TW202408428A - Traction clamp for endoscope - Google Patents

Abstract

[Topic] Provided is a traction clamp for endoscope, which has a simple structure and can easily and stably lift the diseased part. [Solution] The traction clamp for endoscope 1A has a clamp body 10 and a ring member 100, wherein the clamp body 10 has a pair of arms (arm plate portions 30, 40) opened into a roughly V-shape and a ring-shaped fastening ring 50 of a connecting portion slidably fitted to the base end side of the arm, and the ring member 100 is assembled to the clamp body 10 and formed into a ring shape. The loop member 100 is formed by connecting an elastic portion P1 having elasticity and an inelastic portion P2 having inelasticity. The elastic portion P1 is stretched and contracted in the direction of the loop extension, and the inelastic portion P2 is flexible and does not stretch and contract in the direction of the loop extension.

Description

Traction clamp for endoscope

The present invention relates to an endoscopic traction clamp which is inserted into a body by using an endoscope to traction a part of living tissue including a lesion.

In endoscopic submucosal dissection (ESD), in order to facilitate the removal of the diseased part or to increase the certainty of the removal, the following surgery may be performed: part of the diseased part is incised and dissected. At this time, in such a way that the peeled off lesion will not interfere with the subsequent incision, traction force is applied to the lesion in advance to lift the peeled off lesion and simultaneously incise the entire lesion. As a jig for lifting a diseased part during ESD, for example, a medical jig described in Patent Document 1 below and a pulling jig for endoscopes described in Patent Document 2 below are known.

Patent Document 1 describes a medical clip in which a coupling portion having one or more wheels is mounted on a clip body. Furthermore, Patent Document 2 describes an endoscopic pulling jig having a plurality of linear loops that are supported by a jig body and pull the lesion toward the mucosa on the opposite side of the lesion.

"Patent documents" "Patent Document 1": Japanese Patent Publication No. 4472680 "Patent Document 2": Japanese Patent Publication No. 2022-62923

The medical jig described in Patent Document 1 and the traction jig for endoscopes described in Patent Document 2 both have a structure in which a plurality of mutually independent wheels (a plurality of linear loops) are assembled on the jig body, so the plurality of wheels are The connection of the clamp body is complicated, which will cause problems such as multiple wheels entangled with each other. It is not easy to transport multiple wheels into the body at the same time. The number of wheels (that is, the number of anchors during towing) is naturally limited. Such questions.

In addition, when multiple wheels are attached to the lesion for multi-point traction, all the wheels will extend to the portion facing the lesion (opposing portion) during traction, causing obstruction and causing the traction. There is a problem of reduced operability of endoscopes and instruments used to remove diseased areas.

The present invention was made in view of the above-mentioned problems, and an object thereof is to provide an endoscope traction jig that has a simple structure and can easily and stably lift a lesion.

In order to achieve the above object, the traction clamp for endoscopes related to the present invention is characterized in that it has a clamp body and a ring member. The clamp body has a pair of arms with legs opened in a substantially V shape and is slidably embedded in the outside. An annular fastening ring is attached to the connecting portion on the base end side of the arm. The loop member is assembled to the clamp body and is formed into a loop shape. It consists of an elastic elastic part and an inelastic non-elastic part. The elastic portion is connected to each other and is configured to expand and contract in the direction of the circular extension. The non-elastic portion has flexibility and does not expand or contract in the direction of the circular extension.

According to the above structure, an endoscope traction clamp can be provided, which has a simple structure in which a ring component having a partially elastic part and a partially inelastic part is assembled on a clamp body capable of grasping living tissue, and can stably lift the diseased part.

The traction clamp for endoscopes related to the present invention can be set to traction near the lesion by assembling the clamp body at a designated part near the lesion and using another clamp to fix the inelastic part to other parts near the lesion. Anchor points for multiple parts (more than 2 points). By setting the anchor point of the diseased part based on the inelastic part, the traction force acting when lifting the diseased part is reliably transmitted to the anchoring point in the form of the tension of the non-elastic part that does not stretch, and the diseased part can be lifted stably.

Furthermore, the two different points of the inelastic portion are distributed in a manner isolated from each other through the inelastic portion having inelasticity, so the isolated two different points can be easily and reliably set as anchor points fixed near the lesion in the inelastic portion.

Furthermore, by using another clamp to fix the elastic part to the part (opposite part) opposite to the lesion part, the lesion part can be lifted by its traction (elasticity). The elastic part has elasticity of extension and contraction, and when the periphery of the lesion part is cut to peel off from the inner wall of the luminal organ, the lesion part can be lifted in the direction away from the inner wall of the luminal organ (opposite part direction), so the peeled part generated after the lesion part is peeled off can be easily observed, and at the same time, the lesion part can be kept lifted up so as not to hinder the operation, and the entire circle of the lesion part can be easily and reliably cut.

In the above-mentioned structure of the traction clamp for endoscope related to the present invention, the above-mentioned non-elastic part of the above-mentioned ring member can also be assembled to the above-mentioned arm part of the above-mentioned clamp body.

According to the above structure, a designated portion of the jig body near the lesion can be set as one of a plurality of anchor points.

In the traction jig for an endoscope according to the present invention, in the above-mentioned structure, a part of the loop member and the inelastic portion may be composed of an inelastic loop member formed in a loop shape.

According to the above structure, by fixing the inelastic ring member near the lesion, the position where the inelastic ring member is provided can be easily and reliably set as an anchor point fixed near the lesion.

Furthermore, when another clamp is used to fix the non-elastic loop component near the lesion, the non-elastic loop component can be easily fixed near the lesion by hooking the loop of the non-elastic loop component with the arm of the other clamp and clamping it.

The traction clip for endoscope related to the present invention can also be included in the above-mentioned structure, wherein the aforementioned inelastic part of the aforementioned loop component is composed of a flexible inelastic wire and a first inelastic loop component and a second inelastic loop component formed into a loop at both ends of the aforementioned inelastic wire, and the first inelastic loop component and the second inelastic loop component are respectively connected to the two ends of the aforementioned elastic part of the aforementioned loop component.

According to the above structure, by clamping the first inelastic ring component and the second inelastic ring component and fixing them near the lesion, the position where the first inelastic ring component and the second inelastic ring component are provided can be easily and reliably set as an anchor point fixed near the lesion.

Furthermore, by appropriately selecting any one or more points of the inelastic wire existing between the first inelastic ring member and the second inelastic ring member and fixing them near the lesion, in addition to the first inelastic ring member and In addition to the anchor point of the second inelastic ring component, any point of the inelastic wire can be set as an anchor point, and a total of 3 or more anchor points can be pulled (multi-point traction) to stably lift the lesion.

In the traction jig for an endoscope according to the present invention, in the above-mentioned structure, the elastic portion of the loop member may be formed of an elastic loop member formed in a loop shape.

According to the above structure, after a plurality of anchor points are set near the lesion, and another clamp is used to fix the elastic part to the position opposite to the lesion (opposing position), by using the other clamp The arm hooks the loop of the elastic ring component and clamps it, and the elastic ring component can be easily fixed to the opposite part.

The traction clamp for endoscopes according to the present invention may also be provided with a connecting member connecting at least one of the pair of arm portions of the clamp body and the elastic portion in the above-mentioned structure.

According to the above structure, the attraction of the elastic part can be transmitted to the anchor point set according to the clamp body through the intermediate connecting component, so that the diseased part can be stably lifted.

The endoscope pulling fixture according to the present invention may also be configured in the above-mentioned structure such that a non-elastic ring member formed in a ring shape is mounted on a part of the elastic portion of the ring member.

According to the above structure, after setting a plurality of anchor points near the lesion, when using another clamp to fix the elastic part at a part (opposite part) opposite to the lesion, the elastic ring part can be easily fixed at the opposite part by hooking and clamping the ring-shaped non-elastic ring part which is a part of the elastic part of the ring part with the arm of the other clamp.

The pulling jig for an endoscope according to the present invention may have the above structure in which the elastic part is made of an elastomer molded part and the inelastic part is made of a wire made of natural fiber or chemical fiber.

According to the above structure, a loop component is manufactured by connecting the elastic body forming part with the wire rod using natural fiber or chemical fiber, and the loop component is assembled to the clamp body, thereby making it easy to manufacture the traction clamp for endoscope related to the present invention.

Embodiments of the present invention will be described below with reference to the drawings. In this specification, the operator who performs an ESD operation using the endoscopic traction jig related to the present invention is taken as the standard. The inner side of the patient's body is defined as the distal end side, and the side closer to the operator is defined as the proximal end. Bit end side. The drawings referenced in this specification are not necessarily in exact proportions relative to actual dimensions, but are partially exaggerated or simplified in order to schematically represent the structure related to the present invention.

(First implementation type)

The following describes an endoscope pulling fixture 1A in the first embodiment of the present invention.

(Structure of endoscope traction clamp 1A)

FIG. 1 is a perspective view showing the overall structure of the endoscope pulling jig 1A in the first embodiment of the present invention, and is a diagram showing the arm plate portions 30 and 40 of the jig body 10 with their legs opened. FIG. 2 is a front view of the endoscope traction clamp 1A shown in FIG. 1 . FIG. 3 is a diagram illustrating a state in which the arm plate portions 30 and 40 of the clamp body 10 are closed in the traction clamp 1A for endoscopes shown in FIG. 1 .

The endoscope pulling clamp 1A in the first embodiment is roughly composed of a clamp body 10 and a ring member 100.

The clamp body 10 has a connecting plate portion (connecting portion) 20, a pair of arm plate portions (arm portions) 30, 40 and a fastening ring 50. The connecting plate portion 20 has a shape bent into a substantially U-shape, and the arm plate portions 30, 40 are integrally formed in a manner that is continuous to each end of the U-shape and opens toward the end to form a substantially V-shape.

The fastening ring 50 is a ring-shaped member that is slidably fitted to the connecting plate portion 20 at the base end side of the arm plate portions 30 and 40. As described later, the fastening ring 50 is a member that can slide using a clamp device (see Figures 4 to 6 for details), and the clamp device has an inner sheath (sheath) 62 and a connecting hook (connecting member) 61 that is configured to be freely advanced and retreated relative to the inner sheath 62 and connected (connected) to the connecting plate portion 20 in a manner that can be installed and removed (installed and removed). When the fastening ring 50 is connected to the connecting plate portion 20 by the connecting hook 61, the connecting hook 61 is pulled in from the end portion of the inner sheath 62, and is pushed by the end portion of the inner sheath 62 to slide toward the end portion side (distal end side) of the pair of arm plate portions 30, 40, so that the pair of arm plate portions 30, 40 are locked.

At the end of each arm plate portion 30, 40, claw portions 32, 42 are formed integrally. The claw portions 32, 42 can be formed by bending inward (i.e., in the clamping direction) at the end of each arm plate portion 30, 40. The claw portions 32, 42 have recessed notches 32a, 42a at the middle of their ends.

The connecting plate portion 20, the arm plate portions 30, 40 and the claw portions 32, 42 constituting the clamp body 10 can be formed by bending a thin and elongated plate. The plate thickness of the plate constituting the clamp body 10 is not particularly limited, but is preferably 0.10 to 0.30 mm. As the plate constituting the clamp body 10, a plate having elasticity is preferred, and for example, stainless steel can be used.

As shown in FIG. 1 , the pair of arm plate parts 30 and 40 respectively have base end parts 30p and 40p and grip parts 30g and 40g. Through-hole portions 31 and 41 are formed in the grip portions 30g and 40g of the respective arm plate portions 30 and 40, respectively. These penetration portions 31 and 41 are formed so as not to impair the desired strength of the arm plate portions 30 and 40 (grip portions 30g and 40g). One of these through-parts 31 and 41 can also be used to assemble the hoop component 100 to the clamp body 10 . Here, the through portion 31 formed in the grip portion 30g of the arm plate portion 30 is used to connect the clip body 10 and the loop member 100.

