JP4261450B2 - Endoscopic clip device - Google Patents

Description

  The present invention relates to an endoscope clip device that is used through a treatment instrument insertion channel of an endoscope in order to perform hemostasis or marking in a living body or the like.

  Clipping treatment for hemostasis and marking in a luminal organ etc. is performed by passing the clip device through the treatment instrument insertion channel of the endoscope. If it is pulled out from the treatment instrument insertion channel of the endoscope and reloaded with a clip, the operation becomes too complicated.

Therefore, an operation wire arranged in series in a state where a plurality of clips are constricted in the distal end of the sheath inserted into and removed from the treatment instrument insertion channel of the endoscope, and is movable in the axial direction in the sheath. An endoscopic clip device has been devised that is configured so that a plurality of clips can be sequentially pushed out from the distal end of the sheath and each clip can be opened once and then closed (for example, Patent Document 1).
JP 2002-330972 A

  However, in the conventional endoscope clip device described in Patent Document 1, a plurality of clips arranged in the distal end of the sheath are individually connected to the distal end of the operation wire by a ligation wire or the like. Therefore, the more the clip is located at the rear, the more the ligating wire is in an arrangement state, and the structure becomes cluttered and the smooth operation is not the case.

  Accordingly, the present invention provides an endoscopic clip device in which a plurality of clips can be arranged in an orderly and concise manner within the distal end of a sheath, and a continuous clipping procedure can be performed with a smooth operation. Objective.

  In order to achieve the above object, the clip device for an endoscope of the present invention is arranged in series in a state where a plurality of clips are respectively constricted in the distal end of a sheath inserted into and removed from the treatment instrument insertion channel of the endoscope. Endoscopic clips constructed such that a plurality of clips can be sequentially pushed out from the distal end of the sheath by an operation wire disposed in the sheath so as to be movable back and forth in the axial direction, and each clip is opened once and then closed. In the device, each clip is formed by a pair of leaf spring pieces arranged facing each other in the opening and closing direction, and a connecting claw bent outward is formed at the rear end portion of each leaf spring piece, When the clip is constricted in the state where the clip is constricted in the vicinity of the front end of the leaf spring piece, the clip is expanded and the clip is spread. Forming a engagement hole if is out, is the concatenation directly by the coupling claw and the engaging hole of the plurality of clips.

  In addition, if the connecting claw is formed in a length that does not penetrate the engagement hole in the distal end of the sheath, the operation becomes smooth, and the clip that is bent inward at the most distal portion of each leaf spring piece The claw may be formed, and the clip claw may be formed with a notch for avoiding interference with a clip located adjacent to the front side when the clip is in the sheath. .

  In that case, there is a difference in the folding position of the clip claws of the pair of leaf spring pieces so that the clip claws formed at the tip of the pair of leaf spring pieces do not collide with each other when the clip is closed. It may be done.

  In addition, each leaf spring piece has a rear portion oriented parallel to the axis of the sheath, an intermediate portion opened forward in an unloaded state, and a leading portion from an intermediate portion in an unloaded state. Further, it may be bent so as to be opened at a larger angle.

  A clamp ring that engages with the pair of leaf spring pieces being passed is provided, and the pair of leaf spring pieces is not positioned because the clamp ring is located at a rear portion of the pair of leaf spring pieces. When in a load state, it should be open.

  In that case, in a state where the clip is housed in the distal end of the sheath, the clamp ring is located near the rear end of the clip, and the pair of leaf spring pieces are elastically deformed and narrowed in the distal end of the sheath. Then, the clip may be forced to be closed by the clamp ring by moving the clamp ring from the position behind the clip to the position of the intermediate portion.

Further, the front portion of each leaf spring piece may be formed wider than the intermediate portion so as not to enter the ring, and the cross-sectional shape of the inner surface of the ring may be formed in a rectangular shape. .
In addition, the outer surface of the fastener ring may be formed in a tapered shape whose diameter gradually decreases toward the tip side, and a cylindrical tip is attached to the most distal end portion of the sheath, and the tip is tapered with a tapered inner diameter. It is formed in a cylindrical shape so that the inner diameter of its frontmost part is smaller than the outer diameter of the rear end of the clamp ring, and when the clamp ring is pushed in from behind, it is elastically deformed so that the diameter is expanded. It may be formed.

