JPH05208020A - Clip device - Google Patents

Abstract

PURPOSE:To provide a clip device which can perform the stable clipping by a slight force and facilitates the reduction of the diameter of an introducing pipe. CONSTITUTION:An introducing pipe 4 which can be inserted into a celom and each nipping part 8c which is bent inside at the top edges of a pair of arm parts 8b are formed, and the spreading performance for spreading the arm part 8b in the direction for separating the nipping parts 8c is provided. A clip device 1 is constituted of a clip 8 accommodated in the state where the arm part 8b is closed in the introducing pipe 4, clip tightening ring 6 installed in a nontightened state behind the clip 8 in the introducing pipe 4, fiber 2 for introducing beam beam which is installed by directing the radiation edge in the vicinity of the clip tightening ring 6 inside the introducing pipe 4, and a means which shifts the clip tightening ring 6 forward by the action of the laser energy supplied from the fiber 2 for introducing laser beam and allows the ring 6 to be fitted at the arm part 8b of the clip 8 and tightens the nipping part 8c of the clip 8 to a closed state.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a clip device used for endoscopic hemostasis and marking a treatment site.

[0002]

2. Description of the Related Art Conventionally, a procedure has been performed in which a treatment tool is introduced into an internal body of a body through an endoscope to excise or electrically cauterize an affected tissue in the body of the body. Recently, a cholecystectomy using a laparoscope has been frequently performed. In this case, a clip is often used for ligation because it is necessary to ligate the gallbladder artery and the bile duct.

As a clip device having such a clip, for example, the one disclosed in Japanese Utility Model Laid-Open No. 2-6011 has been proposed. As shown in FIG. 6, the clip device 100 includes a clip device body 103 and a clip device body 1
03 and a clip unit 101 detachably attached. The clip unit 101 includes a clip 102, a connecting member 106, and a clip tightening ring 104.

In the clip 102, a thin metal strip plate material is bent in the central portion, and a base end portion 102a is formed in the bent portion. Further, the proximal end portion 1 of this clip 102
The pair of arm portions 102b, 102b extending from 02a are bent inwardly at an angle of approximately 90 degrees at the tip portions of the pair of arm portions 102b, 102b, for example, to sandwich and ligate a ligation site of a biological tissue.
2c and 102c are formed. Further, the clip 102 is provided with open-expanding property for expanding the arms 102b and 102b in the direction in which the holding portions 102c and 102c are separated from each other.

The clip unit 101 also holds a proximal end portion 102a of the clip 102 and a clip tightening ring 104 which can be fitted on the arm portions 102b and 102b of the clip 102, and a hook 106 provided at the tip.
It has a connecting member 106 that engages with the base end portion 102a of the clip 102 in a disengageable manner by hooking a on the base end portion 102a of the clip 102.

On the other hand, the clip device main body 103 is provided with an introducing tube 114 made of a flexible tube that can be inserted into a forceps channel of an endoscope (not shown), and is inserted into the introducing tube 114 so as to be able to advance and retract, and has a distal end. A coil sheath 113 to which a connecting ring 112 is attached and fixed, and this coil sheath 1
The operation wire 110 is inserted into the inside of the housing 13 so as to be able to advance and retract.

A hook 107 is attached to the tip of the operation wire. Pin 1 is vertically attached to the tip of hook 107.
08 is projectingly provided so that it can be detachably engaged with an engaging hole 121 provided at the base end of the connecting member 106. The engagement hole 121 is a long hole 12 extending in the longitudinal direction.
1a and a large diameter hole 121b formed at the end of the elongated hole 121a in the hook 106a direction.