The fastening ring 50 is slidably inserted into the connecting plate portion 20 . The fastening ring 50 is composed of a substantially cylindrical ring member. However, the fastening ring 50 can also be formed by a spring formed by winding a wire into a spiral shape. The fastening ring 50 has the connecting plate portion 20 inserted into the guide hole on its inner side so as to be able to move (slide) in the axial direction through the outer periphery of the connecting plate portion 20 and the base end portions 30p and 40p of the arm plate portions 30 and 40. Installed between the outer periphery (embedded).

As shown in FIGS. 1 and 2 , in a state where the fastening ring 50 is disposed at a position on the proximal end side of the clamp body 10 (a position close to the connecting plate portion 20 ), the pair of arm plate portions 30 and 40 become independent of each other. The elastically opened state (the state in which the arm portions 30 and 40 open their legs). In addition, depending on the needs, the fastening ring 50 can be moved (slided) to the position on the end side of the clamp body 10 (the position close to the gripping parts 30g and 40g) in the direction of arrow D1 shown in Figure 3. The pair of arm plate parts 30 and 40 are in a closed state (legs are closed) to hold the living tissue.

The ring component 100 is a ring-shaped component assembled to the clamp body 10. The ring component 100 is composed of an elastic part P1 having elasticity and an inelastic part P2 having inelasticity, wherein the elastic part P1 stretches and contracts along the ring-shaped extension direction (hereinafter referred to as the ring-shaped extension direction), and the inelastic part P2 has flexibility and does not stretch and contract along the ring-shaped extension direction. That is, the ring component 100 is a ring-shaped component, and with respect to the ring-shaped extension direction, it has a structure in which part of the elastic part P1 and part of the inelastic part P2 are simultaneously provided.

In the first embodiment, the elastic portion P1 of the loop member 100 is composed of the elastic loop member 110 formed in a loop shape. The elastic ring member 110 is preferably made of an elastomer molded component made of an elastomer having stretchability (rubber elasticity). This elastomer molded part can be obtained, for example, by cross-linking a rubbery polymer or melting a thermoplastic elastomer. Furthermore, as the elastic ring member 110, for example, an interpalatal rubber band, which is a medical rubber band with a diameter of approximately 3 to 10 mm and is used for orthodontic treatment, can be used. In the first embodiment, an interpalatal elastic band is used as the elastic ring member 110 .

In the first embodiment, the inelastic portion P2 of the loop component 100 is composed of an anchor wire 120 and a first inelastic loop component 130 and a second inelastic loop component 140. The anchor wire 120 is made of a wire that is flexible and does not stretch in the loop extension direction. The first inelastic loop component 130 and the second inelastic loop component 140 are connected to both ends of the anchor wire 120 and are also made of a wire that is flexible and does not stretch in the loop extension direction. The first inelastic loop member 130 and the second inelastic loop member 140 are loop-shaped members having independent loops that are not connected to each other, and are respectively connected to both ends of the anchor wire 120 and are also respectively connected to the elastic loop member 110 constituting the elastic portion P1 of the loop member 100 .

The anchor wire 120 is composed of a wire that is flexible and can be flexibly bent and has a non-elastic wire that does not stretch relative to its extension direction (a non-elastic wire that does not have rubber elasticity). As the material of the anchor wire 120, for example, wires made of silk (silk), nylon, polyester, polypropylene, stainless steel, titanium, etc. can be used. As an example, wires made of natural fibers or chemical fibers can be used. Surgical sutures. In the first embodiment, surgical sutures made of nylon may be used as the anchor wire 120 .

As will be described later, the anchor wire 120 can be used to set an anchor point for lifting and pulling the lesion. The length of the anchor wire 120 can be set appropriately according to the type and size of the luminal organ in the body in which the diseased part exists. For example, it can be set to be longer than the loop length of the elastic ring member 110 constituting the elastic part P1. Half the length and shorter than the length of the circle.

The first inelastic ring member 130 and the second inelastic ring member 140 are made of a flexible wire that can be flexibly bent and a non-elastic wire that does not stretch with respect to its extending direction (a non-elastic wire that does not have rubber elasticity). ) composed of. As the material of the first inelastic ring member 130 and the second inelastic ring member 140, it is the same as the anchor wire 120. For example, silk (silk), nylon, polyester, polypropylene, stainless steel, titanium can be used. For example, surgical sutures made of natural fibers or chemical fibers can be used as wires. Here, a surgical suture made of silk can be used for the first inelastic ring member 130 , and a surgical suture made of nylon can be used for the second inelastic ring member 140 .

As will be described later, the first inelastic ring member 130 and the second inelastic ring member 140 can be used to set anchor points for lifting and pulling the lesion. The loop lengths of the first inelastic loop member 130 and the second inelastic loop member 140 may be appropriately set according to the type and size of the luminal organ in the body in which the diseased part exists. For example, they may be set to form an elastic The length of the elastic ring member 110 of the portion P1 is approximately half of the ring length. The loop lengths of the first inelastic loop member 130 and the second inelastic loop member 140 may be the same or different from each other.

The first inelastic loop component 130 and the second inelastic loop component 140 are respectively connected to both ends of the anchor wire 120. That is, the anchor wire 120 is interposed between the first inelastic loop component 130 and the second inelastic loop component 140. The method of connecting the anchor wire 120 and the first inelastic loop component 130 and the second inelastic loop component 140 is not particularly limited, but for example, the ends of the anchor wire 120 may be respectively fastened to the wires constituting the first inelastic loop component 130 and the second inelastic loop component 140, or may be formed integrally.

Furthermore, the first inelastic ring component 130 and the second inelastic ring component 140 are connected to both ends of the elastic part P1, respectively. In the first embodiment, the elastic ring component 110 constituting the elastic part P1 is interposed between the first inelastic ring component 130 and the second inelastic ring component 140. The method of connecting the elastic part P1 and the first inelastic ring component 130 and the second inelastic ring component 140 is not particularly limited. The elastic part P1 in the first embodiment is the elastic ring component 110 formed in a ring shape. The elastic ring component 110 and the first inelastic ring component 130 can be connected by allowing the ring formed by the elastic ring component 110 and the ring formed by the first inelastic ring component 130 to pass through each other and be combined. Similarly, by allowing the loop formed by the elastic loop member 110 and the loop formed by the second inelastic loop member 140 to pass through each other and be coupled, the elastic loop member 110 and the second inelastic loop member 140 can be connected. In other words, the first inelastic loop member 130, the elastic loop member 110, and the second inelastic loop member 140 form a chain-like structure.

In addition, the elastic ring member 110 and the first inelastic ring member 130 and the second inelastic ring member 140 may be fixed to each other, or may be free to move with each other. Here, the elastic ring member 110 and the first inelastic ring member 130 and the second inelastic ring member 140 are combined and connected in a state where the rings are free from each other.

In this way, the elastic loop member 110 constituting the elastic part P1, the first inelastic loop member 130 constituting the inelastic part P2, the anchor wire 120, and the second inelastic loop member 140 are connected in a ring shape to form a loop. , thereby forming the loop component 100.

The ring member 100 is mounted on the arm plate portion 30, 40 of the clamp body 10. For example, either the first inelastic ring member 130 or the second inelastic ring member 140 may be mounted on either the arm plate portion 30, 40 of the clamp body 10. Here, as shown in FIG. 1, the first inelastic ring member 130 is mounted on the arm plate portion 30 of the clamp body 10 by inserting the ring formed by the first inelastic ring member 130 through the through portion 31 formed on the grip portion 30g of the arm plate portion 30 to engage the first inelastic ring member 130. In addition, the first inelastic ring member 130 and the arm plate portion 30 may be fixed to each other, or may be free to move from each other. Here, the first inelastic ring member 130 and the arm plate portion 30 are in a state of being separated from each other, although the loop formed by the first inelastic ring member 130 is inserted through the through portion 31 of the arm plate portion 30 .

(Structure of clamp device 60)

In the first embodiment, the endoscope traction clamp 1A is installed/accommodated at the distal end (distal end) of the clamp device 60, and the sheath portion of the clamp device 60 is inserted into the lumen of the endoscope. , guided to the living tissue that should be disposed of.

An example of the clamp device 60 used when transporting the endoscopic traction clamp 1A into the body will be described below with reference to FIGS. 4 to 6 . FIG. 4 is a diagram illustrating the appearance of the clamp device 60 used when transporting the traction clamp 1A for an endoscope in the first embodiment of the present invention into the body. Figure 5 is a cross-sectional view along line Va-Va in Figure 4. FIG. 6 is a perspective view of the connecting hook 61 of the clamp device 60 shown in FIG. 4 and its surrounding structure.

As shown in FIG. 4 , the clamp device 60 schematically includes a connecting hook 61 , an inner sheath 62 , a driving wire 63 , an outer sheath 64 , a reinforcing spiral 65 , a slider 66 , a base 67 and an operating portion 68 .

As shown in Fig. 5, a tubular inner sheath 62 is inserted through a tubular outer sheath 64, and a drive wire 63 is inserted through the inner sheath 62. The inner sheath 62 can slide (slide) in the outer sheath 64, and the drive wire 63 can slide (slide) in the inner sheath 62.

The outer sheath 64 is made of a flexible hollow tube, and a spiral tube, for example, can be used. As the spiral tube, a flat spiral tube made of a long flat plate made of metal (stainless steel) or the like can be used. However, a round spiral tube or an inner flat spiral tube can also be used. The inner diameter of the end of the outer sheath 64 is about 2 to 3 mm.

The inner sheath 62 is made of a flexible hollow tube, and a wire tube, for example, can be used. A wire tube is a tube made of a hollow twisted wire formed by twisting a plurality of wires (cables) made of, for example, metal (stainless steel) into a spiral shape in a hollow manner. In addition, as the inner sheath 62, a wire tube is mainly used, and a spiral tube can also be used in which only a part of the end side is made. The inner diameter of the end portion of the inner sheath 62 is about 1.5 to 2.5 mm.

The drive wire 63 is made of a flexible wire, such as a steel cable. The steel cable is a rope made of a twisted wire formed by twisting a plurality of wires (cables) made of metal (stainless steel) into a spiral shape. However, as the drive wire 63, a wire tube may be used as the inner sheath 62.

As shown in FIG. 6 , the connecting hook 61 arranged at the end of the sheath of the clamp device 60 has a pair of arms 61 a and 61 b made of an elastic body arranged in a roughly V-shape toward the end. By connecting with the inner sheath 62 In collaboration, it becomes possible to adopt two states: the open (open) state and the closed (closed) state. The end portions of the arm portions 61a and 61b of the connecting hook 61 are bent inward (sides facing each other) to form claw portions 61a1 and 61b1, so that the connecting plate portion 20 of the clamp body 10 can be gripped. link.

The base end portion of the connecting hook 61 is connected to the base end portions of the pair of arm portions 61a and 61b and is formed into a U-shaped portion 61c that is substantially U-shaped. The arm portions 61a and 61b including the claw portions 61a1 and 61b1 and the U-shaped portion 61c can be formed by appropriately bending (plastically deforming) an elongated plate made of elastic material. Although not particularly limited, the thickness of the plate material constituting the connecting hook 61 is approximately 0.20 to 0.24 mm, and the width is approximately 0.6 mm. As the plate material, stainless steel can be used, for example.

At the end (distal end) of the drive wire 63 that can be slidably inserted into the inner sheath 62, the annular member 63a formed in a substantially circular ring shape can be welded and fixed into one body through laser welding or the like. The outer diameter of the annular member 63a is about 1.2 mm, and the inner diameter is about 0.8 to 1.0 mm.