  In that case, the tip portion of the tip may be formed in a shape divided by a plurality of slits in a direction parallel to the axis.

  According to the present invention, since the plurality of clips are directly connected in series in the distal end of the sheath and no separate member is required for connection, the plurality of clips are arranged in an orderly and concise manner in the distal end of the sheath. The continuous clipping procedure can be performed smoothly.

  A plurality of clips are arranged in series in the distal end of the sheath inserted into and removed from the treatment instrument insertion channel of the endoscope, respectively, and a plurality of operating wires are arranged in the sheath so as to be movable forward and backward in the axial direction. A pair of leaf springs in which clips are sequentially pushed out from the distal end of the sheath so that the clips can be closed once opened and then closed in the opening / closing direction. The connection claw is formed at the rear end of each leaf spring piece and is bent outward, and the clip near the tip of each leaf spring piece is When the connecting claw of the clip located adjacent to the front side is locked in the inserted state and the clip spreads, an engagement hole is formed to disengage the connecting claw, and the plurality of clips are connected to the connecting claw and the engaging hole. Directly linked by.

Embodiments of the present invention will be described with reference to the drawings.
FIG. 1 is a side cross-sectional view of the vicinity of the distal end of the endoscope clip device, FIG. 2 is a plan cross-sectional view, and FIG. Sheath. The sheath 1 is formed of, for example, a coil pipe in which a stainless steel wire is closely wound with a constant diameter, and has a diameter of about 2 to 3 mm and a length of about 1 to 2 m.

  An operation wire 2 that can be moved back and forth in the axial direction from the proximal end side is inserted in the sheath 1, and the operation wire 2 is operated by an operation from an operation unit that is connected to the proximal end side (not shown) of the sheath 1. Is moved forward and backward.

  A plurality (three in this embodiment) of the clips 3 (3A, 3B, 3C) are arranged in series in the distal end portion of the sheath 1 in such a manner that they are constricted. A plurality of clips 3 are sequentially pushed out from the distal end of the sheath 1 so that the clips 3 can be opened and then closed.

  A connecting member 5 that is detachably connected to the rearmost clip 3 </ b> C is fixedly connected to the distal end of the operation wire 2 via a connecting pipe 6. Further, a metal or plastic cylindrical tip 7 is fixedly attached to the most distal portion of the sheath 1.

  Each clip 3 is formed by a pair of leaf spring pieces 30 made of, for example, a stainless steel plate material for springs, which are arranged facing each other in the opening / closing direction, and each pair of leaf spring pieces 30 is formed outside the sheath 1 by the clip 3. Is engaged with a state of being passed through a fastening ring 4 for forcibly closing.

  FIG. 3 shows a pair of leaf spring pieces 30 in an unloaded state where no external force is applied. Each leaf spring piece 30 has a rear portion 31 facing in a direction parallel to the axis of the sheath 1 and an intermediate portion. 32 is opened at the front, and the leading portion 33 is formed by being bent at the boundary portion between the portions 31, 32, 33 so that 33 is opened at a larger angle than the intermediate portion 32. ing.

  Further, the rear portion 31 and the intermediate portion 32 of the leaf spring piece 30 are formed to be narrow so that they can pass through the fastening ring 4, and the front portion 33 excludes the vicinity of the boundary with the intermediate portion 32. It is formed wide so that it cannot be fitted into the fastening ring 4.

  Further, a connecting claw 34 bent outward is formed at the rear end portion of each leaf spring piece 30. In this embodiment, it is bent at an angle of about 45 ° obliquely rearward to form a narrow width. Has been. An engagement hole 37 into which the coupling claw 34 of the leaf spring piece 30 located adjacent to the front side is inserted and engaged is formed in the vicinity of the tip of each leaf spring piece 30.

