WO2011024886A1 - Clip package - Google Patents

Clip package Download PDF

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Publication number
WO2011024886A1
WO2011024886A1 PCT/JP2010/064453 JP2010064453W WO2011024886A1 WO 2011024886 A1 WO2011024886 A1 WO 2011024886A1 JP 2010064453 W JP2010064453 W JP 2010064453W WO 2011024886 A1 WO2011024886 A1 WO 2011024886A1
Authority
WO
WIPO (PCT)
Prior art keywords
clip
slider
magazine
sheath
hook
Prior art date
Application number
PCT/JP2010/064453
Other languages
French (fr)
Japanese (ja)
Inventor
義明 松岡
敏彦 伊▲崎▼
宏治 伊藤
公寿 斎藤
孝之 飯田
Original Assignee
富士フイルム株式会社
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by 富士フイルム株式会社 filed Critical 富士フイルム株式会社
Publication of WO2011024886A1 publication Critical patent/WO2011024886A1/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/122—Clamps or clips, e.g. for the umbilical cord
    • A61B17/1222—Packages or dispensers therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/128—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips
    • A61B17/1285—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00526—Methods of manufacturing
    • A61B2017/0053—Loading magazines or sutures into applying tools

Definitions

  • the present invention relates to a clip package that includes a clip unit that is loaded on an operation handle that can continuously perform hemostasis, occlusion of a wound, and the like in a living body, and a loading device that loads the clip unit on the operation handle.
  • the clip treatment tool (operation handle) is inserted into the living body through the forceps channel of the endoscope, the clip protrudes from the tip, and the affected part such as the bleeding part or the site where the diseased tissue has been removed is sandwiched between the clips to stop hemostasis or wounds.
  • a clip unit including a clip and a connecting member that engages with the rear end of the clip is used, and the clip unit is connected to an operation wire inserted through a sheath while being accommodated in a clip magazine.
  • a method for loading a unit into a sheath is described.
  • a hook for connecting to the connecting member of the clip unit is provided at the tip of the operation wire.
  • the clip unit is loaded by first entering the clip magazine with the hook exposed from the sheath, butting the hook against the rear end of the connecting member, and moving the operation wire along the axial direction. Push the hook into to connect. Next, after the connection is completed, the operation wire is pulled, the clip unit is pulled out of the clip magazine, and pulled into the sheath. According to this, the clip unit can be loaded by a simple operation such as an axial advance / retreat operation of the operation wire.
  • This loading device is provided with a passage through which the clip unit once pulled out from the clip magazine is sent from the head, and a connection auxiliary member for assisting the connection operation between the connection member exposed from this passage and the hook.
  • the auxiliary connecting member presses a hook that overlaps the connecting member in the axial direction, and pushes the hook into the connecting member to complete the connection.
  • connection operation of the loading device provided with the connection auxiliary member the operator visually aligns the position of the connection member and the hook in the axial direction so that the connection member and the hook protruding from the distal end of the sheath overlap.
  • the operation wire provided with a hook at the tip is inserted into the sheath so as to be movable back and forth with respect to the sheath, and the sheath and the operation wire are long (about 2 m) and have flexibility. For this reason, even if the distal end portion of the sheath is gripped and the axial position of the hook is aligned with the position of the connecting member, the operation wire is not directly gripped. When the hook is stretched or stretched, the hook moves forward and backward with respect to the sheath, and the axial position of the hook may shift.
  • the operator In the hook connection operation, the operator often has to move the proximal end side of the sheath in order to change the posture of holding the proximal end side of the sheath or the holding position thereof. Securing the proximal end side of the sheath significantly deteriorates the operability of the coupling operation. For this reason, even if the proximal end side of the sheath moves, a countermeasure for preventing the position of the hook in the axial direction from shifting is required.
  • the proximal end side of the sheath moves while holding the distal end portion of the sheath and the loading device. It is another object of the present invention to provide a clip package in which the axial displacement of the hook does not occur.
  • the present invention provides a clip package for loading a plurality of clip units into a sheath through which an operation wire is inserted, a clip magazine for accommodating the plurality of clip units along a line, and A magazine insertion portion into which the clip magazine is inserted, a clip removal member for taking out a plurality of clip units from the clip magazine, a housing portion for housing a plurality of clip units taken out from the clip magazine, and a clip unit in the housing portion A position restricting portion for restricting a position of the hook of the operation wire with respect to the clip unit at the endmost portion, and pressing the at least one of the clip unit and the hook at the endmost portion toward the other, thereby
  • the clip unit and the hook And a loading device for loading a plurality of clip units into a sheath by drawing the operation wire after the hook is connected to the clip unit at the end.
  • the position restricting portion includes a pair of positioning pieces formed so as to sandwich the hook from the front and rear in the axial direction.
  • the loading device is formed with an opening that exposes a connecting portion of the clip unit at the endmost portion that is connected to the hook, and the position restricting portion is disposed at a position corresponding to the opening. It is preferable.
  • connection assisting member is a slider that is movable in a sliding direction orthogonal to the axial direction of the clip unit, and the slider has a pressing surface that is inclined with respect to the sliding direction. It is preferable that the amount of pushing by the slide is gradually increased by making contact with one of the hook and the connecting portion and pushing in the pushing direction.
  • the position restricting portion is formed integrally with the slider and protrudes more forward than the pressing surface in the sliding direction. It is preferable that a magazine position restriction groove for restricting the position of the clip magazine inserted into the magazine insertion portion is formed in the loading device.
  • a holding member that is formed integrally with the slider and that abuts on the upper end of the sheath disposed behind the hook and restricts the radial movement of the sheath while the slider slides is provided. It is preferable.
  • the pressing member regulates the movement of the slider by abutting the front end of the pressing member with the clip magazine.
  • the loading device is provided with a slider passage through which the slider slides. The slider engages with an inner wall of the slider passage to prevent the slider from coming off from the slider passage. It is preferable that protrusions are formed. It is preferable that the position restricting portion is provided separately from the connection assisting member.
  • the present invention in a state where the position of the hook of the operation wire with respect to the clip unit at the end of the clip unit in the accommodating portion is regulated, at least one of the clip unit and the hook at the end is pressed toward the other.
  • the clip unit and the hook at the endmost part are connected, even if the proximal end side of the sheath moves during the connection operation, the axial displacement of the hook does not occur.
  • a repetitive operation handle (hereinafter referred to as operation handle) 10 includes a cylindrical sheath 11, an operation wire 12 inserted into the sheath 11, and an operation wire loaded in the sheath 11. And a handle main body 14 used for pulling operation of the sheath 11 and the operation wire 12.
  • the connecting clip unit 13 includes a plurality of hemostatic clip bodies 17 (17A to 17C) connected in a row and a connecting clip body 18 connected to the last hemostatic clip body 17C. It is configured.
  • the hemostatic clip body 17 includes a clip 19 (19A to 19C) and a cylindrical connecting ring 20 (20A to 20C) attached to the outside of the clip 19.
  • the clip 19 is formed by bending a single elongated plate 180 degrees to form a closed end, crossing the two pieces, and bending the two open ends to oppose each other. Portions 23 and 23 are formed.
  • the clip 19 has arm portions 25 and 25 on the open end side and a turn portion 26 on the closed end side, with a crossing portion 24 crossing the elongated plates as a boundary. Convex portions 27 and 27 that are partially wide are formed at the central portions of the arm portions 25 and 25.
  • the arm portions 25 and 25 When the external force is not applied, the arm portions 25 and 25 are in an open state in which the claw portions 23 and 23 are separated, and when the arm portions 25 and 25 are elastically deformed so as to approach each other, the claw portions 23 and 23 mesh with each other. It will be in the closed state which pinches
  • claw parts 23 and 23 are formed in the V-shaped male type and female type
  • the clip 19 can be made of a biocompatible metal, for example, SUS631 which is stainless steel for springs.
  • the connecting ring 20 has a substantially cylindrical shape, and includes a metal fastening portion 30 disposed on the front end side and a plastic holding portion 31 disposed on the rear end side.
  • the hemostatic clip body 17 is formed by inserting the clip 19 into the tightening hole 30 a formed in the tightening portion 30 from the turn portion 26 side and mounting the connecting ring 20 on the outside of the clip 19.
  • the tightening portion 30 is set at an initial position covering the outer periphery of the intersecting portion 24, and the arm portions 25, 25 of the clip 19 are in an open state.
  • the tightening hole 30a closes the claw portions 23 and 23 by tightening the arm portions 25 and 25 when the clip 19 is pulled into the connecting ring 20.
  • the claw portions 23 and 23 exhibit a predetermined meshing force when the arm portions 25 and 25 are tightened. Since the diameter of the fastening hole 30 a is smaller than the width of the convex portion 27 of the clip 19, the tip from the convex portion 27 of the clip 19 is not inserted into the connecting ring 20.
  • the holding portion 31 is formed with a holding hole 31 a continuous with the tightening hole 30 a.
  • the turn part 26 inserted from the tightening hole 30a is accommodated in the holding hole 31a.
  • Two skirt portions 38 are formed on the outer peripheral surface of the holding portion 31 symmetrically with respect to the central axis.
  • the skirt portions 38, 38 are formed so as to expand in the radial direction from the front end side to the rear end side of the holding portion 31, and are opened by their own elasticity when external force is not applied, and are pressed from the outside. Sometimes it closes so as to enter the holding part 31.
  • the connecting ring 20 is attached to the outside of the clip 19 so that the opening / closing direction of the claw portions 23, 23 and the opening / closing direction of the skirt portions 38, 38 are shifted by 90 °.
  • the connecting clip unit 13 When the connecting clip unit 13 is loaded into the sheath 11 and closed, the skirt portions 38 and 38 sandwich the turn portion 26 accommodated in the holding hole 31 a and integrate the connecting ring 20 with the clip 19.
  • the plurality of hemostatic clip bodies 17 are connected in a row by engaging the claw portions 23 and 23 of the rear clip 19 with the turn portion 26 of the clip 19 disposed on the front side.
  • the connection ring 20 covers the outside of the claw portions 23 and 23 of the rear clip 19 and maintains the connection of the clip 19 so that the claw portions 23 and 23 do not open.
  • the projecting portion 27 of the clip 19 has a width that is greater than the diameter of the holding hole 31 a, and abuts against the rear end of the connecting ring 20 when disposed behind the connecting ring 20. Thereby, the movement of the connection ring 20 from the initial position described above to the rear end side of the connection clip unit 13 is restricted.
  • Slits 44 a and 44 a are formed at two positions shifted from the skirt portions 38 and 38 in the circumferential direction at the rear end portion 44 of the connecting ring 20, that is, at the rear portion of the skirt portion 38.
  • the slits 44a and 44a are formed along the axial direction of the connecting ring 20, and the rear end portion 44 is elastically deformed so that the inner diameter thereof is expanded.
  • the slit 44a improves the flexibility of the connecting ring 20 so that the connecting clip unit 13 is bent in accordance with the bending of the endoscope. Further, since the inner diameter of the rear end portion 44 is widened by the slit 44a, it is easy to engage the two clips 19 during assembly.
  • the holding portion 31 is made of a material that is biocompatible and satisfies the elasticity and rigidity required for the skirt portion 38.
  • PPSU polyphenylsulfone
  • the connecting clip body 18 (connecting portion) includes a dummy clip 47 that engages with the turn portion 26 of the rearmost clip 19 ⁇ / b> C and a connecting member 48 that holds the dummy clip 47.
  • the dummy clip 47 is configured by bending an elongated metal plate, and includes a pair of arm portions 47a and 47a that are opened when no external force is applied. Similar to the clip 19, claw portions 47b and 47b and convex portions 47c and 47c are provided at the tips and intermediate portions of the respective arm portions 47a and 47a.
  • the dummy clip 47 can be formed of the same material as the clip 19.
  • the dummy clip 47 is rotated so that the opening / closing direction of the arms 47a, 47a is shifted by 90 ° from the opening / closing direction of the rearmost clip 19C and is inserted into the hole 31a of the connecting ring 20C, and the claw portions 47b, 47b are Engage with the turn part 26 of the clip 19C.
  • the connecting ring 20 ⁇ / b> C maintains the connected state by suppressing the claw portions 47 b and 47 b from being displaced to the open state.
  • the connecting member 48 is, for example, a cylindrical body formed of the same material as the holding portion 31 of the connecting ring 20.
  • a cutout holding portion 49 that holds the dummy clip 47 is provided on the distal end side of the connecting member 48.
  • a connecting portion 50 for connecting to the operation wire 12 is provided on the rear end side of the connecting member 48.
  • the connecting portion 50 includes a pair of elastic arms 53 and 53 that are made elastic in the radial direction of the connecting member 48, and clamping portions 54 and 54 that are provided at the tips of the elastic arms 53 and 53, respectively.
  • the gap between the pair of sandwiching portions 54, 54 is made thinner than the outer diameter of the operation wire 12.
  • semi-circular grooves 54 a and 54 a having the same diameter as the outer diameter of the operation wire 12 are formed in the pair of sandwiching portions 54 and 54 along the central axis of the connecting member 48.
  • the positioning member 51 is provided integrally with the connecting member 48.
  • the positioning unit 51 positions the connecting member 48 in the axial direction when the connecting member 48 and the operation wire 12 are connected by a connecting clip package 80 (see FIG. 7) described later.
  • the positioning part 51 is arranged approximately in the middle between the holding part 49 and the connecting part 50.
  • the positioning portion 51 is located on the upper surface side of the elastic arms 53, 53, and has a flat surface 55 in which a part of the circumferential surface of the connecting member 48 is cut out flat, and a step between the circumferential surface and the flat surface 55.
  • the contact surface 56 is provided and rises outward in the radial direction.
  • the contact surface 56 is formed in a substantially triangular shape that protrudes from the front end side to the rear end side of the connecting member 48.
  • the flat surface 55 is formed at a position that does not hinder the movement of a slider 85 described later, and the contact surface 56 is formed at a position that contacts a positioning surface 158 of the slider 85 described later.
  • the sheath 11 is, for example, a flexible coil sheath in which a metal wire is tightly wound.
  • the inner diameter of the sheath 11 is a dimension in which the engagement between the turn portion 26 of the previous clip 19 and the claws 23 and 23 of the next clip 19 is released. That is, the inner diameter of the sheath 11 is larger than the length obtained by adding the lengths of the two claw portions 23 and 23 and the width of the portion where the claw portions 23 and 23 of the turn portion 26 are engaged.
  • the operation wire 12 is a metal wire formed of a metal having biocompatibility. As shown in FIG. 5, a hook 57 used for connection with the connection clip body 18 is provided at the distal end of the operation wire 12.
  • the hook 57 includes a front hook 58 attached to the tip of the operation wire 12 and a rear hook 59.
  • the front hook 58 has a square columnar part 58 a having a side with the same length as the gap between the elastic arms 53 and 53, and a quadrangular pyramid part 58 b that matches the gap between the elastic arms 53 and 53. Yes.
  • the rear hook 59 has a cylindrical shape having an outer diameter that is larger than the outer diameter of the front hook 58 and slightly smaller than the outer diameter of the connecting member 48.
  • the rear hook 59 is disposed behind the rear end of the front hook 58 by a predetermined distance. This predetermined distance is the same length as the axial length of the clamping part 54.
  • the front hook 58 is fitted between the elastic arms 53 and 53 and comes into contact with a pair of holding portions 54 formed at the end of each elastic arm 53.
  • the operation wire 12 between the front hook 58 and the columnar rear hook 59 is clamped by the clamping unit 54.
  • the rear hook 59 abuts on the rear end of the holding portion 54. Accordingly, the pulling and rotation of the operation wire 12 can be transmitted to the connecting clip unit 13, and the connecting clip unit 13 can be pressed so as not to move together with the sheath 11 by the frictional force generated when the sheath 11 is pulled.
  • the handle main body 14 includes a sheath operation portion 63 that pulls the sheath 11 and the operation wire 12, and a wire operation portion 62.
  • the sheath operation part 63 has a substantially cylindrical shape, and the rear end of the sheath 11 is fixed to the tip.
  • the sheath operating portion 63 is slidably mounted on the outside of a pipe 64 provided at the tip of the wire operating portion 62. By sliding along the pipe 64 toward the wire operating portion 62, the sheath 11 is operated by the operating wire. 12 is pulled to the rear end side.
  • Reference numeral 69 is a notch for allowing the operator to feel the amount of retraction when the sheath 11 is retreated with respect to the operation wire 12.
  • the interval between the notches 69 is set corresponding to the retraction amount for pushing out the clips 19 of the connecting clip unit 13 from the sheath 11 one by one.
  • the wire operation part 62 has a substantially cylindrical shape and has a through window 65 with a slidable operation lever 66 built therein.
  • the operation wire 12 passes through the inside of the sheath operation portion 63 and is engaged with the operation lever 66 at the rear end. When the operation lever 66 is slid, the operation wire 12 is pulled with respect to the sheath 11 by an amount necessary for tightening the clip 19 by the connecting ring 20.
  • the connecting clip unit 13 is loaded in the sheath 11 so that the tip of the leading clip 19 ⁇ / b> A coincides with the tip of the sheath 11.
  • the sheath 11 is inserted into a forceps channel of an endoscope inserted in the living body.
  • the distal end of the sheath 11 protrudes from the forceps exit at the distal end of the endoscope and approaches the affected part.
  • the sheath 11 moves backward with respect to the operation wire 12 by a predetermined amount. Since the operation wire 12 and the connection clip unit 13 are connected, the connection clip unit 13 moves forward with respect to the sheath 11 and, as shown in FIG. 6B, is connected to the leading clip 19A from the distal end of the sheath 11. The ring 20A is sent out.
  • connection rings 20A to 20C do not move backward, but move forward with respect to the sheath 11 together with the clips 19A to 19C.
  • the clip 19A coming out of the sheath 11 opens the claw portions 23 and 23 due to its own elasticity, and as shown in FIG. 2A, the connecting ring 20A opens the skirt portions 38 and 38 wider than the inner diameter of the sheath 11.
  • the connecting ring 20A is engaged so as not to return into the sheath 11.
  • the operating handle 10 is moved, and the claw portions 23 and 23 of the clip 19A in the opened state are pressed against the affected part.
  • the operation lever 66 of the wire operation unit 62 is pulled in this state, the operation wire 12 is pulled by a predetermined amount, and all the clips 19A to 19C that are sequentially engaged from the connecting clip body 18 are pulled uniformly. .
  • the clip 19A fed from the sheath 11 is released from being pressed by the skirts 38, 38 because the skirts 38, 38 of the connecting ring 20A are open. Further, the connecting ring 20 ⁇ / b> A is prevented from retreating into the sheath 11 by the skirt portions 38, 38. Therefore, the leading clip 19A moves backward with respect to the connecting ring 20A when the operation wire 12 is pulled. When the tightening portion 30 is pushed to just below the convex portion 27 of the clip 19A, the tightening of the clip 19A by the connecting ring 20A is completed.
  • the engaging portion of the clip 19A and the next clip 19B comes out from the rear end of the connecting ring 20A.
  • the arm portions 25, 25 of the clip 19B are expanded by their own elastic force until they hit the inner wall of the sheath 11, and the gap between the claw portions 23, 23 opens wider than the width of the turn portion 26 of the clip 19A.
  • the connection with the clip 19B is released.
  • FIG. 6D when the distal end of the sheath 11 is separated from the affected part, the hemostatic clip body 17 ⁇ / b> A comes out from the distal end of the sheath 11.
  • the operation lever 66 When the pulling operation of the operation lever 66 is stopped, the operation lever 66 returns to the original position by a biasing force of a spring (not shown). As a result, the operation wire 12 moves to the distal end side in the sheath 11 and the connecting clip body 18 and the clips 19B and 19C are pushed. As shown in FIG. The distal end moves to a position that substantially coincides with the distal end of the sheath 11. Thereafter, similarly to the first hemostatic clip body 17A, the handle main body 14 is operated, and the second and third hemostatic clip bodies 17B and 17C can be clipped.
  • connection clip package 80 includes a clip magazine 81 that stores the connection clip unit 13 and a loading device 82 in which the clip magazine 81 is inserted.
  • the loading device 82 includes a clip taking-out member 83 for taking out the connecting clip unit 13 from the clip magazine 81, and a pair of brackets 84 for securely engaging the connecting clip unit 13 and the clip taking-out member 83 in the clip magazine 81.
  • 84 see FIGS. 8 and 10
  • a slider 85 connection auxiliary member
  • the clip magazine 81 is provided with a clip accommodating portion 87 that is a cylindrical space on the inner side.
  • the clip magazine 81 has a substantially rectangular tube shape at the top and a semi-cylindrical shape at the bottom.
  • the outer diameter of the lower portion is substantially the same as the outer diameter of the sheath 11, and the vertical height is the outer diameter of the sheath 11.
  • the clip housing portion 87 has a circular cross-sectional shape, and the inner diameter thereof is substantially the same as the inner diameter of the sheath 11.
  • the connecting clip unit 13 is accommodated so that the leading clip 19A is arranged on the leading end side of the clip magazine 81.
  • the clip magazine 81 is formed by joining a semi-cylindrical lower case 111 and a square cylindrical upper case 112 to each other.
  • the lower case 111 and the upper case 112 are provided with semicircular receiving recesses 111a and 112a, respectively, which become circular clip receiving portions 87 when they are joined.
  • the clip accommodating portion 87 is open on both the front end side where the leading clip 19A is accommodated and the rear end side where the connecting clip body 18 is accommodated.
  • the opening on the distal end side of the clip accommodating portion 87 is a delivery port for sending the connecting clip unit 13 out of the clip accommodating portion 87 from the head side.
  • a pressing portion 113 is integrally provided on the upper and rear end portions of the upper case 112.
  • the pressing portion 113 includes a pressing surface 113a formed in a curved surface that is concave downward so that the upper surface matches the shape of the finger, and a base end portion 113b that is fixed to the upper surface of the upper case 112 along the axial direction.
  • the holding surface 113a is provided with a plurality of anti-slip protrusions 113c.
  • the clip magazine 81 is formed of, for example, transparent plastic so that the connected clip unit 13 accommodated in the clip accommodating portion 87 can be seen from the outside of the clip magazine 81.
  • transparent plastic for joining the lower case 111 and the upper case 112 for example, adhesion using an adhesive, welding using ultrasonic waves, engagement by an engaging claw, or the like can be used.
  • a transparent plastic film may be wound around the outer periphery in a state where the lower case 111 and the upper case 112 are combined.
  • the connected clip unit 13 is accommodated in the clip accommodating portion 87 so that the claw portions 23 of the leading clip 19A open and close in the horizontal direction.
  • the clip 19 ⁇ / b> A is pushed against the inner wall of the clip accommodating portion 87 via the bracket 84 and is in a closed state.
  • the hemostatic clip bodies 17A to 17C are connected so that the opening and closing directions of the claw portions 23 and 23 are alternately rotated by 90 °, and the opening and closing directions of the claw portions 23 and 23 and the skirt portions 38 and 38 are also 90 °. It is off. Therefore, the connecting rings 20A and 20C open and close the skirt portion 38 in the vertical direction, and the connecting ring 20B opens and closes the skirt portion 38 in the left and right direction.
  • the lower case 111 and the upper case 112 are formed with skirt openings 114 that accommodate the skirt portions 38 of the coupling rings 20A and 20C in an open state. Further, at the joint of the lower case 111 and the upper case 112, a notch 115 serving as a skirt opening for accommodating the skirt portion 38 of the connecting ring 20B is formed when the two are joined. Accordingly, it is possible to prevent a reduction in restoring force (elastic force) in the opening direction of the skirt portion 38 due to being stored in the clip magazine 81 in a state where the skirt portion 38 is pushed in the closing direction. A recess may be provided instead of the opening.
  • the lower case 111 is provided with ribs 116 and 116 and a positioning key 117.
  • the ribs 116 and 116 and the positioning key 117 are formed integrally with the lower case 111.
  • the ribs 116, 116 protrude from the front end of the lower case 111 at a predetermined interval and from the rear end to both sides, and extend along a horizontal direction perpendicular to the axial direction and the vertical direction of the clip magazine 81. Is formed.
  • the ribs 116 and 116 are arranged so that the upper surface is continuous with the joint of the lower case 111 and the upper case 112. That is, when the lower case 111 and the upper case 112 are joined, the ribs 116 and 116 are positioned below the center of the clip magazine 81.
  • the positioning key 117 is located at the lower part of the lower case, and has a leaf spring 117 a disposed along the axial direction of the clip magazine 81 at the lower end thereof.
