Suture tightening member

Abstract

The present invention provides a suture tightening member capable of easily and reliably suturing and tightening a mucosal defect part of a digestive tract wall, the suture tightening member (100A) being used for suturing and tightening the mucosal defect part of the digestive tract wall, the suture tightening member (100A) being characterized by comprising: a pair of arm plate parts (120, 130) for connecting the pair of arm plate parts (120, 130); the first and second end portions (126, 136) are disposed such that the distance between the first and second end portions (126, 136) increases in a state without external force. A connecting plate section (110) that connects the arm base end sections (121, 131) of the pair of arm plate sections (120, 130); and tip claw sections (150, 160) provided on respective tip sections (126, 136) of the pair of arm plate sections (120, 130) so as to face each other, one arm plate section (120) of the pair of arm plate sections (120, 130) being longer than the other arm plate section (130).

Description

TECHNICAL FIELD

[0001] The present application relates to a suture-tightening member for suturing and tightening a mucosal defect portion of a digestive tract wall. BACKGROUND

[0002] In the past, as a surgery for resecting a lesion portion generated in a digestive tract wall such as a large intestine, an esophagus, a stomach, and the like, an endoscopic submucosal dissection (ESD) is known.

[0003] In the ESD, a suture-tightening member in the shape of a clip is sometimes used to suture and tighten a resection scar (wound) that is a mucosal defect portion generated by resecting the entire lesion portion including a submucosal layer. The suture-tightening member is attached to a distal end of a catheter (clip device) of a treatment instrument guide tube of an endoscope, is guided to the vicinity of the mucosal defect portion, and then, by operating an operation portion provided at a proximal end of the catheter, one arm plate portion and another arm plate portion in the shape of a clip are attached to the mucosa at the periphery of the mucosal defect portion and are closed in a manner of sandwiching the mucosal defect portion, thereby suturing and tightening the mucosal defect portion.

[0004] As the suture-tightening member, an endoscope clip described in Patent Literature 1, for example, is known. The endoscope clip described in Patent Literature 1 is configured to have: a pair of arm plate portions configured in a substantially H shape toward a tip end portion thereof; a link portion linking base end portions of the arm plate portions; a tightening ring constituted by a substantially cylindrical member slidably fitted on the base end portion side of the arm plate portions, which closes the arm plate portions by being slid to the tip end side of the arm plate portions; a claw portion formed by bending each tip end portion of the arm plate portions toward the inside of each other; and a protrusion portion whose tip end is formed near each tip end portion of the arm plate portions and is attached toward the inside of each other.

[0005] PRIOR ART DOCUMENTS

[0006] PATENT LITERATURE

[0007] Patent Literature 1: Japanese Patent Application Publication No. 2015-8858 SUMMARY

[0008] PROBLEMS TO BE SOLVED BY THE INVENTION

[0009] In the case of suturing and tightening a mucosa defect portion using a clamp-like suture and tightening member, it is necessary to hold the mucosa of one side edge of the mucosa defect portion (the proximal side) and the mucosa of the other side edge of the mucosa defect portion located on the opposite side of the edge (the inner side) in a manner of straddling the mucosa defect portion. In order to install one arm plate portion and another arm plate portion on the mucosa of the mucosa defect portion, it is necessary to approach the mucosa defect portion from a direction substantially perpendicular to the digestive tract wall. However, in practice, since the mucosa defect portion is approached from a direction substantially parallel to the digestive tract wall along the lumen axis of the digestive tract in which the mucosa defect has occurred, there is a problem that, when the suture and tightening member is installed, even if one arm plate portion is installed on the mucosa of the proximal side or the inner side of the mucosa defect portion, it is difficult to install another arm plate portion on the mucosa on the opposite side, the time required for the work is long, and the holding cannot be performed reliably.

[0010] In particular, the lengths of the pair of arm plate portions of the conventional clamp-like suture and tightening member are substantially the same as each other. Therefore, there is a problem that, even if one arm plate portion is installed on the mucosa of the proximal side of the mucosa defect portion, for example, another arm plate portion cannot reach the mucosa located on the inner side on the opposite side across the mucosa defect portion, and it is difficult to arrange the suture and tightening member in a manner of being substantially perpendicular to the digestive tract wall.

[0011] The present application has been achieved in view of the above-described problems, and an object thereof is to provide a suture and tightening member capable of easily and reliably performing suturing and tightening of a mucosa defect portion of a digestive tract wall.

[0012] Solution for solving the problem

[0013] In order to achieve the above-described object, the suture and tightening member of the present application for suturing and tightening a mucosa defect portion of a digestive tract wall is characterized by comprising: a pair of arm plate portions arranged in a manner that the separation distance of the arm plate portions from each other becomes larger toward the tip end portions in a state where no external force is applied; a link plate portion linking the arm base end portions of the pair of arm plate portions; and tip end claw portions provided in a manner of facing each other at the respective tip end portions of the pair of arm plate portions, wherein one arm plate portion is longer than the other arm plate portion.

[0014] According to the above-described structure, since one arm plate portion is longer than the other arm plate portion, it is possible to hold the mucosa of the inner side periphery of the mucosa defect portion with the tip end claw portion of one arm plate portion and hold the mucosa of the proximal side periphery of the mucosa defect portion with the tip end claw portion of the other arm plate portion in a state where the suture and tightening member is laid along the lumen axis of the digestive tract with respect to the digestive tract wall, approach the mucosa defect portion of the digestive tract wall along the lumen axis of the digestive tract, and easily and reliably perform suturing and tightening of the mucosa defect portion. Furthermore, the tip end claw portion of one arm plate portion can hold in a manner of protruding the digestive tract tissue of the mucosa defect portion, and suturing and tightening of the mucosa defect portion can be performed in a manner of promoting healing of the mucosa of the mucosa defect portion and the periphery thereof.

[0015] In the above structure, the suture tightening member of the present application can also have an intermediate claw portion 170 provided in the arm intermediate portion 123 of the one arm plate portion in such a manner as to extend in the direction toward the other arm plate portion.

[0016] According to the above structure, since the one arm plate portion has the tip claw portion provided in the tip end portion and the intermediate claw portion provided in the arm intermediate portion, the mucosa on the inner side periphery of the mucosal defect portion can be held by the tip claw portion of the one arm plate portion, and the mucosa on the inner side periphery of the mucosal defect portion or the digestive tract tissue of the mucosal defect portion can be held by the intermediate claw portion, and since the holding is performed by the intermediate claw portion in addition to the tip claw portion, the holding can be more firmly performed, and the mucosal defect portion can be reliably sutured and tightened. In particular, by holding the digestive tract tissue of the mucosal defect portion in such a manner as to be raised by the tip claw portion and the intermediate claw portion of the one arm plate portion, the suture tightening of the mucosal defect portion can be performed in such a manner as to further promote the healing of the mucosal defect portion and the mucosa on the periphery thereof.

[0017] In the above structure, the suture tightening member of the present application can also be such that the angle formed by the extension direction of the tip claw portion of the one arm plate portion and the length of the one arm plate portion is an acute angle, and the tip claw portion of the one arm plate portion extends in the direction toward the tip claw portion of the other arm plate portion.

[0018] According to the above structure, since the tip claw portion of the one arm plate portion extends in the direction close to the tip claw portion of the other arm plate portion, the separation distance between the tip claw portion of the one arm plate portion and the tip claw portion of the other arm plate portion can be reduced when the pair of arm plate portions is closed, and thus the holding force of the tip claw portion of the one arm plate portion and the tip claw portion of the other arm plate portion can be made stronger, and the mucosal defect portion can be reliably sutured and tightened.

