JP2009000364A - Clip device of biotissue - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a clip device of biotissue having high convenience, facilitating the operation and being stably used. <P>SOLUTION: Engagement portions 2d and 2e projecting inward are attached at the distal ends of arm portions 2b and 2d of a clip 2 for gripping the biotissue. An engagement object portion 3e is provided at the tip end of a clip fastening ring 3 which is fitted by the clip 2 and axially moves to open/close the arm parts 2b and 2c, leg portions 3c being outward opened while extending rearward are provided at the rear end part of the fastening ring 3, and engagement portions 3d projecting inward are provided at the tips of the leg portions 3c. The fastening rings 3 are fitted around a plurality of clips 2, engagement portions 2d and 2e of one clip 2 are engaged with the base end portion 2a of another clip 2, the engagement portions 3d of one fastening ring 3 are engaged with the engagement object portion 3e of another fastening ring 3, and the plurality of clips 2 and fastening rings 3 are axially connected and disposed in a tube by being sequentially inserted into the inside from the distal end of the tube 1 insertable in a living body cavity. <P>COPYRIGHT: (C)2009,JPO&INPIT

Description

  The present invention relates to a biological tissue clip device that is inserted into a living body cavity through a forceps channel or the like of an endoscope and grips the living tissue.

  Conventionally, various clip devices for living tissue such as a hemoclip for hemostasis have been proposed. For example, as disclosed in FIG. 1 of Patent Document 1 below, a wire is engaged with the proximal end of the clip, the clip and the wire are accommodated in the introduction tube, and a short tube is attached to the distal end of the introduction tube There is a device. Further, as disclosed in FIG. 20 and the like of Patent Document 1, a wire provided with a stopper at the tip is inserted into each hole provided at a base end portion of a plurality of clips, and the clip and the wire are introduced. There is a device that is housed in a tube and uses a plurality of clips continuously. These are the elastic force that the clip has by inserting the introduction tube into the living body cavity through the forceps channel of the endoscope and pushing the wire so that the pair of arms protrude from the introduction tube and the short tube. To open the pair of arms. Then, by pulling the wire in a state where the distal ends of the pair of arm portions are pressed against the living tissue, the rear portions of the pair of arm portions are accommodated in the short tube, and the proximal end portions of the clips are plastically deformed, thereby the pair of arms. Close the part and grasp the living tissue. Then, by pulling the wire more strongly, the wire is separated from the proximal end portion, and the clip is placed in the living body cavity.

  Further, as disclosed in FIG. 19 and the like of Patent Document 1, the wire is engaged with the proximal end portion of the clip, inserted into the clip clamping ring and the tubular operation member, and the clip and the clip clamping ring There is a device for storing an operating member and a wire in an introduction tube, and fitting a clip fastening ring to the clip to increase and maintain the clip fastening force. Further, as disclosed in FIG. 22 and the like of Patent Document 1, a wire provided with a stopper at the tip is attached to each hole provided in the base end portion of a plurality of clips, a plurality of clip tightening rings, and an operation member. There is an apparatus in which a plurality of clips are continuously used by inserting the clip, the clip clamping ring, the operation member, and the wire into the introduction tube. These insert the introduction tube into the living body cavity and push the wire to cause the clip and the clip clamping ring to protrude from the introduction tube. Then, by pulling the wire, the pair of arm portions of the clip are pulled into the clip tightening ring, and the rear portions of the pair of arm portions are pressed by the clip tightening ring to open the pair of arm portions. Then, by pulling the wire with the tips of the pair of arms pressed against the living tissue, the pair of arms is further pulled into the clip clamping ring, and the front of the pair of arms is pulled by the clip clamping ring. Is pressed to close the pair of arms to grasp the living tissue. Then, by pulling the wire more strongly, the wire is separated from the proximal end portion, and the clip and the clip fastening ring are placed in the living body cavity.

  For example, as disclosed in Patent Document 2 below, a loop step portion is provided at the base end portion of the clip, an inner diameter step portion is provided on the inner peripheral surface of the clip fastening ring, and the loop step portion is an inner diameter step portion. There is a device that prevents the clip from being pulled into the clip clamping ring beyond the closed position.

  Further, for example, as disclosed in the following Patent Document 3, a wire having a plurality of clips and a pusher member connected to the tip is housed in the inner tube, the inner tube is housed in the outer tube, and the clip opener component is placed inside. There is a device that uses a plurality of clips continuously by fixing to the tip of the tube and projecting from the outer tube. This is because the outer tube is inserted into the living body cavity, the wire is pushed, the clip is pushed by the pusher member, and the pair of arm portions of the clip protrude from the slit of the clip opener part, and the tapered side surface portion of the slit. Push to open. Then, with the tips of the pair of arms pressed against the living tissue, by further pressing the wire, the clip is pushed out of the slit by the pusher member and is placed in the living body cavity, and the pair of arms is pressed by the elastic force of the clip. Is closed to grasp the living tissue.

