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WO2012039164A1 - Dispositif de ligature et unité d'agrafe utilisée dans le dispositif - Google Patents

Dispositif de ligature et unité d'agrafe utilisée dans le dispositif Download PDF

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Publication number
WO2012039164A1
WO2012039164A1 PCT/JP2011/062526 JP2011062526W WO2012039164A1 WO 2012039164 A1 WO2012039164 A1 WO 2012039164A1 JP 2011062526 W JP2011062526 W JP 2011062526W WO 2012039164 A1 WO2012039164 A1 WO 2012039164A1
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WO
WIPO (PCT)
Prior art keywords
clip
pair
operation wire
main body
ligation
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/JP2011/062526
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English (en)
Japanese (ja)
Inventor
寺田　和広
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Fujifilm Corp
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Fujifilm Corp
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Fujifilm Corp filed Critical Fujifilm Corp
Publication of WO2012039164A1 publication Critical patent/WO2012039164A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A61B17/128—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord for applying or removing clamps or clips
    • A61B17/1285—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord for applying or removing clamps or clips for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A61B17/122—Clamps or clips, e.g. for the umbilical cord

Definitions

  • the present invention relates to a ligation apparatus for ligating living tissue and a clip unit used for the ligation apparatus.
  • a ligation device for ligating biological tissue for example, insert the ligation device into the body cavity from the forceps opening of the endoscope, align the clip with the arm part of the tip expanded to the position of the desired biological tissue, and connect to the clip A device that closes the arm of the clip and ligates the living tissue by pulling the operated wire is known (see, for example, Patent Document 1).
  • the living tissue ligation device described in Patent Document 1 is fixed to an introduction tube inserted into a body cavity, an operation wire inserted into the introduction tube so as to be movable back and forth, and a loop-shaped ligation wire connected to the operation wire. And a plurality of clips loaded in the introduction tube.
  • the clip and the ligature wire are in a state where the ligature wire is fixed to the coupling portion of the base end portion of the clip by welding, adhesion, etc., and the coupling portion is broken by pulling the operation wire, and the clip sandwiches the living tissue. It is designed to be placed in the body cavity.
  • these clips are fixed in a state in which the arm portion of the clip is closed after the arm portion of the clip is once closed by pulling the operation wire, and cannot be opened again. Therefore, since the biological tissue once grasped by the clip cannot be re-grown, it is necessary to pull the operation wire after carefully positioning the clip. For these reasons, the clip ligation operation requires skill.
  • An object of the present invention is to provide a ligation apparatus that can open and close the arm portion of a clip with a simple configuration, thereby allowing a biological tissue to be re-gripped freely, and that does not cause broken fragments, and a clip unit used therefor. Objective.
  • the present invention has the following configuration.
  • a ligation apparatus for ligating living tissue A flexible introduction tube;
  • An operation wire that is inserted into the introduction tube so as to freely advance and retract, and has a loop portion at the tip,
  • a clip unit disposed inside the distal end of the introduction tube and connected to the operation wire;
  • the clip unit has a pair of arm portions that are urged to expand each other, and a clip body that ligates a living tissue with a base end portion that connects the base ends of the arm portions;
  • a clamping ring in which a base end portion of the clip body is inserted into a cylindrical body to close the pair of arms;
  • Wire locking means provided at a base end portion of the clip body to lock the loop portion of the operation wire;
  • the wire locking means includes a locking claw extending obliquely outward in the radial direction of the clamping ring from the proximal end of the clip body toward the rear in the insertion direction to the clamping ring,
  • the opening / closing operation of the clip can be performed with a simple configuration, and the living tissue can be re-gripped freely. Further, since the clip main body and the operation wire are separated by the deformation of the clip main body, the broken fragments are not left in the body cavity and the continuous ligation operation is not hindered.
  • FIG. 1 A is a side view of the clip main body shown in FIG. 3, and (B) is a plan view.
  • A) is the sectional view on the AA line of FIG. 3
  • B) is the sectional view on the BB line.
  • FIG. 4D is a cross-sectional view of a main part in the middle of being engaged with the wire locking means of the main body
  • FIG. (A) is a cross-sectional view of the main part of the clip unit mounted in the introduction pipe
  • (B) is a cross-sectional view of the main part in which the arm part of the clip body is opened by retreating the introduction pipe
  • (C) is a feeding operation of the operation wire.
  • FIG. 5 is a cross-sectional view of the main part showing a state where the arm part of the clip body is opened and closed by a pulling operation.
  • A is a cross-sectional view of the main part at the start of tissue ligation
  • B is a cross-sectional view of the main part showing a state in which the tissue is ligated by pulling the operation wire
  • C is a plastic deformation of the clip body locking claw
  • D) is principal part sectional drawing which shows the state from which the latching
  • E is a biological tissue.
  • FIG. 11 It is principal part sectional drawing which shows the state which the clip unit ligated leaves
  • (A) is a perspective view of a ligation apparatus before ligation
  • (B) is a perspective view showing a state in which an arm portion of a clip main body which is pulled by an operation wire and is arranged at the distal end is closed
  • (C) is a clip at the distal end.
  • (D) is a perspective view which shows the state which the latching claw plastically deformed and the latching
  • (E ) Is a perspective view showing a state in which the loop portion is guided by the retaining portion of the next clip body and guided to the wire locking means
  • (F) is a wire locking means of the next clip body where the loop portion of the operation wire is guided.
  • FIG. 16 is a perspective view of the fastening ring and the clip body of FIG. 15.
