JP5478447B2 - Ligating device and clip unit used therefor - Google Patents

Description

  The present invention relates to a ligation apparatus for ligating a living tissue and a clip unit used therefor.

  As a ligation device for ligating biological tissue, for example, insert the ligation device into the body cavity from the forceps opening of the endoscope, align the clip with the arm part of the tip expanded to the position of the desired biological tissue, and connect to the clip A device that closes the arm portion of the clip and ligates the living tissue by pulling the operated wire is known (see, for example, Patent Document 1 and Patent Document 2).

  The living tissue ligation apparatus of Patent Document 1 and Patent Document 2 is loaded at the leading end portion of the introducing tube connected to the introducing tube inserted into the body cavity, the operating wire inserted into the introducing tube so as to freely advance and retract. And a clip to be configured. The ligating apparatus has a mechanism in which the clip is indwelled in the body cavity with the living tissue sandwiched by pulling the operation wire. However, although the ligating apparatus of Patent Document 1 pushes and spreads the engaging portion by passing through the bulging body, the amount of deformation is small and the engagement may not be released.

  In the ligating apparatus of Patent Document 2, a clip composed of a clip claw member and a pressing member is temporarily fixed to the sheath tip so that the clip claw member can be operated in an open state and a closed state. Since the clip is separated from the operation wire by the breaking of the semicircular part to be connected, there is a possibility that a broken piece of a small piece is generated when the semicircular part is broken. This broken piece enters the introduction tube of the ligation apparatus or is left in the body cavity. If the broken piece remains in the introduction tube, it may hinder subsequent operation of the operation wire, and it may not be possible to continuously ligate the living tissue with the clip in the next stage, which is not suitable as a structure used in the continuous ligation apparatus. . In addition, it is not preferable that the broken fragments remain in the body cavity unintentionally.

JP 2007-507307 A JP 2006-198388 A

  According to the present invention, among a plurality of clip units arranged in series in the sheath, the clip body arm provided at the distal end of the sheath can be freely opened and closed, and a living tissue can be re-gripped, and a plurality of fragments can be generated without causing fragmentation. An object of the present invention is to provide a ligating apparatus capable of continuously ligating a living tissue with the clip unit of the above and a clip unit used for the ligating apparatus.

The present invention has the following configuration.
A ligation apparatus for ligating biological tissue,
A tubular outer sheath member having flexibility;
A tubular inner sheath member provided in the outer sheath member so as to freely advance and retract;
An operation wire provided in the inner sheath member so as to freely advance and retract;
A plurality of clip units arranged in series inside the distal end of the outer sheath member, and
The clip unit has a pair of arm portions that are expanded and biased to each other, and a clip body that has a base end portion that connects the base ends of the arm portions and ligates a living tissue;
A clamping ring for inserting a base end portion of the clip body into the cylindrical body and closing the pair of arms,
The clamping ring is configured to release the coupling between the clamping rings by coupling a coupling means for coupling adjacent clamping rings with each other, locking the operation wire, and deforming the coupling means by pulling the manipulation wire. A ligation apparatus comprising a connection release means.

  According to the ligating apparatus and the clip unit used therefor according to the present invention, among the plurality of clip units arranged in series in the sheath, the arm portion of the clip body provided at the distal end of the sheath can be freely opened and closed, and the biological tissue is regripped. The living tissue can be ligated continuously with a plurality of clip units without causing breakage.

BRIEF DESCRIPTION OF THE DRAWINGS It is a figure for describing embodiment of this invention, and is the whole block diagram of the ligation apparatus shown by notching a part. It is sectional drawing of the hand operation part of the ligation apparatus shown in FIG. It is a disassembled perspective view of the clip unit shown in FIG. (A) is a side view of the clip main body shown in FIG. 3, and (B) is a plan view. (A) is the sectional view on the AA line of FIG. 3, (B) is the sectional view on the BB line. (A) is a cross-sectional view of the main part of the clip body, the tightening ring, and the operation wire before assembly, (B) is a cross-sectional view of the main part where the clip main body is inserted into the tightening ring, and (C) is a clip of the operation wire. FIG. 4D is a cross-sectional view of a main part in the middle of being engaged with the wire locking means of the main body, and (D) is a cross-sectional view of the main part showing a state where the loop portion of the operation wire is locked to the wire locking means of the clip main body. (A) is a cross-sectional view of the main part of the clip unit mounted in the introduction pipe, (B) is a cross-sectional view of the main part in which the arm part of the clip body is opened by retreating the introduction pipe, and (C) is a feeding operation of the operation wire. FIG. 5 is a cross-sectional view of the main part showing a state where the arm part of the clip body is opened and closed by a pulling operation. They are a vertical sectional view (A) and a horizontal sectional view (B) of a ligating apparatus in which a plurality of clip units are loaded in the outer sheath member. It is a perspective view of the ligation apparatus of FIG. 8 shown except an outer sheath member. (A) is a perspective view of a ligation apparatus before ligation, (B) is a perspective view showing a state in which an arm portion of a clip main body which is pulled by an operation wire and is arranged at the distal end is closed, and (C) is a clip at the distal end. The perspective view which shows the state from which the latching claw of a main body starts plastic deformation, (D) is a perspective view which shows the state which the latching claw plastically deformed and the latching | locking of a clip main body and a loop part was cancelled | released, (E ) Is a perspective view showing a state in which the loop portion is guided by the retaining portion of the next clip body and guided to the wire locking means, and (F) is a wire locking means of the next clip body where the loop portion of the operation wire is guided. And is a perspective view showing a state in which the clip unit at the tip is separated. It is principal part sectional drawing which shows the dimensional relationship between the opening width of the arm part of the clip main body inserted in the clamping ring, and the width | variety of the base end part of a clip main body. It is a principal part expansion perspective view of the clip unit of FIG. (A) is a cross-sectional view of the clip body housed in the outer sheath member and the arm portion is closed, (B) is a cross-sectional view showing a state where the outer sheath member is retracted and the arm portion of the clip body is opened, (C) is sectional drawing which shows the state which the outer sheath member moved forward and the biological tissue was temporarily fixed by a pair of arm part. It is a perspective view of the connection mechanism of a clip unit. It is principal part sectional drawing of the connection mechanism of the clip unit of FIG. FIG. 16 is a cross-sectional view schematically showing a state in which the engagement of the coupling mechanism of FIG. 15 is released. It is a principal part expansion perspective view of the modification of a connection mechanism. (A) is principal part sectional drawing of the connection mechanism of the clip unit of another modification, (B) is a Z direction arrow directional view of (A). It is a perspective view of the connection mechanism of another structural example. It is CC sectional view taken on the line of FIG. (A) is a side view of the clip main body shown in FIG. 19, and (B) is a plan view. It is CC sectional view taken on the line of FIG. 19 which shows the state by which engagement of a connection mechanism is cancelled | released. (A) is an external side view of FIG. 20, and (B) is an external side view of FIG. It is a figure for demonstrating another structural example, and is a top view which shows the several clip unit arranged in series except an outer sheath member. It is a top view which shows the state which the ligation apparatus of FIG. 24 bends. It is a top view which shows the relationship between the spindle of a connection mechanism, and the end surface shape of a clamping ring. FIG. 6 is a perspective view of clip units arranged with the bending directions of the fastening rings being alternately changed by 90 degrees. It is a perspective view which shows the state which changed the expansion direction of the arm part of a some clip unit 90 degrees, and was arranged in a line. FIG. 29 is a perspective view of the fastening ring and clip body of FIG. 28. 29A is a plan view of the clip body, FIG. 29B is a front view, and FIG. 29C is a side view.

Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings. FIG. 1 is a diagram for explaining an embodiment of the present invention. FIG. 2 is an overall configuration diagram of a ligation apparatus shown with a part cut away, and FIG. 2 is a sectional view of a hand operating unit.
The ligating apparatus 100 includes a clip operating device 11 and a clip unit 13 loaded in the clip operating device 11. The clip operation device 11 includes an insertion portion 15 that is inserted into a channel of an endoscope (not shown) and inserted into a body cavity, and a proximal operation portion 17 on the proximal end side of the insertion portion 15. The insertion portion 15 includes an outer sheath member 19 that is an introduction tube made of a high-density polyethylene tube, an inner sheath member 21 that is inserted into the outer sheath member 19 so as to be able to advance and retract, and an advancement and retraction within the inner sheath member 21. And an operation wire 23 to be inserted into the cable.

  The inner sheath member 21 is configured by a flexible coil sheath in which a wire having spring properties is tightly wound. The operation wire 23 is formed of a twisted metal wire having moderate elasticity such as stainless steel or NiTi alloy, and the outer periphery thereof may be coated with high-density polyethylene as necessary, and is slidable with the inner sheath member 21. You may apply the silicone oil for improving. An annular loop portion 71 is provided at the distal end of the operation wire 23 on the side opposite to the hand operation portion 17 side.

  The clip unit 13 includes a tightening ring 37 formed in a tubular body, and a clip body 35 inserted into the tubular body of the tightening ring 37, and is axially extended from the distal end of the outer sheath member 19. Are arranged in series along. The plurality of clip units 13 are arranged such that the terminal clip unit on the opposite side to the distal end has the rear end opposite to the insertion side of the clip body 35 of the fastening ring 37 as the distal end of the inner sheath member 21. It is abutted against the tip of the.

  The hand operating portion 17 is movable forward and backward with respect to the operating portion main body 27, an outer sheath connecting body 25 that fixes the proximal end side of the outer sheath member 19, an operating portion main body 27 that fixes the proximal end side of the inner sheath member 21. And a slider 29 connected to the operation wire 23, and a finger ring 33 connected to the operation unit main body 27. The hand operating section 17 adjusts the relative position of the outer sheath member 19 and the inner sheath member 21 by relatively moving the outer sheath connector 25 and the operating section main body 27, and the operating section main body 27 and the slider 29. The relative position between the inner sheath member 21 and the clip unit 13 connected to the operation wire 23 is adjusted.

  When the clip operating device 11 pushes the operating portion main body 27 forward with the outer sheath connector 25 fixed, the outer sheath member 19 moves rearward relative to the inner sheath member 21 at the distal end, Conversely, when the operation portion main body 27 is pulled backward, the outer sheath member 19 moves forward relative to the inner sheath member 21 at the distal end. Further, when the slider 29 is moved away from the finger ring 33, the operation wire 23 moves from the inner sheath member 21. On the contrary, when the slider 29 is moved closer to the finger ring 33, the operation wire 23 is moved into the inner ring. It moves in the direction of being drawn into the sheath member 21. The clip unit 13 loaded on the distal end of the outer sheath member 19 is held by an operation wire 23, and will be detached from the clip operation device 11 by pulling of the operation wire 23 as will be described in detail later. .

<Clip unit>
Next, the configuration of the clip unit 13 will be described in detail.
FIG. 3 shows an exploded perspective view of the clip unit. The clip unit 13 includes a tightening ring 37 and a clip body 35 that is inserted into the cylindrical body of the tightening ring 37. The clip main body 35 has a pair of arm portions 41 that are urged to expand and a base end portion 39 that connects the base ends of the arm portions 41, and grips the living tissue by the arm portions 41. The clip body 35 is formed by bending a belt-like metal plate material having a spring property such as stainless steel into a substantially U shape. The fastening ring 37 is a cylindrical member made of a metal material such as stainless steel, and the operation wire 23 is inserted through the inside thereof. The base end side of the clip body 35 is accommodated in the fastening ring 37 in a state where the loop portion 71 of the operation wire 23 is locked to a part of the clip body 35.

<Clip body>
The clip main body 35 is shown in FIG. 4A as a side view of the clip main body, and in FIG. The clip main body 35 has wire locking means including a locking claw 43 and a retaining portion 45 at the base end portion 39. The wire locking means locks the loop portion 71 of the operation wire 23. The locking claws 43 are respectively inclined and extended so as to extend outward from the width direction both sides of the arm portion 41 at the bottom 39 a of the base end portion 39 toward the arm portion 41. That is, the latching claw 43 is inclined and extended outward in the radial direction of the clamping ring 37 in the direction opposite to the insertion direction from the proximal end 39 of the clip body 35 to the clamping ring 37. . The locking claw 43 is a plate-like body narrowed so that the force required to plastically deform the locking claw 43 is larger than the force that pulls the clip body 35 into the fastening ring 37.

  The retaining portion 45 is a protrusion projecting toward the locking claw 43 from a position spaced from the connecting portion with the locking claw 43 at the proximal end portion 39 of the clip body 35 toward the arm portion 41 side. There is an inclined surface 45a whose protruding height toward the pawl 43 gradually increases in the direction of insertion of the clip body 35 into the fastening ring 37. Thus, a gap 47 for locking the loop portion 71 of the operation wire 23 is defined by the locking claw 43, the side surface 45b of the base end portion 39 side of the retaining portion 45, and the side surface in the width direction of the base end portion 39. Is done. The gap between the protruding tip of the retaining portion 45 and the locking claw 43 is made smaller than the diameter of the operation wire 23, and details will be described later, but the loop portion 71 of the operation wire 23 elastically deforms the locking claw 43. When entering the gap 47, the loop portion 71 of the operation wire 23 is prevented from falling out of the gap 47.

  In the illustrated example, the upper and lower pairs of locking claws 43 and retaining portions 45 are formed, but they may be formed only on one side. In addition, as shown in the example, a pair of upper and lower locking claws 43 and retaining portions 45 are formed on the clip main body 35, and two loop portions 71 of the operation wire 23 are further formed, and two loop portions are It is good also as a structure each latched to the one latching claw 43 separately. In that case, the clip body 35 can be stably moved without the traction force of the operation wire 23 being biased.

  The pair of arm portions 41 are symmetrically arranged oppositely and are band-shaped metal plate members having spring properties, and have a predetermined width in a direction orthogonal to the expanding direction of the pair of arm portions 41 in order from the base end portion 39. A plate-like piece portion 51, a wide portion 53 wider than the plate-like piece portion 51, and a tissue gripping portion 55 capable of sandwiching a living tissue. The pair of arm portions 41 are urged so as to expand each other by the spring property of the material of the clip body 35. The pair of arms 41 includes a wide portion 53 formed gradually wider from the plate-like piece portion 51, a step portion 57 formed between the wide portion 53 and the plate-like piece portion 51, and a tip of the wide portion 53. A tissue gripping portion 55 formed on the side is provided.

  The pair of arm portions 41 is bent so as to expand outward at a first bending point 41 a provided on the base end portion 39 side of the plate-like piece portion 51, and is provided at a middle position of the plate-like piece portion 51. It is bent inward at a point 41b. Further, the tissue gripping portion 55 is formed by being bent inward at a third bending point 41 c on the distal end side of the wide portion 53.

  When the pair of arm portions 41 are opened due to the spring property of the clip body 35, the pair of tissue gripping portions 55 are spaced apart from each other to form a sandwiching gap 73 between the pair of tissue gripping portions 55. When the arm portion 41 is closed, the tips can come into contact with each other to sandwich the living tissue. It should be noted that the tip of the tissue gripping portion 55 may be linear as shown in the figure, or may be formed in an uneven shape that meshes with each other so that the living tissue can be securely sandwiched.

<Tightening ring>
5A is a cross-sectional view taken along the line AA in FIG. 3, and FIG. 5B is a cross-sectional view taken along the line BB. As shown in FIGS. 3, 5 </ b> A, and 5 </ b> B, the tightening ring 37 includes a hollow cylindrical portion 61, a pair of clip contact portions 63, and a pair of clip retaining pieces 65.

