,
The closely wound coil according to claim 1, wherein a torsional rigidity of the strand is smaller than a torsional rigidity of the reference strand.

4). In a close-wound coil formed by winding a strand densely in a spiral shape over a predetermined length around a predetermined first axis,
A cross section perpendicular to the element wire axis of the element wire passes through the center of the cross section and is perpendicular to the first axis, and passes through the center of the cross section and is relative to the second axis. A third axis that is vertical,
Assuming a reference strand whose cross-sectional shape is a perfect circle whose diameter is the longest dimension among the cross-sectional dimensions of the strand along the second axis or the third axis, the strand is the strand axis. A densely wound coil is characterized in that a cross-sectional secondary moment with respect to the third axis in a cross-section perpendicular to the cross-section is larger than a corresponding cross-sectional secondary moment in the reference strand.

5. In a close-wound coil formed by winding a strand densely in a spiral shape over a predetermined length around a predetermined first axis,
The cross section perpendicular to the strand axis of the strand passes through the center of the cross section, and the dimension along the second axis perpendicular to the first axis passes through the center of the cross section and the second axis. A closely wound coil characterized by being larger than a dimension along a third axis perpendicular to the coil.

6). The closely wound coil according to any one of Items 1 to 5,
A rotation operating means provided at a proximal end of the densely wound coil, for rotating the densely wound coil around its first axis;
A treatment section that is located on the tip side of the densely wound coil and receives the rotational operation force by the rotational operation means via the densely wound coil;
A medical treatment instrument comprising:

  7). The medical treatment instrument according to claim 6, wherein the treatment section is attached to a tip of the closely wound coil.

  8). The medical treatment instrument according to claim 6, wherein an operation wire is inserted into the tightly wound coil so as to be able to advance and retreat, and the treatment portion is attached to a distal end of the operation wire.

  9. The medical treatment instrument according to claim 6, wherein the treatment section is a clip that can be placed in a living body.

10. Connected to the tip of the closely wound coil is a second closely wound coil located between the treatment portion and the closely wound coil and having an inner diameter larger than the inner diameter of the closely wound coil,
The clip is deformable between a first form attached to the tip of the second densely wound coil and a second form housed inside the second closely wound coil;
The length of the second closely wound coil is substantially the same as the axial length of the clip stored in the second form inside the second closely wound coil. 10. A medical treatment instrument according to item 9.

11. The second densely wound coil is formed by densely winding an element wire spirally over a predetermined length around a predetermined fourth axis,
The cross section of the second densely wound coil perpendicular to the strand axis of the strand has a dimension passing through the center of the cross section and along the fifth axis perpendicular to the fourth axis. The medical treatment instrument according to claim 10, wherein the medical treatment instrument is smaller than a dimension along a sixth axis that passes through and perpendicular to the fifth axis.

12 Used in combination with an endoscope,
The closely wound coil according to any one of Items 1 to 5,
An outer tube through which the tightly wound coil is inserted;
Means for rotating the closely wound coil relative to the mantle tube;
A medical treatment instrument comprising:

  13. 6. The close-wound coil according to any one of claims 1 to 5, wherein the coil can be inserted into a channel of an endoscope.

  14 The medical treatment instrument according to any one of items 6 to 11, which can be inserted into a channel of an endoscope.

15. In an endoscope treatment tool used in combination with an endoscope,
The treatment instrument has an elongated member inserted into a narrow lumen;
Means for allowing the elongate member to rotate relative to the narrow lumen;
An endoscope treatment tool, wherein the extension member has high torsional rigidity and high flexibility.

16. In an endoscope treatment tool used in combination with an endoscope,
The treatment instrument has a tightly wound coil that is inserted into a thin lumen;
Means for allowing the closely wound coil to rotate relative to a thin lumen;
The treatment instrument for an endoscope, wherein the wire of the closely wound coil has a high bending rigidity with respect to an orientation with respect to the axis of the treatment tool, and a low torsional rigidity.

18, 18A, 18B, 18C, 28, 38, 48 ... strand 20, 20, A, 20B, 20C, 20D, 20E, 20F ... closely coiled coil O1 ... first axis O2 ... strand axis O3 ... second axis O4 ... Third axis

Claims (3)

A sheath-like force transmission member having a distal end and a proximal end;
An arm capable of performing a gripping operation; and a presser tube that is provided on a proximal end side of the arm and biases the arm in a direction to close the arm when the arm is pulled into the inside, and transmits the force. A clip detachably provided on the distal end of the member;
An operation wire that is inserted into the force transmission member and provided on the base end side of the clip so as to be separable from the clip ;
A first engagement portion provided at a distal end of the force transmission member; and a second engagement portion provided in the presser tube of the clip, wherein the first engagement portion and the second engagement portion are provided. A rotation restricting portion that restricts rotation of the force transmitting member relative to the clip and rotates the clip following the rotation operation of the force transmitting member.
A medical treatment instrument comprising: One of the first engaging portion and the second engaging portion is a protrusion ,
The other of the first engagement portion and the second engagement portion is a recess that can be engaged with the protrusion .
The medical treatment instrument according to claim 1 , wherein: The medical treatment instrument according to claim 1 , further comprising a rotation connecting portion that is provided between the clip and the operation wire and rotatably connects the clip to the operation wire.

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