JPH05212043A - Clipping device - Google Patents

Abstract

PURPOSE:To surely grip a fine blood vessel, etc., and to close the blood vessel by providing a bent part where the middle parts of both arm parts of a clip are bent outwardly so that the spacing between both arm parts can be reduced at the time of closing both arm parts of the clip. CONSTITUTION:A clip unit 1 is first mounted to a clip operating device 6 by engaging the engaging hole of a connecting plate 3 of the clip 2 with the pin 36 of a hook part 30. The hand side end 2d of the clip 2 is then retracted into a retaining pipe 4 by the operation to pull a wire 9, by which both arm parts 2A, 2B are actuated to open so as to bring the stalk part of the polypus to be excised between both arm parts 2a and 2b. The wire 9 is further operated to be pulled to retract the two arm parts 2a, 2b into the retaining pipe 4, by which the arm parts 2a, 2b are closed. The spacing between the arm parts 2a and 2b is sufficiently reduced by the action of the outer bent part 2a provided in the middle part of the arm parts 2a, 2b, by which the polypus is surely gripped.

Description

Detailed Description of the Invention

[0001]

FIELD OF THE INVENTION This invention relates to a clip device used for hemostasis or marking.

[0002]

2. Description of the Related Art Conventionally, a clip has been transendoscopically introduced into a body cavity, and the clip has been used to hold and indwell tissue for hemostasis or marking. As a clip device used for this type of operation, for example, Japanese Patent Application No. 2-21
As shown in No. 9933, by bending the holding portion provided at the tip of the arm of the clip with respect to the arm at an obtuse angle,
There has been proposed a structure in which a deeper part of a tissue is grasped and a hemostatic effect is enhanced.

[0003]

However, in the clip device disclosed in the above-mentioned Japanese Patent Application No. 2-219933,
When the holding part at the tip of the clip meshes with each other, a gap is formed between the pair of arms of the clip, and there is a problem that a thin blood vessel cannot be surely closed.

Also, when gripping a pedicle such as a pedunculated polyp between both arms of a clip, there is a possibility that a blood vessel in the pedicle such as a polyp cannot be completely closed due to a gap between both arms of the clip. is there.

The present invention has been made in view of the above circumstances, and an object thereof is to provide a clip device capable of reliably grasping a thin blood vessel, a stem portion of a pedunculated polyp, etc. and closing the blood vessel. To do.

[0006]

According to the present invention, there is provided an introduction tube which can be inserted into a living body cavity, an operation tube which is inserted into the introduction tube so as to be able to move forward and backward, and an insertion tube which is freely moved forward and backward into the operation tube and which has a hook at a tip thereof. With an operation wire having, and a clip that expands in a direction in which the distal ends of a pair of arms are separated from each other, a clip accommodated in the introduction tube with the arm closed, and a tip of the operation tube. A clip tightening ring that is detachably mounted and is fitted to the arm portion of the clip to close the arm of the clip, and the clip ring that can be inserted into the tightening ring. A clip device for a living tissue, comprising: a first engaging portion that releasably engages with an end portion; and a connecting member that has a second engaging portion that detachably engages with the hook. Direct to the middle of both arms outward Is bent, is provided with a crooked section to reduce the gap between the two arms when closed both arms of the clip.

[0007]

[Function] A thin blood vessel or a pedicle is obtained by reducing the gap between both arms of the clip when the both arms of the clip are closed by the bent portion in which the middle portions of both arms of the clip are bent outward. The stalk and the like of the sex polyp are surely grasped to close the blood vessel.

[0008]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS A first embodiment of the present invention will be described below with reference to FIGS. The clip device of this embodiment is provided with a cassette type clip unit 1 shown in FIGS. 1 (A) and 1 (B) and a clip operating device 6 shown in FIGS. 2 (A) and 2 (B).