  The fastening ring 37 closes the pair of arm portions 41 by inserting the proximal end portion 39 of the clip body 35 into the cylindrical body. The pair of clip contact portions 63 and the pair of clip retaining pieces 65 are formed by bending each pair of protrusions protruding in the axial direction from one end of the cylindrical portion 61 to the inside of the fastening ring 37 in the radial direction. doing. The clip retaining piece 65 extends from the end of the tightening ring 37 on the clip body insertion side so as to incline toward the inside of the ring in the insertion direction of the clip body 35. The pair of clip contact portions 63 and the pair of clip retaining pieces 65 are arranged at circumferential positions different from each other by 180 °, and the clip contact portion 63 and the clip retaining pieces 65 are different from each other by 90 °. It is formed at a circumferential position.

  The pair of clip contact portions 63 has a flat surface parallel to the axis of the tightening ring 37 by bending a protrusion protruding from one end of the cylindrical portion 61. A pair of guide pieces 69 projecting inward in the radial direction of the fastening ring 37 are formed on both sides of the clip contact portion 63. The distance between the pair of guide pieces 69 is set to be larger than the width W1 (see FIG. 4) of the plate-like piece portion 51 of the clip body 35 and smaller than the width W2 of the wide portion 53.

  Thereby, when the clip main body 35 is inserted into the fastening ring 37, the flat surfaces of the clip abutting portion 63 abut against both outer side surfaces of the arm portion 41 to guide the clip main body 35, and the center of the fastening ring 37 While restricting the rotation of the clip body 35 relative to the shaft, the stepped portion 57 of the wide portion 53 and the plate-like piece portion 51 comes into contact with the pair of guide pieces 69, and the insertion length of the clip body 35 into the fastening ring 37 is Limit.

  Further, when the clip main body 35 is inserted into the fastening ring 37 from the base end portion 39 side, both outer side surfaces of the pair of arm portions 41 are pressed by the flat surfaces of the clip abutting portions 63, and the arm portions 41. Is closed. The flat surface of the clip abutting portion 63 with which both outer surfaces of the arm portion 41 abut is not particularly limited to a flat surface as long as the rotation of the clip body 35 with respect to the central axis of the fastening ring 37 can be restricted. A plurality of protrusions that are in point contact with both outer side surfaces of the arm portion 41 or protrusions that are in line contact can also be used.

  The pair of clip retaining pieces 65 are provided at one end of the cylindrical portion 61, and from the end on the clip body insertion side of the tightening ring 37 to the front of the clip body 35 in the insertion direction and radially inward of the tightening ring 37. It is inclined and extends in a substantially V-shaped cross section. The pair of clip retaining pieces 65 are latched by the latching claws 43 (see FIG. 3) of the clip body 35 inserted into the tightening ring 37, and the clip body 35 once inserted comes out of the tightening ring 37. To prevent.

<Connection between clip unit and operation wire>
The clip main body 35 and the tightening ring 37 having the above-described configuration become the clip unit 13 when the clip main body 35 is inserted into the tightening ring 37. A plurality of clip units 13 are loaded in the outer sheath member 19 of the clip operating device 11 (see FIG. 1), and the leading clip unit 13 is locked by the operation wire 23. FIGS. 6A to 6D show the procedure for assembling the leading clip unit 13 to the clip operating device. In the figure, the clip operation device is omitted.

  First, as shown in FIG. 6A, the loop portion 71 formed at the tip of the operation wire 23 is inserted into the fastening ring 37, and the locking claw 43 of the clip body 35 is inserted into the loop portion 71 of the operation wire 23. 6B, the clip main body 35 is inserted into the tightening ring 37 from the base end 39 side. Then, the locking claw 43 abuts against the pair of retaining pieces 65 and elastically deforms inward in the radial direction of the fastening ring 37 to get over the retaining pieces 65. Then, when the pair of latching claws 43 pass through the clip retaining piece 65, the pair of latching claws 43 are elastically restored by a spring force, and the tip ends abut against the inner peripheral surface 37 a of the tightening ring 37. Thereby, the latching claw 43 is latched from the inner side to the clip retaining piece 65, and is prevented from coming off from the tightening ring 37. Although details will be described later, in the ligating apparatus of this configuration, a plurality of clip units 13 are loaded in the outer sheath member 19 in series.

  Here, as shown in FIG. 6C, when the operation wire 23 is pulled in the insertion direction of the clip main body 35 (the right direction in the figure), the loop portion 71 includes the retaining piece 65 of the fastening ring 37 and the clip. It is guided by the inclined surface 45 a of the retaining portion 45 of the main body 35 and comes into contact with the inner surface of the locking claw 43. Then, as shown in FIG. 6D, the locking claw 43 is elastically deformed radially outward of the fastening ring 37, so that the loop portion 71 of the operation wire 23 is detached from the locking claw 43. The operation wire 23 is locked to the locking claw 43 by being inserted into a gap 47 defined by the locking portion 45 and the end surface in the width direction of the base end portion 39.

  Since the loop portion 71 of the operation wire 23 is inserted into the gap 47 due to the elastic deformation of the locking claw 43, once inserted into the gap 47, the loop chamfer 43 can be removed from the gap 47 unless the locking claw 43 is deformed. Absent. Thereby, the clip unit 13 is assembled to the clip operating device 11. The operation wire 23 is locked only on one side (upper side in the figure) of the clip body 35 in the illustrated example, but is locked on both sides (upper and lower sides in the figure) of the clip body 35 by the two operation wires 23. It is good also as a structure.

<Basic ligation procedure with ligation device>
As shown in FIG. 7A, the clip unit 13 assembled to the clip operating device 11 as described above extends the outer sheath member 19 that is an introduction tube to the front, so that the distal side of the outer sheath member 19 Housed in the tip. This is a state in which the outer sheath connection body 25 shown in FIG. 1 is fixed at a position away from the operation portion main body 27. At this time, the proximal end side of the clip unit 13 abuts on the distal end of the inner sheath member 21. Further, the pair of arm portions 41 of the clip main body 35 are in contact with the inner peripheral surface of the extended outer sheath member 19 and are accommodated in the outer sheath member 19 in a state of being elastically deformed in a direction approaching each other. With the outer side of the clip unit 13 covered with the outer sheath member 19 as described above, the insertion portion 15 of the ligating apparatus 100 is inserted into the body cavity from a forceps hole of an endoscope (not shown) that has been previously inserted into the body cavity. And while observing the inside of a body cavity with an endoscope, the front-end | tip of the insertion part 15 is guide | induced to the ligation target site | part of a biological tissue.

  Next, when the outer sheath connector 25 shown in FIG. 1 is moved to the operating portion main body 27 side until the clip located at the head is exposed, the outer sheath member 19 is fixed as shown in FIG. 7B. The clip unit 13 is moved forward (distal end side) by being pressed by the inner sheath member 21 relatively moving inside, and the pair of arm portions 41 of the clip body 35 protrudes from the outer sheath member 19. Since the pair of arm portions 41 are released from the restraint by the outer sheath member 19, the pair of arm portions 41 are expanded by the spring force of the clip body 35, and a sandwiching gap 73 is formed between the tissue gripping portions 55 and 55. In this state, the clip body 35 is positioned so that a desired living tissue is disposed in the holding gap 73.

  Then, in a state where the position of the tissue gripping portion is optimum, the slider 29 shown in FIG. 1 is moved in a direction to approach the finger ring 33 and the operation wire 23 is pulled into the inner sheath member 21, thereby causing the operation wire 23 to move. Pull relative to the inner sheath. Then, as shown in FIG. 7C, the loop portion 71 of the operation wire 23 pulls the locking claw 43 and the clip main body 35 is pulled into the tightening ring 37. At this time, the pair of arm portions 41 that are in contact with the flat surface of the clip contact portion 63 of the tightening ring 37 are closed by the clip contact portion 63 as indicated by a solid line in the drawing.

  Further, when the slider 29 shown in FIG. 1 is moved away from the finger ring 33 and the operation wire 23 is moved out relative to the inner sheath, the clip body 35 is pushed out from the tightening ring 37, and the clip is pressed. Since the restraint of the pair of arm portions 41 by the flat surface of the contact portion 63 is released, the pair of arm portions 41 expands as shown by a broken line in the figure.