  A clip claw 35 is formed at the foremost portion of each leaf spring piece 30 so as to be bent toward the inside in order to eat the living tissue at the time of clipping. However, the folding positions of the clip claws 35 are slightly shifted in the pair of leaf spring pieces 30 so that the clip claws 35 of the pair of leaf spring pieces 30 do not collide with each other when the clip 3 is closed.

  Further, each clip claw 35 interferes with the rear portion 31 of the leaf spring piece 30 located adjacent to the front side when the leaf spring piece 30 is constricted in the sheath 1. A cutout 36 for avoiding is formed, whereby the clip claw 35 has a gate shape.

  FIG. 4 shows a clamp ring 4. The clamp ring 4 has a circular cross-sectional shape on the outer surface and is formed in a tapered shape with a gradually decreasing diameter on the front side, and the inner surface 4a is a pair of leaf spring pieces passed therethrough. It is formed in a rectangular cross-sectional shape according to the cross-sectional shape of 30.

  FIG. 5 shows a state in which the rearward portion 31 of the clip 3 is passed through the fastening ring 4, and the clip 3 has the rearward portions 31 of the pair of leaf spring pieces 30 fitted together in the fastening ring 4. When the leaf spring pieces 30 are not opposed to each other and are not housed in the sheath 1, no external force acts on the leaf spring pieces 30, so that the clip 3 is largely opened.

  Then, as shown in FIG. 6, when the fastening ring 4 is shifted from the rearward portion 31 of the clip 3 toward the intermediate portion 32, the clip 3 gradually closes, and the fastening ring 4 moves from the intermediate portion 32 to the tip. When reaching the boundary position with the side portion 33, the front side portion 33 of each leaf spring piece 30 is forcibly pressed by the fastening ring 4, and the clip claws 35 of the pair of leaf spring pieces 30 cross each other. The clip 3 is tightly closed until it does.

FIG. 7 shows a state where the most advanced clip 3A and the second clip 3B are connected.
Each clip 3 is elastically deformed into a constricted state by being housed in the sheath 1, and the connecting claw 34 at the rear end of the most advanced clip 3A is inserted into the engagement hole 37 of the second clip 3B. Thus, the most advanced clip 3A and the second clip 3B are connected in a state of moving together in the axial direction of the sheath 1.

  Since the notch 36 is formed in the clip claw 35 of the second clip 3B, the clip claw 35 of the second clip 3B in the closed state does not interfere with the most advanced clip 3A. Further, the connecting claw 34 of the most advanced clip 3A is formed to have a length that does not penetrate outward from the engagement hole 37 of the second clip 3B, and as a result, it moves smoothly without being caught on the inner surface of the sheath 1. can do.

  When the second clip 3B is in an open state, the engagement hole 37 of the second clip 3B is disengaged from the connecting claw 34 of the most advanced clip 3A, and the most advanced clip 3A and the second clip 3B The connection of is released. Note that the connecting portion between the second clip 3B and the rearmost clip 3C and the connecting portion between the rearmost clip 3C and the connecting member 5 shown in FIG. 30 are directly connected in series by each connecting claw 34 and the engaging hole 37.

  As shown in FIG. 1, the cylindrical tip 7 attached to the most distal portion of the sheath 1 is formed in a tapered cylindrical shape having a tapered inner diameter. It is formed smaller than the end outer diameter.

  Further, as shown in FIG. 8 alone, when the fastening ring 4 is pushed in from the rear, the tip portion of the tip 7 is in a direction parallel to the axis so that it is elastically deformed so that its diameter is expanded. It is formed in a shape divided by a plurality of slits 7b. In this embodiment, three slits 7b are provided at intervals of 120 °, but four or more may be provided at intervals of 90 °.

  When the endoscope clip device configured as described above is used, as shown in FIG. 1, the clips 3 are squeezed and connected in the sheath 1, and are not illustrated. It is passed through the treatment instrument insertion channel of the endoscope.

