JP2018061671A - Indwelling clip - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an indwelling clip capable of facilitating treatment such as hemostasis. SOLUTION: An indwelling clip is a connection connecting a pair of arm plate portions 21 arranged so as to open a mutual distance toward a tip portion without an external force acting on the base end portion of the arm plate portion 21. The plate portion 22, the tightening ring 24 slidably attached from the connecting plate portion 22 to the arm plate portion, and the side portion intersecting the plate surface of the arm plate portion 21, and the extending direction of the arm plate portion 21. It has a gripping claw portion 23 provided so as to project from a side portion along the above. [Selection diagram] Fig. 1

Description

  The present invention relates to an indwelling clip that is used in, for example, a treatment using an endoscope and is indwelled in a body while grasping a body tissue.

  An indwelling clip used for treatment such as hemostasis of a bleeding part of a body tissue or stitching of a defective part is attached to the distal end of a catheter tube passed through a treatment instrument guide tube of an endoscope, for example, and should be treated. Guided to internal tissues. Thereafter, by an operation from an operation portion provided at the proximal end of the catheter tube, the indwelling clip is removed from the catheter tube while being held in the body tissue (mucosa) and is placed in the body.

  As such an indwelling clip, for example, as shown in Patent Document 1 and Patent Document 2 below, by moving (sliding) the tightening ring, the pair of arm plate portions are brought close to each other, and the arm plate portion One that grasps a body tissue at the tip or the vicinity thereof is known.

  In the indwelling clip described in the cited document 1, in addition to the claw portion provided at the tip of the arm plate portion, the inward projection by the punching process is provided in the vicinity of the tip portion to prevent dropping after gripping. Like to do. In addition, in the indwelling clip described in Patent Document 2, in addition to the claw portion provided at the tip of the arm plate portion, a protrusion having a sharp tip is provided in the vicinity of the tip portion, thereby ensuring a reliable grip. Realized.

  By the way, when such an indwelling clip is used for hemostasis of the body lumen wall, the distal end of the clip device is viewed from the forceps opening at the distal end of the endoscope while looking at the monitor screen. The clip attached to is protruded, and the hemostatic part (bleeding part) is gripped (gripped) by the tip part of the clip. However, in the prior art, basically, the tissue in the body is gripped by the nail portion provided at the tip of the arm plate portion, so that the distal end portion to which the clip of the catheter tube (clip device) is attached is connected to the hemostasis portion. It is necessary to adjust the posture so as to be as perpendicular as possible to the (luminal wall surface).

  However, since such posture adjustment is performed by bending the distal end portion of the endoscope, depending on the position of the hemostasis portion, it may be necessary to greatly curve the distal end portion of the endoscope. Yes, the operation was not always easy. In particular, for example, since the large intestine has a narrow diameter of about 5 cm, it is often difficult to accurately perform an operation of greatly bending the distal end portion of the endoscope.

JP 2002-360589 A Japanese Patent Laying-Open No. 2015-8858

  This invention is made | formed in view of such a point, and it aims at providing the clip for indwelling which can aim at easy treatment, such as hemostasis.

The indwelling clip according to the present invention is
A pair of arm plate portions arranged so that the distance between them becomes wider toward the tip in a state where no external force is applied;
A connecting plate portion for connecting the base end portion of the arm plate portion;
A clamping ring that is slidably attached along the arm plate portion from the connecting plate portion, and that closes the tip ends of the pair of arm plate portions close to each other by sliding to the tip end side of the arm plate portion. ,
The arm plate portions are provided so as to correspond to the respective distal end portions, and are side portions intersecting the plate surface of the arm plate portion, and project from side portions along the extending direction of the arm plate portion. And a gripping claw portion provided on the head.

  The indwelling clip of the present invention has a gripping claw portion provided so as to protrude from a side portion along the extending direction of the arm plate portion. Therefore, even when the gripping claw portion of the clip is arranged substantially parallel or obliquely parallel to the body tissue (lumen wall surface), the body tissue can be gripped by the gripping claw portion. There is less need to bend the distal end greatly. Therefore, for example, even when hemostasis is performed on a lumen wall having a relatively small inner diameter such as the duodenum, this can be easily performed, and the difficulty of the procedure can be reduced.

  The tip part of one gripping claw part and the tip part of the other gripping claw part of the arm plate part may have a shape facing each other.