JP 2002-301082 A JP 2004-121485 A JP 2005-506870 A

  In the devices as disclosed in FIGS. 1 and 19 of Patent Document 1 and Patent Document 2 and the like, once the introduction tube is inserted into the living body cavity, only one clip can be used, which is inconvenient. In addition, in devices such as those disclosed in Patent Documents 1 and 2, etc., the wire is pulled and the tip of the wire or the proximal end of the clip is plastically deformed to separate the wire and the clip. It must be pulled with force and is difficult to operate. In addition, in the apparatus as disclosed in FIG. 20 and FIG. 22 of Patent Document 1, the continuous use of the clip causes the wire retaining stopper to be plastically deformed so that the engagement between the wire and the clip is easily released. May not be able to be used stably, such as being unable to retract into the clip tightening ring. In addition, in an apparatus as disclosed in Patent Document 3, etc., the pair of arms of the clip are pushed open at the side surface of the slit while protruding from the slit of the clip opener part, and the clip is pushed out from the slit and placed. Due to the continuous use, the slit and the side surface portion are plastically deformed so that the clip can easily come out of the slit and the pair of arm portions of the clip cannot be opened. In addition, in the apparatus disclosed in Patent Document 3 and the like, the living tissue is grasped only by the elastic force of the clip, and thus the force is weak and there is a possibility that hemostasis of the living tissue cannot be performed sufficiently.

  The present invention solves the above-mentioned problems, and the object of the present invention is to provide a clip device for living tissue that is convenient, easy to operate, and can be used stably. is there.

  In the present invention, a clip that grips a living tissue with a pair of arms extending forward from the base end, a clip fastening ring that opens and closes the pair of arms by moving in the axial direction by being fitted to the clip, and a clip And a clip device for living tissue comprising a clip tightening ring and a tube that can be inserted into a living body cavity, and an engagement portion projecting inward is provided at the tip of the arm portion of the clip to tighten the clip. A leg that extends rearward at the rear end of the attached ring is provided, an engaging portion that protrudes inward is provided at the tip of the leg, and an engaged portion is provided at the tip of the clip tightening ring. A plurality of clip fastening rings are respectively fitted to a plurality of clips, an engaging portion of another clip is engaged with a base end portion of a certain clip, and another clip is engaged with an engaged portion of a certain clip fastening ring. Clamping ring engagement The engaging, by sequentially inserted from the tip of the tube to the inside, is placed into the tube by connecting a plurality of clips and clip tightening ring in the axial direction of the tube.

  By doing in this way, a some clip and clip clamping ring can be connected to the axial direction of a tube, and can be easily arrange | positioned in a tube. Also, by applying a force that moves in the axial direction of the tube to any clip and clip clamping ring, the force is transmitted in turn to all clips and clip clamping rings, so that all clips and clip clamping rings The attachment ring can be reciprocated in the axial direction of the tube. For this reason, the tube can be inserted into the living body cavity through the forceps channel of the endoscope, and the foremost clip can be protruded from the tube. The pair of arms of the foremost clip can be opened by moving the foremost clip tightening ring. Then, by rotating the tube, all the clips and the clip fastening ring can be rotated, and the distal ends of the pair of arms of the foremost clip can be pressed against the target living tissue. Then, by moving the foremost clip tightening ring, the pair of arms of the foremost clip can be closed and the target living tissue can be grasped. At this time, since the pair of arm portions of the clip are tightened by the clip tightening ring, the target biological tissue can be grasped with a large force and the biological tissue can be sufficiently stopped. Then, the foremost clip and the clip clamping ring are pushed out of the tube, and the engagement between the foremost clip clamping ring engaging portion and the foremost one rearward clip clamping ring engaged portion is engaged. And the foremost clip clamp ring can be separated. Further, the foremost one rear clip tightening ring is moved to open the pair of arms of the foremost one rear clip, and the engagement portion at the tip of the fore arm and the foremost clip The foremost clip can be separated by disengaging the base end. That is, the target biological tissue is gripped by the clip that is in the forefront, and the clip and the clip tightening ring are placed in the living body cavity with the gripping force maintained by the clip tightening ring that is in the forefront. Then, the other living tissue can be immediately gripped by the clip that comes to the front most. Therefore, once the tube is inserted into the living body cavity, the target living tissue can be gripped one after another by using a plurality of clips and clip fastening rings in succession, and convenience is improved. Further, by moving all the clips and the clip clamping ring, the foremost clip and the clip clamping ring can be separated, and the clip and the clip clamping ring are plastically deformed for the separation. A large force is not required, the operation is easy, and a plurality of clips and clip clamping rings can be used stably.

  According to the present invention, in the above-described biological tissue clip device, the clip moving means for reciprocating the clip at the rearmost position in the axial direction of the tube and the clip fastening ring at the rearmost position are reciprocated in the axial direction of the tube. A ring moving means.

  In this way, by moving the rearmost clip and the clip fastening ring by the clip moving means and the ring moving means, the moving force is applied to all the clips and the clip fastening ring from the rear to the front. All the clips and the clip clamping ring can be reliably reciprocated independently in the axial direction of the tube. Further, the clip moving means and the ring moving means do not need to be arranged in parallel to the radial direction of the tube with respect to the clip and the clip clamping ring, and may be arranged in series in the axial direction of the tube. Can be small.

  According to the present invention, in the biological tissue clip device, the pair of arm portions of the clip have different lengths and open outward while extending forward, and the clip engagement portion has the tip of each arm portion facing inward. The pair of arms of the rear clip are bent and closed with a clip tightening ring, and the proximal end of the front clip is sandwiched between the engagement portions at the distal ends of the pair of arms.

  In this way, by closing or opening the pair of arms of the rear clip, the base end of the front clip is clamped or separated by the engaging portion at the tip of the pair of arms. be able to. In addition, by holding the base end of the front clip with the engagement portion of the rear clip, a plurality of clips are connected, and all clips are reciprocated stably and reliably in the axial direction of the tube by the clip moving means. Can be made. Furthermore, the shape of the engaging portion of the clip can be simplified, manufacturing can be facilitated, and cost increase can be suppressed.