The connecting hook 61 is inserted through the annular member 63a and arranged in a manner that the U-shaped portion 61c is movably embedded in the annular member 63a, thereby being mounted on the distal end of the driving wire 63 in a swingable manner. By mounting the connecting hook 61 on the distal end of the driving wire 63 via the annular member 63a and the U-shaped portion 61c movably embedded in the annular member 63a, the connecting hook 61 can be freely rotated along the arrow D2 direction shown in FIG. 6 .

Returning to FIGS. 4 and 5 , the vicinity of the base end (proximal end) side of the outer sheath 64 is inserted into the reinforcing screw 65 and is integrally fixed to the reinforcing screw 65 . The reinforcing screw 65 is integrally fixed to the slider 66 , and the distal end side portion of the base 67 is inserted and disposed inside the slider 66 . The slider 66 can slide to determine a position between a position that moves toward the distal end (distal end) side and a position that moves toward the base end portion (proximal end) side with respect to the base portion 67 .

The operating part 68 is maintained to be slidable on the base 67, and the inner sheath 62 is fixed to the base 67. The base end of the driving wire 63 is fixed to the operating part 68.

If the operating part 68 is slid toward the distal end side (distal end side) relative to the base 67, the drive wire 63 is pushed out relative to the inner sheath 62, and the hook 61 at the end of the drive wire 63 protrudes from the end of the inner sheath 62 and opens due to its own elasticity. If the operating part 68 is slid toward the proximal end side (proximal end side) relative to the base 67, the drive wire 63 is pulled in relative to the inner sheath 62, and the hook 61 at the end of the drive wire 63 enters the inner sheath 62 and is gradually closed at the same time, and is completely closed by being hidden in the inner sheath 62.

If the slider 66 is slid toward the base end side relative to the base portion 67 , the inner sheath 62 can protrude from the distal end of the outer sheath 64 . Conversely, if the slider 66 is moved toward the distal end side relative to the base portion 67 By sliding the position, the end of the inner sheath 62 can be stored (hidden) in the outer sheath 64 .

(How to use the endoscope traction clamp 1A)

Next, the method of using the endoscope retraction clamp 1A in the first embodiment will be described. FIG. 7 is a diagram showing a state where the endoscope retraction clamp 1A in the first embodiment is protruded from the distal end of the clamp device 60, and FIG. 8 is a diagram showing a state where the endoscope retraction clamp 1A in the first embodiment is stored in the distal end of the clamp device 60.

In the clamp body 10, a fastening ring 50 is externally fitted around the base end portions 30p and 40p of the connecting plate portion 20, and a connecting hole 25 (see FIG. 2 and FIG. 7) is formed in the connecting plate portion 20 having a U-shaped cross section. By engaging the connecting hook 61 shown in FIG. 4 to the connecting hole 25 and pulling the connecting hook 61 into the inner sheath 62, the connecting hook 61 is engaged, and the clamp body 10 of the traction clamp 1A for an endoscope is assembled to the distal end portion of the inner sheath 62 as shown in FIG. 7.

In this state, the end portion of the inner sheath 62 connected to the endoscope traction clamp 1A (the clamp body 10 and the ring member 100) is pulled into the outer sheath 64, as shown in FIG. 8, and the inner view is The entire mirror pulling clamp 1A (the clamp body 10 and the ring member 100 ) is housed inside the distal end of the outer sheath 64 . In this state, the fastening ring 50 of the clamp body 10 is still located on the connecting plate portion 20 , and the arm plate portions 30 and 40 are closed by the inner wall of the outer sheath 64 . Furthermore, the elastic ring member 110 , the anchor wire 120 , the first inelastic ring member 130 and the second inelastic ring member 140 constituting the ring member 100 are accommodated in the outer sheath 64 . The elastic ring component 110 is accommodated in the outer sheath 64 in an elastically deformed state by the action of the inner wall of the outer sheath 64 .

Using an endoscope (not shown in the figure), the end portion of the sheath portion (inner sheath 62 and outer sheath 64) of the clamp device 60 equipped with the endoscope traction clamp 1A is positioned to be cut (peeled off). Near the affected area. In addition, in this specification, the vicinity of a lesion means the range including a lesion and its surroundings. Then, the outer sheath 64 is slid toward the proximal end side, so that the endoscopic traction jig 1A is protruded from the distal end of the outer sheath 64 . Thereby, as shown in FIG. 7 , the elastic ring member 110 , the anchor wire 120 , the first non-elastic ring member 130 and the second non-elastic ring member 140 constituting the ring member 100 are released to the outside of the outer sheath 64 , and at the same time, the arm The plate portions 30 and 40 are in an open-leg state due to their own elasticity. The elastic ring component 110 is restored to its original shape from the elastic deformation state by the action of the inner wall of the outer sheath 64 .

When the arm plates 30 and 40 are opened, the inner sheath 62 slides toward the distal end relative to the drive wire 63, and the fastening ring 50 slides toward the distal end of the arm plates 30 and 40. As a result, the arm plates 30 and 40 gradually close (approach each other), and the living tissue can be grasped through the arm plates 30 and 40.

By further sliding the inner sheath 62 toward the distal end side relative to the drive wire 63 , the fastening ring 50 moves toward the grip portions 30 g and 40 g of the arm plate portions 30 and 40 (see FIG. 3 ). Thereby, the grasping of the living tissue using the jig body 10 is completed. In this state, by sliding the inner sheath 62 toward the proximal end side relative to the drive wire 63, the connecting hook 61 is extruded from the distal end of the inner sheath 62 to open its legs, and the use of the connecting hook 61 of the clamp body 10 is released. The endoscope traction clamp 1A is grasped (joined) to release the endoscope traction clamp 1A, thereby completing the clamping of the living tissue using the endoscope traction clamp 1A.

(Method of peeling off the lesion using the endoscopic traction clamp 1A)

The following simultaneously describes the method for removing the lesion using the endoscope pulling clamp 1A in the first embodiment with reference to Figures 9 to 15. Figures 9 to 15 are schematic diagrams showing the steps of the method for removing the lesion using the endoscope pulling clamp 1A in the first embodiment.

The endoscopic traction jig 1A in the first embodiment is used to peel and remove the diseased portion of the inner wall of the luminal organ occurring in the body through ESD. Here, as shown in FIG. 9 , a case in which the mucosa (living tissue) including the lesion X occurring in the large intestine wall W is peeled off and excised will be described as an example. In addition, the endoscopic traction jig 1A according to this embodiment can be suitably used not only in the large intestine but also in luminal organs such as the esophagus, stomach, and duodenum.

The distal end of the endoscope (not shown in the figure) is positioned near the lesion X through the mouth or nose. Then, using the distal end of the endoscope, insert the distal end of the sheath of the clamp device 60 equipped with the endoscope traction clamp 1A into the body so that it is located at the lesion that needs to be incised (stripped). near X. Then, by sliding the outer sheath 64 toward the proximal end side, the endoscopic traction jig 1A is protruded from the distal end of the outer sheath 64, and the arm plate portions 30 and 40 are opened due to their own elasticity. The elastic ring member 110, the anchor wire 120, the first inelastic ring member 130 and the second inelastic ring member 140 constituting the ring member 100 are deployed near the lesion X at the same time.

With the arm plates 30 and 40 opened, the clamp body 10 of the endoscope traction clamp 1A is positioned near the lesion X. It is desirable that the clamp body 10 is positioned to grip a portion near the periphery of the lesion X (e.g., the right end of the lesion X).

Then, by pressing the clamp body 10 against the desired position of the lesion X (e.g., the right end of the lesion X), the inner sheath 62 is slid toward the end side relative to the drive line 63, and the fastening ring 50 is slid toward the end side of the arm plate parts 30, 40. As a result, the arm plate parts 30, 40 are gradually closed (approached to each other) and can hold the lesion X (the right end of the lesion X). By further sliding the inner sheath 62 toward the end side relative to the drive line 63, the fastening ring 50 is moved toward the gripping parts 30g, 40g of the arm plate parts 30, 40, and the gripping of the lesion X by the clamp body 10 of the traction clamp 1A for endoscope is completed.

In this state, by sliding the inner sheath 62 toward the proximal end side relative to the drive wire 63, the connecting hook 61 is extruded from the distal end of the inner sheath 62 to open its legs, and the use of the connecting hook 61 of the clamp body 10 is released. By holding (coupling) the endoscope traction jig 1A, the clamp body 10 of the endoscopic traction jig 1A is released to clamp the lesion X (the state shown in FIG. 10 ).

As described above, the loop of the first inelastic loop member 130 is inserted through the through portion 31 of one of the arm plate portions 30 of the clamp body 10. Therefore, the lesion X gripped by the clamp body 10 is fixed by a portion of the wire material constituting the first inelastic loop member 130. The wire material constituting the first inelastic loop member 130 is fixed to the lesion X, and functions as an anchor point A1 when the lesion X is pulled as described later.

Next, the clamp device 60 is temporarily pulled out from the endoscope, and then another clamp (first clamp) 10A prepared separately is installed on the distal end of the clamp device 60 (or a separately prepared clamp device having the same structure as the clamp device 60), and the distal end of the sheath portion of the clamp device 60 equipped with the first clamp 10A is inserted into the body so as to be located near the lesion X. In addition, as the first clamp 10A, an endoscope clamp having the same structure as the clamp body 10 with the ring member 100 removed from the endoscope traction clamp 1A shown in FIGS. 1 to 3 can be used.

Then, compared with the clamp body 10 of the endoscopic traction clamp 1A, the first clamp 10A is protruded from the distal end of the outer sheath 64, and the pair of arm plate portions 30A and 40A of the first clamp 10A are moved due to their own elasticity. And make it into an open-legged state. Then, one of the pair of arm plate parts 30A and 40A of the first clamp 10A is hooked into the loop of the second inelastic ring member 140, and one of the arm plate parts 30A and 40A is inserted through the second inelastic ring. The circle of the member 140 also allows the first clamp 10A to be positioned at a position that can grasp a different part from the already arranged clamp body 10 (for example, the left end of the lesion X).

Then, by holding the clamp body 10 of the endoscopic traction clamp 1A, the first clamp 10A is pressed against a desired part of the lesion X (for example, the left end of the lesion X), and at the same time, the tightening ring 50A is directed The distal ends of the arm plate portions 30A and 40A slide to hold the lesion X (the left end portion of the lesion X) through the first jig 10A. Then, by releasing the first clamp 10A, clamping of the lesion X by the first clamp 10A is completed (the state shown in FIG. 11 ).

As described above, one of the arm plate portions 30A and 40A of the first clamp 10A is inserted into the loop of the second inelastic ring member 140 , and the arm plate portions 30A and 40A connect the wire constituting the second inelastic ring member 140 Clamp and hold the affected part X together. As a result, the lesion X held by the first jig 10A is fixed by a part of the wire constituting the second inelastic ring member 140 . The portion where the wire constituting the second inelastic ring member 140 is fixed to the lesion X functions as an anchor point A2 when pulling the lesion X as described later.

Next, the clamp device 60 is temporarily pulled out from the endoscope, and another separately prepared clamp (second clamp) 10B is installed on the clamp device 60 (or a separately prepared clamp device having the same structure as the clamp device 60 ). The end part of the sheath part of the clamp device 60 equipped with the second clamp 10B is inserted into the body so that it is located near the lesion X. In addition, as the second jig 10B, an endoscope having the same structure as the jig body 10 for detaching the ring member 100 from the endoscope pulling jig 1A shown in FIGS. 1 to 3 can be used in the same manner as the first jig 10A. Use clamps.

Then, in comparison with the clamp body 10 and the first clamp 10A of the endoscope traction clamp 1A, the second clamp 10B is made to protrude from the distal end of the outer sheath 64, and the pair of arm plates 30B and 40B of the second clamp 10B are made into an open-legged state due to their own elasticity. Then, the arm plates 30B and 40B clamp the anchor wire 120 in a manner that one of the pair of arm plates 30B and 40B of the second clamp 10B hooks the anchor wire 120, and at the same time, the second clamp 10B is arranged at a position where it can hold a different part (e.g., the front end of the lesion X) from the already arranged clamp body 10 and the first clamp 10A.