  • the leaf spring 117a has a base end at the rear end side of the clip magazine 81 and an open end at the tip end side, and is elastic in a direction perpendicular to the axial direction of the clip magazine 81.
  • a semi-cylindrical click protrusion 117b is provided on the tip side surface of the leaf spring 117a.
  • a recessed portion 90 that is recessed in the height direction is formed on one end side in the longitudinal direction of the loading device 82.
  • a magazine insertion groove 91 (magazine insertion portion) to which the clip magazine 81 or the sheath 11 is attached is formed.
  • the magazine insertion groove 91 has an inner diameter slightly larger than the outer diameter of the lower portion of the clip magazine 81, and an opening 91a for exposing the clip magazine 81 or the sheath 11 inserted therein from the upper surface of the loading device 82 is formed. ing. Through this opening 91a, the clip magazine 81 or the sheath 11 can be pressed from above with, for example, the thumb, and the clip magazine 81 or the sheath 11 and the loading device 82 are supported by supporting the loading device 82 from below with another finger. Can be held together.
  • Position restriction grooves 92 and 92 and a positioning key groove 93 are formed inside the magazine insertion groove 91.
  • a clip magazine 81 is inserted into the magazine insertion groove 91, and ribs 116, 116 and a positioning key 117 are engaged with the position regulating grooves 92, 92 and the positioning key groove 93. Further, when the connecting clip unit 13 is loaded from the loading device 82 to the sheath 11, the clip magazine 81 is extracted from the magazine insertion groove 91, and the sheath 11 is inserted instead.
  • connection opening 95 and a wire slit 96 are provided on the upper surface of the loading device 82 adjacent to the recess 90.
  • the connection opening 95 is an opening for inserting the hook 57 of the operation wire 12 into the loading device 82 from a direction orthogonal to the insertion direction of the clip magazine 81 (above the loading device 82).
  • the opening area is larger than the outer diameter dimension at that time.
  • the wire slit 96 is formed so as to connect the magazine insertion groove 91 and the connection opening 95, and has a width dimension in which the operation wire 12 can be inserted.
  • the operation wire 12 and the hook 57 are inserted into the wire slit 96 and the connection opening 95 at the same time, and are pulled into the loading device 82. It is connected to the connecting member 48 (see FIGS. 18 to 20).
  • a skirt closing passage 97 which is a cylindrical space, is provided at the back of the magazine insertion groove 91.
  • the skirt closing passage 97 has the same inner diameter as the sheath 11 and the clip accommodating portion 87 and is formed so as to align the position of the central axis with the clip magazine 81 inserted into the magazine insertion groove 91.
  • the clip magazine 81 inserted into the insertion groove 91 and the inner diameter surface of the sheath 11 are connected.
  • the skirt closing passage 97 closes each skirt portion 38 of the connection clip unit 13 drawn from the clip accommodating portion 87 by pushing the inner diameter surface.
  • an abutting surface 98 that is a step corresponding to the thickness of the sheath 11 or the clip magazine 81 (FIG. 12, FIG. 14 and FIG. 15).
  • the skirt closing passage 97 and the inner diameter surface of the sheath 11 or the clip magazine 81 are connected by the front end of the sheath 11 or the clip magazine 81 being abutted against the abutting surface 98. Accordingly, the connecting clip unit 13 can be loaded from the loading device 82 to the sheath 11 while the skirt portion 38 is kept closed.
  • the clip take-out member 83 includes a substantially elliptical traction portion 101 protruding outward from the other end portion side in the longitudinal direction of the loading device 82, an insertion portion 102 provided with the traction portion 101 at one end, and the insertion portion 102. And a clip engaging portion 103 (see also FIG. 10) provided at the other end.
  • the insertion portion 102 is a rod-like body having a length penetrating the skirt closing passage 97 and is inserted into the skirt closing passage 97.
  • the clip engaging portion 103 is inserted into the clip accommodating portion 87 and is engaged with the leading clip 19A.
  • the insertion portion 102 is inserted into the skirt closing passage 97, and the traction portion 101 is outside the loading device 82 through a traction hole (see reference numeral 104 in FIGS. 18 to 20) formed at the end of the skirt closing passage 97. Protruding.
  • the pulling portion 101 is pulled with respect to the loading device 82, the leading clip 19 ⁇ / b> A is pulled by the clip engaging portion 103, and the connecting clip unit 13 is drawn from the clip accommodating portion 87 into the skirt closing passage 97.
  • check protrusions 102 a that extend from the pulling portion 101 toward the clip engaging portion 103 are provided above and below the insertion portion 102.
  • the check protrusion 102 a jumps out of the loading device 82 from the pulling hole 104 when the insertion portion 102 is elastically deformed.
  • the check protrusion 102 a locks the insertion portion 102 so that the insertion portion 102 does not return to the skirt closing passage 97 again.
  • the clip engagement portion 103 includes a substantially prismatic engagement piece 103a and a retaining portion 103b positioned between the front end portion of the engagement piece 103a and the rear end portion of the insertion portion 102.
  • the engagement piece 103a has engagement holes 103c and 103c with which the claw portions 23 and 23 are engaged.
  • the retaining portion 103 b is formed so as to have an outer diameter that matches the inner diameter of the clip housing portion 87, and restricts the clip 19 ⁇ / b> A from being released to the front of the clip engaging portion 103.
  • the brackets 84 and 84 are a pair of plate members formed in a semi-cylindrical shape having an outer diameter matching the inner diameter of the clip accommodating portion 87 and an inner diameter matching the outer diameter of the engagement piece 103a. Along the closing direction of the clip 19A to be joined, the clip 19A is sandwiched from both sides so as to face each other.
  • These brackets 84, 84 are formed of, for example, a SUS metal plate.
  • the clip engaging portion 103 is accommodated in the clip accommodating portion 87 of the clip magazine 81 together with the brackets 84 and 84 and the connecting clip unit 13.
  • the first clip 19A is pushed by the clip accommodating portion 87 via the brackets 84 and 84 to be closed, and engages the claw portions 23 and 23 with the engagement holes 103c and 103c.
  • the insertion portion 102 moves in the skirt closing passage 97, and the clip engaging portion 103 moves from the clip accommodating portion 87 into the skirt closing passage 97.
  • the connecting clip unit 13 is pulled by the clip engaging portion 103 and pulled into the skirt closing passage 97.
  • a release groove 105 (see FIGS. 18 to 20) protruding in the left-right direction is formed.
  • the release groove 105 has a width dimension in which the arms 25 and 25 of the leading clip 19A can be opened to the extent that the engagement with the clip engagement portion 103 of the clip take-out member 83 is released.
  • the release groove 105 is arranged so that the leading clip 19 ⁇ / b> A reaches the release groove 105 when the connection portion 50 of the connection clip body 18 reaches a position facing the connection opening 95.
  • the insertion portion 102 moves in the skirt closing passage 97.
  • the brackets 84 and 84 move together with the clip engaging portion 103.
  • the clip engaging portion 103, the clip 19 ⁇ / b> A, and the bracket 84 move from the clip accommodating portion 87 into the skirt closing passage 97.
  • the leading clip 19A When the leading clip 19A reaches the release groove 105, it is displaced to its open state by its own elasticity, and the engagement with the clip engaging portion 103 is released. At this time, the bracket 84 is detached from the clip 19 ⁇ / b> A and the clip engaging portion 103 by pressing from the clip 19 ⁇ / b> A displaced to the open state. The bracket 84 removed from the clip 19 ⁇ / b> A and the clip engaging portion 103 remains in the release groove 105. The connecting clip unit 13 pulled in this way is stopped at the rear of the skirt closing passage 97 so that the connecting portion 50 of the connecting clip body 18 is positioned in the slider passage 100 in the skirt closing passage 97.
  • the hemostatic clip body 17 Since the opening and closing direction of the claw portions 23 and 23 and the opening and closing direction of the skirt portions 38 and 38 are shifted by 90 °, the hemostatic clip body 17 has a leading end even when the leading clip 19A is in the release groove 105. The skirt portions 38, 38 of the connecting ring 20A are not opened.
  • the pulling portion 101, the insertion portion 102, and the clip engaging portion 103 constituting the clip takeout member 83 are integrally formed of, for example, plastic having appropriate elasticity. Note that the insertion portion 102 and the clip engagement portion 103 may be formed separately and connected in the loading device 82.
  • the contact surface 56 of the connecting member 48 can be pressed by a positioning surface 158 of the slider 85 described later, and the connecting member 48 can be moved to an appropriate position.
  • the slider 85 is slidably inserted into the slider passage 100 opened from one side surface of the loading device 82.
  • the slider 85 is pushed into the slider passage 100 when the connecting clip body 18 drawn into the loading device 82 and the hook 57 inserted from the connecting opening 95 are connected.
  • the slider passage 100 has a rectangular shape with a cross section having a width substantially equal to the width dimension of the slider 85, and is cut out along the short direction of the loading device 82, that is, the direction perpendicular to the magazine insertion groove 91 and the skirt closing passage 97. It is provided as follows.
  • the loading device 82 is formed by joining a plate-like lower jig 120 and an upper jig 121 formed in a semicircular shape in the front and rear.
  • the loading device 82 is formed of, for example, a transparent plastic so that the connecting clip unit 13, the clip magazine 81, the clip takeout member 83, the slider 85, and the like can be seen from the outside.
  • adhesion using an adhesive, welding using an ultrasonic wave, engagement by an engaging claw, or the like can be used for joining the lower jig 120 and the upper jig 121.
  • a semicircular magazine recess 122 that forms a magazine insertion groove 91 when the upper jig 121 is joined.
  • position restricting recesses 123, 123 that are continuous from both sides of the magazine recess 122 and are one step recessed from the upper surface 120 a are formed.
  • the position restricting recesses 123 extend in the axial direction from the front end to the rear end of the magazine recess 122.
  • the position regulating recesses 123, 123 form the position regulating grooves 92, 92 together with the lower surface 121 a of the upper jig 121 when joined to the upper jig 121.
  • a positioning key groove 93 is provided in the magazine recess 122.
  • the positioning key groove 93 is formed along the axial direction of the clip magazine 81.
  • the positioning key groove 93 is fitted with the positioning key 117 provided on the clip magazine 81.
  • the rotation of the clip magazine 81 around the axis is restricted.
  • the magazine insertion groove 91 including the position restriction grooves 92 and 92 and the positioning key groove 93 has a cross-sectional shape that matches the outer shape of the clip magazine 81, and this cross-sectional shape is near the skirt closing passage 97 from the rear end side of the loading device 82.
  • the clip magazine 81 is detachably attached to the loading device 82 because the clip magazine 81 is continuous along the axial direction.
  • the side surface of the positioning key groove 93 is provided with a click hole (not shown) having a substantially U-shaped cross section.
  • the click hole is arranged at a position corresponding to the click protrusion 117b (see FIG. 10) provided in the positioning key 117, and constitutes a click mechanism together with the click protrusion 117b.
  • a semicircular skirt closing recess 128 that forms a skirt closing passage 97 when joined to the upper jig 121 is formed in the back of the magazine recess 122.
  • a rectangular release recess 129 that extends from the skirt closing recess 128 in the left-right direction is formed.
  • a rectangular notch 130 into which the insertion portion 102 of the clip take-out member 83 is inserted is formed at the front end of the release recess 129.
  • the boundary between the magazine recess 122 and the skirt closing recess 128, that is, the rear end of the skirt closing recess 128, is one step in the radial direction with respect to the inner wall of the skirt closing recess 128.
  • a step 131 is formed.
  • the step 131 constitutes the abutting surface 98 described above.
  • the slider recesses 133 and 134 project from the upper surface 120a of the lower jig 120 to the left and right with the magazine recess 122 and the skirt closing recess 128 sandwiched therebetween. Is formed.
  • the slider projections 133 and 134 project in a substantially rectangular shape having a width substantially equal to the width dimension of the slider 85, and form the slider passage 100 together with the slider recess 144 described later when joined to the upper jig 121. .
  • the slider convex portion 134 has both end portions in the width direction of the slider passage 100 extending to one end portion of the lower jig 120 where the entrance of the slider passage 100 is formed.
  • a slider notch 137 is formed at the center in the width direction of the slider protrusion 134, which is notched from the end of the lower jig 120 toward the magazine recess 122 and the skirt closing recess 128.
  • the inner surface in the sliding direction of the slider notch 137 serves as a stopper when the slider 85 is pushed into the slider passage 100.
  • the slider protrusions 133 and 134 are formed so that the upper surfaces 133a and 134a on both sides of the magazine recess 122 are one step higher than the upper surfaces 133b and 134b on both sides of the skirt closing recess 128 with the step 131 as a boundary.
  • the upper surfaces 133 a and 134 a are formed so that the upper surfaces 133 a and 134 a are higher than the upper end of the sheath 11 when the sheath 11 is inserted into the magazine insertion groove 91.
  • the upper end of the sheath 11 protrudes above the upper surfaces 133a and 134a and does not enter the slider passage 100. Therefore, when the sheath 11 is inserted in the magazine insertion groove 91, the slider 85 can move along the upper surfaces 133a and 134a without the slider 85 and the upper end of the sheath 11 contacting each other.
  • the clip magazine 81 is inserted into the magazine insertion groove 91, the upper and lower dimensions of the clip magazine 81 are larger than the sheath 11, so that the upper end of the clip magazine 81 protrudes upward from the upper surfaces 133 a and 134 a. Enter.
  • the upper surfaces 133b and 134b are formed so that their axial positions correspond to the stop position of the connecting member 48 when the connecting clip unit 13 is drawn into the skirt closing passage 97. Further, the upper surfaces 133b and 134b are formed so that the height thereof is substantially the same as the height of the connecting member 48 (see FIGS. 16A and 16B). For this reason, since the upper end of the connecting member 48 protrudes above the upper surfaces 133b and 134b and does not enter the slider passage 100, the slider 85 and the connecting member 48 do not interfere when the slider 85 moves.
  • the position regulating concave portions 123 and 123 engaged with the ribs 116 and 116 of the clip magazine 81, that is, the position regulating groove 92. , 92 are not formed. Therefore, when the clip magazine 81 is inserted into the magazine insertion groove 91, the position of the clip magazine 81 in the axial direction is positioned at a position where the ribs 116, 116 contact the rear end surfaces of the slider convex portions 133, 134. However, since the ribs 116 are formed at a predetermined interval from the tip of the clip magazine 81 (see FIG. 10), the tip of the clip magazine 81 is raised to the position where it abuts against the abutting surface 98. It is inserted between the parts 133 and 134.
  • a magazine notch 139 that forms a magazine insertion groove 91 is formed together with the magazine recess 122 at a position facing the magazine recess 122 of the lower jig 120.
  • the magazine cutout 139 is formed to have substantially the same width as the upper portion of the clip magazine 81.
  • a skirt closing recess 141 that forms a skirt closing passage 97 together with the skirt closing recess 128 of the lower jig 120 is formed on the lower surface 121a.
  • a release recess 142 and a notch 143 are formed on the lower surface 121a at positions opposite to the release recess 129 of the lower jig 120 and the notch 130, respectively.
  • a slider recess 144 that forms the slider passage 100 is formed.
  • a connecting opening 95 and a wire slit 96 are formed substantially at the center of the slider recess 144 so as to be continuous with the magazine cutout 139.
  • the slider concave portion 144 is formed in a rectangular shape having a width dimension matched to the slider convex portion 133.
  • the slider convex portion 133 is fitted into the slider concave portion 144.
  • the gap between the slider concave portion 144 and the slider convex portion 133 becomes the slider passage 100.
  • the biasing portions 146 and 147 are arranged at positions symmetrical with respect to the magazine notch 139 and the skirt closing recess 141, that is, the magazine insertion groove 91 and the skirt closing passage 97.
  • the urging portions 146 and 147 are formed from plate springs 146a and 147a extending from the widthwise end of the upper jig 121 toward the center, and projecting portions 146b and 147b protruding downward from the tips of the plate springs 146a and 147a. Each is composed.
  • the slider 85 includes an operation unit 150 that is used for a push operation into the slider passage 100 and a single plate-shaped push piece 151 that extends from the operation unit 150 in the sliding direction.
  • the pushing piece 151 is inserted into the slider passage 100, is biased by the biasing portions 146 and 147 of the upper jig 121, and sandwiches the connecting member 48 and the hook 57 together with the lower jig 120 of the loading device 82.
  • the pushing piece 151 is one step higher on the bottom surface 151a on the magazine insertion groove 91 side than the bottom surface 151b on the skirt closing passage 97 side. Is formed.
  • a fitting convex portion 152 that projects downward from the bottom surface 151b is provided in a portion close to the operation portion 150.
  • the fitting convex portion 152 is fitted into the notch 137 of the slider passage 100.
  • the front end surface of the fitting convex portion 152 in the sliding direction is in contact with the abutting surface formed at the back of the notch 137 and prevents the slider 85 from being excessively pushed.
  • the pressing piece 151 is formed with a pressing surface 153 that is inclined from the front end side in the sliding direction toward the bottom surface 151b.
  • the pressing surface 153 is formed such that when the slider 85 is pressed, the pressing amount for pressing the hook 57 in the skirt closing passage 97 in the pressing direction gradually increases, and the connecting clip body is pressed by the pressing surface 153.
  • the hook 57 is connected to the 18 connecting members 48. Further, the pressing surface 153 is supported from behind by the urging portions 146 and 147 of the upper jig 121, that is, the inner wall of the slider passage 100.
  • a recess 154 having an inner diameter substantially the same as the inner diameter of the sheath 11 is formed on the bottom surface 151b. The recess 154 closes the upper part of the skirt closing recess 128 when the slider 85 is in the coupling position, and constitutes a part of the skirt closing passage 97.
  • Two positioning pieces 155 and 156 projecting forward in the sliding direction from both sides of the pressing surface 153 are provided at the front end portion of the pushing piece 151 in the sliding direction.
  • the pair of positioning pieces 155 and 156 are arranged at intervals corresponding to the axial dimension of the hook 57, and the front end portions of the positioning pieces 155 and 156 are formed in the connection opening 95 when the slider 85 is in the initial position. It is provided so as to correspond to the position.
  • the hook 57 when the hook 57 is inserted into the loading device 82 from the connection opening 95, the hook 57 is dropped so as to be sandwiched between the positioning pieces 155 and 156. The end contacts the positioning pieces 155 and 156. Thereby, since the position of the hook 57 in the axial direction is restricted and positioned, the pressing force from the pressing surface 153 to the hook 57 acts appropriately and can be connected to the connecting member 48.
  • the positioning piece 155 on the skirt closing passage 97 side is formed so as to protrude to a position reaching the apex of the quadrangular pyramid portion 58b so that the front hook 58 can be positioned reliably, and the positioning piece on the magazine insertion groove 91 side.
  • 156 is formed to protrude less forward than the positioning piece 155 so as not to interfere with the insertion of the operation wire 12 while abutting the rear end surface of the rear hook 59.
  • a concave portion 157 (see FIG. 9) for accommodating the protruding portion 147b of the biasing portion 147 is formed.
  • the recess 157 retracts the upper surface of the pushing piece 151 from the protrusion 147b when the slider 85 is in the initial position.
  • the protrusion 146 b of the other urging portion 146 is located on the back side of the tip end portion of the positioning piece 155. Therefore, when the slider 85 is in the initial position, the protrusions 146b and 147b do not come into contact with the pushing piece 151 and are not urged by the leaf springs 146a and 147a.
  • An opening may be provided instead of the recess.
  • the positioning piece 155 is provided with a positioning surface 158 on the opposite side of the pressing surface 153.
  • the positioning surface 158 is an inclined surface that inclines so that the width of the pushing piece 151 increases from the front to the rear in the sliding direction of the slider 85.
  • the positioning surface 158 presses the connecting member 48 along the axial direction by pressing against the contact surface 56 of the connecting member 48 described above when the slider 85 is pushed into the connecting position on the back side of the slider passage 100. . Thereby, the connecting member 48 is positioned in the axial direction.
  • the positioning piece 156 is integrally provided with a sheath pressing piece 159 (pressing member) on the opposite side of the pressing surface 153.
  • the sheath pressing piece 159 restricts the radial movement of the sheath 11 by pressing the upper end of the sheath 11 with the lower surface of the sheath pressing piece 159 when the slider 85 moves from the initial position to the coupling position, thereby controlling the magazine insertion groove.
  • the sheath 11 is prevented from being detached from 91.
  • the sheath pressing piece 159 is formed to protrude less forward than the positioning piece 156 so as not to prevent insertion of the sheath 11 into the magazine insertion groove 91. Further, since the clip magazine 81 is higher in the vertical direction than the sheath 11, as shown in FIG.
  • An elastic piece 160 that is elastic in the width direction of the slider 85 is formed on the side surface of the pushing piece 151 opposite to the positioning surface 158.
  • An engaging protrusion 161 protruding in the width direction of the slider 85 is provided at the tip of the elastic piece 160.
  • the engagement protrusion 161 engages with a click groove 162 (see also FIG. 11) provided in the slider recess 144 of the upper jig 121, and the slider 85 slides to the connection position.
  • it engages with the click groove 163 (see also FIG. 11).
  • the engagement of the click groove 162 and the engagement protrusion 161 prevents the slider 85 from coming off from the slider passage 100.
  • the engagement position of the slider 85 can be determined by the engagement of the click groove 163 and the engagement protrusion 161, and the connection position of the slider 85 can be known from the click feeling when engaged.
  • the hook 57 inserted from the lateral direction (above the loading device 82) into the connection opening 95 has a corner portion of the square column portion 58a of the front hook 58, the elastic arm 53 of the connection member 48, 53, and a hook 57 is sandwiched between the positioning pieces 155 and 156 to perform axial positioning.
  • the pressing surface 153 comes into contact with the front hook 58 and the rear hook 59 and gradually presses them downward.
  • the hook 57 positioned in the axial direction receives an appropriate pressing force and is inserted between the elastic arms 53 and 53 of the connecting member 48.
  • the contact surface 56 of the connecting member 48 can be pressed by the positioning surface 158 of the slider 85, and the connecting member 48 can be moved to an appropriate position.
  • the front hook 58 rotates so that the outer peripheral surface of the rectangular column portion 58a is along the pressing surface 153, elastically deforms the elastic arms 53 and 53, Can be pushed in. Then, as shown in FIG. 17B, the front hook 58 is completely inserted between the elastic arms 53, 53, and the operation wire 12 is also sandwiched between both by sandwiching the holding portions 54, 54. Further, the rear hook 59 abuts against the rear end surfaces of the holding portions 54 and 54.
  • connection clip package 80 including the operation of accommodating the connection clip unit 13 in the clip magazine 81, first, the clips 19A to 19C, the connection rings 20A to 20C, the dummy clip 47, and the connection member 48 are placed on the lower case 111. Concatenate.
  • connection clip unit 13 is stored in the lower case 111 such that each skirt portion 38 is inserted into the skirt opening 114 and the notch 115 (see FIG. 25).
  • the clip engaging portion 103 of the clip taking-out member 83 is also accommodated in the lower case 111, the arms 25 and 25 of the leading clip 19A are closed, and the claw portions 23 and 23 are engaged with the engaging holes 103c and 103c.
  • the upper case 112 is put on the lower case 111 to join them together to form the clip magazine 81.
  • the clip magazine 81 in which the connection clip unit 13 is accommodated is set on the lower jig 120 together with the clip take-out member 83 engaged with the connection clip unit 13.
  • the clip magazine 81 is set on the magazine recess 122 and the clip take-out member 83 is set on the skirt closing passage 97 (see FIG. 24).
  • the ribs 116 are engaged with the position regulating recesses 123, 123.
  • the assembly work of the connected clip package 80 is completed.
  • connection clip unit 13 from the connection clip package 80 to the sheath 11
  • the clip magazine 81 is engaged to a position where it abuts against the abutting surface 98 as shown in FIG. .
  • the positioning key 117 is engaged with the positioning key groove 93, and the click protrusion 117b is engaged with the click hole. In this state, even if the slider 85 is pushed into the connection position, the sheath pressing piece 159 hits the clip magazine 81, so that the pushing movement of the slider 85 is restricted.
  • the holding portion 113 of the clip magazine 81 is pressed with a thumb or a thumb ball, and the loading device 82 is sandwiched from below with another finger, and the clip magazine is utilized using the recess 90.
  • 81 and the loading device 82 are held together, and the towing unit 101 is pulled from the loading device 82.
  • the insertion portion 102 is pulled out from the loading device 82, and the clip engaging portion 103 follows this and moves to the skirt closing passage 97.
  • the connecting clip unit 13 is pulled by the clip engaging portion 103 and pulled into the skirt closing passage 97 from the clip accommodating portion 87.