To attach the clip unit 101 to the clip device body 103, as shown in FIG.
Large-diameter hole 12 of connecting member 106 of clip unit 101
The head of the pin 108 of the hook 107 is fitted into the 1b, and in this state, the clip unit 101 is pulled toward the tip side. Then, the long hole 121a of the engaging hole 121 of the connecting member 106 fits into the neck portion of the pin 108 of the hook 107, and cannot be easily removed. In this state, the operation wire is pulled toward the hand side to pull the hook 107 into the connecting ring 112, and the proximal end side of the clip tightening ring 104 on the clip unit 101 side is fitted and fixed in the connecting ring 112. Is.

When grasping a living tissue using the clip device 100 having the above structure, first, the clip device 100 is used.
After being introduced into the living body through the forceps channel of the endoscope, as shown in FIG. 6B, the coil sheath 113 is pushed out with respect to the introduction tube 114, and the clip 102 is projected from the introduction tube 114 to the outside. Arm part 10
Expand 2b and 102b. Then, the operation wire 110
By pulling in the right direction in the drawing, the hook 107 is pulled toward the hand side, and the base end portion 102a of the clip 102 is pulled into the clip tightening ring 104. As a result, the proximal end portion of the proximal end portion 102a of the clip 102 is crushed, and as a result, the arm portions 102b and 102b of the clip 102 are opened to the maximum. In this state, when the clip 102 is pressed against the living tissue requiring clipping and the operation wire 110 is further pulled toward the hand side, the arms 102b and 102 of the clip 102 are
When b is pulled into the clip tightening ring 104, the arms 102b and 102b of the clip 102 are closed, and the sandwiching portions 102c and 102c sandwich the living tissue. After that, by further pulling the operation wire toward the hand side, the clip 102 is deeply driven into the living tissue, the hook 106a of the connecting member 106 is extended and the connecting member 106 is disengaged from the clip 102, and as a result, the clip 102 and the clip are fastened. The working ring 104 is placed in the body.

[0010]

By the way, in the clip device 100 having the above structure, the arm portions 102b, 10 of the clip 102 are pulled by pulling the operation wire 110 toward the hand side.
2b is pulled into the clip tightening ring 104 to close it, sandwich the living tissue, and further pull the operation wire 110 toward the proximal side to engage the hook 106a of the connecting member 106 and the base end portion 102a of the clip 102. The clip 102 and the clip tightening ring 104 are left in the body after being removed, and all clipping of the living tissue is performed by manually pulling the operation wire 110.

Therefore, since a relatively large force is required for the clipping operation, there is a problem that stable clipping cannot be performed. In addition, the coil sheath 11
Since 3 is used, there is also a problem that it is difficult to reduce the diameter of the introduction pipe 114.

The present invention has been made in view of the above circumstances. An object of the present invention is to perform stable clipping with a small force and to easily reduce the diameter of the introduction tube. To provide.

[0013]

In order to solve the above-mentioned problems, the present invention has an introduction tube that can be inserted into a living body, and a pair of arm portions, each of which has a holding portion that is bent inward. A clip that is opened and expands the arm portion in a direction of separating the holding portion, and is accommodated in the introduction tube with the arm portion closed, and the clip in the introduction tube. A clip tightening ring that is mounted rearward in a non-tightened state, a laser light guiding fiber that is provided near the clip tightening ring in the introduction tube with its emission end facing, and the laser light guiding The clip device is constituted by means for moving the clip tightening ring forward by the action of the laser energy from the fiber so as to be fitted on the arm part of the clip and for tightening the holding part of the clip in a closed state. Also It is.

[0014]

By the action caused by the laser light from the laser light guiding fiber, the clip tightening ring moves to the arm part of the clip located in the front and is fitted into the arm part, and the clip holding part is closed. Tighten it to the state where it is completed.

[0015]

Embodiments of the present invention will be described below with reference to the drawings. FIG. 1 shows a first embodiment of the present invention. The clip device 1 of the present embodiment has an introduction tube 4 which can be inserted into the living body through a forceps channel of an endoscope (not shown). The introduction tube 4 is made of, for example, Teflon, and four laser light guide fibers 2 are inserted therein. Each of the laser light guiding fibers 2 is connected to a laser oscillation device (not shown) that oscillates a pulsed laser beam having a high power density, and a clad coating of the fiber 2 is removed from the emitting tip end of the fiber so that the core is exposed. is there. As the laser light sent from the laser oscillator, one having a high peak power such as a Q switch type YAG laser or a flash lamp excited laser is used.

