JPWO2020105253A1 - Endoscopic treatment tool - Google Patents

Abstract

A wire rod (3) arranged in the tubular body (2) and the lumen of the tubular body (2) and having a connecting portion (4) at the distal end for connecting the clip (21), and a handle (7). An endoscopic treatment tool (1) having a It has a slider (9) that is connected to the end and can move in the perspective direction with respect to the handle body (8), and by pulling the slider (9) toward the proximal side, the slider (9) The movement of the slider (9) in the proximal direction is stopped at a predetermined stop point within the movable range of 9), and the stop is released by applying a traction force equal to or more than a predetermined value to the slider (9). Is formed so as to move in the proximal direction, and the connecting portion (4) is housed in the tubular body (2).

Description

The present invention relates to an endoscopic treatment tool used for grasping a treatment object such as a lesion under an endoscope.

Conventionally, in the treatment of early cancer using an endoscope, especially cancer of organs classified into the digestive tract such as the esophagus, stomach, and large intestine, endoscopic submucosal dissection (ESD) and endoscopic Mucosal resection (EMR) is used. In ESD and EMR, clips are used to stop bleeding from a wound after excision of a lesion or to ligate a wound to pinch and close it. The opening and closing of the clip located on the distal side of the endoscopic treatment tool is controlled by the operation of the handle located on the proximal side of the endoscopic treatment tool. As an endoscopic treatment tool of this type, for example, Patent Document 1 discloses a tool for operating a clip by pushing and returning a handle.

International Publication No. 2004/082488

In the endoscopic treatment tool, the treatment object is gripped by the clip attached to the tip by operating the handle on the hand side, and then the clip is detached from the endoscopic treatment tool to grip the treatment target. Clips can be placed inside the body. Conventionally, such an operation has been performed by the operator by sensing a subtle difference in resistance due to the movement of the clip with a hand holding a handle. Therefore, it may be difficult for the operator to properly operate the clip. For example, the gripping position of the clip may deviate from the target position, or the clip may be unintentionally detached. In addition, since speed is required to stop bleeding, it is necessary to perform a clip operation accurately.

The present invention has been made in view of the above circumstances, and an object of the present invention is to provide an endoscopic treatment tool capable of appropriately controlling the position of a connection portion to which a clip is attached in the perspective direction by operating a handle on the hand side. To provide.

The endoscopic treatment tool of the present invention that has been able to solve the above problems includes a tubular body and a wire rod that is arranged in the lumen of the tubular body and has a connecting portion for connecting a clip at a distal end. , An endoscopic treatment tool having a cylinder and a handle provided on the proximal side of the wire, the handle is a handle body to which the proximal end of the cylinder is connected and a proximal of the wire. It has a slider that is connected to the end and can move in the perspective direction with respect to the handle body, and the connection part can be accommodated in the cylinder by pulling the slider from the distal side to the proximal side. It is characterized in that it satisfies the following [Condition 1] and [Condition 2].
[Condition 1] By pulling the slider toward the proximal side in a state where the clip is not attached to the connection portion of the endoscopic treatment tool, at least one of the sliders is set at the primary stop point within the movable range of the slider. The part abuts at least a part of the handle body to stop the movement of the slider in the proximal direction, and by applying a traction force equal to or more than a predetermined value to the slider, the stop is released and the slider moves in the proximal direction, and the slider By pulling the slider further toward the proximal side, at least a part of the slider abuts on at least a part of the handle body and moves in the proximal direction of the slider at the secondary stop point within the movable range of the slider. Is stopped, and by applying a traction force equal to or greater than a predetermined value to the slider, the stop is released and the slider moves in the proximal direction.
[Condition 2] When the slider is located at the primary stop point At least a part of the connection part is housed in the cylinder, and when the slider is located at the secondary stop point, the entire connection part is It is housed in the cylinder.

It is preferable that the endoscopic treatment tool of the present invention further satisfies the following [Condition 3] and [Condition 4].
[Condition 3] The slider is directed toward the proximal side when the 0th stop is located distal to the 1st stop and the clip is not attached to the connection of the endoscopic treatment tool. By pulling the slider, at least a part of the slider comes into contact with at least a part of the handle body at the 0th stop point within the movable range of the slider, and the movement of the slider in the proximal direction is stopped, and the slider is stopped at a predetermined value or more. By applying the traction force of, the stop is released and the slider moves in the proximal direction.
[Condition 4] When the slider is located at the 0th stop point, the connection portion exists on the distal side of the distal end of the cylinder.

It is preferable that the endoscopic treatment tool of the present invention further satisfies the following [Condition 5] and [Condition 6].
[Condition 5] The slider is directed toward the proximal side when the tertiary stop is located proximal to the secondary stop and the clip is not attached to the connection of the endoscopic treatment tool. By pulling the slider, at least a part of the slider comes into contact with at least a part of the handle body at the tertiary stop point within the movable range of the slider, and the movement of the slider in the proximal direction is stopped.
[Condition 6] When the slider is located at the third stop point, the entire connection portion is housed in the cylinder.

In the state where the clip is connected to the connection part of the endoscopic treatment tool, there is an opening / closing adjustment section on the proximal side of the secondary stop point where the clip is opened / closed by adjusting the perspective position of the slider. Is preferable. In the open / close adjustment section, it is preferable that the proximal end of the clip is inside the cylinder and the distal end of the clip is distal to the distal end of the cylinder. Further, it is preferable that there is a connection disconnection position on the proximal side of the opening / closing adjustment section, in which the connection between the clip and the connection portion is released by pulling the slider.

The endoscopic treatment tool preferably further comprises an outer tubular body in which the tubular body is located in the lumen. The outer cylinder is slidable with respect to the cylinder within a specific range, the slider is placed between the primary stop and the secondary stop, and the outer cylinder is farthest from the cylinder. It is preferable that the outer cylinder contains the clip when moved to the position, and the distal end of the clip is exposed from the outer cylinder when the outer cylinder is moved to the most recent position with respect to the cylinder. ..

Each of the stop points described above can be realized by providing a convex portion or a concave portion on the surface of the handle body and the slider facing each other. For example, a convex portion on the handle body side is provided on the surface of the handle body facing the slider, a convex portion on the slider side is provided on the surface of the slider facing the handle body, and the contact is convex on the handle body side. It is preferable that the portion and the convex portion on the slider side are in contact with each other. Further, at least one of the convex portions on the handle body side can be replaced with a concave portion, and at least one of the convex portions on the slider side can be replaced with a concave portion.