  • the clip magazine 81 is restricted from moving toward the opening 91a by the engagement between the ribs 116 and 116 and the position restricting grooves 92 and 92.
  • the connecting clip unit 13 drawn into the skirt closing passage 97 is closed by the skirt portions 38 of the connecting rings 20 being pushed by the inner wall of the skirt closing passage 97.
  • the leading clip 19A reaches the release groove 105
  • the arms 25 and 25 of the clip 19A are released, and the bracket 84 is detached from the clip 19A and the clip engaging portion 103 due to the displacement of the clip 19A, and the claw 23 , 23 and the clip engaging portion 103 are released.
  • the connecting clip unit 13 stops at a predetermined position in the skirt closing passage 97. At this stop position, the connecting member 48 of the connecting clip body 18 reaches a position corresponding to the connecting opening 95.
  • the clip removing member 83 is pulled until the check protrusion 102a protrudes out of the loading device 82.
  • the clip magazine 81 is extracted from the magazine insertion groove 91 in the axial direction.
  • the sheath 11 is inserted into the magazine insertion groove 91 through the opening 91a. From the distal end of the sheath 11, the operation wire 12 and the hook 57 protrude in advance by a pulling operation of the sheath operation unit 63 with respect to the wire operation unit 62.
  • the axial position of the sheath 11 with respect to the loading device 82 is visually determined by the hook 57 protruding from the distal end of the sheath 11.
  • the hook 57 is inserted into the connection opening 95 so as to be overlapped with the connection member 48.
  • the distal end portion of the sheath 11 is held by the thumb applied to the concave portion 90, and the loading device 82 is supported from below by another finger, so that the sheath 11 and the loading device 82 are sandwiched and held.
  • the distal end portion of the sheath 11 is held such that its axial position does not shift with respect to the loading device 82.
  • positioning pieces 155 and 156 of the slider 85 are arranged in the connection opening 95 as shown in FIG.
  • the position of the hook 57 inserted in the connection opening 95 in the axial direction is regulated by the positioning pieces 155 and 156. Therefore, even if the operator grips the distal end portion of the sheath 11 and the loading device 82 and rolls or extends the proximal end side of the sheath 11, the surgeon can axially move with respect to the hook 57 through the operation wire 12.
  • the hook 57 is not displaced because the position of the hook 57 in the axial direction is restricted by the positioning pieces 155 and 156. Thereby, the positional relationship in the axial direction between the hook 57 and the connecting member 48 is maintained at an appropriate position.
  • the front hook 58 is disposed at a position corresponding to the elastic arms 53 and 53.
  • the sheath 11 is advanced with respect to the operation wire 12, the sheath 11 is inserted to the back of the magazine insertion groove 91, and the tip abuts against the abutting surface 98.
  • the slide restriction of the slider 85 which is restricted by the sheath pressing piece 159 of the slider 85 and the clip magazine 81 is released.
  • the pressing surface 153 presses the front hook 58 and the rear hook 59 downward.
  • the sheath pressing piece 159 holds the sheath 11 to prevent the magazine from being removed from the magazine insertion groove 91.
  • the front hook 58 pressed by the slider 85 is inserted between the elastic arms 53 and 53.
  • the operation wire 12 is sandwiched between the sandwiching portions 54 and 54.
  • the rear hook 59 comes into contact with the rear end surfaces of the holding portions 54 and 54.
  • the operation wire 12 is pulled with respect to the sheath 11.
  • the operation wire 12 can be moved largely with respect to the sheath 11 by pulling the wire operation unit 62 with respect to the sheath operation unit 63.
  • FIG. 20B when the operation wire 12 is pulled, the connection clip unit 13 connected to the operation wire 12 is drawn together into the sheath 11 from the rear end side. Since the skirt closing passage 97 and the inner diameter surface of the sheath 11 are connected while the connecting clip unit 13 is being loaded, the connecting clip unit 13 can be moved while the skirt portion 38 is closed, and the resistance can be reduced. it can. As a result, the connecting clip unit 13 can be loaded into the sheath 11 without causing a positional shift between the clips 19A to 19C and the connecting rings 20A to 20C.
  • the hooks 57 in the loading device 82 can be accurately positioned in the axial direction by the positioning pieces 155 and 156 provided integrally with the slider 85. It becomes. Since the movement of the hook 57 in the axial direction is restricted by the positioning pieces 155 and 156, the axial position of the hook 57 does not shift due to the behavior of the proximal end side of the sheath 11. For this reason, since there is no need to fix the proximal end side of the sheath 11 in consideration of the axial displacement of the hook 57 during the coupling operation, the operability of the coupling operation is improved.
  • the hook 57 can be inserted into the loading device 82 from the connection opening 95.
  • the hooks 57 are dropped between the positioning pieces 155 and 156 so that the positioning can be easily performed.
  • the slider 85 in which the pushing piece 151 that presses the hook 57 and the positioning pieces 155 and 156 that position the hook 57 are integrally used is used, but the positioning piece that positions the hook 57 is used. It may be provided separately from the slider.
  • the loading device 82 includes a slider 185 provided with a pushing piece 187 and a positioning member 186 provided separately from the slider 185.
  • the slider 185 is integrally formed with an operation unit (not shown) similar to the operation unit 150 of the first embodiment and a push piece 187 that is provided integrally with the operation unit and inserted into the slider passage 100.
  • the pushing piece 187 is formed with a bottom surface having a step corresponding to the upper surfaces 133a, 134a, 133b, and 134b of the slider projections 133 and 134 in the same manner as the pushing piece 151 provided on the slider 85 of the above embodiment.
  • a pressing surface 188 that is inclined toward the bottom surface on the skirt closing passage 97 side is formed. Further, a recessed portion 189 constituting a part of the skirt closing passage 97 is formed behind the pressing surface 188 when in the connecting position.
  • a contact piece 190 that protrudes forward in the sliding direction from both sides of the pressing surface 188 and a sheath pressing piece 191 are formed on the distal end side of the pushing piece 187.
  • the contact piece 190 contacts the positioning member 186 and pushes the positioning member 186 forward.
  • the contact piece 190 is provided with a positioning surface 192 on the opposite side of the pressing surface 188.
  • the positioning surface 192 contacts and presses against the contact surface 56 of the connecting member 48 to position the connecting member 48.
  • the sheath pressing piece 191 presses the sheath 11 and prevents it from detaching from the magazine insertion groove 91 when the slider 185 moves from the initial position to the coupling position.
  • an elastic piece 193 is formed on the side surface of the pushing piece 187 opposite to the positioning surface 192, and an engaging protrusion that engages with the click grooves 162 and 162 of the loading device 82 is formed at the tip of the elastic piece 160. 194 is provided.
  • the positioning member 186 is located on the opposite side of the slider 185 with the magazine insertion groove 91 and the skirt closing passage 97 interposed therebetween, and a base end portion 195 movably provided along the slider passage 100, and the base end portion 195 Positioning pieces 196 and 197 projecting toward the slider 185 are integrally provided.
  • the positioning piece 196 on the skirt closing passage 97 side is formed so as to protrude beyond the skirt closing passage 97 to a position where it comes into contact with the contact piece 190 of the slider 185.
  • the positioning piece 197 on the magazine insertion groove 91 side is The protrusion to the slider 185 side is formed so as not to interfere with the insertion of the operation wire 12 while being in contact with the rear end surface of the rear hook 59.
  • the hook 57 inserted from the connection opening 95 is disposed between the elastic arms 53 and 53 of the connection member 48, and the front and rear ends of the hook 57 are sandwiched between the positioning pieces 196 and 197, so that the axial direction Is positioned.
  • the pressing surface 188 pushes the hook 57 and the contact piece 190 pushes the positioning member 186 forward.
  • the front hook 58 is inserted between the elastic arms 53 and 53, and the operation wire 12 is also sandwiched between the sandwiching portions 54 and 54.
  • a loading device is used separately from the clip magazine, and the connection clip unit is transferred from the clip housing portion of the clip magazine to the skirt closing passage of the loading device, and then connected by a slider provided in the loading device.
  • a member and a hook are connected is described.
  • the storage unit according to the claims of the present invention corresponds to a loading device, and the storage portion corresponds to a skirt closing passage of the loading device.
  • the connection between the connection member and the hook may be completed by the connection auxiliary member in a state where the connection clip unit is accommodated in the clip magazine without using the loading device.
  • the clip package according to the present invention has been described in detail above. However, the present invention is not limited to the above-described embodiments, and various improvements and modifications may be made without departing from the spirit of the present invention. It is. Moreover, the clip treatment tool using the clip package of the present invention can be used for a rigid endoscope as well as a flexible endoscope.

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  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Vascular Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Reproductive Health (AREA)
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Abstract

A slider (85) is mounted in a loading device (82). A connected clip unit (13) formed by connecting clips and a connection member (48) is delivered into a skirt closing path (97) of the loading device (82). Positioning sections (155, 156) are formed on the slider (85). When a hook (57) which is provided to the tip of an operation wire (12) is dropped into the loading device (82) through a connecting opening (95), the positioning sections (155, 156) make contact with the front end and the rear end of the hook (57) in the axis direction. When the slider (85) is pushed in, the hook (57) provided to the operation wire (12) is pressed in the direction perpendicular to the axis direction of the connected clip unit (13) and the hook (57) is connected to the connection member (48).

Description

クリップパッケージClip package
　本発明は、生体内等で止血や傷口の閉塞等を連続して行うことができる操作ハンドルに装填されるクリップユニットと、これを操作ハンドルに装填する装填器具とを備えたクリップパッケージに関する。 The present invention relates to a clip package that includes a clip unit that is loaded on an operation handle that can continuously perform hemostasis, occlusion of a wound, and the like in a living body, and a loading device that loads the clip unit on the operation handle.
　クリップ処置具（操作ハンドル）は、内視鏡の鉗子チャンネルを通じて生体内に挿入され、その先端からクリップを突出させ、出血部や病変組織を除去した部位といった患部をクリップで挟み、止血や傷口の閉塞等を行うクリップ処置に用いられる。特許文献１には、クリップとクリップの後端と係合する連結部材とからなるクリップユニットを用い、このクリップユニットをクリップマガジンに収容した状態でシースに挿通された操作ワイヤと連結させて、クリップユニットをシースに装填する方法が記載されている。操作ワイヤの先端にはクリップユニットの連結部材と連結するフックが設けられている。 The clip treatment tool (operation handle) is inserted into the living body through the forceps channel of the endoscope, the clip protrudes from the tip, and the affected part such as the bleeding part or the site where the diseased tissue has been removed is sandwiched between the clips to stop hemostasis or wounds. Used for clip treatment for obstruction. In Patent Document 1, a clip unit including a clip and a connecting member that engages with the rear end of the clip is used, and the clip unit is connected to an operation wire inserted through a sheath while being accommodated in a clip magazine. A method for loading a unit into a sheath is described. A hook for connecting to the connecting member of the clip unit is provided at the tip of the operation wire.
　クリップユニットの装填は、まず、フックをシースから露出させた状態でクリップマガジン内に進入させ、フックを連結部材の後端に突き当てて、操作ワイヤを軸方向に沿って移動させることで連結部材にフックを押し込んで連結を行う。次に、連結が完了した後、操作ワイヤを牽引して、クリップユニットをクリップマガジン外に引き出し、シース内に引き込む。これによれば、操作ワイヤの軸方向の進退操作という簡単な操作でクリップユニットの装填を行うことができる。 The clip unit is loaded by first entering the clip magazine with the hook exposed from the sheath, butting the hook against the rear end of the connecting member, and moving the operation wire along the axial direction. Push the hook into to connect. Next, after the connection is completed, the operation wire is pulled, the clip unit is pulled out of the clip magazine, and pulled into the sheath. According to this, the clip unit can be loaded by a simple operation such as an axial advance / retreat operation of the operation wire.
特開２００２－１９１６０９号公報JP 2002-191609 A
　上記クリップ処置具では、操作ワイヤを軸方向に動かす操作によって連結部材に対するフックの押し込みを行うため、連結部材とフックの径方向の位置を合わせた状態でフックを押し込む必要がある。操作ワイヤは柔軟性が高いため、先端のフックはふらつきやすく、両者の位置決め作業には手間がかかるという懸念もある。例えば、操作ワイヤのフックを連結部材に向けて進めて両者を接近させたときに、両者の径方向の位置がずれている場合には連結が行われないため、操作ワイヤをいったん後退させた後、再度操作ワイヤを進めなければならない。また、両者の径方向の位置がずれている状態でフックが連結部材に押し込まれた場合には、両者の係合が不十分となり連結不良が生じる懸念もある。 In the above-mentioned clip treatment tool, since the hook is pushed into the connecting member by moving the operation wire in the axial direction, it is necessary to push the hook in a state where the connecting member and the hook are aligned in the radial direction. Since the operation wire is highly flexible, the hook at the tip is likely to be wobbling, and there is a concern that both positioning operations are troublesome. For example, if the hooks of the operation wire are advanced toward the connecting member and the two are approached, the connection is not performed if the radial positions of the two are shifted. The operation wire must be advanced again. Further, when the hook is pushed into the connecting member in a state where the radial positions of both are shifted, there is a concern that the engagement between the two becomes insufficient and poor connection occurs.
　そこで、本出願人は、両者の連結を簡単に行うための装填器具を備えたクリップパッケージを研究、開発している。この装填器具には、いったんクリップマガジンから引き出したクリップユニットが先頭から送り込まれる通路と、この通路から露出した連結部材とフックとの連結操作を補助する連結補助部材とが設けられている。連結補助部材は、軸方向において連結部材と重なり合ったフックを押圧して、連結部材にフックを押し込んで連結を完了させるものである。 Therefore, the applicant has researched and developed a clip package equipped with a loading device for easily connecting the two. This loading device is provided with a passage through which the clip unit once pulled out from the clip magazine is sent from the head, and a connection auxiliary member for assisting the connection operation between the connection member exposed from this passage and the hook. The auxiliary connecting member presses a hook that overlaps the connecting member in the axial direction, and pushes the hook into the connecting member to complete the connection.
　出願人は、上記連結補助部材を設けた装填器具の製品化に向けて研究開発を重ねているが、その中で、術者の連結操作の操作性に関する以下の課題が見出された。連結補助部材を設けた装填器具の連結操作においては、連結部材と、シースの先端から突出させたフックとが重なり合うように、術者が、連結部材とフックの軸方向の位置を目視で位置合わせし、シースの先端と装填器具とを一緒に把持することによって位置合わせした状態を保持する必要がある。 Applicants have been researching and developing for the commercialization of the loading device provided with the above-mentioned connection auxiliary member, and among them, the following problems related to the operability of the operator's connection operation have been found. In the connection operation of the loading device provided with the connection auxiliary member, the operator visually aligns the position of the connection member and the hook in the axial direction so that the connection member and the hook protruding from the distal end of the sheath overlap. However, it is necessary to maintain the aligned state by grasping the sheath tip and the loading device together.
　しかしながら、先端にフックが設けられた操作ワイヤは、シースに対して進退自在な状態でシース内に挿通されており、シース及び操作ワイヤは長尺（約２ｍ）でかつ可撓性を有する。このため、シースの先端部を把持して連結部材の位置にフックの軸方向の位置を合わせても、操作ワイヤを直接把持するわけではないため、シースの基端側の挙動、例えば、巻き回されたり、伸ばされたりすることによって、フックがシースに対して進退し、フックの軸方向の位置がずれるおそれがあった。 However, the operation wire provided with a hook at the tip is inserted into the sheath so as to be movable back and forth with respect to the sheath, and the sheath and the operation wire are long (about 2 m) and have flexibility. For this reason, even if the distal end portion of the sheath is gripped and the axial position of the hook is aligned with the position of the connecting member, the operation wire is not directly gripped. When the hook is stretched or stretched, the hook moves forward and backward with respect to the sheath, and the axial position of the hook may shift.
　これは、シースを湾曲させたときに生じる、シースの管道内の内周と外周の差に起因するもので、シースの湾曲状態によってその内部を挿通する操作ワイヤの湾曲状態が変化して、操作ワイヤの先端のフックがシースの先端に対して進退するためであることが判明した。 This is caused by the difference between the inner and outer circumferences of the sheath in the conduit, which occurs when the sheath is bent. The bending state of the operation wire that passes through the sheath changes depending on the bending state of the sheath. It has been found that this is because the hook at the tip of the wire advances and retreats with respect to the tip of the sheath.
　フックの連結操作においては、術者がシースの基端側を保持する姿勢や、その保持位置変更するために、シースの基端側を動かさざるを得ない場合が多く、フックの連結操作の間、シースの基端側を固定しておくことは、連結操作の操作性を著しく悪化させる。このため、シースの基端側が動いても、フックの軸方向の位置がずれないようにするための対策が求められていた。 In the hook connection operation, the operator often has to move the proximal end side of the sheath in order to change the posture of holding the proximal end side of the sheath or the holding position thereof. Securing the proximal end side of the sheath significantly deteriorates the operability of the coupling operation. For this reason, even if the proximal end side of the sheath moves, a countermeasure for preventing the position of the hook in the axial direction from shifting is required.
　本発明は、シースに挿通された操作ワイヤのフックと装填器具に収容されたクリップユニットの連結部材との連結に際して、シースの先端部と装填器具とを把持した状態でシースの基端側が動いてもフックの軸方向の位置ずれが生じないクリップパッケージを提供することを目的とする。 In the present invention, when the hook of the operation wire inserted through the sheath and the connecting member of the clip unit accommodated in the loading device are connected, the proximal end side of the sheath moves while holding the distal end portion of the sheath and the loading device. It is another object of the present invention to provide a clip package in which the axial displacement of the hook does not occur.
　上記目的を達成するために、本発明は、操作ワイヤが挿通されたシース内に複数のクリップユニットを装填するためのクリップパッケージにおいて、前記複数のクリップユニットを一列に沿って収容するクリップマガジンと、前記クリップマガジンが挿入されるマガジン挿入部と、前記クリップマガジンから複数のクリップユニットを取り出すクリップ取り出し部材と、前記クリップマガジンから取り出した複数のクリップユニットを収容する収容部と、前記収容部内のクリップユニットのうち最端部のクリップユニットに対する前記操作ワイヤのフックの位置を規制する位置規制部と、前記最端部のクリップユニット及びフックのうち少なくとも一方を他方に向けて押圧することにより、前記最端部のクリップユニットと前記フックを連結させる連結補助部材とを有し、前記最端部のクリップユニットに前記フックを連結した後は、前記操作ワイヤを引き込むことによって複数のクリップユニットをシース内に装填する装填器具とを備えたことを特徴とする。 In order to achieve the above object, the present invention provides a clip package for loading a plurality of clip units into a sheath through which an operation wire is inserted, a clip magazine for accommodating the plurality of clip units along a line, and A magazine insertion portion into which the clip magazine is inserted, a clip removal member for taking out a plurality of clip units from the clip magazine, a housing portion for housing a plurality of clip units taken out from the clip magazine, and a clip unit in the housing portion A position restricting portion for restricting a position of the hook of the operation wire with respect to the clip unit at the endmost portion, and pressing the at least one of the clip unit and the hook at the endmost portion toward the other, thereby The clip unit and the hook And a loading device for loading a plurality of clip units into a sheath by drawing the operation wire after the hook is connected to the clip unit at the end. Features.
　前記位置規制部は、前記フックを、その軸方向の前後から挟み込むように形成された一対の位置決め片からなることが好ましい。前記装填器具には、前記フックと連結する前記最端部のクリップユニットの連結部を外部に露呈させる開口部が形成されており、前記位置規制部は、前記開口部に対応する位置に配置されていることが好ましい。 It is preferable that the position restricting portion includes a pair of positioning pieces formed so as to sandwich the hook from the front and rear in the axial direction. The loading device is formed with an opening that exposes a connecting portion of the clip unit at the endmost portion that is connected to the hook, and the position restricting portion is disposed at a position corresponding to the opening. It is preferable.
　前記連結補助部材は、前記クリップユニットの軸方向と直交するスライド方向に移動自在なスライダであり、前記スライダはスライド方向に対して傾斜している押圧面を有しており、この押圧面を前記フック及び前記連結部のうちの一方に接触させて押圧方向に押し込んでいくことにより、前記スライドによる押し込み量を徐々に増加させることが好ましい。 The connection assisting member is a slider that is movable in a sliding direction orthogonal to the axial direction of the clip unit, and the slider has a pressing surface that is inclined with respect to the sliding direction. It is preferable that the amount of pushing by the slide is gradually increased by making contact with one of the hook and the connecting portion and pushing in the pushing direction.
　前記位置規制部は、前記スライダと一体に形成されており、前記スライド方向において前記押圧面よりも前方に向けて突出していることが好ましい。前記装填器具には、前記マガジン挿入部に挿入されたクリップマガジンの位置を規制するマガジン位置規制溝が形成されていることが好ましい。前記スライダと一体に形成されており、前記スライダのスライド中に、前記フックの後方に配された前記シースの上端と当接し、前記シースの径方向の移動を規制する押さえ部材が設けられていることが好ましい。前記装填器具に前記クリップマガジンが接続された状態において、前記押さえ部材は、その前端が前記クリップマガジンと当接することにより、前記スライダの移動を規制することが好ましい。前記装填器具には、前記スライダがスライドするスライダ通路が設けられており、前記スライダには、前記スライダ通路の内壁と係合して、前記スライダの前記スライダ通路からの抜け止めを防止する係合突起が形成されていることが好ましい。前記位置規制部は、前記連結補助部材と別体に設けられていることが好ましい。 It is preferable that the position restricting portion is formed integrally with the slider and protrudes more forward than the pressing surface in the sliding direction. It is preferable that a magazine position restriction groove for restricting the position of the clip magazine inserted into the magazine insertion portion is formed in the loading device. A holding member that is formed integrally with the slider and that abuts on the upper end of the sheath disposed behind the hook and restricts the radial movement of the sheath while the slider slides is provided. It is preferable. In the state where the clip magazine is connected to the loading device, it is preferable that the pressing member regulates the movement of the slider by abutting the front end of the pressing member with the clip magazine. The loading device is provided with a slider passage through which the slider slides. The slider engages with an inner wall of the slider passage to prevent the slider from coming off from the slider passage. It is preferable that protrusions are formed. It is preferable that the position restricting portion is provided separately from the connection assisting member.
　本発明によれば、収容部内のクリップユニットのうち最端部のクリップユニットに対する操作ワイヤのフックの位置を規制した状態で、最端部のクリップユニット及びフックのうち少なくとも一方を他方に向けて押圧することにより、最端部のクリップユニットとフックとを連結していることから、連結操作の際、シースの基端側が動いても、フックの軸方向の位置ずれが生じることがない。 According to the present invention, in a state where the position of the hook of the operation wire with respect to the clip unit at the end of the clip unit in the accommodating portion is regulated, at least one of the clip unit and the hook at the end is pressed toward the other. Thus, since the clip unit and the hook at the endmost part are connected, even if the proximal end side of the sheath moves during the connection operation, the axial displacement of the hook does not occur.
連発式操作ハンドルの構成を示す外観斜視図である。It is an external appearance perspective view which shows the structure of a repetitive operation handle. クリップユニットの構成を示す断面図である。It is sectional drawing which shows the structure of a clip unit. 図２Ａとは別の側面から見たときのクリップユニットの構成を示す断面図である。It is sectional drawing which shows the structure of a clip unit when it sees from the side different from FIG. 2A. クリップ及び連結リングの外観斜視図である。It is an external appearance perspective view of a clip and a connection ring. 連結リングの断面図である。It is sectional drawing of a connection ring. ダミークリップ及びフックの外観斜視図である。It is an external appearance perspective view of a dummy clip and a hook. 連発式操作ハンドルのクリップ処置操作における段階的な状態を示す部分断面図である。It is a fragmentary sectional view which shows the stepped state in the clip treatment operation of a repetitive operation handle. クリップパッケージの外観斜視図である。It is an external appearance perspective view of a clip package. クリップパッケージの要部断面図である。It is principal part sectional drawing of a clip package. クリップパッケージの分解斜視図である。It is a disassembled perspective view of a clip package. クリップマガジンの分解斜視図である。It is a disassembled perspective view of a clip magazine. 装填器具の分解斜視図である。It is a disassembled perspective view of a loading instrument. スライダ用凸部周辺の構成を示す斜視図である。It is a perspective view which shows the structure of the convex part for sliders. スライダの底面側斜視図である。It is a bottom side perspective view of a slider. スライダの位置決め片によるフックの位置決め状態を示す平面図である。It is a top view which shows the positioning state of the hook by the positioning piece of a slider. マガジン挿入溝にクリップマガジンが挿入された状態を示す平面図である。It is a top view which shows the state by which the clip magazine was inserted in the magazine insertion groove. スライダによる係合部に対するフックの挿入を示す断面図である。It is sectional drawing which shows insertion of the hook with respect to the engaging part by a slider. 図１６Ａの状態からフックが更に挿入されたことを示す断面図である。It is sectional drawing which shows that the hook was further inserted from the state of FIG. 16A. スライダによる係合部とフックとの連結状態を示す断面図である。It is sectional drawing which shows the connection state of the engaging part and hook by a slider. 係合部とフックとが完全に連結された状態を示す断面図である。It is sectional drawing which shows the state by which the engaging part and the hook were connected completely. 連結クリップパッケージでクリップマガジンから装填器具に連結クリップユニットを引き込み、装填器具からケースを抜き取った状態を示す断面図である。It is sectional drawing which shows the state which pulled the connection clip unit from the clip magazine to the loading instrument with the connection clip package, and extracted the case from the loading instrument. 連結クリップパッケージでシース等を装填器具に挿入した状態を示す断面図である。It is sectional drawing which shows the state which inserted the sheath etc. in the loading instrument with the connection clip package. 連結クリップユニットと操作ワイヤとを連結させた状態に、装填器具からシース内に連結クリップユニットを引き込んだ状態を示す断面図である。It is sectional drawing which shows the state which pulled the connection clip unit in the sheath from the loading instrument in the state which connected the connection clip unit and the operation wire. 別の実施形態のスライダ及び位置決め片を示す平面図である。It is a top view which shows the slider and positioning piece of another embodiment.