It is a perspective view which shows schematic structure in the open leg-shaped body of the indwelling clip of embodiment of this invention. It is a perspective view which shows schematic structure in the closed leg state of the indwelling clip shown in FIG. It is a top view which shows the structure of the clip for indwelling shown in FIG. It is a side view which shows the structure of the indwelling clip shown in FIG. It is sectional drawing along the VV line of FIG. It is a top view which shows the external appearance of the treatment tool for endoscopes of embodiment of this invention. It is sectional drawing along the VII-VII line of FIG. It is a figure which shows an example of the treatment using the indwelling clip shown in FIG. It is a figure which shows the state which hold | gripped the body tissue with the indwelling clip shown in FIG. It is a side view of the clip for indwelling of other embodiments of the present invention. It is sectional drawing along the XI-XI line of FIG.

  Embodiments of the present invention will be specifically described below with reference to the drawings. As shown in FIGS. 1 to 5, the indwelling clip 2 according to this embodiment includes a pair of arm plate portions 21 and 21 and a connection for connecting the base end portions of these arm plate portions 21 and 21 to each other. The plate portion 22, the gripping claw portions 23 and 23 provided in the vicinity of the distal end portions of the arm plate portions 21 and 21, and a tightening ring 24 that closes the arm plate portions 21 and 21, respectively.

  The arm plate portions 21 and 21 are arranged so that the distance between them opens (opens) toward the front end portions of the arm plate portions 21 and 21 without any external force, and the plate surfaces (inner surfaces) face each other. Is arranged. The connecting plate portion 22 has a shape that is bent into a substantially U shape, and the arm plate portions 21 and 21 are integrally and continuously connected to the U-shaped ends of the connecting plate portion 22. Is provided.

  The gripping claws 23 and 23 are provided so as to correspond to the vicinity of the respective distal end portions of the arm plate portions 21 and 21. The gripping claws 23, 23 are side portions intersecting (substantially orthogonal to) the plate surface of the arm plate portion 21, and one of both side portions along the extending direction of the arm plate portion 21 (in FIG. 4). It is integrally formed so as to protrude from the lower side. The gripping claws 23 and 23 are formed in a comb-like shape by intermittently arranging a plurality of protrusions. The number of protrusions constituting the gripping claw portion 23 is six in the present embodiment, but may be five or less or seven or more.

  Moreover, in this embodiment, each protrusion part which comprises the grip claw part 23 of one arm plate part 21, and each projection part which comprises the grip claw part 23 of the other arm plate part 21, respectively correspond to each other. Are arranged as follows. However, these do not necessarily correspond completely, and each protrusion constituting the gripping claw 23 of one arm plate 21 and each protrusion constituting the gripping claw 23 of the other arm plate 21. The intermittent portions between the portions may be arranged so as to correspond to each other, that is, alternately.

  Further, in the present embodiment, the tip end portion of each projection portion constituting the grip claw portion 23 of one arm plate portion 21 and the tip end portion of each projection portion constituting the grip claw portion 23 of the other arm plate portion 21 are defined. They are curved in a rounded direction toward each other (see FIGS. 3 and 5). However, the tip of each protrusion constituting the gripping claw 23 of one arm plate 21 and the tip of each protrusion constituting the gripping claw 23 of the other arm plate 21 are directed inward. And it is good also as a bending shape bent in the shape of a square. The tips of these protrusions may have a shape that combines rounded curvature and angular bending.

  The pair of arm plate portions 21 and 21, the connecting plate portion 22, and the pair of gripping claw portions 23 and 23 that constitute the indwelling clip 2 are obtained by punching a single plate material with a press and bending it. Thus, the respective parts are formed integrally with each other. Although the plate | board thickness of the board | plate material which comprises the clip 2 for indwelling is not specifically limited, Preferably it is 0.15-0.17mm, The board width (W1) shown in FIG. 4 becomes like this. Preferably it is 1.0-2.0mm. It is. As the plate material, a plate material having elasticity is used, for example, stainless steel is used.

  As shown in FIGS. 3 and 4, the arm plate portion 21 has a ring locking portion 21 a at a portion slightly closer to the base end portion (portion on the connecting plate portion 22 side) than the gripping claw portion 23. doing. The plate width of the ring locking portion 21a is formed to be slightly wider than the plate width on the base end portion side, and this plate width is the ring locking portion 21a when the fastening ring 24 is slid. It is set in relation to the inner diameter of the fastening ring 24 so as to ride on and be locked.