  That is, the pair of arm portions 41 is closed by pulling the operation wire 23 relative to the inner sheath, and the pair of arm portions 41 is opened by extending the operation wire 23 relatively. During the above operation, both the outer surfaces of the arm portion 41 are in contact with the flat surface of the clip contact portion 63, so that the clip body 35 does not rotate with respect to the central axis of the fastening ring 37. The pair of arms 41 is stably opened and closed by protruding from the tightening ring 37.

  By the above closing and opening operations, the biological tissue can be re-gripped by a simple operation. That is, it is possible to re-grip only by operating the operation unit main body 27 and the finger ring 33, and the operation of the operator can be simplified.

<Continuous configuration of clip unit>
A plurality of clip units having the above configuration are loaded in series in the outer sheath member. Hereinafter, the interrelationship between the plurality of clip units will be described in detail.
FIG. 8A is a vertical sectional view of the ligating apparatus in which a plurality of clip units are loaded in the outer sheath member, FIG. 8B is a horizontal sectional view, and FIG. 9 is a perspective view of the main part of the ligating apparatus except for the outer sheath member. FIG. In the following description, the same members as those shown in FIGS. 1 to 7 are denoted by the same reference numerals, and redundant description is omitted.

  As shown in FIGS. 8A, 8 </ b> B, and 9, the ligating apparatus 100 of this configuration includes a plurality of clip units 13 including a clip main body 35 and a fastening ring 37 in a row in the outer sheath member 19. Inserted in an aligned state. In each clip unit 13, the rotation position within the outer sheath member 19 is restricted by the catch claw 43 of the clip body 35 being sandwiched between the loop portions 71 of the operation wire 23. In the illustrated example, all the clip units 13 are loaded in the outer sheath member 19 in series with the same rotational posture.

  The operation wire 23 is inserted through each of the plurality of tightening rings 37, and the loop portion 71 of the operation wire 23 has an overall length corresponding to the length of the plurality of clip units 13 arranged and arranged in at least one row. . The distal end of the loop portion 71 is the width of the locking claw 43, the retaining portion 45, and the proximal end portion 39 of the clip main body 35 shown in FIG. 3 of the clip unit 13 </ b> A located at the distal end of the outer sheath member 19. It is inserted into a gap 47 defined by the direction end face. That is, the operation wire 23 is locked to the locking claw 43 of the leading clip unit 13A. Further, the locking claws 43 of the rear clip units 13B, 13C, and 13D are in contact with the inner peripheral surface 37a of the tightening ring 37 in a state of entering the loop portion 71.

  The pair of arm portions of the clip main body 35 of each clip unit 13A, 13B, 13C, 13D arranged in a line is adjacent to the front of the pair of arm portions 41 of the clip main body 35 positioned at the rear. Housed in a clamping ring 37. Thereby, when the insertion part 15 of the ligation apparatus 100 is introduced into the body cavity, the tightening rings 37 are prevented from acting on the clip body 35 due to the external force generated by the insertion operation. Therefore, even if the insertion portion 15 is bent and the fastening rings 37 are bent and introduced into the body cavity, the clip body 35 is protected by the fastening ring 37 and the clip body 35 is damaged. Can be prevented.

  In addition, since the plurality of clip units 13A, 13B, 13C, and 13D are aligned and arranged in the same rotational posture, the loop portion 71 of the operation wire 23 is released from the engagement with the leading clip unit 13A. It can be locked to the locking claw 43 of the rear clip unit 13B. Similarly, with respect to the rear clip units 13C and 13D, the loop portion 71 can be sequentially locked to the locking claw 43, and continuous ligation can be performed by continuously extending each clip body 35. Become.

<Procedure for continuous feeding of clip unit>
Here, a continuous feeding procedure of the clip unit by the ligating apparatus having the above configuration will be described.
FIGS. 10A to 10F are schematic perspective views showing a continuous ligation procedure by the ligation apparatus. First, the insertion portion 15 is introduced into the body cavity via an endoscope channel that has been inserted into the body cavity in advance, and the distal end of the insertion portion 15 is ligated in a living tissue while observing the inside of the body cavity with the endoscope. To be located. Thereafter, as shown in FIG. 10A, the pair of arm portions 41 of the clip unit 13A located at the head of the outer sheath member (not shown) is opened. Note that the operations for opening and closing the arm portion 41 are the same as described above, and thus the description thereof is omitted here.

  Next, as shown in FIG. 10 (B), the operation wire 23 is pulled with respect to the inner sheath member, and via the locking claw 43 of the leading clip unit 13A to which the loop portion 71 of the operation wire 23 is locked. Then, the clip main body 35 of the clip unit 13 </ b> A is pulled into the fastening ring 37. As a result, the pair of arm portions 41 of the clip unit 13 </ b> A is closed by being guided by the clip contact portion 63 of the fastening ring 37, and the living tissue 81 is gripped between the tissue gripping portions 55 and 55.

  As shown in FIG. 11, the base end portion 39 of the clip main body 35 of the clip unit 13A is inserted into the arm portion 41 of the clip main body 35 of the rear clip unit 13B. Therefore, the maximum width WF of the base end portion 39 in the arm portion 41 expansion direction with respect to the clip main body 35 of the clip unit 13A is the rear clip unit that is elastically biased to contact the inner peripheral surface 37a of the tightening ring 37. The opening width WR of the pair of arm portions 41 (tissue gripping portion 55) of the 13B clip main body 35 is set smaller. Therefore, when the clip main body 35 of the clip unit 13A is pulled into the fastening ring 37, the base end portion 39 of the clip main body 35 of the clip unit 13A is inserted into the arm portion 41 of the clip main body 35 of the rear clip unit 13B. The

  With this configuration, the axial length of the tightening ring 37 can be shortened, and the insertion portions 15 accommodated in the clip units 13A, 13B, 13C, and 13D aligned in a row can be easily bent. Thus, the flexibility is improved, and the bending operability when inserted into the body cavity and the shape followability to the body lumen are improved.

  When the operation wire 23 is pulled as shown in FIG. 10B, the step between the wide portion 53 of the arm portion 41 and the plate-like piece portion 51 in the clip body 35 of the leading clip unit 13A shown in FIG. The portions 57 are in contact with the pair of guide pieces 69, respectively, so that the backward movement of the clip body 35 is restricted. When the operation wire 23 is further pulled from this state as shown in FIG. 10C, the locking claw 43 of the leading clip body 35 starts plastic deformation in the pulling direction of the operation wire 23, and FIG. As shown in FIG. 4, the locking claw 43 is greatly plastically deformed, and the locking claw 43 and the loop portion 71 are unlocked. At this time, the tissue gripping portion 55 of the leading clip body 35 holds the ligation of the living tissue 81.

  As described above, in the ligating apparatus 100 of this configuration, the separation between the operation wire 23 and the clip main body 35 is realized by plastic deformation of the locking claw 43 regardless of the breakage of the member, so that no broken pieces are generated. Thus, damage caused by broken fragments is completely prevented.

  When the operation wire 23 continues to be pulled, as shown in FIG. 10 (E), the loop portion 71 unlocked from the leading clip body 35 is the retaining portion of the clip body 35 disposed on the rear side. It is guided by the inclined surface 45 a of 45 and moves outward in the radial direction of the tightening ring 37 and abuts against the inner surface of the locking claw 43.

  Then, as shown in FIG. 10 (F), by slightly elastically deforming the locking claw 43 by pulling the operation wire 23, the loop portion 71 of the operation wire 23 becomes the locking claw 43, the retaining portion 45, And the gap 47 defined by the end surface in the width direction of the base end portion 39 enters. Thereby, the locking claw 43 of the clip main body 35 of the next-stage clip unit 13B and the operation wire 23 are automatically locked, and preparation for the next living tissue ligation is completed. Further, the clip unit 13A is separated from the ligation apparatus 100 and is left in the body cavity while the living tissue is ligated.

