JP7104927B1 - medical clip - Google Patents

Abstract

A medical clip that can be used in a clipping device for an endoscope and that can be used both for hemostasis and for marking, is provided so that the clip can be opened and closed again until the clip is completely closed. . A medical clip (1A) in the shape of a leaf spring having a first arm (10) and a second arm (20) facing each other, and a continuous portion (30) between one end of the first arm (10) and one end of the second arm (20) is attached to the first arm. A pair of hook-like protrusions 12a and 12b capable of latching both sides of the second arm 20 are provided at the central portion in the longitudinal direction of the arm 10. The hook-shaped projections 12a and 12b latch both sides of the second arm 20 to keep the first arm 10 and the second arm 20 close to each other. [Selection drawing] Fig. 2

Description

The present invention relates to medical clips.

2. Description of the Related Art Conventionally, a medical clip attached to an endoscopic clip device has been used as a hemostatic clip or as a marker clip for specifying the position of an affected area during a surgical operation. For example, a clip body that is formed by bending a leaf spring made of metal such as stainless steel into a roughly ">" shape and a crimping ring that is fitted onto the clip body to close the clip body (Patent Document 1). A clip body made of resin by forming a specific shape (Patent Document 2) is known.

In addition, as a hemostatic clip, there is a clip made of an elastic material that is provided with a hook and a structure that engages with the hook at the tip of the clip so that the clip can be closed without using a crimping ring (Patent Reference 3). The opening and closing of this hemostatic clip is performed using a forceps-type instrument.

Patent No. 6572229 Patent No. 6675674 JP-A-56-3048

A conventional clip using a crimping ring described in Patent Documents 1, 2, etc. is attached to a clip sheath of a clip device for an endoscope, and is opened and closed by operating the clip device. For example, as shown in FIG. 16A of the present application, the clip 1X is attached to the inner sheath 41 of the clip sheath 40, and the operation wire 43 is connected by the connecting portion 44. As shown in FIG. By pulling, it is pulled into the inner sheath 41, and accordingly the crimping ring 2 moves to narrow the opening of the clip 1X. When the operation wire 43 is further pulled, the crimping ring 2 moves toward the distal end of the clip 1X, and the clip 1X closes to clamp the affected area. However, once the opening of the clip 1X is narrowed by the crimping ring 2, the opening of the clip cannot be restored even if one wants to restore the opening of the clip in order to correct the clamping position of the affected area. That is, as shown in FIG. 16C, even if the inner sheath 41 is pulled back, the position of the crimping ring 2 in the clip 1X does not return to its original position, so the opening of the clip 1X remains narrow.

On the other hand, the clip described in Patent Document 3 and the like can be opened and closed again even after the clip is once closed, so that the position of the affected part to be clamped by the clip can be corrected. However, opening and closing the clip requires the use of a forceps-type instrument, and the endoscope clip device cannot open and close the clip. In addition, in this clip, a blood vessel or the like is pinched between the tips of a pair of arms (legs) and a hinge, and this state is maintained by fitting the hooks at the tips. Since the hook at the tip portion cannot be fitted, the state in which the affected part is sandwiched cannot be maintained. Therefore, this clip cannot be used for marking.

In contrast, the present invention provides a medical clip that can be used in an endoscopic clipping device and that can be used for both hemostasis and marking, until the clip is fully closed. The object is to enable redoing.

The present inventors have found that a leaf spring-like clip having arms facing each other is provided with a hook-shaped projection at the center of one arm of the clip in the longitudinal direction, and when the other arm is latched by the hook-shaped projection, the tip of the clip The part can be used for both hemostasis and marking, the crimping ring is no longer required, and the clip can be opened and closed repeatedly until the hook-like protrusion on one arm fully latches the other arm. The headline led to the present invention.

That is, the present invention is a leaf spring-like medical clip having a continuous portion where a first arm and a second arm facing each other and one end of the first arm and one end of the second arm are continuous,
The first arm has a pair of hook-shaped projections at the center in its longitudinal direction that can latch the second arm from both sides,
Provided is a medical clip in which a pair of hook-shaped projections latch both sides of the second arm when the first arm and the second arm are brought close to each other by a predetermined distance, and the close state of the first arm and the second arm is maintained. do.

According to the medical clip of the present invention, the distal end of the clip is held completely closed by the latch between the pair of hook-shaped projections in the longitudinal center of the first arm and the second arm. Therefore, the tip of the clip can be used both for hemostasis and for marking.

