WO2004082488A1 - クリップ及び生体組織のクリップ装置 - Google Patents
クリップ及び生体組織のクリップ装置 Download PDFInfo
- Publication number
- WO2004082488A1 WO2004082488A1 PCT/JP2004/003468 JP2004003468W WO2004082488A1 WO 2004082488 A1 WO2004082488 A1 WO 2004082488A1 JP 2004003468 W JP2004003468 W JP 2004003468W WO 2004082488 A1 WO2004082488 A1 WO 2004082488A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- clip
- living tissue
- handle
- tip
- gripping member
- Prior art date
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/128—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips
- A61B17/1285—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, 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, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/122—Clamps or clips, e.g. for the umbilical cord
Definitions
- the present invention relates to a clip used as a treatment tool for an endoscope for performing ligation of a bleeding site of a living tissue, severing of a tear, and marking at the time of mucosal tissue resection through an endoscope, and a clip of a living tissue.
- Clips used as endoscopic treatment instruments are used in many cases, such as ligating bleeding sites with endoscopes, creased tears, or used as a masking for mucosal resection. Used.
- the clipping device for living tissue disclosed in Japanese Utility Model Laid-Open Publication No. 62-170010 discloses a clip 801 having expandability and a clip tip. Close It is composed of a clip tightening ring 802 and a connecting plate 803 that can be attached to and detached from an operation wire with a hook attached to the tip (not shown).
- the clip device 800 of the living tissue attaches a connecting plate 803 to a hook, and the open end of the clip 8001 is attached to the lesion via an endoscope.
- the clip 800 is moved so as to be drawn into the clip tightening ring 8002 and the opening is opened.
- the part closes and pinches the lesion.
- a force toward the base end side of the clip 801 acts on the clip tightening ring 802.
- Ligation must be performed. Such re-treatment is painful for the patient.
- Japanese Patent Application Laid-Open No. 50-77597 discloses a tissue clip device in which a tissue in a body is grasped by a clip endoscopically and the clip is placed.
- the clip is attached directly to the hook provided at the tip of the operation wire.Therefore, when placing the clip, the clip device must be moved back and forth and left and right to remove the clip from the hook.
- the method of use is complicated.
- Japanese Utility Model Laid-Open Publication No. 2-61011 discloses a clip device 900 which has solved the above-mentioned problems.
- This clip device 900 has a hook 902 provided at the distal end of the operation wire 901, and an engagement hole 904 at one end for engaging with the pin 906 of the hook 902, and The other end is provided with a connecting member 903 having a hook (not shown) which is connected to a clip and can be deformed by stretching.
- an operating wire 901 is provided.
- the connecting plate 903 is moved to the near side through the hook, the hook of the connecting plate 904 is extended, and the engagement state between the clip 905 and the connecting plate 903 is released. .
- this clip device 900 improves the complicated operation of detaching the clip from the hook, the connecting plate 9 remains connected to the operation wire 9101 even after the clip is placed. Since 03 is engaged, the connecting plate 903 must be removed after being taken out of the endoscope, and there is a problem of discarding the connecting plate 903 which has become an unnecessary part. In addition, since the connecting plate 903 is small, it is rarely sucked into the suction port of the endoscope, which causes a problem of poor suction. In addition, as a common problem of the clip device described in Japanese Patent Application Laid-Open No. 50-77597 and Japanese Utility Model Application Laid-Open No. 2-61011, when the clip is mounted on the clip device, the hook is cantilevered. Therefore, there was a problem that the balance was poor and the clip was likely to come off the hook.
- Japanese Utility Model Laid-Open Publication No. 1777703 discloses a clip device to which a ratchet mechanism including a ratchet locking claw and an engaged claw is applied.
- the pitch of the claw to be locked is formed finer than that of the claw, or at least two sets of the claw and the claw are arranged, and one phase is maintained without changing the pitch of the claw. This is to reduce the movement pitch as a whole by pulling the wire that secures the clip, opening the clip to the maximum open position, closing the clip by pulling the wire, and finally destroying the connecting plate and clipping. It is to release.
- the moving amount of the operating member can be finely operated by the ratchet mechanism, but the clip is securely stopped at the intended position because the mounting and opening of the clip are performed by the ratchet mechanism.
- the operator has to perform the position adjustment operation while watching the clip, and there is a problem that the operation is complicated.
- the clipping device 900 described in Japanese Utility Model Application Laid-Open No. 2-61011 is designed such that the operation of engaging the pin 906 of the hook and the small engaging hole 904 of the connecting plate 903 is as follows. It was difficult to attach the clip 905 because it was performed in a dimly lit endoscope room. Also, since the handle is operated while the pin 906 is engaged with the engagement hole 904, the pin 906 comes off during the operation of the handle. Or something. Furthermore, in many cases where the lesion had to be grasped with clips, it was difficult to perform the task quickly.
