JPH0819548A - Colic mucosa clip device - Google Patents

Abstract

PURPOSE:To certainly sandwich only colic mucosa by specifing the maximum opening width of a clip device provided with a clamping ring which is given widely-opening custom in a direction of separating a sandwiching part and fitted to an arm part so as to close the sandwiching part. CONSTITUTION:The introducing duct of a clip operating device is introduced into a body cavity through an endoscopic channel inserted into the body cavity and when an operating wire is pulled, arm parts 2c, 2c' of the clip 2 are drawn into a clip clamping ring 4. Thereby, the arm parts 2c, 2c' of the clip 2 are closed and colic mucosa is sandwiched between the arm parts 2c, 2c' of the clip. As the opening width X when the clip is maximally opened is very narrow such as 5-9mm, and the lengths Y of the arm parts 2c, 2c' projected from the clip clamping ring 4 is short such as 2-4mm when the sandwiching parts 2d, 2d' are closed in this occasion, even deep parts of colic mucosa having a thickness of an average of 2-4mm are not sandwiched.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a clip device for holding colonic mucosa.

[0002]

2. Description of the Related Art Heretofore, a clip device has been known which is placed in a living body while holding a tissue in the living body for the purpose of hemostasis or marking of a lesion. As this type of clip device, for example, the one disclosed in Japanese Utility Model Laid-Open No. 2-6011 is proposed. This clip device is shown in FIG.

As shown in the figure, the clip device has a clip a.
The clip a is formed by bending a thin metal strip material at the central portion and forming a base end portion b at the bent portion. Further, the pair of arms c and c extending from the base end b of the clip a are respectively formed with pinching portions d and d which are bent inward at an angle of 90 ° and pinch the living tissue g. Has been done. One end of each of the sandwiching parts d is formed in a convex shape and the other end is formed in a concave shape so that the living tissue g can be easily grasped. Further, the clip a is provided with the open-expanding property for expanding the arm parts c, c in the direction of separating the holding parts d, d.

Also, in this clip device, a clip tightening ring e which is fitted and mounted on the arm portions c, c of the clip a and a base end portion b of the clip a are detachably engaged. And a connecting member f. When the connecting member f is engaged with the base end portion b of the clip a, the connecting member f is pulled to the right in the drawing to move the clip a into the clip tightening ring e. When the clip tightening ring e is inserted from the side and fitted and attached to the arm parts c, c of the clip a, the holding parts d, d of the clip a are closed and the living tissue g is held by the holding part. It is sandwiched by d and d.

[0005]

Generally, mucous membranes and polyps held by clips have various thicknesses and sizes. However, in the conventional clip device having the above-mentioned configuration, the maximum opening width of the clip a is only one, and the clip a depends on the thickness of the mucous membrane and the size of the polyp.
Could not be used selectively.

When sandwiching a mucous membrane with a clip, the maximum opening width of the clip has an important meaning. That is, the clip is pressed against the mucous membrane in the maximum open state,
In this state, the sandwiching portions d, d are closed to sandwich the mucous membrane, and the larger the maximum opening width, the deeper the sandwiching of the mucous membrane. Therefore, if the maximum opening width of the clip a is only one, the large intestine mucosa (average of 2 to 3 m)
If a thin mucous membrane (having a thickness of m) is to be sandwiched by the clip a, it may be sandwiched together to a deep portion that does not need to be sandwiched, and it may be difficult to remove the clip thereafter.

The present invention has been made in view of the above circumstances, and an object thereof is to provide a clip device for the large intestine mucosa which can reliably hold only the large intestine mucosa.

[0008]

Means and Actions for Solving the Problems In order to solve the above-mentioned problems, the present invention provides a pair of arm portions with a sandwiching portion capable of sandwiching large intestine mucosa, and separating the sandwiching portions. A clip provided with openness and expandability for expanding the arm portion in a direction of causing the clip, and a clip tightening ring that closes the holding portion of the clip by being fitted and attached to the arm portion of the clip. In the clip device for colonic mucosa, the maximum opening width of the clip is 5 to 9 mm. With the above configuration, since the maximum opening width of the clip is 5 to 9 mm, it is possible to sandwich only the large intestine mucosa having an average thickness of 2 to 3 mm.

[0009]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS An embodiment of the present invention will be described below with reference to the drawings. FIG. 1 shows a clip unit 1 according to an embodiment of the present invention. This clip unit 1
Is composed of a clip 2, a connecting plate 3 as a connecting member that is removably engaged with the clip 2, and a clip tightening ring 4.