[0019] In the above structure, the suture tightening member of the present application can also be such that the tip claw portions of the pair of arm plate portions each have a holding claw portion divided into two prongs, and the length of the holding claw portion provided in the one arm plate portion is longer than the length of the holding claw portion provided in the other arm plate portion.

[0020] According to the above structure, since the tip claw portion of the one arm plate portion can hold the mucosa on the inner side periphery of the mucosal defect portion in such a manner as to be embedded, the holding force of the tip claw portion of the one arm plate portion can be further enhanced, and the mucosal defect portion can be more reliably sutured and tightened. In addition, the holding can be performed in such a manner as to more raise the digestive tract tissue of the mucosal defect portion, and the suture tightening of the mucosal defect portion can be performed in such a manner as to further promote the healing of the mucosal defect portion and the mucosa on the periphery thereof. BRIEF DESCRIPTION OF DRAWINGS

[0021] Figure 1FIG. 1 is a perspective view showing one example of a suture tightening member of a first embodiment of the present application and a tightening member attached to the suture tightening member.

[0022] Figure 2 FIG. 2 is a side view showing one example of an open state of the suture tightening member of the first embodiment of the present application.

[0023] Figure 3 FIG. 3 is a side view showing one example of a closed state of the suture tightening member of the first embodiment of the present application.

[0024] Figure 4 FIG. 4 is a side view showing a clip device for delivering the suture tightening member of the first embodiment of the present application into a body.

[0025] Figure 5 FIG. 5 is a cross-sectional view taken along the line A-A of FIG. 4. Figure 4

[0026] Figure 6 FIG. 6 is a side view showing a part of a link hook and a drive wire constituting the clip device for delivering the suture tightening member of the first embodiment of the present application into a body.

[0027] Figure 7 FIG. 7 is a view showing a state in which the suture tightening member of the first embodiment of the present application protrudes from a distal end of the clip device.

[0028] Figure 8 FIG. 8 is a view showing a state in which the suture tightening member of the first embodiment of the present application is accommodated in the distal end of the clip device.

[0029] Figure 9 FIG. 9 is a view showing a first process of suture tightening using the suture tightening member of the first embodiment of the present application.

[0030] Figure 10 FIG. 10 is a view showing a second process of suture tightening using the suture tightening member of the first embodiment of the present application.

[0031] Figure 11 FIG. 11 is a view showing a third process of suture tightening using the suture tightening member of the first embodiment of the present application.

[0032] Figure 12 FIG. 12 is a perspective view showing one example of a suture tightening member of a second embodiment of the present application and a tightening member attached to the suture tightening member.

[0033] Figure 13 FIG. 13 is a side view showing one example of an open state of the suture tightening member of the second embodiment of the present application.

[0034] Figure 14 ​A side view for showing one example of a closed state of the suture tightening member of the second embodiment of the present application.

[0035] Figure 15 A view for showing a first step of suture tightening using the suture tightening member of the second embodiment of the present application.

[0036] Figure 16 A view for showing a second step of suture tightening using the suture tightening member of the second embodiment of the present application.

[0037] Figure 17 A view for showing a third step of suture tightening using the suture tightening member of the second embodiment of the present application.

[0038] Figure 18 A perspective view for showing one example of the suture tightening member of the third embodiment of the present application and a tightening member attached to the suture tightening member.

[0039] Figure 19 A side view for showing one example of an open state of the suture tightening member of the third embodiment of the present application.

[0040] Figure 20 A side view for showing one example of a closed state of the suture tightening member of the third embodiment of the present application.

[0041] Figure 21 A view for showing a first step of suture tightening using the suture tightening member of the third embodiment of the present application.

[0042] Figure 22 A view for showing a second step of suture tightening using the suture tightening member of the third embodiment of the present application.

[0043] Figure 23 A view for showing a third step of suture tightening using the suture tightening member of the third embodiment of the present application. DETAILED DESCRIPTION

[0044] Hereinafter, a suture tightening member of an embodiment of the present application will be described with reference to the drawings. In the present specification, a user of a device (a clip device) and an endoscope by which the suture tightening member is introduced into a body will be taken as a reference, a side of a patient's body will be taken as a distal side or a side of the interior, and a side of the user's hand will be taken as a proximal side or a side of the front. The drawings referred to in the present specification do not necessarily have an accurate scale with respect to actual dimensions, and a part will be exaggerated or simplified in order to schematically show the structure of the present application.

[0045] (First Embodiment)

[0046] First, with reference to Figures 1-3The structure of the suture tightening member 100A of the first embodiment of the present application will be described. Figure 1 A perspective view showing the suture tightening member 100A of the first embodiment of the present application and one example of the harness member 200 attached to the suture tightening member 100A. Figure 2 A side view showing one example of the open state of the suture tightening member 100A of the first embodiment of the present application. Figure 3 A side view showing one example of the closed state of the suture tightening member 100A of the first embodiment of the present application.

[0047] As Figures 1-3 shown, the suture tightening member 100A is formed in a clip shape, and has a link plate portion 110 and a pair of arm plate portions 120, 130.

[0048] The link plate portion 110 has a shape bent in a substantially U-letter shape, and a pair of arm plate portions 120, 130 are integrally formed at the distal ends of the U-letter shape so as to open in a substantially V-letter shape toward the distal side. The link plate portion 110 forms a link hole 110a which can be gripped by the link hook 11 of the clip device 10 described later.

[0049] The link plate portion 110 and the pair of arm plate portions 120, 130 can be formed by, for example, bending and plastically deforming a thin and elongated plate material composed of an elastic body. Although not particularly limited, as the plate material constituting the link plate portion 110 and the pair of arm plate portions 120, 130, stainless steel can be used, and the thickness thereof is preferably 0.10 to 0.30 mm.

[0050] The link plate portion 110 has a wide portion 111, 112 at each of the distal ends thereof. As Figure 1 shown, the width of the wide portions 111, 112 of the link plate portion 110 is larger than the width of each of the arm base end portions 121, 131 of the pair of arm plate portions 120, 130 which are continuous with the distal side of the link plate portion 110.

[0051] The pair of arm plate portions 120, 130 are composed of the arm base end portions 121, 131 and the arm wide portions 123, 133.

[0052] The arm base end portions 121, 131 constitute proximal sides of the pair of arm plate portions 120, 130, and are connected to the distal ends of the link plate portion 110, respectively. Thus, the pair of arm plate portions 120, 130 are connected via the link plate portion 110. The pair of arm plate portions 120, 130 are configured to be arranged such that a separation distance therebetween increases toward the tip end portions 126, 136 in a state where no external force is applied, and the separation distance therebetween is reduced by reducing an angle formed by the pair of arm plate portions 120, 130. That is, the pair of arm plate portions 120, 130 are configured to be spread apart in a state where no external force is applied, and to be elastically deformed to be closed when an external force is applied to reduce the separation distance therebetween, and to be spread apart again by the elastic force thereof when the external force is removed.

[0053] Further, the arm base end portions 121, 131 each have a locking portion 122, 132 in which an end portion on the arm width portion 123, 133 side is formed to have a larger width. The width of the locking portion 122, 132 is substantially the same as the width of the width portion 111, 112 of the link plate portion 110.

[0054] The arm base end portions 121, 131 are curved in a convex shape toward each other. The widths of the arm base end portions 121, 131 are substantially the same in the length direction except for the locking portions 122, 132 in which the width is larger, and are smaller than the width of the width portion 111, 112 of the link plate portion 110 located proximally.

[0055] The arm width portions 123, 133 each constitute a distal side of the pair of arm plate portions 120, 130. The base end portions (proximal side end portions) 125, 135 of the arm width portions 123, 133 are connected to the distal ends of the arm base end portions 121, 131, respectively.

[0056] Tip end claw portions 150, 160 are integrally formed at the tip end portions (distal side end portions) 126, 136 of the pair of arm plate portions 120, 130, respectively. Each of the tip end claw portions 150, 160 is formed by being bent inward in a direction toward the facing arm plate portion 120, 130 at the tip end portion 126, 136 of each arm plate portion 120, 130. Further, a notch portion 152, 162 in a concave shape is formed at a central portion of a tip end edge of each of the tip end claw portions 150, 160, and thus two gripping claw portions 155, 165 are formed at the tip end edge of each of the tip end claw portions 150, 160 with the notch portion 152, 162 therebetween. In the present embodiment, the tip end claw portions 150, 160 are integrally formed at the tip end portions 126, 136 of the pair of arm plate portions 120, 130, respectively. Further, the gripping claw portion 155 of one arm plate portion 120 and the gripping claw portion 165 of the other arm plate portion 130 have substantially the same shape and size.

[0057] The suture tightening member 100A can also be integrally formed by bending, for example, an elongated plate material so as to plastically deform it, thereby forming the link plate portion 110, the pair of arm plate portions 120, 130, and the tip claw portions 150, 160, or the tip claw portions 150, 160 can be attached to the tip end portions 126, 136 of the pair of arm plate portions 120, 130 by welding or the like.

[0058] In the suture tightening member 100A of the present embodiment, as shown in Figures 1-3 one of the pair of arm plate portions (for example, the arm plate portion 120) is longer than the other (for example, the arm plate portion 130).

[0059] For example Figure 3 As shown in the state in which the suture tightening member 100A is closed, when viewed from the side, for example, the base end portions 125, 135 of the pair of arm plate portions 120 are disposed at substantially the same position in the axial direction, the range from the link plate portion 110 to the base end portions 125, 135 of the pair of arm plate portions 120 is a symmetrical shape, and on the other hand, the length of the arm plate portion 120 in the lengthwise direction from the base end portion 125 to the tip end portion 126 is longer than the length of the other arm plate portion 130 in the lengthwise direction from the base end portion 135 to the tip end portion 136, and is an asymmetrical shape. Thus, the tip claw portion 150 of the arm plate portion 120 is disposed further distally than the tip claw portion 160 of the arm plate portion 130.

[0060] The separation distance D1 in the lengthwise direction between the tip end portion 126 of the arm plate portion 120 and the tip end portion 136 of the arm plate portion 130 (see Figure 3 ) can be appropriately set, but since the pair of arm plate portions 120, 130 are to be used to hold the mucosa of the periphery of the mucosal defect portion in a manner so as to span the mucosal defect portion, it is preferable to be larger than the diameter of the mucosal defect portion. As one example, the diameter of the mucosal defect portion generated in ESD is 1 to 4 cm, and in correspondence therewith, the separation distance D1 in the lengthwise direction between the tip end portion 126 of the arm plate portion 120 and the tip end portion 136 of the arm plate portion 130 can also be set to 1 to 4 cm.

[0061] The suture tightening member 100A can be in an open state in which the pair of arm plate portions 120, 130 are spread apart in the distal direction so as to be substantially V-shaped, and a closed state in which the pair of arm plate portions 120, 130 are close to each other, and can maintain the closed state of the pair of arm plate portions 120, 130. The mechanism for maintaining the closed state of the pair of arm plate portions 120, 130 is not particularly limited as long as it can maintain the state in which the pair of arm plate portions 120, 130 are close to each other, but in the present specification, as one example, a case in which the closed state of the pair of arm plate portions 120, 130 is maintained using the tightening member 200 will be described.

[0062] The tightening member 200 is one example of a mechanism that maintains the closed state of the pair of arm plate portions 120, 130. The tightening member 200 is composed of a substantially cylindrical member that forms a lumen 210 inside, and the arm base end portions 121, 131 of the pair of arm plate portions 120, 130 are attached to the tightening member 200 by being inserted into the lumen 210 of the tightening member 200. The tightening member 200 is fitted to the pair of arm plate portions 120, 130 in a manner that is movable along the length direction of the pair of arm plate portions 120, 130. The material of the tightening member 200 is not particularly limited, and a metal can be used, for example.

[0063] By moving the tightening member 200 along the length direction of the pair of arm plate portions 120, 130, the opening and closing state of the pair of arm plate portions 120, 130 can be adjusted.

[0064] Specifically, the tightening member 200 is fitted to the arm base end portions 121, 131 of the pair of arm plate portions 120, 130 in a manner that is movable along the length direction of the pair of arm plate portions 120, 130. The tightening member 200 is, for example, locked by making the wide portions 111, 112 of the link plate portion 110 enter the lumen 210 of the tightening member 200, and is restricted from further moving proximally, and is locked by making the locking portions 122, 132 of the arm base end portions 121, 131 enter the lumen 210 of the tightening member 200, and is restricted from further moving distally.

[0065] The length of the length direction of the tightening member 200 is not particularly limited as long as it can be moved relative to the pair of arm plate portions 120, 130 to control the opening and closing state of the pair of arm plate portions 120, 130. Furthermore, the inner diameter of the lumen 210 of the tightening member 200 is set to a size that allows the tightening member 200 to be locked by being fitted to the wide portions 111, 112 of the link plate portion 110 and the locking portions 122, 132 of the arm base end portions 121, 131.

[0066] The opening angle of the pair of arm plate portions 120, 130 becomes larger when the tightening member 200 is moved proximally (toward the link plate portion 110), and the pair of arm plate portions 120, 130 become in an open state. On the other hand, when the tightening member 200 is moved distally (toward the arm wide portions 123, 133 of the pair of arm plate portions 120, 130), the pair of arm plate portions 120, 130 are pressed close to each other and elastically deformed. At this time, the opening angle of the pair of arm plate portions 120, 130 becomes smaller, and the pair of arm plate portions 120, 130 become in a closed state. In the case where the tightening member 200 is moved to the distal-most side, the locking portions 122, 132 of the arm base end portions 121, 131 become in a state of being fitted into the tightening member 200. Thus, the tightening member 200 is locked by the locking portions 122, 132, and the closed state of the pair of arm plate portions 120, 130 can be maintained.

[0067] In Figure 2 , the state in which the binding member 200 is moved to the proximal side, the pair of arm plate portions 120, 130 are shown in an open state. In Figure 3 , the state in which the binding member 200 is moved to the distal side, the pair of arm plate portions 120, 130 are shown in a closed state.

[0068] In the open state in which the binding member 200 is located at the proximal side, as shown in Figure 2 , the pair of arm plate portions 120, 130 are open, and the top end portions 126, 136 of the pair of arm plate portions 120, 130 are separated. In moving the binding member 200 to the distal side from this state, as shown in Figure 3 , the pair of arm plate portions 120, 130 are closed. In the closed state in which the pair of arm plate portions 120, 130 are closed, the pair of arm plate portions 120, 130 are in a state of approaching each other.