  In addition, the connecting plate portion 22 has a ring locking portion 22a at a portion closer to the arm plate portion 21 than the base end thereof. The plate width of the ring locking portion 22a is formed slightly wider than the plate width on the arm plate portion 21 side, and the plate width of the fastening ring 24 is closer to the base end side than the ring locking portion 22a. It is set in relation to the inner diameter of the tightening ring 24 so as not to slide.

  In the present embodiment, the tightening ring 24 is composed of a substantially cylindrical ring member, but may be composed of a spring formed by winding a wire in a coil shape.

  The tightening ring 24 is inserted into a guide hole inside thereof, and a portion of the connecting plate portion 22 that is set substantially in parallel is inserted, and an axial direction is formed between the outer periphery of the connecting plate portion 22 and the outer periphery of the arm plate portions 21 and 21. Is attached (externally fitted) so as to be movable (slidable). When the tightening ring 24 is slid from the connecting plate portion 22 to the outer periphery of the base end portion of the arm plate portion 21, the base ends of the pair of arm plate portions 21 and 21 inside the tightening ring 24 (guide holes). The arm plate portions 21 and 21 are closed, that is, the arm plate portions 21 and 21 and the gripping claw portions 23 and 23 are brought close to each other.

  As shown in FIG. 1 or FIG. 3, the arm plate portions 21 and 21 are opened (opened) by their own elasticity when the clamping ring 24 is disposed rearward (the connecting plate portion 22). It is in a state. If necessary, as shown in FIG. 2, the arm plates 21 and 21 are gradually closed by moving (sliding) the tightening ring 24 to a position closer to the tip. By moving to the ring locking portions 21a and 21a, the arm plate portions 21 and 21 can be closed (legged).

  The height (the height from the side portion of the arm plate portion 21) W2 (see FIG. 4) of each protrusion constituting the gripping claw portion 23 is the width of the arm plate portion 21 (the portion other than the ring locking portion 21a). The plate width) is preferably 0.2 to 1.0 times W1, more preferably 0.4 to 0.6 times W1. The maximum dimension (height) of the protruding portion is set to a size that can be accommodated without any problem in the distal end portion of the outer sheath 14 of the clip device 1 to be described later, in relation to the plate width of the arm plate portion 21. The

  In the present embodiment, the heights of the projecting portions constituting the gripping claw portion 23 are set to be substantially the same, but some or all of the heights may be different. In this case, the height of each protrusion may be set so as to increase or decrease stepwise from the base end side toward the tip end side. In addition, the height of each projection may be such that the base end side and the tip end side are low and the central portion (middle) is high.

  The indwelling clip 2 as described above is mounted and stored at the distal end portion of the endoscope treatment tool (clip device), and the sheath of the clip device is placed in the endoscope treatment tool guide tube (lumen). Insert and lead to the body tissue to be treated. Here, an example of the clip device will be described with reference to FIGS.

  The clip device 1 includes a connection hook 11, an inner sheath (inner tube) 12, a drive wire 13, an outer sheath (outer tube) 14, a reinforcing coil 15, a slider 16, a base portion 17, and an operation portion 18. Has been.

  Similarly, a tubular inner sheath 12 is inserted through the tubular outer sheath 14, and a drive wire 13 is inserted through the inner sheath 12. The inner sheath 12 is slidable within the outer sheath 14, and the drive wire 13 is slidable within the inner sheath 12.

  The outer sheath 14 is made of a flexible hollow tube, and a coil tube is used in this embodiment. As the coil tube, a flat wire coil tube formed by spirally winding a long flat plate made of metal (stainless steel) or the like can be used. However, a round wire coil tube or an inner flat coil tube may be used.

  The inner sheath 12 is made of a flexible hollow tube, and a wire tube is used in this embodiment. The wire tube is a tube made of a hollow stranded wire that is formed by spirally twisting a plurality of wires (cables) made of, for example, metal (stainless steel). In addition, as the inner sheath 12, a wire tube may be mainly used, and only a part on the tip side may be a coil tube.

  The drive wire 13 is made of a flexible wire, and a wire rope is used in this embodiment. The wire rope is a rope made of a stranded wire formed by twisting a plurality of wires (cables) made of metal (stainless steel) or the like, for example. However, a wire tube similar to the inner sheath 12 may be used as the drive wire 13. A single wire may be used as the drive wire 13.

  Such a coil tube or wire tube is used as the outer sheath 14 or the inner sheath 12 because, when the clip device 1 is ultrasonically cleaned using a cleaning liquid, the cleaning liquid is sufficient on the inner side through the gap between the tubes. This is to allow the inside and outside to be cleaned well by penetrating into the water. Further, as the material of such a coil tube or wire tube, it is preferable to use a metal because high temperature and high pressure autoclave sterilization may be repeatedly performed.