- Japanese Patent Application Laid-Open No. 2000-335635 discloses an endoscope clip package in which an endoscope clip can be stored between base materials. I have. According to this endoscope package, sterilization is facilitated by preliminarily sterilizing the package. However, in order to attach the clip from the clip package for endoscope to the clip device, the clip package for endoscope must be opened halfway from the top of the package so that the clip is not directly touched. With one hand holding the clip, and the other hand holding the handle and the operating member, the hook pin had to be hooked into the small engagement hole in the connecting plate. Such an operation requires skill and is complicated.
- an object of the present invention is to reliably pinch a lesion over a long period of time in ligation of a bleeding site in a living tissue, severing of a tear, and marking in mucosal tissue resection through an endoscope.
- An endoscope treatment tool clip is provided.
- Another object of the present invention is to provide a clipping apparatus for living tissue which does not require the user to check the degree of opening of the clip and does not require fine position adjustment. It is another object of the present invention to provide a clipping device for living tissue, which does not require complicated operations for mounting and removing the clip. Disclosure of the invention
- the present invention comprises a self-expanding clip main body having a clamping portion at a distal end and both arms extending from a base end portion, and a tightening ring, wherein the self-expanding clip main body is a clip base.
- a first recess at an end, and a second recess between the first recess and the tip of the clip Used as an endoscope treatment tool that is attached to the first concave portion and slides from the mounting position of the first concave portion by an external force to be mounted in the second concave portion to close the holding portion at the tip of the clip body.
- the present invention provides an outer tube that can be inserted into a living body cavity, an operation member that is inserted into and retracted from the outer tube, and an operation wire that is inserted into and retracted from the operation member.
- An object of the present invention is to provide a clipping device for living tissue provided with a self-expanding gripping member that is opened and closed by the advancement and retreat of the operation member attached to the distal end of the operation wire.
- the present invention provides a self-expanding clip main body having a holding portion at a distal end and having both arms extending from a proximal end, and a movable body in a distal direction mounted in a concave portion of the proximal end.
- An object of the present invention is to provide a clip holder having one or two or more clip storage grooves for storing a clip including a fastening ring in a state of being immersed with its tip directed downward.
- FIG. 1 is a perspective view of the clip of the present embodiment
- FIG. 2 is a view showing a closed state of the clip of FIG. 1
- FIG. 3 is a use form of the clip of FIG. Sectional view
- FIG. 4 is a perspective view showing a part of the distal end side of the living tissue clip device of the present example
- FIG. 5 is a view showing a state in which the clip is mounted
- FIG. 6 is a view showing a state in which the clip is closed.
- FIG. 7, FIG. 7 is a view showing a state in which a closed clip is removed
- FIG. 8 is a cross-sectional view of the distal end side of the clip device in which the description of the clip is omitted
- FIG. 9 is a vertical cross-sectional view of FIG.
- FIG. 0 is a view showing a modified example of the living tissue clip device of the present example
- FIG. 11 is a perspective view showing a part of the living tissue clip device in the second embodiment
- FIG. FIG. 13 is a cross-sectional view showing a part of the clipping device for living tissue of the present embodiment
- FIG. 13 is an exploded view of the clipping device for living tissue of the present example
- Fig. 16 is an enlarged view of the operating wire
- Fig. 15 is a view of the operating wire viewed from above
- Fig. 17 (A) is a diagram showing the abutting relationship between the operating member and the short slide
- FIG. 18 (A) is a view taken along the line AA
- Fig. 18 (B) is a front view showing a part of a handle shaft which is a component of the clip device of the present example
- (A) is a view of (B).
- Left side view Fig. 19 (B) is a front view of a rotating body which is a component of the clip device of this example, (A) is a left side view of (B), (C) is a right side of (B).
- Fig. 20 (B) is a front view of the position holding means which is a component of the clip device of the present embodiment, (A) is a left side view of (B), and Fig. 21 (B) is a view of the present embodiment.
- FIG. 25 is a perspective view of a clipping device for a living tissue in a state
- FIG. 25 is a front view of a mounting device to be attached to the clipping device for a biological tissue of this example
- FIG. 28 is a cross-sectional view of the clip holding member
- FIG. 28 is a diagram for explaining how to use the living tissue clipping device of the present example
- FIG. 29 is a diagram showing a state where the clip is held
- FIG. FIG. 31 shows a state in which the clip is housed in the outer tube
- FIG. 31 shows a state in which the clip with the closed end has come off the gripping member
- FIG. 32 is a perspective view of another clip holding member
- FIG. 3 and 34 are cross-sectional views for explaining how to use another clip holding member
- FIG. 35 is a cross-sectional view of a part of a conventional clip device
- FIG. 36 is another conventional clip device. It is a perspective view of a part of apparatus.
- the distal end means the living tissue side in a use state, and the proximal end is opposite to the living tissue. Say the side.
- the clip in the embodiment will be described with reference to FIGS.
- the clip 10 of this example is composed of a clip body 1 obtained by bending an elongated metal plate panel at the center and a cylindrical tightening ring 2. Become.