Also, unless the hook-shaped projection of the first arm latches the second arm, the first arm and the second arm can be repeatedly opened and closed. Therefore, even after the clip is about to close, it becomes easy to correct the position where the clip pinches the affected area.

In addition, this medical clip can be used by being attached to the inner sheath of an endoscope clipping device.

FIG. 1A is a perspective view of the state in which the clip 1A of the embodiment is opened, viewed from the tip side thereof. FIG. 1B is a perspective view of a state in which the clip 1A of the embodiment is opened, viewed from the continuous portion side. FIG. 1C is a top view of the clip 1A of the embodiment in an open state. FIG. 1D is a side view of the clip 1A of the embodiment in an open state. FIG. 2 is a perspective view of the latched state of the clip 1A of the embodiment. FIG. 3A is a cross-sectional view explaining how to use the clip 1A of the embodiment. FIG. 3B is a cross-sectional view explaining how to use the clip 1A of the embodiment. FIG. 3C is a cross-sectional view explaining how to use the clip 1A of the example. FIG. 3D is a cross-sectional view explaining how to use the clip 1A of the embodiment. FIG. 3E is a cross-sectional view explaining how to use the clip 1A of the example. FIG. 4A is a cross-sectional view illustrating a method of pinching a mucous membrane with the clip 1A of the embodiment. FIG. 4B is a cross-sectional view illustrating a method of clamping a mucous membrane with the clip 1A of the embodiment. FIG. 4C is a cross-sectional view illustrating a method of pinching a mucous membrane with the clip 1A of the embodiment. FIG. 4D is a cross-sectional view illustrating a method of pinching a mucous membrane with the clip 1A of the embodiment. FIG. 5A is a perspective view of the state in which the clip 1B of the embodiment is opened, viewed from the tip side thereof. FIG. 5B is a perspective view of a state in which the clip 1B of the embodiment is opened, viewed from the continuous portion side. FIG. 6 is a perspective view of the latched state of the clip 1B of the embodiment. FIG. 7A is a cross-sectional view illustrating a method of pinching a mucous membrane with the clip 1B of the embodiment. FIG. 7B is a cross-sectional view illustrating a method of pinching a mucous membrane with the clip 1B of the embodiment. FIG. 8A is a cross-sectional view explaining how to use the clip 1C of the embodiment. FIG. 8B is a cross-sectional view explaining how to use the clip 1C of the example. FIG. 9 is a side view of a modified form of the clip 1A of the embodiment. FIG. 10 is a side view of an embodiment clip 1A with a compression piece attached. FIG. 11 is a top view of an embodiment clip 1A with a compression piece attached. FIG. 12 is a cross-sectional view showing a state in which the mucous membrane is clamped by the clip 1A of the embodiment to which the compression piece is attached. FIG. 13 is a perspective view of the clip 1D of the example. FIG. 14A is a perspective view of an embodiment clip 1D to which a compression piece is attached, viewed from the distal end side. FIG. 14B is a perspective view of the clip 1D of the embodiment to which the compression piece is attached, viewed from the connecting portion side. FIG. 15 is a cross-sectional view showing a state in which the mucous membrane is clamped by the clip 1D of the embodiment to which the compression pieces are attached. FIG. 16A is a cross-sectional view of a conventional medical clip 1X attached to an inner sheath. FIG. 16B is a cross-sectional view of a state in which the conventional medical clip 1X is slightly pulled into the inner sheath, and the opening of the clip narrows accordingly. FIG. 16C is a cross-sectional view showing a state in which the conventional medical clip 1X is slightly pulled into the inner sheath and then the inner sheath is pulled back.

The present invention will be described in detail below with reference to the drawings. In each figure, the same reference numerals denote the same or equivalent components.

<Basic Configuration of Medical Clip>
1A and 1B are perspective views of an open medical clip 1A according to an embodiment of the present invention, FIG. 1C being a top view thereof, and FIG. 1D being a side view thereof. Moreover, FIG. 2 is a perspective view of the medical clip 1A in a latched state.

The clip 1A is formed of an elastic material such as a leaf spring, and the first arm 10 and the second arm 20 facing each other, and one end of the first arm 10 and one end of the second arm 20 are curved and continuous. It has a continuation 30 that extends. The other ends of the first arm 10 and the second arm 20 are separated from each other, and the whole is bent in a general "<" shape. In addition, in the present invention, the continuous portion 30 is not necessarily limited to a curved portion or a bent portion that connects the first arm and the second arm, which is obtained by bending a sheet of strip-shaped metal material. As shown in FIGS. 4 and 7 of JP-A-6694893, when the first arm and the second arm are formed from two leaf springs with their rear ends bent in an L shape, the rear ends The vicinity can be made into the part which made it continuous with the reinforcement member.