  Further, according to the present invention, in the above-described biological tissue clip device, a pair of leg portions of the clip clamping ring are provided symmetrically with respect to the rear end of the clip clamping ring and open outwardly larger than the inner diameter of the tube. The engaging portion of the ring is provided by bending the tip of each leg inward, and the engaged portion of the clip clamping ring is a plurality of holes provided symmetrically on the peripheral surface of the tip of the clip clamping ring. The pair of leg portions of the front clip clamping ring is closed, and the engaging portions at the tips of the pair of leg portions are hooked on the respective engaged portions of the rear clip clamping ring to Insert the attached ring into the tube.

  By doing so, by opening and closing the pair of leg portions of the clip tightening ring by opening / closing the front clip tightening ring from / into the tube, the engaging portion of the clip tightening ring can be closed. It can be hooked or removed from the engaged portion of the rear clip clamping ring. Further, by hooking the engaging portion of the front clip tightening ring to the engaged portion of the rear clip tightening ring, a plurality of clip tightening rings are connected, and all clip tightening rings are connected by the ring moving means. Can be reciprocated in the axial direction of the tube stably and reliably. Furthermore, the shapes of the engaging portion and the engaged portion of the clip tightening ring can be simplified, facilitating manufacturing, and suppressing cost increase.

  According to the present invention, in the above-described clip device for living tissue, a step that cannot be inserted into the clip tightening ring is provided at the distal ends of the pair of arms of the clip.

  By doing so, it is possible to prevent the clip and the clip tightening ring from being detached when the living tissue grasped by the tip portion of the clip and the pair of arms is drawn into the clip tightening ring.

  Further, according to the present invention, in the biological tissue clipping device, the pair of arm portions of the clip extend in parallel from the proximal end portion toward the front at a predetermined interval, and then extend in a crossing manner. A constriction having an inner diameter smaller than a predetermined interval between the pair of arms is provided at the rear end of the attached ring.

  By doing so, the clip tightening ring is fitted to the clip, and the clip tightening ring is moved forward from the crossing portion of the pair of arm portions, so that the clip tightening ring is moved from the crossing portion of the pair of arm portions. The pair of arms can be closed by pressing the front. In addition, by moving the clip tightening ring to the intersection of the pair of arm portions, the pair of arm portions can be opened by the elastic force of the clip. Furthermore, by moving the clip tightening ring backward from the crossing part of the pair of arm parts, the pair of arm parts is greatly opened by pressing the rear part from the crossing part of the pair of arm parts by the constriction of the clip tightening ring. Can do. For this reason, a biological tissue can be reliably hold | gripped with a pair of arm part of a clip, and this holding state can be stably maintained with a clip clamping ring.

  According to the present invention, once a tube is inserted into a living body cavity, a plurality of clips and a clip clamping ring can be used in succession, and a target living tissue can be gripped one after another, which is convenient. good. Further, by moving all the clips and the clip tightening ring by the clip moving means and the ring moving means, the foremost clip and the clip tightening ring can be separated, and the operation is easy. The clip clamping ring can be used stably.

  FIG. 1 is a cross-sectional view of a biological tissue clip device (hereinafter referred to as “clip device”) 100 according to an embodiment of the present invention. The clip device 100 is for holding a living tissue to stop bleeding. The clip device 100 is long in front of the remote control unit 100c so that it can be inserted into a living body cavity (for example, in the intestinal tract) through a forceps channel of an endoscope. In FIG. 1, for the sake of convenience, illustration between the distal end portion 100a and the intermediate main portion 100b of the clip device 100 and between the intermediate main portion 100b and the remote operation portion 100c is omitted.

  FIG. 2 is an enlarged cross-sectional view of the distal end portion 100 a of the clip device 100. FIG. 3 is an enlarged cross-sectional view of the intermediate main part 100 b of the clip device 100. The tube 1 of the clip device 100 is made of a synthetic resin such as Teflon (registered trademark) and has flexibility. The tube 1 has a length and a diameter that can be inserted into a living body cavity through a forceps channel or the like of an endoscope. In the tube 1, a plurality of clips 2, a plurality of clip clamping rings (hereinafter referred to as “clamping rings”) 3, serpentine tubes 4, and wires 5 are accommodated.

  4A and 4B are views showing the clip 2, wherein FIG. 4A is a plan view, FIG. 4B is a side view, and FIG. 4C is a perspective view. The clip 2 is formed by pressing a metal such as stainless steel. As shown in FIGS. 4 (a) and 4 (c), the pair of arms 2b and 2c extend from the base end 2a of the clip 2 to the front in parallel at a predetermined interval W and then intersect with each other. While extending forward, it opens outward (on the opposite side). The arms 2b and 2c are normally in the open state as described above, have elasticity, and are pressed inward to be closed as shown by a two-dot chain line in FIG. The clip 2 grips (holds) the living tissue with the arm portions 2b and 2c. The lengths of the arms 2b and 2c are different. The difference in length between the arms 2b and 2c is larger than the thickness of the base end 2a. Engaging portions 2d and 2e are provided at the tips of the arm portions 2b and 2c so as to protrude inward (center side). Specifically, the engaging portions 2d and 2e are provided by bending the tips of the arm portions 2b and 2c inwardly in a hook shape. In order to easily bite into the living tissue, the tips of the engaging portions 2d and 2e are formed in a mountain shape as shown in FIG. A step 2f is provided at the tip of the arms 2b and 2c so as to increase the width.

