JPH0741448Y2 - Biological tissue clip device - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION [Industrial field of application] The present invention relates to a clip device used for a living tissue site in a body cavity.

[Prior Art] Conventionally, there is known a treatment in which a treatment tool such as forceps is introduced into a living body cavity using an endoscope or the like, and the affected tissue in the body cavity is excised or electrically cauterized. ing.

In such treatment, there are problems in terms of therapeutic effect such as a large amount of bleeding occurring at the treated site and the excised wound is difficult to heal.

Therefore, in recent years, a method has been developed in which a tissue portion to be excised in a body cavity is grasped by a clip and the clip is left indwelling in the body cavity as it is. According to this method, the grasped tissue eventually becomes necrotic, falls off together with the clip, and is discharged to the outside of the body. Therefore, it is possible to solve the problem of the therapeutic effect when using forceps and eliminate the therapeutic risk.

A clip device of this type is disclosed in Japanese Utility Model Publication No. 53-20957. An example thereof is shown in FIGS. 12 to 14 below.

That is, as shown in FIG. 12, this clip device is provided with a clip b having a pair of fitting portions a and having an open-expanding property, and a clip fastening member having an inner diameter narrower than the distance between the pair of fitting portions a. A ring-shaped clip c and a connecting member d constitute a cassette-type clip e. Further, the cassette-type clip e is detachably attached to a hook h at the tip of an operation wire g in a clip device body f. I try to wear it.

When this is used, as shown in FIG. 13, the cassette type clip e and the operating member i are pulled into the introduction pipe j and stored while the clip e is closed. In this state, it is introduced into the body cavity through the forceps channel of the endoscope and guided to the target site. When the target portion is reached, the tip ends of the cassette type clip e and the operating member i are projected from the introducing tube j, and the operating wire g is pulled toward the hand side as shown in FIG. This makes clip b
Is drawn into the clip tightening ring c, and the clip b
Are opened even larger than the state shown in FIG.

The tissue is positioned in the opening portion of the clip b, the operation wire g in the clip device main body f is pulled from the proximal side, the clip tightening ring c is relatively extended and fitted in the fitting portion a, and the cassette type Close the clip e. This sandwiches the tissue site. After that, the connecting member d is removed from the clip b and left in the body cavity. Clip device body f
Pull out of the body.

[Problems to be Solved by the Invention] In such a clip device, in order to maximize the opening amount of the clip b, the interval between the fitting portions a of the clip b is widened or the clip is tightened. Ring c
It is conceivable to make the inner diameter of the clip smaller or to increase the initial opening amount of the clip b as shown in FIG.

However, the first and second proposals for widening the interval between the fitting portions a of the clip b and for reducing the inner diameter of the clip tightening ring c are for drawing into the clip tightening ring c of the clip b. Increases the ability of.

Further, the third proposal for increasing the initial opening amount of the clip b as shown in FIG. 12 has a problem that the amount of force for drawing the clip b into the introducing pipe j increases.

That is, it is difficult to increase the opening amount of the clip b in the above-mentioned conventional method. Furthermore, in the body cavity,
There is a problem that the operation for grasping the tissue becomes difficult.

The present invention has been made in view of the above problems, and an object thereof is to provide a clip device for living tissue having a large opening amount of the clip.

[Means and Actions for Solving the Problems] In order to solve the above problems, the clip device of the present invention includes an introducing tube inserted into a living body cavity, an operating member inserted in the introducing tube so as to be able to move forward and backward, and this operation. An operation wire that is movable back and forth with respect to the member and is provided in the introduction pipe and has a hook at the tip, a clip tightening ring detachably attached to the operation member, and a state in which the hook is detachably attached to the hook and is normally opened. It is urged toward and is stored sideways in the introduction pipe along the opening opened in the pipe axial direction, and it is pulled out from the tip of the introduction pipe to pull the operation wire toward the hand side and tighten the clip. And a clip which is closed by being pulled into the attachment ring.

According to this configuration, since the clip is stored in the introduction tube as it is in a state where it is wide open, the opening amount of the clip can be increased. Therefore, the operation for grasping the tissue is easy.

