JP4311953B2 - Endoscopic clip device - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to an endoscope clip device that is used through a treatment instrument insertion channel of an endoscope to perform hemostasis, ligation, marking, or the like in the body.
[0002]
[Prior art]
In general, an endoscopic clip device is a flexible sheath in which a clip closing cylinder for maintaining an openable / closable clip in a closed state is fitted to a portion on the rear end side of the clip to form an indwelling clip unit. The front end of an operation wire that is inserted in the axial direction so as to be movable back and forth is connected to the rear end of the clip.
[0003]
Then, by pulling the operation wire from the proximal end side after the clip is opened, the clip is drawn into the clip closing cylinder at the distal end portion of the flexible sheath and closed (for example, Patent Document 1).
[0004]
[Patent Document 1]
JP2002-191609
[0005]
[Problems to be solved by the invention]
In the conventional clip device for an endoscope, when the operation wire is pulled from the proximal end side, the axial movement of the clip closing cylinder is restricted by contacting the distal end member of the sheath. It is supposed to be drawn into.
[0006]
However, when the operation wire is pushed in from that state, the clip closing cylinder moves away from the distal end of the sheath and moves together with the clip. Therefore, once the operation wire is pulled to close the clip, the clip is opened again. Cannot return to the state.
[0007]
Therefore, even when the clip is not sufficiently bitten with respect to the affected part, clipping cannot be performed again, and the user may have to leave the clip as it is.
[0008]
Therefore, an object of the present invention is to provide an endoscopic clip device that can reopen a clip and repeat a clipping operation as many times as possible when the clip bite state with respect to an affected area is insufficient.
[0009]
[Means for Solving the Problems]
In order to achieve the above object, the clip device for an endoscope of the present invention is such that a clip closing cylinder for maintaining an openable / closable clip in a closed state is movable in the axial direction to a portion on the rear end side of the clip. The distal end portion of the operation wire, which is inserted into the flexible sheath and inserted in the flexible sheath so as to be movable forward and backward in the axial direction, is detachably connected to the rear end portion of the clip, and the operation wire is pulled from the proximal end side. By doing so, the clip is pulled into the clip closing cylinder and closed at the distal end portion of the flexible sheath, and the connection state between the clip and the connecting member is released by pulling the operation wire. In a clip apparatus for an endoscope, a closed cylinder receiver that engages in a state in which movement in the axial direction with respect to the clip closed cylinder is restricted can be engaged and disengaged from the side. The clip is moved inside the clip-closed cylinder by moving the operation wire and the flexible sheath relatively in the axial direction while the clip-closed cylinder is attached to the distal end of the conductive sheath and the clip-closed cylinder is engaged with the closed cylinder receiver. The clip can be moved back and forth to repeatedly open and close the clip.
[0010]
In addition, the closed cylinder receiver is formed in a shape obtained by cutting a cylindrical member fitted into the clip closed cylinder by a half circumference, and is formed on the outer peripheral surface of the clip closed cylinder and the inner peripheral surface of the closed cylinder receiver. Steps that engage with each other may be formed.
[0011]
A rear end portion of the clip is formed in a cylindrical shape, and a connecting member that can be inserted and removed from the rear side of the cylindrical portion is attached to the distal end of the operation wire and is elastically engaged with and disengaged from the connecting member. The joint click part may be formed in the cylindrical part.
[0012]
Further, in a state where the clip closed cylinder and the closed cylinder receiver are engaged with each other, the clip closed cylinder and the closed cylinder receiver may be relatively movable in the axial direction within a certain range.
[0013]
DETAILED DESCRIPTION OF THE INVENTION
Embodiments of the present invention will be described with reference to the drawings.
2 and 3 show the indwelling clip unit 10, FIG. 2 is a side sectional view of the indwelling clip unit 10, and FIG. 3 is a front view of the indwelling clip unit 10 as viewed from the front.
