JP2009261772A - Coupling ring, coupling clip package, and clip loading method - Google Patents

Abstract

When a connecting clip unit in which a plurality of clips and a connecting ring are connected is loaded from a case into a sheath, a skirt portion of each connecting ring is easily closed.
A connecting clip unit 17 is moved to the front end side in a case 82. The skirt portion 38 of the connecting ring 14 is closed in the connecting ring 14 by moving from the skirt receiving portion 90 into the connecting clip receiving portion 83 having a small diameter. The cylindrical sheath 16 constituting the clip treatment tool is inserted into the connection clip accommodating portion 83, and the connection clip unit 17 is loaded into the sheath 16. Since the inclined portion 38 a provided at the free end of the skirt portion 38 is pushed by the distal end of the sheath 16 and closed, the connecting clip unit 17 can be loaded into the sheath 16 without receiving the resistance of the skirt portion 38.
[Selection] Figure 10

Description

  The present invention relates to an endoscope clip that performs hemostasis, wound closure, etc. in a living body, and more specifically, a connection ring used in a repetitive clip treatment instrument that can continuously use a clip, and a plurality of clips. The present invention relates to a connection clip package for distributing and storing a connection clip unit in a connected state with a ring, and a clip loading method for loading a connection clip unit from a connection clip package into a sheath.

  Endoscopic clip treatment tool is designed to project the clip from the tip of the endoscope inserted into the living body, pick the treatment part after removal of the bleeding part or lesion tissue with the clip, and stop hemostasis or wound closure Used. The conventional clip treatment tool has a clip with an open tip and a fastening part for closing and fastening the clip, and the clip is closed by advancing the fastening part with respect to the opened clip. It has become.

  For example, Patent Document 1 describes a configuration in which a clip is pulled into a clip tightening ring attached to a rear end portion of the clip, a clip portion at the tip end portion of the clip is closed, and a living tissue is gripped. . When the clip is pushed out from the tip of the introduction tube (sheath), the clip clamping ring of Patent Document 1 is pushed out together. This clip tightening ring has two blades that can be protruded and retracted, and the blade protrudes when it passes through a tip attached to the tip of the introduction tube. Even if the clip is pulled after the protrusion of the blade, the clip clamping ring does not retract into the introduction tube, so that the clip is clamped by the clip clamping ring. The clip clamping ring is placed in the body cavity together with the clip.

  Conventional clip treatment devices such as the clip device described in Patent Document 1 are such that only one clip is attached to the tip of an operation wire. Therefore, it is necessary to perform a cumbersome operation of pulling out the entire sheath from the endoscope every time a clip treatment is performed, setting the next clip, and inserting the sheath into the endoscope again.

  On the other hand, an endoscopic clip device that enables continuous clip treatment has been proposed. For example, in Patent Document 2, a plurality of clips are alternately turned 90 degrees each time by engaging a front end claw portion of a rear clip with a connecting hole formed in a rear end portion of a front clip. An endoscopic clip device that is directly coupled is described.

  According to the apparatus of Patent Document 2, continuous clip treatment can be performed. However, in the above apparatus, the clip connection is maintained only by the engagement of the front and rear clips, and the connecting portion is exposed in the sheath. For this reason, the connection state is unstable, and when inserted into the endoscope, it will come off when passing the curved part, or an excessive force will be applied to the connection part, causing the clip before use to be twisted or distorted. There is a possibility.

  In view of this, the present inventor has researched and developed a repetitive clip treatment instrument in which an engaging portion of two clips is provided with a connecting ring that covers the engaging portion and maintains the connecting state of the clips. In the inventor's continuous clip treatment tool, the connection ring provided at the connection portion of the clip also has a clip tightening function. This connecting ring is provided with two skirt-like spreading portions that close inward within the sheath and open wider than the inner diameter of the sheath after passing through the distal end of the sheath, for example, at two locations in the circumferential direction of the connecting ring. The skirt portion prevents the connecting ring from retracting from the sheath tip into the sheath when the clip is pulled into the sheath when the clip is tightened, and allows the clip to be tightened by the connecting ring.

  The inventor has also developed a connected clip package that allows the user to easily load the clip into the sheath. For example, a connection clip unit that maintains a state where a plurality of clips and a connection ring are connected is accommodated in a dedicated case, and the connection clip unit is loaded into the sheath from the case while maintaining the connection state of each clip. I can do it.

  The distribution and storage environment of the clip may vary in temperature in the range of about 5 ° C to 38 ° C. The connecting ring is made of resin, and the skirt portion is configured to expand when it goes out of the sheath due to its own elasticity. If the skirt part is stored for a long time with the skirt part closed inward, and thermal stress due to a change in temperature is repeatedly applied, the elasticity of the skirt part may be lost, and the skirt part may not be opened to a predetermined diameter at the time of clip treatment. Therefore, it is considered that the connecting ring is accommodated in the case with the skirt portion opened.

Japanese Patent Laid-Open No. 2002-272751 JP 2006-187391 A

  An operation wire for operating the clip is inserted into the sheath. A grip device for operating the operation wire is connected to the root side of the sheath. Therefore, the connection clip unit must be loaded from the distal end side of the sheath. However, since the connecting ring is accommodated in the case with the skirt portion open, the skirt portion must be closed when the coupling ring is loaded.

  An object of the present invention is to easily close a skirt portion of each connection ring when a connection clip unit in which a plurality of clips and a connection ring are connected is loaded from a case to a sheath.

  The connection ring of the present invention covers an engagement portion between a first clip used in a repetitive clip treatment instrument and a second clip that is arranged behind the first clip and engages the first clip. And a skirt provided on the outer peripheral surface of the holding portion, which extends radially from the front end side to the rear end side and closes when pressed from the outside in the radial direction. Part. The free end of the skirt portion is provided with an inclined portion that closes the skirt portion when pushed from the rear end side.

  The skirt portion of the connection ring of the present invention protrudes into the holding portion when closed, and has a function of pressing and holding at least one of the first clip or the second clip. Moreover, it is preferable that the skirt part is provided with two or more in the circumferential direction of the holding | maintenance part.

  The connection clip package of the present invention includes a connection clip unit and a case that houses the connection clip unit. The connection clip unit includes a plurality of clips that are aligned with the front and rear clips, a plurality of connection rings that cover the engagement portions of the clips and maintain the connection state of the clips, and a clip disposed at the end. And a dummy clip to be engaged. As the connection ring, the connection ring having the inclined portion described above is used. The case has a connecting clip housing portion and a skirt housing portion. The connecting clip housing portion has an inner diameter into which a cylindrical sheath into which the connecting clip unit is loaded can be inserted. Moreover, the skirt accommodating part can accommodate the skirt part expanded in the radial direction.

  The connection clip loading method of the present invention is a clip loading method for loading a connection clip unit into a sheath from the above-described connection clip package, and connecting the tip of an operation wire accommodated in the sheath so as to be retractable to a dummy clip. A step of closing the skirt portion by moving the connecting clip unit and the dummy clip to the front end side or the rear end side in the connecting clip housing portion by the operation wire, and bringing the skirt portion into contact with the connecting clip housing portion; have. In addition, there is a sheath insertion step in which the sheath is inserted into the connection clip housing portion, and the connection clip unit is loaded into the sheath while pushing the inclined portion at the distal end of the sheath to close the skirt portion. The sheath loaded with the connecting clip unit is pulled out of the case in the final pulling process.