  • 15A is a plan view of the clip body
  • FIG. 15B is a front view
  • FIG. 15C is a side view.
  • FIG. 1 is a diagram for explaining an embodiment of the present invention.
  • FIG. 2 is an overall configuration diagram of a ligation apparatus shown with a part cut away, and FIG. 2 is a sectional view of a hand operating unit.
  • the ligating apparatus 100 includes a clip operating device 11 and a clip unit 13 loaded in the clip operating device 11.
  • the clip operation device 11 includes an insertion portion 15 that is inserted into a channel of an endoscope (not shown) and inserted into a body cavity, and a proximal operation portion 17 on the proximal end side of the insertion portion 15.
  • the insertion portion 15 includes an outer sheath member 19 that is an introduction tube made of a high-density polyethylene tube, an inner sheath member 21 that is inserted into the outer sheath member 19 so as to be able to advance and retract, and an advancement and retraction within the inner sheath member 21. And an operation wire 23 to be inserted into the cable.
  • the inner sheath member 21 is composed of a flexible coil sheath in which a wire material having a spring property is closely wound.
  • the operation wire 23 is formed of a twisted metal wire having moderate elasticity such as stainless steel or NiTi alloy, and the outer periphery thereof may be coated with high-density polyethylene as necessary, and is slidable with the inner sheath member 21. You may apply the silicone oil for improving.
  • An annular loop portion 71 is provided at the distal end of the operation wire 23 on the side opposite to the hand operation portion 17 side.
  • the clip unit 13 includes a tightening ring 37 formed in a tubular body, and a clip body 35 inserted into the tubular body of the tightening ring 37, and is axially extended from the distal end of the outer sheath member 19. Are arranged in series along.
  • the clip unit at the end opposite to the distal end is configured such that the rear end of the fastening ring 37 opposite to the insertion side of the clip body 35 is the distal end of the inner sheath member 21. It touches the tip of the end.
  • the hand operation unit 17 is movable forward and backward with respect to the operation unit main body, an outer sheath connection body 25 in which the proximal end side of the outer sheath member 19 is fixed, an operation unit main body 27 in which the proximal end side of the inner sheath member 21 is fixed. And a slider 29 connected to the operation wire 23 and a finger ring 33 connected to the operation unit main body 27.
  • the hand operation unit 17 adjusts the relative position between the outer sheath member 19 and the inner sheath member 21 by relatively moving the outer sheath connector 25 and the operation unit main body 27. Further, the relative position between the inner sheath member 21 and the clip unit 13 connected to the operation wire 23 is adjusted by relatively moving the operation portion main body 27 and the slider 29.
  • FIG. 3 shows an exploded perspective view of the clip unit.
  • the clip unit 13 includes a tightening ring 37 and a clip body 35 that is inserted into the cylindrical body of the tightening ring 37.
  • the clip main body 35 has a pair of arm portions 41 that are urged to expand and a base end portion 39 that connects the base ends of the arm portions 41, and grips the living tissue by the arm portions 41.
  • the clip main body 35 is formed by bending a belt-shaped metal plate having a spring property such as stainless steel into a substantially U shape.
  • the fastening ring 37 is a cylindrical member made of a metal material such as stainless steel, and the operation wire 23 is inserted through the inside thereof.
  • the base end side of the clip main body 35 is accommodated in the fastening ring 37 in a state where the loop portion 71 of the operation wire 23 is locked to a part of the clip main body 35.
  • the clip main body 35 has a shape shown in FIG. 4A as a side view of the clip main body, and in FIG.
  • the clip main body 35 has wire locking means including a locking claw 43 and a retaining portion 45 at the base end portion 39.
  • the wire locking means locks the loop portion 71 of the operation wire 23.
  • the locking claws 43 are respectively inclined and extended so as to extend outward from the width direction both sides of the arm portion 41 at the bottom 39 a of the base end portion 39 toward the arm portion 41. That is, the latching claw 43 is inclined and extended outward in the radial direction of the fastening ring 37 in the direction opposite to the insertion direction from the proximal end 39 of the clip body 35 to the fastening ring 37.
  • the locking claw 43 is a plate-like body narrowed so that the force required to plastically deform the locking claw 43 is larger than the force that pulls the clip body 35 into the fastening ring 37.
  • the retaining portion 45 is a protrusion projecting toward the locking claw 43 from a position spaced from the connecting portion with the locking claw 43 at the proximal end portion 39 of the clip body 35 toward the arm portion 41 side.
  • a gap 47 for locking the loop portion 71 of the operation wire 23 is defined by the locking claw 43, the side surface 45b of the base end portion 39 side of the retaining portion 45, and the side surface in the width direction of the base end portion 39. Is done.
  • the gap between the protruding tip of the retaining portion 45 and the locking claw 43 is made smaller than the diameter of the operation wire 23, and details will be described later, but the loop portion 71 of the operation wire 23 elastically deforms the locking claw 43. When entering the gap 47, the loop portion 71 of the operation wire 23 is prevented from falling out of the gap 47.
  • the locking claw 43 and the retaining portion 45 are formed as a pair on the upper and lower sides, but may be formed only on one side.
  • a pair of upper and lower locking claws 43 and retaining portions 45 are formed on the clip main body 35, and two loop portions 71 of the operation wire 23 are further formed, and two loop portions are It is good also as a structure each latched to the one latching claw 43 separately. In that case, the clip body 35 can be stably moved without the traction force of the operation wire 23 being biased.
  • the pair of arm portions 41 are symmetrically arranged oppositely and are band-shaped metal plate members having spring properties, and have a predetermined width in a direction orthogonal to the expanding direction of the pair of arm portions 41 in order from the base end portion 39.
  • the pair of arm portions 41 are urged so as to expand each other by the spring property of the material of the clip body 35.