A bag body 10 containing a fluid having a high density such as water or oil is attached to the emission end of each laser light guide fiber 2, and the bag body 10 can be inserted into the introduction tube 4 to the outside. It is fixed to the outer peripheral surface of a tubular clip tightening ring 6 having a diameter. A ring-shaped projection 6a is formed on the outer periphery of the base end of the clip tightening ring 6 so as to project radially outward, and the bag body 10 is clipped in a state of abutting against the back surface of the projection 6a. The laser light guide fiber 2 is fixed to the outer peripheral surface of the tightening ring 6, and the emission end of the laser light guide fiber 2 is arranged so as to face the back surface of the protrusion 6a. The bag body 10 is mounted without protruding from the tip of the protrusion 6a.

A clip 8 held by holding means (not shown) is set in the clip tightening ring 6. The clip 8 can be moved forward and backward together with the clip tightening ring 6 in the introduction tube 4 by the holding means. In addition, as the holding means,
For example, an operation wire having a hook at the tip is inserted into the introducing tube 4 so as to be able to move back and forth, and the base end of the clip 8 is hooked on the hook of the operation wire. Then, the engagement between the hook of the operation wire and the base end portion of the clip 8 is to be released by a reaction when the clip fastening ring 6 is blown off by the shock wave stress described later.

The clip 8 is formed by bending a thin metal strip material from the central portion, and a pair of fitting portions extending from the bent portion at intervals larger than the inner diameter of the clip tightening ring 6. 8a, 8a are formed. And
The clip 8 is set in a state in which the fitting portions 8a, 8a are crushed and fitted into the clip tightening ring 6.

Further, the fitting portions 8a, 8a are further extended to intersect both the arm portions 8b, 8b, and the arm portions 8b, 8b.
The tip of b is bent so as to face each other, and the holding portion 8c,
8c is formed. Further, the clip 8 is provided with arms 8b and 8b in a direction to separate the holding portions 8c and 8c from each other.
It has been given the ability to expand and expand.

In the set state of the clip 8 as shown in FIG. 1 (a), the clip 8 has its fitting portions 8a, 8a.
Is in a non-tightened state in which it is simply clamped by the clip tightening ring 6. Further, the clip 8 is clamped only when the clip tightening ring 6 is moved forward by the stress of a laser shock wave described later and the clip tightening ring 6 is fitted on the arms 8b, 8b. Is to be closed. It should be noted that the tip of the clip tightening ring 6 tapers outward so that the clip tightening ring 6 can be easily moved in the direction of the arms 8b and 8b of the clip 8 by the stress of the laser shock wave. A tapered portion 6 is formed.

The laser light guided by the laser guiding fiber 2 is converted into a shock wave inside the bag body 10. That is, the laser light guided by the laser light guiding fiber 2 is focused at the distal end of the fiber 2, and the focused light is dielectrically broken down inside the fluid filled in the bag body 10. To generate a plasma, and a shock wave is generated in the fluid atmosphere in the bag body 10 due to the expansion of the plasma and the accompanying cavitation phenomenon.

Next, the operation of the clip device 1 having the above structure will be described. When grasping a living tissue using the clip device 1, first, the clip device 1 is introduced into the living body through a forceps channel of an endoscope (not shown). In this case, the clip 8 is housed in the introduction tube 4 with the arm 8b closed. Then, the holding means (not shown), for example, an operation wire is pushed forward to push the clip 8 out of the introduction tube 4, and the arms 8b and 8b of the clip 8 are expanded as shown in FIG. 1 (a). To do. In this state, the clip 8 is pressed against the living tissue that requires clipping, and a pulsed laser beam with a high power density is oscillated from a laser oscillator (not shown). This laser light is focused at the distal end of the laser light guide fiber 2 and abruptly increases the electric field strength in the bag body 10 to cause dielectric breakdown in the fluid of the bag body 10 as described above. Due to this dielectric breakdown, a shock wave is generated inside the bag body 10. In this case, since a shock wave is generated in the fluid having a high density, the generated stress becomes extremely large.