　図１に示すように、連発式操作ハンドル（以下、操作ハンドルと呼ぶ）１０は、円筒状のシース１１と、シース１１内に挿通された操作ワイヤ１２と、シース１１内に装填されて操作ワイヤ１２に連結される連結クリップユニット１３と、シース１１と操作ワイヤ１２との牽引操作に用いるハンドル本体１４を備えている。 As shown in FIG. 1, a repetitive operation handle (hereinafter referred to as operation handle) 10 includes a cylindrical sheath 11, an operation wire 12 inserted into the sheath 11, and an operation wire loaded in the sheath 11. And a handle main body 14 used for pulling operation of the sheath 11 and the operation wire 12.
　図２に示すように、連結クリップユニット１３は、１列に連結された複数個の止血クリップ体１７（１７Ａ～１７Ｃ）と、最後尾の止血クリップ体１７Ｃに連結された連結用クリップ体１８から構成されている。止血クリップ体１７は、クリップ１９（１９Ａ～１９Ｃ）と、クリップ１９の外側に装着された筒状の連結リング２０（２０Ａ～２０Ｃ）とを備えている。 As shown in FIG. 2, the connecting clip unit 13 includes a plurality of hemostatic clip bodies 17 (17A to 17C) connected in a row and a connecting clip body 18 connected to the last hemostatic clip body 17C. It is configured. The hemostatic clip body 17 includes a clip 19 (19A to 19C) and a cylindrical connecting ring 20 (20A to 20C) attached to the outside of the clip 19.
　図３に示すように、クリップ１９は、一枚の細長い板を１８０度湾曲させて閉塞端を作った後、その両片を交差させ、かつ２つの開放端が対向するように屈曲させて爪部２３，２３を形成している。クリップ１９は、細長い板を交差させた交差部２４を境にして、開放端側が腕部２５，２５であり、閉塞端側がターン部２６である。腕部２５，２５の中央部分には、部分的に広幅とされた凸部２７，２７が形成されている。 As shown in FIG. 3, the clip 19 is formed by bending a single elongated plate 180 degrees to form a closed end, crossing the two pieces, and bending the two open ends to oppose each other. Portions 23 and 23 are formed. The clip 19 has arm portions 25 and 25 on the open end side and a turn portion 26 on the closed end side, with a crossing portion 24 crossing the elongated plates as a boundary. Convex portions 27 and 27 that are partially wide are formed at the central portions of the arm portions 25 and 25.
　腕部２５，２５は、外力が加えられていないときに、爪部２３，２３が離れた開放状態となり、互いに接近するように弾性変形したときに爪部２３，２３が噛合し、クリップ処置の対象となる患部を挟む閉じ状態となる。爪部２３，２３は、患部を確実に挟むために、Ｖ字のオス型とメス型に形成されている。クリップ１９には、生体適合性のある金属を用いることができ、例えば、ばね用ステンレス鋼であるＳＵＳ６３１を用いることができる。 When the external force is not applied, the arm portions 25 and 25 are in an open state in which the claw portions 23 and 23 are separated, and when the arm portions 25 and 25 are elastically deformed so as to approach each other, the claw portions 23 and 23 mesh with each other. It will be in the closed state which pinches | interposes the affected part used as object. The nail | claw parts 23 and 23 are formed in the V-shaped male type and female type | mold in order to pinch | interpose an affected part reliably. The clip 19 can be made of a biocompatible metal, for example, SUS631 which is stainless steel for springs.
　連結リング２０は、略円筒形状であり、先端側に配された金属製の締付部３０と、後端側に配されたプラスチック製の保持部３１とを備えている。止血クリップ体１７は、締付部３０に形成された締付穴３０ａに、クリップ１９がターン部２６側から挿入され、連結リング２０がクリップ１９の外側に装着されることにより形成される。締付部３０は、交差部２４の外周を覆う初期位置にセットされ、クリップ１９の腕部２５，２５は、開いた状態となる。 The connecting ring 20 has a substantially cylindrical shape, and includes a metal fastening portion 30 disposed on the front end side and a plastic holding portion 31 disposed on the rear end side. The hemostatic clip body 17 is formed by inserting the clip 19 into the tightening hole 30 a formed in the tightening portion 30 from the turn portion 26 side and mounting the connecting ring 20 on the outside of the clip 19. The tightening portion 30 is set at an initial position covering the outer periphery of the intersecting portion 24, and the arm portions 25, 25 of the clip 19 are in an open state.
　締付穴３０ａは、クリップ１９が連結リング２０内に引き込まれたときに、腕部２５，２５を締め付けて爪部２３，２３を閉じる。爪部２３，２３は、腕部２５，２５が締め付けられることにより、所定の噛合力を発揮する。締付穴３０ａの径は、クリップ１９の凸部２７の幅よりも小さいので、クリップ１９の凸部２７から先は連結リング２０内に挿入されない。 The tightening hole 30a closes the claw portions 23 and 23 by tightening the arm portions 25 and 25 when the clip 19 is pulled into the connecting ring 20. The claw portions 23 and 23 exhibit a predetermined meshing force when the arm portions 25 and 25 are tightened. Since the diameter of the fastening hole 30 a is smaller than the width of the convex portion 27 of the clip 19, the tip from the convex portion 27 of the clip 19 is not inserted into the connecting ring 20.
　図４に示すように、保持部３１には、締付穴３０ａに連なる保持穴３１ａが形成されている。締付穴３０ａから挿入されたターン部２６は、保持穴３１ａ内に収容される。保持部３１の外周面には、中心軸に対して対称に、２つのスカート部３８，３８が形成されている。スカート部３８，３８は、保持部３１の先端側から後端側に向かって半径方向に広がるように形成されており、外力が加えられていないときに自身の弾性で開き、外側から押されたときに保持部３１内に入り込むようにして閉じる。 As shown in FIG. 4, the holding portion 31 is formed with a holding hole 31 a continuous with the tightening hole 30 a. The turn part 26 inserted from the tightening hole 30a is accommodated in the holding hole 31a. Two skirt portions 38 are formed on the outer peripheral surface of the holding portion 31 symmetrically with respect to the central axis. The skirt portions 38, 38 are formed so as to expand in the radial direction from the front end side to the rear end side of the holding portion 31, and are opened by their own elasticity when external force is not applied, and are pressed from the outside. Sometimes it closes so as to enter the holding part 31.
　連結リング２０は、爪部２３，２３の開閉方向と、スカート部３８，３８の開閉方向とが９０°ずれるように、クリップ１９の外側に装着される。スカート部３８，３８は、連結クリップユニット１３がシース１１内に装填されて閉じたときに、保持穴３１ａ内に収容されているターン部２６を挟み込み、連結リング２０をクリップ１９と一体化させる。 The connecting ring 20 is attached to the outside of the clip 19 so that the opening / closing direction of the claw portions 23, 23 and the opening / closing direction of the skirt portions 38, 38 are shifted by 90 °. When the connecting clip unit 13 is loaded into the sheath 11 and closed, the skirt portions 38 and 38 sandwich the turn portion 26 accommodated in the holding hole 31 a and integrate the connecting ring 20 with the clip 19.
　複数個の止血クリップ体１７は、前方に配されているクリップ１９のターン部２６に後方のクリップ１９の爪部２３，２３を係合することによって１列に連結している。連結リング２０は、後方のクリップ１９の爪部２３，２３の外側を覆い、爪部２３，２３が開かないようにして、クリップ１９の連結を維持する。クリップ１９の凸部２７は、保持穴３１ａの径よりも大きな幅寸法を有しており、連結リング２０の後方に配されたときに、その連結リング２０の後端に当接する。これにより、連結リング２０は、上述した初期位置から、連結クリップユニット１３の後端側への移動が規制される。 The plurality of hemostatic clip bodies 17 are connected in a row by engaging the claw portions 23 and 23 of the rear clip 19 with the turn portion 26 of the clip 19 disposed on the front side. The connection ring 20 covers the outside of the claw portions 23 and 23 of the rear clip 19 and maintains the connection of the clip 19 so that the claw portions 23 and 23 do not open. The projecting portion 27 of the clip 19 has a width that is greater than the diameter of the holding hole 31 a, and abuts against the rear end of the connecting ring 20 when disposed behind the connecting ring 20. Thereby, the movement of the connection ring 20 from the initial position described above to the rear end side of the connection clip unit 13 is restricted.
　連結リング２０の後端部４４、すなわち、スカート部３８よりも後方部分には、周方向においてスカート部３８，３８から９０°ずれた２箇所に、スリット４４ａ，４４ａが形成されている。スリット４４ａ，４４ａは、連結リング２０の軸方向に沿って形成されており、後端部４４が弾性変形してその内径が広がるようになっている。このスリット４４ａは、内視鏡の湾曲に合わせて連結クリップユニット１３が湾曲するように、連結リング２０のフレキシブル性を向上させる。また、スリット４４ａによって、後端部４４の内径が広がるため、組立時において、２つのクリップ１９の係合作業が行いやすい。 Slits 44 a and 44 a are formed at two positions shifted from the skirt portions 38 and 38 in the circumferential direction at the rear end portion 44 of the connecting ring 20, that is, at the rear portion of the skirt portion 38. The slits 44a and 44a are formed along the axial direction of the connecting ring 20, and the rear end portion 44 is elastically deformed so that the inner diameter thereof is expanded. The slit 44a improves the flexibility of the connecting ring 20 so that the connecting clip unit 13 is bent in accordance with the bending of the endoscope. Further, since the inner diameter of the rear end portion 44 is widened by the slit 44a, it is easy to engage the two clips 19 during assembly.
　保持部３１には、生体適合性があり、かつ、スカート部３８に要求される弾性および剛性を満たす材料が用いられる。このような保持部３１の材料としては、例えば、ＰＰＳＵ（ポリフェニルサルホン、polyphenylsulfone）が用いられる。 The holding portion 31 is made of a material that is biocompatible and satisfies the elasticity and rigidity required for the skirt portion 38. For example, PPSU (polyphenylsulfone) is used as the material of the holding unit 31.
　図５に示すように、連結用クリップ体１８（連結部）は、最後尾のクリップ１９Ｃのターン部２６に係合するダミークリップ４７と、ダミークリップ４７を保持する連結部材４８とから構成されている。ダミークリップ４７は、細長い金属の板を折り曲げて構成されており、外力が与えられていないときに開放状態となる一対の腕部４７ａ，４７ａを備えている。各腕部４７ａ，４７ａの先端と中間部分とには、クリップ１９と同様に、爪部４７ｂ，４７ｂと凸部４７ｃ，４７ｃが設けられている。ダミークリップ４７は、クリップ１９と同じ材質で形成することができる。 As shown in FIG. 5, the connecting clip body 18 (connecting portion) includes a dummy clip 47 that engages with the turn portion 26 of the rearmost clip 19 </ b> C and a connecting member 48 that holds the dummy clip 47. Yes. The dummy clip 47 is configured by bending an elongated metal plate, and includes a pair of arm portions 47a and 47a that are opened when no external force is applied. Similar to the clip 19, claw portions 47b and 47b and convex portions 47c and 47c are provided at the tips and intermediate portions of the respective arm portions 47a and 47a. The dummy clip 47 can be formed of the same material as the clip 19.
　ダミークリップ４７は、腕部４７ａ，４７ａの開閉方向が、最後尾のクリップ１９Ｃの開閉方向と９０°ずれるように回転されて連結リング２０Ｃの穴３１ａ内に挿入され、爪部４７ｂ，４７ｂが、クリップ１９Ｃのターン部２６に係合する。連結リング２０Ｃは、爪部４７ｂ，４７ｂが開放状態に変位しないように抑えて、連結状態を維持する。 The dummy clip 47 is rotated so that the opening / closing direction of the arms 47a, 47a is shifted by 90 ° from the opening / closing direction of the rearmost clip 19C and is inserted into the hole 31a of the connecting ring 20C, and the claw portions 47b, 47b are Engage with the turn part 26 of the clip 19C. The connecting ring 20 </ b> C maintains the connected state by suppressing the claw portions 47 b and 47 b from being displaced to the open state.
　連結部材４８は、例えば、連結リング２０の保持部３１と同じ材質で形成された円柱体である。連結部材４８の先端側には、ダミークリップ４７を保持する切欠状の保持部４９が設けられている。連結部材４８の後端側には、操作ワイヤ１２と連結するための連結部５０が設けられている。 The connecting member 48 is, for example, a cylindrical body formed of the same material as the holding portion 31 of the connecting ring 20. A cutout holding portion 49 that holds the dummy clip 47 is provided on the distal end side of the connecting member 48. A connecting portion 50 for connecting to the operation wire 12 is provided on the rear end side of the connecting member 48.
　連結部５０は、連結部材４８の半径方向において弾性自在にされた一対の弾性アーム５３，５３と、弾性アーム５３，５３の先端にそれぞれ設けられた挟持部５４，５４とを有している。一対の挟持部５４，５４の隙間は、操作ワイヤ１２の外径よりも細くされている。また、一対の挟持部５４，５４には、連結部材４８の中心軸に沿って、操作ワイヤ１２の外径と同径の半円形の溝５４ａ，５４ａが形成されている。 The connecting portion 50 includes a pair of elastic arms 53 and 53 that are made elastic in the radial direction of the connecting member 48, and clamping portions 54 and 54 that are provided at the tips of the elastic arms 53 and 53, respectively. The gap between the pair of sandwiching portions 54, 54 is made thinner than the outer diameter of the operation wire 12. In addition, semi-circular grooves 54 a and 54 a having the same diameter as the outer diameter of the operation wire 12 are formed in the pair of sandwiching portions 54 and 54 along the central axis of the connecting member 48.
　連結部材４８には、位置決め部５１が一体に設けられている。位置決め部５１は、後述する連結クリップパッケージ８０（図７参照）によって連結部材４８と操作ワイヤ１２とを連結させる際に、連結部材４８をその軸方向において位置決めする。位置決め部５１は、保持部４９と連結部５０との略中間に配されている。 The positioning member 51 is provided integrally with the connecting member 48. The positioning unit 51 positions the connecting member 48 in the axial direction when the connecting member 48 and the operation wire 12 are connected by a connecting clip package 80 (see FIG. 7) described later. The positioning part 51 is arranged approximately in the middle between the holding part 49 and the connecting part 50.
　位置決め部５１は、弾性アーム５３，５３の上面側に位置し、連結部材４８の円周面の一部が平坦に切り欠かれた平坦面５５と、円周面と平坦面５５との段差に設けられ、径方向外側に向けて立ち上がる当接面５６とからなる。また、当接面５６は、連結部材４８の先端側から後端側へ突出する略三角形状に形成されている。平坦面５５は、後述するスライダ８５の移動を妨げない位置に形成されており、当接面５６は、後述するスライダ８５の位置決め面１５８と当接する位置に形成されている。 The positioning portion 51 is located on the upper surface side of the elastic arms 53, 53, and has a flat surface 55 in which a part of the circumferential surface of the connecting member 48 is cut out flat, and a step between the circumferential surface and the flat surface 55. The contact surface 56 is provided and rises outward in the radial direction. The contact surface 56 is formed in a substantially triangular shape that protrudes from the front end side to the rear end side of the connecting member 48. The flat surface 55 is formed at a position that does not hinder the movement of a slider 85 described later, and the contact surface 56 is formed at a position that contacts a positioning surface 158 of the slider 85 described later.
　シース１１は、例えば、金属ワイヤを密着巻きした可撓性のコイルシースである。シース１１の内径は、先のクリップ１９のターン部２６と、次のクリップ１９の爪部２３，２３との係合が解除される寸法である。すなわち、シース１１の内径は、２つの爪部２３，２３の長さと、ターン部２６の爪部２３，２３が係合する部分の幅とを足し合わせた長さよりも大きい。 The sheath 11 is, for example, a flexible coil sheath in which a metal wire is tightly wound. The inner diameter of the sheath 11 is a dimension in which the engagement between the turn portion 26 of the previous clip 19 and the claws 23 and 23 of the next clip 19 is released. That is, the inner diameter of the sheath 11 is larger than the length obtained by adding the lengths of the two claw portions 23 and 23 and the width of the portion where the claw portions 23 and 23 of the turn portion 26 are engaged.
　操作ワイヤ１２は、生体適合性を有する金属で形成された金属ワイヤである。図５に示すように、操作ワイヤ１２の先端には、連結用クリップ体１８との連結に用いられるフック５７が設けられている。フック５７は、操作ワイヤ１２の先端に取り付けられた前フック５８と、後フック５９とを備えている。 The operation wire 12 is a metal wire formed of a metal having biocompatibility. As shown in FIG. 5, a hook 57 used for connection with the connection clip body 18 is provided at the distal end of the operation wire 12. The hook 57 includes a front hook 58 attached to the tip of the operation wire 12 and a rear hook 59.
　前フック５８は、弾性アーム５３，５３の間の隙間と同じ長さの１辺を有する正方形状の四角柱部５８ａと、弾性アーム５３，５３の隙間に合せた四角錐部５８ｂと有している。後フック５９は、前フック５８の外径よりも大きく、連結部材４８の外径よりもわずかに小さな外径を有する円柱形状である。後フック５９は、前フック５８の後端から所定距離だけ離れた後方に配されている。この所定距離とは、挟持部５４の軸方向の長さと同じ長さである。 The front hook 58 has a square columnar part 58 a having a side with the same length as the gap between the elastic arms 53 and 53, and a quadrangular pyramid part 58 b that matches the gap between the elastic arms 53 and 53. Yes. The rear hook 59 has a cylindrical shape having an outer diameter that is larger than the outer diameter of the front hook 58 and slightly smaller than the outer diameter of the connecting member 48. The rear hook 59 is disposed behind the rear end of the front hook 58 by a predetermined distance. This predetermined distance is the same length as the axial length of the clamping part 54.
　前フック５８は、弾性アーム５３，５３の間に嵌合され、各弾性アーム５３の端部に形成された一対の挟持部５４と当接する。前フック５８と、円柱形状の後フック５９との間の操作ワイヤ１２は、挟持部５４により挟持される。後フック５９は、挟持部５４の後端に当接する。これにより、操作ワイヤ１２の牽引と回転とを連結クリップユニット１３に伝達し、シース１１の牽引時に生じる摩擦力によって連結クリップユニット１３がシース１１と一緒に動かないように押さえることができる。 The front hook 58 is fitted between the elastic arms 53 and 53 and comes into contact with a pair of holding portions 54 formed at the end of each elastic arm 53. The operation wire 12 between the front hook 58 and the columnar rear hook 59 is clamped by the clamping unit 54. The rear hook 59 abuts on the rear end of the holding portion 54. Accordingly, the pulling and rotation of the operation wire 12 can be transmitted to the connecting clip unit 13, and the connecting clip unit 13 can be pressed so as not to move together with the sheath 11 by the frictional force generated when the sheath 11 is pulled.
　図１に示すように、ハンドル本体１４は、シース１１と操作ワイヤ１２とをそれぞれ牽引するシース操作部６３と、ワイヤ操作部６２とを有している。シース操作部６３は、略円筒形状であり、先端にシース１１の後端が固定されている。シース操作部６３は、ワイヤ操作部６２の先端に設けられたパイプ６４の外側にスライド自在に装着されており、パイプ６４に沿ってワイヤ操作部６２側にスライドすることにより、シース１１が操作ワイヤ１２に対して後端側に牽引される。符合６９は、シース１１が操作ワイヤ１２に対して後退するときに、その後退量を術者に対して触知させるためのノッチである。ノッチ６９の間隔は、連結クリップユニット１３のクリップ１９を、１つずつシース１１から押し出すための後退量に対応して設定されている。 As shown in FIG. 1, the handle main body 14 includes a sheath operation portion 63 that pulls the sheath 11 and the operation wire 12, and a wire operation portion 62. The sheath operation part 63 has a substantially cylindrical shape, and the rear end of the sheath 11 is fixed to the tip. The sheath operating portion 63 is slidably mounted on the outside of a pipe 64 provided at the tip of the wire operating portion 62. By sliding along the pipe 64 toward the wire operating portion 62, the sheath 11 is operated by the operating wire. 12 is pulled to the rear end side. Reference numeral 69 is a notch for allowing the operator to feel the amount of retraction when the sheath 11 is retreated with respect to the operation wire 12. The interval between the notches 69 is set corresponding to the retraction amount for pushing out the clips 19 of the connecting clip unit 13 from the sheath 11 one by one.
　ワイヤ操作部６２は、略円筒形状であり、スライド自在な操作レバー６６を内蔵した貫通窓６５を有している。操作ワイヤ１２は、シース操作部６３内を通って、操作レバー６６に後端が係止されている。操作レバー６６をスライドすると、連結リング２０によるクリップ１９の締め付けに必要な量だけ、操作ワイヤ１２がシース１１に対して牽引される。 The wire operation part 62 has a substantially cylindrical shape and has a through window 65 with a slidable operation lever 66 built therein. The operation wire 12 passes through the inside of the sheath operation portion 63 and is engaged with the operation lever 66 at the rear end. When the operation lever 66 is slid, the operation wire 12 is pulled with respect to the sheath 11 by an amount necessary for tightening the clip 19 by the connecting ring 20.
　次に、操作ハンドル１０の作用について、簡単に説明する。図６（Ａ）に示すように、連結クリップユニット１３は、先頭のクリップ１９Ａの先端がシース１１の先端に一致するようにシース１１内に装填されている。シース１１は、生体内に挿入された内視鏡の鉗子チャンネルに挿入される。シース１１の先端は、内視鏡先端の鉗子出口から突出して患部に近付けられる。 Next, the operation of the operation handle 10 will be briefly described. As shown in FIG. 6A, the connecting clip unit 13 is loaded in the sheath 11 so that the tip of the leading clip 19 </ b> A coincides with the tip of the sheath 11. The sheath 11 is inserted into a forceps channel of an endoscope inserted in the living body. The distal end of the sheath 11 protrudes from the forceps exit at the distal end of the endoscope and approaches the affected part.
　シース操作部６３を所定量だけ牽引すると、シース１１が操作ワイヤ１２に対して、所定量だけ後退する。操作ワイヤ１２と連結クリップユニット１３は連結されているので、連結クリップユニット１３がシース１１に対して前進し、図６（Ｂ）に示すように、シース１１の先端から、先頭のクリップ１９Ａと連結リング２０Ａとが送り出される。 When the sheath operating portion 63 is pulled by a predetermined amount, the sheath 11 moves backward with respect to the operation wire 12 by a predetermined amount. Since the operation wire 12 and the connection clip unit 13 are connected, the connection clip unit 13 moves forward with respect to the sheath 11 and, as shown in FIG. 6B, is connected to the leading clip 19A from the distal end of the sheath 11. The ring 20A is sent out.
