JP5412167B2 - Endoscopic clip device - Google Patents

Description

  The present invention relates to an endoscope clip device.

  An endoscope clip device is generally an operation unit in which an operation wire, which is inserted and removed in an axial direction in a sheath inserted into and removed from a treatment instrument insertion channel of an endoscope, is connected to the proximal end side of the sheath. By being pulled, the clip disposed on the distal end side of the sheath is once opened and then forcibly closed.

  Then, when the clip is in a state where it has bitten into the affected area or the like, the clip can be separated from the operation wire or the like and placed in the body by pushing the operation wire from the operation unit side (for example, Patent Document 1, 2).

JP-A-8-126648 JP 2006-87537 A

  When the clip is forcibly closed in order to clip the affected part or the like, it is necessary to pull the operation wire to a certain extent. However, the force of the operation can only be adjusted by intuition, and if the traction operation force is small, the clip will not bite against the affected area and clipping will fail, and if the traction operation force is too large, the sheath or clip will be damaged. In some cases, it became useless.

  According to the present invention, when the operation wire is pulled to forcibly close the clip, the operation wire can always be pulled with an appropriate pulling operation force, and a reliable clipping process is performed without damaging the member. An object of the present invention is to provide an endoscopic clip device.

In order to achieve the above object, an endoscope clip device according to the present invention is configured to pull an operation wire, which is inserted into a sheath so as to be able to advance and retreat in an axial direction, from an operation portion connected to the proximal end side of the sheath. An endoscope configured so that the clip placed on the distal end side of the sheath is forcibly closed, and then the clip can be separated from the other by pushing the operation wire. An operation clip body connected to a proximal end of a sheath, and a proximal end rod-like portion formed at the proximal end of an operation wire that is slidably engaged with the operation portion main body. in those and the slide operating member is provided in the operation portion, the proximal end the rod-like portion of the operation wire is engaged with the slidable state in the axial direction with respect to the slide operation member, slide to the base end rod portion In the state where the traction stopper for preventing the pulling movement of the load operation member is fixed at a predetermined bond strength to the base end rod portion, a slide operation member is towing a proximal rod portion with a force within a predetermined fixing strength, When the operation wire is pulled by the slide operation member via the pulling stopper and the proximal end bar-shaped portion is pulled by the slide operation member with a force larger than the predetermined fixing strength, the fixed portion of the tow stopper with respect to the proximal end bar-shaped portion is damaged. It is what you do.

Note that push the stopper for preventing the pushing movement of the slide operation member relative to the proximal rod portion may be provided on the proximal end the rod-like portion.
In addition, a plurality of clips are connected in series within the distal end of the sheath, and the operation wire is pushed from the operation portion to open the clip located at the forefront, and then the operation wire is pulled to operate the most. The clip located at the tip is forcibly closed, and then the cutting-edge clip is configured to be separated from the clip located at the rear side by pushing the operating wire. A plurality of stoppers are provided and they are fixed to the proximal end rod-shaped portion of the operation wire at intervals in series. The fixing strength is gradually increased from the front-side traction stopper to the rear-side traction stopper. May be.

  In that case, even if a plurality of traction stoppers are fixed to the proximal end rod-shaped portion of the operation wire by laser spot welding, the number of laser spot welding locations gradually increases from the traction stopper on the front end side to the traction stopper on the rear side. Good.

  According to the present invention, when the proximal end rod-shaped portion of the operation wire is pulled by the slide operation member with a force larger than a predetermined fixing strength (the retention strength of the traction stopper with respect to the proximal end rod-shaped portion of the operation wire), When the operation wire is pulled to forcefully close the clip, the operation wire can always be pulled with an appropriate pulling operation force. Thus, a reliable clipping procedure can be performed without damaging the member.