Further, in the clip 1A of the present embodiment, the distal end portion 11 of the first arm 10 is bent toward the second arm 20 side, the distal end portion 21 of the second arm 20 is bent toward the first arm 10 side, and these distal end shapes are triangular waveforms that fit together. In the clip of the present invention, the shape of the distal end portions 11 and 21 is not limited to this, and may be trapezoidal, rectangular, or the like. The tip portions 11 and 21 may be formed so as to overlap each other when the second arm 20 is closed.

The holding portion 15 adjacent to the distal end portion 11 of the first arm 10 and the holding portion 25 adjacent to the distal end portion 21 of the second arm 20 are wider than the continuous portion 30 . Both sides of the clamping portions 15 and 25 are raised inwardly to facilitate clamping of the living tissue by the clamping portions 15 and 25 . In addition, in the present invention, the shape of the clamping portions 15 and 25 can be appropriately changed according to the use of the clip.

(hook-shaped protrusion)
The first arm 10 has a pair of hook-like protrusions 12a, 12b that can latch the second arm 20 from both sides of the second arm 20 at the central portion in the longitudinal direction. More specifically, a pair of hook-shaped projections 12a and 12b extend in the direction of the second arm portion 20 along both sides of the first arm 10 between the distal end portion 11 of the first arm 10 and the continuous portion 30. The tips of the pair of hook-shaped projections 12a and 12b are bent in directions facing each other. In the clip 1A of this embodiment, the hook-shaped projections 12a and 12b stand up along both sides of the first arm 10, so that the clip 1A can be easily manufactured by bending a metal plate. becomes. On the other hand, when the clip 1A is resin-molded, the hook-shaped projections 12a and 12b may be erected from the inside of the first arm 10 rather than the side edges thereof.

In this clip 1A, when the first arm 10 and the second arm 20 are pressed and come close to each other by a predetermined distance, the pair of hook-shaped projections 12a and 12b are latched by the second arm 20 as shown in FIG. Latch part 22; This latched portion 22 has a flat plate shape, and once the hook-shaped projections 12a and 12b of the first arm 10 latch the latched portion 22 of the second arm 20, the clip 1A is formed of an elastic material. As a result, the second arm 20 is biased in the direction in which the gap between the first arm 10 and the second arm 20 is increased, so that the latched state is stabilized and the close state between the first arm 10 and the second arm 20 is maintained. retained.

(Slope-shaped protrusion)
On the other hand, on the outer surface 20o of the second arm 20 on the opposite side of the first arm 10, a slope extending in the longitudinal direction of the second arm 20 from the latched portion 22 of the second arm 20 to the tip portion 21 is provided. shaped protrusions 23 are provided. As shown in FIG. 1D, the height Hs of the slope-like protrusion 23 with respect to the outer surface 20o of the second arm 20 gradually increases toward the distal end portion 21 of the second arm 20. As shown in FIG. Therefore, when the clip 1A is viewed from the side, the slope-like protrusion 23 has a triangular plate shape.

As will be described later, when the clip 1A is clipped to the affected part using the clipping sheath 40, the clip 1A is pulled toward the inner sheath 41, and the inner wall of the inner sheath 41 brings the first arm 10 and the second arm 20 closer together. When the slope-like projection 23 is inclined as described above, the second arm 20 can be efficiently pressed. After the hook-shaped projections 12a and 12b of the first arm 10 have latched the latched portion 22 of the second arm 20, the slope-shaped projection 23 is pulled back when the inner sheath 41 is pulled back in order to retain the clip 1A in the affected area. is inclined as described above, the contact area between the clip 1A and the inner wall of the inner sheath 41 is reduced, and the frictional resistance therebetween is reduced. Therefore, it becomes easy to pull back the inner sheath 41 while leaving the clip 1A in the affected area.

The inclination angle α of the slope-shaped projection 23 with respect to the outer surface 20o of the second arm 20 is gradually increased toward the distal end portion 21 of the second arm 20, that is, the inclined surface of the slope-shaped projection 23 is rounded. is more preferable. For the same reason, it is preferable to narrow the width Ws of the slope-shaped protrusion 23 in the lateral direction of the second arm 20 (FIG. 1C). It is preferable to set the thickness to about the plate thickness.

In the present embodiment, two slope-shaped projections 23 are formed along the left and right sides of the second arm 20, but the manner in which the slope-shaped projections 23 are formed is not limited to this. A single slope-like projection may be formed on the center line A of the width in the width direction of the .