[Embodiment] FIGS. 1 to 7 show a first embodiment of the present invention. 1 and 2 show the tip side portion of the clip device.

This clip device is composed of a clip device body 1 and a cassette-type clip 6 described later.

The clip device body 1 has an introduction pipe 2, and the introduction pipe 2 is formed by a flexible tube made of tetrafluoroethylene resin or the like. The introduction tube 2 can be introduced into the body cavity by using, for example, a forceps channel of an endoscope (not shown).

Although not shown, the operation portion is attached to the base end of the introduction pipe 2 through a tube joint.

An operation tube 4 which is a flexible tube as an operation member is inserted into the introduction tube 2 so that the operation tube 4 can advance and retreat in a state of being able to project and retract from the tip of the introduction tube 2. The operation tube 4 is, for example, a tightly wound stainless wire. A connecting ring 3 made of a short tube made of stainless steel or the like is attached and fixed to the tip of the operation tube 4, and is connected to a first operation body of an operation section (not shown) at the base end of the operation tube 4. The first operating body is slidably connected to the main body of the operating portion.

An operation wire 5 made of stainless steel, such as a twisted wire, is inserted into the operation tube 4 so as to be able to move back and forth. A second operating body (not shown) is connected to the proximal end of the operating wire 5. The second operating body is the same as the first operating body in the main body of the operating portion.
Is slidably connected to the operating body.

At the tip of the operation wire 5, there is a cassette type clip 6 which will be described later.
A hook 8 for detachably locking the connecting plate 7 is attached. The hook 8 is formed by cutting out one side surface portion of the tip end side of the cylindrical member, and a pin 9 perpendicular to the longitudinal direction of the hook 8 is provided so as to project on the cutout surface. The pin 9 is composed of a neck portion 10 and a circular head portion 11, and the connecting plate 7 is locked to the pin 9.

As shown in FIGS. 1 to 3, the cassette-type clip 6 is composed of a clip member 12, a connecting plate 7 engaged with the clip member 12, and a clip tightening ring 13.

First, for the clip member 12, a thin strip-shaped plate material made of stainless steel is bent into a ring shape in the middle portion to form the base end portion 14.
Further, curved portions 15 and 15 are formed at respective root portions extending from the base end portion 14 while intersecting with each other, and further extended from the curved portions 15 and 15 to form the arm portions 16 and 16. As shown in FIGS. 1 to 3, the arms 16 and 16 are spread apart from each other so that the angle between them is 180 °, and this state has a natural shape. Each arm 16,1
At the tip of 6, the sandwiching portions 17, 17 facing each other when the clip member 12 is closed are bent and formed.

The connecting plate 7 is configured as follows. That is, this is formed by punching out a thin strip made of stainless steel. A J-shaped hook 18 that engages with the base end portion 14 of the clip member 12 is formed at one end of the strip, and the operation wire is formed at the other end. A hole 19 having a daruma shape with which the hook 8 of 5 is engaged is formed. That is, as shown in FIG. 3, the hole 19 is continuous with a large-diameter hole 20 through which the head 11 of the pin 9 of the hook 8 can be inserted, and from the large-diameter hole 20 to the other end side, and with the neck 10 of the pin 9. The long holes 21 having the same diameter are formed. The hook 18 of the connecting plate 7 is formed so that it can be stretched if a constant force is applied.

Further, the clip tightening ring 13 is formed by a pipe having a step on the outer circumference so that it can be engaged with and disengaged from the connecting ring 3.
The small diameter portion is formed smaller than the inner diameter of the connecting ring 3, and the large diameter portion is formed larger than the inner diameter of the connecting ring 3.

Then, in the cassette type clip 6, the hook 18 of the connecting plate 7 is engaged with the base end portion 14 of the clip member 12, the connecting plate 7 is inserted from the thicker outer diameter of the clip tightening ring 13, and the state Then, the clip fastening ring 13 is filled with a filler made of, for example, silicone and temporarily fixed to be assembled.

Next, the operation when the clip device for living tissue is used will be described.