The clip 2 is formed by bending a thin strip of stainless steel at the central portion and using the bent portion as a base end portion 2a. A distance larger than the inner diameter of the clip tightening ring 4 is provided from the base end portion 2a. A pair of fitting portions 2b, 2b 'of
Further, the fitting portions 2b and 2b 'are extended so that both arm portions 2c and 2c' intersect each other. Further, the end portions of the respective arm portions 2c and 2c 'are bent so as to face each other to form the sandwiching portions 2d and 2d'. Further, the clip 2 is provided with open-expansion property to the arms 2c and 2c 'so as to open the holding portions 2d and 2d'.

Further, the tips of the sandwiching portions 2d and 2d 'are shaped so as not to damage living tissue and to be easily grasped. For example, as shown in FIG. 1C, a protruding tooth portion 21 is provided at the center of the tip of one holding portion 2d, and the other holding portion 2d '.
At the center of the tip of the concave portion 2 which can be fitted into the convex tooth portion 21
1'is provided.

On the other hand, the connecting plate 3 is a metal plate material,
It is formed by processing by photo etching. Therefore, a bridge for connecting the base material and the connecting plate 3 is required at the time of processing, and the bridge is formed in the cutout portion 3e arranged at a portion of the connecting plate 3 that does not come into contact with the clip tightening ring 4. It is located in the center.
Accordingly, the cut end of the bridge of the connecting plate 3 is
It is set so that it does not project outward from the extension line of the side surface of.

Further, as shown in FIG. 1B, a J-shaped hook portion 3a is formed at one end of the connecting plate 3 so as to engage with the base end portion 2a of the clip 2 in a disengageable manner. . Further, an engaging hole 3b for connection with a hook portion 30 (see FIG. 2) described later is formed near the other end of the connecting plate 3. The engagement hole 3b includes a long hole 3c extending in the longitudinal direction and a long hole 3c.
and a large diameter hole 3d connected to c. In this case, the large hole 3
d is located closer to the tip side than the long hole 3c.

The clip tightening ring 4 is detachably attached to a connecting ring 8 at the tip of an operation tube 9 (see FIG. 2) which will be described later, and is fitted on the arm portions 2c and 2c 'of the clip 2. By mounting, the holding portions 2d, 2 of the clip 2
It closes d '. As shown in FIGS. 1A and 1B, a step is formed on the outer peripheral surface of the clip tightening ring 4. The portion of the clip tightening ring 4 having a small diameter forms a connecting portion 4a smaller than the inner diameter of the connecting ring 8 of the operation tube 9. The thick part of the clip tightening ring 4 (large diameter part 4b)
Is larger than the inner diameter of the connecting ring 8. A taper portion 4c is formed on the inner peripheral surface of the tip end portion of the clip tightening ring 4.

As shown in FIGS. 1A and 1B, the cassette type clip unit 1 hooks the hook portion 3a of the connecting plate 3 on the base end portion 2a of the clip 2 and in that state. Is inserted into the clip tightening ring 4 from the one with the larger pipe outer diameter (the base end portion 2a of the clip 2 is tapered portion 4b).
The connecting plate 3 is inserted into the clip tightening ring 4 until it is located in the vicinity of or near the taper portion 4b),
In this state, the clip tightening ring 4 is filled with a fixing agent 5 such as silicone, and the clip 2 and the connecting plate 3 are temporarily fixed in the clip tightening ring 4.

In this embodiment, the most characteristic points are the maximum opening width of the clip 2 and the lengths of the arm portions 2c and 2c '. That is, as shown in (a) of FIG. 8, the opening width X of the clip 2 is 5 to 9 when the clip 2 is opened to the maximum.
Opening and expanding property is given so as to be mm, and as shown in FIG. 8B, the arm portion 2c protruding from the clip tightening ring 4 with the holding portions 2d and 2d 'closed. ,
The length Y of 2c 'is formed to be 2 to 4 mm.

Next, the clip operating device 6 will be described with reference to FIG. As shown in FIG. 2A, the clip operating device 6 includes an inserting portion 6a and a hand side operating portion 6b.
It consists of and.

The insertion portion 6a is composed of an introduction pipe 7 formed of a flexible tube made of tetrafluoroethylene resin, and a flexible operation pipe 9 inserted into the introduction pipe 7 so as to be able to move back and forth. An operation wire 10 is inserted into the operation tube 9 so as to be able to move back and forth.