  As described above, according to the ligation apparatus 100 of this configuration, every time the ligation of the living tissue is finished, the insertion unit 15 of the ligation apparatus 100 is continuously inserted into the body cavity without being pulled out of the body cavity. Living tissue can be ligated. Therefore, efficient ligation is possible and the burden on the patient can be reduced.

  In the above description, the pair of arms 41 are opened and closed by pulling and feeding the operation wire 23. However, as shown in FIG. 13, the outer sheath member 19 is advanced relative to the inner sheath member 21, By retracting, the pair of arm portions 41 can be opened and closed. Specifically, as shown in FIG. 13A, the pair of arm portions 41 accommodated and closed in the outer sheath member 19 retreats the outer sheath member 19, thereby causing FIG. ), The restraint by the outer sheath member 19 is released to open, and a sandwiching gap 73 is formed between the pair of arm portions 41.

  Next, as shown in FIG. 13C, after the sandwiching gap 73 is positioned in the living tissue 81, when the outer sheath member 19 is advanced, the outer surfaces of the pair of arm portions 41 become the inner periphery of the outer sheath member 19. The pair of arms 41 sandwich the living tissue 81 by contacting the surface and closing. Thus, by moving the outer sheath member 19 forward and backward, the pair of arms 41 can be opened and closed to temporarily fix the living tissue 81. Then, after confirming that the target biological tissue 81 is held between the pair of arm portions 41, the biological tissue 81 is ligated by pulling the operation wire 23 as already described with reference to FIG.

<Means for connecting adjacent clip units>
Next, a connecting mechanism (connecting means) between adjacent clip units will be described. 14 is a perspective view of a configuration example of the coupling mechanism of the clip unit, FIG. 15 is a cross-sectional view of the main part of the coupling mechanism of the clip unit of FIG. 14, and FIG. 16 shows a state in which the engagement of the coupling mechanism of FIG. It is sectional drawing shown roughly.

  In the tightening ring of this configuration, the tightening rings 38 </ b> A and 38 </ b> B adjacent in the front-rear direction are coupled by the coupling mechanism 85. The coupling mechanism 85 is formed on a lock piece 87 extending from one fastening ring 38 </ b> A toward the other fastening ring 38 </ b> B and a part of the other fastening ring 38 </ b> B, and engages with the lock piece 87. Engagement receiving portion 101. The fastening rings 38A and 38B constitute the clip unit 14 with the clip body 35 assembled thereto.

  The lock piece 87 is provided on the front end side of the tightening ring 38, and protrudes from the inner peripheral surface of the cylindrical portion 62 toward the radially inner side, and branches from the base portion 89 and extends forward in the axial direction. After that, a support shaft 91 (first engaging portion) that is bent outward in the radial direction, a branch from the base portion 89 and extending inward in the radial direction, and a tip portion having a substantially square shape toward the front in the axial direction. A bent wire locking piece 93. The engagement receiving portion 101 is provided on the rear end side of the tightening ring 38 and includes an engagement hole 103 (second engagement portion) that can engage with the support shaft 91 (first engagement portion).

  The support shaft 91 (first engagement portion) of the lock piece 87 is engaged with the engagement hole 103 (second engagement portion) of the engagement receiving portion 101 by its elasticity, so that the tightening rings 38A, 38B are engaged. They are linked together. The joining surfaces of the end faces of the fastening rings 38A and 38B are preferably arcuate when viewed in the axial direction (see FIG. 26), and the support shaft 91 of the coupling mechanism 85 has the arcuate shape of the joining surface. It should be placed at the center of curvature. Thereby, even when the tightening rings 38A and 38B are bent, the engagement between the support shaft 91 (first engagement portion) and the engagement hole 103 (second engagement portion) is smoothly performed, The connected state of both the fastening rings 38A and 38B can be stably maintained.

Next, the disengagement of the coupling mechanism 85 will be described with reference to FIG.
FIGS. 16A to 16D are cross-sectional views schematically showing a state where the coupling mechanism is disengaged. FIG. 16A shows a state corresponding to FIG. 10D in which the engagement between the front clip body 35 (not shown) and the loop portion 71 of the operation wire 23 is released, and the engagement with the clip body 35. By pulling the operation wire 23 released, the loop portion 71 of the operation wire 23 protrudes from the base 89 of the lock piece 87 toward the inside of the fastening ring 38 as shown in FIG. As shown in FIG. 16 (C), the operation wire 23 is pulled, so that the wire locking piece 93 is elastically deformed or plastically deformed by the traction force, as shown in FIG. 91 (first engagement portion) is pulled out from the engagement hole 103 (second engagement portion). Thereby, the engagement of the coupling mechanism 85 is released, and the tightening rings 38A and 38B are separated.

  Then, as shown in FIG. 16D, the loop portion 71 released from the leading clip body 35 is guided and tightened to the inclined surface 45a of the retaining portion 45 of the clip body 35 disposed rearward. It moves outward in the radial direction of the attached ring 38 </ b> A and comes into contact with the inner surface of the locking claw 43 to slightly elastically deform the locking claw 43 and enter the gap 47. Thereby, the locking claw 43 of the clip main body 35 of the clip unit 14 of the next stage and the operation wire 23 are automatically locked, and the preparation for the next living tissue ligation is completed.

  In the illustrated example, the lock piece 87 and the engagement hole 103 are provided in two locations at different circumferential positions of the tightening ring, but the engagement of either one of the sets is released. It may be a configuration. In that case, the fastening ring is displaced by releasing the engagement of one set, and the engagement of the other set is automatically released. In addition, as shown in FIG. 16, if the loop portion 71 of the operation wire 23 is locked to both sets and the both are disengaged at the same time, a more reliable connection release operation can be performed.

<Modification of coupling mechanism>
FIG. 17 is an enlarged perspective view of a main part of a modification of the coupling mechanism. As shown in FIG. 17, the lock piece 87 of the coupling mechanism 85 of the modified example is configured such that the base 89 extends forward from the front end of the fastening ring 38 (cylindrical portion 62) and is bent radially inward. ing. Since other configurations and operations are the same as those of the coupling mechanism 85 described with reference to FIGS. 14 to 16, the same portions are denoted by the same reference numerals and description thereof is omitted.

  Further, as shown in FIGS. 18A and 18B, the lock piece of the coupling mechanism is a lock piece 87A formed by bending a belt-like plate portion 105 protruding forward from the fastening ring 38 (cylindrical portion 62). May be. The lock piece 87A is bent in a substantially square shape at the root portion 107 branched from the fastening ring 38, and extends in a radially inward direction toward the front (in the other fastening ring 38 direction). A plate portion 105, a wire locking portion 109 that is curved in a substantially U shape from the belt-shaped plate portion 105 outward in the radial direction, and provided at the tip of the wire locking portion 109, and protrudes outward in the radial direction. And a supporting shaft 111 (first engaging portion).

  In the lock piece 87A of this configuration example, the support shaft 111 (first engagement portion) is engaged with the engagement hole 103 (second engagement portion) of the fastening ring 38 adjacent to the front by the elastic force. As a result, the fastening rings 38 are connected to each other. Then, the fastening rings 38 are connected to each other by pulling the lock piece 87A elastically by engaging the loop portion 71 of the operation wire 23 with the wire locking portion 109 and pulling it. Part) is pulled out from the engagement hole 103 (second engagement part), and the fastening rings 38 are separated from each other.

<Other structural examples of connecting means>
Next, another configuration example of the coupling mechanism (coupling means) will be described with reference to FIGS. 19 is a perspective view of another connecting mechanism, FIG. 20 is a cross-sectional view of the main part of the connecting mechanism, and FIG. 23A is an external side view of FIG.