  5A and 5B are diagrams showing the tightening ring 3, wherein FIG. 5A is a plan view, FIG. 5B is a side view, and FIG. 5C is a perspective view. The fastening ring 3 is formed by injection molding a metal such as stainless steel. A constriction 3b having an inner diameter smaller than the interval W (FIG. 4A) between the arm portions 2b and 2c of the clip 2 is provided at the rear end portion of the tightening ring 3. Further, a leg 3c is provided at the rear end of the tightening ring 3 so as to open outward while extending rearward. Specifically, as shown in FIGS. 5 (a) and 5 (c), a pair of leg portions 3c are provided symmetrically with respect to a plane (not shown) to which the axis of the tightening ring 3 belongs at the rear end of the tightening ring 3. It is larger than the inner diameter of the tube 1 and opens outward. The leg 3c is normally in such an open state, has an elastic force, and is pressed inward to be in a closed state as shown by a two-dot chain line in FIG. An engaging portion 3d is provided at the tip of the leg portion 3c so as to protrude inward. Specifically, the engagement portion 3d is provided by bending the tip of the leg portion 3c inwardly in a bowl shape. On the peripheral surface of the tip portion 3a of the tightening ring 3, a pair (plural) of engaged portions 3e formed of holes are provided symmetrically with respect to the surface to which the axis of the tightening ring 3 belongs. The arrangement direction of the pair of engaged portions 3e is orthogonal to the arrangement direction of the pair of leg portions 3c and the engagement portions 3d.

  The fastening ring 3 is fitted around the clip 2 as shown in FIG. By moving the fastening ring 3 in the axial direction with respect to the clip 2, the arms 2b and 2c of the clip 2 are opened and closed. Specifically, by moving the front end portion 3a of the tightening ring 3 forward from the intersecting portion of the arms 2b and 2c of the clip 2, the front surface is pressed from the crossing portion of the arm portions 2b and 2c on the inner surface of the front end portion 3a. The arm portions 2b and 2c can be closed. When the fastening ring 3 is moved forward with respect to the clip 2, the front end surface of the fastening ring 3 comes into contact with the step 2f of the arm portions 2b and 2c. Thereby, the forward movement of the clamping ring 3, that is, the insertion of the clip 2 into the clamping ring 3 becomes impossible. Further, by moving the distal end portion 3a of the tightening ring 3 to the intersecting portion of the arm portions 2b and 2c, the arm portions 2b and 2c are moved by the elastic force of the arm portions 2b and 2c, as shown in FIGS. Can be opened to the normal state indicated by a solid line. Further, by moving the constriction 3b of the tightening ring 3 to the rear from the intersecting portion of the arm portions 2b and 2c, the inner portion of the constriction 3b is pressed behind the intersecting portion of the arm portions 2b and 2c, and the arm portions 2b and 2c. Can be opened larger than normal.

  The serpentine tube 4 shown in FIG. 3 and the like is made of metal and has flexibility. Similar to the engaged portion 3 e of the fastening ring 3, an engaged portion 4 e composed of a pair of holes is provided at the distal end portion 4 a of the snake tube 4. The wire 5 is made of metal and has flexibility and straightness. At the distal end of the wire 5, arms 5b and 5c similar to the arms 2b and 2c of the clip 2 are provided. The arm portions 5 b and 5 c penetrate the distal end portion 4 a of the serpentine tube 4. Engaging portions 5d and 5e are provided at the tips of the arm portions 5b and 5c.

  The rear end of the tube 1 is fixed to the front end of the main body pipe 6 of the remote control unit 100c shown in FIG. A flange 6 a is provided at the rear end of the main body tube 6. A first slide tube 7 is inserted into the main body tube 6 so as to be capable of reciprocating in the axial direction. A second slide tube 8 is inserted into the rear end portion of the first slide tube 7 so as to be capable of reciprocating in the axial direction. A stopper 9 that prevents the first slide tube 7 from coming off is attached to the tip of the second slide tube 8 exposed from the opening 7 a on the peripheral surface of the first slide tube 7. An operation ring 10 is fixed to the outer peripheral surface of the rear end portion of the first slide tube 7. An operation ring 11 is fixed to the rear end of the second slide tube 8. The snake tube 4 passes through the first slide tube 7. The rear end 4 b of the snake tube 4 is fixed to the rear end of the first slide tube 7. The wire 5 passes through the rear end portion 4 b of the serpentine tube 4 and the second slide tube 8. The rear end portion 5 f of the wire 5 is fixed to the rear end of the second slide tube 8.