The stress generated by the shock wave acts on the back surface of the protrusion 6a of the clip tightening ring 6, and the stress shown in FIG.
(C), the clip tightening ring 6 is blown away in the forward direction of tightening the clip 10. At this time, the bag body 10 is also blown off by the shock wave stress. The clip fastening ring 6 blown off in the forward direction is fitted onto the arms 8b and 8b of the clip 8 to close the arms 8b and 8b,
As a result, the sandwiching portions 8c, 8c of the clip 8 sandwich the living tissue. The engagement between the base end of the clip 8 and the hook at the tip of the operation wire as the holding means is released by a reaction when the clip fastening ring 6 is blown away by the stress of the shock wave. For this reason, the clip 8 and the clip tightening ring 6 fitted to the clip 8 are each left inside the body.

As described above, in the clip device 1 of the present embodiment, the clip tightening ring 6 is moved forward by the stress of the laser shock wave and the arms 8b, 8 of the clip 8 are moved.
It is fitted in b, and the holding portions 8c, 8c of the clip 8 are closed. By pulling the operating wire manually, the clip on the distal end side of the operating wire is pulled into the clip tightening ring. Unlike the conventional method of closing the clip, no force is required for the clipping operation.

In addition, the clip device 1 does not close the clip while moving the clip as in the conventional case, but clips the clip 8 to the arm portions 8b and 8b of the clip 8 while fixing the clip 8 against the living tissue. Since the tightening ring 6 can be fitted, stable clipping can be performed. Further, the clip device 1 has an introduction pipe 4
Since the conventional coil sheath is not inserted into the inside of the tube, the diameter of the introduction tube 4 can be reduced accordingly.

FIG. 2 shows a second embodiment of the present invention. In the clip device 20 of the present embodiment, the bag body 10 attached to the tip of the laser light guiding fiber 2 is fixed to a round clip tightening ring 22, and other configurations are the first. Same as the embodiment. Therefore,
Also in the clip device 20 having this configuration, as shown in FIG. 2B, the clip fastening ring 22 is blown forward by the laser shock wave and fitted onto the arm portion 8b of the clip 8, so that the first embodiment is achieved. It can have the same effect as. Further, since the structure of the clip tightening ring 22 is simpler than that of the first embodiment, the cost can be reduced, which is useful.

FIG. 3 shows a third embodiment of the present invention. The clip device 30 of the present embodiment has a rod-shaped ring push-out member 34 made of a shape memory alloy at a position facing the emission end of the laser light guide fiber 2 inserted in the introduction tube 4. The ring pushing member 34 is fixed in the introduction tube 4 by a ring-shaped fixing portion 36 that is integrally provided at the base end portion of the ring pushing member 34. In addition, the tip of the ring pushing member 34 is bent toward the inner side, and the bent portion 34 is bent.
It is a.

The ring pushing member 34 is memorized so that when heated above the shape recovery temperature, the bent portion 34a at the tip rises outward and expands linearly. Further, a round clip tightening ring 32 is arranged in the developing direction of the bent portion 34a while being in contact with the bent portion 34a. The clip tightening ring 32 is fitted to a base end 9a of a clip 9 formed by bending a thin metal strip material from a central portion thereof, and is shown, for example, engaged with the base end of the clip 9. A state of being pressed against the bent portion 34a of the ring pushing member 34 by a pulling force of a holding means such as an operation wire (for example, the same as the above-mentioned operation wire with a hook that is inserted into the introducing tube 4 so as to be able to advance and retract). It is in. The clip 9 has nipping portions 9c and 9c in which the tips of the arm portions 9b and 9b extending from the bent proximal end portion 9a are inwardly bent, and the nipping portions 9c and 9c form living tissue. It is possible to pinch.

When performing a clipping operation using the clipping device 30 having the above-described configuration, first, the introduction tube 4 is introduced into the living body by the same operation as in the first embodiment, and the outside of the introduction tube 4 is clipped. 9 is projected and the arms 9b and 9b of the clip 9 are expanded as shown in FIG. In this state, the clip 9 is pressed against a living tissue that requires clipping, and a pulsed laser beam having a high power density is oscillated from a laser oscillator (not shown).
This laser light is emitted from the emission end of the laser light guiding fiber 2 and heats the ring pushing member 34 to a temperature above the shape recovery temperature. In the ring extruding member 34 heated to the shape recovery temperature or higher, the bent portion 34a of the ring extruding member 34 starts to restore to a linear shape, as shown in FIG. 3B. The bent portion 34a is restored to a linear shape and pushes out the clip tightening ring 32, which abuts against the bent portion 34a, to push forward the arm portion 9b of the clip 9,
Move to 9b. As a result, the clip 9 has its arms 9b, 9b clamped and closed by the clip clamping ring 32, and the living tissue is clamped by the clamps 9c, 9c. The engagement between the base end of the clip 9 and the hook at the tip of the operation wire as the holding means is
Bending portion 34a for pushing the clip fastening ring 32 forward
It is better to be released by the reaction of. As a result, the clip 8 and the clip tightening ring 6 fitted to the clip 8 are each left inside the body.

Therefore, the clip device 30 having the above structure
Is to deform the shape of the clip tightening ring 32 by the thermal energy of the laser light to move the clip tightening ring 32 forward, and tighten the arms 9b, 9b of the clip 9 to close it. As in the above embodiment, the clipping operation requires no force. Further, since the clip tightening ring 32 can be fitted on the arms 9b, 9b of the clip 9 in a fixed state in which the clip 9 is pressed against the living tissue, stable clipping can be performed. Furthermore, since the clip device 30 does not have a conventional coil sheath inserted in the introduction tube 4, the diameter of the introduction tube 4 can be reduced accordingly.

FIG. 4 is a modified example of the second embodiment, in which a recess 8d into which the clip tightening ring 22 can be fitted is formed in the vicinity of the central portion of the arms 8b and 8b of the clip 8.
In this structure, the clip tightening ring 22 is blown forward by the laser shock wave, and then the concave portion 8 is formed.
It fits in d and is fixed. As a result, the clip tightening ring 22 can be prevented from coming off the clip 8, and reliable clipping can be realized.

FIG. 5 shows a fourth embodiment of the present invention. The clip device 50 of this embodiment is different from the third embodiment only in the configuration of the ring pushing member 54, and the other configurations are the same as those in the third embodiment. Therefore, the configuration of the ring pushing member 54 is here. And only the operation will be described.

The ring extruding member 54 is a shape memory alloy wire formed in a coil shape, and is mounted in the introducing pipe 4 with its base end fixed to the inner surface of the introducing pipe 4. The ring extruding member 54 has a base end portion facing the emission end of the laser light guide fiber 2 and is heated by the laser light emitted from the laser light guide fiber 2. In addition, the ring pushing member 54
A plurality of projections 54a, which project inward in the radial direction, are formed in the circumferential direction at the tip end of each of them in the shape of a ring or in the shape of a ring. Are in contact. Then, the ring pushing member 5
When No. 4 is heated above the shape recovery temperature, (b) in FIG.
As shown in FIG. 7, the clip tightening ring 32, which is adapted to be elongated and deformed along the axial direction of the introduction tube 4 and which abuts on the protruding portion 54a, is moved forward to move the clip tightening ring 32 to the arm portions 9b and 9b of the clip 9. It can be fitted to the.