A hook portion 30 is connected to the tip of the operation wire 10. The hook portion 30 is formed of a rod-shaped member, and as shown in detail in FIG. 4, a recessed notch portion 33 is formed on the tip end side thereof. A pin 36 is provided on the bottom surface of the cutout 33 so as to be perpendicular to the direction in which the operation wire 10 advances and retracts. This pin 36
Is formed by a circular head portion 34 and a handle portion 35 having a smaller diameter than the head portion 34. In this case, as shown in FIG. 4B, the head 34 of the pin 36 has an outer diameter smaller than the large diameter hole 3d of the connecting plate 3 of the clip 2 and larger than the elongated hole 3c. Has been done. Further, the outer diameter of the handle 35 of the pin 36 is smaller than that of the elongated hole 3c of the connecting plate 3.

The cross section of the handle 35 of the pin 36 may be circular, but it is desirable that it be rectangular as shown in FIGS. Further, the handle portion 35 of the pin 36 improves the attachability of the clip 2,
As shown in FIG. 5, the tip side is formed on the same surface as the head 34,
A step with the head 34 may be provided on the hand side.

Further, the tetrafluoroethylene resin, which is the material of the introduction tube 7, is a material which has been heated to a temperature above its melting point and irradiated with γ rays. Such a tetrafluoroethylene resin does not deteriorate even if it is sterilized by γ-rays. Therefore, if the introduction tube 7 is formed of such a tetrafluoroethylene resin, the introduction tube 7 can be sterilized by γ-rays.

As shown in FIG. 2 (b), the proximal side operating portion 6b is connected to the proximal side extending end portion of the introduction tube 7.
The hand side operation portion 6b includes a tube joint 14 fixed to the hand side of the introduction tube 7, an operation portion main body 22 for operating the operation tube 9 forward and backward, and a slider portion 32 for operating the operation wire 10 forward and backward. There is.

A tube pressing member 13 is arranged in the tip portion of the tube joint 14. The proximal end of the introduction tube 7 is fitted to the outer circumference of a tapered taper portion formed at the tip of the tube receiving member 12. Therefore, when the tube receiving member 12 is screwed into the tube pressing member 13 and the tapered portion of the tube receiving member 12 is pressed against the tapered hole formed at the rear end portion of the tube pressing member 13, The extended end on the proximal side is sandwiched and fixed between the tapered surfaces. A break-prevention tube 20 is fitted on the outer circumference of the proximal end of the introduction tube 7, and the base end of the break-prevention tube 20 is fitted and fixed to the outer circumference of the tip end of the tube pressing member 13. There is.

The tube fitting 14 is a tube fitting body 1
5, the operating portion main body 22 that is arranged to move back and forth in the tube joint main body 15, the lock release button 16 built in the proximal end of the tube joint main body 15, and the lock release button 16 by the spring 17. The fixing member 18 biased in the direction of and the lid body 19 screwed to the proximal end of the tube joint body 15 are provided. In this case, the lid 19 includes the lock release button 16, the spring 17, and the fixing member 1.
8 and 8 are held in a state of being housed in the tube joint main body 15.

A connecting ring 8 having an inner diameter larger than the connecting portion 4a of the clip tightening ring 4 and smaller than the large diameter portion 4b is connected to the tip of the operation tube 9. Also,
A tubular operation portion main body 22 is provided on the proximal side of the operation tube 9. The inner hole of the operation portion main body 22 is a large diameter hole 22a on the tip side.
And a small diameter hole 22b on the proximal side. As shown in FIG. 3, a guide member 23 connected to the end of the operation tube 9 is inserted through the inner hole of the operation portion main body 22. The guide member 23 includes a large diameter portion 23a on the tip side and a small diameter portion 23b on the hand side.
And consists of. In addition, the large diameter portion 23 of the guide member 23
A coil member 24 is wound around the outer periphery of a, and a small diameter portion 23b
A distal end side of a spring 46 into which the operation wire 10 is inserted is wound around the outer periphery of the operation portion main body 22 and the slider portion 32. Then, the operation pipe 9 is screwed into the small diameter hole 22b of the operation portion main body 22 by screwing the coil member 24,
It is connected and fixed to the operation portion main body 22 via the guide member 23.