  When the distal end of the sheath 1 is directed to the target affected part in the body, the operation wire 2 is pushed from the proximal end side, and as shown in FIG. 9, three clips 3A and 3B connected in series are connected. , 3C moves forward in the sheath 1 and the tip of the most advanced clip 3A passes through the tip 7.

  Further, when the operation wire 2 is further pushed in, as shown in FIG. 10, the intermediate portion 32 and the leading portion 33 of the most advanced clip 3A are pushed forward from the tip tip 7, and the most advanced clip. 3A is fully opened.

  At this time, the fastening ring 4 is stopped at the distal tip 7, but when the operation wire 2 is pushed in with a greater force, the fastening ring 4 is elastically deformed so as to push the distal tip 7 apart, as shown in FIG. 11. The fastening ring 4 jumps out from the tip of the tip 7.

  Then, since the outer diameter of the rear end portion of the clamp ring 4 is larger than the tip inner diameter of the tip chip 7, the clamp ring 4 can not go back and return to the tip chip 7, and the cutting edge clip 3A that is wide open can be removed. In this state, it can be pressed against the target affected area.

  Therefore, as shown in FIG. 12, when the operation wire 2 is pulled toward the proximal end side, the pair of cutting-edge clips 3 </ b> A in a state where the rear end of the fastening ring 4 is in contact with the distal end surface of the distal end tip 7. The leaf spring piece 30 is drawn into the sheath 1, and accordingly, the fastening ring 4 moves relatively to a position closer to the tip of the clip 3, and the state-of-the-art clip 3 </ b> A is closed.

  Then, as shown in FIG. 13, when the fastening ring 4 is engaged with the boundary portion between the intermediate portion 32 and the leading portion 33 of the leading edge clip 3A, the leading edge clip 3A is tightly closed. The operation wire 2 can no longer be pulled.

  When that happens, as shown in FIG. 14, the operation wire 2 is pushed again into the distal end side, and as shown in FIG. 15, the second clip 3B is pushed out from the distal end of the distal tip 7. When the second clip 3B is opened, the connection between the cutting edge clip 3A and the second clip 3B is released, and the cutting edge clip 3A is left in the body with the target affected area being clipped. The clip 3B is in a state where a clipping operation can be performed on the next target affected area.

  When the clipping operation with the second clip 3B is finished, the clipping operation with the last clip 3C can be continuously performed in the same manner.

It is side surface sectional drawing of the front-end | tip vicinity of the clip apparatus for endoscopes of the Example of this invention. It is a plane sectional view near the tip of the clip device for endoscopes of the example of the present invention. It is a perspective view of a pair of leaf | plate spring pieces of the clip apparatus for endoscopes of the Example of this invention. It is a perspective view of a clamp ring of the clip device for endoscopes of the example of the present invention. It is side surface sectional drawing of the state which the clip of the clip apparatus for endoscopes of the Example of this invention opened. It is side surface sectional drawing of the state which the clip of the clip apparatus for endoscopes of the Example of this invention closed. It is side surface sectional drawing which shows the connection state of the clip of the clip apparatus for endoscopes of the Example of this invention. It is a perspective view of the front-end | tip chip | tip of the clip apparatus for endoscopes of the Example of this invention. It is side surface sectional drawing which shows operation | movement at the time of use of the clip apparatus for endoscopes of the Example of this invention. It is side surface sectional drawing which shows operation | movement at the time of use of the clip apparatus for endoscopes of the Example of this invention. It is side surface sectional drawing which shows operation | movement at the time of use of the clip apparatus for endoscopes of the Example of this invention. It is side surface sectional drawing which shows operation | movement at the time of use of the clip apparatus for endoscopes of the Example of this invention. It is side surface sectional drawing which shows operation | movement at the time of use of the clip apparatus for endoscopes of the Example of this invention. It is side surface sectional drawing which shows operation | movement at the time of use of the clip apparatus for endoscopes of the Example of this invention. It is side surface sectional drawing which shows operation | movement at the time of use of the clip apparatus for endoscopes of the Example of this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Sheath 2 Operation wire 3 (3A, 3C, 3D) Clip 4 Fastening ring 5 Connection member 7 Tip tip 7b Slit 30 Leaf spring piece 31 Rear part 32 Intermediate part 33 Front part 34 Connection claw 35 Clip claw 37 Engagement Hole