The endoscopic treatment tool of the present invention is arranged on a tubular body and a wire rod arranged in the lumen of the tubular body and having a connecting portion for connecting a clip at a distal end, and on the proximal side of the tubular body and the wire rod. It is an endoscopic treatment tool having a handle provided, and the handle is connected to a handle body to which a proximal end of a cylinder is connected and a proximal end of a wire rod to the handle body. On the other hand, it has a slider that can move in the perspective direction, and a first locking portion and a second locking portion that regulate the movement of the slider in the perspective direction, and the slider is locked by the first locking portion. When the distal end of the connection is protruding from the distal end of the cylinder and the slider is locked by the second locking part, the distal end of the connection is within the lumen of the cylinder. Those configured to be arranged in are also preferred. It is preferable that the endoscopic treatment tool configured as described above further includes an outer tubular body in which the tubular body is arranged in the lumen. The outer cylinder is slidable with respect to the cylinder within a specific range, and the position when the slider is locked by the first locking portion and the position when the slider is locked by the second locking portion. When the outer cylinder is moved most distal to the cylinder when it is placed between the positions, the outer cylinder contains the clip and the outer cylinder is in the most recent position with respect to the cylinder. When moved to, the clip is preferably exposed from the outer cylinder.

In the endoscopic treatment tool of the present invention, the handle on the hand side is composed of a handle body and a slider, and by moving the slider in the perspective direction with respect to the handle body, the position of the connection portion to which the clip is connected in the perspective direction. Can be adjusted. Since the handle is provided with a predetermined stop point within the movable range of the slider according to the position of the connection part in the perspective direction, the operator can refer to the stop point when operating the slider as a guideline for the connection part. The position of the slider in the perspective direction can be appropriately controlled. Therefore, the clipping operation of the clip attached to the connection portion becomes easy.

An example of an overall view of the endoscopic treatment tool according to the embodiment of the present invention is shown, and a state in which a clip is attached to a connecting portion of a wire rod and exposed from the distal end of the cylinder is shown. In the endoscopic treatment tool shown in FIG. 1, a state is shown in which a clip is not attached to a connecting portion of a wire rod and the connecting portion is arranged inside a cylinder. An example of a side view of the distal end of the clip and wire is shown. The perspective view of the distal end portion of the wire rod shown in FIG. 3 is shown. An example of a side view of the handle is shown, FIG. 5 (a) shows a state where the slider is at the primary stop point, and FIG. 5 (b) shows a state where the slider is at the secondary stop point. FIG. 6A shows an example of a side view of the distal end of the endoscopic treatment tool when the slider is at the primary stop, and FIG. 6B shows the slider at the secondary stop. It shows an example of the side view of the distal end part of an endoscopic treatment tool at the time of. An example of the distal end of an endoscopic treatment tool having an outer cylinder is shown, FIG. 7 (a) shows a cross-sectional view in a state where a clip is arranged inside the outer cylinder, and FIG. 7 (b) shows the outer cylinder. Shows a side view of a clip exposed from the body. An example of a side view of the handle is shown, FIG. 8A shows a state in which the slider is at the 0th stop point, and FIG. 8B shows a state where the slider is at the 3rd stop point. FIG. 9A shows an example of a side view of the distal end of the endoscopic treatment tool when the slider is at the 0th stop point, and FIG. 9B shows the slider at the 3rd stop point. It shows an example of the side view of the distal end part of an endoscopic treatment tool at the time of. An example of a cross-sectional view taken along the perspective direction of the handle is shown. In the handle shown in FIG. 10, a cross-sectional view showing the handle body and the slider separately is shown.

The endoscopic treatment tool of the present invention has a tubular body, a wire rod arranged in the lumen of the tubular body and having a connection portion at the distal end for connecting a clip, and a wire rod proximal to the tubular body and the wire rod. It has a handle provided. The handle has a handle body and a slider, and by moving the slider in the perspective direction with respect to the handle body, the wire rod can be moved in the perspective direction with respect to the cylinder body. When the clip is connected to the connection portion at the distal end of the wire, the clip tightening mechanism can be operated by moving the slider in the proximal direction to clip the object to be treated. The endoscopic treatment tool of the present invention is provided with a stop portion of the slider when the slider is pulled proximally to the handle body in this way, whereby the clip operation by the endoscopic treatment tool is provided. Can be easily and appropriately performed.

Hereinafter, the endoscopic treatment tool of the present invention will be specifically described based on the following embodiments, but the present invention is not limited by the following embodiments, and is within the range that can be applied to the above-mentioned purpose. Of course, it is also possible to carry out with appropriate modifications in the above, and all of them are included in the technical scope of the present invention. In each drawing, hatching, member reference numerals, and the like may be omitted for convenience, but in such cases, the specification and other drawings shall be referred to. In addition, the dimensions of various members in the drawings may differ from the actual dimensions because priority is given to contributing to the understanding of the features of the present invention.

First, the entire endoscopic treatment tool will be described with reference to FIGS. 1 to 4. The endoscopic treatment tool 1 is arranged in the tubular body 2 and the lumen of the tubular body 2, and has a connecting portion 4 for connecting the clip 21 at the distal end, and the tubular body 2 and the wire rod 3. It has a handle 7 provided on the proximal side of the. The handle 7 has a handle body 8 and a slider 9 that can move in the perspective direction with respect to the handle body 8. In the present invention, the perspective direction refers to the long axis direction of the tubular body 2 and the wire rod 3, the proximal side in the perspective direction refers to the direction of the user, that is, the operator's hand side, and the distal side refers to the proximal side. In the opposite direction of, that is, the direction of the treatment target side.

When performing the treatment with the endoscopic treatment tool 1, as shown in FIG. 3, the clip 21 is connected to the connecting portion 4 provided at the distal end of the wire rod 3, and the wire rod 3 is inside the tubular body 2. The endoscopic treatment tool 1 placed in the cavity is inserted into the forceps channel of the endoscope. When inserting the endoscopic treatment tool 1 into the forceps channel, it is preferable that the clip 21 cannot be clipped. The wire rod 3 to which the clip 21 is connected is conveyed to the vicinity of the object to be treated through the forceps channel, and then the slider 9 of the handle 7 on the hand side is operated to control the opening and closing of the clip 21 provided on the distal side. Therefore, the object to be treated can be gripped by the clip 21.

Clip 21 is used during endoscopic procedures to seal the object and to pinch the object for hemostasis, suturing, ligation, and marking. The clip 21 is preferably formed so that the distal portion can be opened and closed with the proximal portion as a fulcrum. The proximal end of the clip 21 preferably has a shape that can be connected to the connecting portion 4 of the distal end of the wire 3.

The wire rod 3 is arranged inside the tubular body 2, and the proximal end thereof is connected to the handle body 8. The cylinder body 2 and the handle body 8 may be connected so as not to move, or may be rotatably connected. It is desirable that the tubular body 2 has both the flexibility of bending along the shape in the body cavity and the rigidity of reliably reaching the treatment target portion in a well-balanced manner. The cylinder 2 is preferably made of a biocompatible material. The tubular body 2 is formed of, for example, a tubular body formed of a coiled metal or a synthetic resin, a tubular body formed by connecting a plurality of short tubular joint pieces in the perspective direction and making them rotatable, and a synthetic resin. The cylinder is mentioned.