  According to the connecting ring of the present invention, since the inclined portion is provided at the free end of the skirt portion, the inclined portion can be pushed from the rear end side of the connecting ring to close the skirt portion.

  According to the connection clip package of the present invention, a plurality of clips, a connection ring, and a dummy clip can be accommodated in a connected state. Further, since the skirt portion can be accommodated without being closed, the elasticity of the skirt portion can be prevented from deteriorating during distribution and storage, and the performance of the clip and the connection ring can be maintained until use. Furthermore, since the inner diameter of the connection clip housing portion is made substantially equal to the outer diameter of the sheath, the sheath can be inserted into the connection clip housing portion and the connection clip unit can be loaded into the sheath.

  In the connecting clip loading method of the present invention, the connecting clip unit connected to the operation wire is moved in the connecting clip housing portion to close the skirt portion, and then the sheath is inserted into the connecting clip housing portion. It can be loaded from the tip of. In addition, even when the skirt part opens slightly when loading the connection clip unit from the tip of the sheath, the skirt part can be closed by pushing the inclined part at the tip of the sheath, so the connection clip is not affected by the resistance of the skirt part. The unit can be loaded.

  First, the continuous clip treatment tool used in the present invention will be described. FIG.1 and FIG.2 is typical sectional drawing which shows an example of a repetitive clip treatment tool. FIG. 1B is a view as seen from an angle 90 degrees different from FIG. 2 (A) and 2 (B) are enlarged views of the tip portion of FIGS. 1 (A) and 1 (B).

  The clip treatment tool 10 is a repetitive clip treatment tool that can continuously use clips, and includes a plurality of clips 12 (12A, 12B, 12C, 12D). Each of the clips 12A to 12D is connected to the rear end of the front clip by engaging the rear clip. A dummy clip 13 is connected to the last clip 12D. A connection ring 14 (14A, 14B, 14C, 14D) is provided on the outer side of each clip 12A to 12D and the dummy grip 13 so as to cover the engaging portion of the clip 12 arranged in the front-rear direction and maintain the connection state of the clip 12. Is inserted.

  A plurality of clips 12, a connection ring 14, and a connection clip unit 17 including a dummy clip 13 are inserted into a sheath 16. A connection member 19 provided at the rear end of the dummy clip 13 is connected to an operation wire 20 that is inserted through the sheath 16 so as to be freely pulled.

  One clip 12 and one connection ring 14 constitute one endoscopic hemostatic clip body. In the clip treatment instrument 10, a connection clip unit 17 in which the hemostatic clip body is connected is loaded inside the distal end of a long sheath 16. The operation wire 20 extends to the proximal end portion of the sheath 16 and is connected to an operation portion described later. By pulling the operation wire 20 from the operation unit by a predetermined length and moving the dummy clip 13 by a predetermined length in one direction, the connecting clip unit 17 moves by the same amount. The leading clip 12 is tightened by a connecting ring 14 that holds the clip, and clip treatment (clipping) for hemostasis, marking, and the like by the leading clip 12 is performed. After the clip treatment with the first clip 12 is completed, the sheath 16 is pulled to the operation unit side by a predetermined length, so that the next clip 12 can be used (standby state), and then the clip treatment is performed. Can do.

  1 and 2 show an initial state immediately before the start of the clip treatment operation by the leading clip 12. The leading clip 12 </ b> A is in a state of protruding from the distal end of the sheath 16. When the clip 12 or the like is loaded into the sheath 16, as shown in FIG. 6A described later, the leading clip 12A is set in a state of being completely contained in the sheath 16. In FIG. 1, four clips 12 are provided as a four-shot clip treatment device, but the number of clips 12 may be two or more.

  FIG. 3 is a perspective view of the clip 12. The clip 12 is a closed clip having a turn part 24 that is turned 180 degrees with respect to the claw part 22. That is, the clip 12 is made by bending a single elongated plate 180 degrees to form a closed end, intersecting both pieces, and bending the two open ends so that the ends are opposed to each other. It has a shape in which the portions 22 and 22 are formed. The open end side is the arm portions 28 and 28, and the closed end side is the turn portion 24, with the crossing portion 26 intersecting the elongated plates as a boundary. Convex portions 30, 30 that are partially wide are formed at the central portions of the arm portions 28, 28. The clip 12 can be made of a biocompatible metal, for example, SUS631 which is stainless steel for springs.

  The clip 12 is moved by a predetermined amount toward the claw portions 22 and 22 while the front end portion (clamping portion 40 described later) of the connecting ring 14 fitted to the intersecting portion 26 presses the arm portions 28 and 28. By doing so, the arm portions 28 and 28 and the claw portions 22 and 22 are closed, and a predetermined fitting force is exhibited in the claw portions 22 and 22.

  The nail | claw parts 22 and 22 are formed in the V-shaped male type | mold and the female type | mold, in order to pick up a target part reliably. Further, as shown in FIG. 3, the arm portion 28 of the clip 12 is gradually widened from the intersecting portion 26 to the convex portion 30.

  The convex portion 30 has a width wider than the portion of the opening on the distal end side and the opening on the proximal end side of the connection ring 14 with which the convex portion 30 abuts. Therefore, portions other than the convex portion 30 of the clip 12 can enter the inside of the connecting ring 14, but the convex portion 30 cannot enter the inside from the front end side or the base end side of the connecting ring 14.

  As shown in FIGS. 1 and 2, the first clip 12A and the next clip 12B are held by the connecting ring 14A with the claw portion 22 of the clip 12B engaged with the turn portion 24 of the clip 12A and closed. Thus, a connected state is established. The claw portions 22 and 22 of the clip 12B are engaged with and coupled to the turn portion 24 of the clip 12A in the orthogonal direction, and the clip 12A and the clip 12B are connected in a direction different by 90 degrees. Similarly, the following clips 12C and 12D are connected by alternately changing the direction by 90 degrees.

  The connection ring 14 is fitted in the sheath 16 so as to be able to advance and retract while covering the engaging portions of the two clips 12 and 12 and maintaining the connection state. That is, the outer diameter of the connection ring 14 is substantially equal to the inner diameter of the sheath 16, and the connection ring 14 can smoothly move back and forth in the sheath 16 as the clip 12 moves. 4A to 4D show a schematic configuration of the connection ring 14. FIG. 3A is a front view of the connecting ring 14 and FIG. FIG. 3C is a cross-sectional view taken along the line A-A in FIG. 4A, and FIG. 4D is a bottom view.

  The connection ring 14 includes a tightening portion 40 and a holding portion 42. The connection ring 14 has a metal fastening part 40 fixed to the tip of a resin holding part 42 and has an integral structure with two members. The resin holding part 42 is in charge of maintaining the connected state and holding the clip in the connecting ring, and the metal fastening part 40 is in charge of fastening the clip. The connection ring 14 may be formed of one member as long as both functions of the tightening portion 40 and the holding portion 42 can be exhibited.

