WO2012039164A1

WO2012039164A1 - Ligature device and clip unit used therein

Info

Publication number: WO2012039164A1
Application number: PCT/JP2011/062526
Authority: WO
Inventors: 寺田　和広
Original assignee: 富士フイルム株式会社
Priority date: 2010-09-22
Filing date: 2011-05-31
Publication date: 2012-03-29
Also published as: JP5579004B2; JP2012065834A

Abstract

Provided is a ligature device, which allows the opening and closing of clip arms with a simple configuration, thereby allowing easy re-positioning of the grasp thereof on somatic tissue, and which does not generate fracture pieces; and a clip unit used therein. The main clip body (35) having a base end (39) that connects the bases of a pair of open-and-closeable arms (41, 41) and a wire hooking means, is inserted inside a squeezing ring (37) with the pair of arms (41) closed and is disposed inside an introduction tube (19). The main clip body (35) is configured to be advanced and retracted freely by an operating wire (23) that engages with a wire hooking means configured from a hook (43) and a disengagement stop (45). The engagement of the main clip body (35) with the operating wire (23) is released by plastic deformation of the hook (43).

Description

Ligating device and clip unit used therefor

The present invention relates to a ligation apparatus for ligating living tissue and a clip unit used for the ligation apparatus.

As a ligation device for ligating biological tissue, for example, insert the ligation device into the body cavity from the forceps opening of the endoscope, align the clip with the arm part of the tip expanded to the position of the desired biological tissue, and connect to the clip A device that closes the arm of the clip and ligates the living tissue by pulling the operated wire is known (see, for example, Patent Document 1).

The living tissue ligation device described in Patent Document 1 is fixed to an introduction tube inserted into a body cavity, an operation wire inserted into the introduction tube so as to be movable back and forth, and a loop-shaped ligation wire connected to the operation wire. And a plurality of clips loaded in the introduction tube. The clip and the ligature wire are in a state where the ligature wire is fixed to the coupling portion of the base end portion of the clip by welding, adhesion, etc., and the coupling portion is broken by pulling the operation wire, and the clip sandwiches the living tissue. It is designed to be placed in the body cavity.

However, in the ligating apparatus having the above configuration, since the clip is separated from the operation wire by the breakage of the connecting portion between the clip and the ligating wire, there is a possibility that a broken piece of a small piece is generated when the connecting portion is broken. This broken piece enters the introduction tube of the ligation apparatus or is left in the body cavity. When the broken piece remains in the introduction tube, the operation of the operation wire performed subsequently is hindered, and there is a possibility that continuous ligation of the living tissue cannot be performed by the clip in the next stage. In addition, it is not preferable that the broken fragments remain in the body cavity unintentionally.
In addition, these clips are fixed in a state in which the arm portion of the clip is closed after the arm portion of the clip is once closed by pulling the operation wire, and cannot be opened again. Therefore, since the biological tissue once grasped by the clip cannot be re-grown, it is necessary to pull the operation wire after carefully positioning the clip. For these reasons, the clip ligation operation requires skill.

Japanese Patent No. 4059656

An object of the present invention is to provide a ligation apparatus that can open and close the arm portion of a clip with a simple configuration, thereby allowing a biological tissue to be re-gripped freely, and that does not cause broken fragments, and a clip unit used therefor. Objective.

The present invention has the following configuration.
A ligation apparatus for ligating living tissue,
A flexible introduction tube;
An operation wire that is inserted into the introduction tube so as to freely advance and retract, and has a loop portion at the tip,
A clip unit disposed inside the distal end of the introduction tube and connected to the operation wire;
With
The clip unit has a pair of arm portions that are urged to expand each other, and a clip body that ligates a living tissue with a base end portion that connects the base ends of the arm portions;
A clamping ring in which a base end portion of the clip body is inserted into a cylindrical body to close the pair of arms;
Wire locking means provided at a base end portion of the clip body to lock the loop portion of the operation wire;
Have
The wire locking means includes a locking claw extending obliquely outward in the radial direction of the clamping ring from the proximal end of the clip body toward the rear in the insertion direction to the clamping ring,
A ligating apparatus comprising: a retaining portion that prevents the loop portion of the operation wire that is retained by the retaining claw from falling off the retaining claw.

According to the ligating apparatus and the clip unit used therefor according to the present invention, when the living tissue is ligated, the opening / closing operation of the clip can be performed with a simple configuration, and the living tissue can be re-gripped freely. Further, since the clip main body and the operation wire are separated by the deformation of the clip main body, the broken fragments are not left in the body cavity and the continuous ligation operation is not hindered.

BRIEF DESCRIPTION OF THE DRAWINGS It is a figure for describing embodiment of this invention, and is the whole block diagram of the ligation apparatus shown by notching a part. It is sectional drawing of the hand operation part of the ligation apparatus shown in FIG. It is a disassembled perspective view of the clip unit shown in FIG. (A) is a side view of the clip main body shown in FIG. 3, and (B) is a plan view. (A) is the sectional view on the AA line of FIG. 3, (B) is the sectional view on the BB line. (A) is a cross-sectional view of the main part of the clip body, the tightening ring, and the operation wire before assembly, (B) is a cross-sectional view of the main part of the clip body inserted into the tightening ring, and (C) is a clip of the operation wire FIG. 4D is a cross-sectional view of a main part in the middle of being engaged with the wire locking means of the main body, and FIG. (A) is a cross-sectional view of the main part of the clip unit mounted in the introduction pipe, (B) is a cross-sectional view of the main part in which the arm part of the clip body is opened by retreating the introduction pipe, and (C) is a feeding operation of the operation wire. FIG. 5 is a cross-sectional view of the main part showing a state where the arm part of the clip body is opened and closed by a pulling operation. (A) is a cross-sectional view of the main part at the start of tissue ligation, (B) is a cross-sectional view of the main part showing a state in which the tissue is ligated by pulling the operation wire, and (C) is a plastic deformation of the clip body locking claw The principal part sectional view which shows the state which starts a state, (D) is principal part sectional drawing which shows the state from which the latching | locking nail | claw of a clip main body and the loop part of an operation wire are cancelled | released, (E) is a biological tissue. It is principal part sectional drawing which shows the state which the clip unit ligated leaves | separates from a ligation apparatus and is detained in a body cavity. It is a principal part expansion perspective view of the clip unit of FIG. It is a perspective view of the clip main body of a modification. They are a vertical sectional view (A) and a horizontal sectional view (B) of a repetitive ligating apparatus in which a plurality of clip units are loaded in the outer sheath member. It is a perspective view of the ligation apparatus of FIG. 11 shown except an outer sheath member. (A) is a perspective view of a ligation apparatus before ligation, (B) is a perspective view showing a state in which an arm portion of a clip main body which is pulled by an operation wire and is arranged at the distal end is closed, and (C) is a clip at the distal end. The perspective view which shows the state from which the latching claw of a main body starts plastic deformation, (D) is a perspective view which shows the state which the latching claw plastically deformed and the latching | locking of a clip main body and a loop part was cancelled | released, (E ) Is a perspective view showing a state in which the loop portion is guided by the retaining portion of the next clip body and guided to the wire locking means, and (F) is a wire locking means of the next clip body where the loop portion of the operation wire is guided. And is a perspective view showing a state in which the clip unit at the tip is separated. It is principal part sectional drawing which shows the dimensional relationship between the opening width of the arm part of the clip main body inserted in the clamping ring, and the width | variety of the base end part of a clip main body. It is a perspective view which shows the state which changed the expansion direction of the arm part of a some clip unit 90 degrees, and was arranged in a line. FIG. 16 is a perspective view of the fastening ring and the clip body of FIG. 15. 15A is a plan view of the clip body, FIG. 15B is a front view, and FIG. 15C is a side view.

Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings.
FIG. 1 is a diagram for explaining an embodiment of the present invention. FIG. 2 is an overall configuration diagram of a ligation apparatus shown with a part cut away, and FIG. 2 is a sectional view of a hand operating unit.

The ligating apparatus 100 includes a clip operating device 11 and a clip unit 13 loaded in the clip operating device 11. The clip operation device 11 includes an insertion portion 15 that is inserted into a channel of an endoscope (not shown) and inserted into a body cavity, and a proximal operation portion 17 on the proximal end side of the insertion portion 15. The insertion portion 15 includes an outer sheath member 19 that is an introduction tube made of a high-density polyethylene tube, an inner sheath member 21 that is inserted into the outer sheath member 19 so as to be able to advance and retract, and an advancement and retraction within the inner sheath member 21. And an operation wire 23 to be inserted into the cable.

The inner sheath member 21 is composed of a flexible coil sheath in which a wire material having a spring property is closely wound. The operation wire 23 is formed of a twisted metal wire having moderate elasticity such as stainless steel or NiTi alloy, and the outer periphery thereof may be coated with high-density polyethylene as necessary, and is slidable with the inner sheath member 21. You may apply the silicone oil for improving. An annular loop portion 71 is provided at the distal end of the operation wire 23 on the side opposite to the hand operation portion 17 side.

The clip unit 13 includes a tightening ring 37 formed in a tubular body, and a clip body 35 inserted into the tubular body of the tightening ring 37, and is axially extended from the distal end of the outer sheath member 19. Are arranged in series along. Among the plurality of clip units 13, the clip unit at the end opposite to the distal end is configured such that the rear end of the fastening ring 37 opposite to the insertion side of the clip body 35 is the distal end of the inner sheath member 21. It touches the tip of the end.

The hand operation unit 17 is movable forward and backward with respect to the operation unit main body, an outer sheath connection body 25 in which the proximal end side of the outer sheath member 19 is fixed, an operation unit main body 27 in which the proximal end side of the inner sheath member 21 is fixed. And a slider 29 connected to the operation wire 23 and a finger ring 33 connected to the operation unit main body 27. The hand operation unit 17 adjusts the relative position between the outer sheath member 19 and the inner sheath member 21 by relatively moving the outer sheath connector 25 and the operation unit main body 27. Further, the relative position between the inner sheath member 21 and the clip unit 13 connected to the operation wire 23 is adjusted by relatively moving the operation portion main body 27 and the slider 29.

When the clip operating device 11 pushes the operating portion main body 27 forward with the outer sheath connector 25 fixed, the outer sheath member 19 moves rearward relative to the inner sheath member 21 at the distal end, Conversely, when the operation portion main body 27 is pulled backward, the outer sheath member 19 moves forward relative to the inner sheath member 21 at the distal end. Further, when the slider 29 is moved away from the finger ring 33, the operation wire 23 moves from the inner sheath member 21. On the contrary, when the slider 29 is moved closer to the finger ring 33, the operation wire 23 is moved into the inner ring. It moves in the direction of being drawn into the sheath member 21. The clip unit 13 loaded on the distal end of the outer sheath member 19 is held by an operation wire 23, and will be detached from the clip operation device 11 by pulling of the operation wire 23 as will be described in detail later. .

<Clip unit>
Next, the configuration of the clip unit 13 will be described in detail.
FIG. 3 shows an exploded perspective view of the clip unit. The clip unit 13 includes a tightening ring 37 and a clip body 35 that is inserted into the cylindrical body of the tightening ring 37. The clip main body 35 has a pair of arm portions 41 that are urged to expand and a base end portion 39 that connects the base ends of the arm portions 41, and grips the living tissue by the arm portions 41. The clip main body 35 is formed by bending a belt-shaped metal plate having a spring property such as stainless steel into a substantially U shape. The fastening ring 37 is a cylindrical member made of a metal material such as stainless steel, and the operation wire 23 is inserted through the inside thereof. The base end side of the clip main body 35 is accommodated in the fastening ring 37 in a state where the loop portion 71 of the operation wire 23 is locked to a part of the clip main body 35.

<Clip body>
The clip main body 35 has a shape shown in FIG. 4A as a side view of the clip main body, and in FIG. The clip main body 35 has wire locking means including a locking claw 43 and a retaining portion 45 at the base end portion 39. The wire locking means locks the loop portion 71 of the operation wire 23. The locking claws 43 are respectively inclined and extended so as to extend outward from the width direction both sides of the arm portion 41 at the bottom 39 a of the base end portion 39 toward the arm portion 41. That is, the latching claw 43 is inclined and extended outward in the radial direction of the fastening ring 37 in the direction opposite to the insertion direction from the proximal end 39 of the clip body 35 to the fastening ring 37. . The locking claw 43 is a plate-like body narrowed so that the force required to plastically deform the locking claw 43 is larger than the force that pulls the clip body 35 into the fastening ring 37.