  When assembling the clip device 100, first, the tip portions 3a of the plurality of fastening rings 3 are respectively fitted around the intersections of the arms 2b and 2c of the plurality of clips 2, and the arms 2b and 2c are opened. To do. Further, the serpentine tube 4 is passed through the tube 1, and the distal end portion 4 a is projected from the distal end of the tube 1. Further, the wire 5 is passed through the serpentine tube 4, and the arm portions 5b and 5c are projected from the distal end portion 4a so as to be opened. Next, the arm portions 5 b and 5 c of the wire 5 are pressed and closed, and the engaging portions 5 d and 5 e are engaged with the proximal end portion 2 a of a certain clip 2. That is, the base end portion 2a of a certain clip 2 is sandwiched between the engaging portions 5d and 5e. Then, the wire 5 is inserted into the serpentine tube 4 until an intermediate portion between the intersecting portion of the arm portions 5b and 5c and the engaging portion 5d is within the distal end portion 4a. As a result, as shown in FIG. 3 and the like, the arm portions 5b and 5c of the wire 5 are pressed and closed by the inner surface of the distal end portion 4a, and the holding state between the engaging portions 5d and 5e of the base end portion 2a of a certain clip 2 is maintained. Maintained. Next, the leg portion 3c of the fastening ring 3 fitted to the clip 2 is pressed and closed, and the engaging portion 3d is engaged with the engaged portion 4e of the distal end portion 4a of the serpentine tube 4. That is, the engaging portion 3d is inserted into the engaged portion 4e and hooked. Then, the serpentine tube 4, the fastening ring 3, and the clip 2 are inserted into the tube 1 from the tip until the leg portion 3 c is accommodated in the tube 1. As a result, as shown in FIG. 2 and the like, the leg portion 3c of the clamping ring 3 is pressed and closed by the inner surface of the tube 1, and the engaging portion 3d of the clamping ring 3 and the engaged portion 4e of the serpentine tube 4 are closed. The hooked state is maintained. At this time, the distal end portion 3a of the tightening ring 3 is positioned around the intersecting portion of the arms 2b and 2c of the clip 2 so that the arms 2b and 2c are opened.

  Next, the arm portions 2b and 2c of the clip 2 protruding from the distal end of the tube 1 are pressed and closed, and the engaging portions 2d and 2e at the distal ends of the arm portions 2b and 2c are connected to the proximal end portion 2a of another clip 2. Engage with. That is, the base end portion 2a of another clip 2 is sandwiched between the engaging portions 2d and 2e of the clip 2 protruding from the tube 1. Also, the leg 3c of another fastening ring 3 fitted to another clip 2 is pressed and closed, and the engagement portion 3d at the tip of the leg 3c is engaged with the fastening ring 3 protruding from the tube 1. Engage with the joint 3e. That is, the engaging portion 3d of another tightening ring 3 is inserted into the engaged portion 3e of the tightening ring 3 protruding from the tube 1 and hooked. Then, the fastening ring 3 and another clip 2 are inserted from the tip of the tube 1 into the inside until the leg portion 3 c of the other fastening ring 3 is accommodated in the tube 1. As a result, as shown in FIG. 2 and the like, the arms 2b and 2c of the rear clip 2 (previously inserted into the tube 1) are pressed and closed by the inner surface of the tube 1, and the engaging portion 2d of the rear clip 2 is closed. 2e, the proximal end portion 2a of the front clip 2 (next inserted into the tube 1) is maintained, and the front clip 2 is rotated 90 ° around the axis of the tube 1 with respect to the rear clip 2. Connected in state. Further, the leg portion 3c of the front tightening ring 3 is pressed and closed by the inner surface of the tube 1, and the engagement portion 3d of the front tightening ring 3 and the engaged portion 3e of the rear tightening ring 3 are closed. The hooked state is maintained, and the front tightening ring 3 is connected to the rear tightening ring 3 in a state of being rotated 90 ° around the axis. Then, the other clip 2 and the fastening ring 3 are sequentially inserted from the tip of the tube 1 into the inside by the above procedure, so that the plurality of clips 2 and the fastening ring 3 are connected to the tube 1 as shown in FIGS. Are arranged so as to be completely accommodated in the tube 1.

  Next, as shown in FIG. 1, the rear end of the tube 1 is fixed to the front end of the main body tube 6. Next, the first slide tube 7 is inserted into the main body tube 6 while the serpentine tube 4 protruding from the rear end of the tube 1 is inserted into the first slide tube 7, and the rear end portion 4 b of the serpentine tube 4 is connected to the first slide tube 7. 1 Fix to the rear end of the slide tube 7. Next, the second slide tube 8 is inserted into the first slide tube 7 while the wire 5 protruding from the rear end of the snake tube 4 is inserted into the second slide tube 8, and the rear end portion 5f of the wire 5 is inserted. Is fixed to the rear end of the second slide tube 8. Then, a stopper 9 is attached to the distal end portion of the second slide tube 8 exposed from the opening 7 a of the first slide tube 7.

  After assembling the clip device 100 as described above, a finger is put on the collar 6a of the main body tube 6 and the operation rings 10 and 11, and the first slide tube 7 is axially moved with respect to the main body tube 6 by the operation of the operation ring 10. The moving force is transmitted to the serpentine tube 4 so that the serpentine tube 4 and the rearmost clamping ring 3 reciprocate in the axial direction with respect to the tube 1, and the moving force is further forward. The other tightening rings 3 are also reciprocated in the axial direction with respect to the tube 1. Further, by moving the second slide tube 8 in the axial direction with respect to the main body tube 6 and the first slide tube 7 by operating the operation ring 11, the moving force is transmitted to the wire 5. The other clip 2 reciprocates in the axial direction with respect to the tube 1 and the first slide tube 7, and the moving force is sequentially transmitted to the other clip 2 in the front, so that the other clip 2 is also a tube. It reciprocates in these axial directions relative to the first and first slide tubes 7. The snake tube 4, the main body tube 6, the first slide tube 7, and the operation ring 10 constitute an embodiment of the ring moving means in the present invention. The wire 5, the main body tube 6, the second slide tube 8, and the operation ring 11 constitute an embodiment of the clip moving means in the present invention.