  The tightening portion 40 is a metal cylindrical (ring-shaped) part attached to the distal end side of the connection ring 14, and is larger than the width of the clip 12 near the intersection 26 and larger than the width of the convex portion 30. A small inner diameter hole 40a is formed. Therefore, the tightening portion 40 can move in the vicinity of the intersecting portion 26 of the clip 12 to be held, but cannot be pulled out beyond the convex portion 30. That is, the convex portion 30 functions as a stopper that determines the movement limit of the connecting ring 14 that moves forward with respect to the clip 12.

  The tightening portion 40 is set at a predetermined position set in the vicinity of the intersecting portion 26 of the clip 12. The tightening portion 40 moves from the initial position to the convex portion 30 side from the intersecting portion 26 where the arm portion 28 of the clip 12 becomes wide, so that both the arm portions 28 of the clip 12 that has spread. , 28 is closed and fixed. For the tightening portion 40, a biocompatible metal is used. For example, stainless steel SUS304 can be used. Since the tightening portion 40 is made of metal, it is possible to exert a frictional force as a tightening force on the metal clip 12.

  The holding portion 42 is a resin-molded, generally cylindrical (ring-shaped) part. The holding unit 42 includes a first area 32 that holds the previous clip 12 and a second area 34 that is a connected holding area that holds the next clip 12 in a state of being connected to the previous clip.

  In the first region 32, a circular hole 32 a that can accommodate the turn part 24 of the clip 12 and is larger than the hole of the fastening part 40 is formed. A stepped portion 32b for fitting the tightening portion 40 is formed on the outer surface of the distal end portion of the first region 32. The tightening portion 40 and the holding portion 42 are in a state of being loaded in the sheath 16 and clipping. It is fitted with an interference fit that does not come off during operation. Further, the first region 32 has a skirt portion 38 that is inclined and spreads in a skirt shape with respect to the axis of the connecting ring 14 main body.

  The skirt portion 38 has a tip side, that is, an upper root in FIG. 4 connected to the main body of the holding portion 42, and as shown in FIG. It expands and closes in the radial direction. Two skirt portions 38 are provided in the circumferential direction of the holding portion 42. The positions are formed at two positions 180 degrees apart at the same position in the pulling direction of the clip 12, that is, the vertical direction in FIG.

  The skirt portions 38 and 38 spread in a skirt shape as shown in FIG. 3A in a natural state where no external force is applied. At this time, the inside of the first region 32 of the holding portion 42 is a cylindrical space as shown in FIG. On the other hand, when the connecting ring 14 is loaded into the sheath 16, for example, as shown in the connecting ring 14 </ b> B of FIG. 2B, the skirt portion 38 is pushed inward and enters the internal space, The inner peripheral portion presses the side surface (edge portion) of the turn portion 24 of the clip 12B held in the first region 32 so that the clip 12B does not move in the rotation direction and the forward / backward direction in the connecting ring 14B. Hold. The skirt portion 38 may press and hold a clip held in the second region 34, that is, a rear clip.

  As shown in the first connection ring 14A of FIG. 2A, the skirt portions 38, 38 are released from the distal end of the sheath 16, and at the same time, are opened by their own elasticity to release the holding of the clip 12A. It becomes wider than the inner diameter of 16 to prevent the connecting ring 14 </ b> A from retracting into the sheath 16. In this state, the operation wire 20 is pulled and the clip 12A moves backward, whereby the connecting ring 14A moves forward relative to the clip 12A and tightens the clip 12A.

  Therefore, the skirt portion 38 needs to have elasticity so that it can be closed inward within the sheath 16 and spreads in a skirt shape when released from the external force from the distal end of the sheath 16. . At the same time, the skirt portion 38 needs to have a rigidity that can hold the clip 12 inside the sheath 16 and a rigidity that can withstand a reaction force of the tightening force of the clip 12 at the distal end of the sheath 16.

From these viewpoints, the holding portion 42 is made of a material that is biocompatible and satisfies the elasticity and rigidity required for the skirt portion 38. The shape is determined so as to satisfy the elasticity and rigidity required for the skirt portion 38. For example, PPSU (polyphenylsulfone) can be used as the material of the holding unit 42. From the standpoint of ease of manufacture, the holding portion 42 is preferably integrally formed.

  The skirt portions 38, 38 are formed with inclined portions 38a, 38a that are inclined from the rear end side toward the front end side at the outer corners of the free ends. The inclined portions 38 a and 38 a have a function of closing the skirt portions 38 and 38 when the connecting clip unit 17 is loaded into the sheath 16 from the distal end side of the sheath 16. That is, when the inclined portions 38 a and 38 a are pushed by the distal end of the sheath 16, the skirt portions 38 and 38 are closed so as to be accommodated in the holding portion 42.

  The second region 34 is provided on the proximal end side of the first region 32. The second area 34 maintains a state in which the next clip 12 that engages with the clip 12 held in the first area 32 is closed with the claw portions 22 and 22 sandwiching the turn portion 24 of the previous clip 12. To do.

  The second region 34 has a length substantially equal to the moving length required for the tightening portion 40 set at the initial position with respect to the clip 12 to complete the tightening of the clip 12 as the region length. . That is, the second region 34 of the connection ring 14 holds the connection between the two clips 12 and 12 held therein while the clip 12 is retracted and tightened relative to the connection ring 14. In addition, the traction force of the rear clip 12 is transmitted to the front clip 12, and when the tightening is completed, the engaging portions of the two clips 12, 12 are disengaged from the second region 34, whereby the clip 12 , 12 are released.

  In the second region 34, as shown in FIG. 4C, a hole 43 having the same inner diameter as that of the proximal end portion of the first region 32 is formed, and a groove (concave portion) 43a is formed at two opposing positions. Is formed. The grooves 43a and 43a can accommodate the arm portions 28 and 28 of the clip 12 held in the second region 34 with the claw portions 22 and 22 closed. In the second region 34, as shown in FIGS. 3A and 3D, slits 44 cut from the base end are formed at two locations.

  The grooves 43a and 43a are provided at two locations along the opening / closing direction (left-right direction in FIG. 3) of the claw portion 22 of the clip 12 held in the second region 34. The plate surfaces of the arm portions 28 and 28 of the clip 12 held in the second region 34 abut against the inner walls of the grooves 43a and 43a. The width (opening width) of the groove 43a is slightly larger than the maximum width of the arm portion 28 of the clip 12, and the distance from the wall surface of one groove 43a to the wall surface of the other groove 43a is the two claw portions 22 of the clip 12. , 22 (length in the expanding direction) is approximately equal to the total length. Further, the width of the groove 43 a is smaller than the width of the convex portion 30 formed in the arm portion 28. Therefore, the convex portion 30 of the clip 12 held in the second region 34 cannot enter the groove 43a.