A spring member 25 is provided at the tip of the guide member 23 located in the large diameter hole 22a of the operation portion main body 22.
Are fixed via a coarsely wound coil member 26 screwed and fixed to the spring member 25. This spring member 2
5 always urges the operating portion main body 22 toward the hand side, and the tip of the operating portion main body 22 extends beyond the tip end surface of the operating portion main body 22.
2 is extended to the outside.

A groove 27 for guiding the fixing member 18 of the tube joint 14 is formed on the outer peripheral surface of the operation portion main body 22. At the end on the proximal side of the groove 27, the operation portion main body 22
A step portion 28 for locking the slide is formed. That is, in a normal state (state shown in the drawing) in which the fixing member 18 is dropped below the step portion 28, the fixing member 18 is
Since it hits the stepped portion 28, the operation portion main body 22 cannot be slid toward the hand side. However, when the lock release button 16 pushes the fixing member 18 beyond the step portion 28 against the biasing force of the spring 17, the contact between the fixing member 18 and the step portion 28 is released, so that the operating portion is released. The main body 22 can be slid toward the hand side. In this case, the fixing member 18 is in a state of being pressed by the biasing force of the spring 17 against the groove 27 of the operating portion main body 22 that slides. The operation unit main body 2
A ring 29 is rotatably connected to the proximal end of 2.

Further, the operating wire 10 is attached to the slider portion 32.
The proximal side extended end portions of are connected. That is, the slider portion 32 includes the first slider member 38 divided into two bodies.
And the second slider member 39 are joined together, and the connecting member 37 fixed to the end of the operation wire 10 is sandwiched between the first slider member 38 and the second slider member 39. By operating wire 10
Is connected to the slider portion 32.

The first slider member 38 and the second slider member 39 are joined by fixed tubes 40 and 41 which are screwed to the outer peripheral surface of the front end portion and the outer peripheral surface of the rear end portion of the slider portion 32. That is, the first slider member 38 and the second slider member 39 are butted against each other so as to sandwich the connecting member 37 connected to the operation wire 10, and in this state, the fixed pipes 40 and 41 are connected to the slider members 38 and 3.
9 is screwed into the outer circumference of both ends of the slider member 3
8 and 39 fixed each other. As a result, the first slider member 38 and the second slider member 39 are integrated, and the operation wire 10 and the slider portion 32 are connected.

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 in contact with the ratchet release button 44 and meshed with the ratchet 45 formed on the outer peripheral surface of the operation unit body 22 on the proximal side.

Next, a case where the clip unit 1 is attached to the clip device 6 having the above structure will be described. First, in the state of FIG. 2B, the operation tube 9 is in a state of protruding from the tip of the introduction tube 7. In this state, push in the ratchet release button 44 in response to the urging force of the spring 43,
When the meshing state of the ratchet pawl 42 and the ratchet 45 is released and the slider portion 32 is pushed out toward the tip side, the operation wire 10 is pushed out toward the tip side, and the hook portion 30 projects from the tip end of the connecting ring 8. This state is maintained by returning the ratchet release button 44 to the original state and engaging the ratchet claw 42 and the ratchet 45 again.

In this way, the hook portion 30 is connected to the connecting ring 8
The pin 36 of the hook portion 30 while protruding from the tip of the
After passing through the large-diameter hole 3d of the connecting plate 3 of the clip 2, the slider portion 32 is pulled lightly to pull the operation wire 10 toward the hand side. As a result, the head portion 34 of the pin 36 engages with the elongated hole 3c of the connecting plate 3 so that the connecting plate 3 cannot be easily disengaged from the hook portion 30.

After that, when the ratchet release button 44 is pushed again, the slider portion 32 is automatically pulled to the hand side by the urging force of the spring 46, and the clip fastening ring 4 of the clip fastening ring 4 is pushed, as shown in FIG. The connecting portion 4 a is pulled into the connecting ring 8. As a result, the clip unit 1 becomes the operation tube 9
It is attached to the tip of.

Subsequently, when the lock release button 16 of the tube joint 14 is pushed, the fixing member 18 is pushed and disengaged from the step portion 28 of the operating portion main body 22, and the biasing force of the spring member 25 of the operating portion main body 22 is released. It As a result, the operation portion main body 22 is pushed toward the proximal side with respect to the tube joint 14.
As a result, the operation tube 9 connected to the operation section main body 22 is pulled toward the hand side, and the clip 2 is housed in the introduction tube 7. This state is shown in FIG.