It is side surface sectional drawing of the whole structure of the clip apparatus for endoscopes which concerns on the Example of this invention. It is the elements on larger scale of the clip apparatus for endoscopes which concerns on the Example of this invention. It is the III-III sectional view in Drawing 2 of the clip device for endoscopes concerning the example of the present invention. It is a partial expanded side sectional view of the clip device for endoscopes concerning the example of the present invention. It is a partial expansion perspective view of the clip device for endoscopes concerning the example of the present invention. It is side surface sectional drawing of the pushing operation state of the clip apparatus for endoscopes which concerns on the Example of this invention. It is side surface sectional drawing of the pulling operation state of the clip apparatus for endoscopes which concerns on the Example of this invention. It is side surface sectional drawing of the pulling operation state of the clip apparatus for endoscopes which concerns on the Example of this invention. It is a partial expanded side sectional view of the pulling operation state of the clip device for endoscopes concerning the example of the present invention. It is a partial expanded side sectional view of the pulling operation state of the clip device for endoscopes concerning the example of the present invention. It is a partial expanded side sectional view of the pulling operation state of the clip device for endoscopes concerning the example of the present invention.

Embodiments of the present invention will be described below with reference to the drawings.
FIG. 1 shows an overall configuration of a so-called continuous-type endoscope clip device. The distal end side where the clip 3 is disposed and the hand (base end) side where the operation unit 10 is provided are illustrated at different scales.

  Reference numeral 1 denotes a flexible sheath that can be inserted into and removed from a treatment instrument insertion channel of an endoscope (not shown), and the flexible operation wire 2 extends in the axial direction over substantially the entire length of the flexible sheath 1. It is inserted and arranged so as to be freely movable forward and backward and rotatable in the direction around the axis.

  The flexible sheath 1 is formed of a flexible tube such as a tetrafluoroethylene resin tube. The operation wire 2 is formed of a stranded wire obtained by twisting a plurality of (for example, seven) stainless steel fine wires.

  In the distal end of the flexible sheath 1, a plurality of clips 3 (3A, 3B, 3C), which are distal treatment members, are arranged in series. Then, by operating the operation wire 2 forward and backward from the proximal end side (the operation unit 10 side described later) of the flexible sheath 1, it is opened outside the distal end of the flexible sheath 1 in order from the clip 3A on the distal end side. After the closing operation, a clipping operation is performed that is separated from the next clip 3B.

  Specifically, the clip 3A located at the foremost position is opened by pushing the operation wire 2 from the operation unit 10, and then the clip 3A is forcibly closed by pulling the operation wire 2. Then, the cutting-edge clip 3A can be separated from the clip 3B located on the rear side thereof by pushing the operation wire 2 into the state.

  Such a continuous clip mechanism is a known one described in Japanese Patent Application Laid-Open No. 2008-111068 and the like, and thus detailed description of the clip mechanism is omitted. Reference numeral 4 denotes a flexibility that is loosely arranged so as to fill a gap between the operation wire 2 and the inner peripheral surface of the flexible sheath 1 in order to reduce the bending of the operation wire 2 in the flexible sheath 1. This is an insertion tube.

  In the operation unit 10 connected to the proximal end side of the flexible sheath 1, a slide operation member 12 for advancing and retracting the operation wire 2 in the axial direction is slidable in a slit 13 formed in the operation unit main body 11. The engagement is arranged. The slide operation member 12 engaged with the slit 13 cannot rotate in the direction around the axis with respect to the operation unit main body 11.

  The slide operation member 12 is connected to a proximal end rod-shaped portion 2 a formed at the proximal end of the operation wire 2, and the operation wire 2 is moved in the flexible sheath 1 by sliding the slide operation member 12. The clip 3 can be clipped on the distal end side of the flexible sheath 1 by moving back and forth in the axial direction.

  As shown in FIG. 2 showing a part of the proximal end rod-like portion 2a of the operation wire 2 and FIG. 3 showing a III-III cross section, a stainless steel pipe material or the like is fixedly fitted to the operation wire 2. Has been formed.

  And the front-end | tip of the connection pin 12a provided in the slide operation member 12 opens a very slight gap (for example, 0.05 mm or less) in the plane part 2b of the D-shaped cross section formed in the base end rod-like part 2a. Is engaged.

  As a result, the base end rod-like portion 2a cannot rotate in the direction around the axis with respect to the slide operation member 12, but the base end rod-like portion 2a does not rotate to the slide operation member 12 in the region where the flat portion 2b is formed. On the other hand, it can slide in the axial direction.