Therefore, the clip device 50 having the above structure
Is the same as in the third embodiment, the laser light is emitted from the emission end of the laser light guide fiber 2 and the ring extruding member 54.
If the ring is heated above the shape recovery temperature, the ring extruding member 5
The protrusion 54a is moved forward by the extension deformation of 4, and the clip tightening ring 32 is moved to the arms 9b and 9b of the clip 9.
The arm portions 9b and 9b can be closed by fitting the same to the above, and the same operational effect as that of the third embodiment can be obtained.

[0035]

As described above, in the clip device of the present invention, the clip tightening ring moves forward due to the action of the laser energy and is fitted on the arm portion of the clip, and the clip holding portion is closed. The pulling operation of the operating wire manually pulls the clip on the tip side of the operating wire into the clip tightening ring to close the clip. Not. Further, the clip device of the present invention does not close the clip while moving the clip as in the prior art, but covers the arm portion of the clip with a clip tightening ring in a fixed state in which the clip is pressed against living tissue. Since it can be fitted, stable clipping can be performed. Further, since the clip device of the present invention does not have a conventional coil sheath inserted inside the introduction tube, the diameter of the introduction tube can be reduced accordingly.

[Brief description of drawings]

FIG. 1 (a) is a sectional view of the front end side of a clip device showing a first embodiment of the present invention, (b) is a vertical sectional view taken along the line AA of (a), and (c) shows a clip. FIG. 6 is a sectional view of the front end side of the clip device in a closed state.

FIG. 2A is a sectional view of a clip device on the distal end side showing a second embodiment of the present invention, and FIG. 2B is a sectional view of the clip device on the distal end side of FIG. ..

FIG. 3A is a sectional view of a clip device on the distal end side showing a third embodiment of the present invention, and FIG. 3B is a sectional view of the clip device on the distal end side of FIG. ..

FIG. 4 shows a modified example of the clip device of FIG. 2, and is a cross-sectional view of the front end side of the clip device in a state where the clip is closed.

FIG. 5A is a sectional view of a clip device on the distal end side showing a fourth embodiment of the present invention, and FIG. 5B is a sectional view of the clip device on the distal end side of FIG. ..

FIG. 6A is a perspective view showing a method of attaching a clip unit and a clip device main body in a conventional clip device, and FIG. 6B is a sectional view of a tip side of the clip device in FIG. 6A.

[Explanation of symbols]

1, 20, 30, 40, 50 ... Clip device, 2 ... Laser guiding fiber, 4 ... Introducing tube, 6, 22, 32, 52
... clip tightening ring, 8, 9 ... clip, 8b ... arm portion, 8c ... clamping portion, 10 ... bag body.

 ─────────────────────────────────────────────────── ─── Continued Front Page (72) Inventor Yasuhiro Ueda 2-43-2 Hatagaya, Shibuya-ku, Tokyo Olympus Optical Co., Ltd. (72) Inventor Sayuri Kamiya 2-43-2 Hatagaya, Shibuya-ku, Tokyo Olympus Optical Co., Ltd.

Claims (1)

[Claims] 1. An introduction tube that can be inserted into a living body, and a pair of arm portions each having a nipping portion that is bent inwardly are formed at the tips of the arm portions, and the arm portions are arranged in a direction in which the nipping portions are separated from each other. A clip that has an opening and expanding property for expanding and is accommodated in the introduction pipe in a state where the arm portion is closed, and a clip tightening ring that is mounted behind the clip in the introduction pipe in a non-tightened state. A laser light guide fiber provided with its emission end facing in the vicinity of the clip tightening ring in the introduction pipe, and the clip tightening ring forward by the action of laser energy from the laser light guiding fiber. And a means for fitting the arm of the clip to the arm and tightening the holding portion of the clip in a closed state.