First, the cassette-type clip 6 is attached to the hook 8 of the clip device body 1. In this mounting method, the operation tube 4 is projected from the tip of the introduction tube 2, and as shown in FIG. 3, the large diameter hole 20 of the hole 19 of the connecting plate 7 of the cassette type clip 6 is inserted.
After inserting the pin 9 of the hook 8 into the, the cassette type clip 6 is pulled toward the tip side. By this action, the hole 19 of the connecting plate 7
The slot 21 of the hook engages with the neck 10 of the hook 8. Then, in this engaged state, the operation wire 5 is pulled toward the hand side, and the hook 8 is fitted into the connecting ring 3. Then, the operation tube 4 is pulled into the inside of the introduction tube 2, and further, as shown in FIG. 2, the clip member 12 is opened and stored in the distal end portion of the introduction tube 2 in a sideways state. That is, the clip member
As shown in FIGS. 1 to 3, the twelve arm portions 16, 16 are spread out so that the angle formed by each arm portion is 180 °, and the arm portions 16 and 16 are placed in the introduction tube 2 while being biased to the naturally open state. It is accommodated along the tube axis along the open opening. Therefore, in this stored state, the arms 16, 16 of the clip member 12 are
Are arranged laterally along the inner peripheral surface of the introduction tube 2 and along the longitudinal direction of the introduction tube.

In this way, the cassette-type clip 6 is attached to the clip device main body 1
After being loaded into the living body, the whole introduction tube 2 is introduced into the living body cavity through the forceps channel of the endoscope.

Under the observation with the endoscope, the operation tube 4 is pushed from the tip of the introduction tube 2 so that the clip member 12 is projected outside from the tip of the introduction tube 2. Then, by pulling the operation wire 5 toward the proximal side, the curved portions 15, 15 of the clip member 12 are pulled into the clip tightening ring 13. As a result, as shown in FIG. 4, both arms 16 and 16 are oriented in the direction perpendicular to the axial direction of the clip device body 1, and in this state, they are pressed against the living tissue 22 requiring clipping.

Therefore, the operation wire 5 is pulled toward the hand side. By this action, the arm portions 14, 14 of the clip member 12 come into contact with the opening portion of the clip fastening ring 13 and are drawn into the clip fastening ring 13, so that the arm portions 14, 14 of the clip member 12 are closed. The sandwiching parts 17, 17 sandwich the living tissue 22.

Here, by further pulling the operating wire 5 toward the hand side, as shown in FIGS. 5 and 6, the hook 18 of the connecting plate 7
Is extended and the clip member 12 is disengaged from the connecting plate 7. At this time, since the clip fastening ring 13 fastens and fits the arm portions 14, 14 of the clip member 12,
As shown in the figure, they are integrally connected without coming off from the clip member 12, and are left inside the body together with the clip member 12.

Then, when the living tissue 22 is killed by the death, the cassette type clip 6 is naturally discharged to the outside of the body through the digestive tract along with this.

According to the above configuration, the clip member 12 can be housed in the introduction tube 2 in the open state, so that the clip member 12 can be set to have a large opening amount. Therefore, the operation for grasping the tissue 22 is easy.

FIG. 8 shows a second embodiment of the present invention.

In the clip member 12 in this embodiment, bent portions 23, 23 that are bent toward the closing direction of the clip member 12 are formed in the vicinity of the tips of the both arm portions 16, 16. The other structure is the same as that of the first embodiment.

Since the bent portions 23, 23 are formed in the vicinity of the distal end portions of the both arm portions 16, 16 as described above, the amount of force for grasping the living tissue becomes stronger than that of the first embodiment. Other functions are the same as above
Is the same as that of the embodiment.

FIG. 9 shows a third embodiment of the present invention.

In this embodiment, the distal end side portion of the introduction tube 2 in which the clip member 12 is accommodated sideways is configured as an enlarged opening portion 24 having an inner diameter larger than that of the portion on the proximal side. The other points are the same as those in the first embodiment.

According to this structure, when the clip 2 is housed in the introduction tube 2, the clip member 12 that is easily biased to the side is provided.
It is easily stored in the enlarged opening 24 of the. Therefore, it is easy to store the clip 2 in the introduction tube 2.

