JP6700572B2 - Clip device for endoscope - Google Patents

Description

  The present invention relates to a treatment instrument for an endoscope for treating a body tissue by an operation outside the body using an endoscope.

  A treatment instrument for an endoscope is a device in which the distal end side is inserted into the body through an endoscope and performs various treatments on body tissues by an operation outside the body. , Widely used. As endoscopic treatment tools, various forms according to the intended treatment are known, and as one of the forms, there is an endoscopic treatment device having a double-tube structure. it can. An endoscopic treatment tool having a double-tube structure is inserted into a coaxially arranged double-tube and a tube inside the double-tube, and a distal end is used to perform treatment on body tissue. The operating part is configured by an operating wire to which the operating part is attached, and by relatively moving the respective tubes (sheath) and the operating wire along the axial direction, the operating part is projected from the respective sheaths, or It is embedded in each sheath to allow the operation section to perform a desired operation according to the intended treatment.

  An example of an endoscopic treatment tool having a double-tube structure is a clip device described in Patent Document 1. The clip device is a device which is inserted into a body through a treatment instrument guide tube of an endoscope and is used for grasping body tissue with a clip and placing the clip in the body for hemostasis and marking. Is.

  In the clip device described in Patent Document 1, a connecting hook that is engageable with and disengageable from a connecting portion formed at the rear end portion of the clip to be placed inside the body is provided inside the sheath (inner sheath) of the double pipe. It is attached to the tip (distal end) of the threaded drive wire. This connecting hook is urged by the elasticity of itself toward the front so as to open in a substantially V shape, and has a shape in which the tip is bent inward, and when it is drawn into the inner sheath. The substantially C-shaped part closes so that it can be connected to the rear end part of the clip. Then, the clip connected to the connecting hook can be accommodated in the outer sheath (outer sheath) of the double pipe in a closed state. When the outer sheath is pulled into the inner sheath and the drive wire, The clip projects from the outer sheath and is opened. When the clip with the legs opened is brought close to the body tissue to be grasped, and the inner sheath is pushed out against the drive wire, the fastening ring provided on the clip is pushed out by the inner sheath and slides distally. This allows the clip to close its legs and grip (clipping) internal tissue.

Japanese Patent Laid-Open No. 2012-200518

  By the way, the distal end of the endoscope is appropriately curved for the convenience of treatment, but when it is curved relatively large (when it is curved so that the curvature becomes relatively small), it passes through this portion. In doing so, the tip side portion of the clip device is also curved following the bending of the endoscope. Therefore, a certain degree of flexibility is required for the tip side portion of the clip device. On the other hand, when the outer sheath is pulled in to open the clip and the rigidity of the inner sheath is insufficient, the outer sheath is not pulled in well and the clip does not deploy well (the clip does not open or The phenomenon that the legs of the clip are insufficiently opened may occur. Further, when the fastening ring is pushed out by the inner sheath to close the clip, if the rigidity of the inner sheath is insufficient, the force for sliding the fastening ring may be insufficient and clipping may not be performed well. Therefore, the inner sheath is required to have sufficiently high rigidity.

  In order to meet such a contradictory request, in the clip device described in Patent Document 1, an inner sheath is provided with a distal tube disposed at a distal end portion (a portion corresponding to a curved distal end portion of an endoscope), Two tubes, a proximal tube of the tip tube and a body tube arranged over the operating portion, are continuously connected and fixed, and the rigidity of the tip tube is set to be smaller than the rigidity of the body tube. That is, by making the distal end portion of the inner sheath soft and increasing the rigidity of the remaining portion on the proximal end side, the above-mentioned contradictory requirements can be solved at the same time.

  However, even if such a structure is adopted, if the degree of bending of the distal end portion of the endoscope is large (curvature is small), deployment failure of the clip may still occur. Therefore, when the inventor of the present application repeatedly performed simulation experiments and the like, when there was a sharp difference in rigidity at the connecting portion between the distal end tube and the main body tube, when the inner sheath was bent, this connecting portion Is deformed so that it will fold against the remaining part, and this part interferes (is caught, etc.) with the inner surface of the outer sheath and prevents smooth relative movement between the outer sheath and the inner sheath. I found out what was happening.

  The present invention has been made in view of the above circumstances, and is an endoscopic treatment tool that includes an outer sheath and an inner sheath in which two tubes having different rigidity are connected to each other. It is an object of the present invention to solve a malfunction of an endoscopic treatment tool that may occur when the relative movement of the clip is not smooth (for example, a clip deployment defect in the clip device).

The treatment tool for an endoscope according to the present invention,
With a tubular outer sheath,
A tubular inner sheath inserted through the outer sheath,
A drive wire inserted through the inner sheath;
A working portion attached to the distal end of the drive wire,
The inner sheath is
Comprising a tip tube disposed at the tip and a body tube having a distal end connected to the proximal end of the tip tube,
The rigidity of the tip tube is set to a value smaller than the rigidity of the main body tube,
In a predetermined section on the distal end side of the main body tube, the rigidity of the predetermined section is larger than the rigidity of the tip tube, and is smaller than the rigidity of the section of the main body tube other than the predetermined section, It is characterized in that it is a small diameter portion having an outer diameter smaller than a section other than the predetermined section of the main body tube.

  In the present invention, a wire tube formed by spirally twisting a plurality of wire strands is used as the main body tube, and a coil tube formed by spirally winding a single long material is used as the tip tube. You can

  In the present invention, the small diameter portion can be formed by polishing the predetermined section of the main body tube.

  In the present invention, the operating portion includes a pair of arm portions arranged so as to open in a substantially V-shape toward the distal end thereof, and the arm portion has the drive wire attached to the inner sheath. It is possible to use a member that is slid against the inner sheath so as to project from the distal end of the inner sheath to open the leg, and to be embedded in the distal end of the inner sheath to close the leg. In this case, the arm portion may be a connection hook that releasably connects the clip that holds the in-vivo tissue.

  In the present invention, an operation having a base portion connected to the proximal end of the inner sheath and a slider portion connected to the proximal end of the outer sheath and slidably held with respect to the base portion. A part may be further provided. In this case, the operation unit may further include a wire operation unit to which the proximal end of the drive wire is connected and which is slidably held with respect to the base unit.

  According to the treatment tool for an endoscope of the present invention, in the inner sheath, the rigidity of the predetermined section of the distal end side of the main body tube is greater than the rigidity of the distal end tube, and the predetermined section of the main body tube is The small diameter portion of the main body tube having an outer diameter smaller than that of the section other than the predetermined section is used so as to be smaller than the rigidity of the section other than the section. A small-diameter part with medium rigidity is interposed (arranged) between the two, and the bending that was caused by the rapid change in the rigidity of the connection part between the main body tube and the tip tube is suppressed, resulting in a smoother surface. Since the outer sheath is curved, the interference with the inner surface of the outer sheath is reduced. Therefore, the relative movement between the outer sheath and the inner sheath becomes smooth, and the occurrence of malfunction of the endoscopic treatment tool (for example, poor deployment of the clip in the clip device) can be reduced. Therefore, the treatment can be performed smoothly.

It is a figure which shows the whole structure of the treatment tool for endoscopes of embodiment of this invention. It is sectional drawing which followed the AA line of FIG. It is sectional drawing of the main body tube which comprises the inner sheath of embodiment of this invention. It is sectional drawing of the small diameter part of the main body tube which comprises the inner sheath of embodiment of this invention. It is a perspective view showing composition of a coil tube of an embodiment of the present invention. It is a perspective view showing composition of a wire tube of an embodiment of the present invention. It is a side view which shows the structure of the inner sheath of embodiment of this invention. It is a side view which shows the structure after grinding|polishing of the wire tube of embodiment of this invention. It is a figure which shows the structure of the connection hook of embodiment of this invention. It is a perspective view showing composition of a connecting hook of an embodiment of the present invention. It is a top view showing composition of a clip of an embodiment of the present invention. It is a side view which shows the structure of the clip of embodiment of this invention. It is a side view showing the state where the connecting hook of the embodiment of the present invention is projected from the distal end of the inner sheath and the connecting hook is opened. It is a side view showing the state where a clip was connected with the distal end of the inner sheath of an embodiment of the present invention, and was stored in the outer sheath. It is a top view showing the state where a clip was connected with the distal end of the inner sheath of an embodiment of the present invention, and was stored in the outer sheath. It is a top view showing the state where a clip was made to project from the distal end of the outer sheath of an embodiment of the present invention, and a clip was expanded (leg opening). It is a figure which shows the problem when not providing a thin diameter part in an inner sheath. It is a figure which shows the effect at the time of providing a small diameter part in the inner sheath of embodiment of this invention.

  Hereinafter, with reference to the drawings, as an embodiment of a treatment tool for an endoscope according to the present invention, a clip (hemostatic clip) that performs hemostasis and the like is connected and conveyed into the body through an endoscope, and internal tissue A clip device for gripping (clipping) will be described.

  However, the present invention is not limited to such a clip device, and can be widely applied to endoscopic treatment tools having a structure having an outer sheath and an inner sheath (double pipe structure).

  More specifically, for example, it can be applied to a snare ligating device that connects indwelling snares to ligate body tissue, a forceps device that includes forceps that grasp body tissue, and a bipolar high-frequency device that includes a high-frequency electrode that opens and closes. it can.

  First, refer to FIG. 1 and FIG. The clip device 1 is configured to roughly include a connecting hook (operating part) 11, an inner sheath 12, a drive wire 13, an outer sheath 14, a reinforcing coil 15, and an operating part. The operation section has a slider section 16, a base section 17, and a wire operation section 18.

  A tubular inner sheath 12 is also inserted through the tubular outer sheath 14, and a drive wire 13 is inserted through the inner sheath 12. The inner sheath 12 can slide (slide) in the outer sheath 14, and the drive wire 13 can slide (slide) in the inner sheath 12.

  The outer sheath 14 is made of a flexible hollow tube, and as the outer sheath 14, for example, a coil tube can be used. The coil tube is a hollow tube formed by spirally winding a single wire. As the coil tube, for example, as shown by reference numeral 31 in FIG. 5, a single long flat plate 31a made of metal (stainless steel) or the like and having a rectangular cross section is wound in a spiral shape while being closely attached thereto. Wire coil tubes can be used. A round wire coil tube having a circular cross section or an inner flat coil tube having a substantially semicircular cross section (a flat inner surface and a circular outer surface) may be used. The coil tube has a characteristic that the rigidity can be set relatively small (low).

  Further, as the outer sheath 14, a simple tube made of resin or the like may be used, and like the main body tube 12a of the inner sheath 12 described later in detail, the wire tube 32 as shown in FIG. 6 may be used. You may use.

  In the present invention, the rigidity means the degree of difficulty in dimensional change (deformation) with respect to a bending load, and the bending load is F and the bending deformation amount is δ, and the rigidity is represented by k=F/δ. Is large (high), the deformation is small with respect to the force, and the rigidity is small (low), the deformation is large with respect to the force.

  The inner sheath 12 is made of a flexible hollow tube, and as shown in FIG. 7, a distal end tube 12a disposed at the distal end (distal end), a proximal end of the distal end tube 12a, and a base. It is possible to use a body tube 12b arranged over the portion 17 and integrally connected and fixed so as to be continuous with each other. The rigidity of the tip tube 12a is set to a value smaller than the rigidity of the main body tube 12b.

  Adopting such a structure in which tubes of different rigidity are connected is because the inner sheath 12 lacks in rigidity and the clip 2 (details described later) does not deploy properly (the clip does not open or the clip does not open sufficiently). In order to prevent the occurrence of clipping defects and the occurrence of clipping defects, the inner sheath 12 as a whole has sufficient rigidity, and at the distal end portion, the flexibility to follow the bending of the endoscope and smoothly bend. This is because. The length of the distal tube 12a is set to be about the length corresponding to the movable end portion of the endoscope (the portion that is freely curved according to the operation).

  A wire tube can be used as the main body tube 12b. The wire tube is, for example, as shown by reference numeral 32 in FIG. 6, a hollow stranded wire formed by spirally twisting a plurality of wires (cables) 32a made of metal (stainless steel) or the like into a hollow shape. It is a tube consisting of. Since the wire tube has a characteristic that the rigidity can be set relatively high, it is suitable to be used for the main body tube 12b which is required to have sufficiently high rigidity. Due to the high rigidity of the main body tube 12b, when the base portion 17 is slid to the distal end side with respect to the wire operating portion 18, the operated force is surely pushed up by the inner sheath tip portion to push up the ring 24 of the clip 2. It can be a force (sliding).

  A coil tube can be used as the tip tube 12a. As the coil tube used for the distal end tube 12a, for example, a flat wire coil tube 31 as shown in FIG. 5 can be used as in the outer sheath 14 described above. However, as in the case of the outer sheath 14 described above, a round wire coil tube having a circular cross section or an inner flat coil tube having a substantially semicircular cross section (inner surface is flat and outer surface is arcuate) may be used. Is. Since the coil tube has a characteristic that the rigidity can be set to be relatively low, it is suitable to be used for the tip tube 12a which is required to have flexibility (low rigidity).

  When both the outer sheath 14 and the inner sheath 12 are composed of a coil tube or a wire tube, when the clip device 1 is ultrasonically cleaned, the cleaning liquid sufficiently permeates the inside of the tube and the inside and outside are well cleaned. The effect that it becomes possible can be produced.

  When both the outer sheath 14 and the inner sheath 12 are made of a coil tube or a wire tube, it is preferable that the winding directions of the outer sheath 14 and the inner sheath 12 are opposite to each other. It is preferable from the viewpoint of reducing the sliding resistance generated between them. For example, when the outer sheath 14 is Z-wound, the inner sheath 12 is S-wound.

  In the present embodiment, as shown in FIG. 7, on the tip side (distal end side) of the main body tube 12b, a small-diameter portion having an outer diameter smaller than that of the other portion (section) of the main body tube 12b. 12c is formed. The rigidity of the small diameter portion 12c is larger than the rigidity of the distal end tube 12a, and is smaller than the portion (section) other than the small diameter portion 12c of the main body tube 12b. In addition, in the present embodiment, the small-diameter portion 12c has a tapered taper portion 12d having an outer diameter that decreases toward the tip side (distal end side) and the tip side (distal end side) of the taper portion 12d. The constant diameter portion 12e is continuous and has a substantially constant outer diameter in the longitudinal direction. In the present embodiment, polishing is used to form the small diameter portion 12c. The polishing process is not particularly limited, but for example, centerless polishing process can be used. Here, FIG. 3 shows a cross-sectional shape of a portion of the main body tube 12b before polishing which should be the small diameter portion 12c or a portion other than the portion which should be the small diameter portion 12c, and FIG. 4 shows the main body tube 12b after polishing processing. The cross section of the small diameter portion 12c of FIG.

  The method of manufacturing the inner sheath 12 is not particularly limited, but the tip tube 12a and the body tube 12b may be manufactured as separate members, and integrally connected and fixed by laser welding or the like so as to be continuous with each other. Processing such as polishing for forming the small-diameter portion 12c of the main body tube 12b may be performed before connecting the tip tube 12a and the main body tube 12b, or after connecting the two. From the viewpoint of easiness, it is preferable to carry out before connecting the distal end tube 12a and the main body tube 12b.

  When connecting the tip tube 12a and the body tube 12b after forming the small-diameter portion 12c on the body tube 12b, as shown in FIG. It is preferable to form a connection thin portion 12f having an outer diameter smaller than that of the thin portion 12c on the (distal end side). Providing this connection small-diameter portion 12f makes it easy to insert the connection small-diameter portion 12f into the inner cavity of the tip tube 12a to connect the tip tube 12a and the main body tube 12b. For example, when the connecting thin portion 12f is inserted into the lumen of the tip tube 12a and the tip tube 12a existing outside the connecting thin portion 12f is irradiated with the laser beam of the laser welding machine, the tip tube 12a at that portion is Since it melts and is welded to the outer peripheral surface of the connection small-diameter portion 12f, the welded portion 12g shown in FIG. 7 can be formed. The method for forming the connection small diameter portion 12f is not particularly limited and may be formed by polishing or the like. However, when the formation of the small diameter portion 12c is performed by centerless polishing, the connection small diameter portion 12f has a good shape. From the viewpoint of forming the portion 12f, it is preferable to perform a polishing process separate from the centerless polishing process, and for example, a polishing process using a small electric grinder is preferable.