(Inner sheath stopper)
A protruding portion 13 is provided as an inner sheath stopper on the outer surface 10o of the first arm 10 on the side opposite to the second arm 20 and closer to the distal end portion 11 of the first arm than the pair of hook-shaped projections 12a and 12b. It is As will be described later, the inner sheath stopper 13 is provided when the clip 1A attached to the clip sheath 40 is pulled toward the inner sheath 41 by the operation wire 43 and the first arm 10 and the second arm 20 are brought close to each other. This is preferable because the open end surface of the inner sheath 41 abuts against the inner sheath stopper 13 and the clip 1A is prevented from being drawn into the inner sheath 41 unnecessarily.

As shown in FIG. 2, when the hook-shaped projections 12a and 12b of the first arm 10 latch the second arm 20, the position of the continuous portion side end 13a of the inner sheath stopper 13 in the clip longitudinal direction is the same. is preferably within the formation range of the slope-shaped projection 23 in the clip longitudinal direction. As a result, when the first arm 10 and the second arm 20 are brought close to each other by pulling the clip 1A attached to the clip sheath 40 toward the inner sheath 41, the clip 1A is pulled into the inner sheath 41. can be minimized.

(Bending portion of first arm and bending portion of second arm)
The first arm 10 has a first arm curved portion 14 that is convexly curved toward the second arm 20 side between the hook-shaped projections 12 a and 12 b and the continuous portion 30 . On the other hand, the second arm 20 has a second arm curved portion 24 that is convexly curved toward the first arm 10 side between the latched portion 22 and the continuous portion 30 .

When the clip 1A is pulled into the inner sheath 41 to close the clip 1A, the first arm bending portion 14 and the second arm bending portion 24 come into contact with each other and serve as a fulcrum for opening and closing the first arm 10 and the second arm 20. As shown in FIG. As the retraction amount of the clip 1A in the inner sheath 41 increases and the opening between the first arm 10 and the second arm 20 decreases, the contact point between the first arm bending portion 14 and the second arm bending portion 24 moves to the first position. The tip 11 of the arm moves toward the tip 21 of the second arm. As a result, the clip 1A is closed to increase the force of clamping the biological tissue between the clamping portions 15 and 25, and the stress applied to the clip 1A when the clip 1A is closed is dispersed. Therefore, even when the clip 1A is made of resin, it is possible to prevent the arms 10 and 20 from breaking when the clip 1A is opened and closed.

(Width of first arm and second arm)
The width W2 of the second arm 20 (the length in the direction orthogonal to the longitudinal direction of the second arm 20) when viewed from the top of the clip 1A (FIG. 1C) is the narrowest at the continuous portion 30 and the curved portion 24 of the second arm. The width of the portion to be latched 22 and the formation portion of the slope-like projection 23 is wider than that of the case of FIG. The distal end portion 21 and the clamping portion 25 that directly clip the affected area should be wider and accommodated in the outer sheath 42 of the sheath 40 for clipping. Similarly, the width W1 of the first arm 10 is such that the hook-shaped projections 12a and 12b are wider than the continuous portion 30 and the first arm curved portion 14, and the distal end portion 11 and the clamping portion 15 are wider than the hook-shaped projections 12a and 12b. It is formed wider than the formation part of 12b.

(formation material)
The clip 1A can be manufactured easily and inexpensively by bending a metal plate, such as stainless steel, which will be a leaf spring.
In addition, the clip 1A may be formed from a resin such as polycarbonate or ABS that exhibits high rigidity, similar to the resin described in Patent Document 2, or may be formed from a heat-resistant thermoplastic resin such as PEEK (polyetheretherketone). may be used. It is selected as appropriate according to the use of the clip.

The bending elastic modulus (JIS K 7171) of the resin is preferably 2000 MPa or more, and the bending strength (JIS K 7171) is preferably 90 MPa or more. Polycarbonate, ABS and the like are preferable from the viewpoint of excellent acid resistance and alkali resistance to digestive fluids.

When the clip 1A is made of resin, it is preferable to increase the amount of resin in the continuous portion 30 in order to increase the elastic force of the "<" shaped clip 1A.

Further, when the clip 1A is used as a marker, the resin forming the clip 1A preferably contains a fluorescent dye. The fluorescent dye preferably emits fluorescence in the red to near-infrared wavelength range of 600 to 1400 nm, preferably in the red to near-infrared wavelength range of 700 to 1100 nm. Light in such a wavelength range is highly permeable to human tissue such as skin, fat, and muscle, and can reach, for example, the mucous membrane of tubular human tissue such as the rectum to the serosal surface.