[0014]
In this embodiment, the three clip claws 11 are elastically deformed in the vicinity of the rear end portion A thereof so as to open and close with the vicinity of the rear end portion A as a base point at intervals of approximately 120 ° around the central axis. It arrange | positions at the extended shape and is mutually connected in the cylindrical connection part 12 (cylindrical part) provided in the rear-end part.
[0015]
FIG. 4 shows a single part in which such a clip claw 11 and a cylindrical connecting portion 12 are formed. The cylindrical connecting portion 12 is made of a pipe material such as a superelastic alloy or a stainless steel pipe material having a spring property. It is a cylindrical thing using the raw material as it is, and the rear end side (the upper end in FIG. 4) is open.
[0016]
The three clip claws 11 are connected to the cylindrical connecting portion 12 from the same material pipe as the cylindrical connecting portion 12 so that all the clip claws 11 are connected to the cylindrical connecting portion 12 at the rear end A. In the normal state, each is bent at the rear end portion A so that the front end side is widened, and the front end portion of each clip claw 11 is bent inwardly in a hook shape.
[0017]
Reference numeral 13 denotes an engagement click part for engaging with a connecting member 5 described later, and the cylindrical connecting part 12 is cut from the rear side by a pair of parallel slits so as to form a leaf spring. It is integrally formed with the shape connecting portion 12 and the clip claw 11.
[0018]
In the vicinity of the rear end of the engagement click portion 13, as shown in FIG. 2, which is a cross-sectional view, an inward protrusion 13 a that protrudes inward is formed. In this embodiment, the engagement click portions 13 are formed at three positions at intervals of 120 °, but may be formed at least at one position.
[0019]
As shown in FIGS. 2 and 3, a clip closing cylinder 15 made of, for example, a stainless steel pipe, which is another part constituting the indwelling clip unit 10, is slidable in the axial direction in the cylindrical connecting portion 12. Is fitted from behind. On the outer peripheral surface of the clip closing cylinder 15, a circumferential groove 15 a for engaging with an inner surface convex portion 3 a of the closing cylinder receiver 3 described later is formed.
[0020]
The cylindrical connecting portion 12 and the clip closing cylinder 15 are elastically frictionally engaged so that a certain amount of force needs to be applied to slide relatively, and the clip closing cylinder 15 is cylindrical. By moving the clip claw 11 from the connecting portion 12 side so as to cover the clip claw 11, the clip claw 11 is elastically deformed and held in a closed state.
[0021]
In this way, the clip closing cylinder 15 is fitted from the rear to the cylindrical connecting part 12 that connects all the three clip claws 11 in a continuous manner on the rear end A side, and the indwelling clip A unit 10 is configured.
[0022]
FIG. 1 shows a ready-to-use state in which the indwelling clip unit 10 is loaded at the distal end portion of the endoscope clip device. A cylindrical closed tube receiver 3 is fixed to the tip of a flexible sheath 2 made of, for example, a coil pipe in which a stainless steel wire is tightly wound with a certain diameter at the tip of the endoscope clip device. The clip cylinder 15 is supported by the cylinder receiver 3. The sheath 2 may be formed of a super elastic alloy pipe or the like.
[0023]
As shown in FIG. 5, which is a perspective view of the closed cylinder receiver 3 with the indwelling clip unit 10 not attached, the cylindrical member fitted to the clip closed cylinder 15 is cut by a half circumference. An inner surface convex portion 3a that engages with a circumferential groove 15a on the outer peripheral surface of the clip closed cylinder 15 is formed on the inner peripheral surface of the distal end portion of the closed cylinder receiver 3 so as to protrude over a half circumference. Yes.
[0024]
As a result, the clip closing cylinder 15 can be engaged with and disengaged from the side with respect to the closing cylinder receiver 3, and the inner surface convex portion 3 a of the closing cylinder receiver 3 is fitted into the circumferential groove 15 a of the clip closing cylinder 15. As shown in FIG. 1, the two stepped portions come into contact with each other, and the clip closing cylinder 15 is engaged with the closing cylinder receiver 3 so that it cannot move in the axial direction.