Subsequently, in comparison with the gripping of the clamp body 10 and the first clamp 10A using the traction clamp 1A for endoscope, the second clamp 10B is pressed against the desired part of the lesion X (e.g., the front end of the lesion X), and the fastening ring 50B is slid toward the end side of the arm plate parts 30B and 40B to grip the lesion X (the front end of the lesion X) through the second clamp 10B. Then, the gripping of the lesion X using the second clamp 10B is completed by releasing the second clamp 10B (the state shown in FIG. 12 ).

As described above, the arm plates 30B and 40B of the second clamp 10B are in a state of clamping the anchor wire 120, and the arm plates 30B and 40B clamp and hold the anchor wire 120 together with the lesion X. As a result, a part of the anchor wire 120 is fixed to the lesion X held by the second clamp 10B. In addition, the position of the anchor wire 120 clamped by the second clamp 10B is not particularly limited, but it is preferable to clamp the central part of the anchor wire 120 (a part separated from each of the first inelastic ring member 130 and the second inelastic ring member 140 by a distance as equal as possible). The anchor wire 120 is fixed to the site of the lesion X to function as an anchor point A3 when the lesion X is pulled as described later.

Next, the clamp device 60 is temporarily pulled out from the endoscope, and another clamp (third clamp) 10C prepared separately is installed on the distal end of the clamp device 60 (or a clamp device prepared separately with the same structure as the clamp device 60), and the distal end of the sheath portion of the clamp device 60 equipped with the third clamp 10C is inserted into the body so that it is located near a suitable portion (opposite portion) Y facing the lesion X. For example, the opposite portion Y is the inner wall of the lumen organ facing the lesion X in the lumen organ. In addition, as the third clamp 10C, a clamp for endoscope having the same structure as the clamp body 10 from which the ring member 100 is removed from the traction clamp for endoscope 1A shown in FIGS. 1 to 3 can be used, similarly to the first clamp 10A and the second clamp 10B.

Then, in comparison with the clamp body 10, the first clamp 10A and the second clamp 10B of the endoscope traction clamp 1A, the third clamp 10C is made to protrude from the distal end of the outer sheath 64, and the pair of arm plates 30C and 40C of the third clamp 10C are made into an open-legged state due to their own elasticity. Then, one of the pair of arm plates 30C and 40C of the third clamp 10C is inserted through the loop of the elastic loop member 110 in such a way that one of the arm plates 30C and 40C of the third clamp 10C hooks the loop of the elastic loop member 110, and the third clamp 10C is arranged at a position where the opposite part Y can be grasped.

Then, the third clamp 10C is pressed against the portion Y opposite to the lesion X by stretching the elastic ring member 110 and lifting the lesion X, and the fastening ring 50C is slid toward the end of the arm plate portions 30C and 40C to grip the portion Y opposite to the lesion X through the third clamp 10C. Then, the third clamp 10C is released to complete the gripping of the portion Y opposite to the lesion X by the third clamp 10C (the state shown in FIG. 13 ).

As described above, one of the arm plate portions 30C and 40C of the third clamp 10C is in a state of inserting the elastic ring member 110, and the arm plate portions 30C and 40C connect a part of the elastic ring member 110 to the opposing portion Y of the lesion X Clamp and hold together. As a result, the opposing portion Y of the lesion X held by the third jig 10C is fixed by a part of the elastic ring member 110 .

In the state shown in FIG. 13 , the elastic ring member 110 has a force (traction force) that pulls the lesion X toward the opposite site Y due to its elastic force (tension).

The first inelastic ring member 130 connected to the elastic ring member 110 is fixed to the lesion X (the right end of the lesion X) through the clamp body 10. The fixing point of the first inelastic ring member 130 to the lesion X functions as an anchor point A1 for lifting the lesion X through the pulling force of the elastic ring member 110. In addition, since the first inelastic ring member 130 is made of a material that does not stretch in the pulling direction, it becomes possible to reliably transmit the pulling force of the elastic ring member 110.

The second inelastic ring member 140 connected to the elastic ring member 110 is fixed to the lesion X (the left end of the lesion X) through the first clamp 10A. The fixing point of the second inelastic ring member 140 to the lesion X functions as an anchor point A2 for lifting the lesion X through the pulling force of the elastic ring member 110. In addition, since the second inelastic ring member 140 is made of a material that does not stretch in the pulling direction, it becomes possible to reliably transmit the pulling force of the elastic ring member 110.

The anchor wire 120 is fixed to the lesion X (the center of the front end of the lesion X) through the second clamp 10B. Both ends of the anchor wire 120 are connected to the first inelastic ring component 130 and the second inelastic ring component 140 and become interposed with at least one or both of the first inelastic ring component 130 and the second inelastic ring component 140 To convey the traction force of the elastic ring component 110 . Thereby, the fixed point of the anchor wire 120 to the lesion X functions as the anchor point A3 that lifts the lesion X through the traction force of the elastic ring member 110 . Furthermore, since the anchor wire 120 is made of a material that does not expand or contract in the pulling direction, it is possible to reliably transmit the pulling force of the elastic ring member 110 .

In this way, three anchor points A1, A2, and A3 are set at the lesion X, and the lesion X is pulled toward the opposite site Y through the traction force of the elastic ring member 110, whereby the lesion X can be lifted.

After the diseased part Peripheral incision. Normally, the diseased part The submucosal layer includes the mucosal layer where the diseased part X occurs, whereby the diseased part X can be separated from the luminal organ.

FIG. 14 shows a state in which the lesion part X is peeled off to produce a peeled part Z. Since the lesion X is lifted from the peeled portion Z produced by the incision due to the elastic force (tension) of the elastic ring member 110, the lesion , can easily and reliably cut through the entire circle of the lesion X.

Afterwards, after the peeling of the lesion X is completed, the elastic ring member 110 is cut using an endoscopic cautery knife or the like. When the elastic ring member 110 is cut, the part other than the elastic ring member 110 on which the endoscopic traction jig 1A is mounted and the first jig 10A and the second jig 10B are positioned relative to the luminal organ. The diseased part X is in a free state, so the diseased part The diseased part X is removed from the body. After the diseased part X is removed, as shown in Figure 15, a peeling part Z will remain at the site where the diseased part In addition, like the lesion X, the cut elastic ring member 110 can be grasped by the connecting hook 61 of the clamp device 60 or the endoscope holding forceps and removed outside the body. In addition, the third clamp 10C fixed to the opposing part Y remains in the luminal organ (not shown in FIG. 15 ), but like a general endoscope clamp, the third clamp 10C remains in the luminal organ through the metabolism of the luminal organ, etc. As time passes, it becomes naturally separated and discharged.

Furthermore, in order to remove the lesion X that has been peeled off outside the body, the connecting hook 61 of the clamp device 60 or the endoscope holding forceps is used to open the arm plate portions 30C and 40C of the third clamp 10C. The third jig 10C can be detached from the opposing portion Y, so that the diseased portion X can be freed from the luminal organ.

In addition, in the above-mentioned method of peeling off the lesion X, the second clamp 10B is used to fix a part of the anchor wire 120 to the lesion X to set the anchor point A3, but only two anchor points, namely the anchor point A1 set using the clamp body 10 and the anchor point A2 set using the first clamp 10A, may be set at the lesion X to pull the lesion X without using the second clamp 10B to fix the anchor wire 120 to the lesion X. Alternatively, another clamp may be further used to fix a part of the anchor wire 120 (different from the anchor point A3) to the lesion X, and more than four anchor points may be set at the lesion X to pull the lesion X. The number of anchor points set on the anchor wire 120 is not particularly limited. As required, any location of the anchor wire 120 can be fixed to the lesion part X using multiple clamps, thereby appropriately setting multiple anchor points.

(The function of the traction clamp 1A for endoscopes)

The following description is about the functions of the traction clamp for endoscope 1A which is one embodiment of the traction clamp for endoscope related to the present invention.

The traction clamp 1A for endoscope in the first embodiment has a clamp body 10 and a ring member 100. The clamp body 10 has a pair of arm plates 30, 40 opened into a substantially V-shape and an annular fastening ring 50 of a connecting plate portion 20 slidably fitted to the base end side of the arm plates 30, 40. The ring member 100 is assembled to the clamp body 10, and is constructed in a manner of forming a ring by connecting an elastic portion P1 having elasticity and an inelastic portion P2 having inelasticity, wherein the elastic portion P1 is stretched and contracted in the extension direction of the ring, and the inelastic portion P2 is flexible and does not stretch and contract in the extension direction of the ring.

More specifically, in the traction jig 1A for endoscopes in the first embodiment, the elastic part P1 is composed of the elastic ring member 110 formed in a loop shape, and the inelastic part P2 is composed of the anchor wire 120 and the anchor wire 120. The first inelastic ring member 130 and the second inelastic ring member 140 are composed of the anchor wire 120 which is a flexible inelastic wire. The first inelastic ring member 130 and the second inelastic ring member 140 at both ends of the anchor wire 120 are formed in a loop shape. Furthermore, the first non-elastic ring member 130 and the second non-elastic ring member 140 are respectively connected to both ends of the elastic ring member 110 constituting the elastic part P1. The ring member 100 is the elastic ring member 110, the anchor wire 120, the first non-elastic ring member 110, and the anchor wire 120. The elastic ring member 130 and the second inelastic ring member 140 are connected to form a ring as a whole.

As described above, the traction clip 1A for endoscope has a simple structure in which the ring member 100 having a part of the elastic portion P1 and a part of the non-elastic portion P2 is attached to the clip body 10 capable of grasping living tissue.

Thereby, the anchor point A1 fixed to the lesion X is set by assembling the clamp body 10 at a designated location near the lesion X, and then, by using another clamp (the first clamp 10A and the second clamp 10B) Fix the inelastic part P2 at other parts near the lesion A1, A2, A3.

Furthermore, by using the inelastic part P2 to set the anchor points A1, A2, and A3 of the lesion X, the traction force acting when lifting the lesion Anchor points A1, A2, and A3 allow the lesion X to be lifted stably.

Furthermore, the two different points of the inelastic part P2 are distributed through the inelastic part P2 and are isolated from each other. Therefore, the two different points can be easily and surely set in the inelastic part P2. Anchor points A1, A2, and A3 are fixed near the lesion X. For example, since the anchor wire 120 exists between the first inelastic loop component 130 and the second inelastic loop component 140, the first inelastic loop component 130 and the second inelastic loop component 140 become disposed with each other. At far away positions, "the first inelastic ring member 130 is fixed to the anchor point A1 of the lesion X" and "the second inelastic ring member 140 is fixed to the anchor point A2 of the lesion X" can be easily and reliably fixed. By setting them to distant positions, the entire lesion X can be lifted.

In the first embodiment, the inelastic portion P2 of the endoscope retraction jig 1A is partially formed of an inelastic ring member 100. More specifically, the inelastic portion P2 of the endoscope retraction jig 1A is formed of a first inelastic ring member 130 and a second inelastic ring member 140 formed in an annular shape.

According to this structure, by fixing the first inelastic ring member 130 and the second inelastic ring member 140 of the inelastic part P2 near the lesion X, the first inelastic ring member 130 and the second inelastic ring member 140 can be easily and reliably installed. The position of the second inelastic ring member 140 is set as anchor points A1 and A2 fixed near the lesion X. Since the first inelastic ring member 130 and the second inelastic ring member 140 are formed in a ring shape, another clamp is used to hook the rings of the first inelastic ring member 130 and the second inelastic ring member 140 and fix them simultaneously. The first inelastic ring member 130 and the second inelastic ring member 140 can be easily and reliably fixed in the vicinity of the lesion X.