Next, a case where the large intestine mucosa is grasped by the clip device 6 and the clip unit 1 will be described. In the state of (a) of FIG. 2 in which the clip 2 is housed in the introducing tube 7, 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,
When the operation portion main body 22 is pushed into the tube joint 14 in this state in which the distal end portion of the introduction tube 7 is positioned near the clip target tissue, for example, the large intestine mucosa, the clip 2
Project from the introduction pipe 7. At this time, the fixing member 18 of the tube joint 14 falls into and is fixed to the step portion 28 of the operation portion main body 22. That is, the slides of the operation portion main body 22 and the operation tube 9 are locked.

Next, when the slider 32 is pulled toward the operator's side and the operation wire 10 is pulled, the fitting portions 2b, 2b 'of the clip 2 are placed inside the clip tightening ring 4 as shown in FIG. 7 (a). And the fitting portions 2b and 2b 'are crushed. As a result, the arms 2c and 2c 'of the clip 2 are opened.

In this state, the clip 2 is guided so as to sandwich the large intestine mucosa 47. After that, when the operation portion 10 is pulled by further pulling the slider portion 32 toward the hand side, the arm portions 2c and 2c 'of the clip 2 are pulled into the clip tightening ring 4. Therefore, the arms 2c and 2c 'of the clip 2 are closed as shown in FIG. 7B, and the large intestine mucosa 47 is sandwiched between the arms 2c and 2c' of the clip 2. At this time, the opening width X of the clip 2 is 5 to 9 mm, which is very narrow when the clip 2 is opened to the maximum.
Since the lengths Y of the arms 2c and 2c 'protruding from the clip fastening ring 4 with d and 2d' closed are as short as 2 to 4 mm, the colonic mucosa 47 having an average thickness of 2 to 4 mm is sandwiched. When doing, it will not be pinched to the deep part.

When the large intestine mucous membrane 47 is securely clipped between the arm portions 2c and 2c 'of the clip 2 as described above, when the slider portion 32 is further pulled toward the hand side, the hook 3a of the connecting plate 3 of the clip 2 is pulled. Is deformed and stretched, and the clip unit 1 is detached from the clip operating device 6 and placed in a state of sandwiching the mucous membrane 47.

As described above, in the clip unit 1 of this embodiment, the maximum opening width of the clip 2 is as narrow as 5 to 9 mm, and the clip protruding length from the clip tightening ring 4 when closed is 2 to 4 mm. Because of the short length, the mucous membrane of the large intestine 47
When pinching, it will not be pinched deeply. Therefore, it is very easy to remove the clip 2 thereafter.

By the way, when a polyp having a blood vessel in the stem portion is excised, it is desirable to clamp the stem portion with a clip in advance because bleeding may occur at the time of excision. However, when trying to pinch the stalk of a large polyp such as an esophageal varices or gastric varices, the conventional clip has a narrow opening width and a short arm length, so if the stalk cannot be sufficiently pinched. There is. That is, a clip that has been conventionally used for hemostasis or marking of polyps has a maximum opening width of 10 to 14 mm, and an arm length when closed is 5 mm.
Since it is ˜9 mm, even if a plurality of clips are used, the stem portion cannot be sufficiently clamped, and a situation in which complete hemostasis cannot be performed occurs.

In order to solve such a problem, the maximum opening width of the clip is set to 1 in order to prevent blood when the large polyp is resected.
5 to 25 mm and the arm length when closed is 10 to 15 mm
Is good. This is because the stalk portion of a large polyp having a blood vessel inside is generally 10 mm or more, and the outer diameter of the polyp that can be endoscopically resected is about 20 mm. However, if the arm length exceeds 15 mm, the clamping force becomes weak and there is a possibility that hemostasis may not be sufficiently achieved.

According to such a clip, even with a large polyp P as shown in FIG. 9, the stem Q of the large polyp P can be reliably clamped and blood can be surely stopped. Also, if you have clips of various sizes including those of the above size,
When hemostasis or marking is performed, the clip 2 (including the conventional clip) can be selected according to the application site and the size of the polyp, so that the treatment can be performed effectively and safely.

On the other hand, when excising a mucous membrane, there is a conventional treatment method in which a plurality of portions of the mucous membrane are clamped by a clip and a tissue portion clamped by the clip is excised by a high-frequency snare to surely excise a target range. . However, since the conventional clips all have the same appearance, it is very difficult to understand in what positional relationship the excised tissue exists in the body.