[0069] Next, with reference to Figures 4-6 , a gripper device 10 for delivering the suture tightening member 100A of the first embodiment of the present application into the body will be described. Figure 4 is a side view showing the gripper device 10 for delivering the suture tightening member 100A of the first embodiment of the present application into the body. Figure 5 is a cross-sectional view along the A-A line of Figure 4 . Figure 6 is a side view showing a part of the link hook 11 and the drive wire 13 constituting the gripper device 10 for delivering the suture tightening member 100A of the first embodiment of the present application into the body.

[0070] As shown in Figure 4 , the gripper device 10 is configured to have a link hook 11, an inner sheath 12, a drive wire 13, an outer sheath 14, a reinforcing coil 15, a first slider portion 16, a base portion 17, and a second slider portion 18.

[0071] As shown in Figure 5 , the inner sheath 12, which is also tubular, is inserted into the tubular outer sheath 14, and the drive wire 13 is inserted into the inner sheath 12. The inner sheath 12 is slidable within the outer sheath 14, and the drive wire 13 is slidable within the inner sheath 12.

[0072] The outer sheath 14 is formed from a flexible hollow tube; in this embodiment, a spiral tube is used. As the spiral tube, a flat spiral tube formed by winding a long flat plate of metal (stainless steel) into a spiral shape can be used, but a round spiral tube or a spiral tube with a smooth inner surface can also be used. Furthermore, the outer sheath 14 can also be a component formed from a flexible polymer material (e.g., a resin such as polyamide resin or an elastomer such as a polyamide-based elastomer) molded into a tubular shape. The inner diameter of the distal end of the outer sheath 14 is approximately 2 to 3 mm.

[0073] The inner sheath 12 is formed of a flexible hollow tube, and in this embodiment, a metal wire tube is used. The metal wire tube is a tube formed by twisting multiple metal wires, such as those made of metal (stainless steel), into a helical hollow strand. Alternatively, the inner sheath 12 may primarily use a metal wire tube, with a helical tube used only in its distal portion. Furthermore, the inner sheath 12 may also be a component formed by molding a flexible polymer material (such as a resin like polyamide resin or an elastomer like a polyamide-based elastomer) into a tubular shape. The inner diameter of the distal end of the inner sheath 12 is approximately 1.5 to 2.5 mm.

[0074] The drive wire 13 is formed of a flexible metal wire, and in this embodiment, a metal wire rope is used. A metal wire rope is a rope formed by twisting multiple metal wires, such as those made of metal (stainless steel), into a spiral. However, as the drive wire 13, a metal wire tube similar to the inner sheath 12 can be used, or a single-strand metal wire can be used.

[0075] The connecting hook 11, located at the distal end of the clamping device 10, has a pair of arms 11a made of elastic bodies arranged in a generally V-shape toward its tip (distal side). The connecting hook 11 can be in two states, an open state and a closed state, by linkage with the inner sheath 12.

[0076] like Figure 6 As shown, claw portions 11b are formed at the top ends of a pair of arms 11a of the connecting hook 11 by bending inward (towards each other). By using the pair of arms 11a to hold the connecting plate portion 110 of the sewing tightening member 100A, the claw portions 11b are engaged with the connecting plate portion 110, thereby enabling the sewing tightening member 100A and the drive wire 13 to be detachably connected.

[0077] like Figure 6As shown, the base end portion of the coupling hook 11 has a U-shaped portion 11c that is continuous with the base end portions of the pair of arm portions 11a and is formed in a substantially U shape. Each of the arm portions 11a including the claw portion 11b and the U-shaped portion 11c can be formed by plastically deforming an elongated sheet material composed of an elastic body by appropriately bending the sheet material. Although not particularly limited, the sheet material that constitutes the coupling hook 11 has a thickness of about 0.2 to 0.4 mm and a width of about 0.6 mm. As the sheet material, for example, stainless steel can be used.

[0078] As shown in FIG. 1, the coupling hook 11 is composed of a pair of arm portions 11a and a claw portion 11b that is provided at the base end portions of the pair of arm portions 11a. The base end portions of the pair of arm portions 11a are fixed to the inner surface of the outer sheath 14. Figure 6 As shown in FIG. 1, the base end portion of the coupling hook 11 has a U-shaped portion 11c that is continuous with the base end portions of the pair of arm portions 11a and is formed in a substantially U shape. Each of the arm portions 11a including the claw portion 11b and the U-shaped portion 11c can be formed by plastically deforming an elongated sheet material composed of an elastic body by appropriately bending the sheet material. Although not particularly limited, the sheet material that constitutes the coupling hook 11 has a thickness of about 0.2 to 0.4 mm and a width of about 0.6 mm. As the sheet material, for example, stainless steel can be used.

[0079] As the members that constitute the U-shaped hook-side ring portion 11d and the wire-side ring portion 13a, respectively, members that are formed by appropriately bending a sheet material that is the same as the sheet material that constitutes the coupling hook 11 can be used. In addition, as the material of the members that constitute the U-shaped hook-side ring portion 11d and the wire-side ring portion 13a, respectively, for example, stainless steel can be used. Although not particularly limited, the outer diameter of the semicircular-arc-shaped portions of the hook-side ring portion 11d and the wire-side ring portion 13a can be about 1.0 to 1.2 mm, for example, and the inner diameter thereof can be about 0.8 to 1.0 mm, for example, and the cross-sectional shape thereof can be, for example, a rectangular shape, a circular shape, or a semicircular shape.

[0080] As shown in FIG. 1, the base end portion of the coupling hook 11 has a U-shaped portion 11c that is continuous with the base end portions of the pair of arm portions 11a and is formed in a substantially U shape. Each of the arm portions 11a including the claw portion 11b and the U-shaped portion 11c can be formed by plastically deforming an elongated sheet material composed of an elastic body by appropriately bending the sheet material. Although not particularly limited, the sheet material that constitutes the coupling hook 11 has a thickness of about 0.2 to 0.4 mm and a width of about 0.6 mm. As the sheet material, for example, stainless steel can be used. Figure 4 As shown in FIG. 1, the base end portion of the coupling hook 11 has a U-shaped portion 11c that is continuous with the base end portions of the pair of arm portions 11a and is formed in a substantially U shape. Each of the arm portions 11a including the claw portion 11b and the U-shaped portion 11c can be formed by plastically deforming an elongated sheet material composed of an elastic body by appropriately bending the sheet material. Although not particularly limited, the sheet material that constitutes the coupling hook 11 has a thickness of about 0.2 to 0.4 mm and a width of about 0.6 mm. As the sheet material, for example, stainless steel can be used.

[0081] The second slider portion 18 is slidably held in the base portion 17, and the inner sheath 12 is fixed to the base portion 17. The proximal end of the drive wire 13 is fixed to the second slider portion 18.

[0082] When the second slider portion 18 is slid to the tip end side (distal side) with respect to the base portion 17, the inner sheath 12 is pulled in with respect to the drive wire 13, and the link hook 11 at the tip end of the drive wire 13 protrudes from the tip end of the inner sheath 12 and is opened by its own elasticity. Further, when the second slider portion 18 is slid to the base end side (proximal side) with respect to the base portion 17, the drive wire 13 is pulled in with respect to the inner sheath 12, and the link hook 11 at the tip end of the drive wire 13 enters the inner sheath 12 while gradually closing and sinking into the inner sheath 12, whereby it is completely closed.

[0083] Further, when the first slider portion 16 is slid to the base end side with respect to the base portion 17, the inner sheath 12 can be made to protrude from the tip end of the outer sheath 14. Conversely, when the first slider portion 16 is slid to the tip end side with respect to the base portion 17, the tip end of the inner sheath 12 can be made to be housed in the outer sheath 14.

[0084] Further, the finger ring portion 17a is supported in a rotatable manner about the axis at the proximal end of the base portion 17. For example, by inserting the thumb into the finger ring portion 17a in a state in which the second slider portion 18 is held with the index finger and middle finger, the action of sliding the second slider portion 18 with respect to the base portion 17 can be smoothly performed with one hand. Further, when the finger ring portion 17a is rotated, the drive wire 13 is integrally rotated, whereby the suture tightening member 100A held by the link hook 11 can be made to rotate integrally with the drive wire 13.

[0085] Reference Signs List Figure 7 and Figure 8 A state in which the suture tightening member 100A of the first embodiment of the present application is installed at the distal end portion of the clip device 10 is described. Figure 7 A figure showing a state in which the suture tightening member 100A of the first embodiment of the present application protrudes from the distal end of the clip device 10. Figure 8 A figure showing a state in which the suture tightening member 100A of the first embodiment of the present application is housed in the distal end of the clip device 10. In addition, in Figure 7 and Figure 8 in the distal end portion of the clip device 10 is illustrated by a dotted line.

[0086] When the suture tightening member 100A is inserted into the body, the suture tightening member 100A is installed at the distal end portion of the clip device 10. The link hook 11 of the clip device 10 in the opened state is engaged with the link hole 110a formed on the inner side of the link plate portion 110 of the suture tightening member 100A, and the link hook 11 is slightly pulled in toward the inside of the inner sheath 12, whereby the suture tightening member 100A is installed at the tip end of the inner sheath 12 (refer to Figure 7 ).

[0087] In this state, the distal end portion of the drive wire 13 and the inner sheath 12, to which the suture tightening member 100A is linked, is pulled into the outer sheath 14, and the suture tightening member 100A is housed inside the distal end portion of the outer sheath 14 as a whole (see Figure 8 ). In this state, the binding member 200 mounted on the suture tightening member 100A is positioned proximally of the pair of arm plate portions 120, 130, and the suture tightening member 100A is housed in the outer sheath 14 in a state in which the pair of arm plate portions 120, 130 are closed by being pressed by the inner wall of the outer sheath 14.

[0088] Next, the method of using the suture tightening member 100A of the first embodiment will be described with reference to Figures 9-11 Figures 9-11 are shown. In Figures 9-11 , a schematic cross section of a digestive tract such as a large intestine, an esophagus, a stomach, or the like is shown. In Figures 9-11 , a case in which a mucosal defect portion D generated in a digestive tract wall W is approached from the right side of the drawing is depicted. The mucosal defect portion D has a mucosal defect portion opening Dm generated by resecting a mucosal layer and a submucosal layer of the digestive tract wall W and a mucosal defect portion floor Db formed by a submucosal layer or a muscular layer exposed from the inside of the mucosal defect portion D. The right side of the mucosal defect portion opening Dm is a peripheral mucosa Mp on the proximal side (an anterior side) of the mucosal defect portion opening Dm, and the left side of the mucosal defect portion opening Dm is a peripheral mucosa Md on the distal side (a posterior side) of the mucosal defect portion opening Dm. In Figures 9-11 , the mucosal layer is indicated by a cross-hatched line.

[0089] For example, after resecting a lesion portion including a submucosal layer as a whole by ESD, in order to suture and tighten a mucosal defect portion D generated by the resection, the suture tightening member 100A is introduced into the body. The suture tightening member 100A is inserted into the body through a treatment instrument guide tube of an endoscope not shown in a state in which it is mounted on the distal end portion of the clip device 10 and housed in the outer sheath 14 (a state shown in Figure 8 ), and guided to the vicinity of the mucosal defect portion D to be sutured and tightened.

[0090] Next, in the vicinity of the mucosal defect portion D, the outer sheath 14 is slid proximally, whereby the suture tightening member 100A is caused to protrude from the distal end of the outer sheath 14. By this, as shown in Figure 9 , the pair of arm plate portions 120, 130 protrude from the distal end of the outer sheath 14 and become a state in which they are spread apart by their own elasticity (a state shown in Figure 7 ).

[0091] ​Next, the suture tightening member 100A in the state where the pair of arm plate portions 120, 130 are spread is disposed above the mucosa defect portion opening Dm. Then, while the tip claw portion 150 of the relatively long one arm plate portion 120 is positioned on the circumferential mucosa Md on the distal side (inner side) of the mucosa defect portion opening Dm, and the tip claw portion 160 of the relatively short other arm plate portion 130 is positioned on the circumferential mucosa Mp on the proximal side (front side) of the mucosa defect portion opening Dm, the suture tightening member 100A is pressed toward the mucosa defect portion D.

[0092] As described above, one arm plate portion 120 of the suture tightening member 100A is longer than the other arm plate portion 130. Therefore, without making the suture tightening member 100A stand in a direction substantially perpendicular to the digestive tract wall W, it is easy to approach the mucosa defect portion D in a state where the length direction of the suture tightening member 100A is substantially parallel to the lumen axis of the digestive tract, that is, in a state where the suture tightening member 100A is laid flat, to position the tip claw portion 150 of one arm plate portion 120 on the circumferential mucosa Md on the distal side (inner side) of the mucosa defect portion opening Dm, and to position the tip claw portion 160 of the other arm plate portion 130 on the circumferential mucosa Mp on the proximal side (front side) of the mucosa defect portion opening Dm.

[0093] When the suture tightening member 100A is pressed against the digestive tract wall W in the vicinity of the mucosa defect portion D, the suture tightening member 100A becomes in a state where the length direction thereof is naturally inclined with respect to the lumen axis of the digestive tract. When the suture tightening member 100A is further pressed against the digestive tract wall W, as shown in FIG. 6, the gripping claw portion 155 of the tip claw portion 150 of one arm plate portion 120 is embedded in the circumferential mucosa Md on the distal side (inner side) of the mucosa defect portion opening Dm, and the gripping claw portion 165 of the tip claw portion 160 of the other arm plate portion 130 is embedded in the circumferential mucosa Mp on the proximal side (front side) of the mucosa defect portion opening Dm. Figure 10 The suture tightening member 100A is pressed against the digestive tract wall W in the vicinity of the mucosa defect portion D, the suture tightening member 100A becomes in a state where the length direction thereof is naturally inclined with respect to the lumen axis of the digestive tract. When the suture tightening member 100A is further pressed against the digestive tract wall W, as shown in FIG. 6, the gripping claw portion 155 of the tip claw portion 150 of one arm plate portion 120 is embedded in the circumferential mucosa Md on the distal side (inner side) of the mucosa defect portion opening Dm, and the gripping claw portion 165 of the tip claw portion 160 of the other arm plate portion 130 is embedded in the circumferential mucosa Mp on the proximal side (front side) of the mucosa defect portion opening Dm.

[0094] One arm plate portion 120 of the suture tightening member 100A is longer than the other arm plate portion 130. The claw portion 150 at the tip of the relatively longer arm plate portion 120 functions by rolling into the bottom surface Db of the mucosal defect while grasping it from the side. Thus, the pair of arm plate portions 120 and 130 of the suture tightening member 100A can hold the mucosal defect not only by closing the opening Dm but also by raising the bottom surface Db of the mucosal defect. As a result, the peripheral mucosa Md and Mp of the opening Dm of the mucosal defect are closely adhered to the bottom surface Db of the mucosal defect, which can promote the healing of the mucosal defect D.