Furthermore, in the endoscope pulling jig 1A in the first embodiment, since the first non-elastic ring member 130 of the non-elastic part P2 is mounted on the arm plate part 30 of the jig body 10, the jig body 10 is When it is mounted on the lesion X, it becomes easy to set the position of the mounting jig body 10 as the anchor point A1.

Furthermore, in the traction clamp 1A for endoscope in the first embodiment, it becomes possible to appropriately select any one or more points of the anchor wire 120 existing between the first inelastic loop member 130 and the second inelastic loop member 140 to be fixed near the lesion X. Thus, in addition to the anchor point A1 of the first inelastic loop member 130 and the anchor point A2 of the second inelastic loop member 140, any one (or more) points of the anchor wire 120 can be set as the anchor point A3, and a total of more than three anchor points A1, A2, and A3 can be pulled to stably lift the lesion X.

In the traction jig 1A for endoscopes in the first embodiment, the elastic part P1 is fixed to the opposing portion Y of the lesion X using another jig (the third jig 10C), so that it becomes permeable. Traction force (elasticity) lifts the lesion X. The elastic part P1 has stretchable elasticity. When the outer periphery of the lesion X is incised and peeled off from the inner wall of the luminal organ, the elastic part P1 can move in a direction away from the inner wall of the luminal organ (the direction opposite to the lesion X). By lifting the diseased part X, the peeled part Z produced after peeling off the diseased part Full circle.

In the traction clamp 1A for endoscope in the first embodiment, since the elastic portion P1 is composed of the elastic ring member 110 formed in a ring shape, after setting a plurality of anchor points A1, A2, A3 near the lesion site X, when another clamp (the third clamp 10C) is used to fix the elastic portion P1 to the opposite portion Y of the lesion site X, the elastic ring member 110 can be easily fixed to the opposite portion Y by hooking the ring of the elastic ring member 110 with the arm plate portions 30C and 40C of the third clamp 10C and clamping it.

Furthermore, the endoscope traction clamp 1A in the first embodiment can be easily manufactured by manufacturing a loop component 100 connecting an elastic portion P1 formed by an elastic body molded part and an inelastic portion P2 formed by a wire rod using natural fiber or chemical fiber, and assembling the loop component 100 to the clamp body 10.

(Second implementation form)

The following describes the endoscope retraction clamp 1B in the second embodiment of the present invention. The same structures as those in the first embodiment described above are simplified or omitted, and the same symbols are used.

(Structure of endoscope traction clamp 1B)

Fig. 16 is a perspective view showing the overall structure of the endoscope pulling jig 1B in the second embodiment of the present invention, showing the arm plates 30, 40 of the jig body 10 in an open state. Fig. 17 is a front view of the endoscope pulling jig 1B shown in Fig. 16.

The pulling jig 1B for endoscopes in the second embodiment is generally configured to include a jig body 10 and a ring member 100B.

The clamp body 10 includes a connecting plate portion (connecting portion) 20 , a pair of arm plate portions (arm portions) 30 and 40 , and a tightening ring 50 . The clamp body 10 can be the same as the clamp body 10 in the first embodiment described above.

The ring component 100B is a ring-shaped component that is assembled to the clamp body 10. The ring component 100B is the same as the ring component 100 in the first embodiment described above, and is composed of an elastic part P3 with elasticity and an inelastic part P4 with inelasticity. The elastic part P3 stretches and contracts along the ring extension direction, and the inelastic part P4 has flexibility and does not stretch and contract along the ring extension direction. That is, the ring component 100B is a ring-shaped component that has a structure that partially has the elastic part P3 and partially has the inelastic part P4 in the ring extension direction.

In the second embodiment, the elastic portion P3 of the loop member 100B is composed of the elastic loop member 110B formed in a loop shape. The elastic ring member 110B can be the same as the elastic ring member 110 in the first embodiment described above. The elastic ring member 110B in the second embodiment uses an interpalatal rubber band similarly to the elastic ring member 110 in the first embodiment described above.

In the second embodiment, the inelastic portion P4 of the loop component 100B is composed of an anchor wire 120B and a first inelastic loop component 130B and a second inelastic loop component 140B. The anchor wire 120B is made of a wire that is flexible and does not stretch in the loop extension direction. The first inelastic loop component 130B and the second inelastic loop component 140B are connected to both ends of the anchor wire 120B and are also made of a wire that is flexible and does not stretch in the loop extension direction. The first inelastic loop member 130B and the second inelastic loop member 140B are loop-shaped members having independent loops that are not connected to each other, and are respectively connected to both ends of the anchor wire 120B and are also respectively connected to the elastic loop member 110B constituting the elastic portion P3 of the loop member 100B.

The anchor wire 120B, the first inelastic loop member 130B, and the second inelastic loop member 140B are not particularly limited as long as they are flexible and can be flexibly bent and have an inelastic property that does not stretch relative to the extending direction thereof. In the second embodiment, the anchor wire 120B, the first inelastic loop member 130, and the second inelastic loop member 140B may use surgical sutures made of resistant nylon.

Compared with the first embodiment described above, the first inelastic ring member 130B and the second inelastic ring member 140B are respectively connected to the two ends of the elastic ring member 110B constituting the elastic portion P3, and the first inelastic ring member 130B, the elastic ring member 110B, and the second inelastic ring member 140B are connected in a chain-like structure. That is, in the ring member 100B in the second embodiment, compared with the ring member 100 in the first embodiment, the elastic ring member 110B, the anchor wire 120B, the first inelastic ring member 130B, and the second inelastic ring member 140B are connected to form a ring as a whole.

In this way, the elastic loop member 110B constituting the elastic part P3, the first inelastic loop member 130B constituting the inelastic part P4, the anchor wire 120B, and the second inelastic loop member 140B are connected in a ring shape to form a loop. , thereby forming the loop component 100B.

The loop member 100B is mounted on the arm plate portions 30 and 40 of the clamp body 10 . In the first embodiment described above, either the first non-elastic ring member 130 or the second non-elastic ring member 140 has a structure that is assembled to any one of the arm plate portions 30 and 40 of the clamp body 10 However, in the second embodiment, as shown in FIG. 16 , the anchor wire 120B is assembled by inserting the anchor wire 120B through the through portion 31 formed in the grip portion 30g of the arm plate portion 30 to couple them. on the arm plate portion 30 of the clamp body 10 . In addition, the anchor wire 120B and the arm plate portion 30 may also be fixed to each other, or may be detached from each other in a freely movable manner. Here, although the anchor wire 120B and the arm plate portion 30 are inserted into the through portion 31 of the arm plate portion 30, they are in a free state from each other.

As shown in FIGS. 16 and 17 , the endoscope pulling jig 1B in the second embodiment may be further provided with a connecting member 150B.

The connecting member 150B is a member that connects the arm plate portion 30 of the clamp body 10 and the elastic ring member 110B. For example, it is made of a flexible material that can be flexibly bent and has non-elastic properties such that it does not expand or contract with respect to its extension direction. Made of wire (inelastic wire without rubber elasticity). As the material of the connecting member 150B, for example, a wire made of silk (silk), nylon, polyester, polypropylene, stainless steel, titanium, etc. can be used. As an example, a surgical material using natural fiber or chemical fiber can be used. Use sutures. In the second embodiment, surgical sutures made of silk can be used as the connecting member 150B.

One end of the connecting member 150B is mounted on the arm plate portion 30 to which the anchor wire 120B is mounted, and the other end of the connecting member 150B is mounted on the elastic ring member 110B. In addition, the through portion 31 of the arm plate portion 30 can be used to connect the connecting member 150B to the arm plate portion 30.

The method of connecting the connecting member 150B to the arm plate portion 30 and the elastic ring member 110B is not particularly limited, but for example, the connecting member 150B to the arm plate portion 30 and the elastic ring member 110B may be fixed to each other, or loops may be formed at both ends of the connecting member 150B, and the loops at both ends of the connecting member 150B are connected to the through-portion 31 of the arm plate portion 30 and the elastic ring member 110B in a state where they are free to move with each other. Here, by fastening the ends of the connecting member 150B to the through-portion 31 of the arm plate portion 30 and the elastic ring member 110B, the connecting member 150B to the arm plate portion 30 and the connecting member 150B to the elastic ring member 110B are connected and fixed, respectively.

The connecting member 150B serves as a traction force transmitting member that transmits the traction force of the elastic ring member 110B generated when the lesion is lifted relative to the portion of the jig body 10 that is fixed to the lesion. The length of the connecting member 150B can be set appropriately according to the type and size of the luminal organ in the body in which the diseased part exists, the anchor wire 120B, etc., but for example, it can be set shorter than the length of the anchor wire 120B. half the length.

As shown in FIGS. 16 and 17 , in the traction clamp 1B for endoscopes in the second embodiment, a part of the elastic ring member 110B constituting the elastic part P3 may be further equipped with a traction ring member (non-elastic). Circle parts) 160B.

The traction loop member 160B is made of a non-stretchable wire material (non-elastic wire material without rubber elasticity) that is flexible and can be flexibly bent and does not stretch relative to its extension direction. As the material of the traction loop member 160B, for example, a wire material made of silk, nylon, polyester, polypropylene, stainless steel, titanium, etc. can be used. As an example, a surgical suture made of natural fiber or chemical fiber can be used. Here, a surgical suture made of nylon can be used for the traction loop member 160B.

The traction loop component 160B is a component formed in a loop shape and is assembled to a part of the elastic loop component 110B constituting the elastic portion P3. The method of connecting the traction loop component 160B and the elastic loop component 110B is not particularly limited, but for example, the traction loop component 160B and the elastic loop component 110B may be fixed to each other, or may be connected in a state where they are free to move with each other. Here, the traction loop component 160B and the elastic loop component 110B are connected and fixed by tightening the loop of the elastic loop component 110B and the loop of the traction loop component 160B using the tightening wire 161B.

The traction ring member 160B is a member used when attaching the endoscopic traction jig 1B to the opposing portion of the lesion. When assembling the endoscopic traction clamp 1A in the first embodiment described above to the opposite part of the lesion, another clamp is used to hook the loop of the elastic ring member 110B while holding the opposite part. However, in contrast to this, in the traction jig 1B for endoscopes in the second embodiment, by using another jig to hook the loop of the traction hoop member 160B while holding the opposing part, it becomes possible to pull the inner endoscope into the traction jig 1B. The traction jig 1B for the sight glass is attached to the opposite part of the lesion. The loop length of the traction loop member 160B may be set appropriately according to the type and size of the luminal organ in the body in which the diseased part exists, but for example, it may be set to be the same as the first inelastic loop member 130B or the second inelastic loop member 130B. The size of the non-elastic ring member 140B is approximately the same.

In the second embodiment, the endoscope traction clamp 1B can be transported into the body using the clamp device 60 described above. FIG. 18 is a diagram showing a state in which the endoscope traction clamp 1B is protruded from the end of the clamp device 60 in the second embodiment, and FIG. 19 is a diagram showing the internal view of the endoscope in the second embodiment. A diagram showing a state in which the mirror pulling clamp 1B is housed in the end portion of the clamp device 60 .

The endoscope traction clamp 1B in the second embodiment can be stored in the end portion of the clamp device 60 in the same manner as the endoscope traction clamp 1A in the first embodiment described above. transported to the body.

By engaging the connecting hook 61 of the clamp device 60 with the connecting hole 25 formed in the connecting plate portion 20 of the clamp body 10 and pulling the connecting hook 61 into the inner sheath 62, the connecting hook 61 is engaged, and the clamp body 10 of the endoscope traction clamp 1B is assembled to the distal end of the inner sheath 62 as shown in FIG. 18 .