　この際に、シース１１の内壁面と接触している連結リング２０Ａ～２０Ｃに対しては、シース１１との間に生じる摩擦力によって、シース１１とともに後端側へ移動する力が働く。しかし、連結リング２０Ａ～２０Ｃは、閉じたスカート部３８，３８によってクリップ１９Ａ～１９Ｃと一体化されており、また、後方のクリップ１９Ｂ，１９Ｃの凸部２７と、ダミークリップ４７の凸部４７ａとにより後端側への移動が規制されている。このため、連結リング２０Ａ～２０Ｃが後退することはなく、クリップ１９Ａ～１９Ｃとともにシース１１に対して前進する。 At this time, a force that moves to the rear end side together with the sheath 11 acts on the coupling rings 20A to 20C that are in contact with the inner wall surface of the sheath 11 due to a frictional force generated between the sheath 11 and the coupling rings 20A to 20C. However, the connecting rings 20A to 20C are integrated with the clips 19A to 19C by the closed skirt portions 38 and 38, and the protrusions 27 of the rear clips 19B and 19C and the protrusions 47a of the dummy clip 47 are combined. The movement to the rear end side is restricted by the above. For this reason, the connection rings 20A to 20C do not move backward, but move forward with respect to the sheath 11 together with the clips 19A to 19C.
　シース１１から出たクリップ１９Ａは、自身の弾性による爪部２３，２３を開く、また、図２Ａに示すように、連結リング２０Ａは、スカート部３８，３８がシース１１の内径よりも広幅に開き、連結リング２０Ａがシース１１内に戻らないように係合する。 The clip 19A coming out of the sheath 11 opens the claw portions 23 and 23 due to its own elasticity, and as shown in FIG. 2A, the connecting ring 20A opens the skirt portions 38 and 38 wider than the inner diameter of the sheath 11. The connecting ring 20A is engaged so as not to return into the sheath 11.
　操作ハンドル１０を移動させて、開放状態にあるクリップ１９Ａの爪部２３，２３を患部に押し付ける。この状態で、ワイヤ操作部６２の操作レバー６６を引くと、操作ワイヤ１２が所定量だけ引っ張られ、連結用クリップ体１８から順に係合している全クリップ１９Ａ～１９Ｃが、一様に引っ張られる。 The operating handle 10 is moved, and the claw portions 23 and 23 of the clip 19A in the opened state are pressed against the affected part. When the operation lever 66 of the wire operation unit 62 is pulled in this state, the operation wire 12 is pulled by a predetermined amount, and all the clips 19A to 19C that are sequentially engaged from the connecting clip body 18 are pulled uniformly. .
　図６（Ｃ）に示すように、シース１１から送りだされたクリップ１９Ａは、連結リング２０Ａのスカート部３８，３８が開いているので、スカート部３８，３８による押圧保持が解除されている。また、連結リング２０Ａは、スカート部３８，３８によりシース１１内への後退が阻止されている。そのため、先頭のクリップ１９Ａは、操作ワイヤ１２が引かれることにより、連結リング２０Ａに対して後退する。締付部３０がクリップ１９Ａの凸部２７の直下まで押し込まれることにより、連結リング２０Ａによるクリップ１９Ａの締め付けが完了する。 As shown in FIG. 6C, the clip 19A fed from the sheath 11 is released from being pressed by the skirts 38, 38 because the skirts 38, 38 of the connecting ring 20A are open. Further, the connecting ring 20 </ b> A is prevented from retreating into the sheath 11 by the skirt portions 38, 38. Therefore, the leading clip 19A moves backward with respect to the connecting ring 20A when the operation wire 12 is pulled. When the tightening portion 30 is pushed to just below the convex portion 27 of the clip 19A, the tightening of the clip 19A by the connecting ring 20A is completed.
　クリップ１９Ａの締め付け完了と同時に、クリップ１９Ａと次のクリップ１９Ｂの係合部が連結リング２０Ａの後端から抜け出る。クリップ１９Ｂの腕部２５，２５は、自身の弾性力によってシース１１の内壁に当たるまで拡開し、爪部２３，２３の間がクリップ１９Ａのターン部２６の幅よりも広く開いて、クリップ１９Ａとクリップ１９Ｂとの連結が解除される。図６（Ｄ）に示すように、シース１１の先端を患部から離すと、止血クリップ体１７Ａがシース１１の先端から抜け出る。 Simultaneously with the completion of the tightening of the clip 19A, the engaging portion of the clip 19A and the next clip 19B comes out from the rear end of the connecting ring 20A. The arm portions 25, 25 of the clip 19B are expanded by their own elastic force until they hit the inner wall of the sheath 11, and the gap between the claw portions 23, 23 opens wider than the width of the turn portion 26 of the clip 19A. The connection with the clip 19B is released. As shown in FIG. 6D, when the distal end of the sheath 11 is separated from the affected part, the hemostatic clip body 17 </ b> A comes out from the distal end of the sheath 11.
　操作レバー６６の牽引操作をやめると、操作レバー６６は図示しないバネの付勢力によって元の位置に復帰する。これにともない、操作ワイヤ１２がシース１１内で先端側に移動し、連結用クリップ体１８、クリップ１９Ｂ，１９Ｃが押されるので、図６（Ｄ）に示すように、２発目のクリップ１９Ｂの先端は、シース１１の先端にほぼ一致する位置に移動する。以降、一発目の止血クリップ体１７Ａと同様に、ハンドル本体１４を操作して、２発目、３発目の止血クリップ体１７Ｂ，１７Ｃでクリップ処置を行うことができる。 When the pulling operation of the operation lever 66 is stopped, the operation lever 66 returns to the original position by a biasing force of a spring (not shown). As a result, the operation wire 12 moves to the distal end side in the sheath 11 and the connecting clip body 18 and the clips 19B and 19C are pushed. As shown in FIG. The distal end moves to a position that substantially coincides with the distal end of the sheath 11. Thereafter, similarly to the first hemostatic clip body 17A, the handle main body 14 is operated, and the second and third hemostatic clip bodies 17B and 17C can be clipped.
　次に、連結クリップパッケージ８０について説明する。図７～図９に示すように、連結クリップパッケージ８０は、連結クリップユニット１３を収容したクリップマガジン８１と、クリップマガジン８１が挿入された装填器具８２とからなる。装填器具８２には、クリップマガジン８１から連結クリップユニット１３を取り出すクリップ取り出し部材８３と、クリップマガジン８１内の連結クリップユニット１３とクリップ取り出し部材８３とを確実に係合させるための一対のブラケット８４，８４（図８、図１０参照）と、操作ワイヤ１２と連結用クリップ体１８との連結に用いられるスライダ８５（連結補助部材）とが組み込まれている。 Next, the connection clip package 80 will be described. As shown in FIGS. 7 to 9, the connection clip package 80 includes a clip magazine 81 that stores the connection clip unit 13 and a loading device 82 in which the clip magazine 81 is inserted. The loading device 82 includes a clip taking-out member 83 for taking out the connecting clip unit 13 from the clip magazine 81, and a pair of brackets 84 for securely engaging the connecting clip unit 13 and the clip taking-out member 83 in the clip magazine 81. 84 (see FIGS. 8 and 10) and a slider 85 (connection auxiliary member) used for connecting the operation wire 12 and the connecting clip body 18 are incorporated.
　図９において、クリップマガジン８１は、内側に円柱状の空間であるクリップ収容部８７が設けられている。クリップマガジン８１は、上部が略角筒形状、下部が半円筒形状に形成されており、下部の外径はシース１１の外径とほぼ同じで、上下の高さ寸法は、シース１１の外径より大きく形成される。クリップ収容部８７の断面形状は円形であり、その内径は、シース１１の内径とほぼ同じである。クリップ収容部８７内には、先頭のクリップ１９Ａがクリップマガジン８１の先端側に配されるように連結クリップユニット１３が収容されている。 9, the clip magazine 81 is provided with a clip accommodating portion 87 that is a cylindrical space on the inner side. The clip magazine 81 has a substantially rectangular tube shape at the top and a semi-cylindrical shape at the bottom. The outer diameter of the lower portion is substantially the same as the outer diameter of the sheath 11, and the vertical height is the outer diameter of the sheath 11. Formed larger. The clip housing portion 87 has a circular cross-sectional shape, and the inner diameter thereof is substantially the same as the inner diameter of the sheath 11. In the clip accommodating portion 87, the connecting clip unit 13 is accommodated so that the leading clip 19A is arranged on the leading end side of the clip magazine 81.
　図１０に示すように、クリップマガジン８１は、半円筒形状の下ケース１１１と、角筒形状の上ケース１１２とを互いに接合して形成されている。下ケース１１１と上ケース１１２には、両者が接合されたときに円形のクリップ収容部８７となる、半円形の収容凹部１１１ａ，１１２ａがそれぞれ設けられている。クリップ収容部８７は、先頭のクリップ１９Ａが収容される先端側、連結用クリップ体１８が収容される後端側ともに開口となっている。クリップ収容部８７の先端側の開口は、連結クリップユニット１３をその先頭側からクリップ収容部８７の外に送り出す送出口である。 As shown in FIG. 10, the clip magazine 81 is formed by joining a semi-cylindrical lower case 111 and a square cylindrical upper case 112 to each other. The lower case 111 and the upper case 112 are provided with semicircular receiving recesses 111a and 112a, respectively, which become circular clip receiving portions 87 when they are joined. The clip accommodating portion 87 is open on both the front end side where the leading clip 19A is accommodated and the rear end side where the connecting clip body 18 is accommodated. The opening on the distal end side of the clip accommodating portion 87 is a delivery port for sending the connecting clip unit 13 out of the clip accommodating portion 87 from the head side.
　上ケース１１２の上部且つ後端部には、押さえ部１１３が一体に設けられている。押さえ部１１３は、上面が指の形状に合うように下方に凹となる曲面に形成された押さえ面１１３ａと、上ケース１１２の上面に軸方向に沿って固着される基端部１１３ｂとを有する。また、押さえ面１１３ａには、複数の滑り止め用突起１１３ｃが設けられている。 A pressing portion 113 is integrally provided on the upper and rear end portions of the upper case 112. The pressing portion 113 includes a pressing surface 113a formed in a curved surface that is concave downward so that the upper surface matches the shape of the finger, and a base end portion 113b that is fixed to the upper surface of the upper case 112 along the axial direction. . The holding surface 113a is provided with a plurality of anti-slip protrusions 113c.
　クリップマガジン８１は、クリップ収容部８７内に収容した連結クリップユニット１３をクリップマガジン８１の外側から視認できるように、例えば、透明なプラスチックで形成されている。下ケース１１１と上ケース１１２との接合には、例えば、接着剤を用いた接着、あるいは超音波等を用いた溶着、係合爪による係合等を用いることができる。また、下ケース１１１と上ケース１１２とを合せた状態で、外周に透明なプラスチックフイルムを巻き付けてもよい。 The clip magazine 81 is formed of, for example, transparent plastic so that the connected clip unit 13 accommodated in the clip accommodating portion 87 can be seen from the outside of the clip magazine 81. For joining the lower case 111 and the upper case 112, for example, adhesion using an adhesive, welding using ultrasonic waves, engagement by an engaging claw, or the like can be used. Further, a transparent plastic film may be wound around the outer periphery in a state where the lower case 111 and the upper case 112 are combined.
　連結クリップユニット１３は、先頭のクリップ１９Ａの爪部２３，２３が水平方向で開閉するように、クリップ収容部８７に収容される。クリップ１９Ａは、ブラケット８４を介してクリップ収容部８７の内壁に押されて閉じ状態となる。上述のとおり、止血クリップ体１７Ａ～１７Ｃは、爪部２３，２３の開閉方向が交互に９０°回転するように連結し、爪部２３，２３とスカート部３８，３８との開閉方向も９０°ずれている。よって、連結リング２０Ａ，２０Ｃは、スカート部３８が上下方向で開閉し、連結リング２０Ｂは、スカート部３８が左右方向で開閉する。 The connected clip unit 13 is accommodated in the clip accommodating portion 87 so that the claw portions 23 of the leading clip 19A open and close in the horizontal direction. The clip 19 </ b> A is pushed against the inner wall of the clip accommodating portion 87 via the bracket 84 and is in a closed state. As described above, the hemostatic clip bodies 17A to 17C are connected so that the opening and closing directions of the claw portions 23 and 23 are alternately rotated by 90 °, and the opening and closing directions of the claw portions 23 and 23 and the skirt portions 38 and 38 are also 90 °. It is off. Therefore, the connecting rings 20A and 20C open and close the skirt portion 38 in the vertical direction, and the connecting ring 20B opens and closes the skirt portion 38 in the left and right direction.
　下ケース１１１と上ケース１１２には、連結リング２０Ａ，２０Ｃのスカート部３８を開いた状態で収容するスカート用開口１１４が形成されている。また、下ケース１１１と上ケース１１２との合せ目には、両者が接合されたときに、連結リング２０Ｂのスカート部３８を収容するスカート用開口となる切欠１１５がそれぞれ形成されている。これにより、クリップマガジン８１内でスカート部３８が閉じ方向に押された状態で保管されることによる、スカート部３８の開き方向への復元力（弾性力）の低下を防止することができる。なお、開口に代えて、凹部を設けてもよい。 The lower case 111 and the upper case 112 are formed with skirt openings 114 that accommodate the skirt portions 38 of the coupling rings 20A and 20C in an open state. Further, at the joint of the lower case 111 and the upper case 112, a notch 115 serving as a skirt opening for accommodating the skirt portion 38 of the connecting ring 20B is formed when the two are joined. Accordingly, it is possible to prevent a reduction in restoring force (elastic force) in the opening direction of the skirt portion 38 due to being stored in the clip magazine 81 in a state where the skirt portion 38 is pushed in the closing direction. A recess may be provided instead of the opening.
　下ケース１１１には、リブ１１６，１１６、及び位置決めキー１１７が設けられている。リブ１１６，１１６及び位置決めキー１１７は、下ケース１１１と一体に形成されている。 The lower case 111 is provided with ribs 116 and 116 and a positioning key 117. The ribs 116 and 116 and the positioning key 117 are formed integrally with the lower case 111.
　リブ１１６，１１６は、下ケース１１１の先端から所定の間隔を置いた位置及び後端から両側方へ突出し、クリップマガジン８１の軸方向及び上下方向に直交する水平方向に沿って延びる矩形の板状に形成されている。このリブ１１６，１１６は、上面が下ケース１１１及び上ケース１１２の合せ目と連続するように配されている。すなわち、下ケース１１１及び上ケース１１２を接合したとき、リブ１１６，１１６は、クリップマガジン８１の中央よりも下部に位置する。位置決めキー１１７は、下ケースの下部に位置し、その下端部にクリップマガジン８１の軸方向に沿って配された板バネ１１７ａを有する。板バネ１１７ａはクリップマガジン８１の後端側が基端で、先端側が開放端となっており、クリップマガジン８１の軸方向に直交する方向で弾性自在とされている。板バネ１１７ａの先端側面には、半円柱状のクリック突部１１７ｂが設けられている。 The ribs 116, 116 protrude from the front end of the lower case 111 at a predetermined interval and from the rear end to both sides, and extend along a horizontal direction perpendicular to the axial direction and the vertical direction of the clip magazine 81. Is formed. The ribs 116 and 116 are arranged so that the upper surface is continuous with the joint of the lower case 111 and the upper case 112. That is, when the lower case 111 and the upper case 112 are joined, the ribs 116 and 116 are positioned below the center of the clip magazine 81. The positioning key 117 is located at the lower part of the lower case, and has a leaf spring 117 a disposed along the axial direction of the clip magazine 81 at the lower end thereof. The leaf spring 117a has a base end at the rear end side of the clip magazine 81 and an open end at the tip end side, and is elastic in a direction perpendicular to the axial direction of the clip magazine 81. A semi-cylindrical click protrusion 117b is provided on the tip side surface of the leaf spring 117a.
　図９において、装填器具８２の長手方向の一端部側には、高さ方向で凹まされた凹部９０が形成されている。凹部９０内には、クリップマガジン８１又はシース１１が取り付けられるマガジン挿入溝９１（マガジン挿入部）が形成されている。 In FIG. 9, a recessed portion 90 that is recessed in the height direction is formed on one end side in the longitudinal direction of the loading device 82. In the recess 90, a magazine insertion groove 91 (magazine insertion portion) to which the clip magazine 81 or the sheath 11 is attached is formed.
　マガジン挿入溝９１は、クリップマガジン８１下部の外径よりもわずかに大きな内径を有し、内部に挿入されたクリップマガジン８１、あるいはシース１１を装填器具８２の上面から露呈させる開口部９１ａが形成されている。この開口部９１ａを介して、例えば親指でクリップマガジン８１又はシース１１を上方から押さえることができ、他の指で装填器具８２を下方から支えることによって、クリップマガジン８１又はシース１１と装填器具８２とを一緒に挟み込むようにして把持することができる。 The magazine insertion groove 91 has an inner diameter slightly larger than the outer diameter of the lower portion of the clip magazine 81, and an opening 91a for exposing the clip magazine 81 or the sheath 11 inserted therein from the upper surface of the loading device 82 is formed. ing. Through this opening 91a, the clip magazine 81 or the sheath 11 can be pressed from above with, for example, the thumb, and the clip magazine 81 or the sheath 11 and the loading device 82 are supported by supporting the loading device 82 from below with another finger. Can be held together.
　マガジン挿入溝９１の内部には、位置規制溝９２，９２及び位置決めキー溝９３が形成されている。このマガジン挿入溝９１には、クリップマガジン８１が挿入されるとともに、位置規制溝９２，９２及び位置決めキー溝９３に、リブ１１６，１１６及び位置決めキー１１７が係合する。また、装填器具８２からシース１１に連結クリップユニット１３を装填する際には、マガジン挿入溝９１からクリップマガジン８１が抜き取られ、代わりにシース１１が挿入される。 Position restriction grooves 92 and 92 and a positioning key groove 93 are formed inside the magazine insertion groove 91. A clip magazine 81 is inserted into the magazine insertion groove 91, and ribs 116, 116 and a positioning key 117 are engaged with the position regulating grooves 92, 92 and the positioning key groove 93. Further, when the connecting clip unit 13 is loaded from the loading device 82 to the sheath 11, the clip magazine 81 is extracted from the magazine insertion groove 91, and the sheath 11 is inserted instead.
　図８及び図９において、装填器具８２の上面には、凹部９０に隣接して連結用開口９５と、ワイヤ用スリット９６とが設けられている。連結用開口９５は、操作ワイヤ１２のフック５７をクリップマガジン８１の挿入方向と直交する方向（装填器具８２の上方）から装填器具８２内に挿入するための開口であり、フック５７を横から見たときの外径寸法よりも大きな開口面積を有している。ワイヤ用スリット９６は、マガジン挿入溝９１と連結用開口９５とを接続するように形成されており、操作ワイヤ１２が挿入可能な幅寸法を有している。操作ワイヤ１２及びフック５７は、シース１１がマガジン挿入溝９１に挿入されたときに、同時にワイヤ用スリット９６及び連結用開口９５に挿入され、装填器具８２内に引き込まれた連結用クリップ体１８の連結部材４８に連結される（図１８～図２０参照）。 8 and 9, a connection opening 95 and a wire slit 96 are provided on the upper surface of the loading device 82 adjacent to the recess 90. The connection opening 95 is an opening for inserting the hook 57 of the operation wire 12 into the loading device 82 from a direction orthogonal to the insertion direction of the clip magazine 81 (above the loading device 82). The opening area is larger than the outer diameter dimension at that time. The wire slit 96 is formed so as to connect the magazine insertion groove 91 and the connection opening 95, and has a width dimension in which the operation wire 12 can be inserted. When the sheath 11 is inserted into the magazine insertion groove 91, the operation wire 12 and the hook 57 are inserted into the wire slit 96 and the connection opening 95 at the same time, and are pulled into the loading device 82. It is connected to the connecting member 48 (see FIGS. 18 to 20).
　装填器具８２内には、マガジン挿入溝９１の奥に、円柱状の空間であるスカート閉じ通路９７が設けられている。スカート閉じ通路９７は、シース１１及びクリップ収容部８７と同じ内径を有するとともに、マガジン挿入溝９１に挿入されたクリップマガジン８１と中心軸の位置を合わせるように形成されており、その内径面がマガジン挿入溝９１に挿入されたクリップマガジン８１及びシース１１の内径面と連接する。スカート閉じ通路９７は、クリップ収容部８７から引き込まれた連結クリップユニット１３の各スカート部３８を内径面によって押して閉じる。 In the loading device 82, a skirt closing passage 97, which is a cylindrical space, is provided at the back of the magazine insertion groove 91. The skirt closing passage 97 has the same inner diameter as the sheath 11 and the clip accommodating portion 87 and is formed so as to align the position of the central axis with the clip magazine 81 inserted into the magazine insertion groove 91. The clip magazine 81 inserted into the insertion groove 91 and the inner diameter surface of the sheath 11 are connected. The skirt closing passage 97 closes each skirt portion 38 of the connection clip unit 13 drawn from the clip accommodating portion 87 by pushing the inner diameter surface.
　マガジン挿入溝９１とスカート閉じ通路９７との境界であって、スカート閉じ通路９７の出入口付近には、シース１１またはクリップマガジン８１の厚み分に相当する段差である突き当て面９８（図１２、図１４及び図１５参照）が設けられている。スカート閉じ通路９７と、シース１１またはクリップマガジン８１の内径面は、シース１１またはクリップマガジン８１の先端が突き当て面９８に突き当てられることにより連接される。これにより、スカート部３８が閉じた状態を維持しながら、装填器具８２からシース１１に連結クリップユニット１３を装填することができる。 At the boundary between the magazine insertion groove 91 and the skirt closing passage 97 and in the vicinity of the entrance / exit of the skirt closing passage 97, an abutting surface 98 that is a step corresponding to the thickness of the sheath 11 or the clip magazine 81 (FIG. 12, FIG. 14 and FIG. 15). The skirt closing passage 97 and the inner diameter surface of the sheath 11 or the clip magazine 81 are connected by the front end of the sheath 11 or the clip magazine 81 being abutted against the abutting surface 98. Accordingly, the connecting clip unit 13 can be loaded from the loading device 82 to the sheath 11 while the skirt portion 38 is kept closed.
　クリップ取り出し部材８３は、装填器具８２の長手方向の他端部側から外に突出された略楕円形の牽引部１０１と、牽引部１０１が一端に設けられた挿通部１０２と、挿通部１０２の他端に設けられたクリップ係合部１０３（図１０も参照）とを備えている。挿通部１０２は、スカート閉じ通路９７を貫通する長さを有した棒状体であり、スカート閉じ通路９７に挿通される。クリップ係合部１０３は、クリップ収容部８７に挿入され、先頭のクリップ１９Ａと係合している。 The clip take-out member 83 includes a substantially elliptical traction portion 101 protruding outward from the other end portion side in the longitudinal direction of the loading device 82, an insertion portion 102 provided with the traction portion 101 at one end, and the insertion portion 102. And a clip engaging portion 103 (see also FIG. 10) provided at the other end. The insertion portion 102 is a rod-like body having a length penetrating the skirt closing passage 97 and is inserted into the skirt closing passage 97. The clip engaging portion 103 is inserted into the clip accommodating portion 87 and is engaged with the leading clip 19A.
　挿通部１０２は、スカート閉じ通路９７に挿入されており、牽引部１０１は、スカート閉じ通路９７の端部に形成された牽引穴（図１８～２０の符号１０４参照）を通して装填器具８２の外に突出される。連結クリップユニット１３は、牽引部１０１が装填器具８２に対して牽引されたときに、クリップ係合部１０３により先頭のクリップ１９Ａが引っ張られ、クリップ収容部８７からスカート閉じ通路９７内に引き込まれる。 The insertion portion 102 is inserted into the skirt closing passage 97, and the traction portion 101 is outside the loading device 82 through a traction hole (see reference numeral 104 in FIGS. 18 to 20) formed at the end of the skirt closing passage 97. Protruding. When the pulling portion 101 is pulled with respect to the loading device 82, the leading clip 19 </ b> A is pulled by the clip engaging portion 103, and the connecting clip unit 13 is drawn from the clip accommodating portion 87 into the skirt closing passage 97.
　図１０に示すように、挿通部１０２の上下には、牽引部１０１からクリップ係合部１０３に向かって広がる逆止突起１０２ａが設けられている。逆止突起１０２ａは、挿通部１０２が弾性変形することにより、牽引穴１０４から装填器具８２の外に飛び出る。逆止突起１０２ａは、挿通部１０２が再びスカート閉じ通路９７内に戻らないように、挿通部１０２を係止する。 As shown in FIG. 10, check protrusions 102 a that extend from the pulling portion 101 toward the clip engaging portion 103 are provided above and below the insertion portion 102. The check protrusion 102 a jumps out of the loading device 82 from the pulling hole 104 when the insertion portion 102 is elastically deformed. The check protrusion 102 a locks the insertion portion 102 so that the insertion portion 102 does not return to the skirt closing passage 97 again.