The wire rod 3 has a connecting portion 4 for connecting the clip 21 at the distal end portion, and the proximal end portion of the wire rod 3 is connected to the slider 9 of the handle 7. The wire rod 3 is configured by providing, for example, a connecting portion 4 on the distal side of the linear object 5. It is desirable that the linear object 5 has both the flexibility of bending along the shape in the body cavity and the rigidity of reliably reaching the treatment target portion in a well-balanced manner. The linear object 5 is preferably composed of a biocompatible material, for example, a metal wire such as stainless steel or carbon steel, a polyamide resin (for example, nylon), or a polyolefin resin (for example, polyethylene or polypropylene). , Polyetherketone resin (eg PET), aromatic polyetherketone resin (eg PEEK), polyimide resin, fluororesin (eg PTFE, PFA, ETFE) and other synthetic resins can be used. .. The wire rod 3 may be a composite made of a plurality of materials, and for example, the wire rod 5 may be a composite of a metal and a synthetic resin. Further, the linear object 5 may have a structure in which a wire-shaped base material is coated.

The connecting portion 4 is a portion of the wire rod 3 to which the clip 21 is connected. The connecting portion 4 may be provided as a separate body from the linear object 5, or the distal end portion of the linear object 5 may be formed as the connecting portion 4. The connecting portion 4 has a shape that can be connected to the clip 21, and the clip 21 and the connecting portion 4 can be selected from various shapes as long as they can be connected to each other. For example, as shown in FIGS. 3 and 4, a claw is provided at the proximal end of the clip 21 and an opening is provided at the connection portion 4 so that the claw provided on one side and the opening on the other side mesh with each other, or both. It is possible to provide a claw on the surface and connect the claws so that the claws mesh with each other.

The connecting portion 4 is preferably made of a biocompatible material, for example, a stainless steel such as SUS303, SUS304, SUS631 or a Ni—Ti alloy. In addition, polyamide resin (for example, nylon), polyolefin resin (for example, polyethylene or polypropylene), polyester resin (for example, PET), aromatic polyetherketone resin (for example, PEEK), polyimide resin, fluororesin (for example, PTFE, etc.) It may be formed from a synthetic resin such as PFA or ETFE).

The size of the connecting portion 4 can be appropriately set according to the size of the clip 21 connected to the connecting portion 4, the outer diameter of the wire rod 3, the inner diameter of the tubular body 2, and the like. For example, the outer diameter of the connecting portion 4 can be set in the range of 0.3 mm or more and 2.0 mm or less, and the length of the connecting portion 4 in the perspective direction is set in the range of 3.0 mm or more and 6.0 mm or less. be able to.

As shown in FIG. 3, the clip 21 is preferably composed of the clip body 22 and the tightening ring 23. In this case, it is preferable that the clip main body 22 is configured so that the distal side can be opened and closed with the proximal side as a fulcrum, and the tightening ring 23 is provided so as to surround the proximal portion of the clip main body 22. By connecting the clip 21 to the connecting portion 4 of the wire rod 3 and moving the wire rod 3 to the proximal side with respect to the tubular body 2, the tightening ring 23 comes into contact with the tubular body 2 and the tightening ring 23 is clipped. It can be formed so as to move distal to the body 22 and close the clip 21. After closing the clip 21, the wire rod 3 is further moved to the proximal side with respect to the tubular body 2 to separate the clip 21 from the connecting portion 4, and the clip 21 is placed inside the body with the object to be treated clipped. Can be detained in.

The clip main body 22 is formed, for example, by bending one metal plate into a U-shape or a V-shape, or by connecting two metal plates arranged opposite to each other. The clip body 22 and the tightening ring 23 are preferably made of a material having high elasticity and biocompatibility, for example, stainless steel such as SUS301, SUS303, SUS304, SUS631, metal such as Ni—Ti alloy, or synthetic. It is preferably composed of resin.

The size of the clip body 22 and the tightening ring 23 may be appropriately set according to the size of the connecting portion 4 to which the clip 21 is connected, the inner diameter of the tubular body 2, and the like. The clip body 22 preferably has a perspective length of, for example, 7.0 mm or more and 20.0 mm or less when the clip 21 is closed, and at least one of the clip bodies 22 when the clip 21 is closed. It is preferable that the portion is formed so as to be able to be stored in the tubular body 2. The length of the tightening ring 23 in the perspective direction is preferably 0.5 mm or more and 3.0 mm or less, for example. The outer diameter of the tightening ring 23 is preferably larger than the inner diameter of the cylinder 2, and the inner diameter of the tightening ring 23 is preferably smaller than the outer diameter of the cylinder 2.

As shown in FIGS. 1 and 2, the endoscopic treatment tool 1 preferably further has an outer cylinder 6. It is preferable that the tubular body 2 is arranged in the lumen of the outer tubular body 6 and the outer tubular body 6 is formed so as to be slidable with respect to the tubular body 2 in a specific range. Specifically, the outer cylinder 6 is located at a position where the distal end of the outer cylinder 6 is distal to the distal end of the cylinder 2 and proximal to the distal end of the cylinder 2. It is preferable that the body is formed so as to be movable in the perspective direction from the position. Further, in order to enable such a movement operation on the hand side of the endoscopic treatment tool 1, it is preferable that the outer tubular body 6 extends to the proximal portion of the tubular body 2.

It is preferable that the outer cylinder 6 is formed so that the clip 21 can be taken in and out from the outer cylinder 6 in a state where the clip 21 is connected to the connecting portion 4 at the distal end of the wire rod 3. As a result, the endoscopic treatment tool 1 can be inserted into the forceps channel from the forceps opening of the endoscope with the clip 21 housed in the outer cylinder 6. As a result, the clip 21 cannot be clipped, and the clip 21 is moved by the outer cylinder 6 to the body tissue other than the forceps channel in the endoscope and the lesion part until the clip 21 is transported near the treatment target part. It is possible to prevent damage to the like.

It is desirable that the outer tubular body 6 has both the flexibility to bend along the shape in the body cavity and the rigidity to surely reach the tissue to be treated in a well-balanced manner. The outer cylinder 6 is preferably made of a biocompatible material, for example, a cylinder formed of a synthetic resin, a cylinder formed of a coiled metal or a synthetic resin, or a short tubular joint. It can be composed of a tubular body in which a plurality of pieces are connected in the axial direction and made rotatable. As the outer cylinder 6, a cylinder formed of synthetic resin is preferably used, and the outer cylinder 6 can be visually confirmed by the user so that the positional relationship between the outer cylinder 6 and the cylinder 2 can be visually confirmed. Is preferably formed of a transparent or translucent material.