  6A to 6F are diagrams illustrating an operation state of the clip device 100. FIG. When using the clip device 100, first, as shown in FIGS. 1 and 2, the clip 1 and the fastening ring 3 are completely stored in the tube 1, and the tube 1 is inserted from the distal end to the forceps channel of the endoscope. Through the body cavity. Next, put a finger on the flange 6a of the main body tube 6 and the operation rings 10 and 11, push the slide tubes 7 and 8 against the main body tube 6, and tighten all the clips 2 via the snake tube 4 and the wire 5. The ring 3 is moved forward, and the arms 2b and 2c of the foremost clip 2 and a part of the fastening ring 3 are protruded from the tube 1 as shown in FIG. 6A. Next, the first slide tube 7 is pulled with respect to the main body tube 6, and all the fastening rings 3 are moved rearward through the serpentine tube 4, so that the arm portion of the foremost clip 2 as shown in FIG. 6B. Open 2b and 2c. At this time, the fitting position of the constriction ring 3b of the fastening ring 3b with respect to the arms 2b and 2c of the clip 2 is shifted, and the opening angle of the arms 2b and 2c of the foremost clip 2 is set to the size of the target living tissue. Adjust accordingly.

  Next, the remote control unit 100c is operated to rotate all the clips 2 and the tightening ring 3 together with the tube 1 around the axis of the tube 1 so that the orientation of the foremost clip 2 can easily grasp the target living tissue. The tube 1 as a whole is brought close to the target biological tissue, and the engaging portions 2d and 2e at the tips of the arms 2b and 2c of the foremost clip 2 as shown in FIG. Press. Next, the first slide tube 7 is pushed against the main body tube 6 to move all the fastening rings 3 forward through the serpentine tube 4, and as shown in FIG. 6D, the arm portion 2b of the foremost clip 2; 2c is closed by the foremost tightening ring 3, and the living tissue 20 is gripped by the arm portions 2b and 2c and the engaging portions 2d and 2e. As a result, the blood vessels inside the living tissue 20 that have been bleeding are ligated by the engaging portions 2d and 2e and stopped. The forward movement of the clamping ring 3 with respect to the clip 2 is limited by the tip of the clamping ring 3 being in contact with the step 2 f of the clip 2.

  Next, the slide tubes 7 and 8 are pushed against the main body tube 6 to move all the clips 2 and the fastening ring 3 forward through the serpentine tube 4 and the wire 5, and as shown in FIG. The clip 2 and the clamping ring 3 are completely pushed out of the tube 1. As a result, the leg portion 3c of the fastening ring 3 located at the forefront is opened, and the engaging portion 3d at the tip of the leg portion 3c and the engaged portion of the fastening ring 3 located at the back of the foremost one. The engagement with 3e is disengaged, and the fastening ring 3 located at the forefront is separated. Next, the first slide tube 7 is pulled with respect to the main body tube 6, and all the fastening rings 3 in the tube 1 are moved rearward through the serpentine tube 4, so that the foremost portion protruding from the tube 1 is moved. The arms 2b and 2c of the clip 2 that is one behind are opened, and the entire tube 1 is moved away from the living tissue 20 as shown in FIG. 6F. As a result, the engaging portions 2d and 2e at the distal ends of the arms 2b and 2c of the clip 2 located at the back of the proximal end 2a of the clip 2 holding the living tissue 20 located at the forefront. Is removed, and the clip 2 located at the forefront is separated. That is, the target living tissue 20 is gripped by the clip 2 that is at the forefront of the tube 1, and the gripping force is maintained by the tightening ring 3 that is at the forefront, so that the clip 2 and the tightening ring 3 are It is in a state of being placed in the cavity. Further, the arm portions 2b and 2c of the clip 2 that comes to the forefront of the tube 1 project from the tube 1 and open as shown in FIG. 6B, and can continuously grip another living tissue.

  According to the above, the plurality of clips 2 and the fastening ring 3 can be easily arranged in the tube 1 by connecting them in the axial direction of the tube 1. Further, by applying a force that moves in the axial direction of the tube 1 to one clip 2 and the tightening ring 3, the moving force is sequentially transmitted to all the clips 2 and the tightening rings 3, so that all the clips 2 and the fastening ring 3 can be reciprocated in the axial direction of the tube 1. In particular, by moving the rearmost clip 2 and the fastening ring 3 by the remote control unit 100c, the wire 5 and the serpentine tube 4, the moving force is applied to all the clips 2 and the fastening ring 3 from the rear to the front. All the clips 2 and the fastening ring 3 can be reciprocated independently and reliably in the axial direction of the tube 1 by being transmitted in order. Further, the wire 5 and the serpentine tube 4 do not have to be arranged in parallel with the clip 2 and the fastening ring 3 in the radial direction of the tube 1, and may be arranged in series in the axial direction of the tube 1. The diameter can be reduced.

  Further, by making the clip 2 have the structure shown in FIG. 4 and the like, the pair of arms 2b, 2c of the rear clip 2 is closed or opened, so that the engaging portion at the tip of the arms 2b, 2c The proximal end 2a of the front clip 2 can be sandwiched or separated by 2d and 2e. Further, by holding the proximal end 2a of the front clip 2 between the engaging portions 2d and 2e of the rear clip 2, a plurality of clips 2 are connected, and all the clips 2 are connected by the remote control unit 100c and the wires 5. Can be reciprocated in the axial direction of the tube 1 stably and reliably. Furthermore, since each engaging part 2d and 2e of the clip 2 should just be made into the simple shape of a hook shape, manufacture can be made easy and a cost increase can be suppressed.