Therefore, in FIG. 10, different markings 50, 50 '... Are provided on each clip fastening ring 4 so that the positional relationship of the excised tissue with respect to the body can be easily grasped.
Is provided so that the clip fastening rings 4 can be identified. Of course, the markings 50, 50 ′ may be provided on the clip 2.

When the markings 50, 50 ', ... Are given in this manner, even if the target site of the tissue 47 including the tissue site 47a held by the clip 2 is excised by the high frequency snare 21, the excised tissue 49 (see FIG. 10). It becomes easy to understand in what positional relationship (see (b)) the object existed in the body. As a result, the diagnosis can be easily performed.

In FIG. 10, markings 50 and 50 'are provided.
It was made possible to identify Clip 2 comrades by ...
As shown in FIG. 11, the surfaces of the clip fastening ring 4 or the clip 2 may be colored so that the clips 2 can be identified. For example, one clip tightening ring 4 is made colorless, and the surface of the other clip tightening ring 4 is colored.

In the treatments shown in FIGS. 10 and 11, it is desirable that at least the clip 2 be covered with an insulating film. As a result, even if a high-frequency current flows through the clip 2, the tissue sandwiched between the clips 2 does not burn.

By the way, the sandwiching portions 2d, 2 for sandwiching the tissue
It is desirable that d ′ has a shape that does not damage the tissue. As mentioned above, the conventional clip device
One tip shape of the clip holding portion has a convex shape, and the other has a concave shape, which allows the concave and convex fitting. Therefore, for example, when pinching and stopping bleeding of a biological tissue having a soft mucous membrane such as an esophageal varices by the pinching part of this clip, the tip of each pinching portion is likely to damage the surface of the biological tissue, and the tip of each pinching part causes bleeding. There was a risk that it would end up. Therefore, the tip shape of each holding portion may be set as shown in FIG.

That is, the tips of the holding portions 2b, 2b 'of the clip 2 of the clip unit 1 are formed into convex curved surfaces 21, 21' as shown in FIG. 12 (a) or (b). When the tips of the clip portions 2b, 2b 'of the clip 2 are rounded in a convex shape in this way, the tips of the clip portions 2b, 2b' of the clip 2 do not damage the mucous membrane when hemostasis is performed, and hemostasis is safe and easy. Can be done. In particular, it is useful when the soft esophageal varices 47 are held between the holding portions 2d and 2d '.

The configurations described above can provide various configurations shown in the following paragraphs. 1.1 A clip having a pair of arms that is capable of sandwiching large intestinal mucosa at the tips of the arms, and is provided with a clip that expands and expands the arms in a direction of separating the sandwiches; A clip device for large intestine mucosa, comprising a clip tightening ring that closes the sandwiching part of the clip by being fitted and attached to the arm part of the clip, and the maximum opening width of the clip is 5 to 9 mm. And the protruding length of the arm from the clip tightening ring when the clip is closed is 2
Clip device for large intestine mucosa characterized in that it is ˜4 mm 2. A holding part capable of holding biological tissue is formed at the tips of a pair of arm parts, and the arm parts are arranged in a direction to separate the holding parts. In a clip device including a clip provided with openness and expandability for expanding the clip, and a clip tightening ring that closes the holding portion of the clip by being fitted and attached to an arm portion of the clip. A clip device, wherein the maximum opening width of the clip is 5 to 9 mm, and the protruding length of the arm portion from the clip tightening ring when the clip is closed is 2 to 4 mm.

3.1 A clip provided with a pair of arm portions at the tips of which a living tissue can be sandwiched, and which is provided with open-expansion characteristics for expanding the arm portions in the direction of separating the sandwich portions. And a clip tightening ring that closes the sandwiching portion of the clip by being fitted and attached to the arm portion of the clip, the maximum opening width of the clip being 15 to 25 mm. A clip device characterized by being present.

4.1 A sandwiching portion capable of sandwiching a large polyp such as an esophageal varices or gastric varices is formed at the tips of the pair of arms, and the arms are expanded in a direction in which the sandwiching portions are separated from each other. Clip for clipping a large polyp, which includes a clip to which openness and expandability is applied, and a clip tightening ring that closes the pinch portion of the clip by being fitted and attached to the arm part of the clip. In the device, the maximum opening width of the clip is 15 to 25 mm, and a clip device for pinching a large polyp.