In this state, pull the end portion of the inner sheath 62 connected to the endoscope traction clamp 1B (the clamp body 10 and the ring member 100B) into the outer sheath 64, as shown in Fig. 19, and pull the end of the inner sheath 62 into the outer sheath 64. The entire mirror pulling clamp 1B (the clamp body 10 and the ring member 100B) is housed inside the distal end of the outer sheath 64 . Thereby, the elastic ring member 110B, the anchor wire 120B, the first inelastic ring member 130B, the second inelastic ring member 140B, the connecting member 150B and the traction ring member 160B constituting the ring member 100B are stored together with the clamp body 10 within the outer sheath 64.

Furthermore, by sliding the outer sheath 64 toward the proximal end side from this stored state, if the endoscopic traction jig 1B is protruded from the distal end of the outer sheath 64, as shown in Fig. 18, a loop will be formed. The elastic ring component 110B, the anchor wire 120B, the first non-elastic ring component 130B, the second non-elastic ring component 140B, the connecting component 150B and the traction loop component 160B of the component 100B are released to the outside of the outer sheath 64, and at the same time, the arm plate The parts 30 and 40 are in an open state due to their own elasticity.

(Method for peeling off the lesion using endoscopic traction jig 1B)

The following simultaneously describes the method for removing the lesion using the endoscope pulling clamp 1B in the second embodiment with reference to Figures 20 to 24. Figures 20 to 24 are schematic diagrams showing the steps of the method for removing the lesion using the endoscope pulling clamp 1B in the second embodiment.

The endoscopic traction jig 1B in the second embodiment is used to peel and remove the diseased portion of the inner wall of the luminal organ occurring in the body through ESD. Here, as shown in FIG. 9 , a case in which the mucosa (living tissue) including the lesion X occurring in the large intestine wall W is peeled off and excised will be described as an example. In addition, the endoscopic traction jig 1B according to this embodiment can be suitably used not only in the large intestine but also in luminal organs such as the esophagus, stomach, and duodenum.

The distal end of the endoscope (not shown in the figure) is positioned near the lesion X through the mouth or nose. Then, using the distal end of the endoscope, insert the distal end of the sheath of the clamp device 60 equipped with the endoscopic traction clamp 1B into the body so that it is located at the lesion that needs to be incised (stripped). near X. Then, by sliding the outer sheath 64 toward the proximal end side, the endoscope traction jig 1B is protruded from the distal end of the outer sheath 64, and the arm plate portions 30 and 40 are opened due to their own elasticity. In the state of the foot, the elastic ring member 110B, the anchor wire 120B, the first inelastic ring member 130B, the second inelastic ring member 140B, the connecting member 150B and the traction ring member 160B constituting the ring member 100B are placed on the lesion X at the same time. expand nearby.

With the arm plates 30 and 40 opened, the clamp body 10 of the endoscope traction clamp 1B is positioned near the lesion X. It is desirable that the clamp body 10 is positioned to grip a portion near the periphery of the lesion X (e.g., the front end of the lesion X).

Then, by pressing the clamp body 10 against the desired part of the lesion X (e.g., the front end of the lesion X), the inner sheath 62 is slid toward the end side relative to the drive line 63, and the fastening ring 50 is slid toward the end side of the arm plate parts 30, 40. As a result, the arm plate parts 30, 40 are gradually closed (approached to each other), and the lesion X (the front end of the lesion X) can be grasped. By further sliding the inner sheath 62 toward the end side relative to the drive line 63, the fastening ring 50 is moved toward the gripping parts 30g, 40g of the arm plate parts 30, 40, and the gripping of the lesion X by the clamp body 10 of the traction clamp 1B for endoscope is completed.

In this state, by sliding the inner sheath 62 toward the proximal end side relative to the drive wire 63, the connecting hook 61 is extruded from the distal end of the inner sheath 62 to open its legs, and the use of the connecting hook 61 of the clamp body 10 is released. By holding (coupling) the endoscope traction clamp 1B, the clamp body 10 of the endoscope traction clamp 1B is released to clamp the lesion X (the state shown in FIG. 20 ).

As described above, the anchor wire 120B is inserted through the through portion 31 of one of the arm plate portions 30 of the clamp body 10. Therefore, the lesion X gripped by the clamp body 10 is fixed by a portion of the anchor wire 120B. The portion where the anchor wire 120B is fixed to the lesion X functions as an anchor point A4 when the lesion X is pulled as described later.

Next, the clamp device 60 is temporarily pulled out from the endoscope, and then another clamp (first clamp) 10A prepared separately is installed on the distal end of the clamp device 60 (or a separately prepared clamp device having the same structure as the clamp device 60), and the distal end of the sheath portion of the clamp device 60 equipped with the first clamp 10A is inserted into the body so as to be located near the lesion X. In addition, as the first clamp 10A, an endoscope clamp having the same structure as the clamp body 10 with the ring member 100B removed from the endoscope traction clamp 1B shown in Figures 17 and 18 can be used.

Then, compared with the clamp body 10 of the endoscopic traction clamp 1B, the first clamp 10A is protruded from the distal end of the outer sheath 64, and the pair of arm plate portions 30A and 40A of the first clamp 10A are moved due to their own elasticity. And make it into an open-legged state. Then, one of the pair of arm plate parts 30A and 40A of the first clamp 10A is hooked into the loop of the first inelastic ring member 130B, and one of the arm plate parts 30A and 40A is inserted through the first inelastic ring. The loop of the member 130B also allows the first clamp 10A to be positioned at a position that can grasp a different part from the already arranged clamp body 10 (for example, the right end of the lesion X).

Then, by holding the clamp body 10 of the endoscopic traction clamp 1B, the first clamp 10A is pressed against a desired part of the lesion X (for example, the right end of the lesion X), and at the same time, the tightening ring 50A is directed The distal ends of the arm plate portions 30A and 40A slide to hold the lesion X (right end portion of the lesion X) through the first jig 10A. Then, by releasing the first clamp 10A, the clamping of the lesion X by the first clamp 10A is completed (the state shown in FIG. 21 ).

As described above, one of the arm plates 30A and 40A of the first clamp 10A is inserted into the loop of the first inelastic loop member 130B, and the arm plates 30A and 40A clamp and hold the wire rod constituting the first inelastic loop member 130B together with the lesion X. As a result, the lesion X held by the first clamp 10A is fixed as a part of the wire rod constituting the first inelastic loop member 130B. The part where the wire rod constituting the first inelastic loop member 130B is fixed to the lesion X functions as an anchor point A5 when the lesion X is pulled as described later.

Next, the clamp device 60 is temporarily pulled out from the endoscope, and another separately prepared clamp (second clamp) 10B is installed on the clamp device 60 (or a separately prepared clamp device having the same structure as the clamp device 60 ). The end part of the sheath part of the clamp device 60 equipped with the second clamp 10B is inserted into the body so that it is located near the lesion X. In addition, as the second jig 10B, an endoscope having the same structure as the jig body 10 in which the ring member 100B is removed from the endoscope pulling jig 1B shown in FIGS. 17 and 18 can be used in the same manner as the first jig 10A. Use clamps.

Then, comparing the clamp body 10 of the endoscopic traction clamp 1B and the first clamp 10A, the second clamp 10B is protruded from the distal end of the outer sheath 64, and the pair of arm plate portions 30B and 30B of the second clamp 10B are 40B is made into an open-leg position due to its own elasticity. Then, one of the pair of arm plate parts 30B and 40B of the second clamp 10B is hooked into the loop of the second inelastic ring member 140B, and one of the arm plate parts 30B and 40B is inserted into the second inelastic ring. The circle of the component 140B also allows the second clamp 10B to be positioned at a position that can grasp a different part (for example, the left end of the lesion X) from the already arranged clamp body 10 and the first clamp 10A.

Then, the second clamp 10B is pressed against the desired part of the lesion X (for example, the left end of the lesion The fastening ring 50B slides toward the distal ends of the arm plate portions 30B and 40B to hold the lesion X (the left end portion of the lesion X) through the second clamp 10B. Then, by releasing the second clamp 10B, clamping of the lesion X by the second clamp 10B is completed (the state shown in FIG. 22 ).

As described above, one of the arm plate portions 30B and 40B of the second clamp 10B is inserted into the loop of the second inelastic ring member 140B, and the arm plate portions 30B and 40B insert the wire constituting the second inelastic ring member 140B. Clamp and hold the affected part X together. As a result, the lesion X held by the second jig 10B is fixed by a part of the wire constituting the second inelastic ring member 140B. The portion where the wire constituting the second inelastic ring member 140B is fixed to the lesion X functions as an anchor point A6 when pulling the lesion X as described later.

Next, the clamp device 60 is temporarily pulled out from the endoscope, and another separately prepared clamp (third clamp) 10C is mounted on the clamp device 60 (or a separately prepared clamp device having the same structure as the clamp device 60 ). The distal end of the sheath of the clamp device 60 equipped with the third clamp 10C is inserted into the body and transported to the vicinity of an appropriate site (opposing site) Y opposite to the lesion X. The opposing part Y is, for example, the inner wall facing the diseased part X in the luminal organ. In addition, as the third clamp 10C, the same clamp body 10 having the ring member 100B removed from the endoscope pulling clamp 1B shown in FIGS. 17 and 18 can be used in the same manner as the first clamp 10A and the second clamp 10B. Structure fixture.

Then, in comparison with the clamp body 10, the first clamp 10A and the second clamp 10B of the endoscope traction clamp 1B, the third clamp 10C is made to protrude from the distal end of the outer sheath 64, and the pair of arm plates 30C and 40C of the third clamp 10C are made to be in an open-legged state due to their own elasticity. Then, one of the pair of arm plates 30C and 40C of the third clamp 10C is inserted through the loop of the traction loop member 160B in such a way that one of the arm plates 30C and 40C of the third clamp 10C hooks the loop of the traction loop member 160B, and the third clamp 10C is arranged at a position where the opposite part Y can be grasped.

Subsequently, in such a manner that the elastic ring member 110B is stretched by the traction ring member 160B while lifting the lesion The distal sides of 30C and 40C slide, and the opposing part Y of the lesion X is held by the third jig 10C. Then, by releasing the third clamp 10C, clamping of the opposing portion Y of the lesion X by the third clamp 10C is completed (the state shown in FIG. 23 ).

As described above, one of the arm plates 30C and 40C of the third clamp 10C is inserted through the pulling loop member 160B, and the arm plates 30C and 40C clamp and hold a part of the wire constituting the pulling loop member 160B together with the opposing portion Y of the lesion X. As a result, the opposing portion Y of the lesion X held by the third clamp 10C is fixed by a part of the wire constituting the pulling loop member 160B.

In the state shown in FIG. 23 , a force (attractive force) is acting on the elastic ring member 110B to pull the lesion site X toward the opposite site Y due to its elastic force (tension).

The anchor wire 120B is fixed to the lesion X (the front end of the lesion X) through the clamp body 10. Both ends of the anchor wire 120B are connected to the first inelastic loop component 130B and the second inelastic loop component 140B, so that the traction force of the elastic loop component 110B is transmitted through at least one or both of the first inelastic loop component 130B and the second inelastic loop component 140B. In this way, the fixing point of the anchor wire 120B to the lesion X functions as an anchor point A4 that lifts the lesion X through the traction force of the elastic loop component 110B. Furthermore, since the anchor wire 120B is made of a material that does not stretch in the pulling direction, it can surely transmit the pulling force of the elastic ring component 110B.

Furthermore, the clamp body 10 is connected to the elastic ring member 110B through the connecting member 150B. When the clamp body 10 is fixed at the anchor point A4, the connecting member 150B is used to transmit the traction force of the elastic ring member 110B. Thereby, for example, even if at least one or both of the first inelastic ring member 130B and the second inelastic ring member 140B cannot transmit sufficient traction force, the elastic ring can be caused by the connecting member 150B. The traction force of component 110B is transmitted to anchor point A4. Furthermore, since the connecting member 150B is made of a material that does not expand or contract in the pulling direction, it is possible to reliably transmit the pulling force of the elastic ring member 110B.