The retaining portion 45 is a protrusion projecting toward the locking claw 43 from a position spaced from the connecting portion with the locking claw 43 at the proximal end portion 39 of the clip body 35 toward the arm portion 41 side. There is an inclined surface 45a whose protruding height toward the pawl 43 gradually increases in the direction of insertion of the clip body 35 into the fastening ring 37. Thus, a gap 47 for locking the loop portion 71 of the operation wire 23 is defined by the locking claw 43, the side surface 45b of the base end portion 39 side of the retaining portion 45, and the side surface in the width direction of the base end portion 39. Is done. The gap between the protruding tip of the retaining portion 45 and the locking claw 43 is made smaller than the diameter of the operation wire 23, and details will be described later, but the loop portion 71 of the operation wire 23 elastically deforms the locking claw 43. When entering the gap 47, the loop portion 71 of the operation wire 23 is prevented from falling out of the gap 47.

In the illustrated example, the locking claw 43 and the retaining portion 45 are formed as a pair on the upper and lower sides, but may be formed only on one side. In addition, as shown in the example, a pair of upper and lower locking claws 43 and retaining portions 45 are formed on the clip main body 35, and two loop portions 71 of the operation wire 23 are further formed, and two loop portions are It is good also as a structure each latched to the one latching claw 43 separately. In that case, the clip body 35 can be stably moved without the traction force of the operation wire 23 being biased.

The pair of arm portions 41 are symmetrically arranged oppositely and are band-shaped metal plate members having spring properties, and have a predetermined width in a direction orthogonal to the expanding direction of the pair of arm portions 41 in order from the base end portion 39. A plate-like piece portion 51, a wide portion 53 wider than the plate-like piece portion 51, and a tissue gripping portion 55 capable of sandwiching a living tissue. The pair of arm portions 41 are urged so as to expand each other by the spring property of the material of the clip body 35. As described above, the pair of arm portions 41 includes a wide portion 53 formed gradually wider from the plate-like piece portion 51, a step portion 57 formed between the wide portion 53 and the plate-like piece portion 51, and a wide width. A tissue gripping portion 55 formed on the distal end side of the portion 53 is provided, and details thereof are as follows.

The pair of arm portions 41 is bent so as to expand outward at a first bending point 41 a provided on the base end portion 39 side of the plate-like piece portion 51, and is provided at a middle position of the plate-like piece portion 51. It is bent inward at a point 41b. Further, the tissue gripping portion 55 is formed by being bent inward at a third bending point 41 c on the distal end side of the wide portion 53.

When the pair of arm portions 41 are opened due to the spring property of the clip main body 35, the pair of tissue gripping portions 55 are largely separated from each other to form a sandwiching gap 73 between the pair of tissue gripping portions 55. Further, when the pair of arm portions 41 are closed, the distal ends come into contact with each other and the living tissue can be sandwiched. It should be noted that the tip of the tissue gripping portion 55 may be linear as shown in the figure, or may be formed in an uneven shape that meshes with each other so that the living tissue can be securely sandwiched.

<Tightening ring>
5A is a cross-sectional view taken along the line AA in FIG. 3, and FIG. 5B is a cross-sectional view taken along the line BB. As shown in FIGS. 3, 5 A, and 5 B, the tightening ring 37 includes a hollow cylindrical portion 61, a pair of clip contact portions 63, and a pair of clip retaining pieces 65.

The fastening ring 37 closes the pair of arm portions 41 of the clip body 35 by inserting the proximal end portion 39 of the clip body 35 into the cylindrical body. The pair of clip contact portions 63 and the pair of clip retaining pieces 65 are formed by bending each pair of protrusions protruding in the axial direction from one end of the cylindrical portion 61 to the inside of the fastening ring 37 in the radial direction. is doing. The clip retaining piece 65 extends from the end of the tightening ring 37 on the clip body insertion side so as to incline toward the inside of the ring in the insertion direction of the clip body 35. The pair of clip contact portions 63 and the pair of clip retaining pieces 65 are arranged at circumferential positions different from each other by 180 °, and the clip contact portion 63 and the clip retaining pieces 65 are different from each other by 90 °. It is formed at a circumferential position.

The pair of clip contact portions 63 have a flat surface parallel to the axis of the tightening ring 37 by bending a protrusion projecting from one end of the cylindrical portion 61. A pair of guide pieces 69 projecting inward in the radial direction of the fastening ring 37 are formed on both sides of the clip contact portion 63. The distance between the pair of guide pieces 69 is set to be larger than the width W1 (see FIG. 4) of the plate-like piece portion 51 of the clip body 35 and smaller than the width W2 of the wide portion 53.

Thereby, when the clip main body 35 is inserted into the fastening ring 37, the flat surfaces of the clip abutting portion 63 abut against both outer side surfaces of the arm portion 41 to guide the clip main body 35, and the center of the fastening ring 37 While restricting the rotation of the clip body 35 relative to the shaft, the stepped portion 57 of the wide portion 53 and the plate-like piece portion 51 comes into contact with the pair of guide pieces 69, and the insertion length of the clip body 35 into the fastening ring 37 is Limit.

Further, when the clip main body 35 is inserted into the fastening ring 37 from the base end portion 39 side, both outer side surfaces of the pair of arm portions 41 are pressed by the flat surfaces of the clip abutting portions 63, and the arm portions 41. Is closed. The flat surface of the clip abutting portion 63 with which both outer surfaces of the arm portion 41 abut is not particularly limited to a flat surface as long as the rotation of the clip body 35 with respect to the central axis of the fastening ring 37 can be restricted. A plurality of protrusions that are in point contact with both outer side surfaces of the arm portion 41 or protrusions that are in line contact can also be used.

The pair of clip retaining pieces 65 are provided at one end of the cylindrical portion 61, are bent into a substantially V-shaped cross section from the end of the clamping ring 37 toward the inside of the cylinder, and are radially inward of the clamping ring 37. Inclined and extended. The pair of clip retaining pieces 65 are latched by the latching claws 43 (see FIG. 3) of the clip body 35 inserted into the tightening ring 37, and the clip body 35 once inserted comes out of the tightening ring 37. To prevent.

<Connection between clip unit and operation wire>
The clip main body 35 and the tightening ring 37 having the above-described configuration become the clip unit 13 when the clip main body 35 is inserted into the tightening ring 37. The clip unit 13 is loaded and fixed in the outer sheath member 19 of the clip operating device 11 (see FIG. 1) by the operation wire 23. FIGS. 6A to 6D show the procedure for assembling the clip unit 13 to the clip operating device. In the figure, the clip operation device is omitted.