[0025]
An operation wire 4 is inserted through the sheath 2 so as to be movable back and forth in the axial direction, and the operation wire 4 can be moved forward and backward from an operation portion (not shown) connected to the base end of the sheath 2.
[0026]
A connecting member 5 that can be engaged and disengaged from the rear side with respect to the cylindrical connecting portion 12 is connected and fixed to the distal end of the operation wire 4 when the clip closing cylindrical body 15 is not covered.
[0027]
The connecting member 5 has a front half formed in a columnar shape with a rounded head and is loosely fitted into the cylindrical connecting portion 12. A constricted portion 5a with which the protrusion 13a is engaged is formed.
[0028]
As a result, when the engagement click portion 13 is covered with the clip closing cylinder 15, the engagement click portion 13 and the constricted portion 5 a are not disengaged, and the clip closing cylinder 15 is not covered. The inward projection 13a and the constricted portion 5a can be engaged and disengaged by elastically deforming the engagement click portion 13 outward.
[0029]
6 is an outer tube made of, for example, a tetrafluoroethylene resin tube or the like, which is fitted over the entire length of the sheath 2 so as to be able to advance and retreat in the axial direction independently from the operation unit side, as shown in FIG. Can be fitted to the clip claw 11 portion. However, the outer tube 6 may be formed of a superelastic alloy pipe or the like.
[0030]
6 to 8 show a procedure for attaching the indwelling clip unit 10 until the clip apparatus for endoscope is put into the use ready state shown in FIG. 1, and before that, it is shown in FIG. Thus, on the indwelling clip unit 10 side, the clip closing cylinder 15 is slid forward so that the engagement click portion 13 is exposed, and the clip claw 11 is thereby closed.
[0031]
Then, as shown in FIG. 6, the inner surface convex portion 3a of the closed cylinder receiver 3 is fitted into the circumferential groove 15a of the clip closed cylinder 15 from the side, and then, as shown in FIG. When the operation wire 4 is pushed relative to the sheath 2, the inward protrusion 13 a interferes with the outer peripheral surface of the connecting member 5, but the engagement click portion 13 is elastically deformed to be spread outward. The connecting member 5 enters the cylindrical connecting portion 12.
[0032]
As shown in FIG. 8, when the inward projection 13a reaches the position of the constricted portion 5a as shown in FIG. 8, the engagement click portion 13 returns to the original unexpanded shape by its own elasticity, and the inward projection 13a Engage in a state of falling into the constricted portion 5a.
[0033]
Therefore, by pushing the mantle tube 6 forward from the base end side. As shown in FIG. 1, the outer tube 6 is entirely covered and ready for use, and in this state, it is passed through the treatment instrument insertion channel of the endoscope.
[0034]
9 to 12 show the state of use in the body. The distal end portion of the endoscope clip device protrudes from the treatment instrument insertion channel of the endoscope, and as shown in FIG. The clip nail 11 is directed to the affected area 100.
[0035]
Then, by pushing the operation wire 4 forward with respect to the sheath 2 (or by pulling the sheath 2 to the proximal end side with respect to the operation wire 4), the clip claw 11 comes out of the clip closing cylinder 15 and becomes self- Open shape due to elasticity. At the same time, the engagement click portion 13 is covered with the clip closing cylinder 15 so that the engagement with the connecting member 5 is not released.
[0036]
Therefore, when the affected part 100 is surrounded by the tips of the three clip claws 11, as shown in FIG. 10, the operation wire 4 is pulled from the rear with respect to the sheath 2 (or the sheath 2 with respect to the operation wire 4). ).
[0037]
As a result, the clip claw 11 is fitted into the clip closed cylinder 15 pressed by the closed cylinder receiver 3 from the rear end A side, the clip claw 11 is narrowed, and the affected part 100 can be clipped. Further, in accordance with the operation, the engagement click portion 13 moves to a position where it has come out of the rear end of the clip closing cylinder 15.
[0038]
If the clipping state at that time is incomplete, the operation wire 4 is again pushed forward with respect to the sheath 2 (or the sheath 2 is pulled toward the proximal end side with respect to the operation wire 4). As shown in FIG. 9, the clip claw 11 returns to the open shape by its own elasticity.
[0039]
This is possible because the axial movement of the clip closing cylinder 15 is restricted by the closing cylinder receiver 3, and the clip claw 11 can be opened and closed until a satisfactory clipping state is obtained with respect to the affected part 100. Can be repeated any number of times.
[0040]
A step portion formed on the outer peripheral surface of the connecting member 5 so that when the operation wire 4 is pushed in, the connecting member 5 at the tip thereof does not push out the cylindrical connecting portion 12 from the inside of the clip-closed cylindrical body 15. Comes into contact with the rear end of the clip closing cylinder 15 to stop the advancement of the connecting member 5.
[0041]
In this way, when a satisfactory clipping state is obtained, the operation wire 4 is strongly pulled backward with respect to the sheath 2 (or the sheath 2 is pushed strongly), and the clip is closed to the engagement click portion 13. Since the cylindrical body 15 is not covered, as shown in FIG. 11, the engagement click portion 13 is elastically deformed outward, and the constricted portion 5a of the connecting member 5 and the engagement click portion 13 The engagement with the inward projection 13a is released.
[0042]
Then, by slightly shaking the sheath 2 and the distal end portion of the outer tube 6 left and right, as shown in FIG. 12, the indwelling clip unit 10 is placed in the body with the affected part 100 clipped and frictionally engaged from the outside. The clip claw 11 pressed by the clip closing cylinder 15 is kept closed.
[0043]
FIGS. 13 to 16 show a second embodiment of the present invention. As shown in FIG. 13, the width (axial length) M of the circumferential groove 15a of the clip closing cylinder 15 is closed. The clip closed cylinder 15 and the closed cylinder body are larger than the width (length in the axial direction) N of the inner surface convex portion 3a of the receiver 3 and the clip closed cylinder 15 and the closed cylinder receiver 3 are engaged with each other. The receiver 3 is relatively movable in the axial direction.
[0044]
However, the advancing / retreating range is limited to the difference between the width M of the circumferential groove 15a and the width N of the inner convex portion 3a, and the clip closing cylinder 15 moves in the axial direction and separates from the closing cylinder receiver 3. It will not be in a state. The structure of the other parts is the same as that of the first embodiment.
[0045]
With this configuration, as shown in FIGS. 14 and 15, when the operation wire 4 is pushed and pulled, the coupling member 5 is closed for a certain length in the axial direction with respect to the closed cylindrical receiver 3, and then the clip claw. 11 opens and closes, but shortens the distal end rigid portion length (the length between the distal end of the clip claw 11 and the proximal end of the connecting member 5) L of the endoscope clip device in the ready-to-use state shown in FIG. The insertion ability of the endoscope into the treatment instrument insertion channel can be enhanced.
[0046]
In addition, this invention is not limited to the said Example, For example, the operation wire 4 may be not only a single wire and a strand wire, but a hollow tube-shaped thing etc. may be sufficient.
[0047]
【The invention's effect】
According to the present invention, the clip is moved back and forth in the clip-closed cylinder by moving the operation wire and the flexible sheath relatively in the axial direction while the clip-closed cylinder is engaged with the closed cylinder receiver. Since the clip can be opened and closed repeatedly, the clip can be reopened and the clipping operation can be repeated as many times as necessary, so that the surgeon is always satisfied. Any number of high level clipping procedures can be performed.
[Brief description of the drawings]
FIG. 1 is a side sectional view of an endoscope clip device according to a first embodiment of the present invention in a ready state for use.
FIG. 2 is a side partial sectional view of the indwelling clip unit according to the first embodiment of the present invention.
FIG. 3 is a front view of the indwelling clip unit according to the first embodiment of the present invention as viewed from the front.