  As shown in FIGS. 19, 20, and 23 (A), the clip unit 113 of this configuration example includes a tightening ring 115 and a clip body 117 that is inserted into the tightening ring 115. The outer sheath member 19 is arranged in series along the axial direction from the distal end. The tightening ring 115 has an outer diameter slightly smaller than the inner diameter of the outer sheath member 19, a large diameter portion 119 formed on the front end side, and a small diameter reduced diameter formed continuously from the large diameter portion 119. A portion 121, and an intermediate diameter portion 123 having an intermediate outer diameter between the large diameter portion 119 and the reduced diameter portion 121 and continuously formed from the reduced diameter portion 121.

  As a result, when the clip unit 113 is inserted into the outer sheath member 19, a radial clearance CL, which will be described later, is released between the intermediate diameter portion 123 and the inner diameter of the outer sheath member 19 on the entire circumference. Formed over. The large diameter portion 119, the reduced diameter portion 121, and the intermediate diameter portion 123 form a cylindrical portion 125.

  The cylindrical portion 125 is cut along the axial direction from the end of the tightening ring 115 opposite to the insertion side of the clip body 117, that is, from the end of the intermediate diameter portion 123 to a position beyond the reduced diameter portion 121. A pair of slits 127 for expanding the diameter are formed. Each of the diameter-enlarging slits 127 is formed at a circumferential position different by 180 °, and the cylindrical part 125 has semi-cylindrical parts 125a and 125b separated into two in the radial direction by the diameter-enlarging slit 127. The semi-cylindrical portions 125a and 125b have a cylindrical shape in a normal state. When an external force is applied by the clip main body 117 as described later, the rear end portions of the semi-cylindrical portions 125a and 125b (the insertion side of the clip main body is defined as The opposite end) is elastically deformed in a direction away from each other radially outward.

  The large-diameter portion 119 is formed with a connecting portion 119a having an outer diameter to which the intermediate-diameter portion 123 can be fitted, that is, an outer diameter slightly smaller than the inner diameter of the intermediate-diameter portion 123, at the front end. A pair of engaging holes 129 (second engaging portions) penetrating in the radial direction are formed in the connecting portion 119a at circumferential positions different by 180 °. The large-diameter portion 119 includes the clip contact portion 63, the clip retaining piece 65, and the guide piece 69 that have already been described with reference to FIG.

  The reduced diameter portion 121 has a conical inclined surface 131 that is reduced in diameter from the large diameter portion 119 toward the rear, and is connected to the large diameter portion 119 via the inclined surface 131. In addition, a pair of support shafts 133 (first engaging portions) projecting radially inward are formed at the rear end portion of the intermediate diameter portion 123 at the center in the circumferential direction of the two diameter expansion slits 127. That is, the pair of support shafts 133 (first engagement portions) are provided at positions corresponding to the pair of engagement holes 129 (second engagement portions). The support shaft 133 (first engagement portion) and the engagement hole 129 (second engagement portion) constitute a connecting means, and the support shaft 133 engages with the engagement hole 129 by the elastic force of the cylindrical portion 125. The fastening rings 115 are connected to each other.

  As shown in the side view of FIG. 21A and the plan view of FIG. 21B, the clip main body 117 has the same shape as the clip main body 35 shown in FIG. , A locking claw 43, a retaining portion 45, and a gap 47 that locks the loop portion 71 of the operation wire 23. Further, the clip main body 117 is provided with a protrusion 135 as a connection releasing means at the proximal end 39 of the clip main body 117. The projecting portions 135 are disposed behind the retaining portions 45 (on the bottom 39a side of the base end portion 39), and project from the both sides in the width direction of the base end portion 39 in a direction perpendicular to the longitudinal direction of the clip body 117. The locking claw 43 is formed on both sides of the locking claw 43 so as to sandwich it. Other configurations and operations are the same as those of the clip main body 35 shown in FIG.

  As shown in FIG. 20, a plurality of clip units 113 in which a clip main body 117 having a protrusion 135 as a connection release means is inserted into the fastening ring 115 are connected to the support shaft 133 (first engagement) of the fastening ring 115. Portion) and the engagement hole 129 (second engagement portion) are connected to each other, so that the rotational positions of the fastening rings 115 are regulated and inserted in the outer sheath member 19 in a line. Is done. The locking claw 43 of each clip unit 113 is sandwiched between the loop portions 71 of the operation wires 23 inserted through the respective tightening rings 115. The tip of the loop portion 71 is inserted between the pair of protrusions 135 of the clip unit 113 located at the distal end of the outer sheath member 19 and is locked to the locking claw 43.

  FIG. 22 is a cross-sectional view showing a state in which the coupling mechanism is disengaged, and FIG. 23B is an external side view of FIG. When the clip body 117 of the leading clip unit 113 is pulled into the fastening ring 115 via 43, the pair of protrusions 135 eventually abut against the inclined surface 131 of the reduced diameter portion 121, and the inclined surface 131 is moved radially outward. Press. As a result, the semi-cylindrical portions 125a and 125b are elastically deformed so that the rear end portions on the opposite side to the insertion side of the clip body are separated from each other outward in the radial direction. ) Engages with the support shaft 133 (the first engagement portion) to come out of the engagement hole 129 and release the connection between the tightening rings 115. At this time, since the radial clearance CL is formed over the entire circumference between the intermediate diameter portion 123 (semi-cylindrical portions 125a and 125b) and the inner diameter of the outer sheath member 19, the semi-cylindrical portions 125a and 125b are formed. The elastic deformation in the radially outward direction is not hindered, and the connection between the engagement hole 129 and the support shaft 133 is easily released.

  By the subsequent pulling of the operation wire 23, the latching claw 43 is plastically deformed, so that the engagement between the loop portion 71 of the operation wire 23 and the leading clip body 117 is released, and the leading clip unit 113 is separated. Further, when the operation wire 23 is pulled, the loop portion 71 automatically engages with the locking claw 43 of the next clip unit 113, and preparation for the next living tissue ligation is completed.

<Connection structure between adjacent clip units>
24 is a plan view showing a state in which a plurality of clip units are arranged in a straight line, and FIG. 25 is a plan view showing a state in which a plurality of clip units are arranged in a bent and curved state. In the configuration of the clip unit of this configuration, the joining surfaces 37b and 37c between the end surfaces of the adjacent tightening rings 37 are each formed in an arc shape when viewed in the axial direction of the tightening ring 37 (viewed in the direction perpendicular to the paper surface of FIG. 24). Has been. By forming the joint surfaces 37b and 37c between the end faces of the tightening ring 37 into an arc shape when viewed in the axial direction, the tightening ring 37 can be arranged in an inclined state from the axial direction. That is, the adjacent fastening rings 37 can be connected to each other in a plane parallel to the axial direction by the arc-shaped joining surfaces 37b and 37c.

  The joint surfaces 37b and 37c of the tightening ring 37 have a contact area A1 that always contacts at a circumferential position different by at least 180 ° regardless of the bending of the tightening ring 37. Further, it has a contact disengagement region A2 that comes into contact when the tightening rings 37 are arranged in a straight line and does not come into contact when bent.

  At least the joint surfaces 37b and 37c in the contact area A1 are formed in circular arc shapes having the same curvature as viewed in the vertical direction of the fastening ring 37 in the axial direction. For the clip unit of the illustrated example, in the contact area A1, the joining surface 37b on the front side in the axial direction is concave and the joining surface 37c on the rear side in the axial direction is convex, but these joining surfaces 37b, The unevenness of 37c may be reversed.

  Further, on the joint surfaces 37b and 37c of the tightening ring 37, relief portions in which the end portions of the tightening ring 37 are notched in advance may be formed on the concave surface side of the contact disengagement region A2. The escape portion does not come into contact with the facing joint surface 37b and can reliably prevent interference between the side surfaces of the tightening rings 37 when the adjacent tightening rings 37 are bent.