First, as shown in FIG. 6A, the loop portion 71 formed at the tip of the operation wire 23 is inserted into the fastening ring 37, and the locking claw 43 of the clip body 35 is inserted into the loop portion 71 of the operation wire 23. 6B, the clip main body 35 is inserted into the tightening ring 37 from the base end 39 side. Then, the locking claw 43 abuts against the pair of retaining pieces 65 and elastically deforms inward in the radial direction of the fastening ring 37 to get over the retaining pieces 65. Then, when the pair of latching claws 43 pass through the clip retaining piece 65, the pair of latching claws 43 are elastically restored by a spring force, and the tip ends abut against the inner peripheral surface 37 a of the tightening ring 37. Thereby, the latching claw 43 is latched from the inner side to the clip retaining piece 65, and is prevented from coming off from the tightening ring 37.

Here, as shown in FIG. 6C, when the operation wire 23 is pulled in the insertion direction of the clip main body 35 (the right direction in the figure), the loop portion 71 includes the retaining piece 65 of the fastening ring 37 and the clip. It is guided by the inclined surface 45 a of the retaining portion 45 of the main body 35 and comes into contact with the inner surface of the locking claw 43. Then, as shown in FIG. 6D, the locking claw 43 is elastically deformed radially outward of the fastening ring 37, so that the loop portion 71 of the operation wire 23 is detached from the locking claw 43. The operation wire 23 is locked to the locking claw 43 by being inserted into a gap 47 defined by the locking portion 45 and the end surface in the width direction of the base end portion 39. Since the loop portion 71 of the operation wire 23 is inserted into the gap 47 due to the elastic deformation of the locking claw 43, once inserted into the gap 47, the loop chamfer 43 can be removed from the gap 47 unless the locking claw 43 is deformed. Absent. Thereby, the clip unit 13 is assembled to the clip operating device 11. The operation wire 23 is locked only on one side (upper side in the figure) of the clip body 35 in the illustrated example, but is locked on both sides (upper and lower sides in the figure) of the clip body 35 by the two operation wires 23. It is good also as a structure.

<Basic ligation procedure with ligation device>
As shown in FIG. 7A, the clip unit 13 assembled to the clip operating device 11 as described above extends the outer sheath member 19 that is an introduction tube to the front, so that the distal side of the outer sheath member 19 Housed in the tip. This is a state in which the outer sheath connection body 25 shown in FIG. 1 is fixed at a position away from the operation portion main body 27. At this time, the proximal end side of the clip unit 13 abuts on the distal end of the inner sheath member 21. Further, the pair of arm portions 41 of the clip main body 35 are in contact with the inner peripheral surface of the extended outer sheath member 19 and are accommodated in the outer sheath member 19 in a state of being elastically deformed in a direction approaching each other. With the outer side of the clip unit 13 covered with the outer sheath member 19 as described above, the insertion portion 15 of the ligating apparatus 100 is inserted into the body cavity from a forceps hole of an endoscope (not shown) that has been previously inserted into the body cavity. And while observing the inside of a body cavity with an endoscope, the front-end | tip of the insertion part 15 is guide | induced to the ligation target site | part of a biological tissue.

Next, when the outer sheath connector 25 shown in FIG. 1 is moved to the operating portion main body 27 side until the clip located at the head is exposed, the outer sheath member 19 is fixed as shown in FIG. 7B. The clip unit 13 is moved forward (distal end side) by being pressed by the inner sheath member 21 relatively moving inside, and the pair of arm portions 41 of the clip body 35 protrudes from the outer sheath member 19. Since the pair of arm portions 41 are released from the restraint by the outer sheath member 19, the pair of arm portions 41 are expanded by the spring force of the clip body 35, and a sandwiching gap 73 is formed between the

tissue gripping portions

55 and 55. In this state, the clip body 35 is positioned so that a desired living tissue is disposed in the holding gap 73.

Then, in a state where the position of the tissue gripping portion is optimum, the slider 29 shown in FIG. 1 is moved in a direction to approach the finger ring 33 and the operation wire 23 is pulled into the inner sheath member 21, thereby causing the operation wire 23 to move. Pull relative to the inner sheath. Then, as shown in FIG. 7C, the loop portion 71 of the operation wire 23 pulls the locking claw 43 and the clip main body 35 is pulled into the tightening ring 37. At this time, the pair of arm portions 41 that are in contact with the flat surface of the clip contact portion 63 of the tightening ring 37 are closed by the clip contact portion 63 as indicated by a solid line in the drawing.

Further, when the slider 29 shown in FIG. 1 is moved away from the finger ring 33 and the operation wire 23 is moved out relative to the inner sheath, the clip body 35 is pushed out from the tightening ring 37, and the clip is pressed. Since the restraint of the pair of arm portions 41 by the flat surface of the contact portion 63 is released, the pair of arm portions 41 expands as shown by a broken line in the figure.

That is, the pair of arm portions 41 is closed by pulling the operation wire 23 relative to the inner sheath, and the pair of arm portions 41 is opened by relatively drawing out. During the above operation, both the outer surfaces of the arm portion 41 are in contact with the flat surface of the clip contact portion 63, so that the clip body 35 does not rotate with respect to the central axis of the fastening ring 37. The pair of arms 41 is stably opened and closed by protruding from the tightening ring 37.

The above-mentioned closing and opening operations enable easy re-gripping of living tissue. If the pair of arms 41 of the clip main body 35 is to be opened and closed by extending the outer sheath member 19 with respect to the inner sheath member 21, the outer sheath connector 25 and the operating portion shown in FIG. It is necessary to operate all of the main body 27 and the finger ring 33, and the operation of the operator becomes complicated. On the other hand, when the pair of arm portions 41 are opened and closed by pulling and drawing out the operation wire 23, only the operation portion main body 27 and the finger ring 33 are operated, and the operation of the operator can be simplified.

Next, with reference to FIGS. 8A to 8E, a procedure up to completion of ligation of a living tissue will be described.
As shown in FIG. 8A, after the desired living tissue is gripped between the

tissue gripping portions

55 and 55 of the pair of arm portions 41, the operation wire 23 is pulled.