Examples of the synthetic resin forming the cylinder 2 and the outer cylinder 6 include a polyamide resin such as nylon, a polyolefin resin such as polypropylene (PP) and polyethylene (PE), a polyester resin such as polyethylene terephthalate (PET), and a polyether. Aromatic polyether ketone resin such as ether ketone (PEEK), polyimide resin, polytetrafluoroethylene (PTFE), tetrafluoroethylene-perfluoroalkyl vinyl ether copolymer (PFA), ethylene-tetrafluoroethylene copolymer (ETFE) ) And other synthetic resins such as fluororesins can be used. From the viewpoint of slipperiness, it is preferable that the synthetic resins forming the tubular body 2 and the outer tubular body 6 are made of different materials.

The handle 7 has a handle body 8 and a slider 9 that can move in the perspective direction with respect to the handle body 8. The handle body 8 and the slider 9 can be composed of one or a plurality of members. The constituent materials of the handle body 8 and the slider 9 include, for example, a polyolefin resin such as polypropylene (PP) and polyethylene (PE), a polyester resin such as polyethylene terephthalate (PET), a synthetic resin such as a polycarbonate resin, an ABS resin, and a polyurethane resin. Can be used.

The proximal end of the cylinder 2 is connected to the handle body 8, the proximal end of the wire 3 is connected to the slider 9, and the slider 9 is moved in the perspective direction with respect to the handle body 8. 3 can be moved in the perspective direction with respect to the tubular body 2. Specifically, by moving the slider 9 to the proximal side with respect to the handle body 8, the wire rod 3 can be moved to the proximal direction with respect to the tubular body 2, and the slider 9 can be moved with respect to the handle body 8. By moving the wire rod 3 to the distal side, the wire rod 3 can be moved in the distal direction with respect to the tubular body 2. The endoscopic treatment tool 1 can accommodate the connecting portion 4 provided at the distal end portion of the wire rod 3 in the tubular body 2 by pulling the slider 9 from the distal side to the proximal side. The fact that the slider 9 can move in the perspective direction with respect to the handle body 8 includes the fact that the positions of the slider 9 and the handle body 8 in the perspective direction can be relatively changed. It is preferable that the slider 9 can slide in the perspective direction with respect to the handle body 8.

It is preferable that the position of the connecting portion 4 in the perspective direction of the endoscopic treatment tool 1 is appropriately controlled when the clip 21 grips the treatment object or before and after the clip 21. For example, when the endoscopic treatment tool 1 is inserted into the forceps channel of the endoscope and the clip 21 is transported close to the treatment object, the clip 21 is located at or near the distal end of the tubular body 2. Is preferable. As a result, the gripping operation of the treatment object can be started immediately after the clip 21 is conveyed to the treatment object. Further, since the distance for pulling the wire rod 3 to the proximal side does not need to be excessively long before the clip 21 is closed, the position of the clip 21 in the perspective direction can be prevented from being significantly deviated from the object to be treated. can. Therefore, the clip 21 makes it easy to grip the desired portion of the object to be treated. When actually performing the operation of closing the clip 21, it is preferable to gradually close the clip 21 while checking the gripping state of the object to be treated, and for this purpose, the slider 9 is pulled from the distal side to the proximal side. At that time, it is preferable that the operator can detect while operating the handle 7 that the clip 21 is at or near the point where the clip 21 starts to close. This facilitates careful pulling of the slider 9 to the proximal side when the clip 21 is closed to grip the object to be treated.

From the above viewpoint, the endoscopic treatment tool 1 is configured so that when the slider 9 of the handle 7 is pulled to the proximal side, the movement of the slider 9 in the proximal direction is stopped at a predetermined stop point. There is. The predetermined stop location preferably corresponds to the clip 21 being located at or near the distal end of the tubular body 2 when the clip 21 is attached to the connecting portion 4 of the wire rod 3. When the clip 21 is not attached to the connecting portion 4, it is preferable that a part or all of the connecting portion 4 corresponds to a position where the clip 21 is housed in the tubular body 2. Therefore, the endoscopic treatment tool 1 is preferably configured to satisfy the following conditions 1 and 2, which will be described with reference to FIGS. 5 and 6.

FIG. 5A shows a state in which the slider 9 is stopped at the primary stop point of the following condition 1, and FIG. 5B shows the slider 9 is stopped at the secondary stop point of the following condition 1. The state of the slider is shown. In FIG. 5, the stop position of the slider 9 is represented by the position of the proximal end of the slider 9 in the perspective direction. FIG. 6A shows the positional relationship between the connecting portion 4 and the tubular body 2 when the slider 9 is at the primary stop position, together with the state of the clip 21, and FIG. 6B shows FIG. , The positional relationship between the connecting portion 4 and the tubular body 2 when the slider 9 is at the secondary stop position is shown together with the state of the clip 21.

[Condition 1] A primary stop within the movable range of the slider 9 by pulling the slider 9 toward the proximal side in a state where the clip 21 is not attached to the connection portion 4 of the endoscopic treatment tool 1. In 11, at least a part of the slider 9 comes into contact with at least a part of the handle body 8 to stop the movement of the slider 9 in the proximal direction, and the stop is released by applying a traction force of a predetermined value or more to the slider 9. By moving the slider 9 in the proximal direction and pulling the slider 9 further toward the proximal side, at least a part of the slider 9 is a handle body 8 at the secondary stop point 12 within the movable range of the slider 9. The movement of the slider 9 in the proximal direction is stopped by abutting at least a part of the slider 9, and the stop is released by applying a traction force of a predetermined value or more to the slider 9, and the slider 9 moves in the proximal direction.

[Condition 2] When the slider 9 is located at the primary stop point 11, at least a part of the connecting portion 4 is housed in the tubular body 2, and the slider 9 is located at the secondary stop point 12. When is present, the entire connection portion 4 is housed in the tubular body 2.

The primary stop portion 11 and the secondary stop portion 12 can function as signals indicating that the clip 21 is in an appropriate position when the operator performs the treatment with the endoscopic treatment tool 1. When the operator pulls the slider 9 to the proximal side, the operator can detect the primary stop portion 11 and the secondary stop portion 12 at hand while operating the handle 7, whereby the clip 21 can be appropriately attached. The clip 21 can be set at an appropriate position and the clip 21 can be operated appropriately. The operation of pulling the slider 9 to the proximal side can be equated with the operation of pushing the handle body 8 to the distal side.

The primary stop portion 11 can function as a signal informing that the clip 21 is in a position suitable for the standby state before the gripping operation by the clip 21 is performed. The standby state is a state in which the gripping operation by the clip 21 can be performed immediately. At the primary stop portion 11, at least a part of the connecting portion 4 is housed in the tubular body 2, and if the clip 21 is connected to the connecting portion 4 in this state, the clip 21 is far from the tubular body 2. It can be located at or near the edge. At the primary stop portion 11, the entire connecting portion 4 may be housed in the tubular body 2, and in this case, the distal end of the connecting portion 4 is, for example, proximal to the distal end of the tubular body 2. It is preferably located within 3.0 mm, more preferably within 2.5 mm. When the slider 9 is located at the primary stop point 11, the entire clip 21 is located distal to the distal end of the tubular body 2 or the clip 21 is attached to the connection portion 4. It is preferable that only a part of 21 is housed in the cylinder 2.