  In addition, it is preferable to use the opposite direction for the winding direction of the outer sheath 14 and the winding direction of the inner sheath 12 from the viewpoint of reducing the sliding resistance generated between them. For example, when the outer sheath 14 is Z-winding, the inner sheath 12 is S-winding. When a wire rope or wire tube made of a stranded wire is used for the drive wire 13, it is also preferable that the winding direction is opposite to the winding direction of the inner sheath 22.

  The connecting hook 11 disposed at the distal end of the sheath of the clip device 1 has a pair of arm portions 11a, 11a made of an elastic body disposed so that the mutual distance increases toward the distal end. As a result of this cooperation, two states, an open leg (open) state and a closed leg (closed) state, can be taken. A claw portion is formed at the distal end portion of the arm portions 11a, 11a of the connecting hook 11 by being bent inward (towards each other), and can be connected by gripping the connecting plate portion 22 of the clip 2 described above. It is like that. Although not specifically limited, the plate | board thickness of the board | plate material which comprises the connection hook 11 is about 0.20-0.25 mm, and a width | variety is about 0.55-0.65 mm. As the plate material, for example, stainless steel is used.

  The vicinity of the proximal end (proximal end) side of the outer sheath 14 is inserted into the reinforcing coil 15 and fixed integrally to the reinforcing coil 15. The reinforcing coil 15 is integrally fixed to the slider 16, and a portion on the distal end side of the base portion 17 is inserted inside the slider 16. The slider 16 can be slidably positioned relative to the base portion 17 between a position moved toward the distal end (distal end) and two positions moved toward the proximal end (proximal end). It has become.

  An operating portion 18 is slidably held on the base portion 17, and the proximal end of the inner sheath 12 is fixed to the base portion 17. The proximal end of the drive wire 13 is fixed to the operation unit 18.

  Next, a method for using the clip device 1 will be described. First, the slider 16 is slid to a position on the proximal end side with respect to the base portion 17 so that the distal end of the inner sheath 12 protrudes from the distal end of the outer sheath 14. Further, the base portion 17 is slid toward the proximal end side with respect to the operation portion 18, the inner sheath 12 is drawn into the drive wire 13, and the connecting hook 11 at the distal end of the drive wire 13 is moved away from the inner sheath 12. It protrudes from the end and is opened by its own elasticity.

  When the base portion 17 is slid to the distal end side with respect to the operating portion 18 from this state, the inner sheath 12 is pushed out with respect to the drive wire 13 and the connecting hook 11 at the distal end of the drive wire 13 is moved to the inner sheath. 12 and gradually close the legs. Then, the clip 2 is positioned at the distal end portion of the inner sheath 12 by positioning the clip plate 22 of the clip 2 so that the link hook 11 grips it, burying it in the inner sheath 12 and completely closing the leg. Can be linked.

  Next, the slider 16 is slid to the position on the distal end side with respect to the base portion 17, and the distal end of the inner sheath 12 to which the clip 2 is connected is housed (embedded) in the outer sheath 14 together with the clip 2. Let In this state, the fastening ring 24 of the clip 2 remains positioned on the connecting plate portion 22, and the arm plate portion 21 is closed by the inner wall of the outer sheath 14.

  Next, with reference to FIG. 8, a procedure for stopping hemorrhage of a bleeding part to be treated in a body tissue using the clip device 1 to which the clip 2 is connected will be described. Please refer to FIG. 6 and FIG. 7 as appropriate.

  The distal end portion of the sheaths 12 and 14 of the clip device 1 in which the clip 2 is connected and accommodated via the forceps port 31 of the treatment instrument guide tube of the endoscope 3 is subjected to treatment such as hemostasis. Is positioned in the vicinity of the part (hemostatic part) 4a to be grasped. Thereafter, the slider 16 is slid toward the proximal end side with respect to the base portion 17, that is, the outer sheath 14 is slid toward the proximal end side, thereby causing the clip 2 to protrude from the distal end of the outer sheath 14. As a result, the arm plate portion 21 of the clip 2 is in a state of being opened by its own elasticity. FIG. 8 shows this state. In FIG. 8, 32 is a camera, and 33 is an illumination lens.

  Next, the gripping claws 23 and 23 of the opened clip 2 are brought close to the lumen wall surface (in-vivo tissue 4) where the hemostatic portion 4a is present in a state where the sheaths 12 and 14 are substantially parallel or nearly parallel. Thus, the gripping claw portion 23 of one arm plate portion 21 and the gripping claw portion 23 of the other arm plate portion 21 are arranged with the hemostatic portion 4a interposed therebetween.

  In this state, the base portion 17 is slid to the distal end side with respect to the operation portion 18, that is, the inner sheath 12 is slid to the distal end side with respect to the drive wire 13, so that the distal end of the inner sheath 12 As a result, the clamping ring 24 slides toward the distal end side of the arm plate portion 21. As a result, the arm plate portion 21 is gradually closed (approached to each other), and the hemostatic portion 4a is sandwiched between the grip claw portion 23 of one arm plate portion 21 and the grip claw portion 23 of the other arm plate portion 21. The mucous membrane on the other side and the mucous membrane on the other side are drawn together.

  The base portion 17 is further slid toward the distal end side with respect to the operation portion 18, that is, the inner sheath 12 is further slid toward the distal end side with respect to the drive wire 13, whereby the fastening ring 24 is moved to the arm plate portion 21. By moving to the ring locking part 21a, the grasping of the body tissue 4 by the clip 2 is completed. In this state, the base portion 17 is slid toward the proximal end side with respect to the operation portion 18, that is, the inner sheath 12 is slid toward the proximal end side with respect to the drive wire 13. The clip 2 is pushed out from the distal end to open, and the clip 2 is released from the engagement (engagement) by the connecting hook 11, and the clipping of the clip 2 to the body tissue 4 is completed as shown in FIG. 9.

  In the embodiment described above, the indwelling clip 2 includes the comb-like gripping claw portion 23 integrally formed so as to protrude from the side portion extending along the extending direction of the arm plate portions 21 and 21. ing. Therefore, the body tissue 4 can be gripped by the gripping claw portion 23 in a state where the gripping claw portion 23 of the clip 2 is disposed substantially parallel or obliquely parallel to the body tissue (lumen wall surface) 4. it can. Therefore, treatment such as hemostasis by the clip 2 can be performed without greatly bending the distal end portion of the endoscope 3. For example, even when hemostasis is performed on a lumen wall having a relatively small inner diameter such as a duodenum, this can be easily performed, and the difficulty of the procedure can be reduced.

  In the above-described embodiment, as shown in FIGS. 4 and 5, each gripping claw portion 23 of the arm plate portion 21 protrudes from one (downward) of both side portions of the arm plate portion 21. Are integrally provided. However, as shown in FIGS. 10 and 11, gripping claws 25 similar to the gripping claws 23 may be provided on both sides (upper and lower) of the arm plate portion 21. . As described above, when the gripping claw portions 23 are provided on both sides of the arm plate portion 21, either the upper or lower gripping claw portion 25 can be selected and used, so that the posture adjustment in the rotation direction of the clip 2 can be performed. It becomes easy.

  The embodiment described above is described for facilitating understanding of the present invention, and is not described for limiting the present invention. Therefore, each element disclosed in the above-described embodiment is intended to include all design changes and equivalents belonging to the technical scope of the present invention.

1. Clip device (endoscopic treatment tool)
DESCRIPTION OF SYMBOLS 11 ... Connection hook 12 ... Inner sheath 13 ... Drive wire 14 ... Outer sheath 16 ... Slider 17 ... Base part 18 ... Operation part 2 ... Indwelling clip 21 ... Arm plate part 22 ... Connection plate part 23 ... Grip claw part 24 ... Tightening Ring 3 ... Endoscope 31 ... Treatment instrument guide tube (forceps opening)
4 ... Body tissue (mucosa)
4a ... Hemostasis

Claims (2)

A pair of arm plate portions arranged so that the distance between them becomes wider toward the tip in a state where no external force is applied;
A connecting plate portion for connecting the base end portion of the arm plate portion;
A clamping ring that is slidably attached along the arm plate portion from the connecting plate portion, and that closes the tip ends of the pair of arm plate portions close to each other by sliding to the tip end side of the arm plate portion. ,
The arm plate portions are provided so as to correspond to the respective distal end portions, and are side portions intersecting the plate surface of the arm plate portion, and project from side portions along the extending direction of the arm plate portion. A holding clip having a holding claw.   The indwelling clip according to claim 1, wherein a tip end portion of one gripping claw portion and a tip end portion of the other gripping claw portion of the arm plate portion have shapes that face each other.

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