Then, as shown in FIG. 8B, since the loop portion 71 of the operation wire 23 is locked to the locking claw 43 of the clip main body 35, the clip main body 35 is drawn into the tightening ring 37. Then, as shown in FIG. 9, the stepped portion 57 of the wide portion 53 and the plate-like piece portion 51 of the clip body 35 abuts against the pair of guide pieces 69 of the fastening ring 37, and beyond that of the clip body 35. Movement is restricted. On the other hand, since the locking claw 43 of the clip body 35 is pulled by the loop portion 71 of the operation wire 23, as shown in FIG. 8C, plastic deformation starts in the pulling direction of the operation wire 23, and finally. As shown in FIG. 8 (D), the locking claw 43 and the loop portion 71 are unlocked by a large plastic deformation in the pulling direction of the operation wire 23.

As described above, in the ligating apparatus 100 of this configuration, the separation between the operation wire 23 and the clip main body 35 is realized by plastic deformation of the locking claw 43 regardless of the breakage of the member, so that no broken pieces are generated. Thus, damage caused by broken fragments is completely prevented.

When the insertion portion 15 of the ligating apparatus 100 is extracted from the body cavity after the operation wire 23 and the clip body 35 are separated, as shown in FIG. 37 together with the body cavity.

When ligating a living tissue subsequently, the clip operating device 13 is inserted from the distal end of the outer sheath member 19 taken out from the body cavity shown in FIG. It becomes possible by setting to 11.

The clip body 35 described above is not limited to the configuration shown in FIGS. 3 and 4 and can be appropriately modified. FIG. 10 is a perspective view showing a modification of the clip body.
The clip main body 35 A of the present modification includes the above-described wire locking means configured by the locking claw 43 and the retaining portion 45 shown in FIGS. 3 and 4, only by a pair of locking pieces 75. . The locking piece 75 extends from both sides in the width direction of the bottom portion 39a of the base end portion 39, and inclines from the base end portion 39 side and extends outwardly toward the arm portion 41. And a curved portion 75b that is curved toward the axial center of the clip main body 35A.

The inclined portion 75a of the locking piece 75 is formed by gradually decreasing the protruding height from the base end portion 39 in the insertion direction of the clip body 35A into the fastening ring. The curved portion 75b extends from the position of the maximum projecting height of the inclined portion 75a toward the base end 39, and gradually reduces the projecting height in the insertion direction of the clip body 35A into the fastening ring. Is formed.

Thus, a gap 77 that locks the loop portion 71 of the operation wire 23 is defined by the inclined portion 75a, the curved portion 75b, and the end surface in the width direction of the base end portion 39.

When the clip main body 35A is inserted into the tightening ring 37, the connecting portion between the inclined portion 75a and the curved portion 75b is engaged with an inner peripheral surface 37a of the tightening ring 37 (see FIG. 5A). 75 is elastically biased and abuts. In addition, a gap dimension is set between the distal end of the bending portion 75b and the end surface in the width direction of the base end portion 39 so that the loop portion 71 of the operation wire 23 does not fall out. Moreover, you may contact both with the elastic force of 35 A of clip main bodies. According to the above configuration, when the loop portion 71 of the operation wire 23 is locked to the locking piece 75, the locking piece 75 is positioned in the loop portion 71 and the operation wire 23 is pulled, thereby The loop portion 71 is guided toward the base end portion 39 along the curved portion 75 b and surely enters the gap 77. Once the loop portion 71 of the operation wire 23 enters the gap 77, it does not fall out of the gap 77. Other configurations and effects are the same as those of the above-described configuration example, and thus description thereof is omitted.

<Sequential ligation device>
Next, a ligation apparatus according to another embodiment will be described. FIG. 11A is a vertical sectional view of a continuous ligation apparatus in which a plurality of clip units are loaded in the outer sheath member, FIG. 11B is a horizontal sectional view, and FIG. It is a principal part perspective view of a ligation apparatus. In the following description, the same members as those shown in FIGS. 1 to 9 are denoted by the same reference numerals, and redundant description is omitted.

As shown in FIGS. 11A, 11B, and 12, the ligating apparatus 100A having this configuration includes a plurality of clip units 13 including a clip main body 35 and a fastening ring 37 arranged in a row in the outer sheath member 19. Inserted in an aligned state. In each clip unit 13, the rotation position within the outer sheath member 19 is restricted by the catch claw 43 of the clip body 35 being sandwiched between the loop portions 71 of the operation wire 23. In the illustrated example, all the clip units 13 are loaded in the outer sheath member 19 in series with the same rotational posture.

The operation wire 23 is inserted through each of the plurality of tightening rings 37, and the loop portion 71 of the operation wire 23 has an overall length corresponding to the length of the plurality of clip units 13 arranged and arranged in at least one row. . The distal end of the loop portion 71 is the width of the locking claw 43, the retaining portion 45, and the proximal end portion 39 of the clip main body 35 shown in FIG. 3 of the clip unit 13 A located at the distal end of the outer sheath member 19. It is inserted into a gap 47 defined by the direction end face. That is, the operation wire 23 is locked to the locking claw 43 of the leading clip unit 13A. Further, the locking claws 43 of the

rear clip units

13B, 13C, and 13D are in contact with the inner peripheral surface 37a of the tightening ring 37 in a state of entering the loop portion 71.

The clip main body 35 of each

clip unit

13A, 13B, 13C, 13D aligned in a line has a pair of arm portions, and a pair of arm portions 41 of the clip main body 35 located at the rear are adjacent and positioned forward. The clamping ring 37 is accommodated. Thereby, when the insertion part 15 of the ligation apparatus 100 is introduced into the body cavity, the tightening rings 37 receive an external force generated by the insertion operation, thereby preventing the external force from acting on the clip body 35. Therefore, even if the insertion portion 15 is bent and the fastening rings 37 are bent and introduced into the body cavity, the clip body 35 is protected by the fastening ring 37 and the clip body 35 is damaged. Can be prevented.

In addition, since the plurality of

clip units

13A, 13B, 13C, and 13D are aligned and arranged in the same rotational posture, the loop portion 71 of the operation wire 23 is released from the engagement with the leading clip unit 13A. It can be locked to the locking claw 43 of the rear clip unit 13B. Similarly, with respect to the

rear clip units

13C and 13D, the loop portion 71 can be sequentially locked to the locking claw 43, and continuous ligation can be performed by continuously extending each clip body 35. Become. Other configurations are the same as the above-described configuration example.