  As a result, the fastening rings 37 can be bent in a plane parallel to the axial direction of the fastening ring 37 by always contacting the concave surface of the joining surface 37b and the convex surface of the joining surface 37c in the contact region A1. It becomes. In addition, the contact area A1 that is always in contact can be made flexible while securing the compression rigidity of the tightening ring 37. As a result, the bending operability when inserted into the body cavity and the shape followability to the body cavity are improved, and the burden on the patient is reduced. In addition, the joint surfaces 37b and 37c of each fastening ring 37 may have, for example, a spherical shape in addition to the above-described configuration having an arc shape when viewed in the axial direction. In this case, the adjacent tightening rings 37 can be bent in any direction.

  As shown in FIG. 26, when the adjacent tightening rings 37 are connected by the connecting mechanism, the support shaft 91 of the connecting mechanism is arranged at the center of curvature of the arc shape of the joint surfaces 37b and 37c. Accordingly, even when the tightening ring 37 is bent, the engagement of the coupling mechanism is not released, and the connection state of both the tightening rings 37 can be stably maintained.

In addition to the connection configuration of the clip unit that can be bent in one direction, the clip unit can be bent in two different directions.
FIG. 27 is a perspective view of clip units in which the bending directions of the tightening rings are alternately arranged at 90 degrees. In the clip unit of this configuration example, the bending center axes C of the adjacent tightening rings 37 are alternately varied by 90 degrees along the arrangement direction of the clip units. That is, the contact areas A1 of the joint surfaces 37b and 37c between the end surfaces of the adjacent tightening rings 37 are alternately varied by 90 degrees.

  As a result, the connected clip units can be bent in two orthogonal directions by the adjacent tightening rings 37. As a result, the bendability of the clip unit is further improved, and bending operability when inserted into a body cavity, Shape followability to the body cavity duct is further improved.

<Other configuration examples of the clip unit>
Next, another configuration example of the clip unit will be described. FIG. 28 is a perspective view showing a state in which a plurality of clip units are arranged in a line with the opening directions of the arms differing from each other by 90 °, FIG. 29 is an exploded perspective view of the clip unit, and FIG. The top view of a main body, (B) is a front view, (C) is a side view.

  As shown in FIG. 28, in this clip unit configuration, a plurality of clip units 42 each having a clip body 36 inserted into a fastening ring 40 are alternately arranged in the axial direction, and an outer sheath member (not shown) is shown. 19 are aligned in series. In the aligned clip bodies 36, the expanding direction of the arm portion 41 is different by 90 °. The tightening ring 40 is also rotated 90 °.

  29 and 30A, 30B, and 30C, the clip body 36 is provided with a base end portion 39 on the side inserted into the fastening ring 40, and extends from the base end portion 39. It is formed by bending a belt-shaped metal plate material having a pair of arms 41 and having spring properties such as stainless steel into a substantially U shape.

  A pair of wire locking means of the clip main body 36 including the locking claw 44 and the retaining portion 46 are extended from both sides in the width direction of the base end portion 39 orthogonal to the arm portion expanding direction of the base end portion 39. The parallel part 50 is bent in the plate thickness direction of the clip main body 36 (arm part expanding direction), and is arranged at a diagonal position of the base end part 39.

  The locking claw 44 is inclined and extended so as to extend outward from the position on the bottom 39 a side of the base end 39 toward the arm 41 from the retaining portion 46. The force required for plastic deformation of the locking claw 44 is a plate-like body narrowed to such an extent that the force required to pull the clip main body 36 into the fastening ring 40 is larger.

  The retaining portion 46 is a protruding portion that protrudes toward the locking claw 44 from a position spaced from the locking claw 44 toward the arm portion 41, and the protruding height toward the locking claw 44 has a clip body 36. And an inclined surface 46a that gradually increases in the direction of insertion into the tightening ring 40. The locking claw 44 and the retaining portion 46 are formed by a parallel portion 50 that is bent and erected from the width direction end portion of the base end portion 39. Accordingly, as shown in FIGS. 29 and 30A, a gap for locking the loop portion 71 of the operation wire 23 by the locking claw 44, the retaining portion 46, and the parallel portion 50 of the base end portion 39. 47 is defined.

  The force required to plastically deform the locking claw 44 is set to be larger than the force that pulls the clip body 36 into the tightening ring 40. As a result, the clip body 36 is plastically deformed when the operation wire 23 is pulled while the loop portion 71 of the operation wire 23 shown in FIG. 28 is engaged with the engagement claw 44. Without being retracted into the tightening ring 40.

  As shown in FIG. 29, the tightening ring 40 includes a hollow cylindrical portion 61 and a pair of clip contact portions 63. The pair of clip abutting portions 63 bends the projecting portion projecting from one end portion of the cylindrical portion 61 and has a flat surface parallel to the axis of the fastening ring 40. The clip body 36 is guided by coming into contact with the outer surface, and the rotation of the clip body 36 with respect to the central axis of the tightening ring 40 is restricted.

  A pair of guide pieces 69 are formed on both sides of the clip abutting portion 63 so as to protrude inward in the radial direction of the fastening ring 40. When the clip main body 36 is inserted into the tightening ring 40, the guide piece 69A on the side where the locking claw 44 abuts is formed so as to be inclined toward the inner side of the ring toward the insertion direction of the clip main body 36. Thereby, when the clip main body 36 is inserted into the tightening ring 40, the locking claw 44 abuts on the inner side of the guide piece 69 </ b> A to prevent the clip main body 36 from coming out of the tightening ring 40. Further, the distance between the pair of guide pieces 69 is smaller than the width W2 of the wide portion 53 (see FIG. 4), and the step portion 57 of the wide portion 53 and the plate-like piece portion 51 abuts against the pair of guide pieces 69, The insertion length of the clip body 36 into the tightening ring 40 is limited.

  Then, when the operation wire 23 is pulled and the clip body 36 is pulled into the fastening ring 40 and the stepped portion 57 of the clip body 36 contacts the fastening ring 40 (a pair of guide pieces 69), the locking claw The plastic deformation 44 starts, and the loop portion 71 of the operation wire 23 and the locking claw 44 are unlocked. As a result, the clip unit 42 can be separated from other clip units.

When the clip main body 36 is inserted into the fastening ring 40, the locking claw 44 is elastically urged against and abuts on the inner peripheral surface of the fastening ring 40. Further, the inclined surface 46a of the retaining portion 46 guides the loop portion 71 and reliably inserts it into the clearance 47 for retaining the operation wire when the operation wire 23 is pulled.
Other configurations and effects are the same as those of the above-described configuration example, and thus description thereof is omitted.

  As described above, the present invention is not limited to the above-described configuration example, and modifications and applications by those skilled in the art based on the description of the specification and well-known techniques are also intended to be covered by the present invention. It is included in the range to calculate.

As described above, the following items are disclosed in this specification.
(1) A ligation apparatus for ligating living tissue,
A tubular outer sheath member having flexibility;
A tubular inner sheath member provided in the outer sheath member so as to freely advance and retract;
An operation wire provided in the inner sheath member so as to freely advance and retract;
A plurality of clip units arranged in series inside the distal end of the outer sheath member, and
The clip unit has a pair of arm portions that are expanded and biased to each other, and a clip body that has a base end portion that connects the base ends of the arm portions and ligates a living tissue;
A clamping ring for inserting a base end portion of the clip body into the cylindrical body and closing the pair of arms,
The clamping ring is configured to release the coupling between the clamping rings by coupling a coupling means for coupling adjacent clamping rings with each other, locking the operation wire, and deforming the coupling means by pulling the manipulation wire. A ligation apparatus comprising a connection release means.
According to this ligating apparatus, since the adjacent tightening rings are connected to each other by the connecting means, the connecting means is deformed by pulling the operation wire to release the connection between the tightening rings. A living tissue can be ligated continuously by a plurality of clip units.

(2) The ligation apparatus according to (1),
The operation wire has a loop portion at a tip of the operation wire;
The fastening means of the fastening ring is formed in a lock piece extending from one fastening ring to the other fastening ring and having a first engaging portion on the tip side, and a part of the other fastening ring. A ligation apparatus comprising: an engagement receiving portion having a second engagement portion that engages with the first engagement portion.
According to this ligating apparatus, the coupling means of the tightening ring includes the first engagement portion provided in one of the tightening rings and the second engagement portion provided in the other tightening ring and engaged with the first engagement portion. Since the engaging portion is provided, adjacent fastening rings can be reliably connected to each other.