Examples of fluorescent dyes that emit fluorescence in the above wavelength range include riboflavin, thiamine, NADH (nicotinamide adenine dinucleotide), indocyanine green (ICG), the azo-boron complex compound described in JP-A-2011-162445, and WO2016/132596. A dye having a condensed ring structure described in the publication, a dye having a boron dipyrromethene skeleton described in Japanese Patent No. 5177427, a dye that chemically bonds with silica particles described in JP-A-2020-74905, JP-A-2020-105170. Phthalocyanine dyes and the like described in JP-A-2004-200065 can be mentioned.

A preferable concentration of the fluorescent dye in the resin can be set according to the types of the fluorescent dye and the resin, and is usually preferably 0.001 to 1% by mass.

As a method for incorporating the fluorescent dye into the resin, for example, a twin-screw kneader is used to knead the fluorescent dye into the resin. After that, the clip body may be molded by injection molding.

(how to use)
When using the clip 1A as an endoscope clip, for example, as shown in FIG. 3A, the clip 1A is attached to a clip sheath 40 of an endoscope clip device. As the clip sheath 40, for example, one having an inner sheath 41, an outer sheath 42, and an operation wire 43 described in Japanese Patent No. 4388324, Japanese Patent No. 5045484, etc. can be used, and a commercially available one can be used. can do. As a method for attaching the clip 1A to the clip sheath 40, for example, the connecting portion 44 of the operation wire 43 may be engaged with the end portion of the continuous portion 30 of the clip 1A. Also, a connection hook may be used as described in Japanese Patent No. 5781347 or the like.

When the clip 1A is pulled into the outer sheath 42 by the operation wire 43 by operating the endoscope clip device, the clip 1A is closed as shown in FIG. As shown, the tip portions 11 and 21 of the clip 1A are opened. As the clip 1A is drawn into the inner sheath 41 as shown in FIG. 3C, the distal end portions 11 and 21 of the clip 1A gradually close, and the inner sheath 41 moves toward the continuous portion of the inner sheath stopper 13 as shown in FIG. 3D. The hook-shaped projections 12a and 12b of the first arm 10 latch the second arm 20 when it hits the end 13a and the slope of the slope-shaped projection 23 . The clip 1A can no longer be pulled into the inner sheath 41. Next, when the inner sheath 41 is pulled back, the clip 1A with the first arm 10 and the second arm 20 latched by the hook-shaped projections 12a and 12b can be removed from the clip sheath 40 as shown in FIG. 3E. .

Therefore, to explain the case of clamping, for example, an affected part of the mucous membrane of a hollow organ with the clip 1A, the clip 1A is attached to the operation wire 43, and the clip 1A is inserted into the outer sheath 42 by the operation wire 43 as shown in FIG. It is retracted, and in that state, the clipping sheath 40 is inserted into the hollow organ. The endoscope clipping device is operated to protrude the clip 1A from the outer sheath 42 as shown in FIG. Then, as shown in FIG. 4B, the clip 1A is brought into contact with the mucous membrane X and the clip 1A is drawn into the inner sheath 41, thereby closing the distal end portions 11 and 21 of the clip 1A. As shown in FIG. 4B, even if the distal ends 11 and 21 of the clip 1A grab the mucous membrane X, the hook-shaped projections 12a and 12b of the first arm 10 do not latch the second arm 20. By pulling back the clip 41, the distal end portions 11 and 21 of the clip 1A are opened again, so that the position of the mucous membrane to be clipped by the distal end portions 11 and 21 of the clip 1A can be corrected as necessary.

When the distal end portions 11 and 21 of the clip 1A are grasped at the target position of the mucous membrane X, as shown in FIG. The distal end portions 11 and 21 of the mucous membrane X are fixed. At this time, the inner sheath 41 only contacts the end portion 13a of the inner sheath stopper 13 on the side of the continuous portion and the slope of the slope-shaped projection 23, so that when the inner sheath 41 is pulled back, the sliding resistance between the inner sheath 41 and the clip 1A is increased. is low. Therefore, the inner sheath 41 can be easily pulled back. Therefore, as shown in FIG. 4D, the connecting portion 44 of the operation wire 43 is removed from the continuous portion 30 of the clip 1A, and the inner sheath 41 and the outer sheath 42 are pulled back, so that the clip 1A holding the mucous membrane X is inserted into the hollow organ. It can be left in the mucosa.