  In addition, the distance from the wall surface to the wall surface of both grooves 43a and 43a should just be a dimension in which the engagement between the turn part 24 of the previous clip 12 and the claw parts 22 and 22 of the next clip 12 is not released. What is necessary is just to make shorter than the length which added the length of the two nail | claw parts 22 and 22 and the width | variety of the part which the nail | claw parts 22 and 22 of the turn part 24 engage. For example, the claw portions 22 and 22 of the clip 12 held in the second region 34 may be in a slightly overlapped state, or with a slight gap between the claw portions 22 and 22, The connection with the clip 12 may be maintained.

  The engaging portions of the two clips 12 and 12 are held in a portion of the second region 34 that is close to the boundary with the first region 32. Since the previous clip 12 (for example, the clip 12B in the connection ring 14B in FIG. 2B) is held by the closed skirt portion 38 of the first region 32 inside the sheath 16, Forward / backward movement and rotational movement are suppressed. Further, the next clip 12 that engages with the previous clip 12 (for example, the clip 12C in the connection ring 14B in FIG. 2B) is held in a direction different from the previous clip by 90 degrees by the groove 43a of the second region 34. Thus, the rotational movement is suppressed, and the forward / backward movement is suppressed by engaging with the previous clip in which the forward / backward movement is suppressed. That is, the engaging portions of the front and rear clips are held by the connection ring 14 with a very small play.

  The slits 44 are formed at two positions shifted by 90 degrees from the skirt portions 38 and 38 to a position shallower than the upper end of the second region 34. In other words, the slit 44 is provided at a position shifted by 90 degrees from the spreading direction of the clip 12 held in the second region 34.

  By providing the slit 44, the flexibility of the connection ring 14 can be improved, and the clip treatment tool 10 can pass through a curved portion having a small curvature. In addition, since the skirt (base end portion) of the connection ring 14 is partially turned up by providing the slit 44, when connecting the front and rear clips 12, 12 before loading the clip 12 into the sheath 16, There is also an advantage that the connection ring 14 can be easily connected by turning the skirt.

  The depth of the slit 44 is set to a position shallower than the skirt portion 38, and the strength of the connecting ring 14 is prevented from greatly decreasing. The depth of the slit 44 is set to a position at the rear end of the clip 12 held in the first region 32, that is, a position shallower than the engaging position of the clips 12 and 12. Thereby, also in the connection clip unit 17 before being loaded into the sheath 16, the holding of the clip 12 in the second region 34 of the connection ring 14 can be maintained.

  As shown in FIG. 1, the claw portions 22 of the next clip 12B engage with the turn portion 24 of the leading clip 12A, and the connecting ring 14A holds the engaging portion. The claws 22 and 22 of the clip 12B are held in a closed state by the inner wall of the connecting ring 14A (the second region 34). Thereby, the connection state of the clip 12A and the clip 12B is maintained. Similarly, the connection state between the clip 12B and the clip 12C is maintained by the connection ring 14B. Further, the connection state between the clip 12C and the clip 12D is maintained by the connection ring 14C. Similarly, the connection state between the clip 12D and the dummy clip 13 is maintained by the connection ring 14D.

  As shown in FIG. 1, a dummy clip 13 that is not used for clip treatment is engaged with the last clip 12D. The dummy clip 13 has a clip portion 13a having a spring property having a shape similar to a half portion of the open end side from the intersection portion 26 of the clip 12 on the tip end side, and the claw portions 22 and 22 are closed. Then, the clip 12D is released by engaging with the turn portion 24 of the clip 12D and opening the claw portions 22,22. A connection member 19 is attached to the proximal end side of the dummy clip 13. The connection member 19 is provided so as to be connectable to and detachable from the operation wire 20.

  The sheath 16 is, for example, a flexible coil sheath in which a metal wire is tightly wound. The inner diameter of the sheath 16 is such that the engagement between the turn portion 24 of the previous clip 12 and the claw portions 22 of the next clip 12 is released. That is, the inner diameter of the sheath 16 is larger than the total length of the lengths of the two claw portions 22 and 22 and the width of the portion of the turn portion 24 where the claw portions 22 and 22 are engaged.

  The proximal ends of the operation wire 20 and the sheath 16 are attached to the operation unit. 5A and 5B are partial cross-sectional views illustrating a schematic configuration of an example of the operation unit, in which FIG. 5A is a plan view and FIG. 5B is a front view. 5A and 5B, the left side is the distal end side connected to the clip treatment instrument 10, and the right side is the rear end side (or the proximal end side). The operation unit 50 includes a wire operation handle 52 and a sheath operation handle 54.

  The wire operation handle 52 includes a cylindrical case 58, a positioning pipe 56 that is fixed to the tip of the case 58 with its axis aligned, and a lever 60 and a spring 62 that are held inside the case 58. .

  The lever 60 is held inside the case 58 so as to be movable in the front-rear direction (the axial direction of the wire operation handle 52). A part of the rear end side of the lever 60 appears in a through window 59 provided in the central portion of the case 58 so that the operator can pull the lever 60 toward the rear end side by placing a finger. A spring 62 is attached to the rear end of the lever 60. The spring 62 is compressed by pulling the lever 60 backward, and when the force pulling the lever 60 is released, the spring 60 pushes the lever 60 forward by the repulsive force. Thereby, the lever 60 returns to the original position (home position).

  The rearward movement limit of the lever 60 is defined by the through window 59. That is, the position at which the surface 60 a on which the finger of the lever 60 is applied coincides with the rear end of the through window 59 is the movement limit of the lever 60. Note that a restriction plate may be provided behind the lever 60, and the rearward limit of the lever 60 may be defined by the rear end of the lever 60 hitting the restriction plate.

  On the other hand, a regulating plate 61 is provided in front of the lever 60 to define the home position of the lever 60. The lever 60 is urged by the spring 62 and moves forward, stops against the restriction plate 61, and returns to the home position. In FIG. 5, the spring 62 is shown as a coil spring, but the spring 62 only needs to be able to urge the lever 60 forward, and a leaf spring or other elastic body may be used.

  An operation wire 20 for pulling the clip 12 is fixed to the tip of the lever 60. The operation wire 20 passes through the sheath operation handle 54 and the positioning pipe 56 and reaches the lever 60.

  When the operator inserts a finger into the penetrating window 59 and pulls the lever 60 so that the lever 60 moves backward, the operation wire 20 attached to the tip of the lever 60 also moves in the same manner, and the tip of the operation wire 20 is moved. Moves backward. When the pulling force of the lever 60 is released and the lever 60 returns to the original position, the operation wire 20 moves in the same manner, and the tip thereof returns to the original position.

  Since the pulling amount of the operation wire 20 in the clip treatment is a very small amount such as 3.1 mm, for example, the pulling amount of the operation wire 20 and the operation amount of the lever 60 are given in order to give a reliable operation feeling in the operation unit 50. Between them, a magnifying mechanism for the pulling amount of the operation wire 20 may be provided.

  The positioning pipe 56 is a hollow pipe-like member through which the operation wire 20 passes. Further, the inner diameter of the positioning pipe 56 is larger than the outer diameter of the sheath 16, and the sheath 16 can be inserted into the positioning pipe 56. As shown in FIG. 5B, the upper surface of the positioning pipe 56 is formed with a plurality of notches 66 that are carved at predetermined intervals in the axial direction. The distal end portion of the positioning pipe 56 is inserted into the sheath operation handle 54, and a retaining ring 64 is attached to the distal end portion.