  • the pair of arm portions 41 includes a wide portion 53 formed gradually wider from the plate-like piece portion 51, a step portion 57 formed between the wide portion 53 and the plate-like piece portion 51, and a wide width.
  • a tissue gripping portion 55 formed on the distal end side of the portion 53 is provided, and details thereof are as follows.
  • the pair of arm portions 41 is bent so as to expand outward at a first bending point 41 a provided on the base end portion 39 side of the plate-like piece portion 51, and is provided at a middle position of the plate-like piece portion 51. It is bent inward at a point 41b. Further, the tissue gripping portion 55 is formed by being bent inward at a third bending point 41 c on the distal end side of the wide portion 53.
  • the pair of tissue gripping portions 55 are largely separated from each other to form a sandwiching gap 73 between the pair of tissue gripping portions 55. Further, when the pair of arm portions 41 are closed, the distal ends come into contact with each other and the living tissue can be sandwiched. It should be noted that the tip of the tissue gripping portion 55 may be linear as shown in the figure, or may be formed in an uneven shape that meshes with each other so that the living tissue can be securely sandwiched.
  • ⁇ Tightening ring> 5A is a cross-sectional view taken along the line AA in FIG. 3, and FIG. 5B is a cross-sectional view taken along the line BB.
  • the tightening ring 37 includes a hollow cylindrical portion 61, a pair of clip contact portions 63, and a pair of clip retaining pieces 65.
  • the fastening ring 37 closes the pair of arm portions 41 of the clip body 35 by inserting the proximal end portion 39 of the clip body 35 into the cylindrical body.
  • the pair of clip contact portions 63 and the pair of clip retaining pieces 65 are formed by bending each pair of protrusions protruding in the axial direction from one end of the cylindrical portion 61 to the inside of the fastening ring 37 in the radial direction. is doing.
  • the clip retaining piece 65 extends from the end of the tightening ring 37 on the clip body insertion side so as to incline toward the inside of the ring in the insertion direction of the clip body 35.
  • the pair of clip contact portions 63 and the pair of clip retaining pieces 65 are arranged at circumferential positions different from each other by 180 °, and the clip contact portion 63 and the clip retaining pieces 65 are different from each other by 90 °. It is formed at a circumferential position.
  • the pair of clip contact portions 63 have a flat surface parallel to the axis of the tightening ring 37 by bending a protrusion projecting from one end of the cylindrical portion 61.
  • a pair of guide pieces 69 projecting inward in the radial direction of the fastening ring 37 are formed on both sides of the clip contact portion 63.
  • the distance between the pair of guide pieces 69 is set to be larger than the width W1 (see FIG. 4) of the plate-like piece portion 51 of the clip body 35 and smaller than the width W2 of the wide portion 53.
  • both outer side surfaces of the pair of arm portions 41 are pressed by the flat surfaces of the clip abutting portions 63, and the arm portions 41. Is closed.
  • the flat surface of the clip abutting portion 63 with which both outer surfaces of the arm portion 41 abut is not particularly limited to a flat surface as long as the rotation of the clip body 35 with respect to the central axis of the fastening ring 37 can be restricted.
  • a plurality of protrusions that are in point contact with both outer side surfaces of the arm portion 41 or protrusions that are in line contact can also be used.
  • the pair of clip retaining pieces 65 are provided at one end of the cylindrical portion 61, are bent into a substantially V-shaped cross section from the end of the clamping ring 37 toward the inside of the cylinder, and are radially inward of the clamping ring 37. Inclined and extended. The pair of clip retaining pieces 65 are latched by the latching claws 43 (see FIG. 3) of the clip body 35 inserted into the tightening ring 37, and the clip body 35 once inserted comes out of the tightening ring 37. To prevent.
  • FIGS. 6A to 6D show the procedure for assembling the clip unit 13 to the clip operating device. In the figure, the clip operation device is omitted.
  • the loop portion 71 formed at the tip of the operation wire 23 is inserted into the fastening ring 37, and the locking claw 43 of the clip body 35 is inserted into the loop portion 71 of the operation wire 23.
  • the clip main body 35 is inserted into the tightening ring 37 from the base end 39 side. Then, the locking claw 43 abuts against the pair of retaining pieces 65 and elastically deforms inward in the radial direction of the fastening ring 37 to get over the retaining pieces 65.
  • the pair of latching claws 43 pass through the clip retaining piece 65, the pair of latching claws 43 are elastically restored by a spring force, and the tip ends abut against the inner peripheral surface 37 a of the tightening ring 37. Thereby, the latching claw 43 is latched from the inner side to the clip retaining piece 65, and is prevented from coming off from the tightening ring 37.
  • the loop portion 71 when the operation wire 23 is pulled in the insertion direction of the clip main body 35 (the right direction in the figure), the loop portion 71 includes the retaining piece 65 of the fastening ring 37 and the clip. It is guided by the inclined surface 45 a of the retaining portion 45 of the main body 35 and comes into contact with the inner surface of the locking claw 43. Then, as shown in FIG. 6D, the locking claw 43 is elastically deformed radially outward of the fastening ring 37, so that the loop portion 71 of the operation wire 23 is detached from the locking claw 43. The operation wire 23 is locked to the locking claw 43 by being inserted into a gap 47 defined by the locking portion 45 and the end surface in the width direction of the base end portion 39.
  • the clip unit 13 is assembled to the clip operating device 11.
  • the operation wire 23 is locked only on one side (upper side in the figure) of the clip body 35 in the illustrated example, but is locked on both sides (upper and lower sides in the figure) of the clip body 35 by the two operation wires 23. It is good also as a structure.
  • the clip unit 13 assembled to the clip operating device 11 as described above extends the outer sheath member 19 that is an introduction tube to the front, so that the distal side of the outer sheath member 19 Housed in the tip.
  • This is a state in which the outer sheath connection body 25 shown in FIG. 1 is fixed at a position away from the operation portion main body 27.
  • the proximal end side of the clip unit 13 abuts on the distal end of the inner sheath member 21.