This clip unit 1 has a clip 2,
A connecting plate (connecting member) 3 and a pressing tube (clip tightening ring) 4 are provided respectively. Further, the clip 2 is provided with a pair of arm portions 2A and 2B having a spreading and expanding property that spreads in a direction in which the tip portions are separated from each other. in this case,
For the clip 2, for example, a metal plate material such as a leaf spring material is bent at the central portion, and the plate material is crossed at a crossing portion 2c in the vicinity of the bent portion. The pair of arms 2A and 2B having the open-expanding property are formed by being extended in the state of being formed, and a substantially elliptical proximal end 2d is formed on the proximal end side.

The curved portion 2g of the proximal end portion 2d on the elliptical base end portion (folded portion) side is formed with a smaller radius of curvature than the curved portion 2h on the crossing portion 2c side. Further, the pair of arm portions 2A and 2B of the clip 2 are formed with an inner bent portion 2b on the proximal side.

Further, the middle portions of the arms 2A and 2B, which are closer to the tip than the inner bent portion 2b, are bent outward, respectively, so that both arms 2A and 2B of the clip 2 are closed. An outer bent portion 2a is formed to reduce the gap between 2A and 2B.

Then, as shown in FIG. 1C, the arm portion 2
When A and 2B are closed, the portion 2f on the tip side of the outer bent portion 2a is formed to be joined in a state of being substantially in close contact. A cutout 2e is formed in the bent portion of the proximal end 2d as shown in FIG. 1 (A).

Further, as shown in FIG. 1 (A), a hook-shaped hook portion (first engaging portion) 3a is formed at the tip of the connecting plate 3. Then, attach the hook portion 3a to the clip 2
The clip 2 is engaged with the notch 2e so that the clip 2 can be engaged and disengaged.

Further, at the other end of the connecting plate 3, there are provided a large diameter hole (second engaging portion) 3b for connecting with the clip operating device 6 and a small diameter hole (second engaging portion) 3c connected thereto. Has been formed. Since the connecting plate 3 is formed by processing a metal plate material by photoetching, a bridge for connecting the base material and the connecting plate 3 is required at the time of processing, and the bridge is the pressing pipe 4 in the connecting plate 3. It is provided at the center of the cutout portion 3d arranged in a portion that does not come into contact with. Thereby, the cut end of the bridge of the connecting plate 3 is set so as not to project outward from the extension line of the side surface of the connecting plate 3.

As shown in FIG. 1 (C), the holding tube 4 is fitted and fitted on the arm portions 2A and 2B of the clip 2 to close the arm portions 2A and 2B of the clip 2. is there. The holding tube 4 is the arm portion 2 of the clip 2.
In the standby state before the clip operation for closing A and 2B is performed, as shown in FIG.

Further, a taper portion 4b is formed on the inner peripheral surface of the tip portion of the pressing tube 4. Then, as shown in FIG. 1 (B), the holding pipe 4 is inserted until the end of the proximal end 2d of the clip 1 connected to the connecting plate 3 comes into contact.

The holding tube 4 is filled with the filler 5 in a volume of about 70%. And the holding tube 4
Is temporarily fixed to the connecting portion between the clip 2 and the connecting plate 3 by the filler 5. Further, an R chamfered portion 4a is formed on the outer peripheral surface of the tip end portion of the pressing tube 4, a step is formed near the central portion of the outer peripheral surface of the pressing tube 4, and a small diameter portion 4c is formed on the proximal side. Has been done.

Next, the structure of the clip operating device 6 shown in FIGS. 2A and 2B will be described. The clip operating device 6 includes an introduction tube 7 made of a flexible tube such as a synthetic resin, a flexible coil sheath portion 8 inserted into the introduction tube 7 so as to be able to advance and retract, and an advance / retreat inside the coil sheath portion 8. An operation wire 9 freely inserted is provided.

A hand-side operation section 10 is provided at the hand-side extending end portion of the introducing pipe 7. This hand side operation unit 10
Is a tube joint 14 fixed on the proximal side of the introduction pipe 7,
An operation section main body 22 for advancing and retracting the coil sheath section 8 and a slider section 32 for advancing and retracting the operation wire 9 are provided.

Further, inside the tube joint 14, the tube receiving member 1 connected to the proximal end of the introduction tube 7 is connected.
1 and the tube pressing member 13 are provided. In this case, a tapered taper portion is formed at the tip of the tube receiving member 11, and the proximal side extension end portion of the introduction tube 7 is externally fitted to the taper portion.

The tube receiving member 11 is screwed into the tube pressing member 13 to press and fix the end of the introducing pipe 7 at the taper portion. A break stopper 12 is provided at the tip of the tube pressing member 13.

Further, the tube joint 14 has a tube joint body 15, a lock release button 16 built in at the proximal end of the tube joint body 15, an interlock with the lock release button 16, and a lock release by a spring 17. The fixing member 18 biased in the direction of the button 16 and the tube joint body 15 are screwed and fixed, and the unlocking button 1
6, the spring 17 and the fixing member 18 to the tube joint body 1
5 and a lid 19 that holds the housing 5 in a state of being housed therein.

Further, a clip 2 is attached to the coil sheath portion 8.
And a tip member 20 having an inner diameter larger than the small diameter portion 4c of the pressing tube 4 and smaller than the large diameter portion.
Coil sheath (operation tube) 21 connected to the end of the coil sheath, and operation section body 2 connected to the proximal side of this coil sheath 21.
2 and are provided.

In this case, as shown in FIG. 3, the coil sheath 2
A guide member 23 having a thin outer diameter on the proximal side is connected to the end of 1. A coil member 24 is fixed to a large diameter portion of the guide member 23 on the front end side. Then, the coil sheath 24 and the operating portion main body 22 are connected by screwing and fixing the coil member 24 to the operating portion main body 22.

A spring member 25 is fixed to the tip of the guide member 23 via a coarsely wound coil member 26 screwed and fixed to the spring member 25. The tip of the spring member 25 extends beyond the tip surface of the operation section body 22 to the outside of the operation section body 22.

Further, as shown in FIG.
As shown in (B), a groove 27 for guiding the fixing member 18 of the tube joint 14 is formed. A step portion 28 for locking is formed at the proximal end of the groove 27. A ring 29 is rotatably connected to the proximal end of the operation portion main body 22.

The end of the hook portion 30 is connected to the tip of the operation wire 9. Further, the slider portion 32 of the proximal operation portion 10 is connected to the proximal end of the operation wire 9.

Further, the hook portion 30 is formed with a recessed notch 33 on the tip end side of the rod-shaped body. This notch 3
A pin 36 is provided on the inner bottom surface of the pin 3 so as to be perpendicular to the direction in which the operation wire 9 advances and retracts. The pin 36 has a circular head portion 34 and a small diameter portion 35 having a diameter smaller than that of the head portion 34. In this case, the head portion 34 of the pin 36 is formed smaller than the large diameter hole 3b of the connecting plate 3 of the clip 2 and larger than the small diameter hole 3c. In addition, pin 36
The small diameter portion 35 is formed smaller than the small diameter hole 3c of the connecting plate 3.

Further, the slider portion 32 is provided with a first slider member 38 and a second slider member 39 which are divided into two bodies. Further, a connecting member 37 is fixed to the end of the operation wire 9. This connecting member 37 is the first
It is sandwiched between the slider member 38 and the second slider member 39.

Further, fixed tubes 40 and 41 are screwed and fixed to the outer peripheral surface of the front end and the outer peripheral surface of the rear end of the slider portion 32, respectively, and the first slider member 38 and the second slider member 39 are integrally formed. In addition, the operation wire 9 and the slider portion 32 are connected to each other.

The slider portion 32 has a ratchet pawl 4
2 is built in in a state of being biased by the spring 43.
The ratchet pawl 42 is provided so as to contact the ratchet release button 44 and engage with the ratchet 45 of the operation portion main body 22. Further, the spring 4 for inserting the operation wire 9 between the operation section body 22 and the slider section 32.
6 is provided.

Next, the operation of the above configuration will be described.
First, when attaching the clip unit 1 to the clip operating device 6, the slider portion 32 is pushed out to the tip side while pushing the ratchet release button 44. As a result, the hook portion 30 projects from the tip member 20.

Then, after the pin 36 of the hook portion 30 is passed through the large diameter hole 3b of the connecting plate 3 of the clip 2, the slider portion 32 is pulled lightly. Then, the head 34 of the pin 36 engages with the small diameter hole 3c of the connecting plate 3, so that the clip unit 1 is connected to the clip operating device 6 in a state where the clip 2 cannot be easily removed.

After that, when the ratchet release button 44 is pushed, the slider portion 32 is automatically pulled to the hand side by the spring 46, and as shown in FIG. 2, the small diameter portion 4c of the pressing tube 4 of the clip 2 is a tip member. The clip 2 is pulled into the clip 20, and the clip 2 is attached to the clip operating device 6.

Subsequently, when the lock release button 16 of the tube joint 14 is pushed, the fixing member 18 is retracted and disengaged from the step portion 28 of the operation portion main body 22, and the biasing force of the spring member 25 of the operation portion main body 22 is released. .. Therefore, the operation unit main body 2
2 is pushed out toward the hand side with respect to the tube joint 14.
As a result, the clip 2 is housed in the introduction tube 7.

In this state, the introducing tube 7 of the clip operating device 6 is introduced into the body cavity through the channel of the endoscope inserted into the body cavity. Then, the distal end portion of the introduction tube 7 is guided to a clip target tissue, for example, a position near the stem portion Q of the pedunculated polyp P as shown in FIG. 1 (D).

Thereafter, the operation section main body 22 is attached to the tube joint 1
When the push-in operation is performed with respect to 4, the clip 2 moves into the introduction tube 7
Stick out from. At this time, the fixing member 18 of the tube joint 14 falls and is fixed to the step portion 28 of the operation portion main body 22.

Next, when the slider portion 32 is pulled toward the ring 29, the proximal end portion 2d of the clip 2 is pulled into the holding tube 4, and the elliptical portion of the proximal end portion 2d is crushed.
As a result, the arms 2A and 2B of the clip 2 are opened.

In this state, the clip 2 is guided so as to sandwich the stem portion Q of the pedunculated polyp P as shown in FIG. 1 (D). Then, when the slider portion 32 is further retracted to the ring 29 side, the arm portions 2A and 2B of the clip 2 are retracted into the holding tube 4. Therefore, the arm 2 of the clip 2
A and 2B are closed as shown in FIG. 1 (C), and the stem portion Q of the polyp P is connected to the arm portion 2 of the clip 2 as shown in FIG. 1 (D).
It can be reliably sandwiched between A and 2B.

When the stem portion Q of the polyp P is securely clipped between the arm portions 2A and 2B of the clip 2, when the slider portion 32 is further pulled toward the ring 29, the clip 2
The hook 3a of the connecting plate 3 of the
Is detached from the clip operating device 6 and placed. Then, the polyp P above the clip 2 is cut and collected by a snare of a known technique.

Therefore, in the above-mentioned structure, the outer folds 2a formed by bending the middle portions of the arms 2A, 2B of the clip 2 toward the outside are used to connect the arms 2A, 2B of the clip 2 to each other. Since the gap between the two arm portions 2A and 2B can be reduced when closed, the stem portion Q of the polyp P and the like can be reliably pinched between the both arm portions 2A and 2B of the clip 2, and the subsequent polypeftmy or the like can be used. Bleeding can be reliably prevented.

Further, FIGS. 4 to 6 show a second embodiment of the present invention. This is one in which a pair of arm portions 2A and 2B of the clip 2 of the first embodiment are formed with claw portions 51 which are bent inward, respectively.

In this case, as shown in FIG. 5, when the clip 2 is closed, the claws 51, 51 of the arms 2A, 2B are engaged with each other so that the clearance between the central portions of the arms 2A, 2B becomes narrow. Has been formed. Further, the arms 2A and 2B are formed so as to gradually become thinner toward the tip.

Therefore, in the above-mentioned structure, since the tips of the arms 2A and 2B of the clip 2 are thin, as shown in FIG. 6, for example, the submucosal tissue layer M under the mucous membrane L of the living tissue. The tips of the arms 2A and 2B of the clip 2 can be deeply driven, and the submucosal tissue layer M can be reliably grasped by the claws 51 and 51. It is possible to prevent it from coming off easily.

Further, the outer bent portions 2a of the arms 2A and 2B of the clip 2 allow the arms 2A and 2B of the clip 2 to be bent.
Since the gap can be narrowed, even if the thin blood vessel K in the mucous membrane L is bleeding, this thin blood vessel K
Can be closed to stop bleeding. Furthermore, it goes without saying that various modifications can be made without departing from the scope of the present invention.

[0046]

According to the present invention, a bent portion is provided in which a middle portion of both arm portions of a clip is bent outward.
When the both arms of the clip are closed, this bent part reduces the gap between the arms, so thin blood vessels and
The pedicle of a pedunculated polyp can be reliably grasped and the blood vessel can be closed.

[Brief description of drawings]

FIG. 1 shows a first embodiment of the present invention,
(A) is a vertical cross-sectional view seen from the upper surface showing a state where the base end portion of the clip is connected to the connecting member, (B) is a vertical cross-sectional view seen from the same side, (C) shows both arm portions of the clip. The longitudinal cross-sectional view which shows a closed state, (D) is a perspective view which shows the clip state of the stem part of the polyp by a clip.

2A and 2B show a clip operating device, in which FIG. 2A is a vertical sectional view showing a schematic configuration of a distal end portion of an introduction tube, and FIG. 2B is a vertical sectional view showing a schematic configuration of a hand operation portion.

FIG. 3 is a vertical cross-sectional view showing the internal configuration of the operation unit body.

FIG. 4 shows a second embodiment of the present invention,
(A) is a vertical cross-sectional view seen from the upper surface showing a state in which the proximal end portion of the clip is connected to a connecting member, and (B) is a vertical cross-sectional view seen from the same side surface.

FIG. 5 is a vertical cross-sectional view showing a state in which both arms of the clip are closed.

FIG. 6 is a vertical cross-sectional view showing a clipped state of a blood vessel with a clip.

[Explanation of symbols]

2 ... Clip, 2A, 2B ... Arm part, 2a ... Outer bent part, 3 ... Connecting plate (connecting member), 3a ... Hook part (first engaging part), 3b ... Large diameter hole (second engaging part) Mating part), 3c ... Small diameter hole (second engaging part), 4 ... Pressing tube (clip tightening ring), 7 ... Introducing tube, 9 ... Operation wire, 21 ... Coil sheath (operation tube), 30 ... Hook Department.

 ─────────────────────────────────────────────────── ─── Continuation of the front page (72) Inventor Akifumi Ishikawa 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside Olympus Optical Co., Ltd.

Claims (1)

[Claims] 1. An introduction tube which can be inserted into a living body cavity, an operation tube which is inserted into the introduction tube so as to advance and retreat, and an operation wire which is inserted into the operation tube so as to advance and retract and which has a hook at a tip thereof. A clip that has the expandability of expanding in a direction in which the distal ends of a pair of arms are separated from each other, and a clip that is accommodated in the introduction pipe with the arms closed, and is detachably attached to the distal end of the operation pipe. By fitting and mounting on the arm part of the clip, the clip tightening ring that closes the arm of the clip and the tightening ring can be inserted and detached from the base end part of the clip. A clip device for a biological tissue, comprising: a first engaging portion that engages with the hook; and a connecting member that has a second engaging portion that detachably engages with the hook, in a middle part of both arm portions of the clip. Bend each toward the outside and A clip device having a bent portion for reducing a gap between both arm portions when the both arm portions are closed.