Claims (13)

A plurality of clips are placed in series in the distal end of the sheath inserted into and removed from the treatment instrument insertion channel of the endoscope, respectively, and the operation wire is disposed in the sheath so as to be movable back and forth in the axial direction. In an endoscopic clip device configured to sequentially extrude a plurality of clips from the distal end of the sheath and then close each clip once opened,
Each clip is formed by a pair of leaf spring pieces arranged facing each other in the opening and closing direction, and a connecting claw that is bent outward is formed at the rear end of each leaf spring piece, and In the vicinity of the tip of the leaf spring piece, when the clip is in a squeezed state, the coupling claw of the clip located adjacent to the front side of the leaf spring piece is locked in a state where it is inserted and the clip spreads, and the engagement with the coupling claw An endoscope clip device, wherein an engagement hole is formed to disengage, and the plurality of clips are directly connected by the connection claw and the engagement hole. The endoscope clip device according to claim 1, wherein the connection claw is formed in a length that does not penetrate the engagement hole in the distal end of the sheath.   A clip claw bent inward is formed at the most distal portion of each leaf spring piece, and the clip claw has a front side when the clip is constricted in the sheath. The endoscope clip device according to claim 1, wherein a notch is formed to avoid interference with a clip located adjacent to the endoscope.   A difference is provided in the folding position of the clip claws of the pair of leaf spring pieces so that the clip claws formed at the most distal portion of the pair of leaf spring pieces do not collide with each other when the clip is closed. The endoscope clip device according to claim 3. In each of the leaf spring pieces, the rear portion is oriented parallel to the axis of the sheath, the intermediate portion is opened forward in the unloaded state, and the forward portion is the intermediate portion in the unloaded state. 5. The endoscope clip device according to claim 1, wherein the endoscope clip device is bent so as to be opened at an even larger angle.   A clamp ring that engages with the pair of leaf spring pieces being passed is provided, and the pair of leaf spring pieces is located at a rear portion of the pair of leaf spring pieces. 6. The endoscope clip device according to claim 1, wherein the endoscope clip device is opened when there is no load.   In a state where the clip is housed in the distal end of the sheath, the fastener ring is located near the rear end of the clip, and the pair of leaf spring pieces are elastically deformed and constricted in the distal end of the sheath. The endoscopic clip device according to claim 6, which is in a trapped state.   The endoscope clip according to claim 6 or 7, wherein the clip is forcibly closed by the clamp ring by moving the clamp ring from a position behind the clip to a position of an intermediate portion. apparatus. The clip device for an endoscope according to claim 6, 7 or 8, wherein the front portion of each leaf spring piece is formed wider than the intermediate portion so as not to enter the fastening ring. The endoscope clip device according to claim 6, 7, 8, or 9, wherein a cross-sectional shape of an inner surface of the fastening ring is formed in a rectangular shape.   The clip device for an endoscope according to claim 6, 7, 8, 9 or 10, wherein an outer surface of the clamp ring is formed in a tapered shape whose diameter gradually decreases toward the front side.   A cylindrical tip is attached to the most distal portion of the sheath, and the tip is formed in a tapered cylindrical shape having a tapered inner diameter, and the inner diameter of the distal portion is larger than the outer diameter of the rear end of the fastening ring. 12. The endoscope clip device according to claim 11, wherein the endoscope clip device is formed so as to be elastically deformed in a state where a diameter thereof is pushed and widened when the fastening ring is pushed from behind.   The endoscope clip device according to claim 12, wherein a tip portion of the tip is formed in a shape divided by a plurality of slits in a direction parallel to the axis.

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