  • the pair of arm portions 41 of the clip main body 35 are in contact with the inner peripheral surface of the extended outer sheath member 19 and are accommodated in the outer sheath member 19 in a state of being elastically deformed in a direction approaching each other.
  • the insertion portion 15 of the ligating apparatus 100 is inserted into the body cavity from a forceps hole of an endoscope (not shown) that has been previously inserted into the body cavity. And while observing the inside of a body cavity with an endoscope, the front-end
  • the outer sheath connector 25 shown in FIG. 1 is moved to the operating portion main body 27 side until the clip located at the head is exposed, the outer sheath member 19 is fixed as shown in FIG. 7B.
  • the clip unit 13 is moved forward (distal end side) by being pressed by the inner sheath member 21 relatively moving inside, and the pair of arm portions 41 of the clip body 35 protrudes from the outer sheath member 19. Since the pair of arm portions 41 are released from the restraint by the outer sheath member 19, the pair of arm portions 41 are expanded by the spring force of the clip body 35, and a sandwiching gap 73 is formed between the tissue gripping portions 55 and 55. In this state, the clip body 35 is positioned so that a desired living tissue is disposed in the holding gap 73.
  • the slider 29 shown in FIG. 1 is moved in a direction to approach the finger ring 33 and the operation wire 23 is pulled into the inner sheath member 21, thereby causing the operation wire 23 to move. Pull relative to the inner sheath.
  • the loop portion 71 of the operation wire 23 pulls the locking claw 43 and the clip main body 35 is pulled into the tightening ring 37.
  • the pair of arm portions 41 that are in contact with the flat surface of the clip contact portion 63 of the tightening ring 37 are closed by the clip contact portion 63 as indicated by a solid line in the drawing.
  • the pair of arm portions 41 is closed by pulling the operation wire 23 relative to the inner sheath, and the pair of arm portions 41 is opened by relatively drawing out.
  • both the outer surfaces of the arm portion 41 are in contact with the flat surface of the clip contact portion 63, so that the clip body 35 does not rotate with respect to the central axis of the fastening ring 37.
  • the pair of arms 41 is stably opened and closed by protruding from the tightening ring 37.
  • the above-mentioned closing and opening operations enable easy re-gripping of living tissue. If the pair of arms 41 of the clip main body 35 is to be opened and closed by extending the outer sheath member 19 with respect to the inner sheath member 21, the outer sheath connector 25 and the operating portion shown in FIG. It is necessary to operate all of the main body 27 and the finger ring 33, and the operation of the operator becomes complicated. On the other hand, when the pair of arm portions 41 are opened and closed by pulling and drawing out the operation wire 23, only the operation portion main body 27 and the finger ring 33 are operated, and the operation of the operator can be simplified.
  • FIGS. 8A to 8E a procedure up to completion of ligation of a living tissue will be described.
  • the operation wire 23 is pulled.
  • the separation between the operation wire 23 and the clip main body 35 is realized by plastic deformation of the locking claw 43 regardless of the breakage of the member, so that no broken pieces are generated. Thus, damage caused by broken fragments is completely prevented.
  • the clip operating device 13 When ligating a living tissue subsequently, the clip operating device 13 is inserted from the distal end of the outer sheath member 19 taken out from the body cavity shown in FIG. It becomes possible by setting to 11.
  • FIG. 10 is a perspective view showing a modification of the clip body.
  • the clip main body 35 ⁇ / b> A of the present modification includes the above-described wire locking means configured by the locking claw 43 and the retaining portion 45 shown in FIGS. 3 and 4, only by a pair of locking pieces 75.
  • the locking piece 75 extends from both sides in the width direction of the bottom portion 39a of the base end portion 39, and inclines from the base end portion 39 side and extends outwardly toward the arm portion 41. And a curved portion 75b that is curved toward the axial center of the clip main body 35A.
  • the inclined portion 75a of the locking piece 75 is formed by gradually decreasing the protruding height from the base end portion 39 in the insertion direction of the clip body 35A into the fastening ring.
  • the curved portion 75b extends from the position of the maximum projecting height of the inclined portion 75a toward the base end 39, and gradually reduces the projecting height in the insertion direction of the clip body 35A into the fastening ring. Is formed.
  • a gap 77 that locks the loop portion 71 of the operation wire 23 is defined by the inclined portion 75a, the curved portion 75b, and the end surface in the width direction of the base end portion 39.
  • FIG. 11A is a vertical sectional view of a continuous ligation apparatus in which a plurality of clip units are loaded in the outer sheath member
  • FIG. 11B is a horizontal sectional view
  • FIG. It is a principal part perspective view of a ligation apparatus.
  • the same members as those shown in FIGS. 1 to 9 are denoted by the same reference numerals, and redundant description is omitted.
  • the ligating apparatus 100A having this configuration includes a plurality of clip units 13 including a clip main body 35 and a fastening ring 37 arranged in a row in the outer sheath member 19. Inserted in an aligned state. In each clip unit 13, the rotation position within the outer sheath member 19 is restricted by the catch claw 43 of the clip body 35 being sandwiched between the loop portions 71 of the operation wire 23. In the illustrated example, all the clip units 13 are loaded in the outer sheath member 19 in series with the same rotational posture.
  • the operation wire 23 is inserted through each of the plurality of tightening rings 37, and the loop portion 71 of the operation wire 23 has an overall length corresponding to the length of the plurality of clip units 13 arranged and arranged in at least one row. .
  • the distal end of the loop portion 71 is the width of the locking claw 43, the retaining portion 45, and the proximal end portion 39 of the clip main body 35 shown in FIG. 3 of the clip unit 13 ⁇ / b> A located at the distal end of the outer sheath member 19. It is inserted into a gap 47 defined by the direction end face. That is, the operation wire 23 is locked to the locking claw 43 of the leading clip unit 13A. Further, the locking claws 43 of the rear clip units 13B, 13C, and 13D are in contact with the inner peripheral surface 37a of the tightening ring 37 in a state of entering the loop portion 71.