- the clip body 1 has a holding portion 3, 3 holding a living tissue at a distal end, a base end 4 having a substantially U-shaped cross-section, and a self-expanding arm at a distal end extending from the base end 4.
- Part 1 consists of 1 and 1 1
- the width w of the metal plate panel constituting the clip body is limited because it is inserted into the lumen of the operation member described later so as to be able to advance and retreat.
- the clip body 1 has a first concave portion 5 at the base end portion 4 and second concave portions 6 and 6 between the first concave portion 5 and the clip end portion, and the fastening ring 2 has the first concave portion 5. It is attached to.
- the installation site of the second concave portion 6 is not particularly limited as long as it is between the first concave portion 5 and the clip distal end portion and at a position where the holding portions 3 at the distal end of the clip come into close contact.
- a plate width step 69 is provided at the distal end side of the second recess 6 and the base end side of the step 69 is recessed, so that the tightening ring 2 slides from the mounting position of the first recess 5 by an external force.
- the degree of depression of the second concave portion 6 of the clip body is larger than that of the first concave portion 5 in that the fastening link 2 can be securely mounted.
- the holding portions 3 at the tip of the clip bend the tips of both arms inwardly and provide an uneven portion on the abutting surface, since the living tissue can be firmly held. .
- the clip 10 normally has the holding portion 3 at the distal end open, and in this state, the tightening ring 2 is attached to the first concave portion 5 of the base end 4. Have been.
- the tightening ring 2 attached to the first recess 5 does not naturally move back and forth unless an external force acts, because the hollow portion of the tightening ring 2 is caught in the concave portion.
- the opening width of the holding portion 3 is not reduced without being shifted to the distal end side.
- the material of the clip include stainless steel and titanium.
- the length of the arm portion of the clip is not particularly limited, but is preferably from 2.0 to 6.0 mm, and particularly preferably from 3.0 to 5.0 mm. When the length is within the above range, the gripping property of the clip is particularly excellent.
- a pair of self-expandable arm-shaped gripping members 8 attached to the distal end of the operation wire 7 of the clip device is attached to the inside of the substantially U-shaped cross-section 41 of the base end 4 of the clip 1. Hook on.
- the gripping member 8 is pulled into the lumen of the operation member 9, and the tightening ring 2 abuts on the distal end 91 of the operation member 9.
- the arms 11 of the clip body are gradually pulled into the inner space of the tightening ring 2 from the base end side of the clip, and the step is formed when it is pulled to the position of the second recess 6. 6 9 and the tightening ring 2 come into contact and the tightening ring 2 stops, and the holding parts 3 and 3 at the tip of the clip body 1 abut and hold the living tissue (not shown) (Fig. 2) .
- the operation wire 7 is pulled in the opposite direction, that is, pushed forward, the self-expanding gripping member 8 is automatically disengaged from the base end 4 of the clip.
- the clip body 1 in the closed state since the tightening ring 2 is firmly fixed to the recessed portion of the second concave portion 6, the clip body 1 is related to the size of the living tissue to be clamped. Since it can be securely clamped without being detached immediately, it is possible to maintain the state where the biological tissue is clamped for a long period of time.
- the material of the clip body 1 is gold such as stainless steel and titanium alloy. Or plastics such as ABS resin, rigid vinyl chloride resin, polyamide and polyethylene are preferred because they do not corrode in the body cavity, especially in the stomach where digestive enzymes are secreted. In addition, it is necessary to use a material with a high paneling property in order to hold the closed state for a long period of time when holding the living tissue by holding the clip part 3 at the tip of the clip from an open state to a closed state. preferable.
- the material of the tightening ring 2 is not particularly limited, but may be the same as the material of the clip body 1 because it is used together with the clip body 1. Specifically, plastics such as fluororesins, polyamides, and silicone resins, or metals such as stainless steel and titanium alloys are preferable.
- a living tissue such as a lesion can be reliably held for a long period of time.
- FIG. 1 A clipping apparatus for a living tissue according to a first embodiment of the present invention will be described with reference to FIGS. 4 to 10.
- FIG. The clip device 20 for living tissue according to the embodiment of the present embodiment includes an outer tube 21 that can be inserted into a living body cavity, an operation member 22 that is inserted into the outer tube 21 so as to be able to advance and retreat, and an operation device.
- a self-expanding clip 10a is provided at the tip of the member 24 so as to be detachably attached to the holding member by closing the holding member and has a holding portion for holding the living tissue.
- the base end of the operation wire 23 is connected to a handle (not shown).
- the material of the operation member 22 is not particularly limited, and examples thereof include thermoplastic resins such as polyetheretherketone, polyamide, and polyimide, and thin metal coils.
- Thermoplastic resin is preferable in that it can reliably transmit the movement of the operation handle to the distal end, and thin metal coils have a gap due to bending or pulling. However, it is preferable because it has excellent flexibility and rigidity.
- the outer diameter of the operation member 22 is not particularly limited, it is preferably 1.7 to 2.7 mm, and particularly preferably 1.9 to 2.2 mm.