(3) The ligation apparatus according to (2),
The ligation apparatus provided with the wire latching piece which the said connection cancellation | release means extended from a part of said lock piece, and latches the loop part of the said operation wire.
According to this ligating apparatus, the coupling of the tightening ring is released by the wire locking piece that extends from a part of the lock piece and locks the loop portion of the operation wire. Rings can be automatically disconnected.

(4) The ligation apparatus of (2),
A protrusion projecting from the base end of the clip body in a direction perpendicular to the clip longitudinal direction;
A reduced diameter portion that is formed on a part of the clamping ring, and that the projection portion abuts upon insertion of the clip body into the clamping ring,
A ligation apparatus comprising: a diameter-enlarging slit cut out from an end of the fastening ring opposite to the clip main body insertion side to a position exceeding the reduced-diameter portion along the axial direction.
According to this ligating apparatus, the connection release means includes a protrusion projecting from the base end of the clip body, a reduced diameter portion of the tightening ring against which the protrusion contacts, and a tightening ring along the axial direction. Since the protrusion is in contact with the reduced diameter portion, the fastening ring can be pressed outward by the projection portion being in contact with the reduced diameter portion, so that the connection between the fastening rings can be reliably released.

(5) The ligation apparatus according to (4),
The ligation apparatus in which the slits for diameter expansion are formed at a plurality of circumferential positions straddling the arrangement positions of the coupling means of the tightening ring.
According to this ligating apparatus, since the diameter-enlarging slits are formed at a plurality of circumferential positions straddling the arrangement position of the coupling means, the coupling between the tightening rings can be reliably released.

(6) The ligation apparatus according to any one of (1) to (5),
A wire locking portion provided at a base end portion of the clip body to lock the loop portion of the operation wire;
The wire locking portion includes a locking claw that extends from the proximal end portion of the clip main body toward the rear in the insertion direction of the tightening ring and is inclined outward.
A ligating apparatus comprising: a retaining portion that prevents the loop portion of the operation wire that is latched by the latching claw from being detached from the latching claw.
According to this ligation apparatus, when the living tissue is ligated, the relative position between the clip body and the tightening ring can be changed by pulling and feeding the operation wire, so that the clip can be freely opened and closed. Re-grabbing can be done with a simple operation. In addition, since the clip body and the operation wire are separated due to the deformation of the clip body's latching claw, no fragmentation occurs during the separation, and the fragmentation affects the living tissue or interferes with the ligation operation. There is no fear of it.

(7) The ligation apparatus according to any one of (1) to (6),
The retaining portion protrudes from the base end portion of the clip body toward the locking claw, and a protruding portion that defines a gap for accommodating the loop portion of the operation wire between the locking claw and the locking claw. A ligation device comprising and comprising.
According to this ligating apparatus, the operation wire is maintained in a state of being locked in a gap for locking the loop portion, and even if the operation wire is fed out, the operation wire may be detached from the clip body by the protrusion. Is prevented. Thereby, a clip main body can be advanced and retracted reliably and stably, and a tissue can be regripped smoothly.

(8) The ligation apparatus according to any one of (1) to (7),
A ligating apparatus in which the joining surfaces of the end faces of the tightening ring are each formed in an arc shape when viewed in the axial direction of the tightening ring, and the tightening ring can be bent in a plane parallel to the axial direction. .
According to this ligating apparatus, since the joining surfaces of the end faces of the adjacent tightening rings are each formed in an arc shape, the individual tightening positions are changed from the linear arrangement to the arrangement in which the fastening rings are mutually bent. The ring can be tilted. Thereby, the flexibility of the ligation apparatus is improved, and the bending operability when inserted into the body cavity and the shape following ability to the body cavity duct are improved.

(9) A clip unit used in the ligating apparatus according to any one of (1) to (8).
According to this clip unit, the living tissue can be re-gripped, and the living tissue can be continuously ligated by the plurality of clip bodies.

13, 14, 42, 113 Clip unit 19 Outer sheath member 21 Inner sheath member 23 Operation wire 35, 36, 117 Clip body 37, 38, 40, 115 Clamping ring 37b, 37c Joint surface 39 Base end portion 41 Arm portion 43 44 Locking claws (wire locking part)
45, 46 Retaining part (wire locking part)
47 Gap 71 Loop portion 81 Biological tissue 87 Lock piece 91, 111, 133 Support shaft (first engaging portion, connecting means)
93 Wire locking piece (connection release means)
DESCRIPTION OF SYMBOLS 100 Ligating apparatus 101 Engagement receiving part 103,129 Engagement hole (2nd engaging part, connection means)
121 Reduced-diameter portion 127 Increased-diameter slit 135 Protrusion (connection release means)

Claims (9)

A ligation apparatus for ligating biological tissue,
A tubular outer sheath member having flexibility;
A tubular inner sheath member provided in the outer sheath member so as to freely advance and retract;
An operation wire provided in the inner sheath member so as to freely advance and retract;
A plurality of clip units arranged in series inside the distal end of the outer sheath member, and
The clip unit has a pair of arm portions that are expanded and biased to each other, and a clip body that has a base end portion that connects the base ends of the arm portions and ligates a living tissue;
A clamping ring for inserting a base end portion of the clip body into the cylindrical body and closing the pair of arms,
The clamping ring is configured to release the coupling between the clamping rings by coupling a coupling means for coupling adjacent clamping rings with each other, locking the operation wire, and deforming the coupling means by pulling the manipulation wire. A ligation apparatus comprising a connection release means. The ligation apparatus according to claim 1,
The operation wire has a loop portion at a tip of the operation wire;
The fastening means of the fastening ring is formed in a lock piece extending from one fastening ring to the other fastening ring and having a first engaging portion on the tip side, and a part of the other fastening ring. A ligation apparatus comprising: an engagement receiving portion having a second engagement portion that engages with the first engagement portion. The ligation apparatus according to claim 2,
The ligation apparatus provided with the wire latching piece which the said connection cancellation | release means extended from a part of said lock piece, and latches the loop part of the said operation wire. The ligation apparatus according to claim 2,
A protrusion projecting from the base end of the clip body in a direction perpendicular to the clip longitudinal direction;
A reduced diameter portion that is formed on a part of the clamping ring, and that the projection portion abuts upon insertion of the clip body into the clamping ring,
A ligation apparatus comprising: a diameter-enlarging slit cut out from an end of the fastening ring opposite to the clip main body insertion side to a position exceeding the reduced-diameter portion along the axial direction. The ligation apparatus according to claim 4,
The ligation apparatus in which the slits for diameter expansion are formed at a plurality of circumferential positions straddling the arrangement positions of the coupling means of the tightening ring. The ligation apparatus according to any one of claims 1 to 5,
A wire locking portion provided at a base end portion of the clip body to lock the loop portion of the operation wire;
The wire locking portion includes a locking claw that extends from the proximal end portion of the clip main body toward the rear in the insertion direction of the tightening ring and is inclined outward.
A ligating apparatus comprising: a retaining portion that prevents the loop portion of the operation wire that is latched by the latching claw from being detached from the latching claw. The ligation apparatus according to any one of claims 1 to 6,
The retaining portion protrudes from the base end portion of the clip body toward the locking claw, and a protruding portion that defines a gap for accommodating the loop portion of the operation wire between the locking claw and the locking claw. A ligation device comprising and comprising. The ligation apparatus according to any one of claims 1 to 7,
A ligating apparatus in which the joining surfaces of the end faces of the tightening ring are each formed in an arc shape when viewed in the axial direction of the tightening ring, and the tightening ring can be bent in a plane parallel to the axial direction. .   The clip unit used for the ligation apparatus of any one of Claims 1-8.

Images