The position of the clip 21 in the standby state may be the primary stop portion 11, or may be a section between the primary stop portion 11 and the secondary stop portion 12. In the former case, the slider 9 can be pulled toward the proximal side to put the clip 21 in a standby state when the slider 9 stops at the primary stop point 11, and in the latter case, the slider 9 is further placed. Can be put into the standby state of the clip 21 in the range from the primary stop portion 11 to the secondary stop portion 12 by pulling the slider toward the proximal side.

When performing treatment with the endoscopic treatment tool 1, the endoscopic treatment tool 1 may be inserted into the forceps channel of the endoscope while the clip 21 is on standby, and the clip 21 may be transported close to the treatment target. preferable. At this time, it is preferable that the clip 21 is conveyed close to the object to be treated while maintaining the standby position. As a result, the gripping operation of the treatment target can be started immediately after the clip 21 is transported to the treatment target. From such a viewpoint, it is preferable that the clip 21 is in a standby state in a range from the primary stop portion 11 to the secondary stop portion 12. As a result, the clip 21 is likely to be maintained in the standby state until the clip 21 is conveyed close to the object to be treated.

The length from the primary stop point 11 to the secondary stop point 12 in the perspective direction can be appropriately set according to the length and shape of the clip 21 in the perspective direction, and is preferably 1.0 mm or more, for example, 1 5.5 mm or more is more preferable, 5.0 mm or less is preferable, and 4.0 mm or less is more preferable.

In the standby state of the clip 21, it is preferable that the clip 21 can be taken in and out from the distal end of the outer cylinder 6. This will be described with reference to FIG. In the standby state of the clip 21, when the outer cylinder 6 is moved most distally to the cylinder 2 with the clip 21 connected to the connecting portion 4, the outer cylinder is as shown in FIG. 7A. When the body 6 includes the clip 21 and the outer cylinder 6 is moved to the most recent position with respect to the cylinder 2, the distal end of the clip 21 is from the outer cylinder 6 as shown in FIG. 7 (b). It is preferable to expose it. As a result, the clip 21 is protected by the outer cylinder 6 while the clip 21 is conveyed near the treatment target portion through the forceps channel of the endoscope, and the clip 21 is used as the forceps channel in the endoscope. It is possible to prevent damage to internal tissues other than the lesion. After the clip 21 is transported close to the object to be treated, the outer cylinder 6 is pulled toward the proximal side of the endoscopic treatment tool 1 to expose the clip 21 from the outer cylinder 6, and the treatment with the clip 21 is performed. It can be performed.

The clip 21 may be able to be taken in and out from the distal end of the outer cylinder 6 at the primary stop portion 11 as described above, and is between the primary stop portion 11 and the secondary stop portion 12. Then, it may be possible to put in and take out from the distal end of the outer cylinder 6. Further, when the slider 9 is arranged on the distal side of the primary stop portion 11, the clip 21 may be able to be taken in and out from the distal end of the outer cylinder 6.

The secondary stop point 12 can function as a signal indicating that the clip 21 is in a position suitable for starting the gripping operation. At the secondary stop point 12, the entire connecting portion 4 is housed in the tubular body 2, and if the clip 21 is connected to the connecting portion 4 in this state, the proximal portion of the clip 21 is accommodated in the tubular body 2. It can be housed inside and the distal portion can be extended distally from the distal end of the cylinder 2. That is, when the slider 9 is located at the secondary stop point 12, it is preferable that only a part of the clip 21 is housed in the tubular body 2 with the clip 21 attached to the connecting portion 4. .. When the clip 21 is composed of the clip body 22 and the tightening ring 23, the proximal end of the tightening ring 23 is the distal end of the tubular body 2 when the slider 9 is located at the secondary stop point 12. It is preferably in contact with the edge. At the secondary stop point 12, the distal end of the connecting portion 4 is preferably located within 5.0 mm, for example, proximal to the distal end of the tubular body 2.

It is preferable that the secondary stop portion 12 functions as a reference position at which the clip 21 starts to close when the slider 9 is pulled closer to the proximal side. As a result, the operator can carefully pull the slider 9 to the proximal side on the proximal side of the secondary stop point 12, and can perform the gripping operation of the treatment object more appropriately. ..

The traction force F ₁ required to tow the slider 9 on the proximal side of the first pause position 11, the traction force F ₂ required to drive the slider 9 on the proximal side of the second pause position 12 , They may be the same or different from each other. _{The traction force F 0-1} required to pull the slider 9 to the proximal side in the section adjacent to the distal side of the primary stop portion 11 is preferably smaller than the traction force F _{1, and the first The traction force F 1-2} required to pull the slider 9 to the proximal side in the section adjacent to the distal side of the secondary stop point 12 on the proximal side of the next stop point 11 is the traction force. It is preferably smaller than F _2. Further, the traction force F _1-2 is preferably smaller than the traction force F _1.

In the endoscopic treatment tool 1, when the clip 21 is connected to the connection portion 4, the clip 21 is opened and closed by adjusting the perspective position of the slider 9 on the proximal side of the secondary stop point 12. It is preferable that an open / close adjustment section exists. In the opening / closing adjustment section, the opening degree of the clip 21 can be reversibly adjusted, so that the gripping position of the object to be treated by the clip 21 can be set more accurately. In the opening / closing adjustment section, it is preferable that the proximal end of the clip 21 is inside the cylinder 2 and the distal end of the clip 21 is distal to the distal end of the cylinder 2. As a result, the opening degree of the clip 21 can be adjusted by adjusting the perspective position of the slider 9.

It is preferable that there is a connection disconnection position on the proximal side of the opening / closing adjustment section, in which the connection between the clip 21 and the connection portion 4 is released by pulling the slider 9. When the connection between the clip 21 and the connecting portion 4 is released, the clip 21 can be separated from the connecting portion 4 and the clip 21 can be placed in the body in a state where the object to be treated is clipped.

It is also preferable that the endoscopic treatment tool 1 is configured to satisfy the following conditions 3 and 4. This will be described with reference to FIGS. 8 (a) and 9 (a). FIG. 8A shows a state in which the slider 9 is stopped at the 0th stop point under the following condition 3, and FIG. 9A shows a connection portion when the slider 9 is at the 0th stop point. The positional relationship between 4 and the cylinder 2 is shown together with the state of the clip 21. In FIG. 8, the stop position of the slider 9 is represented by the position of the proximal end of the slider 9 in the perspective direction.

[Condition 3] The slider 9 is in a state where the 0th stop point 10 exists on the distal side of the 1st stop point 11 and the clip 21 is not attached to the connection portion 4 of the endoscopic treatment tool 1. By pulling the slider 9 toward the proximal side, at least a part of the slider 9 comes into contact with at least a part of the handle body 8 at the 0th stop point 10 within the movable range of the slider 9, and the direction is proximal to the slider 9. The movement to the slider 9 is stopped, and by applying a traction force of a predetermined value or more to the slider 9, the stop is released and the slider 9 moves in the proximal direction.