  As shown in FIG. 5A, a hole that is slightly larger than the outer diameter of the sheath 16 is formed at the center of the retaining ring 64. The retaining ring 64 holds the sheath 16 so as to be movable in the axial direction.

  The sheath operation handle 54 includes a cylindrical case 68, a support block 70, and a sheath holding ring 72. The support block 70 is disposed at the rear end portion of the sheath operation handle 54 and supports the positioning pipe 56 inserted into the sheath operation handle 54. Further, as shown in FIG. 5B, the support block 70 has a surface on the tip side abutting against a retaining ring 64 attached to the tip of the positioning pipe 56, so that the positioning pipe 56 is connected to the sheath operation handle 54. To prevent it from coming off.

  The sheath holding ring 72 is provided at the distal end of the case 68 on the axis line of the sheath operation handle 54 and fixedly holds the outer periphery of the sheath 16 inserted into the sheath operation handle 54. Accordingly, when the sheath operation handle 54 moves, the sheath 16 also moves.

  The sheath operation handle 54 further includes a button 74 protruding outside the case 68 and a claw 76 provided inside the case 68 and interlocking with the movement of the button 74. The claw 76 is urged in a direction to be pressed against the positioning pipe 56 and is hooked on the notch 66 of the positioning pipe 56 to determine the position of the sheath operating handle 54 with respect to the wire operating handle 52 and stop the movement.

  When the button 74 is pressed, the claw 76 is lifted and rides up from the notch 66, and the sheath operation handle 54 can move with respect to the sheath operation handle 54. When the sheath operating handle 54 is moved relative to the wire operating handle 52 by releasing the button 74, the movement is stopped when the claw 76 is caught by the next notch 66. Therefore, the sheath operation handle 54 and the sheath 16 can move in units of length of one stroke, with the notch 66 as one stroke. 5 has six notches 66 formed in the positioning pipe 56, and can be applied to a five-shot clip treatment instrument.

  When the sheath 16 moves with the movement of the sheath operation handle 54, the proximal end of the sheath 16 advances through the hole of the retaining ring 64 and enters the positioning pipe 56.

  Next, the operation of the continuous clip treatment device 10 will be described with reference to FIG. 6 (A) to 6 (E) are partial cross-sectional views showing a stepped state during the clip treatment operation of the clip treatment device 10. FIG.

  First, as shown in FIG. 6A, after the sheath 16 is loaded with four hemostatic clip bodies (hereinafter simply referred to as clip bodies) including clips 12A to 12D and connecting rings 14A to 14D, the sheath 16 Inserted into the forceps channel of the endoscope. For loading the clip body, for example, a clip unit 17 in which four clip bodies (the clip 12 fitted with the connection ring 14) and the dummy clip 13 are prepared in advance, and the dummy clip 13 is attached to the sheath 16 is prepared. It can be performed by attaching to the distal end of the operation wire 20 protruding from the distal end, and then moving the sheath 16 forward relative to the operation wire 20 so that the leading clip 12A is completely accommodated in the sheath 16. . This method will be described in detail later.

  In the illustrated example, the tip of the clip 12A substantially coincides with the tip of the sheath 16 as shown in FIG. The leading clip 12A may be set at a position retracted from the distal end of the sheath 16 by a predetermined amount.

  The leading clip 12 </ b> A is held closed by the inner wall of the sheath 16. Each of the connection rings 14A to 14D is fitted so that the tightening portion 40 comes to an initial position set in the vicinity of the intersecting portion 26 of the clips 12A to 12D. At this time, the upper ends of the protrusions 30 of the clips 12B to 12D are positioned directly below the coupling rings 14A to 14C, respectively.

  When the distal end of the sheath 16 reaches the distal end of the insertion portion of the endoscope inserted into the living body and protrudes from the distal end of the endoscope, the claw 76 of the sheath operation handle 54 is moved in the operation portion 50 shown in FIG. The sheath operating handle 54 is pulled so as to move from the first notch 66 to the second notch 66. Since the sheath 16 is fixed to the sheath operation handle 54, the sheath 16 moves backward by the same amount as the movement amount of the sheath operation handle 54. By this operation, the operation wire 20 does not move, and only the sheath 16 is pulled to the operation unit side.

  When the sheath 16 is pulled by a predetermined amount corresponding to the interval between the first notch 66 and the second notch 66, the distal end of the sheath 16 is lowered to a position where the skirt portion 38 of the leading connecting ring 14 </ b> A is opened. The nail | claw parts 22 and 22 of the clip 12A which protruded spread with the urging | biasing force, and will be in the state of FIG. 6 (B). As a result, the first clip 12A can be used. In FIG. 6B, the skirt portion 38 of the connecting ring 14A is not shown in the figure because it is in the direction perpendicular to the paper surface.

  Since the coupling portion between the clip 12A and the clip 12B is located immediately below the skirt portion 38 of the connecting ring 14A, the tip of the clip 12B substantially coincides with the tip of the sheath 16 in the state of FIG. ing.

  When the sheath 16 is pulled, a frictional force acts between the sheath 16 and the connection rings 14 </ b> A to 14 </ b> D fitted in the sheath 16. However, between the connecting rings 14A to 14D and the clips 12A to 12D, the pressing force of the clip 12 by the inner portion of the closed skirt portion 38 and the spring force to open the claw portion 22 of the rear clip 12 are opened. A pressing force is applied to the inner wall surface of the connecting ring 14 (second region 34, see FIG. 4). Furthermore, the convex part 30 of clip 12B-12D contact | abuts to the base end of connection ring 14A-14C, and cannot enter into the hole 43 (refer FIG. 4) of the connection ring 14. FIG. Therefore, even if the sheath 16 is pulled, the connection rings 14A to 14D do not move unnecessarily. Therefore, the connection rings 14A to 14D can maintain the state of holding the clips 12A to 12D, respectively.

  Next, the clip treatment tool 10 in the state shown in FIG. 6B is moved, and the claw portions 22 and 22 of the expanded clip 12A are pressed against the portion to be clipped, and the lever of the operation unit 50 (see FIG. 5). By pulling 60, the operation wire 20 is pulled by a predetermined amount. By pulling the operation wire 20, all the clips 12 </ b> A to 12 </ b> D that are sequentially engaged from the dummy clip 13 are pulled uniformly.

  At this time, in the state shown in FIGS. 6B and 6C, the skirt portion 38 of the connecting ring 14 </ b> A protruding from the distal end of the sheath 16 is open, and the pressing and holding of the clip 12 </ b> A by the skirt portion 38 is released. . Further, the connecting ring 14 </ b> A is prevented from retreating into the sheath 16 because the skirt portion 38 is opened at the distal end of the sheath 16. Therefore, as shown in FIG. 6C, the leading clip 12A moves backward with respect to the connecting ring 14A. When the tip of the connection ring 14A, that is, the tightening portion 40 is pushed down to just below the convex portion 30 of the clip 12A, the fastening of the clip 12A by the connection ring 14A is completed.