In addition, since only the diameter of the portion for housing the clip member 12 is thick, the diameter of the introduction tube 2 on the proximal side can be minimized. Therefore, since the clearance between the clip device and the forceps channel of the endoscope is increased, the air supply, water supply, and suction properties of the endoscope are improved, and the insertability of the clip device into the forceps channel of the endoscope is improved. .

FIG. 10 shows a fourth embodiment of the present invention.

In this embodiment, a reinforcing pipe member 25 made of, for example, stainless is fitted and fixed to the inner surface portion of the enlarged opening 24 of the third embodiment.

If the pipe member 25 is provided on the inner surface of the enlarged opening 24 as described above, when the clip member 12 of the clip 2 is housed in or ejected from this part, both the sandwiching portions 17 and 17 of the clip member 12 can be inserted. It does not come into direct contact with the inner surface portion of the introduction tube 2 made of a flexible tube. Therefore, it is possible to prevent the tube material of the introduction tube 2 from being scraped, scratched, or the like. It is possible to prevent the introduction pipe 2 from being damaged due to the insertion / removal of the clip 2 and improve its durability. Further, slipping when the clip member 12 is housed or projected can be improved.

FIG. 11 shows a fifth embodiment of the present invention.

In this embodiment, as shown in FIG. 11, the arms 16, 16 of the clip member 12 naturally open at an angle of 180 ° or more, for example 190 °.
And The other points are the same as those in the first embodiment.

In this way, when the clip member 12 is drawn into the introduction tube 2 and is projected, the two clamping portions 17, 17 of the clip member 12 are less likely to contact the inner surface portion of the introduction tube 2. Moreover,
As shown in FIG. 11, normally, only one side of the sandwiching portion 17 is in contact, so that the force required for pulling in and out of the introducing tube 2 can be reduced as compared with the above-described embodiments.

[Advantage of the Invention] As described above, according to the present invention, the opening amount of the clip can be increased because the clip is laterally accommodated in the introduction pipe in the opened state. Therefore, the operation for grasping the tissue is easy.

[Brief description of drawings]

1 to 7 show a first embodiment of the present invention, and FIG. 1 is a side sectional view of a distal end portion of a clip device for living tissue,
2 is a sectional view taken along the line AA in FIG. 1, FIG. 3 is a perspective view of the clip, FIGS. 4 and 5 are side sectional views of the tip portion of the clip device in use, and FIG. 5 is a cross-sectional view taken along the line BB in FIG. 5, and FIG. 7 is a cross-sectional view in which the clip holds the tissue. FIG. 8 is a perspective view of a clip showing a second embodiment of the present invention. FIG. 9 is a side sectional view of a tip portion of a clip device showing a third embodiment of the present invention. FIG. 10 is a side sectional view of a tip portion of a clip device showing a fourth embodiment of the present invention. FIG. 11 is a side sectional view of a tip portion of a clip device showing a fifth embodiment of the present invention. 12 to 14 show a conventional clip device for a living tissue, FIG. 12 is a perspective view of the clip, FIG. 13 is a side sectional view of the tip portion of the clip device, and FIG. 14 is a state of use. It is a sectional side view of the tip part of a clip device. 1 ... Clip device main body, 2 ... Introduction pipe, 4 ... Operation pipe, 5 ... Operation wire, 6 ... Cassette type clip, 12
...... Clip member, 13 ...... Clip tightening ring, 16 ...
... arms.

Claims (1)

[Scope of utility model registration request] 1. An introduction tube which is inserted into a living body cavity, an operation member which is inserted into the introduction tube so as to be able to advance and retreat, and an insertion member which is made to advance and retract with respect to the operation member and is inserted into the introduction tube and is provided with a hook at a tip thereof. An operation wire, a clip tightening ring detachably attached to the operation member, and an opening opened in the introduction tube which is detachably attached to the hook and is urged to a normally open state. And a clip that is stored laterally along the pipe axis direction and is pulled out from the tip of the introduction pipe to pull the operation wire toward the proximal side and pull it into the clip tightening ring to close the clip.
A clip device for biological tissue, comprising: