JP6784516B2 - Clip unit cartridge and clip unit engagement method - Google Patents

Description

The present invention relates to a clip unit cartridge and a clip unit engaging method that can easily attach a clip unit for a ligator that clips an affected portion to an operation wire of the ligator.

Generally, a ligation device for endoscopic treatment is guided to the digestive organs through a channel of the endoscope, and opens and closes an arm of a clip unit arranged at the tip of the ligation device to pinch an affected area, a blood vessel, or the like. , The clip unit in a state where the affected part or the like is sandwiched is separated and left in the body.

The following patent documents can be cited as documents describing techniques relating to a ligation device including a clip unit according to the prior art and a clip unit cartridge used in the ligation device. This patent document describes a clip case (cartridge) technology in which a clip, a tightening ring, and a connecting member are enclosed, and the introduction pipe is fixed at a position where the clip, the tightening ring, and the connecting member can be stored in the introduction pipe. Is described.

JP-A-2007-209775

In the technique described in Patent Document 1 described above, the structure of the ligation device including the clip unit is complicated, and the clip unit for the ligation device is attached to the operation wire of the ligation device by the operation force applied to the operation wire. There was a problem that it was difficult to install the wire.

An object of the present invention has been made in view of such a situation, and provides a clip unit cartridge and a clip unit engaging method capable of easily attaching a clip unit for a ligator to an operation wire of a ligator. That is.

In order to achieve the above object, the present invention has a pair of arm arms whose tips open and close, and an arm whose tip side is open so that the clip root side connecting member including the root portion of the pair of arm arms is in the longitudinal direction. A clip case having a triangular clip storage area for storing in a state where movement toward the tip of the arm is blocked, and a clip case provided at the tip of an operation wire extending from the base end side and penetrating a cylindrical ring to the base side of the clip. A sheath insertion hole for inserting a base end side connecting member to be connected to the connecting member and a ring case having a structure for temporarily fixing the ring are provided, and the base end side connecting member and the clip root side connecting member are connected. Clip unit cartridge and clip unit engagement method.
Align the center line in the longitudinal direction of the clip root side connecting member of the arm stored in the clip case with the ring temporarily fixed to the ring case.
The clip case containing the arm in a state of preventing the movement toward the tip of the arm and the ring case in a state of preventing the base end side connecting member protruding from the ring from moving toward the base end side are brought close to each other. By configuring the clip root side connecting member and the base end side connecting member to be connected, the clip unit for the ligation device can be easily attached to the operation wire of the ligation device.

In the clip unit cartridge and clip unit engaging method according to the present invention, the clip unit for the ligator is attached to the operating wire of the ligator by bringing the clip case containing the clip unit and the ring case containing the ring coaxially close to each other. Can be easily installed.

The figure for demonstrating the ligation apparatus including the clip unit applied to the Example of this invention. The figure for demonstrating the clip unit of the leaf spring structure arm applied to this embodiment. The figure which shows the open state and the cross section of the leaf spring structure arm applied to this embodiment. The perspective view of the clip unit of the leaf spring structure arm applied to this embodiment. The figure which shows the arm open state of the clip unit applied to this embodiment. The perspective view of the clip unit applied to this embodiment in an open state. The figure which shows the joint removal state of the clip unit applied to this embodiment. The figure for demonstrating the coupling structure of a clip unit and a joint applied to this embodiment. The figure for demonstrating the joining stage of a clip unit and a joint by this embodiment. The figure for demonstrating the joining stage of a clip unit and a joint by this embodiment. The figure for demonstrating the joining stage of a clip unit and a joint by this embodiment. The figure for demonstrating the joining stage of a clip unit and a joint by this embodiment. The figure for demonstrating the joining stage of a clip unit and a joint by this embodiment. The figure for demonstrating the joining stage of a clip unit and a joint by this embodiment. The figure which shows the whole structure of the cartridge by the Example of this invention. The figure which shows the state which the sheath of the cartridge is not attached according to this Example. The figure which shows the initial state of the sheath insertion of the cartridge by this Example. The figure which shows the joint protruding state from the sheath tip of the cartridge by this Example. The figure which shows the joint fixed state of the cartridge by this Example. The figure which shows the AA cross section of FIG. 14A. The figure which shows the BB cross section of FIG. 14A. The figure which shows the BB cross section of FIG. 14A. The figure which shows the clip unit insertion state in the ring of the cartridge by this Example. The figure which shows the sheath retracted state of the cartridge by this Example. The figure which shows the state after the sheath withdrawal of the cartridge by this Example. The figure for demonstrating the engagement principle of a joint and an arm by this Example. The figure for demonstrating the engagement mechanism of a ring and an arm by this Embodiment. The figure for demonstrating the engagement state of the joint and the arm by this Embodiment.

Hereinafter, examples of the clip unit cartridge and the clip unit engaging method used in the ligation device according to the present invention will be described. First, the clip unit structure and the ligation device applied to the present embodiment will be described.

[Ligature device structure]
The clip unit for the ligation device applied to the present embodiment is passed through the treatment tool guide tube of the endoscope, and is attached to the tip of the ligation device that sandwiches an arbitrary affected part in the digestive organ to stop bleeding. As shown in FIG. 1, the ligation device inserted into the endoscope is connected to an operation unit 300 for a doctor or the like to operate the opening and closing of the clip unit 100 via the operation unit 300 and the coupling unit 210. The flexible tubular sheath 200 is connected to the operation wire 340 that extends from the slider 320 of the operation unit 300 and penetrates the inside of the sheath 200, and the arm at the tip is opened and closed by the operation of the doctor of the operation unit 300. It is composed of a clip unit 100.

The operation unit 300 includes a cylindrical shaft-shaped portion 310 that is held by a doctor's hand, a slider 320 that is fitted around the outer circumference of the shaft-shaped portion 310 and slides in the axial direction, and a rear end of the shaft-shaped portion 310. It is composed of a finger hook ring 330 attached to the shaft-shaped portion 310, and the operation wire 340 is pulled or pushed out by moving the slider 320 in the longitudinal direction with respect to the shaft-shaped portion 310 to open and close the arm at the tip. For example, a doctor opens and closes the arm at the tip of the sheath 200 with the clip unit 100 positioned at the affected part in the digestive organ to sandwich the affected part, and removes the clip unit 100 from the operation wire with the affected part sandwiched. By doing so, it is configured to stop bleeding in the affected area.

[Structure of clip unit 100]
The clip unit 100 according to this embodiment is shown in FIG. 2A showing a state in which the clip unit 100 is slightly protruded from the state of being attached to the sheath, FIG. 3 showing a state in which the clip is expanded, and FIG. 4 showing a state of being detached from the sheath. As described above, the cylindrical ring 101 fitted to the sheath cap 210 at the tip of the sheath 200 and the pair of arm arms facing forward (toward the tip) when the end portion protrudes from the ring 101 and no external force is applied. It is provided with an arm 120 which is formed by being folded back into a U shape by a material having a springy property in an expanded shape, and which is connected to the tip of an operation wire and whose folded root portion engages with a joint 128 (FIG. 8 and others). .. The arm 120 is formed by folding back a long plate member at the center, and is composed of a leaf spring material having a spring property in which the tip ends of the two arm arms open when no external force is applied. The clip unit 100 according to the present embodiment may include a bobbin 106 described later, which is housed in a folded portion formed in a U shape of the arm 120.

In this application, an example of using the arm 120 folded back into a U shape will be described, but the arm 120 is not limited to the U shape, and as illustrated in Patent Document 1, the arm 120 is opened toward the tip. It may have two arm arms that are urged, and may have, for example, a pair of arm arms that intersect from the folded portion, or other structures. Further, the ring 101 has a recess 101z, which will be described later, engraved on the tip side along the outer peripheral surface.

The sheath cap 210 applied to this embodiment extends in the longitudinal direction of the cylinder, and a groove 211 provided with a hook-shaped groove portion at a substantially central portion is opened, and the groove 211 releases the connection between the joint 128 and the clip unit 100. It is configured to open in the circumferential direction within a predetermined range.

As shown in FIG. 2B, the groove 211 having the hook-shaped groove includes a straight portion 211a extending linearly from the sheath 200 side, a wide portion 211b widely opened on the ring 101 side, and the straight portion. The hook-shaped portion 211c opened in a hook shape between the 211a and the wide portion 211b is opened so as to form a groove (space) of a gap L in the longitudinal direction of the sheath cap 210. Through the groove 211, the sheath cap 210 according to the present embodiment is formed so that the two folded portions 210a extending in parallel in the longitudinal direction face each other and project in opposite directions, and the sheath cap 210 is formed in the gap L between the folded portions 210a. The diameter is variably configured in the circumferential direction.

As shown in FIG. 6 showing the engaged state and FIG. 7 showing the disengaged state, the clip unit 100 according to the present embodiment has a connecting portion 107 at the tip of an operation wire penetrating the sheath 200 and the sheath cap 210. A cylindrical joint 128 to be connected and an arm 120 in which a root portion (arm folded portion 122) is inserted and engaged with the inside of the cylinder of the joint 128 are provided, and the joint 128 and the arm 120 can be easily attached and detached. Has been done.

The clip unit 100 presses the joint 128 by operating the operation wire and pushes the arm 120 out of the cylinder of the ring 101, so that the tips of the two arm arms of the arm 120 are opened by their own elastic restoring force. As shown in the above, and the bobbin 106 having a pincushion shape is housed in the curvature of the arm folding portion 122 that folds the arm 120. In this embodiment, a clip is formed by the arm 120 and the bobbin 106 (arm 120 + bobbin 106 = clip), and the clip unit 100 is formed by the clip and the ring 101 [clip (arm 120 + bobbin 106) + ring 101 = clip). [Unit], but the bobbin 106 is not always essential.

The bobbin 106 is formed in the curvature of the arm folding portion 122 in order to prevent the arm folding portion 122 from being deformed when the arm folded portion 122 is attached to or detached from the cylindrical joint 128 provided at the tip of the connecting portion 107 extending from the sheath 200, which will be described later. It is attached to the peripheral surface by means such as welding or caulking. This bobbin 106 is for preventing deformation of the arm folded portion 122, and is not limited to the bobbin shape of a pincushion shape, and may be an external force resistance member such as a columnar or polygonal pillar shape.

As shown in FIGS. 4 and 5, the arm 120 closes the tip of the arm 120 by covering the base of the arm 120 with the ring 101, and when the ring 101 is removed, the tip of the arm 120 is as shown in FIG. Is configured to open. Further, the arm 120 according to the present embodiment is composed of two arm arms (unsigned) and an arm folding portion 122 corresponding to the root portion of the two arm arms.

Further, the two arm arms of the arm 120 are provided with two slits 120a opened from the arm folding portion 122 toward the tip end direction and a pair of protrusions 125, for example, as shown in FIG. 2A. .. The two slits 120a are provided in order to reduce the arm width and facilitate the attachment / detachment when the arm folding portion 122, which will be described later, is attached / detached to / from the cylindrical joint 128. In this embodiment, an example in which the two slits 120a are elongated in the longitudinal direction of the arm will be described, but the present invention is not limited to the two elongated slits, and for example, one wide slit or a large number of slits. A circular hole or a slit having a different shape may be opened.

As shown in FIG. 19, the pair of protrusions 125 provided on the arm 120 are provided for fitting with the groove 101c of the inner diameter of the ring 101 and engaging the two, and gradually extend from the rear end direction of the arm to the outer width direction. It is composed of an inclined surface 125b that inclines toward the surface, a vertex 125a that is the end point of the inclined surface 125b, and an inclined surface 125c that gradually inclines inward from the apex 125a. Further, the arm 120 according to the present embodiment constitutes a contact surface 120d that extends from the protrusion 125 in the longitudinal direction of the arm and becomes wider in the outer width direction.

As shown in FIG. 8A, the clip unit 100 is provided with a protruding portion 128a protruding toward the center along the circumferential direction on the inner wall of the cylinder of the joint 128, and the arm 120 is bent in an arc shape. When a hooking portion 129 that serves as a step is provided with respect to the folded-back portion 122 and the two are fitted together, the protruding portion 128a of the joint 128 engages with the hooking portion 129 of the arm folded-back portion 122 as shown in FIG. 8 (b). By doing so, it is lightly and detachably combined.

In the clip unit 100 according to the present embodiment, the hooked portion 129 of the arm folded portion 122 of the arm 120 is engaged (hooked) with the protruding portion 128a at four points on the inner wall of the cylinder of the joint 128 to make both detachable. , This detachable structure will be described below.

As shown in FIG. 18B, this detachable structure has an arm when the radius of the inner wall of the cylindrical Jonite 128 is r2, the radius of the protruding portion 128a is r1, and the outer diameter radius of the arm folded portion 122 is a. As shown in FIG. 18A showing the four-divided cross section of the folded-back portion 122 and the protruding portion 128a, the contact points between the cylindrical cross-section of the joint 128 and the hooked portion 129 on the four-divided surface are painted black as indicated by reference numeral C. It is only the contact point of the roughly triangular shape.

The arm folded portion 122 (arm 120) and the joint 128 are elastic metal materials such as stainless steel or cobalt or nickel used in medical equipment, and the joint 128 is relative to the hardness of the arm folded portion 122 (arm 120). The hardness of is set in the range of 1.5 to 5 times. This hardness ratio indicates that the joint 128 is used about 10 times in one treatment, whereas the arm folded portion 122 (arm 120) is used once because it is left in the body in principle. In consideration of this, in order to prevent the joint 128 side from being deformed and to deform the arm folded portion 122 (arm 120) side, the joint 128 is set to have a high hardness with respect to the arm folded portion 122.

The detachable structure between the arm folded portion 122 and the joint 128 has a contact portion area C indicated by a black triangle of about 0.3% to 1.5% with respect to the pentagonal area A shown in FIG. 18 (a). It is set to the area ratio. As a result of trial and error in experiments by changing the hardness and diameter thickness, this area ratio can obtain the required strength when the arm folded portion 122 of the arm 120 is attached to the joint 128, and can be removed by the operation described later. It was set based on the discovery that strength can be obtained.

That is, in this detachable structure, the four contact portions of the hooking portion 129 are hooked and connected to the protruding portion 128a of the inner wall of the joint 128, and the hooking area C of the arm folding portion 122 and the joint 128 is combined with the arm folding portion 122. By setting it to 0.3% to 1.5% with respect to the projected area of, the protruding portion 128a can be deformed and separated without damaging the joint 128. Further, by providing the slit 120a in the longitudinal direction of the clip, springiness is added and a stable bonding force can be obtained. By setting the hardness difference between the clip and the joint to 1.5 to 5 times, the clip side Can be damaged and separated with appropriate operating force. Further, by incorporating the bobbin 106 in the curved portion (U-shaped portion) of the arm folded portion 122, it is possible to prevent the arm folded portion 122 from being deformed and improve the stability.

[Explanation of attachment / detachment state]
As shown in FIG. 9A, the ligation device configured in this way inserts the arm folding portion 122 of the arm 120 of the clip unit 100 into the inner cylinder of the joint 128 connected to the operation wire 340, as shown in FIG. 9B. By connecting the two and pulling the operation wire 340 toward the proximal end side from this coupled state, the arm folded portion 122 of the arm 120 was pulled into the inner cylinder of the coupled sheath cap 210 and the ring 101 as shown in FIG. 9C. In this state, a doctor or the like positions the tip of the arm 120 on the affected part using an endoscope, pushes out the arm 120 as shown in FIG. 9D to open the tip of the arm, and then pulls in the arm to pull in the tip of the arm 120 as shown in FIG. 9E. The clip unit 100 is operated so as to leave the affected portion 90 in the body while sandwiching the affected portion 90 as shown in FIG. 9F by further pulling the operation wire 340 toward the proximal end side. For the detailed operation of this ligation device, refer to the specification of Japanese Patent Application No. 2016-78714, which has been filed earlier.

As described above, in the clip unit 100 applied to the present embodiment, the curved arm folding portion 122 of the arm 120 that opens and closes is attached to the cylindrical joint 128 provided at the tip of the operation wire 340 that penetrates the sheath cap 210 and the ring 101. An embodiment of the present invention, which is a feature of the present invention, will be described in which the clip unit 100 is detachably configured by a step and the clip unit 100 can be easily attached to the joint 128 at the tip of the operation wire 340.

[Description of clip unit cartridge]
As shown in FIG. 10, the cartridge 900 according to the present embodiment constitutes a clip case in which the upper clip case 90a and the lower clip case 91a, which are integrated by fitting, sandwich and hold the arm 120 in an open state, and by fitting. The integrated upper ring case 90b and lower ring case 91b form a ring case that is fitted into the clip case. Further, the upper clip case 90a and the upper ring case 90b form the upper case 90, and the lower clip case 91a and the lower ring case 91b form the lower case 91.

As shown in FIG. 10, the clip case (upper clip case 90a and lower clip case 91a) according to the present embodiment roughly accommodates the arm 120 whose tip is open so that the arm folded portion 122 is in the left-right longitudinal direction in the drawing. A pair of projecting portions 90aa and projecting portions 90ab that form a triangular clip storage area, extend along the longitudinal direction, and form an arrowhead (right triangle) -shaped inclined portion 90s that is inclined with respect to the longitudinal direction. It is provided with a pusher 92 that pushes out the ring 101 when it comes into contact with the ring case described later. Further, in the arm storage area of the lower clip case 91a, a triangular stopper 99 for preventing the arm 120 from moving to the left in the drawing when the arm 120 is stored or when the arm 120 is stored is provided. There is. The shape of the stopper 99 is not limited to the illustrated example, and may be a shape that does not hinder the proper closing operation of the arm 120 within a range in which the strength of the movement prevention is maintained, for example, an elongated shape or other shape. You may.

Further, in the ring case (upper ring case 90b and lower ring case 91b) according to the present embodiment, the protruding portion 90aa and the protruding portion 90ab protruding from the clip case are guided and inserted along the longitudinal direction, and the protruding portion 90aa is inserted. The ring 101 is housed between the protruding portion 90ab and the protruding portion 90ab, and is formed in an inverted arrowhead shape with the protruding portion 90aa and the protruding portion 90ab so as to close the tip by contacting the protruding portion 90aa and the inclined portion 90s of the protruding portion 90ab. A cam unit 93 having an inclined portion 93s, a sheath insertion hole 96 for inserting a tubular joint 128 attached to the tip of an operation wire 340 into the ring 101, and a temporary ring 101 at a position where the ring 101 is arranged. It is provided with a groove (not shown) for fixing. Further, in the middle portion in the longitudinal direction of the sheath insertion port 96 of the lower ring case 9b, a rectangular tooth shape provided at the tip of the arm 120 when the clip unit 100 having the arm 120 attached to the joint 128 is moved toward the right hand in the drawing. A pull-out prevention recess 95 for slightly hooking the corner portion of the portion 105 is widely opened.

That is, in the cartridge 900 according to the present embodiment, as shown in FIG. 14D, the inclined portion 90s of the protruding portion of the clip case and the inclined portion 93s formed in the inverted arrowhead shape of the cam unit 93 provided inside the ring case are in contact with each other. The cam unit 93 is configured to be openable and closable according to the approach distance between the clip case and the ring case. In the present specification, the protruding portion 90aa, the protruding portion 90ab, the protruding portion 91aa, and the protruding portion 91ab are collectively referred to as a protruding portion.

The outer diameter of the cartridge 900 is, for example, about 60 mm in the horizontal direction, about 33 mm in the vertical direction, and about 8 mm in thickness as shown in FIG. 10, but the outer diameter is not limited to this size, and is not limited to this size. The size may be small enough to fit in the palm (palm), and the outer shape may be such that the ring case is supported by the index finger and ring finger of one hand of the person, and the clip case can be brought close to the ring case by pressing the thumb. ..

In this cartridge 900, the arm 120 stored in the clip case and the ring 101 stored in the ring case are arranged coaxially, and the sheath cap is provided through the sheath insertion hole 96 with the clip case and the ring case spaced apart from each other. The arm 120 can be attached to the joint 128 of the sheath 200 by inserting the sheath 200 having 210 attached to the tip and pressing them so that they come into contact with each other. Next, this attachment operation is performed by omitting the upper case 90. Mainly, only the lower case 91 will be illustrated and described. Further, the cylindrical ring 101 housed in the ring case and the center line of the folded-back portion 122 of the arm 120 housed in the clip unit are aligned with each other.

(1) First, in the cartridge 900 in the initial state, as shown in FIG. 11, the arm 120 is housed in the clip case (upper clip case 90a and lower clip case 91a), and the ring case (upper ring case 90b and lower ring case 91b) is stored. ), And a predetermined dimension (about 5 mm) is opened between the clip case and the ring case. As shown in FIG. 20A, the ring 101 in this state is fitted with a convex portion 90z provided in a cylindrical guide portion extending from the sheath insertion hole 96 of the ring case into a concave portion 101z provided around the outer circumference. Temporarily fixed by.

(2) Next, as shown in FIGS. 12 and 20 (b), the sheath 200 having the sheath cap 210 attached to the tip is inserted from the sheath insertion hole 96 of the ring case (upper ring case 90b and lower ring case 91b). The sheath cap 210 is brought into contact with the ring 101 to connect the two.

(3) Next, as shown in FIG. 13, the operation wire 340 is pushed to project the joint 128 from the tip of the ring 101 from the end face of the ring case toward the clip unit, and then the clip case and the ring case are brought close to each other. For this approach, for example, the cartridge 900 is placed on the palm (palm), the index finger and ring finger are hung on the shoulders of the ring case (upper ring case 90b and lower ring case 91b), and the clip case (upper clip case 90a and lower clip case 91a) is placed. ) Is performed by grasping the index finger and ring finger so as to pull it toward the bottom palm (palm bottom).

(4) Next, in the cartridge 900 according to the present embodiment, by further bringing the clip case and the ring case closer to the first predetermined position, as shown in FIGS. 14A and 14D, the protruding portion 90aa protruding from the lower clip case 91a. And 90ab's inclined portion 93s (FIG. 14D) rides on the inclined portion 93s (FIG. 14D) of the cam unit 93, so that the tip of the cam unit 93 begins to close, and the tip side of the closed cam unit 93 is connected to the joint 12. The operation wire 240 is sandwiched and the rear end (side surface of the operation portion) of the joint 128 is abutted against the end faces of the two closed cam tips, and the end faces of the two cam tips in the closed state push the rear end side of the joint 12. As a result, the joint 12 protrudes and operates so as to be inserted and engaged in the inner cylinder of the arm folding portion 122 whose movement is blocked by the stopper 99.

(5) From this state, when the clip case and the ring case are further brought closer to the second predetermined position, as shown in FIG. 15, the cartridge 900 has an arrowhead-shaped inclined portion of the protruding portion of the clip case. It operates so that the tip of the cam unit opens over the inclined portion of the cam unit and the clip case and the ring case come into contact with each other. That is, in the cartridge 900, the inclined portions 93s having the arrowhead shape (right triangle shape) of the protruding portions 90aa and 90ab shown in FIG. 14D get over the inclined portion 93s of the cam unit 93, the tip of the cam unit 93 opens, and the joint The rear end of the 128 is released from the tip of the cam and is inserted and engaged with the inner cylinder of the joint 128.

When the inclined portion 93s gets over the inclined portion 93s, the cartridge 900 according to the present embodiment is subjected to vibration and opening sound because the elastic repulsive force generated when the tip of the cam unit 92 is about to close is momentarily released. Is generated, and the joint 128 provided at the tip of the operation wire 340 is fixed while both ends of the joint 128 are sandwiched between the left end surface of the ring case and the tip surface of the clip unit 100, and the arm folded portion of the clip unit 100 is fixed. 122 is inserted and engaged in the inner cylinder of the joint 12.

As described above, in the insertion engagement of the arm folding portion 122 into the inner cylinder of the joint 128 according to the present embodiment, as shown in FIG. 20 (c), the rear end side surface of the joint 128 is on the right side (operation portion side) of the drawing. The arm folding portion 122 in the clip case is abutted from the direction of the arrow in a state where the movement is blocked (fixed state), and the arm folding portion 122 which is blocked from moving to the left is pushed in.

The reason for inserting and fixing the arm folding portion 122 into the inner cylinder of the joint 128 by pressing the clip case with the joint 128 fixed by the end of the cam tip is to operate the arm folding portion 122 in the fixed state. When the joint 128 provided at the tip of the wire 340 is struck to insert and engage the two, the force from the operating portion that pushes the joint 128 is transmitted by the operating wire 340, and the wire is manufactured to be bendable and have low rigidity. This is because the operating wire 340 cannot transmit a pressing force sufficient for the above-mentioned insertion and fixing. That is, when the joint 128 is extruded by using the operation wire 340 having low rigidity, the operation wire 340 is deformed due to the low rigidity and the force from the operation portion cannot be transmitted to the joint 128. Therefore, in this embodiment, Adopts a structure in which the joint 128 side is fixed by the end face of the tip of the cam, and the arm folding portion 122 of the clip unit 100 is pushed into the fixed joint 128 by the operating force of the operator to insert and engage the two. There is.

(6) Next, the cartridge 900 according to the present embodiment is a clip unit in which the arm is closed in the sheath cap 210 and the ring 101 attached to the tip of the sheath 200 as shown in FIG. 17 by further pulling out the sheath 200. 100 can be formed.

As described above, in this embodiment, the arm 120 whose tip side is open so that the folded portion curved in a U shape is in the longitudinal direction is housed, extends along the longitudinal direction of the arm 120, and is inclined with respect to the longitudinal direction. A clip case having a pair of protrusions forming an arrowhead-shaped inclined portion and a pair of protrusions protruding from the clip case are guided and inserted along the longitudinal direction, and a ring is inserted between the pair of protrusions. A storage area for accommodating the 101 is opened, and the cam unit 93 having a reverse arrow-shaped inclined portion that closes the tip by abutting with the inclined portion of the pair of protruding portions and the ring 101 are attached to the tip of the operation wire 340. A clip unit cartridge 900 is configured from a ring case having a sheath insertion hole 96 for inserting a tubular joint 128, and a cylindrical ring 101 temporarily fixed to the ring case and an arm 120 housed in the clip unit. The clip case and the ring case are placed in the first predetermined positions in a state where the center lines of the U-shaped folded-back portion 122 in the longitudinal direction are aligned and the joint 128 in the ring 101 is projected from the end face of the ring case toward the clip unit. When the clip case is brought close to the clip case, the inclined portions of the pair of protruding portions of the clip case come into contact with the inverted arrow-shaped inclined portions of the cam unit 93 to close the tip of the cam unit 93, and the tip of the closed cam unit 93 is the ring case. With the operation wire connected to the joint protruding from the end face of the clip unit to the clip unit side, the rear end of the joint 128 is abutted against the end face of the cam tip and fixed, and the arm folded portion 122 of the clip unit 100 is joined. When the clip case and the ring case are further brought closer to a second predetermined position after being inserted and engaged in the inner cylinder of 128, the arrowhead-shaped inclined portion of the protruding portion of the clip case becomes the inclined portion of the cam unit. The clip unit for the ligation device can be easily attached to the operation wire of the ligation device by opening the tip of the cam unit 93 over the above.

Further, the cartridge 900 according to the present embodiment requires a highly rigid (thick) operation wire for attaching the clip unit to the operation wire by the operation force applied to the operation wire by the conventional cartridge, whereas the clip case and the cartridge 900 Since the clip unit is attached to the operation wire by manually pressing the ring case, a thin operation wire having low rigidity can be used.

In this embodiment, a cam unit that opens and closes the rear end of the clip unit on the premise of a structure in which the rear end of the clip unit is inserted and engaged with the U-shaped folded portion in the inner cylinder of the cylindrical joint. An example of a mechanism in which the folded-back portion is inserted into and engaged with the joint while being fixed by the mechanism has been described, but the clip unit cartridge and the clip unit engaging method according to the present invention are not limited to the structure shown in the examples. In a structure in which a treatment tool for an endoscope that detachably connects a base end side connecting member provided at the tip of an operation wire and a clip root side connecting member of a clip unit is detachably connected to the tip of an operation wire, the base end side connection It can also be applied to those in which the clip root side connecting member is manually connected to the base end side connecting member in a state where the member is fixed.

For example, the connection mechanism between the U-shaped folded portion and the joint according to this embodiment may be changed to another connecting structure, or the inclination directions of the clip case side protrusion portion and the cam unit side inclination portion according to this embodiment may be formed in opposite directions. The base end side connecting member (joint) is fixed to the ring case by another mechanism instead of the mechanism using the inclined portion on the clip case side and the ring case side, and the fixed base end side connecting member ( It can also be applied to a mechanism in which a clip root side connecting member is manually pressed and connected to a joint).

In this improved example, for example, an arm having a pair of arm arms whose tips open and close, and an arm whose tip side is open so that the clip root side connecting member including the root portion of the pair of arm arms is in the longitudinal direction is set in the arm tip direction. A clip case having a triangular clip storage area for storing in a state of being blocked from moving to, and a clip base side connecting member provided at the tip of an operation wire extending from the base end side and penetrating a cylindrical ring. A clip unit that includes a sheath insertion hole for inserting a base end side connecting member to be connected and a ring case having a structure for temporarily fixing the ring, and connects the base end side connecting member and the clip root side connecting member. An arm in a state in which the ring temporarily fixed to the ring case and the center line of the clip root side connecting member of the arm housed in the clip case are aligned with each other to prevent movement toward the tip of the arm. By bringing the clip case accommodating the clip case and the ring case in a state where the base end side connecting member protruding from the ring is prevented from moving to the base end side, the clip root side connecting member and the base end side connecting member are brought close to each other. It can be expressed that it is configured to connect with.

90 upper case, 90a upper clip case, 90b upper ring case,
91 lower case, 91a lower clip case, 91b lower ring case,
93 cam unit, 96 sheath insertion hole, 100 clip unit,
101 ring, 120 arm, 128 joint, 150 separator,
200 sheath, 210 sheath cap, 900 cartridge

Claims (8)

The arm tip end side is opened as a clip root side coupling member is in the longitudinal direction including the root portion of the arm tip to open and close, having a triangular clip housing area for housing in a state of being prevented from moving in the arm distal direction With a clip case
A sheath insertion hole provided at the tip of an operation wire extending from the base end side and for inserting and connecting the clip root side connecting member into the cylindrical base end side connecting member through a cylindrical cylindrical ring. A ring case having a structure for temporarily fixing the cylindrical ring is provided.
A clip unit cartridge that houses a clip unit including the cylindrical ring that covers the arm and the root portion, and connects the base end side connecting member and the clip root side connecting member.
The cylindrical ring temporarily fixed to the ring case and the center line in the longitudinal direction of the clip root side connecting member of the arm housed in the clip case are aligned with each other.
The clip case containing the arm in a state where the movement in the direction toward the tip of the arm is blocked and the ring case in a state in which the proximal end side connecting member protruding from the cylindrical ring is blocked from moving toward the proximal end side are brought close to each other . The clip root side connecting member is inserted into the cylinder of the base end side connecting member and connected.
A cartridge for a clip unit that is characterized by this. A triangular clip storage area is formed by accommodating an arm whose tip side is open so that a folded portion of an elongated metal plate curved in a U shape is in the longitudinal direction, extends along the longitudinal direction, and extends in the longitudinal direction. A clip case having a pair of protrusions forming an arrowhead-shaped inclined portion that inclines with respect to
A pair of protrusions protruding from the clip case are guided and inserted along the longitudinal direction, and a storage area for accommodating a cylindrical cylindrical ring is opened between the pair of protrusions, and the pair of protrusions A cam unit having a reverse arrow-shaped inclined portion that closes the tip by contacting with the inclined portion, and a ring case having a sheath insertion hole for inserting a tubular joint attached to the tip of the operation wire into the cylindrical ring. A clip unit cartridge that houses a clip unit including a cylindrical ring that covers the arm and the folded portion, and attaches the joint to the arm.
The cylindrical ring temporarily fixed to the ring case and the center line of the folded portion housed in the clip case in the longitudinal direction are aligned with each other, and the joint in the cylindrical ring is projected from the end face of the ring case toward the clip case. ,
When the clip case and the ring case are brought close to the first predetermined position, the inclined portions of the pair of protruding portions of the clip case come into contact with the inverted arrow-shaped inclined portions of the cam unit to close the tip of the cam unit, and the closing portion is closed. The tip of the cam unit is projected from the end face of the ring case toward the clip unit, and the operation wire connected to the joint is sandwiched, and the rear end of the joint is abutted against the end face of the cam to be fixed. Insert and engage the folded part in the inner cylinder,
Wherein when brought into close proximity to the clip case and the ring case further to a second predetermined position, Open the tip of the cam unit inclined portion of the arrowhead shape of the protruding portion of the clip case climbs over the inclined portion of the cam unit,
A cartridge for a clip unit that is characterized by this. The triangular of the clip housing area of the clip case, the clip unit cartridge according to claim 2, wherein the stopper for preventing the distal movement of the arms is provided. The clip unit, and the cylindrical ring recess before Symbol arm makes a round the outer periphery at the tip end to be inserted is engraved, the latching portion to be stepped in the folded portion is inserted into the cylinder of the cylindrical ring Including the arm to have
The ring case is provided with a convex portion to be fitted with a concave portion engraved on the outer circumference of the cylindrical ring .
Clip assembly cartridge according to claim 2 or 3, wherein the this. The clip unit includes an arm that is inserted into the cylinder of the cylindrical ring and has a hook portion that becomes a step at the folded portion.
The operating wire has a cylindrical joint at the tip into which the folded portion is inserted.
The joint has a protrusion on the inner wall of the cylinder that projects along the circumferential direction and toward the center.
When the clip case and the ring case are brought closer to the first predetermined position and further to the second predetermined position, the folded portion is inserted into the inner cylinder of the joint, and the hooked portion is inserted into the inner cylinder of the joint. The cartridge for a clip unit according to any one of claims 2 to 4, wherein the cartridge is hooked on and engaged with four protrusions on the inner wall of the cylinder. The clip according to any one of claims 2 to 5, wherein a retaining recess for hooking an arm when the clip unit is pulled out from the ring case is widely opened in the sheath insertion hole of the ring case. Cartridge for the unit. The arm tip end side is opened as a clip root side coupling member is in the longitudinal direction including the root portion of the arm tip to open and close, having a triangular clip housing area for housing in a state of being prevented from moving in the arm distal direction With a clip case
A sheath insertion hole provided at the tip of an operation wire extending from the base end side and for inserting and connecting the clip root side connecting member into the cylindrical base end side connecting member through a cylindrical cylindrical ring. A clip unit cartridge that includes a ring case having a structure for temporarily fixing the cylindrical ring and includes the arm and a cylindrical ring that covers the root portion is used to connect the base end side connecting member and the clip root side. A clip unit engagement method for connecting a connecting member.
The cylindrical ring temporarily fixed to the ring case and the center line in the longitudinal direction of the clip root side connecting member of the arm housed in the clip case are aligned with each other.
The clip case containing the arm in a state where the movement in the direction toward the tip of the arm is blocked and the ring case in a state in which the proximal end side connecting member protruding from the cylindrical ring is blocked from moving toward the proximal end side are brought close to each other. The clip root side connecting member is inserted into the cylinder of the base end side connecting member and connected.
Clip unit engagement wherein the. A triangular clip storage area is formed by accommodating an arm whose tip side is open so that a folded portion of an elongated metal plate curved in a U shape is in the longitudinal direction, extends along the longitudinal direction, and extends in the longitudinal direction. a clip case have a pair of projecting portions, for accommodating the clip unit comprising a cylindrical ring covering the arm and folded portion forming the inclined portion of the arrowhead shape inclined with respect to,
A pair of protrusions protruding from the clip case are guided and inserted along the longitudinal direction, and a storage area for accommodating the cylindrical ring is opened between the pair of protrusions, and an inclined portion of the pair of protrusions is opened. A clip including a cam unit having a reverse arrow-shaped inclined portion that closes the tip by abutting with the cylindrical ring and a ring case having a sheath insertion hole for inserting a tubular joint attached to the tip of the operation wire into the cylindrical ring. A clip unit engagement method for attaching the joint to an arm using a unit cartridge.
A state in which the cylindrical ring temporarily fixed to the ring case and the center line of the folded portion housed in the clip case in the longitudinal direction are aligned, and the joint in the cylindrical ring is projected from the end face of the ring case toward the clip case. The first step and
When the clip case and the ring case are brought close to the first predetermined position, the inclined portions of the pair of protruding portions of the clip case come into contact with the inverted arrow-shaped inclined portions of the cam unit to close the tip of the cam unit, and the closing portion is closed. The tip of the cam unit is projected from the end face of the ring case toward the clip unit, and the operation wire connected to the joint is sandwiched, and the rear end of the joint is abutted against the end face of the cam to be fixed. Insert and engage the folded part in the inner cylinder,
When the clip case and the ring case are further brought closer to a second predetermined position, the arrowhead-shaped inclined portion of the protruding portion of the clip case gets over the inclined portion of the cam unit and opens the tip of the cam unit.
A clip unit engagement method characterized by that.

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