The first inelastic ring member 130B connected to the elastic ring member 110B is fixed to the lesion X (the right end of the lesion X) through the first clamp 10A. The fixing point of the first inelastic ring member 130B to the lesion X functions as an anchor point A5 for lifting the lesion X through the pulling force of the elastic ring member 110B. In addition, since the first inelastic ring member 130B is made of a material that does not stretch in the pulling direction, it becomes possible to reliably transmit the pulling force of the elastic ring member 110B.

The second inelastic ring member 140B connected to the elastic ring member 110B is fixed to the lesion X (the left end of the lesion X) through the second clamp 10B. The fixing point of the second inelastic ring member 140B to the lesion X functions as an anchor point A6 for lifting the lesion X through the pulling force of the elastic ring member 110B. In addition, since the second inelastic ring member 140B is made of a material that does not stretch in the pulling direction, it becomes possible to reliably transmit the pulling force of the elastic ring member 110B.

In this way, three anchor points A4, A5, and A6 are set at the lesion X, and the lesion X is pulled toward the opposite part Y by the pulling force of the elastic ring member 110B, thereby lifting the lesion X.

After the diseased part Peripheral incision. Normally, the diseased part The submucosal layer includes the mucosal layer where the diseased part X occurs, whereby the diseased part X can be separated from the luminal organ.

FIG24 shows a state where the lesion X is peeled off to form a peeling portion Z. Since the lesion X is lifted from the peeling portion Z formed by incision due to the elastic force (tension) of the elastic ring member 110B, the lesion X does not block the peripheral field of vision of the peeling portion Z or cause an obstruction to the operation, and the entire circle of the lesion X can be easily and reliably cut.

After that, after the lesion X is peeled off, the elastic ring member 110B is cut off using an endoscopic electric burner or the like. If the elastic ring member 110B is cut off, the lesion X in the state of being equipped with the elastic ring member 110B of the endoscopic traction clamp 1B and the part other than the traction ring member 160B and the first clamp 10A and the second clamp 10B becomes free relative to the luminal organ, so the lesion X is grasped by the connecting hook 61 of the clamp device 60 or the endoscopic grasping forceps or the like, and pulled out of the body through the endoscope or together with the endoscope, thereby removing the lesion X out of the body. After the lesion X is removed, as shown in FIG. 15 described above, a peeling portion Z will be left at the site where the lesion X once existed, so appropriate hemostasis treatment is performed to complete the treatment. In addition, the cut elastic ring member 110B and the traction ring member 160B can be removed from the body by grasping the connecting hook 61 of the clamp device 60 or the endoscopic grasping forceps, etc., just like the lesion X. In addition, the third clamp 10C fixed to the opposite site Y becomes residual in the luminal organ, but like the general endoscopic clamp, it will naturally detach and be discharged with the passage of time through the metabolism of the luminal organ.

In addition, another clamp can also be used to fix a part of the anchor wire 120B (different from the anchor point A4) to the lesion X, etc., and four or more anchor points can be set to the lesion X to perform the lesion. Part X's traction. The number of anchor points provided on the anchor wire 120B is not particularly limited. If necessary, multiple clamps may be used to fix any part of the anchor wire 120B to the lesion X, thereby setting multiple anchor points appropriately.

(The function of the traction clamp 1B for endoscopes)

The following description is about the functions of the traction clamp for endoscope 1B which is one embodiment of the traction clamp for endoscope related to the present invention.

The traction clamp 1B for endoscope in the first embodiment has a clamp body 10 and a ring member 100B. The clamp body 10 has a pair of arm plates 30, 40 opened into a roughly V-shape and an annular fastening ring 50 of a connecting plate portion 20 slidably fitted to the base end side of the arm plates 30, 40. The ring member 100B is assembled to the clamp body 10 and formed into a ring shape. The ring member 100B is composed of an elastic part P3 with elasticity and an inelastic part P4 with inelasticity connected, the elastic part P3 stretches and contracts along the extension direction of the ring, and the inelastic part P4 has flexibility and does not stretch and contract along the extension direction of the ring.

More specifically, in the endoscope pulling jig 1B in the second embodiment, the elastic part P3 is composed of the elastic ring member 110B formed in a loop shape, and the inelastic part P4 is composed of the anchor wire 120B and the third It is composed of 1 non-elastic ring component 130B and a second non-elastic ring component 140B. The anchor wire 120B is a flexible non-elastic wire. The first non-elastic ring component 130B and the second non-elastic ring component 140B Each of the two ends of the anchor wire 120B is formed in a loop shape. Furthermore, the first non-elastic ring member 130B and the second non-elastic ring member 140B are respectively connected to both ends of the elastic ring member 110B constituting the elastic part P3. The ring member 100B is the elastic ring member 110B, the anchor wire 120B, and the first non-elastic ring member 110B. The elastic ring member 130B and the second inelastic ring member 140B are connected to form a ring as a whole.

As described above, the endoscopic pulling jig 1B has a simple structure in which the loop member 100B partially provided with the elastic part P3 and partly provided with the inelastic part P4 is mounted on the jig body 10 capable of holding the living tissue.

Thereby, the anchor point A4 fixed to the lesion X is set by assembling the clamp body 10 at a designated location near the lesion X, and then, by using another clamp (the first clamp 10A and the second clamp 10B) Fix the inelastic part P4 at other parts near the lesion A4, A5, A6.

Furthermore, by using the inelastic portion P4 to set the anchor points A4, A5, and A6 of the lesion portion X, the pulling force acting when the lesion portion X is lifted is surely transmitted to the anchor points A4, A5, and A6 in the form of tension of the inelastic portion P4 that does not stretch, so the lesion portion X can be stably lifted.

Furthermore, the two different points of the inelastic portion P4 are distributed in a manner isolated from each other through the inelastic portion P4, so the isolated two different points can be easily and reliably set as anchor points A4, A5, and A6 fixed near the lesion site X in the inelastic portion P4. For example, since there is an anchor wire 120B between the first inelastic loop component 130B and the second inelastic loop component 140B, the first inelastic loop component 130B and the second inelastic loop component 140B are arranged at positions far away from each other, and the "anchor point A5 for fixing the first inelastic loop component 130B to the lesion part X" and the "anchor point A6 for fixing the second inelastic loop component 140B to the lesion part X" can be easily and reliably set at positions far away from each other, so that the lesion part X can be lifted as a whole.

In the second embodiment, the inelastic portion P4 of the loop member 100B is partially formed of a loop-shaped inelastic loop member. More specifically, the inelastic portion P4 of the endoscope retraction jig 1B includes a first loop-shaped inelastic loop member 130B and a second loop-shaped inelastic loop member 140B.

According to this structure, by fixing the first inelastic ring member 130B and the second inelastic ring member 140B of the inelastic part P4 near the lesion X, the first inelastic ring member 130B and the second inelastic ring member 140B can be easily and surely attached. The position of the second inelastic ring member 140B is set as anchor points A5 and A6 fixed near the lesion X. Since the first inelastic ring member 130B and the second inelastic ring member 140B are formed in a ring shape, another clamp is used to hook the rings of the first inelastic ring member 130B and the second inelastic ring member 140B and fix them at the same time. The first inelastic ring member 130B and the second inelastic ring member 140B can be easily and reliably fixed in the vicinity of the lesion X.

Furthermore, in the traction clamp 1B for endoscopes in the second embodiment, since the anchor wire 120B of the inelastic part P4 is mounted on the arm plate part 30 of the clamp body 10, it becomes easy to apply it to the lesion part. X is equipped with the position setting of the clamp body 10 as the anchor point A4.

In the traction clamp 1B for endoscope in the second embodiment, by using another clamp (third clamp 10C) to fix the elastic part P3 to the opposite part Y of the lesion X, the lesion X can be lifted by its traction force (elastic force). The elastic portion P3 has stretchable elasticity, and when the periphery of the lesion X is cut open to peel off from the inner wall of the lumen organ, the lesion X can be lifted up in a direction away from the inner wall of the lumen organ (the opposite direction of the lesion X). Therefore, the peeled portion Z produced after the lesion X is peeled off can be easily observed, and at the same time, the lesion X can be kept lifted up without causing interference to the operation, so that the entire circle of the lesion X can be easily and reliably cut open.

The endoscope pulling jig 1B in the second embodiment is provided with a connecting member 150B that connects the arm plate portion 30 and the elastic ring member 110B. Thereby, the traction force of the elastic ring member 110B can be reliably transmitted to the anchor point A4 set through the clamp body 10 through the intermediary connecting member 150B, and the lesion X can be lifted more stably.

In the pulling jig 1B for endoscopes in the second embodiment, a pulling ring member 160B formed in a ring shape is attached to a part of the elastic ring member 110B constituting the elastic portion P3. Thereby, after setting the plurality of anchor points A4, A5, and A6 near the lesion X, and then using another clamp (the third clamp 10C) to fix the elastic part P3 to the opposite part Y of the lesion X, it becomes The arm plate portions 30C and 40C of the third clamp 10C can easily hook the loop of the traction hoop member 160B, and the traction hoop member 160B can be easily fixed to the opposing portion Y. Furthermore, by configuring the traction loop member 160B with an inelastic wire, when the traction loop member 160B is fixed to the opposing portion Y through the third clamp 10C, the traction force of the elastic loop member 110B can be transmitted so as to prevent self-alignment. The way to separate from part Y is definitely fixed.

In addition, the pulling jig 1B for endoscopes in the second embodiment can be easily produced by producing the elastic part P3 made of an elastomer molded part and a wire made of natural fiber or chemical fiber. The loop member 100B connected to the inelastic part P4 is assembled to the jig body 10 .

(Variation of the endoscope traction clamp of the present invention)

The first to third variations of the endoscope pulling clamp related to the present invention are described below with reference to FIGS. 25 to 27. FIGS. 25 to 27 are front views of the first to third variations of the endoscope pulling clamp related to the present invention, respectively. FIGS. 25 to 27 show variations of the structure of the endoscope pulling clamp 1A in the first embodiment of the present invention.

(First variant)

In the traction jig 1A for endoscopes in the first embodiment described above, an elastomer molded part such as an interpalatal rubber band is used as the elastic ring member 110 constituting the elastic portion P1. However, as shown in FIG. 25 The traction jig 1C for endoscopes can also use an annular spring member 110X formed in a coil shape by connecting both ends of a tightly wound coil spring to the elastic part P1 to generate traction force (elastic force) that lifts the diseased part. As the annular spring member 110X, one in which both ends of the spring are connected may be used, or an endless belt spring may be used.

(Second modification and third modification)

In the traction clamp for endoscope 1A in the first embodiment described above, the elastic ring member 110 constituting the elastic portion P1 is formed in a ring shape, but as shown in FIG26 , an elastic body member 110Y formed in an arc shape or a straight line shape may be used for the elastic portion P1 to generate a traction force (elastic force) to lift the lesion portion. Furthermore, as shown in FIG27 , a coil spring member 110Z extending in an arc shape or a straight line shape may be used for the elastic portion P1 to generate a traction force (elastic force) to lift the lesion portion.

In addition, the first to third modifications described above can also be applied to the traction jig 1B for endoscopes in the second embodiment, and the elasticity of the elastic portion P3 constituting the traction jig 1B for endoscopes can be used. The coil member 110B is changed to the annular spring member 110X, the elastomer member 110Y, and the coil spring member 110Z mentioned above.

(Fourth modification)

Next, a fourth modified example of the endoscope pulling jig related to the present invention will be described simultaneously with reference to FIGS. 28 and 29 . FIG. 28 is a perspective view of a fourth modified example of the traction clamp for endoscopes according to the present invention, and shows a state in which the arm plate portions 30 and 40 of the clamp body 10 are opened. FIG. 28 shows an example of a structural modification of the endoscope pulling jig 1B in the second embodiment of the present invention.