  At the same time, the engaging portion between the clip 12A and the next clip 12B comes out from the rear end of the connecting ring 14A. When the engaging portion of the clip 12A and the clip 12B is disengaged from the connecting ring 14A, the arm portion 28 is expanded by the spring force of the clip 12B until it hits the inner wall of the sheath 16, and the turn portion of the clip 12A is between the claws 22 and 22. Opening wider than 24, the connection between the clip 12A and the clip 12B is released. Thereby, the clip 12A and the connection ring 14A can be detached from the sheath 16, and the clip treatment by the clip 12A and the connection ring 14A is completed.

  On the other hand, the subsequent clips 12B to 12D are held by the connection rings 14B to 14D with the skirt portion 38 closed so as not to move in the rotational direction and the forward / backward direction with respect to the connection rings 14B to 14D. Further, the claws 22 are engaged with the clips 12C to 12D and the claws 22 of the clips 12D and the claws 22 of the dummy clips 13 are caused to spread (biasing force) by the claws 22 in the second regions of the coupling rings 14B to 14D. 34 (see FIG. 4), and the frictional force between the clips 12B to 12D and the connection rings 14B to 14D is increased. Therefore, the connection rings 14B to 14D move with the movement of the clips 12B to 12D.

  That is, the clip 12B to 12D and the connecting rings 14B to 14D other than the leading clip 12A and the connecting ring 14A that holds the clip 12A move forward and backward with respect to the sheath 16, and the clips 12B to 12D and the dummy clip 13 The connected state is maintained by the connection rings 14B to 14D.

  The operation wire 20 is configured so that a certain amount can be pulled from the initial state. The fixed amount is equal to or slightly larger than the region length of the second region 34 of the connecting ring 14 and at the same time holds the clip 12 from the lower end of the convex portion 30 of the clip 12. The amount is equal to or slightly smaller than the length to the tip of the connecting ring 14. This fixed amount is determined by the length from the home position of the lever 60 to the rearward movement limit in the operation unit 50 of FIG.

  The operation wire 20 is pulled back by a certain amount by a spring 62 that biases the lever 60 of the operation unit 50, and then immediately returns by the certain amount. When the operation wire 20 pulled from the state of FIG. 6B to the state of FIG. 6C releases the pulling force of the lever 60 in the operation unit 50, the lever 60 returns to the original position, thereby the operation wire. 20 returns to the original position, and the state shown in FIG. That is, the distal end of the second clip 12B returns to a position that substantially coincides with the distal end of the sheath 16 as in the case of FIG.

  Next, in order to make the second clip 12B usable, the sheath 16 is pulled for a predetermined stroke. In the operation unit 50 of FIG. 5A, the sheath operation handle 54 is moved from the second notch 66 to the third notch 66. As a result, the distal end of the sheath 16 is lowered to a position where the skirt portion 38 of the next connecting ring 14B is opened, and the claws 22 and 22 of the clip 12B protruding from the sheath 16 are expanded to be in the state of FIG. .

  The length of one stroke for pulling the sheath 16 is approximately equal to the distance between the tips of the two front and rear clips 12 loaded on the sheath 16. The length of one stroke for pulling the sheath 16 is determined by the length between the notches 66 of the operation unit 50.

  After that, as in the case of the above-described clip 12A, the claw portion of the clip 12B is pressed against the portion to be clipped, and the operation wire 20 is pulled by a predetermined amount. Thereby, the fastening of the clip 12B by the connecting ring 14B is completed, and at the same time, the connection between the clip 12B and the clip 12C is released, and the clip treatment by the clip 12B is completed.

  As described above, in the clip treatment device 10 of the present invention, the connection portion of the clip 12 is covered and held by the connection ring 14, so that the connection state of the plurality of clips 12 is reliably maintained. Then, the operation clip 20 pulls the dummy clip 13 and the plurality of clips 12 connected to the dummy clip 13 in one direction by a predetermined length, whereby the leading clip 12 is tightened by the tightening portion 40 of the connecting ring 14 and the next clip. The clip can be clipped by the leading clip 12 at the same time, and further, the next clip 12 can be used by pulling the sheath 16 toward the operation portion by a predetermined length. The clip treatment can be performed subsequently.

  Further, since the connecting portion of the clip 12 is covered with the connecting ring 14, there is no fear of damaging the inner wall of the sheath 16 at the corner portion of the connecting portion of the clip 12 at the time of a clip treatment operation or the like, and the sheath 16 is used as an endoscope. The possibility of twisting and distortion of the clip 12 at the connecting portion is extremely small even when the connector is inserted.

  Next, the connection clip package of the present invention will be described. The connection clip package of the present invention is a package in which the connection clip unit 17 used in the continuous clip treatment device 10 as described above is housed in a case.

  FIGS. 7A to 7C are views showing a first embodiment of the connection clip package of the present invention. 2A is a front view, FIG. 2B is a cross-sectional view, and FIG. 2C is a cross-sectional view of a surface orthogonal to the axis of the case. Hereinafter, the left side in FIGS. 7A and 7B is referred to as the front end, and the right side is referred to as the rear end. In the description of the clip treatment tool 10 described above, the example in which the four clip bodies are connected has been described. Here, an example in which the five clip bodies are connected will be described.

  As shown in FIG. 7A, the connection clip package 80 includes a case 82, an upper cap 84, and a lower cap 86. The case 82 has a cylindrical shape, and accommodates a connection clip unit 17 including a plurality of clips 12, a connection ring 14, and a dummy clip 13 therein. As shown in FIGS. 7A and 7C, the case 82 is configured by combining two case parts 82a and 82b having a semi-cylindrical shape and substantially the same shape. An upper cap 84 is fitted to the front ends of the two case components 82a and 82b, and a lower cap 86 is fitted to the rear ends, thereby keeping the case 82 closed.

  The case 82 is preferably transparent or translucent so that the inside can be seen. Moreover, it is preferable to form with resin which does not change in the fluctuation | variation range (for example, 5 to 38 degreeC) of ambient temperature from impact resistance, ease of handling, and easy shaping | molding. In the present embodiment, the case 82 is cylindrical, but the outer shape of the case 82 is not limited to a columnar shape, and may be a prism.

  The connection clip package 80 needs to keep the case 82 hermetically sealed in order to store medical clips. Therefore, the case 82 covers the outer surfaces of the case components 82a and 82b with a cover 88 made of a transparent resin, and ensures the sealing inside the case 82. Alternatively, in the case 82, the case parts 82a and 82b are made of an elastic material, and the case parts 82a and 82b are held by the upper cap 84 and the lower cap 86 in a state where they are pressed on the mating surfaces, so as to ensure sealing performance. It may be. Further, a seal may be secured by providing a packing between the case parts 82a and 82b.

  The upper cap 84 and the lower cap 86 only need to seal the case parts 82a and 82b in a sealed state, and can be made of rubber or resin. The lower cap 86 is removable. When the clip body in the case 82 is loaded into the sheath, the lower cap 86 is removed, and the internal connection clip unit 17 is pulled out while being connected. The top cap 84 may or may not be removable. Moreover, it is good also as a form which comprises a front-end | tip part with the case 82 and does not provide the upper cap 84. FIG.