5. The clip device according to claim 3 or 4, wherein the protruding length of the arm portion from the clip tightening ring when the clip is closed is 10 to 15 mm. 6. A clip having a base end portion, and a pair of arm portions extending from the base end portion having a holding portion for holding a biological tissue formed at the tips of the arms, and the clip by being fitted and mounted on the clip. In a clip device including a clip tightening ring that closes a holding portion of the clip, at least one of the clip and the tightening ring is provided with a display unit capable of identifying the clips. clip.

7. 7. The clip device according to claim 6, wherein at least the clip is covered with an insulating coating. 8. 8. The clip device according to any one of items 1 to 7, wherein the holding portion of the clip has a convex curved surface.

9. The clip device according to any one of items 1 to 8, wherein the clip device is used through an endoscope channel. 10. An operation wire having a hook attached to the tip thereof, a clip having a pair of arm portions formed with a sandwiching portion capable of sandwiching biological tissue, and an arm portion of the clip detachably attached to the distal end of the operating member. A clip device including a clip tightening ring that closes the holding portion of the clip by fitting and mounting the clip on the clip, and a connecting member that engages with the clip and detachably engages with the hook. The clip device, wherein the hook has a protrusion that engages with an engagement hole of the connecting member, and the protrusion is formed in an oval shape.

11. In the medical device parts manufacturing method,
(A) The raw material of the tetrafluoroethylene resin is heated to a temperature equal to or higher than the melting point, (b) gamma rays are irradiated in this heating state, and (c)
A method for manufacturing a medical device part, which comprises molding the raw material subjected to the treatments in (a) and (b) to make a medical device part.

12. A medical device component formed by heating a raw material of tetrafluoroethylene resin to a temperature equal to or higher than the melting point and irradiating with γ rays in this heated state. 13. First characterized by being used for endoscopic treatment
The medical device component according to item 2. 14. The medical device component according to item 12 or 13, which is a tubular body.

[0058]

As described above, according to the clip device of the present invention, since the maximum opening width of the clip is 5 to 9 mm, only the large intestine mucosa having an average thickness of 2 to 3 mm can be clamped. It will be possible.

[Brief description of drawings]

1A is a longitudinal sectional view of a clip device for colonic mucosa according to an embodiment of the present invention, FIG. 1B is a transverse sectional view of the clip device of FIG. 1A, and FIG. It is a front view of the clip which comprises a clip device.

FIG. 2 is a side sectional view of a clip operating device to which the clip device of FIG. 1 is attached.

FIG. 3 is a side sectional view of an operating portion main body of the clip operating device of FIG.

4A is a side view showing a first example of a hook portion to which the clip device of FIG. 1 is attached, and FIG. 4B is a plan view of FIG.

5A is a side view showing a second example of a hook portion to which the clip device of FIG. 1 is attached, and FIG. 5B is a plan view of FIG.

6A is a side view showing a third example of a hook portion to which the clip device of FIG. 1 is attached, and FIG. 6B is a plan view of FIG.

FIG. 7 is a state diagram showing a state before and after sandwiching a large intestine mucosa with a clip.

FIG. 8 is a diagram for explaining the dimensions of the clip device of FIG.

FIG. 9 is a state diagram showing a state in which a stalk portion of a large polyp is clamped by a clip device.

FIG. 10 is a schematic view showing a first means for discriminating clips from each other and showing how a clip sandwiching tissue site is cut by a high-frequency snare.

FIG. 11 is a schematic view showing a second means for discriminating between the clips, and showing how the clip sandwiching tissue site is excised by the high frequency snare.

FIG. 12 is a front view showing a tip shape of a clip holding portion.

FIG. 13 is a cross-sectional view showing a configuration of a conventional clip device.

[Explanation of symbols]

1 ... Clip unit (clip device), 2 ... Clip, 2c, 2c '... Arm part, 2d, 2d' ... Clamping part, 4 ...
Clip tightening ring.

Claims (1)

[Claims] 1. A clip formed with a pair of arm portions at the ends of which a colon mucous membrane can be sandwiched, and which is provided with open-expansion characteristics for expanding the arm portions in a direction in which the sandwich portions are separated from each other. In the clip device for large intestine mucosa, which is equipped with a clip tightening ring that closes the sandwiching portion of the clip by being fitted and attached to the arm portion of the clip, the maximum opening width of the clip is Clip device for large intestine mucosa having a size of 5 to 9 mm.