  If the tip tube 12a having low rigidity and the main body tube 12b having high rigidity are simply connected and fixed, a sharp difference in rigidity exists at the connecting portion between the tip tube 12a and the main body tube 12b. As shown in the drawing, when curved, the connecting portion X is deformed so as to be broken, and the connecting portion (bending portion) X interferes with (interlocks with) the inner surface of the outer sheath 14 and slides. The resistance increases, and the relative movement between the outer sheath 14 and the inner sheath 12 is not performed smoothly. Therefore, even if the outer sheath 14 is slid toward the proximal end side with respect to the inner sheath 12 by the operation of the operation portion, the sliding amount is insufficient and the clip 2 is sufficiently moved from the distal end of the outer sheath 14. As a result of not projecting to the side, the clip 2 may have a deployment failure (the arm plates 22 and 22 do not open or the opening is insufficient).

  On the other hand, by forming the small-diameter portion 12c in the vicinity of the distal end of the main body tube 12b by the above-described polishing process or the like, the rigidity of the small-diameter portion 12c is the remaining portion of the main body tube 12b. As a result, the inner sheath 12 is between the portion (section) other than the small diameter portion 12c of the main body tube 12b having a relatively high rigidity and the distal end tube 12a having a relatively low rigidity. Then, the small-diameter portion 12c having a medium rigidity is arranged, and the rigidity changes stepwise. Therefore, for example, as shown in FIG. 18, the connection portion X between the main body tube 12b (the small diameter portion 12c) and the distal end tube 12a is less likely to be deformed such that the connection portion X has a smoother curve. Therefore, the interference with the inner surface of the outer sheath 14 is reduced, and the sliding resistance is reduced. As a result, the outer sheath 14 and the inner sheath 12 are smoothly moved relative to each other, and the clip 2 is sufficiently protruded from the distal end of the outer sheath 14 to prevent defective deployment of the clip 2.

  Further, since the distal end side of the main body tube 12b is thinned by polishing or the like, the rigidity of the small diameter portion 12c can be arbitrarily changed and adjusted by appropriately adjusting the diameter of the small diameter portion 12c. The rigidity of the diameter portion 12c can be easily changed and adjusted to an optimum value in relation to the rigidity of the distal end tube 12a and the rigidity of the portion (section) other than the small diameter portion 12c of the main body tube 12b.

  In addition, here, although the tapered portion 12d and the constant diameter portion 12e are provided, and the small diameter portion 12c having substantially the same length is provided, the tapered portion 12d and the constant diameter portion 12e have the same length. May be different, and either the tapered portion 12d or the constant diameter portion 12e may be lengthened. Further, the small diameter portion 12c may be configured by only one of the taper portion 12d and the constant diameter portion 12e, but from the viewpoint of making the change in rigidity more gradual, the small diameter portion 12c has a distal end side ( It is preferable to have a tapered taper portion 12d having a smaller outer diameter toward the distal end side). The length of the small-diameter portion 12c is not particularly limited, but from the viewpoint of sufficiently exerting the effect of providing the small-diameter portion 12c and ensuring the rigidity of the inner sheath 12, it is set within a range of 10 to 120 mm. Is preferred.

  The outer diameter of the portion (section) other than the small diameter portion 12c of the main body tube 12b is not particularly limited, but is set in the range of 1.5 to 1.9 mm, for example. The outer diameter of the small diameter portion 12c of the main body tube 12b is not particularly limited as long as it is smaller than the outer diameter of the portion (section) other than the small diameter portion 12c of the main body tube 12b, but the effect of providing the small diameter portion 12c is sufficient. From the viewpoint of ensuring the strength of the inner sheath 12 and ensuring the rigidity of the inner sheath 12, the outer diameter of the portion with the smallest outer diameter of the small diameter portion 12c is the same as the portion (section) other than the small diameter portion 12c of the main body tube 12b. It is preferably set within a range of 60 to 85% of the outer diameter. The outer diameter of the tip tube 12a is also not particularly limited, but is, for example, 55 to 140% of the outer diameter of the portion (section) other than the small diameter portion 12c of the main body tube 12b, preferably 65 to 110%. You can set it with.