  As shown in FIG. 7B, the case 82 is formed with a connection clip accommodating portion 83 having an inner diameter substantially equal to the outer diameter of the sheath 16 so as to penetrate the entire case 82. The connection clip accommodating portion 83 accommodates a connection clip unit 17 including five clips 12A to 12E and a dummy clip 13 and five connection rings 14A to 14E covering the connection portion. The connection member 19 of the dummy clip 13 is held by the lower cap 86.

  FIG. 8 is a partially enlarged view of FIG. As shown in FIG. 8, the connection clip storage portion 83 is provided with a skirt storage portion 90 that is recessed corresponding to the shape of the skirt portion 38 at a position where the connection rings 14 </ b> A to 14 </ b> E are stored. The skirt accommodating portion 90 is substantially the same angle as the inclination of the skirt portion 38 in the natural state, substantially coincides with the spread of the skirt portion 38, and extends radially outward to the first oblique portion 92 and the first oblique portion 92. It is formed by the second slanted portion 94 that narrows in the radial direction from the widened end portion (rear end).

  As described above, the clips 12A to 12E are connected to each other by changing the direction by 90 degrees, and correspondingly, the connecting rings 14A to 14E also change the direction from the front and rear connecting rings 14 by 90 degrees to the clips 12A to 12E. It is fitted. Therefore, the position of the skirt accommodating portion 90 in the case 82 is also shifted by 90 degrees in the circumferential direction at the positions corresponding to the connection rings 14A to 14E. In FIG. 7 (B), the skirt accommodating portions 90 corresponding to the skirt portions 38 of the connecting rings 14A, 14C, and 14E are shown in two upper and lower portions. Skirt accommodating portions 90 corresponding to the skirt portions 38 of the coupling rings 14B and 14D are formed at two locations in a direction perpendicular to the paper surface of FIG. Note that the skirt accommodating portion 90 may be formed over the entire circumference at a position corresponding to the skirt portion 38 in the front-rear direction (left-right direction in the drawing).

  Due to the first inclined portion 92 of the skirt accommodating portion 90, the coupling rings 14A to 14E are accommodated in the case 82 in a state where the skirt portion 38 is expanded without receiving external force. Therefore, the elasticity of the skirt portion 38 can be prevented from deteriorating while being stored in the case 82, and the performance of the coupling rings 14A to 14E can be maintained.

  Further, since the skirt accommodating portion 90 has substantially the same shape as the skirt portion 38, the connecting clip unit 17 can be positioned in the connecting clip accommodating portion 83 having an inner diameter larger than the outer diameter of the connecting ring 14.

  The clip body is stored in the case 82 as follows. First, the clips 12A to 12E are connected in order. The clips 12A to 12E are connected by turning the second region 34 of the connection ring 14 fitted to the clip 12 from the slit 44, and engaging the claw portion 22 of the next clip 12 with the turn portion 24 of the clip 12. This is done by setting the joint at a predetermined position of the connecting ring 14. The dummy clip 13 is connected to the last clip 12E by the same method. Thereby, the connection clip unit 17 is completed.

  The connecting clip unit 17 is housed in one case component 82 a of the case 82. Thereafter, the other case component 82b is put on the case component 82a. The outer periphery of the case parts 82a and 82b is covered with the cover 88, and the case 2 is completed. The connection clip package 80 is obtained by fitting the upper cap 84 and the lower cap 86 to both ends of the case 82.

  Next, a method for loading the connection clip unit 17 from the connection clip package 80 to the sheath 16 will be described with reference to FIGS. First, as shown in FIG. 9A, the lower cap 86 of the connection clip package 80 is removed, and the operation wire 20 and the sheath 16 protruding from the distal end of the sheath 16 are inserted into the connection clip housing portion 83 to operate. The wire 20 and the connection member 19 of the dummy clip 13 are connected.

  The operation wire 20 can be protruded from the sheath 16 by the operation of the operation unit 50 of FIG. That is, after all the clips 12 are used in the clip treatment instrument 10 of FIG. 1, the sheath operation handle 54 of the operation unit 50 of FIG. 5 has moved to the wire operation handle 52 side. For example, the claw 76 of the sheath operation handle 54 is hooked on the rearmost notch 66. In this state, there is a predetermined interval between the wire operation handle 52 and the sheath operation handle 54, and the sheath 16 is pulled with respect to the operation wire 20 by pulling the sheath operation handle 54 by that distance. Thus, the operation wire 20 can be protruded from the distal end of the sheath 16. The positioning pipe 56 may be provided with a notch corresponding to a position where the operation wire 20 protrudes.

  The dummy clip 13 that has been engaged with the tail end of the clip 12 that has already been used is removed in advance with the operation wire 20 protruding from the sheath 16.

  The connection member 19 of the dummy clip 13 and the distal end of the operation wire 20 are detachable and are configured not to be detached by the forward / backward movement of the operation wire 20. For example, the connection member 19 has a connection ring, and a hook-like member is attached to the operation wire 20. The hook-like member of the operation wire 20 is hooked on the connection ring of the connection member 19, and the dummy clip 13 The operation wire 20 is connected.

  When the operation wire 20 is connected to the dummy clip 13, as shown in FIG. 9B, the sheath 16 and the operation wire 20 are moved to the distal end side by a predetermined amount in the connection clip housing portion 83. When the dummy clip 13 is pushed by the operation wire 20, the connecting clip unit 17 moves to the distal end side in the connecting clip housing portion 83. At this time, since the skirt portion 38 of the connection ring 14 is closed by the connection clip accommodating portion 83, the positions of the clip 12 and the connection ring 14 are not shifted.

  The predetermined amount by which the sheath 16 and the operation wire 20 are moved to the distal end side in the connection clip housing portion 83 is an amount by which the skirt portion 38 is pulled out from the skirt housing portion 90 and moved into the connection clip housing portion 83. It is. For example, an index indicating a predetermined amount of movement may be provided on the outer peripheral surface of the sheath 16 so that the amount of movement between the sheath 16 and the operation wire 20 becomes clear.

  As shown in FIG. 10, the skirt portion 38 moved from the skirt accommodating portion 90 to the connecting clip accommodating portion 83 is pushed and closed by the connecting clip accommodating portion 83 narrower than the skirt accommodating portion 90. However, since the inner diameter of the connection clip accommodating portion 83 is approximately the same as the outer diameter of the sheath 16, the skirt portion 38 is not completely closed, and the inclined portion 38 a protrudes from the outer peripheral surface of the connection ring 14. Become.

  Thereafter, as shown in FIG. 9C, the sheath 16 is inserted to the tip of the connection clip housing portion 83. For example, the sheath 16 is inserted into the operation wire 20 by the operator holding the case 82 and moving the sheath operation handle 54 of the operation unit 50 (see FIG. 4) forward with respect to the wire operation handle 52. The sheath 16 can be inserted to the tip of the connection clip accommodating portion 83 by being advanced.

  The sheath 16 inserted into the connection clip housing portion 83 loads the connection clip unit 17 into the inner diameter in the order of the dummy clip 13 and the connection ring 14E. The skirt portion 38 is closed in the connecting ring 14 when the inclined portion 38a is pushed from the rear end side by the distal end portion of the sheath 16, and is thus loaded in the sheath 16 without resistance.