  • the clip main body 35 of each clip unit 13A, 13B, 13C, 13D aligned in a line has a pair of arm portions, and a pair of arm portions 41 of the clip main body 35 located at the rear are adjacent and positioned forward.
  • the clamping ring 37 is accommodated.
  • the loop portion 71 of the operation wire 23 is released from the engagement with the leading clip unit 13A. It can be locked to the locking claw 43 of the rear clip unit 13B.
  • the loop portion 71 can be sequentially locked to the locking claw 43, and continuous ligation can be performed by continuously extending each clip body 35. Become.
  • Other configurations are the same as the above-described configuration example.
  • FIGS. 13A to 13F are schematic perspective views showing a ligation procedure by a continuous ligation apparatus.
  • the ligation apparatus 100A also introduces the insertion portion 15 into the body cavity through the endoscope channel inserted in advance into the body cavity in the same manner as the single-shot ligation apparatus 100 described above. It is located at the ligation target site of the living tissue.
  • the pair of arm portions 41 of the clip unit 13A located at the head of the outer sheath member (not shown) is opened. Since the operations for opening and closing the arm portion 41 are the same as described above, the description thereof is omitted here.
  • the operation wire 23 is pulled with respect to the inner sheath member, and via the locking claw 43 of the leading clip unit 13A to which the loop portion 71 of the operation wire 23 is locked.
  • the clip main body 35 of the clip unit 13 ⁇ / b> A is pulled into the fastening ring 37.
  • the pair of arm portions 41 of the clip unit 13 ⁇ / b> A is closed by being guided by the clip contact portion 63 of the fastening ring 37, and the living tissue 81 is gripped between the tissue gripping portions 55 and 55.
  • the base end portion 39 of the clip main body 35 of the clip unit 13A is inserted into the arm portion 41 of the clip main body 35 of the rear clip unit 13B. Therefore, as shown in FIG. 14, the maximum width WF of the base end portion 39 in the arm portion 41 expanding direction with respect to the clip main body 35 of the clip unit 13A is elastically biased against the inner peripheral surface 37a of the fastening ring 37.
  • the opening width WR of the pair of arm portions 41 (tissue gripping portion 55) of the rear clip body 35 that is in contact is set to be smaller.
  • the axial length of the tightening ring 37 can be shortened, and the insertion portions 15 accommodated in the clip units 13A, 13B, 13C, and 13D aligned in a row can be easily bent.
  • the flexibility is improved, and the operability when inserted into the body cavity and the shape following ability to the body lumen are improved.
  • the insertion unit 15 of the ligating apparatus 100A is not inserted out of the body cavity and continuously inserted into the body cavity. Living tissue can be ligated. Therefore, efficient ligation is possible and the burden on the patient can be reduced.
  • FIG. 15 is a perspective view showing a state in which a plurality of clip units are arranged in a line with the opening directions of arms differing from each other by 90 °
  • FIG. 16 is an exploded perspective view of the clip unit
  • a plurality of clip units 42 each having a clip body 36 inserted into a fastening ring 40 are alternately arranged in the axial direction, and an outer sheath member (not shown) is shown. 19 are aligned in series.
  • the expanding direction of the arm portion 41 is different by 90 °.
  • the tightening ring 40 is also rotated 90 °.
  • the clip body 36 is provided with a base end portion 39 on the side inserted into the fastening ring 40, and extends from the base end portion 39. It is formed by bending a belt-shaped metal plate material having a pair of arms 41 and having spring properties such as stainless steel into a substantially U shape.
  • a pair of wire locking means of the clip main body 36 including the locking claw 44 and the retaining portion 46 are extended from both sides in the width direction of the base end portion 39 orthogonal to the arm portion expanding direction of the base end portion 39.
  • the parallel part 50 is bent in the plate thickness direction of the clip main body 36 (arm part expanding direction), and is arranged at a diagonal position of the base end part 39.
  • the locking claw 44 is inclined and extended so as to extend outward from the position on the bottom 39 a side of the base end portion 39 toward the arm portion 41 from the retaining portion 46.
  • the force required for plastic deformation of the locking claw 44 is a plate-like body narrowed to such an extent that the force required to pull the clip main body 36 into the fastening ring 40 is larger.
  • the retaining portion 46 is a protruding portion that protrudes toward the locking claw 44 from a position spaced from the locking claw 44 toward the arm portion 41, and the protruding height toward the locking claw 44 has a clip body 36. And an inclined surface 46a that gradually increases in the direction of insertion into the tightening ring 40.
  • the locking claw 44 and the retaining portion 46 are formed by a parallel portion 50 that is bent and erected from the width direction end portion of the base end portion 39. As a result, as shown in FIGS. 16 and 17A, a gap for locking the loop portion 71 of the operation wire 23 by the locking claw 44, the retaining portion 46, and the parallel portion 50 of the base end portion 39. 47 is defined.
  • the force required to plastically deform the locking claw 44 is set to be larger than the force for pulling the clip body 36 into the tightening ring 40.
  • the clip body 36 has the locking claw 44 plastically deformed when the operation wire 23 is pulled while the loop portion 71 of the operation wire 23 shown in FIG. 15 is locked by the locking claw 44. Without being retracted into the tightening ring 40.
  • the tightening ring 40 includes a hollow cylindrical portion 61 and a pair of clip contact portions 63.
  • the pair of clip abutting portions 63 bends the projecting portion projecting from one end portion of the cylindrical portion 61 and has a flat surface parallel to the axis of the fastening ring 40.
  • the clip body 36 is guided by coming into contact with the outer surface, and the rotation of the clip body 36 with respect to the central axis of the tightening ring 40 is restricted.
  • a pair of guide pieces 69 and 69A that protrude toward the inside in the radial direction of the fastening ring 40 are formed on both sides of the clip contact portion 63.
  • the guide piece 69A on the side where the locking claw 44 abuts is formed so as to be inclined toward the inner side of the ring toward the insertion direction of the clip main body 36.