[0095] By further sliding the inner sheath 12 relative to the drive wire 13 distally, the tightening member 200 is embedded in the locking portions 122 and 132 of the arm base ends 121 and 131, and a pair of arm plate portions 120 and 130 are fixed in a state where the mucosal defect portion D is sutured and tightened.

[0096] In this state, by sliding the inner sheath 12 proximally relative to the drive wire 13, the connecting hook 11 is exposed and opened from the distal end of the inner sheath 12, and the grip (engagement) of the connecting hook 11 on the suture tightening member 100A is released. Thus, as... Figure 11 As shown, a pair of arm plates 120 and 130 grasp and close the peripheral mucosa Md and Mp of the mucosal defect opening Dm, and the suture tightening member 100A remains in the body while the mucosal defect D is sutured and tightened. When using multiple suture tightening members 100A to suture and tighten the mucosal defect D, the above steps can be repeated for each suture tightening member 100A.

[0097] (Second Implementation)

[0098] Next, refer to Figures 12-14 The structure of the stitching tightening member 100B according to the second embodiment of the present invention will be described. Figure 12 This is a perspective view showing an example of a suture tightening member 100B and a fastening member 200 installed on the suture tightening member 100B according to a second embodiment of the present invention. Figure 13 A side view showing an example of the open state of the stitching tightening member 100B according to the second embodiment of the present invention. Figure 14 A side view showing an example of the closed state of the stitching tightening member 100B according to the second embodiment of the present invention. Figures 12-14 Referring to the first embodiment described above Figures 1-3 Correspondingly. Hereinafter, the same reference numerals will be used to refer to the same structures as those in the first embodiment described above, and their descriptions will be omitted or simplified.

[0099] The suture tightening member 100B of the second embodiment is formed in a clip shape, and has a link plate portion 110 and a pair of arm plate portions 120, 130. The suture tightening member 100B, like the suture tightening member 100A of the first embodiment described above, can take an open state in which the pair of arm plate portions 120, 130 are spread apart toward the distal side in a substantially V shape, and a closed state in which the pair of arm plate portions 120, 130 are closed to each other, and maintain the closed state of the pair of arm plate portions 120, 130. The mechanism for maintaining the closed state of the pair of arm plate portions 120, 130 is not particularly limited, and like the first embodiment described above, the closed state of the pair of arm plate portions 120, 130 can be maintained using the binding member 200.

[0100] In the suture tightening member 100B, like the suture tightening member 100A of the first embodiment described above, one arm plate portion (for example, the arm plate portion 120) is longer than the other arm plate portion (for example, the arm plate portion 130) in the pair of arm plate portions 120. However, the suture tightening member 100B, compared with the suture tightening member 100A of the first embodiment described above, has a further longer length in the length direction of the arm plate portion 120, and has an intermediate claw portion 170 extending in the direction toward the other arm plate portion 130 provided in the arm intermediate portion 127 between the base end portion 125 and the top end portion 126 of the arm plate portion 120. That is, the relatively long arm plate portion 120 of the suture tightening member 100B has both the top end claw portion 150 provided in the top end portion 126 thereof and the intermediate claw portion 170 provided in the arm intermediate portion 127 thereof.

[0101] A concave notch portion 172 is formed in the central portion of the top end edge of the intermediate claw portion 170, and thereby two holding claw portions 175 are formed in the top end edge of each intermediate claw portion 170 with the notch portion 172 interposed therebetween. In the present embodiment, the holding claw portion 155 of the top end claw portion 150 of the arm plate portion 120, the holding claw portion 175 of the intermediate claw portion 170, and the holding claw portion 165 of the top end claw portion 160 of the other arm plate portion 130 have substantially the same shape and size.

[0102] The suture tightening member 100B can also be formed by bending and plastically deforming, for example, one elongated plate material to integrally form the link plate portion 110, the pair of arm plate portions 120, 130, and the top end claw portions 150, 160, and then installing the intermediate claw portion 170 in the arm intermediate portion 127 of the arm plate portion 120 by welding or the like. Alternatively, the arm plate portion 120 located further distally than the arm intermediate portion 127 can be installed by welding or the like after the intermediate claw portion 170 is integrally formed, to extend the distal side of the arm intermediate portion 127.

[0103] The separation distance D2 (see FIG. 6) in the length direction between the arm intermediate portion 127 of the arm plate portion 120 and the top end portion 136 of the arm plate portion 130 is longer than the separation distance Dl (see FIG. 6) in the length direction between the top end claw portion 150 of the arm plate portion 120 and the top end claw portion 160 of the other arm plate portion 130. Figure 14) can be appropriately set, but since a pair of arm plate portions 120, 130 are used to hold the mucosa of the periphery of the mucosal defect portion in a manner so as to span the mucosal defect portion, it is preferable to be larger than the diameter of the mucosal defect portion. As one example, the diameter of the mucosal defect portion generated in ESD is 1 to 4 cm, and in correspondence thereto, the separation distance D2 in the longitudinal direction of the arm intermediate portion 127 of the arm plate portion 120 and the tip end portion 136 of the arm plate portion 130 can also be set to 1 to 4 cm. Further, the separation distance D3 in the longitudinal direction of the tip end portion 126 of the arm plate portion 120 and the arm intermediate portion 127 (refer to FIG. 6) can also be appropriately set, and like the separation distance D2, the separation distance D3 can also be set to 1 to 4 cm. Figure 14

[0104] The method of installing the suture tightening member 100B in the distal end portion of the clip device 10 is the same as the method of installing the suture tightening member 100A in the distal end portion of the clip device 10 described with reference to Figure 7 and Figure 8 In a state in which the pair of arm plate portions 120, 130 are closed by being pressed by the inner wall of the outer sheath 14, the suture tightening member 100B is housed inside the outer sheath 14.

[0105] Next, the method of using the suture tightening member 100B of the second embodiment will be described with reference to Figures 15-17 Figures 15-17 are shown in the drawings. In Figures 15-17 , a schematic cross section of a digestive tract such as the large intestine, esophagus, stomach, etc. is shown. In Figures 15-17 , a case in which the mucosal defect portion D generated in the wall W of the digestive tract is approached from the right side of the drawing is depicted. The mucosal defect portion D has a mucosal defect portion opening Dm generated by cutting the mucosal layer and submucosal layer of the wall W of the digestive tract, and a mucosal defect portion bottom surface Db formed by the submucosal layer or muscle layer exposed from the inside of the mucosal defect portion D. The periphery mucosa Mp of the proximal side (anterior side) of the mucosal defect portion opening Dm is on the right side of the mucosal defect portion opening Dm, and the periphery mucosa Md of the distal side (posterior side) of the mucosal defect portion opening Dm is on the left side of the mucosal defect portion opening Dm. Further, in Figures 15-17 , the mucosal layer is indicated by a cross section line.

[0106] For example, after the entirety of a lesion portion including the submucosal layer has been cut using ESD, in order to suture and tighten the mucosal defect portion D generated due to this cutting, the suture tightening member 100B is introduced into the body. The suture tightening member 100B is inserted into the body through a treatment instrument guide tube of an endoscope not shown, in a state in which it is installed in the distal end portion of the clip device 10 and housed inside the outer sheath 14, and guided to the vicinity of the mucosal defect portion D that should be sutured and tightened.

[0107] ​​Next, the outer sheath 14 is slid proximally in the vicinity of the mucosal defect D, whereby the suture tightening member 100B protrudes from the distal end of the outer sheath 14. Thereby, as shown in Figure 15 the pair of arm plate portions 120, 130 are exposed from the distal end of the outer sheath 14, and become a state of being spread by their own elasticity.

[0108] Next, the suture tightening member 100B in the state of the pair of arm plate portions 120, 130 being spread is disposed above the mucosal defect opening Dm. Then, while the tip claw portion 150 and the intermediate claw portion 170 of the relatively long one arm plate portion 120 are positioned on the circumferential mucosa Md on the distal side (inner side) of the mucosal defect opening Dm, and the tip claw portion 160 of the relatively short other arm plate portion 130 is positioned on the circumferential mucosa Mp on the proximal side (proximal side) of the mucosal defect opening Dm, the suture tightening member 100B is pressed toward the mucosal defect D.

[0109] As described above, one arm plate portion 120 of the suture tightening member 100B is longer than the other arm plate portion 130. Therefore, without making the suture tightening member 100B stand in a direction substantially perpendicular to the digestive tract wall W, it is easy to approach the mucosal defect D in a state in which the length direction of the suture tightening member 100B is substantially parallel to the lumen axis of the digestive tract, that is, in a state in which the suture tightening member 100B is laid flat, and to position the tip claw portion 150 and the intermediate claw portion 170 of one arm plate portion 120 on the circumferential mucosa Md on the distal side (inner side) of the mucosal defect opening Dm, and to position the tip claw portion 160 of the other arm plate portion 130 on the circumferential mucosa Mp on the proximal side (proximal side) of the mucosal defect opening Dm.

[0110] When the suture tightening member 100B is pressed against the digestive tract wall W in the vicinity of the mucosal defect D, the suture tightening member 100B becomes a state in which the length direction thereof is naturally inclined with respect to the lumen axis of the digestive tract. When the suture tightening member 100B is further pressed against the digestive tract wall W, as shown in Figure 16As shown, the holding claw portions 155, 175 of the top claw portion 150 and the intermediate claw portion 170 of one arm plate portion 120 are embedded in the circumferential mucosa Md on the distal (inner) side of the mucosal defect opening Dm, and the holding claw portion 165 of the top claw portion 160 of the other arm plate portion 130 is embedded in the circumferential mucosa Mp on the proximal (front) side of the mucosal defect opening Dm. From this state, the inner sheath 12 is slid distally relative to the driving wire 13, whereby the proximal end face of the tightening member 200 is pressed against the distal end face of the inner sheath 12, and the tightening member 200 is slid toward the direction of the top portions 126, 136 of the pair of arm plate portions 120, 130. As a result, the pair of arm plate portions 120, 130 gradually close in on each other, the circumferential mucosa Md on the distal (inner) side of the mucosal defect opening Dm and the circumferential mucosa Mp on the proximal (front) side of the mucosal defect opening Dm gradually close in on each other, and the mucosal defect opening Dm becomes smaller.

[0111] One arm plate portion 120 of the suture tightening member 100B is longer than the other arm plate portion 130, and two claw portions, the top claw portion 150 and the intermediate claw portion 170, are provided in the relatively long one arm plate portion 120. In the circumferential mucosa Md on the distal (inner) side of the mucosal defect opening Dm, the intermediate claw portion 170 is embedded in the circumferential mucosa Md in a position close to the mucosal defect opening Dm, and the top claw portion 150 is embedded in the circumferential mucosa Md further distally (inner). When the suture tightening member 100B is closed, since it is approached from the proximal (front) side relative to the mucosal defect D, the action of pulling in the circumferential mucosa Md on the distal (inner) side of the mucosal defect opening Dm is performed. At this time, the holding claw portions 155, 175 formed in the two claw portions, the top claw portion 150 and the intermediate claw portion 170, are embedded in and pulled in the circumferential mucosa Md on the distal (inner) side of the mucosal defect opening Dm, and thus the mucosal defect D can be more firmly held and reliably sutured and tightened.

[0112] Further, the top claw portion 150 and the intermediate claw portion 170 of the relatively long one arm plate portion 120 function in a manner of rolling up the mucosal defect bottom surface Db while grasping it from the side. In particular, the top claw portion 150 located further distally (inner) functions in a manner of grasping the mucosal defect bottom surface Db from a deeper position. As a result, the pair of arm plate portions 120, 130 of the suture tightening member 100B in the closed state can hold in a manner of not only closing the mucosal defect opening Dm but also bulging the mucosal defect bottom surface Db, and as a result, the circumferential mucosa Md, Mp of the mucosal defect opening Dm and the mucosal defect bottom surface Db are closely adhered, and the healing of the mucosal defect D can be promoted.

[0113] By further sliding the inner sheath 12 distally relative to the drive wire 13, the tightening member 200 is embedded in the locking portions 122, 132 of the arm base end portions 121, 131, and the pair of arm plate portions 120, 130 are fixed in a state in which the mucosa defect D is sutured and tightened.

[0114] In this state, by sliding the inner sheath 12 proximally relative to the drive wire 13, the linking hook 11 is exposed from the distal end of the inner sheath 12 and is opened, and the grip (engagement) of the linking hook 11 to the suture tightening member 100B is released. Thus, as shown in FIG. 6, the pair of arm plate portions 120, 130 grip the circumferential mucosa Md, Mp of the mucosa defect opening Dm and are closed, and the suture tightening member 100B is left in the body in a state in which the mucosa defect D is sutured and tightened. In the case in which a plurality of suture tightening members 100B are used to suture and tighten the mucosa defect D, the above-described steps can be repeated for each suture tightening member 100B. Figure 17

[0115] In addition, in the above-described description, the two claw portions, the tip claw portion 150 and the intermediate claw portion 170, are embedded in the circumferential mucosa Md on the distal (inner) side of the mucosa defect opening Dm, but for example, the tip claw portion 150 can be embedded in the circumferential mucosa Md on the distal (inner) side of the mucosa defect opening Dm, and the intermediate claw portion 170 can be embedded in the mucosa defect bottom surface Db, and the pair of arm plate portions 120, 130 can be closed.

[0116] (Third Embodiment)

[0117] Next, the structure of the suture tightening member 100C of the third embodiment of the present application will be described with reference to Figures 18-20 Figure 18 FIG. 7 is a perspective view showing one example of the suture tightening member 100C of the third embodiment of the present application and the tightening member 200 attached to the suture tightening member 100C. Figure 19 FIG. 8 is a side view showing one example of an open state of the suture tightening member 100C of the third embodiment of the present application. Figure 20 FIG. 9 is a side view showing one example of a closed state of the suture tightening member 100C of the third embodiment of the present application. Figures 18-20 Corresponding to the suture tightening member 100A of the above-described first embodiment with reference to Figures 1-3 Corresponding to the suture tightening member 100A of the above-described first embodiment with reference to

[0118] ​​The suture tightening member 100C of the third embodiment is formed in a clip shape, and has a link plate portion 110 and a pair of arm plate portions 120, 130. The suture tightening member 100C, like the suture tightening member 100A of the first embodiment described above, can be brought into an open state in which the pair of arm plate portions 120, 130 are spread apart toward the distal side in a substantially V shape, and a closed state in which the pair of arm plate portions 120, 130 are brought close to each other, and maintains the closed state of the pair of arm plate portions 120, 130. The mechanism for maintaining the closed state of the pair of arm plate portions 120, 130 is not particularly limited, and like the first embodiment described above, the closed state of the pair of arm plate portions 120, 130 can be maintained using the binding member 200.

[0119] In the suture tightening member 100C, like the suture tightening member 100A of the first embodiment described above, in the pair of arm plate portions 120, one arm plate portion (for example, the arm plate portion 120) is longer than the other arm plate portion (for example, the arm plate portion 130). However, the suture tightening member 100C has a change in the shape of the tip claw portion 150 compared to the suture tightening member 100A of the first embodiment described above.