　クリップ係合部１０３は、略角柱状の係合片１０３ａと、係合片１０３ａの前端部及び挿通部１０２の後端部の間に位置する抜け止め部１０３ｂとからなる。係合片１０３ａは、爪部２３，２３が係合する係合穴１０３ｃ，１０３ｃが形成されている。抜け止め部１０３ｂは、クリップ収容部８７の内径に合わせた外径となるように形成され、クリップ１９Ａがクリップ係合部１０３の前方へ離脱することを規制する。 The clip engagement portion 103 includes a substantially prismatic engagement piece 103a and a retaining portion 103b positioned between the front end portion of the engagement piece 103a and the rear end portion of the insertion portion 102. The engagement piece 103a has engagement holes 103c and 103c with which the claw portions 23 and 23 are engaged. The retaining portion 103 b is formed so as to have an outer diameter that matches the inner diameter of the clip housing portion 87, and restricts the clip 19 </ b> A from being released to the front of the clip engaging portion 103.
　ブラケット８４，８４は、クリップ収容部８７の内径に合わせた外径、且つ係合片１０３ａの外径に合わせた内径の半円筒状に形成された一対の板材であり、係合片１０３ａに係合するクリップ１９Ａが閉じる方向に沿って、クリップ１９Ａを両側から挟み込んで互いに対面するように配されている。これらのブラケット８４，８４は、例えばＳＵＳの金属板から形成される。 The brackets 84 and 84 are a pair of plate members formed in a semi-cylindrical shape having an outer diameter matching the inner diameter of the clip accommodating portion 87 and an inner diameter matching the outer diameter of the engagement piece 103a. Along the closing direction of the clip 19A to be joined, the clip 19A is sandwiched from both sides so as to face each other. These brackets 84, 84 are formed of, for example, a SUS metal plate.
　クリップ係合部１０３は、ブラケット８４，８４及び連結クリップユニット１３とともにクリップマガジン８１のクリップ収容部８７に収容されている。先頭のクリップ１９Ａは、ブラケット８４，８４を介してクリップ収容部８７に押されて閉じ状態となり、爪部２３，２３を係合穴１０３ｃ，１０３ｃに係合する。牽引部１０１を装填器具８２に対して牽引すると、挿通部１０２は、スカート閉じ通路９７内を移動し、クリップ係合部１０３がクリップ収容部８７からスカート閉じ通路９７内に移動する。 The clip engaging portion 103 is accommodated in the clip accommodating portion 87 of the clip magazine 81 together with the brackets 84 and 84 and the connecting clip unit 13. The first clip 19A is pushed by the clip accommodating portion 87 via the brackets 84 and 84 to be closed, and engages the claw portions 23 and 23 with the engagement holes 103c and 103c. When the pulling portion 101 is pulled with respect to the loading device 82, the insertion portion 102 moves in the skirt closing passage 97, and the clip engaging portion 103 moves from the clip accommodating portion 87 into the skirt closing passage 97.
　連結クリップユニット１３は、クリップ係合部１０３に引っ張られてスカート閉じ通路９７内に引き込まれる。スカート閉じ通路９７の牽引穴１０４近傍には、左右方向に張り出した解除溝１０５（図１８～２０参照）が形成されている。解除溝１０５の左右方向は、先頭のクリップ１９Ａの腕部２５，２５が、クリップ取り出し部材８３のクリップ係合部１０３との係合を解除する程度まで開くことができる幅寸法を有している。解除溝１０５は、連結用クリップ体１８の連結部５０が、連結用開口９５に対面する位置に到達したときに、先頭のクリップ１９Ａが解除溝１０５内に到達するように配置されている。これにより、連結クリップユニット１３がスカート閉じ通路９７に収容された状態において、連結部５０が連結用開口９５から外部に露呈し、この連結用開口９５を通して連結部材４８とフック５７が重なるようにフック５７が挿入される。 The connecting clip unit 13 is pulled by the clip engaging portion 103 and pulled into the skirt closing passage 97. In the vicinity of the pulling hole 104 of the skirt closing passage 97, a release groove 105 (see FIGS. 18 to 20) protruding in the left-right direction is formed. The release groove 105 has a width dimension in which the arms 25 and 25 of the leading clip 19A can be opened to the extent that the engagement with the clip engagement portion 103 of the clip take-out member 83 is released. . The release groove 105 is arranged so that the leading clip 19 </ b> A reaches the release groove 105 when the connection portion 50 of the connection clip body 18 reaches a position facing the connection opening 95. Thus, in a state where the connecting clip unit 13 is accommodated in the skirt closing passage 97, the connecting portion 50 is exposed to the outside from the connecting opening 95, and the connecting member 48 and the hook 57 overlap with each other through the connecting opening 95. 57 is inserted.
　牽引部１０１を装填器具８２に対して牽引すると、挿通部１０２は、スカート閉じ通路９７内を移動する。牽引部１０１が牽引されることによってクリップ係合部１０３とともに、ブラケット８４，８４が移動する。これにより、クリップ係合部１０３、クリップ１９Ａ及びブラケット８４がクリップ収容部８７からスカート閉じ通路９７内に移動する。 When the pulling portion 101 is pulled with respect to the loading device 82, the insertion portion 102 moves in the skirt closing passage 97. By pulling the pulling portion 101, the brackets 84 and 84 move together with the clip engaging portion 103. As a result, the clip engaging portion 103, the clip 19 </ b> A, and the bracket 84 move from the clip accommodating portion 87 into the skirt closing passage 97.
　先頭のクリップ１９Ａは、解除溝１０５内に到達すると自身の弾性によって開放状態に変位し、クリップ係合部１０３との係合を解除する。このとき、開放状態に変位したクリップ１９Ａからの押圧によってブラケット８４がクリップ１９Ａ及びクリップ係合部１０３から外れる。クリップ１９Ａ及びクリップ係合部１０３から外れたブラケット８４は解除溝１０５内に残される。このようにして牽引された連結クリップユニット１３は、連結用クリップ体１８の連結部５０が、スカート閉じ通路９７内でスライダ通路１００に位置するように、スカート閉じ通路９７の後部で停止される。 When the leading clip 19A reaches the release groove 105, it is displaced to its open state by its own elasticity, and the engagement with the clip engaging portion 103 is released. At this time, the bracket 84 is detached from the clip 19 </ b> A and the clip engaging portion 103 by pressing from the clip 19 </ b> A displaced to the open state. The bracket 84 removed from the clip 19 </ b> A and the clip engaging portion 103 remains in the release groove 105. The connecting clip unit 13 pulled in this way is stopped at the rear of the skirt closing passage 97 so that the connecting portion 50 of the connecting clip body 18 is positioned in the slider passage 100 in the skirt closing passage 97.
　なお、止血クリップ体１７は、爪部２３，２３の開閉方向と、スカート部３８，３８の開閉方向とが９０°ずれているので、先頭のクリップ１９Ａが解除溝１０５内にあるときでも、先頭の連結リング２０Ａのスカート部３８，３８が開くことはない。 Since the opening and closing direction of the claw portions 23 and 23 and the opening and closing direction of the skirt portions 38 and 38 are shifted by 90 °, the hemostatic clip body 17 has a leading end even when the leading clip 19A is in the release groove 105. The skirt portions 38, 38 of the connecting ring 20A are not opened.
　クリップ取り出し部材８３を構成する牽引部１０１、挿通部１０２、クリップ係合部１０３は、例えば、適度な弾性を有するプラスチックによって一体に形成されている。なお、挿通部１０２とクリップ係合部１０３とを別体で形成し、装填器具８２内で連結させてもよい。 The pulling portion 101, the insertion portion 102, and the clip engaging portion 103 constituting the clip takeout member 83 are integrally formed of, for example, plastic having appropriate elasticity. Note that the insertion portion 102 and the clip engagement portion 103 may be formed separately and connected in the loading device 82.
　なお、連結部５０の停止位置がずれた場合でも、後述するスライダ８５の位置決め面１５８によって連結部材４８の当接面５６を押圧し、連結部材４８を適正な位置に移動させることができる。 Even when the stop position of the connecting portion 50 is deviated, the contact surface 56 of the connecting member 48 can be pressed by a positioning surface 158 of the slider 85 described later, and the connecting member 48 can be moved to an appropriate position.
　図７及び図９において、スライダ８５は、装填器具８２の一方の側面から開口されたスライダ通路１００内に、スライド自在に挿入されている。スライダ８５は、装填器具８２内に引き込まれた連結用クリップ体１８と、連結用開口９５から挿入されたフック５７とを連結させる際に、スライダ通路１００内に押し込まれる。 7 and 9, the slider 85 is slidably inserted into the slider passage 100 opened from one side surface of the loading device 82. The slider 85 is pushed into the slider passage 100 when the connecting clip body 18 drawn into the loading device 82 and the hook 57 inserted from the connecting opening 95 are connected.
　スライダ通路１００は、断面がスライダ８５の幅寸法とほぼ等しい幅を有する矩形状であり、装填器具８２の短手方向、すなわちマガジン挿入溝９１及びスカート閉じ通路９７と直交する方向に沿って切り欠くように設けられている。 The slider passage 100 has a rectangular shape with a cross section having a width substantially equal to the width dimension of the slider 85, and is cut out along the short direction of the loading device 82, that is, the direction perpendicular to the magazine insertion groove 91 and the skirt closing passage 97. It is provided as follows.
　図９及び図１１に示すように、装填器具８２は、前後を半円形状に形成した板状の下治具１２０、上治具１２１を接合して形成されている。この装填器具８２は、連結クリップユニット１３、クリップマガジン８１、クリップ取り出し部材８３、スライダ８５等が外側から視認できるように、例えば、透明なプラスチックで形成されている。下治具１２０と上治具１２１との接合には、例えば、接着剤を用いた接着、あるいは超音波等を用いた溶着、係合爪による係合等を用いることができる。 As shown in FIGS. 9 and 11, the loading device 82 is formed by joining a plate-like lower jig 120 and an upper jig 121 formed in a semicircular shape in the front and rear. The loading device 82 is formed of, for example, a transparent plastic so that the connecting clip unit 13, the clip magazine 81, the clip takeout member 83, the slider 85, and the like can be seen from the outside. For joining the lower jig 120 and the upper jig 121, for example, adhesion using an adhesive, welding using an ultrasonic wave, engagement by an engaging claw, or the like can be used.
　下治具１２０の上面１２０ａには、上治具１２１と接合したときに、マガジン挿入溝９１を形成する半円形状のマガジン用凹部１２２が形成されている。下治具１２０の上面１２０ａには、マガジン用凹部１２２の両側から連続し、上面１２０ａより一段凹となる位置規制用凹部１２３，１２３が形成されている。位置規制用凹部１２３，１２３は、マガジン用凹部１２２の前端から後端まで軸方向に沿って延びている。位置規制用凹部１２３，１２３は、上治具１２１に接合されたときに、上治具１２１の下面１２１ａとともに位置規制溝９２，９２を形成する。クリップマガジン８１のリブ１１６，１１６と位置規制溝９２，９２とが係合することによって、マガジン挿入溝９１に挿入されたクリップマガジン８１の上下方向の移動を規制する。 On the upper surface 120a of the lower jig 120, there is formed a semicircular magazine recess 122 that forms a magazine insertion groove 91 when the upper jig 121 is joined. On the upper surface 120 a of the lower jig 120, position restricting recesses 123, 123 that are continuous from both sides of the magazine recess 122 and are one step recessed from the upper surface 120 a are formed. The position restricting recesses 123 extend in the axial direction from the front end to the rear end of the magazine recess 122. The position regulating recesses 123, 123 form the position regulating grooves 92, 92 together with the lower surface 121 a of the upper jig 121 when joined to the upper jig 121. By engaging the ribs 116 and 116 of the clip magazine 81 with the position restricting grooves 92 and 92, the vertical movement of the clip magazine 81 inserted into the magazine inserting groove 91 is restricted.
　また、マガジン用凹部１２２内には、位置決めキー溝９３が設けられている。位置決めキー溝９３は、クリップマガジン８１の軸方向に沿って形成されており、クリップマガジン８１が軸方向からマガジン挿入溝９１に挿入されたとき、クリップマガジン８１に設けられた位置決めキー１１７と嵌合してクリップマガジン８１の軸回りの回転を規制する。 Further, a positioning key groove 93 is provided in the magazine recess 122. The positioning key groove 93 is formed along the axial direction of the clip magazine 81. When the clip magazine 81 is inserted into the magazine insertion groove 91 from the axial direction, the positioning key groove 93 is fitted with the positioning key 117 provided on the clip magazine 81. Thus, the rotation of the clip magazine 81 around the axis is restricted.
　位置規制溝９２，９２及び位置決めキー溝９３を含むマガジン挿入溝９１は、クリップマガジン８１の外形に合わせた断面形状を持ち、この断面形状が装填器具８２の後端側からスカート閉じ通路９７の付近まで軸方向に沿って連続しているので、クリップマガジン８１は装填器具８２に対して挿脱自在に取り付けられる。 The magazine insertion groove 91 including the position restriction grooves 92 and 92 and the positioning key groove 93 has a cross-sectional shape that matches the outer shape of the clip magazine 81, and this cross-sectional shape is near the skirt closing passage 97 from the rear end side of the loading device 82. The clip magazine 81 is detachably attached to the loading device 82 because the clip magazine 81 is continuous along the axial direction.
　位置決めキー溝９３の側面には、略コ字状の断面を持つクリック孔（図示せず）が設けられている。このクリック孔は、位置決めキー１１７に設けられたクリック突部１１７ｂ（図１０参照）に対応する位置に配されており、クリック突部１１７ｂとともにクリック機構を構成する。位置決めキー１１７が位置決めキー溝９３の所定位置まで挿入されたとき、クリック突部１１７ｂがクリック孔に進入して係合される。これにより、クリップマガジン８１が軸方向に位置規制されて、装填器具８２からのクリップマガジン８１の離脱が防止される。 The side surface of the positioning key groove 93 is provided with a click hole (not shown) having a substantially U-shaped cross section. The click hole is arranged at a position corresponding to the click protrusion 117b (see FIG. 10) provided in the positioning key 117, and constitutes a click mechanism together with the click protrusion 117b. When the positioning key 117 is inserted to a predetermined position in the positioning key groove 93, the click protrusion 117b enters the click hole and is engaged. Accordingly, the position of the clip magazine 81 is restricted in the axial direction, and the clip magazine 81 is prevented from being detached from the loading device 82.
　マガジン用凹部１２２の奥には、上治具１２１と接合したときにスカート閉じ通路９７を形成する半円形状のスカート閉じ凹部１２８が形成されている。下治具１２０の長手方向の前端側には、スカート閉じ凹部１２８から左右方向に広がる矩形の解除用凹部１２９が形成されている。解除用凹部１２９の前端には、クリップ取り出し部材８３の挿通部１０２が挿通される矩形の切欠１３０が形成されている。 A semicircular skirt closing recess 128 that forms a skirt closing passage 97 when joined to the upper jig 121 is formed in the back of the magazine recess 122. On the front end side in the longitudinal direction of the lower jig 120, a rectangular release recess 129 that extends from the skirt closing recess 128 in the left-right direction is formed. A rectangular notch 130 into which the insertion portion 102 of the clip take-out member 83 is inserted is formed at the front end of the release recess 129.
　図１１及び図１２に示すように、マガジン用凹部１２２とスカート閉じ凹部１２８との境界、すなわちスカート閉じ凹部１２８の後端には、スカート閉じ凹部１２８の内壁に対して半径方向に一段凹となる段差１３１が形成されている。段差１３１は、上述した突き当て面９８を構成している。 As shown in FIGS. 11 and 12, the boundary between the magazine recess 122 and the skirt closing recess 128, that is, the rear end of the skirt closing recess 128, is one step in the radial direction with respect to the inner wall of the skirt closing recess 128. A step 131 is formed. The step 131 constitutes the abutting surface 98 described above.
　段差１３１を基準にして、その軸方向の前後には、マガジン用凹部１２２及びスカート閉じ凹部１２８を挟んで、その左右に下治具１２０の上面１２０ａよりも凸となるスライダ用凸部１３３，１３４が形成されている。このスライダ用凸部１３３，１３４は、スライダ８５の幅寸法とほぼ等しい幅を有する略矩形状に突出し、上治具１２１と接合したときに、後述するスライダ用凹部１４４とともにスライダ通路１００を形成する。 With the step 131 as a reference, front and rear in the axial direction, the slider recesses 133 and 134 project from the upper surface 120a of the lower jig 120 to the left and right with the magazine recess 122 and the skirt closing recess 128 sandwiched therebetween. Is formed. The slider projections 133 and 134 project in a substantially rectangular shape having a width substantially equal to the width dimension of the slider 85, and form the slider passage 100 together with the slider recess 144 described later when joined to the upper jig 121. .
　スライダ用凸部１３４は、スライダ通路１００の幅方向の両端部が、スライダ通路１００の入り口が形成される、下治具１２０の一方の端部まで延びている。スライダ用凸部１３４の幅方向の中央部は、下治具１２０の端部からマガジン用凹部１２２及びスカート閉じ凹部１２８に向かって切り欠かれたスライダ用切欠１３７が形成されている。このスライダ用切欠１３７のスライド方向における奥側の面が、スライダ８５をスライダ通路１００に押し込んだときのストッパとなる。 The slider convex portion 134 has both end portions in the width direction of the slider passage 100 extending to one end portion of the lower jig 120 where the entrance of the slider passage 100 is formed. A slider notch 137 is formed at the center in the width direction of the slider protrusion 134, which is notched from the end of the lower jig 120 toward the magazine recess 122 and the skirt closing recess 128. The inner surface in the sliding direction of the slider notch 137 serves as a stopper when the slider 85 is pushed into the slider passage 100.
　スライダ用凸部１３３，１３４は、段差１３１を境にしてマガジン用凹部１２２両側の上面１３３ａ，１３４ａのほうが、スカート閉じ凹部１２８両側の上面１３３ｂ，１３４ｂよりも一段高く形成されている。上面１３３ａ，１３４ａは、マガジン挿入溝９１にシース１１が挿入されたとき、上面１３３ａ，１３４ａがシース１１の上端よりも高い位置になるように形成されている。 The slider protrusions 133 and 134 are formed so that the upper surfaces 133a and 134a on both sides of the magazine recess 122 are one step higher than the upper surfaces 133b and 134b on both sides of the skirt closing recess 128 with the step 131 as a boundary. The upper surfaces 133 a and 134 a are formed so that the upper surfaces 133 a and 134 a are higher than the upper end of the sheath 11 when the sheath 11 is inserted into the magazine insertion groove 91.
　このため、シース１１をマガジン挿入溝９１に挿入しても、シース１１の上端が上面１３３ａ，１３４ａよりも上方に突出してスライダ通路１００内に進入しない。したがって、シース１１がマガジン挿入溝９１に挿入されているときは、スライダ８５とシース１１の上端が当接することなく、スライダ８５は、上面１３３ａ，１３４ａに沿って移動することができる。一方、マガジン挿入溝９１にクリップマガジン８１が挿入されているときは、シース１１よりも上下方向の寸法が大きいため、クリップマガジン８１の上端が上面１３３ａ，１３４ａよりも上方に突出し、スライダ通路１００内に進入する。このため、スライダ８５を初期位置からスカート閉じ通路９７に向かって押し込もうとしても、スライダ８５とクリップマガジン８１とが当接して、スライダ８５を押し込むことができない。つまり、クリップマガジン８１がマガジン挿入溝９１に挿入されている間は、クリップマガジン８１によって、スライダ８５の移動が規制される（図１５に示す状態）。 For this reason, even if the sheath 11 is inserted into the magazine insertion groove 91, the upper end of the sheath 11 protrudes above the upper surfaces 133a and 134a and does not enter the slider passage 100. Therefore, when the sheath 11 is inserted in the magazine insertion groove 91, the slider 85 can move along the upper surfaces 133a and 134a without the slider 85 and the upper end of the sheath 11 contacting each other. On the other hand, when the clip magazine 81 is inserted into the magazine insertion groove 91, the upper and lower dimensions of the clip magazine 81 are larger than the sheath 11, so that the upper end of the clip magazine 81 protrudes upward from the upper surfaces 133 a and 134 a. Enter. Therefore, even if the slider 85 is pushed from the initial position toward the skirt closing passage 97, the slider 85 and the clip magazine 81 come into contact with each other and the slider 85 cannot be pushed. That is, while the clip magazine 81 is inserted into the magazine insertion groove 91, the movement of the slider 85 is regulated by the clip magazine 81 (state shown in FIG. 15).
　上面１３３ｂ，１３４ｂは、その軸方向の位置が、スカート閉じ通路９７内に連結クリップユニット１３が引き込まれたとき、連結部材４８の停止位置と対応する位置に形成されている。また、上面１３３ｂ，１３４ｂは、その高さが、連結部材４８の高さとほぼ同じ高さになるように形成されている（図１６Ａ、Ｂ参照）。このため、連結部材４８の上端が上面１３３ｂ，１３４ｂよりも上方に突出してスライダ通路１００内に進入しないので、スライダ８５が移動するときに、スライダ８５と連結部材４８が干渉しない。 The upper surfaces 133b and 134b are formed so that their axial positions correspond to the stop position of the connecting member 48 when the connecting clip unit 13 is drawn into the skirt closing passage 97. Further, the upper surfaces 133b and 134b are formed so that the height thereof is substantially the same as the height of the connecting member 48 (see FIGS. 16A and 16B). For this reason, since the upper end of the connecting member 48 protrudes above the upper surfaces 133b and 134b and does not enter the slider passage 100, the slider 85 and the connecting member 48 do not interfere when the slider 85 moves.
　また、スライダ用凸部１３３，１３４の内側面（スカート閉じ凹部１２８の両側の面）には、クリップマガジン８１のリブ１１６，１１６が係合する位置規制用凹部１２３，１２３、すなわち位置規制溝９２，９２が形成されていない。そのため、クリップマガジン８１がマガジン挿入溝９１に挿入されたとき、リブ１１６，１１６がスライダ用凸部１３３，１３４の後端面に当接する位置でクリップマガジン８１の軸方向の位置が位置決めされる。しかし、リブ１１６，１１６は、クリップマガジン８１の先端から所定の間隔を置いて形成されているため（図１０参照）、クリップマガジン８１の先端は、突き当て面９８に突き当たる位置まで、スライダ用凸部１３３，１３４の間に挿入される。 Further, on the inner side surfaces of the slider convex portions 133 and 134 (the surfaces on both sides of the skirt closing concave portion 128), the position regulating concave portions 123 and 123 engaged with the ribs 116 and 116 of the clip magazine 81, that is, the position regulating groove 92. , 92 are not formed. Therefore, when the clip magazine 81 is inserted into the magazine insertion groove 91, the position of the clip magazine 81 in the axial direction is positioned at a position where the ribs 116, 116 contact the rear end surfaces of the slider convex portions 133, 134. However, since the ribs 116 are formed at a predetermined interval from the tip of the clip magazine 81 (see FIG. 10), the tip of the clip magazine 81 is raised to the position where it abuts against the abutting surface 98. It is inserted between the parts 133 and 134.
　上治具１２１の下面１２１ａには、下治具１２０のマガジン用凹部１２２と対向する位置に、マガジン用凹部１２２とともに、マガジン挿入溝９１を構成するマガジン用切欠１３９が形成されている。マガジン用切欠１３９は、クリップマガジン８１上部と略同じ幅に形成されている。また、下面１２１ａには、下治具１２０のスカート閉じ凹部１２８とともにスカート閉じ通路９７を形成するスカート閉じ凹部１４１が形成されている。さらに、下面１２１ａには、下治具１２０の解除用凹部１２９と、切欠１３０のそれぞれと対向する位置に、解除用凹部１４２と、切欠１４３が形成されており、それぞれ解除溝１０５、牽引穴１０４を構成する。 On the lower surface 121a of the upper jig 121, a magazine notch 139 that forms a magazine insertion groove 91 is formed together with the magazine recess 122 at a position facing the magazine recess 122 of the lower jig 120. The magazine cutout 139 is formed to have substantially the same width as the upper portion of the clip magazine 81. A skirt closing recess 141 that forms a skirt closing passage 97 together with the skirt closing recess 128 of the lower jig 120 is formed on the lower surface 121a. Further, a release recess 142 and a notch 143 are formed on the lower surface 121a at positions opposite to the release recess 129 of the lower jig 120 and the notch 130, respectively. Configure.