  • the locking claw 44 abuts on the inner side of the guide piece 69 ⁇ / b> A to prevent the clip main body 36 from coming out of the tightening ring 40.
  • the distance between the pair of guide pieces 69 is smaller than the width W2 of the wide portion 53 (similar to FIG. 4), and the step portion 57 between the wide portion 53 and the plate-like piece portion 51 abuts against the pair of guide pieces 69.
  • the insertion length of the clip body 36 into the tightening ring 40 is limited.
  • the clip unit 42 can be separated from other clip units.
  • the locking claw 44 When the clip main body 36 is inserted into the fastening ring 40, the locking claw 44 is elastically urged against and abuts on the inner peripheral surface of the fastening ring 40. Further, the inclined surface 46a of the retaining portion 46 guides the loop portion 71 and reliably inserts it into the clearance 47 for retaining the operation wire when the operation wire 23 is pulled.
  • Other configurations and effects are the same as those of the above-described configuration example, and thus description thereof is omitted.
  • the present invention is not limited to the above-described embodiments, and modifications and applications by those skilled in the art based on the description of the specification and well-known techniques are also within the scope of the present invention. It is included in the range to calculate.
  • a ligation apparatus for ligating living tissue A flexible introduction tube; An operation wire that is inserted into the introduction tube so as to freely advance and retract, and has a loop portion at the tip; A clip unit disposed inside the distal end of the introduction tube and connected to the operation wire; With The clip unit has a pair of arms that are urged to spread each other, a clip body that ligates a living tissue with a proximal end that connects the proximal ends of the arms, and a proximal end of the clip body A clamping ring that is inserted into the cylindrical body to close the pair of arms, and a wire locking means that is provided at a base end of the clip body and locks the loop portion of the operation wire.
  • this ligation apparatus when the living tissue is ligated, the relative position between the clip body and the tightening ring can be changed by pulling and feeding the operation wire, so that the clip can be freely opened and closed. Re-grabbing can be done with a simple operation.
  • the clip body and the operation wire are separated due to the deformation of the clip body's latching claw, no fragmentation occurs during the separation, and the fragmentation affects the living tissue or interferes with the ligation operation. There is no fear of it.
  • the retaining portion protrudes toward the locking claw from a position spaced from the connecting portion with the locking claw at the proximal end portion of the clip main body toward the arm portion, and between the locking claw
  • a ligating apparatus having a protrusion that defines a gap for locking the loop portion of the operation wire.
  • the operation wire is maintained in a state of being locked in the gap for locking the loop portion, and even if the operation wire is fed out, the operation wire may fall out of the clip body by the protrusion. Is prevented. Thereby, a clip main body can be advanced and retracted reliably and stably, and a tissue can be regripped smoothly.
  • the ligation apparatus according to (2) The ligation apparatus which has the inclined surface which the projection part of the said clip main body increased gradually the protrusion height toward the said latching claw toward the said insertion direction. According to this ligating apparatus, the operation wire to be pulled can be guided into the gap for locking the loop portion of the operation wire by being guided by the locking claw along the inclined surface of the protrusion, and the clip The main body and the operation wire can be securely locked.
  • the ligation apparatus according to any one of (1) to (4),
  • the pair of arm portions of the clip body is formed of a plate-like member having a predetermined width in a direction orthogonal to the expanding direction of the pair of arm portions,
  • a pair of clip abutting portions for restricting the rotation of the clip body by abutting the outer surfaces of the plate-like members in the pair of arm portions inserted into the clamping ring.
  • the rotation phase between the clip main body and the tightening ring can be maintained constant, and the operability for ligating living tissue can be improved.
  • the plate-like member that forms the arm portion of the clip body includes a wide end portion that has a stepped portion on the distal end side of the arm portion and is formed wider than the predetermined width,
  • the clip abutment portion of the tightening ring has a pair of guide pieces projecting toward the inside of the tightening ring at an interval wider than the predetermined width and narrower than the width of the tip wide portion;
  • a ligation apparatus in which an arm portion of the clip main body is inserted between the pair of guide pieces so as to be able to advance and retreat in the longitudinal direction of the clip, and the stepped portion contacts the guide piece.
  • the ligation apparatus according to (7) A ligating apparatus in which the latching claw of the clip main body is deformed in the pulling direction by pulling the operation wire, and the connection between the clip main body and the operation wire is released. According to this ligation device, the locking between the operation wire and the clip body is released by the deformation of the locking claw, so there is no generation of a broken piece due to the release of the lock, and the broken piece affects the living tissue. There is no possibility of causing trouble in the ligation operation.
  • a ligating apparatus in which a plurality of clip units each having the clip main body inserted into the clamping ring are arranged in the introduction pipe. According to this ligation apparatus, a plurality of clip units can be sequentially used for ligation of living tissue, which eliminates the need to pull out the ligation apparatus from the body cavity and re-insert it after ligation, thereby burdening the patient. Can be reduced.
  • a ligation apparatus and a clip unit that can perform opening and closing operations of a clip with a simple configuration when ligating a living tissue, and can freely grip the living tissue. Further, since the clip main body and the operation wire are separated by the deformation of the clip main body, the broken fragments are not left in the body cavity and the continuous ligation operation is not hindered.
  • Japanese application Japanese Patent Application No. 2010-212889