- the operation wire 23 has a connection portion 25 having a gripping member 24 fixed at the tip and a step 26 slightly larger in diameter than the wire body. Further, a stopper is provided at a position where the stroke of the operation member is separated from the distal end of the operation member 22 to the base end side, and the operation wire main body can be inserted into the inner wall of the operation member 22 and contacts the step 26. 27 is provided to prevent the operating member 22 from excessively projecting and prevent the gripping member 24 from excessively entering the operating member 22.
- the material of the operation wire 23 is not particularly limited, but it is preferable that the whole or a part of the operation wire 23 has flexibility. Specific examples include metal wires such as stainless steel and carbon steel, and resin fibers such as polyamide, polyester, and ultrahigh molecular weight polyethylene.
- the outer tube 21 is a hollow elongated flexible member.
- the inner diameter of the outer tube 21 is not particularly limited, but is preferably 1.8 to 2.8 mm, and particularly preferably 2.0 to 2.0 mm.
- the length of the outer tube 21 is not particularly limited, but is preferably 1,500 to 3,000 mm, and particularly preferably 1,600 to 2,300 mm. When the length is within the above range, the operability particularly in the endoscope is excellent.
- the material of the outer tube 21 is not particularly limited. For example, a fluororesin such as polytetrafluoroethylene (PTFE) or tetrafluoroethylene-hexafluoropropylene copolymer resin (FEP) Is mentioned.
- PTFE polytetrafluoroethylene
- FEP tetrafluoroethylene-hexafluoropropylene copolymer resin
- the clip 10 a In the clip device 20 for living tissue, the clip 10 a
- FIG. 4 As shown in FIG. 4, if it is provided with both arms 11a having self-expanding properties and a fastening ring 12 for closing the holding portion 15 of both arms 11a, it is a special feature.
- the clip 10 shown in FIGS. 1 and 2 is preferred. A method of attaching the clip 10a to the clip device 20 for living tissue with the above configuration will be described.
- the operation wire 23 is fixed to the operation handle in the state shown in FIG. 4, and the operation member 22 is moved to the gripping member 24 side in the axial direction of the operation wire 23 by pulling the operation handle.
- the gripping member 24 including the pair of arms is gradually closed because it enters the base end side while being in contact with the inner peripheral surface of the operation member 22.
- the front end hook 28 of the operation member 22 is closed, and the base end portion 14 of the clip 10a is gripped to hold the clip 10a.
- the tightening ring 12 comes into contact with the tip of the operating member 22.
- the tightening ring 12 abuts on the step 13 in the middle of both arms of the clip 10a, and the The holding parts 15 and 15 of the cup close (Figs. 6 and 9) .O
- the operating member 22 is returned to the original position, so that the gripping member 24 projects from the operating member 22.
- the pair of arms are opened by the self-expanding property of the gripping member 24, and the clip 10a that has been closed can be removed.
- the clip device 20 for living tissue complicated operations are not required for mounting and removing the clip. Also, while the clip 10a is being held by the gripping member 24, even if the operating member 22 moves slightly, the gripping member 24 remains housed in the lumen of the operating member 22 and has a distal end. Since the hooks 28 overlap each other, the clip 10a does not fall easily. Also, even if the gap between the distal hooks 28 is slightly open, the width of the U-shaped section 41 of the base end 4 of the clip 10a is large. None fall from 4.
- the shape of the gripping member 24 is not limited to the above-described substantially V-shaped one, and may be, for example, a substantially U-shaped one 24a as shown in FIG. There may be.
- the load applied to the connection portion 25 due to the shape change can be dispersed.
- the panel characteristics are improved, and the tip can be closed more quickly than in a straight line.
- the shape of the curve can be any shape in consideration of the opening / closing operation timing of both arms and the panel characteristics.
- the method of operating the operation member 22 and the operation wire 23 is not limited to the above method.
- a method of fixing the operation wire 23 and moving the operation member 22, and a method of operating the operation wire 23 and operation A method of moving the members 22 together is given.
- the clipping device 20 for living tissue complicated operations are not required for attaching and detaching the clip, so that a system for clarifying an area where a treatment such as ligation or resection of a bleeding site of the living tissue is performed. It is extremely useful as a biological tissue clip device used for kings and the like.
- FIG. FIG. 12 omits the illustration of the slide cylindrical body 211 of FIG.
- the biological tissue clip device 30 of the present embodiment the same components as those of the biological tissue clip device 20 of the first embodiment are denoted by the same reference numerals, and description thereof will be omitted. Will be described. That is, the biological tissue clip device 30 is different from the biological tissue clip device 20 in that the biological tissue clip device 30 further includes a handle 51 for controlling the operating member, and moves the handle 51 forward and stops the advance of the handle 51.