  Returning to FIG. 1 and FIG. 2, the drive wire 13 is made of a flexible wire, and in the present embodiment, a twisted wire (wire) formed by spirally twisting a plurality of wires (cables) made of metal (stainless steel) or the like. Rope) is used. As the drive wire 13, a single (single wire) wire or a wire tube similar to the main body tube 12b of the inner sheath 12 may be used.

  As shown in FIGS. 9 and 10, the connecting hook 11 as an operating portion arranged at the tip of the sheath of the clip device 1 is made of an elastic body arranged in a substantially V-shape toward the tip thereof. It has a pair of arm portions 11a and 11a, and can cooperate with the inner sheath 12 to take two states, an open leg (open) state and a closed leg (closed) state. Claw portions 11b and 11b are formed at the tip ends of the arm portions 11a and 11a of the connecting hook 11 by being bent inward (sides facing each other), and grip the connecting plate portion 21 of the clip 2 described later. Can be connected.

  The base end portion of the connecting hook 11 is a U-shaped portion 11c which is formed in a substantially U-shape continuously with the base end portions of the pair of arm portions 11a, 11a. The arm portions 11a, 11a including the claw portions 11b, 11b and the U-shaped portion 11c can be formed by appropriately bending (plastically deforming) one elongated plate material made of an elastic body. Although not particularly limited, the plate material of the connecting hook 11 has a plate thickness of about 0.20 to 0.24 mm and a width of about 0.6 mm. As the plate material, for example, stainless steel is used.

  At the tip (distal end) of the drive wire 13 slidably inserted into the inner sheath 12, an annular portion (annular portion) 19a formed in a substantially annular shape and integrally formed with the annular portion 19a. The loop member 19 having the bar-shaped portion 19b is integrally welded and fixed by laser welding or the like. The annular portion 19a has an outer diameter of about 1.2 mm and an inner diameter of about 0.8 to 1.0 mm. Although the cross section of the annular portion 19a is rectangular in this embodiment, it may be circular or semicircular.

  The connecting hook 11 is inserted into the annular portion 19a, and is arranged so that the U-shaped portion 11c is loosely fitted in the annular portion 19a, so that the connecting hook 11 is swingably attached to the distal end of the drive wire 13. .. By attaching the connecting hook 11 to the distal end of the drive wire 13 via such an annular portion 19a and the U-shaped portion 11c loosely fitted to the annular portion 19a, the connecting hook 11 can be moved to the position shown in FIG. In Fig. 10, it can freely rotate in the direction of arrow B and in the direction of arrow C in Fig. 10.

  Referring back to FIGS. 1 and 2, the vicinity of the proximal end (proximal end) side of the outer sheath 14 is inserted into the reinforcing coil 15 and integrally fixed to the reinforcing coil 15. The reinforcing coil 15 is integrally fixed to the slider portion 16, and the distal end side portion of the base portion 17 is inserted and arranged inside the slider portion 16. The slider part 16 is slidable with respect to the base part 17 so that it can be positioned between a position moved toward the tip (distal end) side and two positions moved toward the base end (proximal end) side. Is becoming

  A wire operating portion 18 is slidably held by the base portion 17, and the proximal end of the inner sheath 12 is connected to the base portion 17. The proximal end of the drive wire 13 is connected to the wire operation unit 18.

  Next, a clip (hemostatic clip) 2 that holds a body tissue using such a clip device 1 will be described. As shown in FIGS. 11 and 12, the clip 2 has a connecting plate portion 21 bent into a substantially U shape. A pair of arm plate portions 22 are formed integrally with each end of the U-shape of the connecting plate portion 21 so as to open (open legs) in a substantially C-shape toward the tip thereof. ing.

  A claw portion 23 is integrally formed at the tip of each arm plate portion 22. The claw portion 23 is formed at the tip of the arm plate portion 22 by being bent toward the inside (that is, the closing direction). Each claw portion 23 has a notch (not shown) which is recessed in the middle portion of the tip thereof.

  The connecting plate portion 21, the pair of arm plate portions 22, and the pair of claw portions 23 that form the clip 2 are formed by bending (plastically deforming) a single thin and long elastic plate member. You can The plate thickness of the plate material forming the clip 2 is not particularly limited, but is preferably 0.10 to 0.30 mm. As the plate material, for example, stainless steel is used.