[Condition 4] When the slider 9 is located at the 0th stop point 10, the connecting portion 4 exists on the distal side of the distal end of the tubular body 2.

At the 0th stop point 10, when the clip 21 is attached to the connection portion 4 before the endoscopic treatment tool 1 is inserted into the forceps channel of the endoscope, the connection portion 4 is suitable for the work. It can function as a signal to inform you that you are in a position. The 0th stop portion 10 also functions as a stopper for preventing the wire rod 3 from moving in the proximal direction when the clip 21 is attached to the connection portion 4, facilitating the attachment work of the clip 21 to the connection portion 4. To.

When the slider 9 is located at the 0th stop point 10, the connecting portion 4 exists on the distal side of the distal end of the tubular body 2. At this time, the entire connection portion 4 may be present on the distal side of the distal end of the tubular body 2, and only a part of the connection portion 4 may be on the distal side of the distal end of the tubular body 2. It may be present, but the former aspect is preferred. The position of the distal end of the connecting portion 4 at the 0th stop portion 10 can be appropriately set in consideration of the ease of attaching the clip 21 to the connecting portion 4, for example, the 0th stop portion. In No. 10, the distal end of the connecting portion 4 is preferably located 5.0 mm or more and 25.0 mm or less distal to the distal end of the tubular body 2. In the state where the clip 21 is attached to the connection portion 4, when the slider 9 is located at the 0th stop point 10, the entire clip 21 is located on the distal side of the distal end of the tubular body 2. Is preferable.

The perspective length from the 0th stop point 10 to the primary stop point 11 is preferably longer than the perspective length from the primary stop point 11 to the secondary stop point 12. For example, the length in the perspective direction from the 0th stop point 10 to the primary stop point 11 is preferably twice or more the length in the perspective direction from the primary stop point 11 to the secondary stop point 12. 3 times or more is more preferable, and 4 times or more is further preferable. By setting each stop point in this way, the slider 9 moves the slider 9 to the 0th stop point 10 and the 1st stop point 11 when the slider 9 is moved in the perspective direction without visually observing the handle 7. It becomes easy to judge whether it is between the primary stop points 11 and the secondary stop points 12.

Tractive force required to drive the slider 9 on the proximal side than the zero-order stop portion 10 F ₀ is the traction force F ₁ and the slider required to tow the slider 9 on the proximal side of the first pause position 11 It may be the same as or different from the _{traction force F 2} required to traction the 9 to the proximal side from the secondary stop point 12. If there is a section in which the slider 9 can be moved in the perspective direction on the distal side of the 0th stop point 10, the slider 9 is pulled to the proximal side in the section adjacent to the distal side of the 0th stop point 10. The traction force F _D-0 required for this is preferably smaller than the traction force F _{0. Further, the traction force F 0-1} required to pull the slider 9 to the proximal side in the section proximal to the 0th stop point 10 and adjacent to the distal side of the primary stop point 11. Is preferably smaller than the traction force F _0.

It is preferable that the distal end of the movable range of the slider 9 exists on the distal side of the 0th stop point 10. At this time, the length from the distal end of the movable range of the slider 9 to the 0th stop point 10 is preferably 3.0 mm or less from the viewpoint of facilitating the attachment work of the clip 21 to the connection portion 4. , 1.5 mm or less is more preferable. As a result, when the clip 21 is attached to the connecting portion 4, the movement of the connecting portion 4 and the wire rod 3 in the perspective direction is suppressed, and the work becomes easy. The perspective length from the distal end of the movable range of the slider 9 to the 0th stop point 10 is preferably shorter than the perspective length from the 0th stop point 10 to the primary stop point 11. .. For example, the length in the perspective direction from the 0th stop point 10 to the 1st stop point 11 is twice the length in the perspective direction from the distal end of the movable range of the slider 9 to the 0th stop point 10. The above is preferable, 3 times or more is more preferable, and 4 times or more is further preferable. The distal end of the range of motion of the slider 9 is represented in FIG. 8A by the position of the proximal end of the slider 9 when the slider 9 is on the most distal side.

The endoscopic treatment tool 1 is preferably configured to satisfy the following conditions 5 and 6, which will be described with reference to FIGS. 8 (b) and 9 (b). FIG. 8B shows a state in which the slider 9 is stopped at the third stop point under the following condition 5, and FIG. 9B shows a connection portion when the slider 9 is at the third stop point. The positional relationship between 4 and the cylinder 2 is shown.

[Condition 5] The slider 9 is in a state where the tertiary stop portion 13 exists on the proximal side of the secondary stop portion 12 and the clip 21 is not attached to the connection portion 4 of the endoscopic treatment tool 1. By pulling the slider 9 toward the proximal side, at least a part of the slider 9 comes into contact with at least a part of the handle body 8 at the tertiary stop point 13 within the movable range of the slider 9, and the direction is proximal to the slider 9. The move to stops.

[Condition 6] When the slider 9 is located at the tertiary stop portion 13, the entire connecting portion 4 is housed in the tubular body 2.

At the third stop portion 13, the connection between the clip 21 and the connecting portion 4 is released by further pulling the slider 9 to the proximal side after the gripping operation of the object to be treated by the clip 21, and the connecting portion 4 is connected to the clip 21. It can function as a signal to notify that it is in a distant position. The third stop location 13 is located proximal to the disconnection position described above. By pulling the slider 9 to the third stop point 13, the operator can sense at hand that the gripping operation by the clip 21 and the indwelling operation of the clip 21 have been completed.

When the slider 9 is located at the third stop portion 13, the entire connecting portion 4 is housed in the tubular body 2. At the third stop point 13, the distal end of the connecting portion 4 is located proximal to the distal end of the tubular body 2 for at least the perspective length of the clip 21 attached to the connecting portion 4. It is preferable that the tubular body 2 is located at least 7.0 mm or more proximal to the distal end, and more preferably 10.0 mm or more proximally. Considering the operability of the handle 7, the position of the distal end of the connecting portion 4 at the tertiary stop portion 13 may be within 50.0 mm on the proximal side of the distal end of the tubular body 2. preferable.

The tertiary stop point 13 may coincide with the proximal end of the movable range of the slider 9, and the proximal end of the movable range of the slider 9 exists on the proximal side of the tertiary stop point 13. May be good. In the latter case, the condition 5 is that by pulling the slider 9 toward the proximal side, at least a part of the slider 9 is at least a part of the handle body 8 at the third stop point 13 within the movable range of the slider 9. The movement of the slider 9 in the proximal direction is stopped in contact with the slider 9, and by applying a traction force of a predetermined value or more to the slider 9, the stop is released and the slider 9 moves in the proximal direction. In FIG. 8B, the proximal end of the movable range of the slider 9 is represented by the position of the proximal end of the slider 9 when the slider 9 is on the most proximal side.