FIG. 4 is a perspective view of an integrated part of a clip claw, a cylindrical connecting portion, and an engaging click portion according to the first embodiment of the present invention.
FIG. 5 is a perspective view showing a state in which the indwelling clip unit according to the first embodiment of the present invention is not attached to the closed cylindrical body receiver.
6 is a side cross-sectional view showing a procedure for attaching an indwelling clip unit until the endoscope clip device according to the first embodiment of the present invention is in a ready state for use shown in FIG. 1; FIG.
7 is a side cross-sectional view showing a procedure for attaching an indwelling clip unit until the endoscope clip device according to the first embodiment of the present invention is in a ready state for use shown in FIG. 1. FIG.
8 is a side cross-sectional view showing a procedure for attaching an indwelling clip unit until the endoscope clip device according to the first embodiment of the present invention is in a ready state for use shown in FIG. 1; FIG.
FIG. 9 is a side cross-sectional view showing a state in which the endoscope clip device according to the first embodiment of the present invention is used.
FIG. 10 is a side sectional view showing a state when the endoscope clip device according to the first embodiment of the present invention is used.
FIG. 11 is a side cross-sectional view showing a state in which the endoscope clip device according to the first embodiment of the present invention is used.
FIG. 12 is a side sectional view showing a state when the endoscope clip device according to the first embodiment of the present invention is used.
FIG. 13 is a perspective view showing a state in which the indwelling clip unit according to the second embodiment of the present invention is not attached to the closed cylindrical body receiver.
FIG. 14 is a side sectional view showing a state in which the endoscope clip device according to the second embodiment of the present invention is used.
FIG. 15 is a side sectional view showing a state when the endoscope clip device of the second embodiment of the present invention is used;
FIG. 16 is a side sectional view of the endoscope clip device according to the second embodiment of the present invention in a preparation state for use.
[Explanation of symbols]
2 Sheath 3 Closed cylinder receiver 3a Convex part 4 Operation wire 5 Connection member 5a Constriction part 6 Outer tube 10 Indwelling clip unit 11 Clip claw 12 Cylindrical connection part 13 Engagement click part 13a Inward protrusion 15 Clip closing cylinder 15a Circumferential groove

Claims (4)

A clip closing cylinder for keeping the openable / closable clip closed is fitted to the rear end portion of the clip so as to be movable in the axial direction, and can be moved forward and backward in the flexible sheath. The distal end portion of the operation wire inserted and disposed in the clip is detachably connected to the rear end portion of the clip, and the operation wire is pulled from the proximal end side, whereby the clip is In the endoscope clip device configured to be drawn and closed in the clip closing cylinder, and further, the connected state between the clip and the connecting member is released by pulling the operation wire.
A closed cylindrical receptacle that can be engaged and disengaged from the side of the clip closed cylinder and engages in a state in which axial movement of the clip closed cylinder is restricted is attached to the distal end of the flexible sheath. ,
The clip is moved back and forth in the clip closed cylinder by moving the operation wire and the flexible sheath relatively in the axial direction with the clip closed cylinder engaged with the closed cylinder receiver. An endoscopic clip device, wherein the clip can be repeatedly opened and closed. The closed cylinder receiver is formed in a shape obtained by cutting a cylindrical member fitted to the clip closed cylinder half a circumference, and the outer peripheral surface of the clip closed cylinder and the inner peripheral surface of the closed cylinder receiver The endoscope clip device according to claim 1, wherein stepped portions that engage with each other are formed. A rear end portion of the clip is formed in a cylindrical shape, and a connecting member that can be inserted into and removed from the cylindrical portion is attached to the distal end of the operation wire and is elastically engaged with and disconnected from the connecting member. The endoscope clip device according to claim 1 or 2, wherein an engagement click portion is formed in the cylindrical portion. 2. The clip closed cylinder and the closed cylinder receiver are relatively movable in the axial direction within a certain range in a state where the clip closed cylinder and the closed cylinder receiver are engaged with each other. The endoscope clip device according to 2 or 3.

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