- the first pushing mechanism to hold the handle 51, the holding mechanism to temporarily hold the stop position of the handle 51, the second pushing mechanism to further advance the stop position of the handle 51 and stop the advance of the handle, the handle 51 automatically
- a return mechanism is provided to return to the position before one push. That is, the clip device 30 is connected to the outer tube 21 and the outer tube 21 on the distal end side, and the hollow slide cylindrical body 21 1 1 provided with the connection flange 21 on the base end side. And a main body 6 1 having a main chamber in which the tip side fits into the inner cavity of the slide cylindrical body 211.
- Stop means 63 located on the distal end side which is fixedly mounted in the main room of the device main body 61, and position holding which is fixedly mounted in the main room adjacent to the stop means 63 on the base end side
- the handle 51 includes an annular grip portion 5 11 1 and a handle shaft 5 1 2 having one end connected to the grip portion 5 11 1 and the other end having a crown-shaped first cam portion 5 14 ⁇ Grip portion 5
- Reference numeral 11 denotes an operation that the operator grasps with his / her hand and has a space in which the operator's finger can be inserted.
- the first cam portion 514 is an annular protrusion having six triangular protrusions having valleys formed at every 60 degrees on the end surface of the cylindrical member.
- the first cam portion 5 14 moves in the stopping means 63 and the position holding means 64.
- the first cam part 5 14 engages with the three locking blades 65 3 of the rotating body 65 to reduce the forward force and the rotating force of the handle. Give 6 to 5.
- Some drawings have different shapes around the connecting portion between the annular gripper 511 and the handle shaft 5112 in terms of drawing.
- the position holding means 64 is a cylindrical member fixed to the main chamber 615 of the apparatus main body 61, and determines the storage position of the rotating body 65 in a state before the operation. This guides the rotating body 65 forward and guides the rotating body to the start position of the second pushing.
- a cam groove 642 having six notch portions 645 each having a cross section of a saw blade is provided on the circumferential edge of the opening on the tip side. The cam groove 642 gives a maximum rotation of 60 degrees when the tip of the blade member 653 of the rotating body comes into contact with the slope of the notch 645 by the bias of the spring.
- the slope of the notch 645 is formed so as to be inclined in a counterclockwise direction when viewed from the tip side.
- the stopping means 63 is a cylindrical member fixed adjacent to the distal end side of the position holding means 64 in the main chamber of the apparatus main body 61, and stops the rotating body 65 entering by the first pushing operation.
- the second pushing operation guides the entry of the rotating body 65.
- the stopping means 63 has three ribs 631, extending on the inner peripheral surface from the front end side to the middle in the axial direction (the length of the symbol m in FIG. 22).
- the three ribs 631 are formed at intervals of 120 degrees, and one rib is formed at a position of 50 degrees counterclockwise with respect to the vertical axis when viewed from the tip side.
- the stop means 63 is installed in the main room of the apparatus main body 61, and the opening at the tip thereof is in contact with the wall of the main room. Therefore, the rotating body 65 does not protrude from the stopping means 63 toward the distal end.
- the length 1 of the stopping means 63 is the forward stroke of the rotating body 65.
- the rotator 65 engages with the first cam portion 514 at the tip of the handle shaft, and moves forward, backward, or rotates in the position holding means 164 and the stopping means 163 to operate the rod-shaped member 171. It transmits power.
- the rotating body 65 has notches 654 at a pitch of 120 degrees and the substrate 651, which is located on the tip side, and extends above the substrate 651, in the axial direction and between the notches 654.
- a second cam portion 654 having a pointed cross section at one end on the base end side thereof, which is a plate-shaped blade member 653 provided at a pitch of 120 degrees.
- an engagement hole 655 is formed in the center of the rear surface of the substrate 651, in which the tip 731 of the rod-shaped member 71 engages.
- the rod-shaped portion 7 1 has a gripping member 24 attached to the distal end, and an operation wire 23 whose base end is fixed to the fixing ring portion 7 3.
- An operating member 22 having a restricting portion 741, and a slide short tube 75 having a window portion 751 formed on the outer peripheral surface of a cylindrical tube abutting on the restricting portion 741 at the base end side are provided.
- the base end portion 751 of the short slide tube 75 engages with an engagement hole 655 on the back surface of the substrate 651 of the rotating body.
- the fixing ring 73 is fixed to the distal end of the main body 61 slightly from the main chamber so that it does not interlock with the operation of the handle.
- a fixing ring portion 73 of the operation wire 23 is slidably fitted into the window portion 751 of the slide short tube 75.
- the operating member 22 is advanced by rotating the rotating body 65 (forward movement of the handle 51) to the spring 74 via the slide short tube 75, and is moved forward by the spring 74.
- the rotating body 65 retreats, it retreats in conjunction with this.
- the operation wire 23 is inserted into the operation member 22 so as to be able to advance and retreat, and the connecting portion 7 33 on the proximal end side slides through the window 7 51 of the short slide tube 75 so that the handle 5 Does not link with operation 1 (movement of operation member 2 2).
- the distal end opening 6 16 through which the operation member 22 enters and exits in order from the distal end side, the chamber 6 14 for accommodating the spring 74, and the fixing ring portion 73 of the rod-shaped member are fixed. It has a main part 161 in which a fixing part 617, a stopping means 63, and a position holding means 64 are stored, and an insertion port 161 in which the tip of the handle shaft is inserted.
- the device main body 61 has a first flange portion 611 and a second flange portion 612 attached to the cylindrical body from the base end side to enhance operability.
- the slide tubular body 211 is a member that operates to advance and retreat the hollow outer tubular pipe 21, and is a tubular body that is fitted into the distal end of the device main body 61.
- the distal end is connected to a hollow outer tube 21 to be inserted into the body cavity, and the proximal end is a fixed flange 21 having a convex portion (not shown) that fits into the concave portion 6 13 of the device main body. 3 is provided.
- the fixed flange 2 13 is provided with an engagement releasing means 2 14 for releasing the engagement between the slide cylindrical body 2 1 1 and the apparatus main body 6 1.
- An operation member 22 is inserted into the outer tube 21.
- the slide tubular body 211 attached to the device main body 61 is pulled out of the handle 51 in a state where the slide tubular body 211 is disengaged from the device main body 61, or the slide tubular body 211 is removed. If the operation of pushing in is performed, the outer tube 21 moves forward with respect to the operation member 22. As a result, both arms of the clip 10a are closed, and the clip 10a can be temporarily stored in the outer tube 21 with the clip 10a closed. This allows the endoscope to be When the tubular tube 21 is inserted, the lip 10a is housed in the outer tubular tube 21, so that the forceps hole of the endoscope is not damaged.
- the operation method of the clip device 30 includes a first pressing operation, a holding step, a second pressing operation, and a return step.
- the first pushing operation when the handle 51 is pressed, the first cam portion 514 at the tip of the handle comes into contact with the second cam portion 654 of the rotating body 65 (FIGS. 22 (a) and 2). 3 (a)).
- the first cam portion 514 and the second cam portion 654 are arranged such that the mountain-like tops of the cam portions are slightly shifted from each other.
- the mountain-like top portion 5 15 of the first cam portion 5 14 at the tip of the handle advances while contacting the mountain-like inclination of the second cam portion 6 54 of the rotating body.
- the rotating body 65 moves from the position holding means 64 to the inside of the stopping means 63.
- the rotating body 65 enters the stopping means 63 the first cam portion 514 and the second force portion 654 are completely engaged, and the rotating body 65 initially counterclockwise rotates. Rotate 30 degrees from position (first rotation).
- the rotating body 65 moves by the stroke n and hits the end face of the rib 631.
- the revolving body 65 retreats due to the elastic force of the spring 74, and the second cam portion of the revolving body 65 and the cam of the position holding means are moved. Grooves 6 4 2 engage.
- the tip of the second cam portion of the rotating body 65 rotates 60 degrees counterclockwise from the initial position along the inclination of the saw-shaped cam groove 642 (second rotation), and the cam groove Stop at the valley of 6 4 2 (Fig. 22 (c) and Fig. 23 (c)).
- the opening of the clip 10a is constant, it is not necessary to adjust the position by operating the handle finely.
- the operation method is to fix the operation wire 23 and move the operation member 22 when viewed relatively as described above.
- the method is not limited to this.
- the operation member can be fixed and the operation lever can be moved by reversing the positions of the spring, the rotating body, the stopping means, and the direction of the position holding means.
- the shape of the rotating body, the stopping means, and the position holding means it is possible to perform multi-step stopping and position holding.
- the clip device 30 of the second embodiment when ligation or resection of a bleeding site of a living tissue through an endoscope is performed, it is not necessary to check the degree of opening of the clip with the endoscope. Since the position adjustment by fine handle operation is not required, the treatment time can be shortened. In addition, by attaching a stop position with a fixed moving distance to the handle, a fixed amount of the distal end of the endoscope treatment tool can be moved in and out.
- FIG. 1 a clip device according to a third embodiment will be described with reference to FIGS. 24 to 31.
- FIG. In the clip device 40 according to the third embodiment, the same components as those of the clip device 30 according to the second embodiment are denoted by the same reference numerals, and the description thereof is omitted. The different points are mainly described. I do. That is, the clip device 40 differs from the clip device 30 in that a clip holding member 90 is attached to the outer peripheral surface of the device main body 61 near the second flange 612.
- the clip holding member 90 is a block body 91, and a clip storage groove 92 for storing the clip 10 in a state of being immersed with the tip of the clip 10 facing downward, and a guide that goes straight through the center of the storage groove 92.
- the groove 99 has three substantially cross-shaped grooves 94 in the direction perpendicular to the storage groove 92. Further, an engagement groove 94 for engaging with the mounting tool 80 is formed on the back surface of the block body 91. One end of the engagement groove 94 is closed to form a wall to facilitate positioning. That is, when the plate-shaped locking piece 81 of the mounting tool is completely engaged with the engagement groove 94, the clip holding member 90 is positioned substantially at the center of the apparatus main body 61.
- the clip storage groove 92 has a groove width slightly larger than the plate width of the both arm portions 11 and slightly wider from the deepest portion toward the surface.
- the depth of the clip storage groove 92 is such that the base end is slightly visible when the clip 10 is stored, and the length of the clip storage groove 92 is such that the clip 10 is in a natural state. Slightly smaller than open width. Thereby, when the clip 10 is stored in the storage groove 92, both arms are slightly closed so that the clip 10 can be stably stored.
- the shape of the guide grooves 93 is not particularly limited, but in this example, the top hooks 28 of the gripping members 24 are substantially U-shaped at the base end of the clip by using an arrow-shaped groove in plan view. It is easily guided by Part 41. It is preferable that the guide grooves 93 are colored with a luminescent paint since the guide grooves 93 can be recognized even in a dark endoscope room.
- the number of the clip storage grooves 92 formed in the block body 91 is one, two, or four or more in addition to the three described above.
- the material of the clip holding member 90 is not particularly limited, but it is preferable to use a transparent material since it is possible to externally observe whether or not the clip 10 is stored.
- the transparent material include resin materials such as acrylonitrile 'butadiene' styrene resin (ABS resin), polyethylene, polystyrene, polycarbonate, and acrylyl resin.
- ABS resin acrylonitrile 'butadiene' styrene resin
- the clip holding member 90 is stored in a sterilization bag (not shown) with the clip 10 stored in the storage groove 92, so that it is not necessary to perform a sterilization process for each operation. It is preferable because it is excellent.
- the attachment 80 is an adapter for attaching the clip holding member 90 to the cylindrical body of the device main body 61.
- the mounting device 80 is provided in the engagement groove 94 of the clip holding member 90 having a ring portion 82 mounted on the device main body 61 and a flange portion 82 provided above the ring portion 82. It consists of a plate-shaped locking piece 81 to be engaged.
- the description of the flange 213 of the slide cylindrical body 211 is omitted.
- the clip holding member 90 is taken out of the sterilization bag and fixed to the device main body 61. While holding the tip of the outer tube 21 by hand, press the tip of the gripping member 24 into the guide groove 93 of the clip holding member 90. In this case, there is no risk of contamination because the hand does not touch the clip 10 directly.
- the operating member 22 advances, and the distal end of the gripping member 24 attached to the distal end of the operating wire 23 closes, and the base end of the clip 10 is closed.
- Hold 4 Fig. 28, Fig. 29
- This operation can be done simply by holding the handle 51 with one hand and holding the outer tube 21 with the other hand.
- the clip 10 can be attached to the gripping member 24 by a simple operation of pushing the tip of the gripping member 24 into the guide groove 93.
- a ring portion 29 that comes into contact with the tightening ring 2 is provided on the distal end side of the operation member 22.
- the outer diameter of the ring portion 29 is substantially the same as the outer diameter of the tightening ring 2, and the tightening ring 2 can be advanced by moving the operating member 22.
- the operating member 22 advances with respect to the outer tube 21, so that the clip 10 protrudes from the outer tube 21, and the tip is opened.
- the clip 10 whose tip is open is pressed against the target site.
- the handle 5 1 pushes out the clip tightening ring 2 to the distal end side.
- the tightening ring 2 engages with the second concave portion 6 of the clip 10 to close the tip and sandwich the target portion of the living body. Since the tightening ring 2 pushed out by the operating member 22 is engaged with the second concave portion 6, the closed state of the clip is maintained.
- the handle 51 After closing the clip 10 and releasing the handle 51, the handle 51 returns to its original position by the return mechanism. At this time, since the operating member 22 is also retracted, the gripping member 24 is opened, and the closed clip 10 can be removed from the gripping member 24 (FIG. 31). Then, with the clip 10 left in the body, the gripping member 24 is pulled out of the body together with the endoscope. When the part gripped by the clip 10 becomes necrotic, the clip 10 comes off spontaneously and is discharged from the body.
- FIG. 1 In the clip holding member 90a, the same components as those of the clip holding member 90 are denoted by the same reference numerals, and description thereof will be omitted. Differences will mainly be described. That is, the difference between the clip holding member 90a and the clip holding member 90 is that one substantially cross groove is provided, and the guide groove 93a passes through the center of the storage groove and passes through the center. And the depth at the center of the guide groove is above the tightening ring 2 with the clip 10 stored, and the U-shaped base of the stored clip is The point is that the end has a depth at which the gripping member can be hooked. Further, it is not attached to the outer peripheral surface of the device main body 61, but is a member separate from the clip device. Examples of the shape of the guide groove 93 include a sector shape and the like in addition to the arrow shape and the rectangular shape in plan view.
- FIG. 33 is a sectional view of FIG. 32
- FIG. 34 is a view showing a state in which the gripping member 24 in FIG. 33 is closed.
- Clip 1 0 Press the tip of the gripping member 24 into the guide groove 93a of the clip holding member 90a mounted.
- the clip 10 is held by the gripping member 24 (FIG. 34).
- the clip 10 is taken out from the clip holding member 90a, and the attachment of the clip 10 to the clip device is completed.
- the second embodiment In addition to performing the same operation as the clip device 30 in the example, hold the handle 51 with one hand, hold the outer tube 21 with the other hand, and push the tip of the gripping member 24 into the guide groove 93. With this simple operation, the clip 10 can be attached to the gripping member 24. Therefore, even an operator who is not used to this operation can easily and efficiently perform the clip mounting operation. Industrial applicability
- the clip and the clip device of the present invention are extremely useful as a treatment tool used for ligation of a bleeding site of a living tissue, severing of a tear, and marking at the time of mucosal tissue resection through an endoscope.
Abstract
Description
Claims
Priority Applications (5)
Application Number | Priority Date | Filing Date | Title |
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KR1020057017392A KR101078544B1 (ko) | 2003-03-17 | 2004-03-16 | 클립 및 생체 조직의 클립 장치 |
US10/548,835 US20060259049A1 (en) | 2003-03-17 | 2004-03-16 | Clip and clipping instrument for biological tissues |
EP04721011A EP1604614A4 (en) | 2003-03-17 | 2004-03-16 | CLIP AND CLIP APPLICATOR FOR BIOLOGICAL TISSUE |
JP2005503687A JP4502134B2 (ja) | 2003-03-17 | 2004-03-16 | クリップ及び生体組織のクリップ装置 |
US12/500,884 US8419751B2 (en) | 2003-03-17 | 2009-07-10 | Clip and clipping instrument for biological tissues |
Applications Claiming Priority (10)
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JP2003-072747 | 2003-03-17 | ||
JP2003072747 | 2003-03-17 | ||
JP2003-073655 | 2003-03-18 | ||
JP2003073655 | 2003-03-18 | ||
JP2003-190806 | 2003-07-03 | ||
JP2003190806 | 2003-07-03 | ||
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US10/548,835 A-371-Of-International US20060259049A1 (en) | 2003-03-17 | 2004-03-16 | Clip and clipping instrument for biological tissues |
US12/500,884 Division US8419751B2 (en) | 2003-03-17 | 2009-07-10 | Clip and clipping instrument for biological tissues |
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WO2004082488A1 true WO2004082488A1 (ja) | 2004-09-30 |
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PCT/JP2004/003468 WO2004082488A1 (ja) | 2003-03-17 | 2004-03-16 | クリップ及び生体組織のクリップ装置 |
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US (2) | US20060259049A1 (ja) |
EP (2) | EP2522283A3 (ja) |
JP (1) | JP4502134B2 (ja) |
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WO (1) | WO2004082488A1 (ja) |
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US8690899B2 (en) * | 2004-12-24 | 2014-04-08 | Olympus Corporation | Ligation apparatus |
JP2007097664A (ja) * | 2005-09-30 | 2007-04-19 | Sumitomo Bakelite Co Ltd | 内視鏡用クリップ |
JP2007097663A (ja) * | 2005-09-30 | 2007-04-19 | Sumitomo Bakelite Co Ltd | 内視鏡用クリップ |
JP2009538699A (ja) * | 2006-06-01 | 2009-11-12 | ウィルソン−クック・メディカル・インコーポレーテッド | クリップ器具用解除機構 |
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JP2015192725A (ja) * | 2014-03-31 | 2015-11-05 | 日本ゼオン株式会社 | 留置スネア用結紮装置 |
JPWO2015151629A1 (ja) * | 2014-03-31 | 2017-04-13 | 日本ゼオン株式会社 | 内視鏡用処置具 |
US10441292B2 (en) | 2014-10-24 | 2019-10-15 | Kaneka Corporation | Clip device for endoscope |
JP2019514513A (ja) * | 2016-04-21 | 2019-06-06 | ゼンフロー, インコーポレイテッド | インプラントおよび展開デバイスのためのシステムおよび方法 |
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US11903859B1 (en) | 2016-12-09 | 2024-02-20 | Zenflow, Inc. | Methods for deployment of an implant |
WO2022209691A1 (ja) * | 2021-03-31 | 2022-10-06 | 日本ゼオン株式会社 | 内視鏡用処置具 |
Also Published As
Publication number | Publication date |
---|---|
EP1604614A1 (en) | 2005-12-14 |
US8419751B2 (en) | 2013-04-16 |
EP2522283A3 (en) | 2012-11-28 |
EP2522283A2 (en) | 2012-11-14 |
KR101078544B1 (ko) | 2011-11-01 |
JPWO2004082488A1 (ja) | 2006-06-22 |
US20090275958A1 (en) | 2009-11-05 |
KR20050110013A (ko) | 2005-11-22 |
US20060259049A1 (en) | 2006-11-16 |
JP4502134B2 (ja) | 2010-07-14 |
EP1604614A4 (en) | 2010-03-10 |
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