  The connection walls 14A to 14E are pressed by the urging force that the inner wall of the second region 34 (see FIG. 4) on the rear end side is about to spread the rear clip 12B to 12E and the claw portion 22 of the dummy clip 13. ing. Therefore, in the case 82, the connection state of the clips and the positional relationship between the clips 12A to 12E and the connection rings 14A to 14E are maintained.

  Furthermore, since the skirt portion 38 is closed when the sheath 16 is loaded, the clips 12A to 12E inside the coupling rings 14A to 14E are pressed by the inner portion of the skirt portion 38, and the coupling rings 14A to 14E are clipped 12A. The connected state of ˜12E and the dummy clip 13 is maintained. Therefore, it is possible to prevent the clips 12A to 12E and the dummy clip 13 from being disconnected or the positional relationship with the connection rings 14A to 14E from being shifted when the sheath 16 is loaded.

  When the distal end of the sheath 16 moves to the distal end of the connection clip housing portion 83, the loading of the connection clip unit 17 to the sheath 16 is completed. When the loading is completed, the operation unit 50 (see FIG. 5) is in a state where the sheath operation handle 54 moves to the distal end side and the claw 76 is hooked on the first notch 66. As shown in FIG. 9D, the sheath 16 loaded with the connecting clip unit 17 is removed from the case 82.

  As described above, the connected clip package 80 can be distributed and stored in a state where the clip 12 is connected, and can be loaded into the sheath 16 by a simple operation while maintaining the connected state. Therefore, the work burden on the operator is small, and the clip can be easily loaded in a short time.

  Further, since the connection clip package 80 can be stored with the skirt portion 38 of the connection ring 14 open, it is possible to prevent the elasticity of the skirt portion 38 from being damaged, and the clip 12 can be used when the clip 12 is used (during clip treatment). And the connection ring 14 can exhibit sufficient performance. Furthermore, the linking clip package 80 can be easily loaded because the skirt 38 opened inside can be closed before loading the sheath 16. In addition, since the inclined portion 38 a is provided at the free end of the skirt portion 38, it is possible to prevent the skirt portion 38 from being caught on the distal end of the sheath 16.

  In the above embodiment, the connecting clip unit 17 is moved to the front end side in the connecting clip housing portion 83 in order to close the skirt portion 38, but may be moved to the rear end side. Since the skirt portion 38 can be closed by the inclined portion 38 a, no positional deviation occurs between the clip 12 and the connecting ring 14.

  In addition, the sheath 16 is moved forward relative to the operation wire 20 and the connection clip unit 17 is loaded on the sheath 16. However, without moving the sheath 16, the operation wire 20 is pulled to move the connection clip unit 17. It may be retracted into the sheath 16. Also at this time, the skirt portion 38 can be closed by the inclined portion 38 a, so that no positional deviation occurs between the clip 12 and the connecting ring 14.

  Further, the connecting clip unit 17 is moved by the operation wire 20 and the skirt portion 38 is closed. However, a certain traction member is engaged with the leading clip 12A, and the skirt portion 38 is closed by pulling the traction member. Also good.

  In each of the above examples, the clip 12 is connected by changing the direction by 90 degrees, but the present invention is not limited to this. For example, a clip having a shape twisted by 90 degrees at a portion between the claw portions 22 and 22 and the turn portion 24 may be used, and continuous clips may be connected in the same direction.

  In addition, the use of a closed clip having a turn part is preferable in that a spring force (biasing force) that presses the turn part and expands to the arm part can be applied, but the present invention has a turn part. The present invention can also be applied to those using no open clip (U-shaped clip).

  The connection clip package and the connection clip loading method according to the present invention have been described in detail above, but the present invention is not limited to the above-described embodiments, and various improvements and modifications can be made without departing from the spirit of the present invention. Of course. Moreover, the repetitive clip treatment tool using the connection clip package and the connection clip loading method of the present invention can be used for a rigid endoscope as well as a flexible endoscope.

It is a fragmentary sectional view showing an example of a repetitive clip treatment instrument. It is an enlarged view of the front end side of the repetitive clip treatment instrument shown in FIG. It is a perspective view of a clip. It is the side view, sectional drawing, and bottom view which show an example of a connection ring. It is a fragmentary sectional view which shows schematic structure of an operation part. It is a fragmentary sectional view which shows the stepped state in the clip treatment operation of a repetitive clip treatment tool. It is the front view and sectional drawing of the connection clip package of this invention. It is the elements on larger scale of FIG.7 (B). It is a fragmentary sectional view which shows the stepped state in loading operation of the connection clip unit from a connection clip package to a sheath. It is the elements on larger scale of FIG.9 (C).

Explanation of symbols

DESCRIPTION OF SYMBOLS 10 Clip treatment tool 12 Clip 13 Dummy clip 14 Connection ring 16 Sheath 17 Connection clip unit 19 Connection member 20 Operation wire 38 Skirt part 38a Inclination part 42 Holding part 80 Clip package 82 Case 83 Connection clip accommodation part 90 Skirt accommodation part

Claims (5)

Covering the engaging portion between the first clip used in the repetitive clip treatment instrument and the second clip that is arranged behind the first clip and engages with the first clip, the first clip and the second clip A holding part for maintaining a connected state with the clip;
A skirt portion provided on the outer peripheral surface of the holding portion, extending in a radial direction from the front end side toward the rear end side, and closed when pressed from the outside in the radial direction;
A connecting ring comprising: an inclined portion that is provided at a free end of the skirt portion and closes the skirt portion when pushed from the rear end side.   The connection ring according to claim 1, wherein the skirt portion protrudes into the holding portion when closed and presses and holds at least one of the first clip or the second clip.   The connection ring according to claim 1, wherein a plurality of the skirt portions are provided in a circumferential direction of the holding portion. The plurality of clips that engage with the front and rear clips and line up in a row, the plurality of connection rings according to any one of claims 1 to 3, wherein the connection state of the clips is maintained by covering the engagement portions of the clips, and finally A connecting clip unit having a dummy clip that engages with the clip disposed on the tail;
A coupling clip housing portion that houses the coupling clip unit and has an inner diameter into which a cylindrical sheath into which the coupling clip unit is loaded can be inserted, and a skirt housing portion that houses the skirt portion in a radially expanded state. A connected clip package comprising: a case having: A clip loading method for loading the connection clip unit from the connection clip package according to claim 4 to the sheath,
A connection step of connecting a tip of an operation wire accommodated in the sheath so as to be retractable to the dummy clip;
A skirt closing step of closing the skirt portion by moving the connection clip unit to the front end side or the rear end side in the connection clip storage portion by the operation wire, and bringing the skirt portion into contact with the connection clip storage portion;
A sheath insertion step of inserting the sheath into the connecting clip housing portion and loading the connecting clip unit into the sheath while closing the skirt portion by pushing the inclined portion at the distal end of the sheath;
A clip loading method comprising: a pulling step of pulling out the sheath loaded with the connecting clip unit from the case.

Images