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Vascular Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Reproductive Health (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

La présente invention concerne un dispositif de ligature qui permet l'ouverture et la fermeture des bras d'une agrafe dont la configuration est simple, permettant ainsi de repositionner facilement sa saisie sur un tissu somatique, et qui ne génère pas de pièces de fracture. La présente invention concerne en outre une unité d'agrafe utilisée dans ledit dispositif de ligature. Le corps d'agrafe principal (35) ayant une extrémité de base (39) qui relie les bases d'une paire de bras ouverts et refermables (41, 41) et un moyen d'accrochage en fil, est inséré à l'intérieur d'une bague de compression (37) avec la paire de bras (41) fermés et est disposé à l'intérieur d'un tube d'introduction (19). Le corps d'agrafe principal (35) est configuré pour être avancé et retiré librement par un fil de commande (23) qui s'engrène avec un moyen d'accrochage de fil configuré à partir d'un crochet (43) et d'un arrêt de désengagement (45). L'engrènement du corps d'agrafe principal (35) avec le fil de commande (23) est libéré par la déformation plastique du crochet (43).
PCT/JP2011/062526 2010-09-22 2011-05-31 Dispositif de ligature et unité d'agrafe utilisée dans le dispositif Ceased WO2012039164A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
JP2010212889A JP5579004B2 (ja) 2010-09-22 2010-09-22 結紮装置及びこれに用いるクリップユニット
JP2010-212889 2010-09-22