　マガジン用切欠１３９とスカート閉じ凹部１４１との間には、スライダ通路１００を形成するスライダ用凹部１４４が形成されている。スライダ用凹部１４４の略中央には、マガジン用切欠１３９と連続して連結用開口９５及びワイヤ用スリット９６が形成されている。 Between the magazine notch 139 and the skirt closing recess 141, a slider recess 144 that forms the slider passage 100 is formed. A connecting opening 95 and a wire slit 96 are formed substantially at the center of the slider recess 144 so as to be continuous with the magazine cutout 139.
　スライダ用凹部１４４は、スライダ用凸部１３３に幅寸法を合わせた矩形状に形成され、下治具１２０と上治具１２１とを接合したとき、スライダ用凹部１４４にスライダ用凸部１３３が嵌合され、このスライダ用凹部１４４とスライダ用凸部１３３との隙間がスライダ通路１００となる。 The slider concave portion 144 is formed in a rectangular shape having a width dimension matched to the slider convex portion 133. When the lower jig 120 and the upper jig 121 are joined, the slider convex portion 133 is fitted into the slider concave portion 144. The gap between the slider concave portion 144 and the slider convex portion 133 becomes the slider passage 100.
　スライダ用凹部１４４には、スライダ８５によってフック５７と連結部材４８とを連結させる際に、スライダ８５の上面と当接して、スライダ８５をフック５７の押圧方向に向けて付勢する付勢部１４６，１４７が形成されている。付勢部１４６，１４７は、マガジン用切欠１３９及びスカート閉じ凹部１４１、すなわちマガジン挿入溝９１及びスカート閉じ通路９７を基準に線対称な位置に配されている。付勢部１４６，１４７は、上治具１２１の幅方向端部から中央へ向かって延びる板バネ１４６ａ，１４７ａと、この板バネ１４６ａ，１４７ａの先端から下方へ突出する突出部１４６ｂ，１４７ｂとからそれぞれ構成される。 When the hook 57 and the connecting member 48 are connected by the slider 85, the slider recess 144 abuts against the upper surface of the slider 85 and biases the slider 85 in the pressing direction of the hook 57. , 147 are formed. The biasing portions 146 and 147 are arranged at positions symmetrical with respect to the magazine notch 139 and the skirt closing recess 141, that is, the magazine insertion groove 91 and the skirt closing passage 97. The urging portions 146 and 147 are formed from plate springs 146a and 147a extending from the widthwise end of the upper jig 121 toward the center, and projecting portions 146b and 147b protruding downward from the tips of the plate springs 146a and 147a. Each is composed.
　スカート閉じ凹部１４１の後端は、スライダ用凹部１４４の前端で途切れているので、スライダ通路１００の範囲においては、スカート閉じ通路９７の上半分はなく、連結用開口９５及びワイヤ用スリット９６に向けて解放されている。 Since the rear end of the skirt closing recess 141 is interrupted at the front end of the slider recess 144, there is no upper half of the skirt closing passage 97 in the range of the slider passage 100, and it faces the connection opening 95 and the wire slit 96. Have been released.
　図１３に示すように、スライダ８５は、スライダ通路１００への押し込み操作に用いられる操作部１５０と、操作部１５０からスライド方向に延びる１枚の板形状の押し込み片１５１とからなり、それらはプラスチックによって一体に成形されている。押し込み片１５１は、スライダ通路１００に挿入され、上治具１２１の付勢部１４６，１４７から付勢を受けて、装填器具８２の下治具１２０とともに、連結部材４８及びフック５７を挟み込む。 As shown in FIG. 13, the slider 85 includes an operation unit 150 that is used for a push operation into the slider passage 100 and a single plate-shaped push piece 151 that extends from the operation unit 150 in the sliding direction. Are integrally molded. The pushing piece 151 is inserted into the slider passage 100, is biased by the biasing portions 146 and 147 of the upper jig 121, and sandwiches the connecting member 48 and the hook 57 together with the lower jig 120 of the loading device 82.
　押し込み片１５１は、上述したスライダ用凸部１３３，１３４の上面１３３ａ，１３４ａ，１３３ｂ，１３４ｂに合わせて、スカート閉じ通路９７側の底面１５１ｂよりも、マガジン挿入溝９１側の底面１５１ａのほうが一段高く形成されている。また、操作部１５０に近い部分には、底面１５１ｂよりも下方に突出する嵌合凸部１５２が設けられている。嵌合凸部１５２は、スライダ通路１００の切欠１３７に嵌合する。嵌合凸部１５２のスライド方向の前端面は、切欠１３７の奥に形成された突き当て面と当接してスライダ８５が過度に押し込まれるのを阻止する。 In accordance with the upper surfaces 133a, 134a, 133b, and 134b of the slider convex portions 133 and 134, the pushing piece 151 is one step higher on the bottom surface 151a on the magazine insertion groove 91 side than the bottom surface 151b on the skirt closing passage 97 side. Is formed. In addition, a fitting convex portion 152 that projects downward from the bottom surface 151b is provided in a portion close to the operation portion 150. The fitting convex portion 152 is fitted into the notch 137 of the slider passage 100. The front end surface of the fitting convex portion 152 in the sliding direction is in contact with the abutting surface formed at the back of the notch 137 and prevents the slider 85 from being excessively pushed.
　押し込み片１５１には、スライド方向の前端側から底面１５１ｂに向かって傾斜する押圧面１５３が形成されている。押圧面１５３は、スライダ８５が押し込まれた時にスカート閉じ通路９７内のフック５７を押圧方向に押し込む押し込み量が徐々に増加するように形成されており、この押圧面１５３による押圧で連結用クリップ体１８の連結部材４８にフック５７を連結させる。また、押圧面１５３は、背後から上治具１２１の付勢部１４６，１４７、すなわちスライダ通路１００の内壁に支持される。スライダ１８５が押し込まれたときに、付勢部１４６，１４７は、押し込み片１５１の上面と当接することにより、押圧面１５３を、フック５７を押し込む押圧方向に向けて付勢する。底面１５１ｂには、シース１１の内径と略同じ内径の凹部１５４が形成されている。凹部１５４は、スライダ８５が連結位置にあるとき、スカート閉じ凹部１２８の上部を塞ぎ、スカート閉じ通路９７の一部を構成する。 The pressing piece 151 is formed with a pressing surface 153 that is inclined from the front end side in the sliding direction toward the bottom surface 151b. The pressing surface 153 is formed such that when the slider 85 is pressed, the pressing amount for pressing the hook 57 in the skirt closing passage 97 in the pressing direction gradually increases, and the connecting clip body is pressed by the pressing surface 153. The hook 57 is connected to the 18 connecting members 48. Further, the pressing surface 153 is supported from behind by the urging portions 146 and 147 of the upper jig 121, that is, the inner wall of the slider passage 100. When the slider 185 is pushed in, the urging portions 146 and 147 abut against the upper surface of the pushing piece 151 to urge the pressing surface 153 in the pressing direction in which the hook 57 is pushed. A recess 154 having an inner diameter substantially the same as the inner diameter of the sheath 11 is formed on the bottom surface 151b. The recess 154 closes the upper part of the skirt closing recess 128 when the slider 85 is in the coupling position, and constitutes a part of the skirt closing passage 97.
　押し込み片１５１のスライド方向の前端部には、押圧面１５３の両側からスライド方向における前方に突出する２つの位置決め片１５５、１５６が設けられている。一対の位置決め片１５５，１５６はフック５７の軸方向寸法に合わせた間隔で配設されており、位置決め片１５５、１５６の前端部は、スライダ８５が初期位置にあるときに、連結用開口９５の位置と対応するように設けられている。 Two positioning pieces 155 and 156 projecting forward in the sliding direction from both sides of the pressing surface 153 are provided at the front end portion of the pushing piece 151 in the sliding direction. The pair of positioning pieces 155 and 156 are arranged at intervals corresponding to the axial dimension of the hook 57, and the front end portions of the positioning pieces 155 and 156 are formed in the connection opening 95 when the slider 85 is in the initial position. It is provided so as to correspond to the position.
　図１４に示すように、フック５７が連結用開口９５から装填器具８２の内部へ挿入されると、位置決め片１５５，１５６の間に挟まれるように落とし込まれ、フック５７の軸方向前端及び後端が位置決め片１５５，１５６と当接する。これにより、フック５７の軸方向の位置が規制されて位置決めがなされるので、押圧面１５３からフック５７への押圧力が適切に作用し、連結部材４８に連結させることができる。 As shown in FIG. 14, when the hook 57 is inserted into the loading device 82 from the connection opening 95, the hook 57 is dropped so as to be sandwiched between the positioning pieces 155 and 156. The end contacts the positioning pieces 155 and 156. Thereby, since the position of the hook 57 in the axial direction is restricted and positioned, the pressing force from the pressing surface 153 to the hook 57 acts appropriately and can be connected to the connecting member 48.
　スカート閉じ通路９７側の位置決め片１５５は、前フック５８を確実に位置決めできるように、四角錐部５８ｂの頂点に到達する位置まで突出するように形成されており、マガジン挿入溝９１側の位置決め片１５６は、後フック５９の後端面と当接しつつ、操作ワイヤ１２の挿入を妨げないように、位置決め片１５５よりも前方への突出が少なく形成されている。 The positioning piece 155 on the skirt closing passage 97 side is formed so as to protrude to a position reaching the apex of the quadrangular pyramid portion 58b so that the front hook 58 can be positioned reliably, and the positioning piece on the magazine insertion groove 91 side. 156 is formed to protrude less forward than the positioning piece 155 so as not to interfere with the insertion of the operation wire 12 while abutting the rear end surface of the rear hook 59.
　位置決め片１５５の上面には、付勢部１４７の突出部１４７ｂを内部に収納する凹部１５７（図９参照）が形成されている。凹部１５７は、スライダ８５が初期位置にあるときに押し込み片１５１の上面を突出部１４７ｂから退避させる。また、スライダ１８５が初期位置にあるとき、もう一方の付勢部１４６の突出部１４６ｂは、位置決め片１５５の先端部よりも奥側に位置する。よって、スライダ８５が初期位置のときは、突出部１４６ｂ，１４７ｂが押し込み片１５１と当接せず、板バネ１４６ａ，１４７ａからの付勢を受けない。なお、凹部に代えて、開口を設けてもよい。 On the upper surface of the positioning piece 155, a concave portion 157 (see FIG. 9) for accommodating the protruding portion 147b of the biasing portion 147 is formed. The recess 157 retracts the upper surface of the pushing piece 151 from the protrusion 147b when the slider 85 is in the initial position. When the slider 185 is in the initial position, the protrusion 146 b of the other urging portion 146 is located on the back side of the tip end portion of the positioning piece 155. Therefore, when the slider 85 is in the initial position, the protrusions 146b and 147b do not come into contact with the pushing piece 151 and are not urged by the leaf springs 146a and 147a. An opening may be provided instead of the recess.
　位置決め片１５５には、押圧面１５３の反対側に位置決め面１５８が設けられている。位置決め面１５８は、スライダ８５のスライド方向における前方から後方にかけて押し込み片１５１の幅が広がるように傾斜する傾斜面となっている。位置決め面１５８は、スライダ８５をスライダ通路１００の奥側の連結位置に押し込む際、上述した連結部材４８の当接面５６と当接して押圧することにより、連結部材４８を軸方向に沿って押し込む。これによって、軸方向における連結部材４８の位置決めがなされる。 The positioning piece 155 is provided with a positioning surface 158 on the opposite side of the pressing surface 153. The positioning surface 158 is an inclined surface that inclines so that the width of the pushing piece 151 increases from the front to the rear in the sliding direction of the slider 85. The positioning surface 158 presses the connecting member 48 along the axial direction by pressing against the contact surface 56 of the connecting member 48 described above when the slider 85 is pushed into the connecting position on the back side of the slider passage 100. . Thereby, the connecting member 48 is positioned in the axial direction.
　位置決め片１５６は、押圧面１５３の反対側にシース押さえ片１５９（押さえ部材）が一体に設けられている。シース押さえ片１５９は、スライダ８５が初期位置から連結位置に移動するとき、シース押さえ片１５９の下面でシース１１の上端を押さえ付けることにより、シース１１の径方向の移動を規制してマガジン挿入溝９１からシース１１が離脱しないようにする。シース押さえ片１５９は、マガジン挿入溝９１へのシース１１の挿入を妨げないように、位置決め片１５６よりも前方への突出が少なく形成されている。また、シース１１よりもクリップマガジン８１のほうが上下方向の高さがあるので、図１５に示すように、マガジン挿入溝９１にクリップマガジン８１が挿入されているときは、スライダ用凸部１３３，１３４の上面１３３ａ，１３４ａから突出したクリップマガジン８１の上部がシース押さえ片１５９の前端と当接する。これにより、クリップマガジン８１がマガジン挿入溝９１の挿入されている間は、スライダ８５の連結位置へのスライドが規制される。 The positioning piece 156 is integrally provided with a sheath pressing piece 159 (pressing member) on the opposite side of the pressing surface 153. The sheath pressing piece 159 restricts the radial movement of the sheath 11 by pressing the upper end of the sheath 11 with the lower surface of the sheath pressing piece 159 when the slider 85 moves from the initial position to the coupling position, thereby controlling the magazine insertion groove. The sheath 11 is prevented from being detached from 91. The sheath pressing piece 159 is formed to protrude less forward than the positioning piece 156 so as not to prevent insertion of the sheath 11 into the magazine insertion groove 91. Further, since the clip magazine 81 is higher in the vertical direction than the sheath 11, as shown in FIG. 15, when the clip magazine 81 is inserted into the magazine insertion groove 91, the slider protrusions 133, 134. The upper part of the clip magazine 81 protruding from the upper surfaces 133a and 134a contacts the front end of the sheath pressing piece 159. Thereby, while the clip magazine 81 is inserted in the magazine insertion groove 91, the slide of the slider 85 to the coupling position is restricted.
　押し込み片１５１の位置決め面１５８とは反対側の側面には、スライダ８５の幅方向において弾性自在な弾性片１６０が形成されている。この弾性片１６０の先端には、スライダ８５の幅方向に突出した係合突起１６１が設けられている。係合突起１６１は、スライダ８５が初期位置にあるときに、上治具１２１のスライダ用凹部１４４に設けられたクリック溝１６２（図１１も参照）に係合し、スライダ８５が連結位置にスライドしたときに、クリック溝１６３（図１１も参照）に係合する。クリック溝１６２と、係合突起１６１の係合により、スライダ８５のスライダ通路１００からの抜け止めが防止される。一方、クリック溝１６３と係合突起１６１の係合により、スライダ８５の連結位置を位置決めすることができるとともに、係合する際のクリック感によりスライダ８５の連結位置を知ることができる。 An elastic piece 160 that is elastic in the width direction of the slider 85 is formed on the side surface of the pushing piece 151 opposite to the positioning surface 158. An engaging protrusion 161 protruding in the width direction of the slider 85 is provided at the tip of the elastic piece 160. When the slider 85 is in the initial position, the engagement protrusion 161 engages with a click groove 162 (see also FIG. 11) provided in the slider recess 144 of the upper jig 121, and the slider 85 slides to the connection position. When engaged, it engages with the click groove 163 (see also FIG. 11). The engagement of the click groove 162 and the engagement protrusion 161 prevents the slider 85 from coming off from the slider passage 100. On the other hand, the engagement position of the slider 85 can be determined by the engagement of the click groove 163 and the engagement protrusion 161, and the connection position of the slider 85 can be known from the click feeling when engaged.
　図１６Ａに示すように、連結用開口９５に横方向（装填器具８２の上方）から挿入されたフック５７は、前フック５８の四角柱部５８ａの角部が、連結部材４８の弾性アーム５３、５３の間に挿入されるとともに、位置決め片１５５，１５６の間にフック５７が挟まれて、軸方向の位置決めがなされる。 As shown in FIG. 16A, the hook 57 inserted from the lateral direction (above the loading device 82) into the connection opening 95 has a corner portion of the square column portion 58a of the front hook 58, the elastic arm 53 of the connection member 48, 53, and a hook 57 is sandwiched between the positioning pieces 155 and 156 to perform axial positioning.
　図１６Ｂに示すように、スライダ８５をスライダ通路１００内に押し込むと、押圧面１５３が前フック５８及び後フック５９に当接し、これを下方に向けて徐々に押圧する。軸方向に位置決めされたフック５７は適切な押圧力を受けて連結部材４８の弾性アーム５３、５３の間に挿入されていく。また、このとき、スライダ８５の位置決め面１５８によって連結部材４８の当接面５６を押圧し、連結部材４８を適正な位置に移動させることができる。 As shown in FIG. 16B, when the slider 85 is pushed into the slider passage 100, the pressing surface 153 comes into contact with the front hook 58 and the rear hook 59 and gradually presses them downward. The hook 57 positioned in the axial direction receives an appropriate pressing force and is inserted between the elastic arms 53 and 53 of the connecting member 48. At this time, the contact surface 56 of the connecting member 48 can be pressed by the positioning surface 158 of the slider 85, and the connecting member 48 can be moved to an appropriate position.
　図１７Ａに示すように、スライダ８５をさらに押し込むと、前フック５８は、四角柱部５８ａの外周面が押圧面１５３に沿うように回転し、弾性アーム５３，５３を弾性変形させて、その間に押し込められる。そして、図１７Ｂに示すように、弾性アーム５３，５３の間に前フック５８が完全に挿入された状態となり、操作ワイヤ１２も挟持部５４，５４を押し広げて両者の間に挟み込まれる。また、後フック５９は、挟持部５４，５４の後端面に当接する。 As shown in FIG. 17A, when the slider 85 is further pushed in, the front hook 58 rotates so that the outer peripheral surface of the rectangular column portion 58a is along the pressing surface 153, elastically deforms the elastic arms 53 and 53, Can be pushed in. Then, as shown in FIG. 17B, the front hook 58 is completely inserted between the elastic arms 53, 53, and the operation wire 12 is also sandwiched between both by sandwiching the holding portions 54, 54. Further, the rear hook 59 abuts against the rear end surfaces of the holding portions 54 and 54.
　連結クリップユニット１３をクリップマガジン８１へ収容する収容作業を含む連結クリップパッケージ８０の組立作業では、先ず、下ケース１１１の上でクリップ１９Ａ～１９Ｃ及び連結リング２０Ａ～２０Ｃ及びダミークリップ４７及び連結部材４８の連結を行う。 In the assembly work of the connection clip package 80 including the operation of accommodating the connection clip unit 13 in the clip magazine 81, first, the clips 19A to 19C, the connection rings 20A to 20C, the dummy clip 47, and the connection member 48 are placed on the lower case 111. Concatenate.
　連結が終了した後、連結クリップユニット１３を、各スカート部３８がスカート用開口１１４，切欠１１５に挿入されるように下ケース１１１に収納する（図２５参照）。クリップ取り出し部材８３のクリップ係合部１０３も下ケース１１１に収容し、先頭のクリップ１９Ａの腕部２５，２５を閉じて、爪部２３，２３を係合穴１０３ｃ，１０３ｃに係合させる。その後、上ケース１１２を下ケース１１１に被せて両者を接合し、クリップマガジン８１を形成する。 After the connection is completed, the connection clip unit 13 is stored in the lower case 111 such that each skirt portion 38 is inserted into the skirt opening 114 and the notch 115 (see FIG. 25). The clip engaging portion 103 of the clip taking-out member 83 is also accommodated in the lower case 111, the arms 25 and 25 of the leading clip 19A are closed, and the claw portions 23 and 23 are engaged with the engaging holes 103c and 103c. Thereafter, the upper case 112 is put on the lower case 111 to join them together to form the clip magazine 81.
　連結クリップユニット１３が収容されたクリップマガジン８１は、連結クリップユニット１３と係合されたクリップ取り出し部材８３とともに、下治具１２０の上にセットされる。クリップマガジン８１は、マガジン用凹部１２２、クリップ取り出し部材８３は、スカート閉じ通路９７の上にセットされる（図２４参照）。このとき、リブ１１６，１１６は、位置規制用凹部１２３，１２３に係合される。そして、この状態で、下治具１２０の上方から上治具１２１を被せて、装填器具８２にクリップマガジン８１及びクリップ取り出し部材８３を取り付けた状態にすると連結クリップパッケージ８０の組立作業が完了する。 The clip magazine 81 in which the connection clip unit 13 is accommodated is set on the lower jig 120 together with the clip take-out member 83 engaged with the connection clip unit 13. The clip magazine 81 is set on the magazine recess 122 and the clip take-out member 83 is set on the skirt closing passage 97 (see FIG. 24). At this time, the ribs 116 are engaged with the position regulating recesses 123, 123. In this state, when the upper jig 121 is covered from above the lower jig 120 and the clip magazine 81 and the clip take-out member 83 are attached to the loading device 82, the assembly work of the connected clip package 80 is completed.
　図７、図１４、図１５及び図１８～２０を参照して、連結クリップパッケージ８０から、シース１１に連結クリップユニット１３を装填する方法について説明する。まず、連結クリップユニット１３の装填作業をする前、未使用状態の連結クリップパッケージ８０では、図１５に示すように、クリップマガジン８１の先端が突き当て面９８に当接する位置まで係合されている。また、位置決めキー１１７が位置決めキー溝９３に、さらにクリック突部１１７ｂがクリック孔に係合している。この状態では、スライダ８５を連結位置に押し込もうとしてもシース押さえ片１５９がクリップマガジン８１に当たってしまうため、スライダ８５の押し込み移動が規制される。 Referring to FIG. 7, FIG. 14, FIG. 15 and FIGS. 18 to 20, a method of loading the connection clip unit 13 from the connection clip package 80 to the sheath 11 will be described. First, before the connection clip unit 13 is loaded, in the connection clip package 80 in an unused state, the clip magazine 81 is engaged to a position where it abuts against the abutting surface 98 as shown in FIG. . Further, the positioning key 117 is engaged with the positioning key groove 93, and the click protrusion 117b is engaged with the click hole. In this state, even if the slider 85 is pushed into the connection position, the sheath pressing piece 159 hits the clip magazine 81, so that the pushing movement of the slider 85 is restricted.
　次に、図７に示すように、クリップマガジン８１の押さえ部１１３を親指や母指球で押さえて、他の指で装填器具８２を下方から挟み込むようにして、凹部９０を利用してクリップマガジン８１と装填器具８２とを一緒に保持し、牽引部１０１を装填器具８２から牽引する。挿通部１０２は、装填器具８２から引き出され、クリップ係合部１０３がこれに追随してスカート閉じ通路９７に移動する。連結クリップユニット１３は、クリップ係合部１０３に引っ張られてクリップ収容部８７からスカート閉じ通路９７に引き込まれる。クリップマガジン８１は、リブ１１６，１１６と位置規制溝９２，９２との係合によって、開口部９１ａ側への移動が規制される。 Next, as shown in FIG. 7, the holding portion 113 of the clip magazine 81 is pressed with a thumb or a thumb ball, and the loading device 82 is sandwiched from below with another finger, and the clip magazine is utilized using the recess 90. 81 and the loading device 82 are held together, and the towing unit 101 is pulled from the loading device 82. The insertion portion 102 is pulled out from the loading device 82, and the clip engaging portion 103 follows this and moves to the skirt closing passage 97. The connecting clip unit 13 is pulled by the clip engaging portion 103 and pulled into the skirt closing passage 97 from the clip accommodating portion 87. The clip magazine 81 is restricted from moving toward the opening 91a by the engagement between the ribs 116 and 116 and the position restricting grooves 92 and 92.
　図１８（Ａ）に示すように、スカート閉じ通路９７内に引き込まれた連結クリップユニット１３は、各連結リング２０の各スカート部３８がスカート閉じ通路９７の内壁に押されて閉じていく。先頭のクリップ１９Ａが解除溝１０５に到達すると、クリップ１９Ａの腕部２５，２５が解放状態となるとともに、このクリップ１９Ａの変位によってブラケット８４がクリップ１９Ａ及びクリップ係合部１０３から外れ、爪部２３，２３とクリップ係合部１０３との係合が解除される。連結クリップユニット１３は、スカート閉じ通路９７内の所定位置で停止する。この停止位置では、連結用クリップ体１８の連結部材４８が、連結用開口９５に対応する位置に到達する。クリップ取り出し部材８３は、逆止突起１０２ａが装填器具８２の外に突き出るまで牽引される。 As shown in FIG. 18A, the connecting clip unit 13 drawn into the skirt closing passage 97 is closed by the skirt portions 38 of the connecting rings 20 being pushed by the inner wall of the skirt closing passage 97. When the leading clip 19A reaches the release groove 105, the arms 25 and 25 of the clip 19A are released, and the bracket 84 is detached from the clip 19A and the clip engaging portion 103 due to the displacement of the clip 19A, and the claw 23 , 23 and the clip engaging portion 103 are released. The connecting clip unit 13 stops at a predetermined position in the skirt closing passage 97. At this stop position, the connecting member 48 of the connecting clip body 18 reaches a position corresponding to the connecting opening 95. The clip removing member 83 is pulled until the check protrusion 102a protrudes out of the loading device 82.