  Further, by making the tightening ring 3 as shown in FIG. 5 and the like, the pair of legs 3c of the tightening ring 3 can be opened and closed by inserting and removing the front tightening ring 3 from the tube 1. Thus, the engaging portion 3d of the tightening ring 3 can be hooked or removed from the engaged portion 3e of the rear tightening ring 3. Further, by hooking the engaging portion 3d of the front tightening ring 3 to the engaged portion 3e of the rear tightening ring 3, the plurality of tightening rings 3 are connected to each other by the remote control unit 100c and the serpentine tube 4. All the fastening rings 3 can be reciprocated in the axial direction of the tube 1 stably and reliably. Further, since the engaging portion 3d and the engaged portion 3e of the tightening ring 3 may be formed into simple shapes such as a hook shape and a hole shape, manufacturing can be facilitated and cost increase can be suppressed.

  Therefore, the tube 1 is inserted into the living body cavity through the forceps channel of the endoscope, and all the clips 2 and the fastening ring 3 are moved forward by the remote control unit 100c, the wire 5 and the serpentine tube 4, and the foremost part The clip 2 and the fastening ring 3 can be protruded from the tube 1. Then, all the tightening rings 3 can be moved rearward by the remote control unit 100c and the serpentine tube 4, and the arms 2b and 2c of the foremost clip 2 can be opened. Then, the tube 1 is rotated by the remote control unit 100c, all the clips 2 and the fastening ring 3 are rotated, and the distal ends of the arms 2b and 2c of the foremost clip 2 are pressed against the target biological tissue 20. it can. Then, all the tightening rings 3 can be moved forward by the remote control unit 100c and the serpentine tube 4, the arms 2b and 2c of the foremost clip 2 can be closed, and the living tissue 20 can be gripped. At this time, the step 2f of the arm portions 2b and 2c of the clip 2 and the tip of the tightening ring 3 come into contact with each other, whereby the living tissue 20 grasped by the engaging portions 2d and 2e and the arm portions 2b and 2c is tightened. When pulled in, the clip 2 and the fastening ring 3 can be prevented from coming off. In addition, since the arms 2b and 2c of the clip 2 are tightened by the tightening ring 3, the living tissue 20 can be held with a large force and the living tissue 20 can be sufficiently stopped.

  Then, all the clips 2 and the tightening ring 3 are moved forward by the remote control unit 100c, the wire 5 and the serpentine tube 4, and the foremost clip 2 and the tightening ring 3 are pushed out of the tube 1 so that the foremost tightening is performed. It is possible to disengage the engaging portion 3d of the attaching ring 3 from the engaged portion 3e of the foremost one rearward tightening ring 3 to separate the foremost tightening ring 3. Also, the fastening ring 3 other than the forefront is moved by the remote control unit 100c and the serpentine tube 4 to open the arms 2b, 2c of the clip 2 at the back of the forefront, and the tips of the arms 2b, 2c. The proximal end 2a of the foremost clip 2 by the engaging portions 2d and 2e can be removed, and the foremost clip 2 can be separated. That is, the target biological tissue 20 is gripped by the clip 2 located at the forefront, and the clip 2 and the fastening ring 3 are held in the body cavity in a state where the gripping force is maintained by the fastening ring 3 located at the forefront. The other living tissue can be immediately gripped by the clip 2 that comes to the front most.

  As a result, once the tube 1 is inserted into the living body cavity, the target living tissue 20 can be gripped one after another using the plurality of clips 2 and the fastening ring 3 in succession. Sexuality is improved. Further, by moving all the clips 2 and the fastening ring 3 by the remote control unit 100c, the wire 5 and the serpentine tube 4, respectively, the foremost clip 2 and the fastening ring 3 can be separated. In addition, a large force for plastically deforming the clip 2 and the fastening ring 3 is not required, and the operation is easy, and the plurality of clips 2 and the fastening ring 3 can be used stably.

  The present invention can adopt various forms other than the above embodiment. For example, in the above embodiment, the base end 2a of the clip 2 is sandwiched between the engaging portions 2d and 2e provided on the arms 2b and 2c of another clip 2, and a plurality of clips 2 are connected. Although listed, the present invention is not limited to this. In addition to this, for example, at least one of a pair of arm portions of a clip is provided with an engaging portion with a bifurcated tip, and a plurality of clips are connected by sandwiching the base end portion of another clip at the engaging portion. You may make it do. In addition, for example, an engagement portion such as a hole or a recess is provided at the base end portion of the clip, and an engagement portion provided on at least one of a pair of arms of another clip is inserted into the engagement portion and hooked. A plurality of clips may be connected. However, as shown in FIG. 2 and the like, it is easier to manufacture the clip 2 by connecting the clip 2 by sandwiching the base end portion 2a between the engaging portions 2d and 2e, thereby making it possible to reduce the cost. In addition, the connection and interlocking of the plurality of clips 2 can be stabilized.

  Moreover, although the example which provided the leg part 3c, the engaging part 3d, and the to-be-engaged part 3e 2 each was given to the clamping ring 3 in the above embodiment, this invention is not limited only to this. Absent. In addition, one or three or more legs, engaging portions, and engaged portions may be provided on the tightening ring. However, as shown in FIG. 5 and the like, the structure of the tightening ring 3 is simpler if the leg portion 3c, the engaging portion 3d, and the engaged portion 3e are provided two by two in plane symmetry on the tightening ring 3. Manufacturing becomes easy, cost increase can be suppressed, and connection and interlocking of the plurality of fastening rings 3 can be stabilized.