  Returning to FIG. 1, reference numeral 15 denotes a rotation holding ring that is attached to the most distal end portion of the operation unit main body 11 so as to be rotatable in the direction around the axis. For example, the rotation holding ring 15 is tightly connected.

  As a result, when the rotation holding ring 15 is held with a fingertip and the operation unit 10 side (that is, the operation unit main body 11 and the slide operation member 12) is rotated in the direction around the axis, the base end is connected and fixed to the slide operation member 12. The operating wire 2 is rotated in the direction around the axis in the flexible sheath 1, whereby the clip 3 is rotated in the direction around the axis on the distal end side of the flexible sheath 1.

A traction stopper 16 that prevents the slide operation member 12 from moving in the traction direction relative to the base end rod-like portion 2a and a push-in stopper 17 that prevents movement in the push-in direction are fixed to the proximal end rod-like portion 2a of the operation wire 2.

  For example, the push stopper 17 formed of a single short cylindrical member made of stainless steel is in the state where the distal end surface (lower end surface in FIG. 1) of the slide operation member 12 abuts (at the time of the push operation) in the proximal end rod-like portion 2a. And is firmly fixed to the base end rod-like portion 2a by laser welding or the like so that the slide operation member 12 is not peeled off from the base end rod-like portion 2a.

  As shown in FIGS. 4 and 5, the traction stoppers 16 are provided in the same number as the number of the clips 3 so that only the portion is enlarged. Each of the pulling stoppers 16A, 16B, and 16C is formed of a short cylindrical member made of stainless steel, for example, similarly to the pressing stopper 17, and the inner and outer diameters thereof are, for example, 1.3 to 1.6 mm.

  The state-of-the-art traction stopper 16A is fitted on the proximal end rod-shaped portion 2a and fixed to the proximal end rod-shaped portion 2a so that the rear end surface (upper end surface in each drawing) of the slide operation member 12 is in contact with the traction operation. The rear traction stoppers 16B and 16C are fixed to the proximal end rod-like portion 2a with a space therebetween in series. The size of the interval is, for example, about 2 to 5 mm.

  Reference numeral 18 denotes a fixed stopper firmly fixed to the rear end portion of the proximal end rod-shaped portion 2a at a further interval from the rear end pulling stopper 16C. The base end of the base end rod-like portion 2a is extremely firmly fixed by laser welding or the like so as not to peel off.

  The securing strength of the traction stoppers 16A, 16B, and 16C to the proximal end rod-like portion 2a is larger in the intermediate traction stopper 16B than in the distal traction stopper 16A, and further in the rear traction stopper 16C than in the intermediate traction stopper 16B. Is set larger.

  Such a fixing strength is set by, for example, fixing the traction stoppers 16A, 16B, and 16C to the proximal end rod-like portion 2a by laser spot welding, and changing the number of spot welding portions for each of the traction stoppers 16A, 16B, and 16C. Therefore, it can be performed relatively accurately and easily.

  FIG. 5 shows an example of this. The state-of-the-art traction stopper 16A has three spot welds 19 and the fixing strength (shearing force) to the slide operation member 12 is about 7.5 kg. Yes.

  The intermediate traction stopper 16B has four spot welds 19 with a fixing strength of about 10 kg, and the rear traction stopper 16C has five spot welds 19 with a fixing strength of about 12.5 kg. ing.

  When the clip device of the embodiment thus configured is passed through a treatment instrument insertion channel of an endoscope (not shown) and the distal end faces the affected area to be clipped, a slide operation is performed as shown in FIG. By pushing the operation wire 2 with the member 12, the most advanced clip 3 </ b> A is pushed out from the distal end of the flexible sheath 1 and opened in a bowl shape.

  Next, as shown in FIG. 7, when the proximal end rod-like portion 2 a of the operation wire 2 is pulled by the slide operation member 12, the clip 3 </ b> A is closed. When the amount of traction force is increased by applying force to the hand that operates the slide operation member 12, the traction force amount exceeds the fixing force amount of the traction stopper 16A at the distal end (that is, the proximal end rod-like portion 2a is predetermined). At the time when the sliding operation member 12 is pulled by a force larger than the fixing strength, the fixing portion between the leading pulling stopper 16A and the proximal end rod-like portion 2a is broken as shown in FIG.