  As shown in FIG. 12, the arm plate portions 22 each have a base end portion 22a and a grip portion 22b. A penetrating portion 22c is formed on each of the grip portions 22b of each arm plate portion 22. These penetrating portions 22c are formed to reduce the weight without impairing the desired strength of the arm plate portion 22 (holding portion 22b).

  A tightening ring 24 is slidably fitted in the connecting plate portion 21. The tightening ring 24 is composed of a substantially cylindrical ring member. However, the tightening ring 24 may be composed of a spring formed by winding a wire rod in a coil shape. The tightening ring 24 has an inner guide hole into which the connecting plate portion 21 is inserted, and can move (slide) in the axial direction between the outer periphery of the connecting plate portion 21 and the outer periphery of the base end portion 22a of the arm plate portion 22. Is attached (externally fitted) to.

  As shown in FIG. 11 or 12, when the tightening ring 24 is arranged on the rear side (connecting plate portion 21), the arm plate portion 22 is in a state of being opened (opened) by its own elasticity. Therefore, by moving (sliding) the tightening ring 24 to a position closer to the tip (base end 22a) as necessary, the arm plate 22 can be closed (closed).

  Next, a method of using the above-described clip device 1 will be described. First, the slider portion 16 is slid to a position on the proximal end side with respect to the base portion 17 so that the distal end of the inner sheath 12 projects from the distal end of the outer sheath 14 as shown in FIG. Let it be in the state where it was made. Further, the base portion 17 is slid toward the proximal end side with respect to the wire operating portion 18, the inner sheath 12 is retracted with respect to the drive wire 13, and the connecting hook 11 at the distal end of the drive wire 13 is attached to the inner sheath 12. It is made to project from the distal end, and is made to open in a substantially V shape by its own elasticity.

  When the base portion 17 is slid to the distal end side with respect to the wire operating portion 18 from this state, the inner sheath 12 is pushed out with respect to the drive wire 13, and the connecting hook 11 at the distal end of the drive wire 13 is released. Since the legs are gradually closed while entering the inner sheath 12, the connecting plate portion 21 of the clip 2 is positioned so that the connecting hooks 11 hold it, embedded in the inner sheath 12, and completely closed. The clip 2 can be connected to the distal end of the inner sheath 12.

  Next, the slider portion 16 is slid to a position on the distal end side with respect to the base portion 17, and as shown in FIGS. 14 and 15, the distal end of the inner sheath 12 to which the clip 2 is connected. Together with the clip 2 are housed (embedded) in the outer sheath 14. In this state, the tightening ring 24 of the clip 2 remains positioned on the connecting plate portion 21, and the arm plate portion 22 is closed by the inner wall of the outer sheath 14.

  Next, although not shown, the distal ends of the sheaths 12 and 14 of the clip device 1 to which the clip 2 is connected are positioned near an internal tissue to be treated such as hemostasis via an endoscope. .. After that, the slider portion 16 is slid to a position on the proximal end side with respect to the base portion 17, and the outer sheath 14 is slid to the proximal end side, so that the clip 2 is projected from the distal end of the outer sheath 14. .. As a result, as shown in FIG. 16, the arm plate portion 22 of the clip 2 is in a state of being opened by the elasticity of itself (a state of being completely deployed).

  The arm plate portion 22 is positioned in the vicinity of the site to be grasped of the mucous membrane (body tissue) with the legs open. Then, the inner sheath 12 is slid toward the distal end side with respect to the drive wire 13, so that the tightening ring 24 slides toward the grip portion 22b side of the arm plate portion 22. As a result, the arm plate portions 22 are gradually closed (approaching each other), and the mucous membrane on one side and the mucous membrane on the other side are drawn to each other across the body tissue.

  By further sliding the inner sheath 12 to the distal end side with respect to the drive wire 13, the tightening ring 24 moves to the grip portion 22b side of the arm plate portion 22 and reaches the proximal end portion 22a, and the body tissue formed by the clip 2 is moved. Gripping is completed. In this state, by sliding the inner sheath 12 toward the proximal end side with respect to the drive wire 13, the connecting hook 11 is pushed out from the distal end of the inner sheath 12 to open the leg, and by the connecting hook 11 of the clip 2. The connection (engagement) is released, and the clipping of the clip 2 with respect to the internal tissue is completed.

  According to the above-described embodiment, the rigidity of the predetermined section on the distal end side of the main body tube 12b is greater than the rigidity of the distal tube 12a, and the rigidity of the section of the main body tube 12b other than the predetermined section. Since the diameter is reduced so as to be smaller than the above, and the small diameter portion 12c is formed, the medium diameter small diameter portion 12c is interposed between the main body tube 12b having high rigidity and the tip tube 12a having low rigidity. Will be (placed). As a result, as shown in FIG. 17, when it is relatively sharply bent, the bending (bending) caused by the abrupt change in rigidity at the connecting portion X between the main body tube 12b and the distal end tube 12a. 18 and is curved more smoothly as shown in FIG. 18, the relative movement between the outer sheath 14 and the inner sheath 12 becomes smooth, and the occurrence of defective deployment of the clip 2 can be suppressed. ..

  Further, since the small diameter portion 12c can be formed only by polishing the distal end portion of the main body tube 12b, it is easier and less expensive than the case where a separate member having an appropriately set rigidity is interposed. Can be achieved with. Further, since the rigidity can be changed and adjusted according to the polishing amount, it is possible to freely adjust the rigidity to obtain the optimum rigidity.

  The embodiments described above are described to facilitate the understanding of the present invention, and are not described to limit the present invention. Therefore, each element disclosed in the above-described embodiment is intended to include all design changes and equivalents within the technical scope of the present invention.

1... Clip device (treatment tool for endoscope)
11... Connection hook (operating part)
11a... Arm part 11b... Claw part 11c... U-shaped part 12... Inner sheath 12a... Tip tube 12b... Main body tube 12c... Small diameter part (predetermined section)
12d... Taper part 12e... Constant diameter part 13... Drive wire 14... Outer sheath 16... Slider part 17... Base part 18... Wire operating part 19... Loop member 19a... Annular part 19b... Rod part 2... Clip 21... Connection plate Part 22... Arm plate part 22a... Base end part 22b... Grip part 23... Claw part 24... Tightening ring 31... Coil tube 32... Wire tube X... Connection part

Claims (5)

With a tubular outer sheath,
A tubular inner sheath inserted through the outer sheath,
A drive wire inserted through the inner sheath,
A working portion attached to the distal end of the drive wire,
The operation section has a pair of arm sections arranged so as to open each other in a substantially V-shape toward the tip thereof, and the drive wire is slid with respect to the inner sheath in the arm section. By doing so, the leg is projected from the distal end of the inner sheath to open the leg, and is embedded in the distal end portion of the inner sheath to close the leg.
The arm part is a connection hook that releasably connects a clip that holds the body tissue and is left indwelling,
The inner sheath is
Comprising a tip tube disposed at the tip and a body tube having a distal end connected to the proximal end of the tip tube,
The rigidity of the tip tube is set to a value smaller than the rigidity of the main body tube,
In a predetermined section on the distal end side of the main body tube, the rigidity of the predetermined section is larger than the rigidity of the tip tube, and is smaller than the rigidity of the section of the main body tube other than the predetermined section, A small-diameter portion having an outer diameter smaller than a section other than the predetermined section of the main body tube, the small-diameter portion being smaller than the outer diameter of the tip tube and having a substantially constant outer diameter in the longitudinal direction. A clip device for an endoscope, which has a constant diameter portion having a . As the main body tube, using a wire tube formed by twisting a plurality of wire strands in a spiral shape,
The endoscope clip device according to claim 1, wherein a coil tube formed by spirally winding a single long material is used as the tip tube. The small-diameter portion, an endoscopic clipping device according to claim 1 or 2, characterized in that formed by polishing the predetermined section of the main tube. A base portion connected to the proximal end of the inner sheath,
Wherein with the proximal end of the outer sheath is connected, any one of claim 1 to 3, characterized by further comprising an operation unit having a slidably retained slider unit relative to the base portion The clip device for an endoscope according to. The endoscope according to claim 4 , wherein the operation unit further includes a wire operation unit to which the proximal end of the drive wire is connected and which is slidably held with respect to the base unit. Clip device.

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