  Further, in the above embodiment, the example in which the engaged portion 3e formed of the hole is provided in the tightening ring 3 has been described. However, the present invention is not limited to this example. An engaged portion made of a recess such as a groove may be provided.

  Further, in the above embodiment, the rearmost clip 2 and the fastening ring 3 are detachably connected to the wire 5 and the serpentine tube 4 respectively, and all the clips 2 and the fastening rings 3 are used for grasping the living tissue. An example that can be used up is given, but the present invention is not limited to this. In addition to this, for example, the rearmost clip and the fastening ring are connected (fixed) to the wire and the serpentine tube inseparably, and the rearmost clip and the fastening ring are used as part of the clip moving means and the ring moving means. It may be used so that it cannot be placed after being separated from the tube. Further, a linear material such as a tube may be used instead of the wire 5, or a linear material such as a wire may be used instead of the serpentine tube 4. That is, according to the present invention, the clip moving means and the ring moving means are not limited to the parts of the wire 5, the snake tube 4, and the remote control unit 100 c described above. Those that can be reciprocated in the axial direction may be used.

  Furthermore, in the above embodiment, the clip device 100 that grips a living tissue for hemostasis is described as an example. However, the present invention is not limited to this, and a clip that grips a living tissue for marking (marking). It can be applied to a device or the like.

It is sectional drawing of the clip apparatus of the biological tissue which concerns on embodiment of this invention. It is an expanded sectional view of the tip part of the clip device. It is an expanded sectional view of the middle important part of the clip device. It is a figure which shows the clip with which the clip apparatus is equipped. It is a figure which shows the clip fastening ring with which the clip apparatus is equipped. It is a figure which shows the operation state of the clip apparatus. It is a figure which shows the operation state of the clip apparatus. It is a figure which shows the operation state of the clip apparatus. It is a figure which shows the operation state of the clip apparatus. It is a figure which shows the operation state of the clip apparatus. It is a figure which shows the operation state of the clip apparatus.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Tube 2 Clip 2a Base end part 2b, 2c Arm part 2d, 2e Engagement part 2f Step 3 Clip clamping ring 3a Tip part 3b Constriction 3c Leg part 3d Engagement part 3e Engagement part 4 Serpentine pipe 5 Wire 6 Main body pipe 7 First slide tube 8 Second slide tube 10, 11 Operation ring 20 Biological tissue 100 Biological tissue clip device W Predetermined distance between clip arms

Claims (6)

A clip for gripping the living tissue with a pair of arms extending forward from the proximal end,
A clip tightening ring that opens and closes the pair of arms by being fitted to the clip and moving in the axial direction;
In a clip device for living tissue comprising the tube and a tube that can be inserted into a living body cavity by storing the clip and the clip clamping ring inside,
An engagement portion that protrudes inwardly is provided at the tip of the arm portion of the clip,
A leg portion is provided at the rear end portion of the clip fastening ring that extends rearward and opens outwardly.
An engaging part that protrudes inwardly is provided at the tip of the leg part,
An engaged portion is provided at the tip of the clip clamping ring,
A plurality of the clip fastening rings are respectively fitted to the plurality of clips, and the engaging portions of the other clips are engaged with the base end portions of the certain clips, and the engaged portions of the certain clip fastening rings are engaged. The plurality of clips and clip fastening rings are connected in the axial direction of the tube by engaging the engaging portions of the other clip fastening rings and sequentially inserting them from the tip of the tube to the inside. A clip device for living tissue, characterized in that it is arranged in a tube. The biological tissue clip device according to claim 1,
Clip moving means for reciprocating the clip at the rear in the axial direction of the tube;
A clip device for living tissue, comprising: a ring moving means for reciprocally moving the clip tightening ring at the rear end in the axial direction of the tube. The clip device for living tissue according to claim 1 or 2,
The pair of arms of the clip have different lengths and extend forward while extending forward,
The engaging portion of the clip is provided by bending the tip of each arm portion inwardly,
The living body characterized in that the pair of arms of the rear clip are closed by the clip tightening ring, and the proximal end of the front clip is sandwiched between the engagement portions at the distal ends of the pair of arms. Tissue clip device. The biological tissue clip device according to any one of claims 1 to 3,
A pair of the leg portions of the clip clamping ring are provided symmetrically on the rear end of the clip clamping ring, and open outwardly larger than the inner diameter of the tube.
The engagement portion of the clip clamping ring is provided by bending the tip of each leg portion inwardly,
The engaged portion of the clip clamping ring is composed of a plurality of holes provided symmetrically on the peripheral surface of the tip of the clip clamping ring,
Close the pair of leg portions of the front clip clamping ring, hook the engagement portions at the tips of the pair of leg portions on the engaged portions of the rear clip clamping ring, and A clip device for living tissue, wherein a clip clamping ring is inserted into the tube. The biological tissue clip device according to any one of claims 1 to 4,
A clip device for living tissue, wherein a step that cannot be inserted into the clip fastening ring is provided at the tip of the pair of arms of the clip. The biological tissue clip device according to any one of claims 1 to 5,
The pair of arm portions of the clip extend in parallel at a predetermined interval from the base end portion toward the front, and then extend in a crossing manner.
A clip device for living tissue, wherein a constriction having an inner diameter smaller than the predetermined distance between the pair of arm portions is provided at a rear end portion of the clip tightening ring.

Images