  FIG. 9 is an enlarged view of that portion, and when the cutting-edge traction stopper 16A and the proximal end rod-shaped portion 2a are detached while the slide operation member 12 is being pulled, at that moment, The most advanced traction stopper 16A strikes the middle traction stopper 16B and stops.

  Then, due to the sound generated at that time and the impact transmitted to the slide operation member 12, the operator pulls the cutting-edge clip 3A with a predetermined amount of traction force (about 7.5 kg in this case) suitable for the clipping procedure. It is possible to detect the closed state, and by stopping the pulling operation there, proper clipping can be performed without damaging the equipment.

  When the second and third clips 3B and 3C are sequentially clipped, as shown in FIGS. 10 and 11, the second and third traction stoppers 16B and 16C, the proximal end rod-like portion 2a, By sequentially pulling until the adhering part of each piece is damaged individually, the second and third clipping procedures are performed with an appropriate amount of traction force of about 10 kg and 12.5 kg, and proper clipping is performed without damaging the equipment. It can be performed.

  The present invention can also be applied to a single-shot clip device in which only one clip 3 is arranged at the tip of the flexible sheath 1, and in that case, a single traction stopper 16 is provided. When the sliding operation member 12 is pulled by the base end bar-shaped part 2a with a force larger than a predetermined fixing strength, the fixed part of the traction stopper 16 with respect to the base end bar-shaped part 2a is fixed. It should just be damaged.

  The present invention is not limited to the above-described embodiment. For example, the traction stopper 16 is fixed to the proximal end rod-shaped portion 2a by mechanical means such as caulking or chemical means such as adhesion. There is no problem.

1 Flexible sheath (sheath)
2 Operation wire 2a Base rod-like portion 3, 3A, 3B, 3C Clip 10 Operation portion 11 Operation portion main body 12 Slide operation member 16, 16A, 16B, 16C Traction stopper 17 Push stopper 18 Fixed stopper 19 Laser spot welding

Claims (4)

By pulling the operation wire, which is inserted into the sheath so as to be movable back and forth in the axial direction, from the operation portion connected to the proximal end side of the sheath, the clip disposed on the distal end side of the sheath is forcibly moved. An endoscopic clip device configured to be in a closed state, and then to be able to separate the clip from the other by pushing in the operation wire.
An operation portion main body to which the proximal end of the sheath is connected; a slide operation member to which a proximal end rod-like portion formed at the proximal end of the operation wire is slidably engaged and arranged with respect to the operation portion main body; Is provided in the operation unit,
A traction stopper that engages a state in which the proximal end rod-shaped portion of the operation wire is slidable in the axial direction with respect to the slide operation member , and a traction stopper that prevents the slide operation member from moving in the traction direction relative to the proximal end rod-shaped portion . Fixed to the base rod-shaped part with a predetermined fixing strength,
In a state where the slide operation member is pulling the proximal end rod-shaped portion with a force within the predetermined fixing strength, the operation wire is pulled by the slide operation member via the pulling stopper, and the proximal end rod-shaped portion The clip device for an endoscope, wherein when the sliding operation member is pulled with a force larger than the predetermined fixing strength, the fixing portion of the traction stopper with respect to the base end rod-shaped portion is broken. . Endoscopic clipping device according to claim 1, wherein the push stopper for preventing the pushing movement of the slide operation member relative to the proximal rod portion is provided on the proximal rod portion.   A plurality of the clips are connected in series in the distal end of the sheath, and the clip located at the foremost position is opened by pushing the operation wire from the operation portion, and then the operation wire is pulled. The clip located at the forefront is forcibly closed, and then the state-of-the-art clip can be separated from the clip located at the rear side by pushing the operation wire. In addition, a plurality of the traction stoppers are provided, and they are fixed to the proximal end rod-like portion of the operation wire with a series interval, and the fixing strength is increased from the traction stopper on the distal side to the traction on the rear side. The endoscope clip device according to claim 1 or 2, wherein the clip device is gradually set to the stopper.   The plurality of traction stoppers are fixed to a proximal end rod-like portion of the operation wire by laser spot welding, and the number of laser spot welding locations gradually increases from a traction stopper on the front end side to a traction stopper on the rear side. 4. The endoscope clip device according to 3.

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