The perspective length from the secondary stop point 12 to the tertiary stop point 13 is preferably longer than the perspective length from the primary stop point 11 to the secondary stop point 12. For example, the length in the perspective direction from the secondary stop point 12 to the tertiary stop point 13 is preferably twice or more the length in the perspective direction from the primary stop point 11 to the secondary stop point 12. 3 times or more is more preferable, and 4 times or more is further preferable. By setting each stop point in this way, when the slider 9 is pulled to the proximal side to close the clip 21 without visually observing the handle 7, the slider 9 moves to the primary stop points 11 and the second stop point 11. It becomes easy to determine whether it is between the next stop point 12 or between the second stop point 12 and the third stop point 13.

When there is a section in which the slider 9 can be moved in the perspective direction on the proximal side of the tertiary stop point 13, the traction force F _{3 required to pull the slider 9 proximal to the tertiary stop point 13. Is a traction force F 1} required to pull the slider 9 proximal to the primary stop 11 _{and a traction force F 2} required to pull the slider 9 proximal to the secondary stop 12. , It may be the same or different. The traction force F ₃ may be the same as or different from the _{traction force F 0} required to pull the slider 9 proximal to the 0th stop point 10. _{The traction force F 2-3} required to pull the slider 9 to the proximal side in the section proximal to the secondary stop 12 and adjacent to the distal side of the tertiary stop 13. Is preferably smaller than the traction force F _3. Further, the traction force F _2-3 is preferably smaller than the traction force F _2.

The 0th to 3rd stop points described above represent the relative positions of the slider 9 with respect to the handle body 8, and each stop point makes the slider 9 proximal to the distal side within the movable range of the slider 9. It is defined as a position where at least a part of the slider 9 comes into contact with at least a part of the handle body 8 and the movement of the slider 9 to the proximal side is stopped when the slider 9 is pulled to the side with a predetermined traction force. Such contact can be easily realized by providing a convex portion or a concave portion on the surface of the slider 9 facing the handle body 8 and the surface of the handle body 8 facing the slider 9.

FIG. 10 shows a cross-sectional view of the handle 7 in the perspective direction, and FIG. 11 shows a cross-sectional view of the handle 7 shown in FIG. 10 separated into a handle main body 8 and a slider 9. In FIG. 11, a one-dot chain line represents a position in the perspective direction that gives a primary stop point and a secondary stop point when the slider 9 is pulled to the proximal side.

As shown in FIGS. 10 and 11, for example, the handle body side convex portion 14 is provided on the surface of the handle body 8 facing the slider 9, and the slider side convex portion 15 is provided on the surface of the slider 9 facing the slider body 8. The position where the handle body-side convex portion 14 and the slider-side convex portion 15 come into contact with each other when the slider 9 is pulled from the distal side to the proximal side can be set as the above-mentioned stop point. Specifically, the position where the distal surface of the handle body side convex portion 14 and the proximal side surface of the slider side convex portion 15 come into contact with each other is the above-mentioned stop position. In FIGS. 10 and 11, the 0th stop portion, the 1st stop portion, and the 2nd stop portion are realized by the contact between the handle body side convex portion 14 and the slider side convex portion 15. On the other hand, the third stop point is realized by the proximal end of the slider 9 coming into contact with the proximal end of the movable range of the slider 9, that is, a part of the handle body 8.

In FIG. 10, one slider-side convex portion 15 is provided and three handle body-side convex portions 14 are provided as positions with respect to the perspective direction. However, two or more slider-side convex portions 15 may be provided, and the handle may be provided. The main body side convex portion 14 may be provided at only one or two locations, or may be provided at four or more locations. Further, at least one of the convex portion 14 on the handle body side is replaced with a concave portion, and the position where the concave portion on the handle body side and the convex portion 15 on the slider side abut is set as the above stop point, or at least one of the convex portions 15 on the slider side. Can be used as the above-mentioned stop point at a position where the handle body side convex portion 14 and the slider side concave portion come into contact with each other. It is preferable to adopt such a structure and to set the opening / closing adjustment section on the convex portion of the secondary stop portion 12.

The shape of the handle body side convex portion 14, the handle body side concave portion, the slider side convex portion 15, and the slider side concave portion can be appropriately selected according to the shapes of the handle main body 8 and the slider 9. For example, when the outer shape of the handle body 8 or the outer shape of the slider 9 is cylindrical, a convex portion or a concave portion can be provided on the circumference of the cross section perpendicular to the perspective direction of the handle 7. The protrusions and recesses may have a shape that is continuous on the circumference, and one or more protrusions or recesses may be provided intermittently on the circumference. Further, the handle body side convex portion or concave portion may be continuously provided on the circumference, and the slider side convex portion or concave portion may be provided as one or more protrusions or depressions on the circumference, and vice versa. It can also be provided.

In the above description, the 0th stop location is defined as a location where the slider 9 stops moving in the proximal direction when the slider 9 is pulled from the distal side to the proximal side within the movable range of the slider 9. Although the third stop location is specified, the movable range of the slider 9 can be divided according to each stop location, and the first locking portion and the second locking portion can be defined as follows. That is, the section between the distal end of the movable range of the slider 9 and the 0th stop point 10 is the first locking portion, and the section between the primary stop point 11 and the secondary stop point 12 is the second. It can be defined as a locking portion. The details of the positional relationship between the first locking portion and the second locking portion can be appropriately read based on the above description of the 0th stop portion to the 3rd stop portion.

The handle 7 has a first locking portion and a second locking portion that regulate the movement of the slider 9 in the perspective direction, and when the slider 9 is locked by the first locking portion, the connecting portion 4 When the distal end protrudes from the distal end of the tubular body 2 and the slider 9 is locked by the second locking portion, the distal end of the connecting portion 4 is arranged in the lumen of the tubular body 2. It is preferable to have. The state in which the distal end of the connecting portion 4 protrudes from the distal end of the tubular body 2 corresponds to the distal end of the connecting portion 4 being located on the distal side of the distal end of the tubular body 2. However, in the state where the distal end of the connecting portion 4 is arranged in the lumen of the tubular body 2, the distal end of the connecting portion 4 is located proximal to the distal end of the tubular body 2. Equivalent to. In this case, by locking the slider 9 to the first locking portion, the work of attaching the clip 21 to the connecting portion 4 becomes easy. By locking the slider 9 to the second locking portion, the clip 21 prepares for the gripping operation of the object to be treated, and by pulling the slider 9 proximal to the second locking portion, the clip 21 is prepared. The actual gripping operation can be started by.