<Procedure for continuous feeding of clip unit>
A procedure for feeding out the clip unit by the continuous ligation apparatus having the above-described configuration will be described.
FIGS. 13A to 13F are schematic perspective views showing a ligation procedure by a continuous ligation apparatus. In this case, the ligation apparatus 100A also introduces the insertion portion 15 into the body cavity through the endoscope channel inserted in advance into the body cavity in the same manner as the single-shot ligation apparatus 100 described above. It is located at the ligation target site of the living tissue. Thereafter, as shown in FIG. 13A, the pair of arm portions 41 of the clip unit 13A located at the head of the outer sheath member (not shown) is opened. Since the operations for opening and closing the arm portion 41 are the same as described above, the description thereof is omitted here.

Next, as shown in FIG. 13 (B), the operation wire 23 is pulled with respect to the inner sheath member, and via the locking claw 43 of the leading clip unit 13A to which the loop portion 71 of the operation wire 23 is locked. Then, the clip main body 35 of the clip unit 13 A is pulled into the fastening ring 37. As a result, the pair of arm portions 41 of the clip unit 13 A is closed by being guided by the clip contact portion 63 of the fastening ring 37, and the living tissue 81 is gripped between the

tissue gripping portions

55 and 55.

At this time, the base end portion 39 of the clip main body 35 of the clip unit 13A is inserted into the arm portion 41 of the clip main body 35 of the rear clip unit 13B. Therefore, as shown in FIG. 14, the maximum width WF of the base end portion 39 in the arm portion 41 expanding direction with respect to the clip main body 35 of the clip unit 13A is elastically biased against the inner peripheral surface 37a of the fastening ring 37. The opening width WR of the pair of arm portions 41 (tissue gripping portion 55) of the rear clip body 35 that is in contact is set to be smaller. Therefore, when the clip main body 35 of the clip unit 13A is pulled into the fastening ring 37, the base end portion 39 of the clip main body 35 of the clip unit 13A is inserted into the arm portion 41 of the clip main body 35 of the rear clip unit 13B. The

With this configuration, the axial length of the tightening ring 37 can be shortened, and the insertion portions 15 accommodated in the

clip units

13A, 13B, 13C, and 13D aligned in a row can be easily bent. Thus, the flexibility is improved, and the operability when inserted into the body cavity and the shape following ability to the body lumen are improved.

As shown in FIG. 13B, when the operation wire 23 is further pulled, a step 57 (between the wide portion 53 of the arm portion 41 and the plate-like piece portion 51 in the clip body 35 of the leading clip unit 13A). 9) contact with the pair of guide pieces 69, respectively, and the backward movement of the clip body 35 is restricted. When the operation wire 23 is further pulled from this state as shown in FIG. 13C, the locking claw 43 of the leading clip body 35 starts plastic deformation in the pulling direction of the operation wire 23, and FIG. As shown in FIG. 4, the locking claw 43 is greatly plastically deformed, and the locking claw 43 and the loop portion 71 are unlocked. At this time, the tissue gripping portion 55 of the leading clip body 35 holds the ligation of the living tissue 81.

When the operation wire 23 is continuously pulled, as shown in FIG. 13 (E), the loop portion 71 unlocked from the leading clip body 35 is the retaining portion of the clip body 35 disposed on the rear side. It is guided by the inclined surface 45 a of 45 and moves outward in the radial direction of the tightening ring 37 and abuts against the inner surface of the locking claw 43.

Then, as shown in FIG. 13 (F), by slightly elastically deforming the locking claw 43 by pulling the operation wire 23, the loop portion 71 of the operation wire 23 becomes the locking claw 43, the retaining portion 45, And the gap 47 defined by the end surface in the width direction of the base end portion 39 enters. Thereby, the locking claw 43 of the clip main body 35 of the next-stage clip unit 13B and the operation wire 23 are automatically locked, and preparation for the next living tissue ligation is completed. Further, the clip unit 13A is separated from the ligation apparatus and is left in the body cavity while the living tissue is ligated.

As described above, according to the ligating apparatus 100A of the present configuration, every time the ligation of the living tissue is finished, the insertion unit 15 of the ligating apparatus 100A is not inserted out of the body cavity and continuously inserted into the body cavity. Living tissue can be ligated. Therefore, efficient ligation is possible and the burden on the patient can be reduced.

<Other configuration examples of the clip unit>
Next, another configuration example of the clip unit will be described. FIG. 15 is a perspective view showing a state in which a plurality of clip units are arranged in a line with the opening directions of arms differing from each other by 90 °, FIG. 16 is an exploded perspective view of the clip unit, and FIG. The top view of a main body, (B) is a front view, (C) is a side view.

As shown in FIG. 15, in this clip unit configuration, a plurality of clip units 42 each having a clip body 36 inserted into a fastening ring 40 are alternately arranged in the axial direction, and an outer sheath member (not shown) is shown. 19 are aligned in series. In the aligned clip bodies 36, the expanding direction of the arm portion 41 is different by 90 °. The tightening ring 40 is also rotated 90 °.

As shown in FIGS. 16 and 17 (A), (B), and (C), the clip body 36 is provided with a base end portion 39 on the side inserted into the fastening ring 40, and extends from the base end portion 39. It is formed by bending a belt-shaped metal plate material having a pair of arms 41 and having spring properties such as stainless steel into a substantially U shape.

A pair of wire locking means of the clip main body 36 including the locking claw 44 and the retaining portion 46 are extended from both sides in the width direction of the base end portion 39 orthogonal to the arm portion expanding direction of the base end portion 39. The parallel part 50 is bent in the plate thickness direction of the clip main body 36 (arm part expanding direction), and is arranged at a diagonal position of the base end part 39.

The locking claw 44 is inclined and extended so as to extend outward from the position on the bottom 39 a side of the base end portion 39 toward the arm portion 41 from the retaining portion 46. The force required for plastic deformation of the locking claw 44 is a plate-like body narrowed to such an extent that the force required to pull the clip main body 36 into the fastening ring 40 is larger.

The retaining portion 46 is a protruding portion that protrudes toward the locking claw 44 from a position spaced from the locking claw 44 toward the arm portion 41, and the protruding height toward the locking claw 44 has a clip body 36. And an inclined surface 46a that gradually increases in the direction of insertion into the tightening ring 40. The locking claw 44 and the retaining portion 46 are formed by a parallel portion 50 that is bent and erected from the width direction end portion of the base end portion 39. As a result, as shown in FIGS. 16 and 17A, a gap for locking the loop portion 71 of the operation wire 23 by the locking claw 44, the retaining portion 46, and the parallel portion 50 of the base end portion 39. 47 is defined.