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WO2012039164A1 true WO2012039164A1 (fr) 2012-03-29

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Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN115040184A (zh) * 2021-03-08 2022-09-13 奥林巴斯医疗株式会社 内窥镜用处置装置
WO2024125386A1 (fr) * 2022-12-13 2024-06-20 江苏唯德康医疗科技有限公司 Pince de fermeture de tissus mous

Families Citing this family (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2014181678A1 (fr) 2013-05-07 2014-11-13 オリンパスメディカルシステムズ株式会社 Instrument de traitement endoscopique
WO2014181676A1 (fr) * 2013-05-07 2014-11-13 オリンパスメディカルシステムズ株式会社 Instrument de traitement endoscopique
CN104936537B (zh) * 2013-05-07 2017-03-15 奥林巴斯株式会社 夹具单元

Citations (3)

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Publication number Priority date Publication date Assignee Title
JP2002272751A (ja) * 2001-03-14 2002-09-24 Olympus Optical Co Ltd 生体組織のクリップ装置
JP2007097664A (ja) * 2005-09-30 2007-04-19 Sumitomo Bakelite Co Ltd 内視鏡用クリップ
JP2009233309A (ja) * 2008-03-06 2009-10-15 Fujifilm Corp 連発式クリップ処置具

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Publication number Priority date Publication date Assignee Title
JPS60103946A (ja) * 1983-11-10 1985-06-08 オリンパス光学工業株式会社 生体組織のクリツプ装置
JP4059656B2 (ja) * 2001-03-07 2008-03-12 オリンパス株式会社 生体組織のクリップ装置
JP4727074B2 (ja) * 2001-07-09 2011-07-20 オリンパス株式会社 内視鏡用処置具

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2002272751A (ja) * 2001-03-14 2002-09-24 Olympus Optical Co Ltd 生体組織のクリップ装置
JP2007097664A (ja) * 2005-09-30 2007-04-19 Sumitomo Bakelite Co Ltd 内視鏡用クリップ
JP2009233309A (ja) * 2008-03-06 2009-10-15 Fujifilm Corp 連発式クリップ処置具

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN115040184A (zh) * 2021-03-08 2022-09-13 奥林巴斯医疗株式会社 内窥镜用处置装置
WO2024125386A1 (fr) * 2022-12-13 2024-06-20 江苏唯德康医疗科技有限公司 Pince de fermeture de tissus mous

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JP5579004B2 (ja) 2014-08-27
JP2012065834A (ja) 2012-04-05

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