In the above-mentioned second embodiment, the above-mentioned endoscope pulling clamp 1B has a first inelastic ring member 130B and a second inelastic ring member 140B between the elastic ring member 110B and the anchor wire 120B. The first inelastic ring member 130B and the second inelastic ring member 140B are connected to both ends of the anchor wire 120B, respectively, and the first inelastic ring member 130B, the elastic ring member 110B, and the second inelastic ring member 140B are connected in a chain-like structure.

In the endoscope retraction clamp 1B thus constructed, the first inelastic ring member 130B and the second inelastic ring member 140B are not provided. As shown in FIG28, the two ends of the anchor wire 120F corresponding to the anchor wire 120B can be fixed to the elastic ring member 110B. More specifically, as shown in FIG28, for example, the fastening wires 121F and 122F can be provided at the two ends of the anchor wire 120F, and the fastening wires 121F and 122F can be fastened to the elastic ring member 110B, respectively, so that the two ends of the anchor wire 120F are connected and fixed to the elastic ring member 110B.

The positions where both ends of the anchor wire 120F are fixed to the elastic ring member 110B are not particularly limited. For example, it is preferable to fix them to positions far away from the fastening wire 161B or the connection position of the connection fixing and pulling ring member 160B or the connection member 150B.

As described above, the endoscope traction clamp 1B in the second embodiment can set the anchor point A5 by fixing a part of the wire constituting the first inelastic loop component 130B to the lesion site X using the first clamp 10A, and set the anchor point A6 by fixing a part of the wire constituting the second inelastic loop component 140B to the lesion site X using the second clamp 10B (see, for example, FIG. 22).

In contrast, the endoscope traction clamp 1F shown in FIG. 28 can be used as shown in FIG. 29 to set the anchor point A7 by fixing a portion of the anchor wire 120F (different from the anchor point A4 using the clamp body 10) to the lesion X using the first clamp 10A, and to set the anchor point A8 by fixing a portion of the anchor wire 120F (different from the anchor points A4 and A7) to the lesion X using the second clamp 10B. In addition, FIG. 29 is a schematic diagram showing a state in which the anchor wire 120F of the endoscope traction clamp 1F is assembled to the lesion X using the first clamp 10A and the second clamp 10B, which corresponds to the state shown in FIG. 22 described above.

The method of lifting and peeling off the lesion X using the endoscopic traction clamp 1F is the same as that described above, except that a part of the anchor wire 120F is attached to the lesion X using the first clamp 10A and the second clamp 10B. The second implementation type is the same. Furthermore, compared with the second embodiment described above, the number of anchor points provided on the anchor wire 120F is not particularly limited. In the example shown in FIG. 29 , three anchor points A4, A4, and A4 are set. A7, A8, but the anchor point can be 2 points or more than 4 points.

Compared with the endoscope traction jig 1B in the second embodiment, the endoscope pulling jig 1F in the fourth modification does not have the first non-elastic ring member 130B and the second non-elastic ring member 130B. The elastic ring component 140B has a simplified structure. This makes it easy to store the endoscopic traction jig 1F in the distal end of the jig device 60 when transporting the endoscope into the body, and the clamping operation near the lesion X also becomes easy.

In addition, similarly to the traction jig 1A for endoscopes in the first embodiment described above, the first inelastic ring member 130 and the second inelastic ring member 140 may not be provided.

In addition, the present invention also includes a structure obtained by appropriately combining the structural elements described in each embodiment. For example, the traction clamp 1A for endoscopes in the first embodiment may be provided on the connecting member 150B or the traction ring member 160B described in the second embodiment.

The above-described embodiments are recorded for easy understanding of the present invention and are not intended to limit the present invention. The components disclosed in the above-described embodiments are intended to include all design changes and equivalents within the technical scope of the present invention.

1A, 1B, 1C, 1D, 1E, 1F: traction clamp for endoscope 10: Fixture body 10A: 1st fixture 10B: 2nd fixture 10C: 3rd fixture 20:Connecting plate part (connecting part) 25:Connection hole 30, 30A, 30B, 30C, 40, 40A, 40B, 40C: Arm plate part (arm part) 30g, 40g: Grip part 30p, 40p: base end 31,41:Connection Department 32,42,61a1,61b1: Claw 32a, 42a: Notch part 50,50A,50B,50C: Fastening ring 60: Fixture device 61:Connecting hook 61a,61b:Arm 61c: U-shaped part 62:Inner sheath 63: Drive line 63a:Ring parts 64:Outer sheath 65: Reinforcement Spiral 66:Sliding piece 67:Base 68:Operation Department 100,100B: Circle parts 110,110B: Elastic ring parts 110X: Ring spring parts 110Y: Elastomer parts 110Z: Coil spring parts 120,120B,120F: Anchor wire 121F, 122F, 161B: Fastening wire 130,130B: The first non-elastic ring component 140,140B: The second non-elastic ring component 150B:Connecting parts 160B: Traction ring parts (non-elastic ring parts) A1,A2,A3,A4,A5,A6,A7,A8: anchor points P1, P3: elastic part P2, P4: Inelastic part X: lesion area Y: Opposite part Z: peeling part

〈Fig. 1〉 is a three-dimensional diagram showing the overall structure of the traction clamp for endoscope in the first embodiment of the present invention, and is a diagram showing the state in which the arm plate portion of the clamp body is opened.

FIG. 2 is a front view of the endoscope traction clamp shown in FIG. 1 .

FIG. 3 is a diagram showing a state in which the arm plate portion of the clamp body of the endoscope traction clamp shown in FIG. 1 is clamped.

FIG. 4 is a diagram showing the appearance of a clamp device used when the traction clamp for the endoscope in the first embodiment of the present invention is transported into the body.

<Figure 5> is a cross-sectional view along line Va-Va in Figure 4.

〈FIG. 6〉 is a three-dimensional diagram showing the connecting hook of the clamp device shown in FIG. 4 and its surrounding structure.

FIG. 7 is a diagram showing a state in which the endoscope pulling clamp in the first embodiment of the present invention is protruded from the distal end of the clamp device.

FIG. 8 is a diagram showing a state in which the endoscope pulling clamp in the first embodiment of the present invention is stored in the distal end portion of the clamp device.

<Fig. 9> is a schematic diagram illustrating the periphery of a lesion to be peeled off and resected by the endoscopic traction jig used in the first embodiment of the present invention.

<Fig. 10> is a schematic diagram illustrating a state in which the clamp body of the endoscope traction clamp in the first embodiment of the present invention is mounted on the lesion.

FIG. 11 is a schematic diagram showing a state in which the second inelastic ring component of the traction clamp for endoscope in the first embodiment of the present invention is assembled to the lesion part using the first clamp.

〈 FIG. 12 〉 is a schematic diagram showing a state in which the anchor wire of the endoscope traction clamp in the first embodiment of the present invention is assembled to the lesion part using the second clamp.

〈 FIG. 13 〉 is a schematic diagram showing a state in which the elastic ring component of the endoscope traction clamp in the first embodiment of the present invention is assembled to the opposite part of the lesion using the third clamp.

<Fig. 14> is a schematic diagram showing a state in which the outer periphery of the lesion is incised and the lesion is lifted from the state shown in Fig. 13.

〈FIG. 15〉 is a schematic diagram showing the state in which the diseased part is removed from the state shown in FIG. 14.

〈 FIG. 16 〉 is a three-dimensional diagram showing the overall structure of the traction clamp for endoscope in the second embodiment of the present invention, and is a diagram showing the state in which the arm plate portion of the clamp body is opened.

<Fig. 17> is a front view of the traction clamp for the endoscope shown in Fig. 16.

〈 FIG. 18 〉 is a diagram showing a state in which the endoscope pulling clamp in the second embodiment of the present invention is protruded from the distal end of the clamp device.

<Fig. 19> is a diagram illustrating a state in which the pulling clamp for an endoscope in the second embodiment of the present invention is housed in the distal end portion of the clamp device.

〈 FIG. 20 〉 is a schematic diagram showing a state in which the clamp body of the traction clamp for an endoscope in the second embodiment of the present invention is assembled to the lesion site.

〈 FIG. 21 〉 is a schematic diagram showing a state in which the first inelastic ring component of the traction clamp for an endoscope in the second embodiment of the present invention is assembled to the lesion part using the first clamp.

〈 FIG. 22 〉 is a schematic diagram showing a state in which the second inelastic ring component of the traction clamp for an endoscope in the second embodiment of the present invention is assembled to the lesion part using the second clamp.

<Fig. 23> is a schematic diagram illustrating a state in which the elastic ring member of the endoscopic traction clamp in the second embodiment of the present invention is mounted on a portion opposite to the lesion using a third clamp. .

FIG. 24 is a schematic diagram showing a state in which the periphery of the lesion is cut open from the state shown in FIG. 23 and the lesion is lifted up.

〈FIG. 25〉 is a front view showing a first variant of the traction clamp for endoscope related to the present invention.

〈FIG. 26〉 is a front view showing a second modification of the pulling jig for an endoscope according to the present invention.

〈FIG. 27〉 is a front view showing a third modification of the pulling jig for an endoscope according to the present invention.

〈Fig. 28〉 is a three-dimensional diagram of the fourth variant of the traction clamp for endoscope related to the present invention, and is a diagram showing the state in which the arm plate portion of the clamp body is opened.

〈 FIG. 29 〉 is a schematic diagram showing a state in which the anchor wire of the traction clamp for endoscope is assembled to the lesion part using the first clamp and the second clamp in the fourth variant of the traction clamp for endoscope related to the present invention.

1A: Traction clamp for endoscope

10: Clamp body

20:Connecting plate part (connecting part)

25:Connection hole

30,40: Arm plate part (arm part)

30g, 40g: Grip part

30p, 40p: base end

31,41:Connection Department

32,42: Claws

32a,42a: Notch

50: Fastening ring

100: Ring parts

110: Elastic ring parts

120: Anchor wire

130: 1st non-elastic ring component

140: The second non-elastic ring component

P1: elastic part

P2: Inelastic part

Claims (8)

A traction clamp for an endoscope comprises: a clamp body having a pair of arms opened into a roughly V-shape and an annular fastening ring of a connecting portion slidably fitted to the base end side of the arm; and a ring component, which is assembled to the clamp body and formed into a ring, and is composed of an elastic portion having elasticity and an inelastic portion having inelasticity connected, the elastic portion stretches and contracts in the direction in which the ring extends, and the inelastic portion has flexibility and does not stretch and contract in the direction in which the ring extends. The traction clamp for endoscope as described in claim 1, wherein the non-elastic portion of the ring member is assembled to the arm portion of the clamp body. The traction clamp for an endoscope as described in claim 1 or 2, wherein a portion of the aforementioned inelastic portion of the aforementioned ring member is constituted by an inelastic ring member formed into a ring shape. The traction clamp for endoscopes according to claim 1 or 2, wherein the inelastic portion of the loop member is formed of a flexible inelastic wire and is formed into a loop shape at both ends of the inelastic wire. The first non-elastic ring member and the second non-elastic ring member are respectively connected to both ends of the elastic portion of the aforementioned ring member. The traction clamp for an endoscope as described in claim 1 or 2, wherein the elastic portion of the ring member is composed of an elastic ring member formed into a ring shape. The traction clamp for endoscopes according to claim 1 or 2, which is provided with a connecting member that connects at least one of the pair of arm portions of the clamp body and the elastic portion. The traction clamp for an endoscope as described in claim 1 or 2 is provided with a non-elastic ring member formed into a ring shape at a part of the elastic portion mentioned before the ring member. The traction clamp for endoscope as described in claim 1 or 2, wherein the elastic portion is formed by an elastic body forming part, and the inelastic portion is formed by a wire rod using natural fiber or chemical fiber.