The force required to plastically deform the locking claw 44 is set to be larger than the force for pulling the clip body 36 into the tightening ring 40. As a result, the clip body 36 has the locking claw 44 plastically deformed when the operation wire 23 is pulled while the loop portion 71 of the operation wire 23 shown in FIG. 15 is locked by the locking claw 44. Without being retracted into the tightening ring 40.

As shown in FIG. 16, the tightening ring 40 includes a hollow cylindrical portion 61 and a pair of clip contact portions 63. The pair of clip abutting portions 63 bends the projecting portion projecting from one end portion of the cylindrical portion 61 and has a flat surface parallel to the axis of the fastening ring 40. The clip body 36 is guided by coming into contact with the outer surface, and the rotation of the clip body 36 with respect to the central axis of the tightening ring 40 is restricted.

In addition, a pair of

guide pieces

69 and 69A that protrude toward the inside in the radial direction of the fastening ring 40 are formed on both sides of the clip contact portion 63. When the clip main body 36 is inserted into the tightening ring 40, the guide piece 69A on the side where the locking claw 44 abuts is formed so as to be inclined toward the inner side of the ring toward the insertion direction of the clip main body 36. Thereby, when the clip main body 36 is inserted into the tightening ring 40, the locking claw 44 abuts on the inner side of the guide piece 69 A to prevent the clip main body 36 from coming out of the tightening ring 40. Further, the distance between the pair of guide pieces 69 is smaller than the width W2 of the wide portion 53 (similar to FIG. 4), and the step portion 57 between the wide portion 53 and the plate-like piece portion 51 abuts against the pair of guide pieces 69. The insertion length of the clip body 36 into the tightening ring 40 is limited.

Then, when the operation wire 23 is pulled and the clip body 36 is pulled into the fastening ring 40 and the stepped portion 57 of the clip body 36 contacts the fastening ring 40 (a pair of guide pieces 69), the locking claw The plastic deformation 44 starts, and the loop portion 71 of the operation wire 23 and the locking claw 44 are unlocked. As a result, the clip unit 42 can be separated from other clip units.

When the clip main body 36 is inserted into the fastening ring 40, the locking claw 44 is elastically urged against and abuts on the inner peripheral surface of the fastening ring 40. Further, the inclined surface 46a of the retaining portion 46 guides the loop portion 71 and reliably inserts it into the clearance 47 for retaining the operation wire when the operation wire 23 is pulled.
Other configurations and effects are the same as those of the above-described configuration example, and thus description thereof is omitted.

As described above, the present invention is not limited to the above-described embodiments, and modifications and applications by those skilled in the art based on the description of the specification and well-known techniques are also within the scope of the present invention. It is included in the range to calculate.

As described above, the following items are disclosed in this specification.
(1) A ligation apparatus for ligating living tissue,
A flexible introduction tube;
An operation wire that is inserted into the introduction tube so as to freely advance and retract, and has a loop portion at the tip;
A clip unit disposed inside the distal end of the introduction tube and connected to the operation wire;
With
The clip unit has a pair of arms that are urged to spread each other, a clip body that ligates a living tissue with a proximal end that connects the proximal ends of the arms, and a proximal end of the clip body A clamping ring that is inserted into the cylindrical body to close the pair of arms, and a wire locking means that is provided at a base end of the clip body and locks the loop portion of the operation wire. Have
A locking claw in which the wire locking means extends obliquely outward in the radial direction of the clamping ring from the proximal end portion of the clip body toward the direction opposite to the insertion direction into the clamping ring. And a retaining portion that prevents the loop portion of the operation wire that is retained by the retaining claw from falling off the retaining claw.
According to this ligation apparatus, when the living tissue is ligated, the relative position between the clip body and the tightening ring can be changed by pulling and feeding the operation wire, so that the clip can be freely opened and closed. Re-grabbing can be done with a simple operation. In addition, since the clip body and the operation wire are separated due to the deformation of the clip body's latching claw, no fragmentation occurs during the separation, and the fragmentation affects the living tissue or interferes with the ligation operation. There is no fear of it.

(2) The ligation apparatus according to (1),
The retaining portion protrudes toward the locking claw from a position spaced from the connecting portion with the locking claw at the proximal end portion of the clip main body toward the arm portion, and between the locking claw A ligating apparatus having a protrusion that defines a gap for locking the loop portion of the operation wire.
According to this ligating apparatus, the operation wire is maintained in a state of being locked in the gap for locking the loop portion, and even if the operation wire is fed out, the operation wire may fall out of the clip body by the protrusion. Is prevented. Thereby, a clip main body can be advanced and retracted reliably and stably, and a tissue can be regripped smoothly.

(3) The ligation apparatus according to (2),
The ligation apparatus which has the inclined surface which the projection part of the said clip main body increased gradually the protrusion height toward the said latching claw toward the said insertion direction.
According to this ligating apparatus, the operation wire to be pulled can be guided into the gap for locking the loop portion of the operation wire by being guided by the locking claw along the inclined surface of the protrusion, and the clip The main body and the operation wire can be securely locked.

(4) The ligating apparatus according to any one of (1) to (3),
A ligating device in which the locking claw abuts against an inner peripheral surface of the fastening ring.
According to this ligating apparatus, the loop portion of the operation wire is not disengaged from between the locking claw and the inner peripheral surface of the tightening ring, and the loop portion of the operation wire is reliably kept locked to the locking claw. Can do.

(5) The ligation apparatus according to any one of (1) to (4),
The pair of arm portions of the clip body is formed of a plate-like member having a predetermined width in a direction orthogonal to the expanding direction of the pair of arm portions,
A pair of clip abutting portions for restricting the rotation of the clip body by abutting the outer surfaces of the plate-like members in the pair of arm portions inserted into the clamping ring. Having a ligation device.
According to this ligating apparatus, the rotation phase between the clip main body and the tightening ring can be maintained constant, and the operability for ligating living tissue can be improved.

(6) The ligation apparatus according to (5),
The ligating apparatus, wherein the clip abutting portion of the clamping ring has a flat surface that abuts against the outer surfaces of the pair of arm portions of the clip body.
According to this ligating apparatus, since the pair of arm portions abut on the flat surface of the clip abutting surface, the contact area of both increases, and the arm portion can be stably guided, and the rotation of the clip body relative to the tightening ring is restricted. Thus, the pair of arms can be opened and closed smoothly.