(Modification mode)
The medical clip of the present invention can take various forms. For example, in the clip 1A described above, the inner sheath stopper 13 is formed on the first arm 10 having the hook-shaped projections 12a and 12b, and the slope-shaped projection 23 is formed on the second arm 20 having the latched portion 22. Alternatively, the slope-like protrusion 23 may be formed on the first arm 10 having the hook-like protrusions 12 a and 12 b, and the inner sheath stopper 13 may be formed on the second arm 20 having the latched portion 22 .

Also, in the present invention, the slope-shaped projection 23 and the inner sheath stopper 13 may be omitted. For example, in the clip 1B shown in FIGS. 5A, 5B, and 6, the first arm 10 has hook-shaped projections 12a, 12b, and the hook-shaped projections 12a, 12b latch the second arm 20, thereby The tip 11 of the first arm 10 and the tip 21 of the second arm 20 are held in a closed state in common with the clip 1A described above. It is recessed on the arm 10 side. By recessing the latched portion 22 of the second arm 20 toward the first arm 10 in this way, the clip 1B is attached to the clip sheath 40 of the endoscope clip device, and the operation wire 43 is used to attach the clip 1B to the inner sheath. 41, the hook-shaped projections 12a and 12b of the first arm 10 can be latched to the second arm 20 with a smaller retraction amount.

Further, in this clip 1B, the second arm 20 is not formed with a slope-like projection, and the first arm 10 is not formed with the inner sheath stopper 13. As shown in FIG.

Therefore, as shown in FIG. 7A, the clip 1B is attached to the clip sheath 40 of the endoscope clip device, and the operation wire 43 is used to pull the clip 1B into the inner sheath 41. As shown in FIG. , the convex portion 26 adjacent to the recess on the side of the continuous portion 30 of the recess of the latched portion 22 hits the inner wall of the inner sheath 41, thereby closing the tip portions 11 and 21 of the clip 1B.

After the clip 1B is closed in this way, when removing the clip 1B from the clip sheath 40, the inner sheath 41 is pulled back and the operation wire 43 is removed from the clip 1B in the same manner as the clip 1A.

When the inner sheath 41 of the clip 1B is pulled back, the projection 26 of the second arm 20 and the outer surface 10o of the first arm 10 slide against the inner wall of the inner sheath 41. As shown in FIG. Therefore, the surface of the clip 1B preferably has a low sliding resistance.

On the other hand, in order to reduce the sliding resistance by reducing the area where the clip contacts the inner wall of the inner sheath 41, for example, like the clip 1C shown in FIGS. Hemispherical protrusions 17 and 27 may be provided on the side adjacent to the protrusion 26 and on the corresponding sites of the first arm 10 . Since the hemispherical protrusions 17 and 27 are in point contact with the inner wall of the inner sheath 41, sliding resistance between the clip 1C and the inner wall of the inner sheath 41 can be suppressed.

In each of the clips described above, for example, as shown in FIG. 9, as the connection portion 45 of the operation wire 43, the tip is bent into a hook shape, and the hook portion is hooked to the continuous portion 30 of the clip. When used, the continuous portion 30 may be provided with a projecting portion 31 that prevents the tip of the operation wire 43 from moving unnecessarily toward the tips 11 and 21 of the clips 1A, 1B, and 1C.

For example, as shown in FIG. 10, a compression piece 50 made of flexible resin and holding a fluorescent dye is attached to the clamping portions 15 and 25 of each clip described above, and the distal end portions 11 and 21 of the arms are compressed. The piece 50 may also protrude. FIG. 11 is a top view of clip 1A having compression piece 50. FIG. FIG. 12 is a cross-sectional view of the clip 1A with the compression pieces 50 holding the mucous membrane.

As the flexible resin forming the compression piece 50, it is preferable to use a resin that does not degenerate even if left in the gastrointestinal tract or the like for a long period of time and that has acid resistance to withstand gastric acid. Examples of such flexible resins include resins used in medical instruments, such as soft polyvinyl chloride, thermoplastic polyurethane, silicone, and ethylene-vinyl acetate copolymer.

Moreover, the compression piece 50 has appropriate hardness and elasticity so that the protruding portion 51 can effectively compress the biological tissue by bending the compression piece 50 in a state where the clip 1A holds the biological tissue. preferably.

The hardness of the compression piece 50 is preferably in the range of A10 to A90 as Shore A (JIS K 6253) or D40 to D70 as Shore D (JIS K 6253) measured with a durometer. Moreover, it is preferable to appropriately select the hardness of the compression piece 50 according to the shape, size, and the like of the compression piece 50 .