　次に、図１８（Ｂ）に示すように、クリップマガジン８１は、マガジン挿入溝９１から軸方向に抜き取られる。クリップマガジン８１の代わりに、マガジン挿入溝９１には、シース１１が開口部９１ａを介して挿入される。シース１１の先端からは、ワイヤ操作部６２に対するシース操作部６３の牽引操作により、操作ワイヤ１２とフック５７とが予め突出している。 Next, as shown in FIG. 18B, the clip magazine 81 is extracted from the magazine insertion groove 91 in the axial direction. Instead of the clip magazine 81, the sheath 11 is inserted into the magazine insertion groove 91 through the opening 91a. From the distal end of the sheath 11, the operation wire 12 and the hook 57 protrude in advance by a pulling operation of the sheath operation unit 63 with respect to the wire operation unit 62.
　図１９（Ａ）に示すように、シース１１をマガジン挿入溝９１に挿入する際には、シース１１の装填器具８２に対する軸方向の位置が、目視によって、シース１１の先端から突出したフック５７が連結部材４８と重なるように合わせられて、フック５７が連結用開口９５に挿入される。シース１１の先端部は、凹部９０にあてがわれた親指で押さえられ、他の指によって装填器具８２が下方から支えられることによって、シース１１と装填器具８２が挟み込まれるようにして把持される。これにより、シース１１の先端部は、その軸方向の位置が装填器具８２に対してずれないように保持される。 As shown in FIG. 19A, when the sheath 11 is inserted into the magazine insertion groove 91, the axial position of the sheath 11 with respect to the loading device 82 is visually determined by the hook 57 protruding from the distal end of the sheath 11. The hook 57 is inserted into the connection opening 95 so as to be overlapped with the connection member 48. The distal end portion of the sheath 11 is held by the thumb applied to the concave portion 90, and the loading device 82 is supported from below by another finger, so that the sheath 11 and the loading device 82 are sandwiched and held. As a result, the distal end portion of the sheath 11 is held such that its axial position does not shift with respect to the loading device 82.
　スライダ８５が初期位置にあるときには、連結用開口９５には、図１４に示すように、スライダ８５の位置決め片１５５，１５６が配置されている。連結用開口９５に挿入されたフック５７は、位置決め片１５５，１５６によって、その軸方向の位置が規制される。そのため、術者が、シース１１の先端部と装填器具８２とを把持した状態で、シース１１の基端側を巻き回したり、伸ばしたりしても、操作ワイヤ１２を通じてフック５７に対して軸方向に移動しようとする力は作用するものの、フック５７は、位置決め片１５５，１５６によって軸方向の位置が規制されているので、位置ずれしない。これにより、フック５７と連結部材４８の軸方向の位置関係が適切な位置に保たれる。 When the slider 85 is in the initial position, positioning pieces 155 and 156 of the slider 85 are arranged in the connection opening 95 as shown in FIG. The position of the hook 57 inserted in the connection opening 95 in the axial direction is regulated by the positioning pieces 155 and 156. Therefore, even if the operator grips the distal end portion of the sheath 11 and the loading device 82 and rolls or extends the proximal end side of the sheath 11, the surgeon can axially move with respect to the hook 57 through the operation wire 12. However, the hook 57 is not displaced because the position of the hook 57 in the axial direction is restricted by the positioning pieces 155 and 156. Thereby, the positional relationship in the axial direction between the hook 57 and the connecting member 48 is maintained at an appropriate position.
　また、フック５７を位置決め片１５５，１５６の間に配置すると、前フック５８が、弾性アーム５３，５３と対応する位置に配置される。この状態で、図１９（Ｂ）に示すように操作ワイヤ１２に対してシース１１が前進され、シース１１がマガジン挿入溝９１の奥まで挿入されて、先端が突き当て面９８に当接する。 Further, when the hook 57 is disposed between the positioning pieces 155 and 156, the front hook 58 is disposed at a position corresponding to the elastic arms 53 and 53. In this state, as shown in FIG. 19B, the sheath 11 is advanced with respect to the operation wire 12, the sheath 11 is inserted to the back of the magazine insertion groove 91, and the tip abuts against the abutting surface 98.
　また、シース１１がマガジン挿入溝９１に挿入されると、スライダ８５のシース押さえ片１５９とクリップマガジン８１によって規制されていたスライダ８５のスライド規制が解除される。スライダ８５をスライダ通路１００に押し込むと、押圧面１５３が前フック５８及び後フック５９を下方に向けて押圧する。また、このとき、シース押さえ片１５９がシース１１を押さえてマガジン挿入溝９１からの離脱を防止する。図２０（Ａ）に示すように、スライダ８５によって押圧された前フック５８は、弾性アーム５３，５３の間に挿入される。また、操作ワイヤ１２は、挟持部５４，５４に挟み込まれる。後フック５９は、挟持部５４，５４の後端面に当接する。スライダ８５が連結位置まで押し込まれたとき、スライダ８５の凹部１５４がスカート閉じ凹部１２８の上部を塞いで、スカート閉じ通路９７の一部を構成する。 Further, when the sheath 11 is inserted into the magazine insertion groove 91, the slide restriction of the slider 85 which is restricted by the sheath pressing piece 159 of the slider 85 and the clip magazine 81 is released. When the slider 85 is pushed into the slider passage 100, the pressing surface 153 presses the front hook 58 and the rear hook 59 downward. At this time, the sheath pressing piece 159 holds the sheath 11 to prevent the magazine from being removed from the magazine insertion groove 91. As shown in FIG. 20A, the front hook 58 pressed by the slider 85 is inserted between the elastic arms 53 and 53. Further, the operation wire 12 is sandwiched between the sandwiching portions 54 and 54. The rear hook 59 comes into contact with the rear end surfaces of the holding portions 54 and 54. When the slider 85 is pushed to the connecting position, the concave portion 154 of the slider 85 closes the upper portion of the skirt closing concave portion 128 to constitute a part of the skirt closing passage 97.
　操作ワイヤ１２をシース１１に対して牽引する。例えば、ワイヤ操作部６２をシース操作部６３に対して引くことにより、操作ワイヤ１２をシース１１に対して大きく動かすことができる。図２０（Ｂ）に示すように、操作ワイヤ１２が牽引されると、操作ワイヤ１２に接続されている連結クリップユニット１３は、その後端側からシース１１内に一緒に引き込まれていく。連結クリップユニット１３の装填中、スカート閉じ通路９７とシース１１の内径面とが連接しているので、スカート部３８を閉じたまま連結クリップユニット１３を移動することができ、抵抗を小さくすることができる。これにより、各クリップ１９Ａ～１９Ｃと各連結リング２０Ａ～２０Ｃとの間に位置ずれが生じさせることなく、連結クリップユニット１３をシース１１内に装填することができる。 The operation wire 12 is pulled with respect to the sheath 11. For example, the operation wire 12 can be moved largely with respect to the sheath 11 by pulling the wire operation unit 62 with respect to the sheath operation unit 63. As shown in FIG. 20B, when the operation wire 12 is pulled, the connection clip unit 13 connected to the operation wire 12 is drawn together into the sheath 11 from the rear end side. Since the skirt closing passage 97 and the inner diameter surface of the sheath 11 are connected while the connecting clip unit 13 is being loaded, the connecting clip unit 13 can be moved while the skirt portion 38 is closed, and the resistance can be reduced. it can. As a result, the connecting clip unit 13 can be loaded into the sheath 11 without causing a positional shift between the clips 19A to 19C and the connecting rings 20A to 20C.
　シース操作部６３がワイヤ操作部６２の最初のノッチ６９に係合したときに、連結クリップユニット１３の装填が完了する。連結クリップユニット１３が装填されたシース１１は、装填器具８２から抜きとられる。 When the sheath operating portion 63 is engaged with the first notch 69 of the wire operating portion 62, the loading of the connecting clip unit 13 is completed. The sheath 11 loaded with the connecting clip unit 13 is removed from the loading device 82.
　以上で説明したように、本発明の連結クリップパッケージ８０によれば、スライダ８５と一体に設けた位置決め片１５５，１５６によって、装填器具８２内のフック５７を軸方向に正確に位置決めすることが可能となる。そして、位置決め片１５５，１５６によって、フック５７の軸方向の移動が規制されるので、シース１１の基端側の挙動によってフック５７の軸方向の位置がずれない。このため、連結操作の際にフック５７の軸方向の位置ずれを懸念してシース１１の基端側を固定しておかなくて済むので、連結操作の操作性が向上する。 As described above, according to the connection clip package 80 of the present invention, the hooks 57 in the loading device 82 can be accurately positioned in the axial direction by the positioning pieces 155 and 156 provided integrally with the slider 85. It becomes. Since the movement of the hook 57 in the axial direction is restricted by the positioning pieces 155 and 156, the axial position of the hook 57 does not shift due to the behavior of the proximal end side of the sheath 11. For this reason, since there is no need to fix the proximal end side of the sheath 11 in consideration of the axial displacement of the hook 57 during the coupling operation, the operability of the coupling operation is improved.
　また、装填器具８２に形成された連結用開口９５の位置に対応するように位置決め片１５５、１５６が設けられているので、フック５７を連結用開口９５から装填器具８２の内部へ挿入することで、位置決め片１５５，１５６の間にフック５７が落とし込まれ、簡単に位置決めを行うことができる。 Further, since the positioning pieces 155 and 156 are provided so as to correspond to the position of the connection opening 95 formed in the loading device 82, the hook 57 can be inserted into the loading device 82 from the connection opening 95. The hooks 57 are dropped between the positioning pieces 155 and 156 so that the positioning can be easily performed.
　上記実施形態では、フック５７を押圧する押し込み片１５１と、フック５７の位置決めを行う位置決め片１５５，１５６とを一体に設けたスライダ８５を用いる構成としているが、フック５７の位置決めを行う位置決め片をスライダと別体に設けてもよい。この場合、例えば図２１に示すように、装填器具８２には、押し込み片１８７を設けたスライダ１８５と、このスライダ１８５と別体に設けた位置決め部材１８６とを備える。 In the above-described embodiment, the slider 85 in which the pushing piece 151 that presses the hook 57 and the positioning pieces 155 and 156 that position the hook 57 are integrally used is used, but the positioning piece that positions the hook 57 is used. It may be provided separately from the slider. In this case, for example, as shown in FIG. 21, the loading device 82 includes a slider 185 provided with a pushing piece 187 and a positioning member 186 provided separately from the slider 185.
　スライダ１８５は、第１実施形態の操作部１５０と同様の操作部（図示せず）と、この操作部と一体に設けられ、スライダ通路１００に挿入される押し込み片１８７とが一体に形成されている。押し込み片１８７は、上記実施形態のスライダ８５に設けられた押し込み片１５１と同様にスライダ用凸部１３３，１３４の上面１３３ａ，１３４ａ，１３３ｂ，１３４ｂに合わせた段差を有する底面が形成され、先端側からスカート閉じ通路９７側の底面に向かって傾斜する押圧面１８８が形成されている。また、押圧面１８８の後方には、連結位置にあるとき、スカート閉じ通路９７の一部を構成する凹部１８９が形成されている。 The slider 185 is integrally formed with an operation unit (not shown) similar to the operation unit 150 of the first embodiment and a push piece 187 that is provided integrally with the operation unit and inserted into the slider passage 100. Yes. The pushing piece 187 is formed with a bottom surface having a step corresponding to the upper surfaces 133a, 134a, 133b, and 134b of the slider projections 133 and 134 in the same manner as the pushing piece 151 provided on the slider 85 of the above embodiment. A pressing surface 188 that is inclined toward the bottom surface on the skirt closing passage 97 side is formed. Further, a recessed portion 189 constituting a part of the skirt closing passage 97 is formed behind the pressing surface 188 when in the connecting position.
　押し込み片１８７の先端側には、押圧面１８８の両側からスライド方向における前方に突出する当接片１９０、及びシース押さえ片１９１とが形成されている。当接片１９０は、位置決め部材１８６と当接して前方へ位置決め部材１８６を押し込む。また、当接片１９０には、押圧面１８８の反対側に、位置決め面１９２が設けられている。位置決め面１９２は、スライダ１８５を押し込む際、連結部材４８の当接面５６と当接して押圧することにより、連結部材４８を位置決めする。シース押さえ片１９１は、スライダ１８５が初期位置から連結位置に移動するとき、シース１１を押さえてマガジン挿入溝９１からの離脱を防止する。また、押し込み片１８７の位置決め面１９２とは反対側の側面には、弾性片１９３が形成され、この弾性片１６０の先端には、装填器具８２のクリック溝１６２，１６２に係合する係合突起１９４が設けられている。 A contact piece 190 that protrudes forward in the sliding direction from both sides of the pressing surface 188 and a sheath pressing piece 191 are formed on the distal end side of the pushing piece 187. The contact piece 190 contacts the positioning member 186 and pushes the positioning member 186 forward. The contact piece 190 is provided with a positioning surface 192 on the opposite side of the pressing surface 188. When the slider 185 is pushed in, the positioning surface 192 contacts and presses against the contact surface 56 of the connecting member 48 to position the connecting member 48. The sheath pressing piece 191 presses the sheath 11 and prevents it from detaching from the magazine insertion groove 91 when the slider 185 moves from the initial position to the coupling position. Further, an elastic piece 193 is formed on the side surface of the pushing piece 187 opposite to the positioning surface 192, and an engaging protrusion that engages with the click grooves 162 and 162 of the loading device 82 is formed at the tip of the elastic piece 160. 194 is provided.
　位置決め部材１８６は、マガジン挿入溝９１及びスカート閉じ通路９７を挟んでスライダ１８５と反対側に位置し、スライダ通路１００に沿って移動自在に設けられた基端部１９５と、この基端部１９５からスライダ１８５に向かって突出する位置決め片１９６，１９７とが一体に設けられている。フック５７が連結用開口９５から装填器具８２の内部へ挿入されると、位置決め片１９６，１９７の間に挟まれるように落とし込まれ、フック５７の軸方向前端及び後端が位置決め片１９６，１９７と当接する。これにより、フック５７の軸方向の位置決めと、位置規制がなされる。スカート閉じ通路９７側の位置決め片１９６は、スカート閉じ通路９７を越えてスライダ１８５の当接片１９０と当接する位置まで突出するように形成されており、マガジン挿入溝９１側の位置決め片１９７は、後フック５９の後端面と当接しつつ、操作ワイヤ１２の挿入を妨げないように、スライダ１８５側への突出が少なく形成されている。 The positioning member 186 is located on the opposite side of the slider 185 with the magazine insertion groove 91 and the skirt closing passage 97 interposed therebetween, and a base end portion 195 movably provided along the slider passage 100, and the base end portion 195 Positioning pieces 196 and 197 projecting toward the slider 185 are integrally provided. When the hook 57 is inserted into the loading device 82 from the connection opening 95, the hook 57 is dropped so as to be sandwiched between the positioning pieces 196 and 197, and the axially forward and rear ends of the hook 57 are positioned in the positioning pieces 196 and 197. Abut. As a result, the hook 57 is positioned in the axial direction and the position is restricted. The positioning piece 196 on the skirt closing passage 97 side is formed so as to protrude beyond the skirt closing passage 97 to a position where it comes into contact with the contact piece 190 of the slider 185. The positioning piece 197 on the magazine insertion groove 91 side is The protrusion to the slider 185 side is formed so as not to interfere with the insertion of the operation wire 12 while being in contact with the rear end surface of the rear hook 59.
　連結用開口９５から挿入されたフック５７は、連結部材４８の弾性アーム５３、５３の間に配置されるとともに、位置決め片１９６，１９７の間にフック５７の前端及び後端が挟まれ、軸方向の位置決めがなされる。この状態からスライダ１８５を前方へ押し込むと、押圧面１８８がフック５７を押圧するとともに、当接片１９０が位置決め部材１８６を前方へ押し込む。そして、弾性アーム５３，５３の間に前フック５８が挿入された状態となり、操作ワイヤ１２も挟持部５４，５４の間に挟み込まれる。 The hook 57 inserted from the connection opening 95 is disposed between the elastic arms 53 and 53 of the connection member 48, and the front and rear ends of the hook 57 are sandwiched between the positioning pieces 196 and 197, so that the axial direction Is positioned. When the slider 185 is pushed forward from this state, the pressing surface 188 pushes the hook 57 and the contact piece 190 pushes the positioning member 186 forward. Then, the front hook 58 is inserted between the elastic arms 53 and 53, and the operation wire 12 is also sandwiched between the sandwiching portions 54 and 54.
　上記実施形態は、いずれもクリップマガジンとは別に装填器具を用い、クリップマガジンのクリップ収容部から連結クリップユニットを、装填器具のスカート閉じ通路に移送した後、装填器具に設けられたスライダによって、連結部材とフックとを連結させる例で説明している。この場合には、本発明の特許請求の範囲の収容ユニットは、装填器具に相当し、収容部は、装填器具のスカート閉じ通路に相当する。しかし、装填器具を用いずに、クリップマガジンに連結クリップユニットを収容した状態で、連結補助部材によって連結部材とフックの連結を完了させるようにしてもよい。 In each of the above embodiments, a loading device is used separately from the clip magazine, and the connection clip unit is transferred from the clip housing portion of the clip magazine to the skirt closing passage of the loading device, and then connected by a slider provided in the loading device. An example in which a member and a hook are connected is described. In this case, the storage unit according to the claims of the present invention corresponds to a loading device, and the storage portion corresponds to a skirt closing passage of the loading device. However, the connection between the connection member and the hook may be completed by the connection auxiliary member in a state where the connection clip unit is accommodated in the clip magazine without using the loading device.
　以上、本発明に係るクリップパッケージについて詳細に説明したが、本発明は上記の実施例に限定されず、本発明の主旨を逸脱しない範囲において、種々の改良や変更をしてもよいのはもちろんである。また、本発明のクリップパッケージを用いるクリップ処置具は、軟性鏡のほか、硬性鏡にも用いることができる。 The clip package according to the present invention has been described in detail above. However, the present invention is not limited to the above-described embodiments, and various improvements and modifications may be made without departing from the spirit of the present invention. It is. Moreover, the clip treatment tool using the clip package of the present invention can be used for a rigid endoscope as well as a flexible endoscope.

Claims (10)

  1. 　操作ワイヤが挿通されたシース内に複数のクリップユニットを装填するためのクリップパッケージにおいて、
    　前記複数のクリップユニットを一列に沿って収容するクリップマガジンと、
    　前記クリップマガジンが挿入されるマガジン挿入部と、前記クリップマガジンから複数のクリップユニットを取り出すクリップ取り出し部材と、前記クリップマガジンから取り出した複数のクリップユニットを収容する収容部と、前記収容部内のクリップユニットのうち最端部のクリップユニットに対する前記操作ワイヤのフックの位置を規制する位置規制部と、前記最端部のクリップユニット及びフックのうち少なくとも一方を他方に向けて押圧することにより、前記最端部のクリップユニットと前記フックを連結させる連結補助部材とを有し、前記最端部のクリップユニットに前記フックを連結した後は、前記操作ワイヤを引き込むことによって複数のクリップユニットをシース内に装填する装填器具とを備えたことを特徴とするクリップパッケージ。     In a clip package for loading a plurality of clip units into a sheath through which an operation wire is inserted,
    A clip magazine for accommodating the plurality of clip units along a line;
    Magazine insertion portion into which the clip magazine is inserted, a clip removal member for taking out a plurality of clip units from the clip magazine, a housing portion for housing a plurality of clip units taken out from the clip magazine, and a clip unit in the housing portion A position restricting portion for restricting the position of the hook of the operation wire with respect to the clip unit at the outermost portion, and pressing the at least one of the clip unit and the hook at the outermost portion toward the other, thereby A plurality of clip units are loaded into the sheath by pulling the operation wire after connecting the hooks to the clip unit at the end. A clip equipped with a loading device. Package.
  2. 　前記位置規制部は、前記フックを、その軸方向の前後から挟み込むように形成された一対の位置決め片からなることを特徴とする請求の範囲第１項記載のクリップパッケージ。 2. The clip package according to claim 1, wherein the position restricting portion comprises a pair of positioning pieces formed so as to sandwich the hook from the front and rear in the axial direction thereof.
  3. 　前記装填器具には、前記フックと連結する前記最端部のクリップユニットの連結部を外部に露呈させる開口部が形成されており、
    　前記位置規制部は、前記開口部に対応する位置に配置されていることを特徴とする請求の範囲第１項又は第２項記載のクリップパッケージ。     The loading device is formed with an opening that exposes the connecting portion of the clip unit at the endmost portion connected to the hook,
    The clip package according to claim 1 or 2, wherein the position restricting portion is disposed at a position corresponding to the opening.
  4. 　前記連結補助部材は、前記クリップユニットの軸方向と直交するスライド方向に移動自在なスライダであり、
    　前記スライダはスライド方向に対して傾斜している押圧面を有しており、この押圧面を前記フック及び前記連結部のうちの一方に接触させて押圧方向に押し込んでいくことにより、前記スライドによる押し込み量を徐々に増加させることを特徴とする請求の範囲第１項～第３項のいずれかに記載のクリップパッケージ。     The connection auxiliary member is a slider that is movable in a sliding direction orthogonal to the axial direction of the clip unit,
    The slider has a pressing surface that is inclined with respect to the sliding direction, and the pressing surface is brought into contact with one of the hook and the connecting portion to be pushed in the pressing direction, thereby causing the sliding. The clip package according to any one of claims 1 to 3, wherein the push-in amount is gradually increased.
  5. 　前記位置規制部は、前記スライダと一体に形成されており、前記スライド方向において前記押圧面よりも前方に向けて突出していることを特徴とする請求の範囲第４項記載のクリップパッケージ。 5. The clip package according to claim 4, wherein the position restricting portion is formed integrally with the slider, and projects forward from the pressing surface in the sliding direction.
  6. 　前記装填器具には、前記マガジン挿入部に挿入されたクリップマガジンの位置を規制するマガジン位置規制溝が形成されていることを特徴とする請求の範囲第５項記載のクリップパッケージ。 6. The clip package according to claim 5, wherein a magazine position restricting groove for restricting a position of the clip magazine inserted in the magazine insertion portion is formed in the loading device.
  7. 　前記スライダと一体に形成されており、前記スライダのスライド中に、前記フックの後方に配された前記シースの上端と当接し、前記シースの径方向の移動を規制する押さえ部材が設けられていることを特徴とする請求の範囲第６項記載のクリップパッケージ。 A holding member that is formed integrally with the slider and that abuts on the upper end of the sheath disposed behind the hook and restricts the radial movement of the sheath while the slider slides is provided. The clip package according to claim 6, wherein:
  8. 　前記装填器具に前記クリップマガジンが接続された状態において、前記押さえ部材は、その前端が前記クリップマガジンと当接することにより、前記スライダの移動を規制することを特徴とする請求の範囲第７項記載のクリップパッケージ。 The range of claim 7, wherein, in a state where the clip magazine is connected to the loading device, the pressing member restricts the movement of the slider by abutting the front end thereof with the clip magazine. Clip package.
  9. 　前記装填器具には、前記スライダがスライドするスライダ通路が設けられており、前記スライダには、前記スライダ通路の内壁と係合して、前記スライダの前記スライダ通路からの抜け止めを防止する係合突起が形成されていることを特徴とする請求の範囲第４項～第８項のいずれかに記載のクリップパッケージ。 The loading device is provided with a slider passage through which the slider slides. The slider engages with an inner wall of the slider passage to prevent the slider from coming off from the slider passage. The clip package according to any one of claims 4 to 8, wherein a protrusion is formed.
  10. 　前記位置規制部は、前記連結補助部材と別体に設けられていることを特徴とする請求の範囲第１項～第４項のいずれかに記載のクリップパッケージ。 The clip package according to any one of claims 1 to 4, wherein the position restricting portion is provided separately from the connection assisting member.
PCT/JP2010/064453 2009-08-27 2010-08-26 Clip package WO2011024886A1 (en)

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KR102115491B1 (en) * 2017-11-20 2020-05-26 주식회사 파인메딕스 Clipping device for endoscope
WO2021171407A1 (en) * 2020-02-26 2021-09-02 オリンパス株式会社 Cartridge system

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