(7) The ligation apparatus according to (5) or (6),
The plate-like member that forms the arm portion of the clip body includes a wide end portion that has a stepped portion on the distal end side of the arm portion and is formed wider than the predetermined width,
The clip abutment portion of the tightening ring has a pair of guide pieces projecting toward the inside of the tightening ring at an interval wider than the predetermined width and narrower than the width of the tip wide portion;
A ligation apparatus in which an arm portion of the clip main body is inserted between the pair of guide pieces so as to be able to advance and retreat in the longitudinal direction of the clip, and the stepped portion contacts the guide piece.
According to this ligating apparatus, when the clip main body is inserted into the fastening ring by a predetermined amount, the step formed on the arm portion of the clip main body and the guide piece come into contact with each other. Insertion into can be restricted.

(8) The ligation apparatus according to (7),
A ligating apparatus in which the latching claw of the clip main body is deformed in the pulling direction by pulling the operation wire, and the connection between the clip main body and the operation wire is released.
According to this ligation device, the locking between the operation wire and the clip body is released by the deformation of the locking claw, so there is no generation of a broken piece due to the release of the lock, and the broken piece affects the living tissue. There is no possibility of causing trouble in the ligation operation.

(9) The ligating apparatus according to any one of (1) to (8),
A clip retaining piece that extends from the end on the clip main body insertion side of the tightening ring so as to incline toward the inside in the insertion direction and engages with the locking claw. Ligation device with
According to this ligating apparatus, the clip claw can be prevented from falling off the fastening ring by engaging the locking claw with the clip retaining piece.

(10) The ligating apparatus according to any one of (1) to (9),
A ligating apparatus in which a plurality of clip units each having the clip main body inserted into the clamping ring are arranged in the introduction pipe.
According to this ligation apparatus, a plurality of clip units can be sequentially used for ligation of living tissue, which eliminates the need to pull out the ligation apparatus from the body cavity and re-insert it after ligation, thereby burdening the patient. Can be reduced.

(11) A clip unit used in the ligating apparatus according to any one of (1) to (10).
According to this clip unit, the living tissue can be re-gripped, and the living tissue can be continuously ligated by the plurality of clip bodies.

According to the present invention, it is possible to provide a ligation apparatus and a clip unit that can perform opening and closing operations of a clip with a simple configuration when ligating a living tissue, and can freely grip the living tissue. Further, since the clip main body and the operation wire are separated by the deformation of the clip main body, the broken fragments are not left in the body cavity and the continuous ligation operation is not hindered.
This application is based on a Japanese application (Japanese Patent Application No. 2010-212889) filed on Sep. 22, 2010, the contents of which are incorporated herein by reference.

13 Clip unit 19 Outer sheath member (introducing tube)
23

Operation wire

35, 35A, 35B Clip body 37 Tightening ring 37a Inner peripheral surface 39 Base end part 41

Arm part

43, 44

Locking claw

45, 46 Retaining part (protrusion part)
45a

Inclined surface

47, 77 Gap 51 Plate-shaped piece 53 Wide part 57 Step part 63 Clip contact part 65 Clip retaining piece 69 Guide piece 71 Loop part 81

Biological tissue

100, 100A Ligating device

Claims

A ligation apparatus for ligating biological tissue,
A flexible introduction tube;
An operation wire that is inserted into the introduction tube so as to freely advance and retract, and has a loop portion at the tip;
A clip unit disposed inside the distal end of the introduction tube and connected to the operation wire;
With
The clip unit has a pair of arms that are urged to spread each other, a clip body that ligates a living tissue with a proximal end that connects the proximal ends of the arms, and a proximal end of the clip body A clamping ring that is inserted into the cylindrical body to close the pair of arms, and a wire locking means that is provided at a base end of the clip body and locks the loop portion of the operation wire. Have
A locking claw in which the wire locking means extends obliquely outward in the radial direction of the clamping ring from the proximal end portion of the clip body toward the direction opposite to the insertion direction into the clamping ring. And a retaining portion that prevents the loop portion of the operation wire that is retained by the retaining claw from falling off the retaining claw.
The ligation apparatus according to claim 1,
The retaining portion protrudes toward the locking claw from a position spaced from the connecting portion with the locking claw at the proximal end portion of the clip main body toward the arm portion, and between the locking claw A ligating apparatus having a protrusion that defines a gap for locking the loop portion of the operation wire.
The ligation apparatus according to claim 2,
The ligation apparatus which has the inclined surface which the projection part of the said clip main body increased gradually the protrusion height toward the said latching claw toward the said insertion direction.
The ligation apparatus according to any one of claims 1 to 3,
A ligating device in which the locking claw abuts against an inner peripheral surface of the fastening ring.
The ligation apparatus according to any one of claims 1 to 4, wherein
The pair of arm portions of the clip body is formed of a plate-like member having a predetermined width in a direction orthogonal to the expanding direction of the pair of arm portions,
A pair of clip abutting portions for restricting the rotation of the clip body by abutting the outer surfaces of the plate-like members in the pair of arm portions inserted into the clamping ring. Having a ligation device.
The ligation apparatus according to claim 5, wherein
The ligating apparatus, wherein the clip abutting portion of the clamping ring has a flat surface that abuts against the outer surfaces of the pair of arm portions of the clip body.
The ligation apparatus according to claim 5 or 6,
The plate-like member that forms the arm portion of the clip body includes a wide end portion that has a stepped portion on the distal end side of the arm portion and is formed wider than the predetermined width,
The clip abutment portion of the tightening ring has a pair of guide pieces projecting toward the inside of the tightening ring at an interval wider than the predetermined width and narrower than the width of the tip wide portion;
A ligating apparatus in which an arm portion of the clip main body is inserted between the pair of guide pieces so as to be able to advance and retreat in the longitudinal direction of the clip, and the stepped portion comes into contact with the guide piece.
The ligation apparatus according to claim 7,
A ligating apparatus in which the latching claw of the clip main body is deformed in the pulling direction by pulling the operation wire, and the connection between the clip main body and the operation wire is released.
A ligation apparatus according to any one of claims 1 to 8,
A clip retaining piece that extends from the end on the clip main body insertion side of the tightening ring so as to incline toward the inside in the insertion direction and engages with the locking claw. Ligation device with
The ligation apparatus according to any one of claims 1 to 9,
A ligating apparatus in which a plurality of clip units each having the clip main body inserted into the clamping ring are arranged in the introduction pipe.
A clip unit used in the ligating apparatus according to any one of claims 1 to 10.