As for the elasticity of the compression piece 50, the bending elastic modulus (ASTM D 790) is preferably 4 to 200 MPa, more preferably 10 to 100 MPa.

The fluorescent dye to be held by the compression piece 50 preferably emits fluorescence in the wavelength range of red to near-infrared light of 600 to 1400 nm, preferably in the wavelength range of red to near-infrared light of 700 to 1100 nm. Those previously mentioned can be used.

As a specific mode of holding the fluorescent dye in the compression piece 50, the flexible resin forming the compression piece 50 may contain the fluorescent dye, or the surface of the compression piece made of flexible resin may contain the fluorescent dye. It is also possible to form a coating film to be used. When the flexible resin forming the compression piece 50 contains a fluorescent dye, the preferred concentration of the fluorescent dye can be set according to the type of the fluorescent dye and resin, and is usually 0.001 to 1% by mass. It is preferable to

On the other hand, the shape of the compression piece 50 is roughly strip-shaped, and in each of the first arm 10 and the second arm 20, the compression piece 50 protrudes from the holding portions 15 and 25 in the longitudinal direction of the arms. The compression piece 50 may be provided with constrictions 52, 53 near the distal ends 11, 21 of each arm, on the inner and outer longitudinal sides of the arms. This makes it easier for the projecting portion 51 of the compression piece 50 to bend as indicated by the dashed line in FIG. Depending on the size and shape of the constrictions 52 and 53 and the presence/absence of the constrictions 52 and 53, the force with which the compression pieces 50 press the living tissue when the clip 1A with the compression pieces 50 clamps the living tissue can be adjusted.

As shown in FIG. 12, when the body tissue X is clamped by the clip 1A with the compression piece 50, the compression piece 50 is bent, and the bent portion strongly presses the body tissue X in the thickness direction of the body tissue, thereby Blood in the underlying vascular network Y is removed. In this state, when the compression piece 50 is irradiated with excitation light in a wavelength range from red to near-infrared as excitation light from the serosal side, the absorption of the excitation light is hardly inhibited by hemoglobin, and the compression piece 50 holds it. It is absorbed by the fluorescent dye, and the fluorescent dye emits fluorescence in a wavelength range from red to near-infrared. This fluorescence is emitted outside the hollow organ without being substantially inhibited by hemoglobin in absorption. Therefore, this fluorescence can be well observed from the outside of the hollow organ, the position of the biological compression clip clamped inside the hollow organ can be known, and the position of the affected part can be specified.

When the clip is provided with the compression piece 50, the regions from the distal end portions 11, 21 of the arms 10, 20 to the holding portions 15, 25 may be shaped like a clip 1D as shown in FIG. FIGS. 14A and 14B are perspective views of a clip 1D provided with compression pieces 50 by insert molding in the clamping portions 15 and 25. FIG.

That is, in this clip 1D, two comb teeth 11t and 21t are arranged in parallel from the tips 11 and 21 of the arms 10 and 20 to the clamping portions 15 and 25, and a space between the two comb teeth is provided between the two comb teeth. 11s and 21s. In addition, holes 18 and 28 are necessary for securing the fixing of the compression piece 50 in portions closer to the continuous portion 30 than the comb teeth 11t and 21t in the clamping portions 15 and 25 of the arms 10 and 20. provided accordingly. In the clip 1D of this embodiment, each arm 10, 20 is provided with two comb teeth 11t, 21t. It can be two or more, preferably two or three.

In addition, the claws 11a and 21a standing inward at the tips of the comb teeth 11t and 21t are formed so that the claws 11a and 21a are separated from the central axis L of the clip 1D when the clip 1D is closed. is preferred. Here, in the present invention, the central axis L of the clip bisects the width W of the arm in the top view of the clip (Fig. 11) and is equidistant from the pair of arms 10 and 20 in the side view of the clip. axis (Fig. 12). When the clip 1D is closed and the claws 11a and 21a of the distal end portions 11 and 21 are separated from the central axis L, the clip 1D clamps the mucous membrane of the biological tissue as shown in the cross-sectional view of FIG. In addition, fluorescence emitted not only from the protruding portion 51 and the outer portion 54 of the compression piece 50, but also from the inner portion 55 and the portion between comb teeth 56 is not blocked by the metal plates and claws 11a and 21a that constitute the arms 10 and 20. , exits in the serosal direction. Therefore, the fluorescence intensity in the observation direction can be remarkably enhanced.

Moreover, the clip 1D having the compression piece 50 can be easily manufactured by insert molding. By fitting the compression pieces into the spaces 11s and 21s between the comb teeth, the compression pieces 50 can be attached easily and firmly.
The various modifications described above can be combined as appropriate.