When the endoscopic treatment tool 1 includes the outer tubular body 6, the position when the slider 9 is locked by the first locking portion and the position when the slider 9 is locked by the second locking portion. It is preferable that the clip 21 can be taken in and out from the distal end of the outer cylinder 6 while being arranged between the two. That is, when the slider 9 is arranged between the position when it is locked by the first locking portion and the position when it is locked by the second locking portion, the outer cylinder 6 The outer cylinder 6 contains the clip 21 by moving the outer cylinder 6 to the most distal position with respect to the cylinder 2, and the clip 21 is moved to the most recent position with respect to the cylinder 2 to move the clip 21 to the outer cylinder. It is preferably formed so as to be exposed from 6. Further, it is preferable that the clip 21 can be taken in and out from the distal end of the outer cylinder 6 in this way when the slider 9 is locked by the second locking portion.

The description of the positional relationship between the connecting portion and the cylinder when the slider is locked to the first locking portion and when the slider is locked to the second locking portion, the traction force of the slider, and the like is described in the above-mentioned 0th order. The explanations in the stop points to the third stop points can be referred to.

This application claims the benefit of priority under Japanese Patent Application No. 2018-218601 filed on November 21, 2018. The entire contents of the specification of Japanese Patent Application No. 2018-218601 filed on November 21, 2018 are incorporated herein by reference.

1: Endoscopic treatment tool 2: Cylindrical body 3: Wire rod 4: Connection part 5: Linear object 6: Outer tubular body 7: Handle 8: Handle body 9: Slider 10: 0th stop point 11: Primary Stop point 12: Secondary stop point 13: Third stop point 14: Handle body side convex part 15: Slider side convex part 21: Clip 22: Clip body 23: Tightening ring

Claims (12)

With the cylinder
A wire rod arranged in the lumen of the cylinder and having a connection portion at the distal end for connecting a clip, and a wire rod.
An endoscopic treatment tool having a cylinder and a handle provided on the proximal side of the wire rod.
The handle has a handle body to which the proximal end of the cylinder is connected and a slider to which the proximal end of the wire is connected and is movable in the perspective direction with respect to the handle body. By pulling the slider from the distal side to the proximal side, the connecting portion can be accommodated in the tubular body, and the following [Condition 1] and [Condition 2] are satisfied. Endoscopic treatment tool to do.
[Condition 1]
In a state where the clip is not attached to the connection portion of the endoscopic treatment tool,
By pulling the slider toward the proximal side, at least a part of the slider comes into contact with at least a part of the handle body at a primary stop within the movable range of the slider, and is proximal to the slider. The movement in the direction is stopped, and by applying a traction force equal to or higher than a predetermined value to the slider, the stop is released and the slider moves in the proximal direction.
By further pulling the slider toward the proximal side, at least a part of the slider comes into contact with at least a part of the handle body at a secondary stop within the movable range of the slider, and the slider The movement in the proximal direction is stopped, and by applying a traction force of a predetermined value or more to the slider, the stop is released and the slider moves in the proximal direction.
[Condition 2]
When the slider is located at the primary stop, at least a part of the connection is housed in the cylinder, and when the slider is located at the secondary stop, the connection is located. All of them are housed in the cylinder. The endoscopic treatment tool according to claim 1, which further satisfies the following [Condition 3] and [Condition 4].
[Condition 3]
The slider is directed toward the proximal side in a state where the 0th stop is located distal to the 1st stop and the clip is not attached to the connection of the endoscopic treatment tool. By pulling the slider, at least a part of the slider comes into contact with at least a part of the handle body at the 0th stop point within the movable range of the slider, and the movement of the slider in the proximal direction is stopped. By applying a traction force of a predetermined value or more to the slider, the stop is released and the slider moves in the proximal direction.
[Condition 4]
When the slider is located at the 0th stop, the connection is distal to the distal end of the cylinder. The endoscopic treatment tool according to claim 1 or 2, which further satisfies the following [Condition 5] and [Condition 6].
[Condition 5]
The slider is directed toward the proximal side in a state where the tertiary stop portion exists on the proximal side of the secondary stop portion and the clip is not attached to the connection portion of the endoscopic treatment tool. By pulling the slider, at least a part of the slider comes into contact with at least a part of the handle body at the tertiary stop point within the movable range of the slider, and the movement of the slider in the proximal direction is stopped. ..
[Condition 6]
When the slider is located at the tertiary stop, the entire connection is housed in the cylinder. In a state where the clip is connected to the connection portion of the endoscopic treatment tool,
The invention according to any one of claims 1 to 3, wherein an opening / closing adjustment section for opening / closing the clip by adjusting the perspective position of the slider exists on the proximal side of the secondary stop location. Endoscopic treatment tool. 4. In the opening / closing adjustment section, the proximal end of the clip is inside the cylinder, and the distal end of the clip is distal to the distal end of the cylinder. The endoscopic treatment tool described in. The endoscopic treatment tool according to claim 4 or 5, wherein there is a connection disconnection position on the proximal side of the opening / closing adjustment section in which the connection between the clip and the connection portion is released by pulling the slider. .. Further comprising an outer cylinder in which the cylinder is located in the lumen
The outer cylinder is slidable in a specific range with respect to the cylinder, and is slidable.
When the slider is arranged between the primary stop portion and the secondary stop portion and the outer cylinder is moved most distally to the cylinder, the outer cylinder is moved. Any one of claims 4 to 6 in which the distal end of the clip is exposed from the outer cylinder when the clip is included and the outer cylinder is moved to the nearest position with respect to the cylinder. The endoscopic treatment tool described in. A convex portion on the handle body side is provided on the surface of the handle body facing the slider.
A convex portion on the slider side is provided on the surface of the slider facing the handle body.
The endoscopic treatment tool according to any one of claims 1 to 7, wherein the contact is a contact between the convex portion on the handle body side and the convex portion on the slider side. The endoscopic treatment tool according to claim 8, wherein at least one of the convex portions on the handle body side is replaced with a concave portion. The endoscopic treatment tool according to claim 8 or 9, wherein at least one of the slider-side convex portions is replaced with a concave portion. With the cylinder
A wire rod arranged in the lumen of the cylinder and having a connection portion at the distal end for connecting a clip, and a wire rod.
An endoscopic treatment tool having a cylinder and a handle provided on the proximal side of the wire rod.
The handle includes a handle body to which the proximal end of the cylinder is connected, a slider to which the proximal end of the wire is connected and movable in the perspective direction with respect to the handle body, and a slider. It has a first locking part and a second locking part that regulate the movement in the perspective direction.
When the slider is locked by the first locking portion, the distal end of the connecting portion protrudes from the distal end of the cylinder, and the slider is locked by the second locking portion. When the endoscopic treatment tool is characterized, the distal end of the connection portion is arranged in the lumen of the tubular body. Further, the tubular body is provided with an outer tubular body arranged in the lumen.
The outer cylinder is slidable in a specific range with respect to the cylinder, and is slidable.
When the slider is arranged between the position when it is locked by the first locking portion and the position when it is locked by the second locking portion, the outer cylinder When the outer cylinder is moved most distally to the cylinder, the outer cylinder contains the clip, and when the outer cylinder is moved to the most recent position with respect to the cylinder, the clip is said. The endoscopic treatment tool according to claim 11, which is exposed from the outer cylinder.

Images