1A, 1B, 1C, 1D Clip 1X Clip 2 Crimping ring 10 First arm 10o Outer surface 11 of first arm Tip 11a Claw 11t Comb tooth 11s Space between comb teeth 12a, 12b Hook-shaped projection (latch part)
13 Inner sheath stopper, projecting portion 13a Continuing portion side end portion of inner sheath stopper 14 First arm curved portion 15 Clamping portion 16 Operating convex portion 17 Hemispherical convex portion 18 Hole portion 20 Second arm 20o Outer surface of the second arm 21 Tip portion 21a Claw 21t Comb tooth 21s Space between comb teeth 22 Latched portion 23 Slope-shaped projection 24 Second arm curved portion 25 Clamping portion 26 Projection 27 Hemispherical projection 28 Hole 30 Continuous portion 31 Projection 40 For clip Sheath 41 Inner sheath 42 Outer sheath 43 Manipulating wire 44 Connecting part 45 Connecting part 50 Compression piece 51 Protruding part 52 Constriction 53 Constriction 54 Outer part 55 Inner part 56 Part between comb teeth 57 Reinforcement part A Width of the second arm in the lateral direction center line Hs height of slope-like protrusion L central axis of clip W, W1, W2 width of arm, width of first arm, width of second arm Ws width of slope-like protrusion X mucous membrane, biological tissue Y vascular network α Inclination angle of slope-shaped projection

Claims (10)

A leaf spring-shaped medical clip having a first arm and a second arm facing each other, and a continuous portion between one end of the first arm and one end of the second arm,
The medical clip does not have a crimping ring that fits over the first arm and the second arm to close the medical clip,
A pair of hook-shaped projections capable of latching both sides of the second arm are provided in the longitudinal center of the first arm,
When the first arm and the second arm come close to each other by a predetermined distance, the pair of hook-shaped projections latch both sides of the second arm, and the first arm and the second arm are kept in the close proximity ,
The medical clip is located on the outer surface of the second arm on the opposite side of the first arm, and is positioned closer to the distal end of the second arm than the latched portion of the second arm that is latched by the hook-shaped projection of the first arm. has a slope-shaped projection extending in the longitudinal direction of the second arm,
The height of the slope-shaped projection gradually increases toward the tip of the second arm with respect to the outer surface of the second arm.
medical clip. 2. The clip according to claim 1 , wherein the inclination angle of the slope-shaped projection with respect to the outer surface of the second arm gradually increases toward the distal end of the second arm. 3. The clip according to claim 1 , wherein the slope-shaped projections are formed along both sides of the second arm. A projecting portion is provided as an inner sheath stopper on the outer surface of the first arm opposite to the second arm and closer to the tip of the first arm than the pair of hook-shaped projections,
When the hook-shaped projection of the first arm latches the second arm, the position of the end of the inner sheath stopper on the continuous portion side in the clip longitudinal direction is within the formation range of the slope-shaped projection in the clip longitudinal direction in the same state. The clip according to any one of claims 1-3 . The first arm has a first arm curved portion curved toward the second arm between the hook-shaped projection and the continuous portion, and the second arm is located between the latched portion and the continuous portion. It has a second arm curved portion curved toward the first arm side, and the first arm curved portion and the second arm curved portion are in contact with each other, and the contact portion serves as a fulcrum for opening and closing the first arm and the second arm. Item 5. The clip according to any one of items 1 to 4 . A leaf spring-shaped medical clip having a first arm and a second arm facing each other, and a continuous portion between one end of the first arm and one end of the second arm,
A pair of hook-shaped projections capable of latching both sides of the second arm are provided in the longitudinal center of the first arm,
The part of the second arm that is latched by the hook-shaped projection is recessed in a well shape toward the first arm.cage,
When the first arm and the second arm come close to each other by a predetermined distance, the pair of hook-shaped projections latch both sides of the second arm, and the close state of the first arm and the second arm is maintained.
medicalclip. 7. The first arm and the second arm each have a compression piece protruding in the longitudinal direction of the arm portion from the tip of each, and the compression piece is made of an elastic resin containing a fluorescent dye. Crab described clip. The method for manufacturing the clip according to any one of claims 1 to 6 , wherein the clip is manufactured by injection molding of resin. 9. The method of manufacturing a clip according to claim 8 , wherein the resin contains a fluorescent dye. The method for manufacturing the clip according to any one of claims 1 to 6 , wherein the clip is manufactured by bending a metal plate.

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