[0120] Specifically, the angle a (see FIG. 6) formed between the extension direction of the tip claw portion 150 provided in one arm plate portion 120 and the length direction of the one arm plate portion 120 is an acute angle, and as shown in FIG. 6, in the closed state of the pair of arm plate portions 120, 130, the tip claw portion 150 provided in the one arm plate portion 120 extends in the direction toward the tip claw portion 160 of the other arm plate portion 130. Figure 19 Figure 20

[0121] The angle a is not particularly limited as long as it is an acute angle (an angle of more than 0° and less than 90°), but for example, it can be set to an arbitrary angle in a range of more than or equal to 10° and less than or equal to 80°, and further, it can be set to an arbitrary angle in a range of more than or equal to 20° and less than or equal to 60°. In addition, the angle a can be set in a manner such that the tip claw portion 150 extends toward the tip portion 136 of the other arm plate portion 130.

[0122] A notch portion 172 in a concave shape is formed in the central portion of the tip edge of the tip claw portion 150, and two holding claw portions 175 are formed in the tip edge of the tip claw portion 150 across the notch portion 172. The length of the two holding claw portions 155 formed in the tip claw portion 150 of the relatively long one arm plate portion 120 is longer than the length of the two holding claw portions 165 formed in the tip claw portion 160 of the relatively short other arm plate portion 120.

[0123] ​​The suture tightening member 100C can also be bent and plastically deformed to integrally form the link plate portion 110, the pair of arm plate portions 120, 130, and the tip claw portions 150, 160, or the tip claw portions 150, 160 can be attached to the tip end portions 126, 136 of the pair of arm plate portions 120, 130 by welding or the like.

[0124] The separation distance D4 in the length direction of the tip end portion 126 of the arm plate portion 120 and the tip end portion 136 of the arm plate portion 130 (refer to FIG. 6) can be appropriately set, but since the pair of arm plate portions 120, 130 are to be used to hold the mucosa of the periphery of the mucosal defect portion in a manner so as to span the mucosal defect portion, it is preferable to be larger than the diameter of the mucosal defect portion. As one example, the diameter of the mucosal defect portion generated in ESD is 1 to 4 cm, and in correspondence thereto, the separation distance D4 in the length direction of the tip end portion 126 of the arm plate portion 120 and the tip end portion 136 of the arm plate portion 130 can also be set to 1 to 4 cm. Figure 20 ) can be appropriately set, but since the pair of arm plate portions 120, 130 are to be used to hold the mucosa of the periphery of the mucosal defect portion in a manner so as to span the mucosal defect portion, it is preferable to be larger than the diameter of the mucosal defect portion. As one example, the diameter of the mucosal defect portion generated in ESD is 1 to 4 cm, and in correspondence thereto, the separation distance D4 in the length direction of the tip end portion 126 of the arm plate portion 120 and the tip end portion 136 of the arm plate portion 130 can also be set to 1 to 4 cm.

[0125] The method of attaching the suture tightening member 100C to the distal end portion of the clip device 10 is the same as the method of attaching the suture tightening member 100A to the distal end portion of the clip device 10 described with reference to Figure 7 and Figure 8 In a state in which the pair of arm plate portions 120, 130 are closed by being pressed by the inner wall of the outer sheath 14, the suture tightening member 100C is housed inside the outer sheath 14.

[0126] Next, the method of using the suture tightening member 100C of the third embodiment will be described with reference to Figures 21-23 Figures 21-23 are diagrams for respectively showing the first to third procedures of performing suture tightening using the suture tightening member 100C of the third embodiment of the present application. In Figures 21-23 , a schematic cross section of a digestive tract such as a large intestine, an esophagus, a stomach, or the like is shown. In Figures 21-23 , a case in which a mucosal defect portion D generated in a digestive tract wall W is approached from the right side of the drawing is depicted. The mucosal defect portion D has a mucosal defect portion opening Dm generated by cutting the mucosal layer and the submucosal layer of the digestive tract wall W, and a mucosal defect portion floor Db formed by the submucosal layer or the muscular layer exposed from the inside of the mucosal defect portion D. The periphery mucosa Mp of the proximal side (the front side) of the mucosal defect portion opening Dm is on the right side of the mucosal defect portion opening Dm, and the periphery mucosa Md of the distal side (the inner side) of the mucosal defect portion opening Dm is on the left side of the mucosal defect portion opening Dm. In addition, in Figures 21-23 , the mucosal layer is indicated by a cross section line.

[0127] ​For example, after a lesion including a submucosal layer is entirely cut out by ESD, in order to suture and tighten a mucosal defect portion D generated by the cut-out, a suture and tightening member 100C is introduced into the body. The suture and tightening member 100C is inserted into the body through a treatment instrument guide tube of an endoscope not shown, in a state where it is mounted at the distal end portion of the clip device 10 and housed in the outer sheath 14, and guided to the vicinity of the mucosal defect portion D to be sutured and tightened.

[0128] Next, the outer sheath 14 is slid proximally in the vicinity of the mucosal defect portion D, thereby causing the suture and tightening member 100C to protrude from the distal end of the outer sheath 14. Thereby, as shown in Figure 21 a pair of arm plate portions 120, 130 are exposed from the distal end of the outer sheath 14, and become a state where they are spread apart by their own elasticity.

[0129] Next, the suture and tightening member 100C in the state where the pair of arm plate portions 120, 130 are spread apart is disposed above the mucosal defect portion opening Dm. Then, while the tip claw portion 150 of the relatively long one arm plate portion 120 is positioned on the circumferential mucosa Md on the distal side (inner side) of the mucosal defect portion opening Dm, and the tip claw portion 160 of the relatively short other arm plate portion 130 is positioned on the circumferential mucosa Mp on the proximal side (proximal side) of the mucosal defect portion opening Dm, the suture and tightening member 100C is pressed toward the mucosal defect portion D.

[0130] As described above, one arm plate portion 120 of the suture and tightening member 100C is longer than the other arm plate portion 130. Therefore, without making the suture and tightening member 100C stand in a direction substantially perpendicular to the digestive tract wall W, it is easy to approach the mucosal defect portion D in a state where the length direction of the suture and tightening member 100C is substantially parallel to the lumen axis of the digestive tract, that is, in a state where the suture and tightening member 100C is laid flat, to position the tip claw portion 150 of the one arm plate portion 120 on the circumferential mucosa Md on the distal side (inner side) of the mucosal defect portion opening Dm, and to position the tip claw portion 160 of the other arm plate portion 130 on the circumferential mucosa Mp on the proximal side (proximal side) of the mucosal defect portion opening Dm.

[0131] When the suture and tightening member 100C is pressed against the digestive tract wall W in the vicinity of the mucosal defect portion D, the suture and tightening member 100C becomes a state where its length direction is naturally inclined with respect to the lumen axis of the digestive tract. When the suture and tightening member 100C is further pressed against the digestive tract wall W, as shown in Figure 22As shown, the holding claw portion 155 of the top claw portion 150 of one arm plate portion 120 and the holding claw portion 175 of the middle claw portion 170 are embedded in the circumferential mucosa Md on the distal side (inner side) of the mucosal defect portion opening Dm, and the holding claw portion 165 of the top claw portion 160 of the other arm plate portion 130 is embedded in the circumferential mucosa Mp on the proximal side (front side) of the mucosal defect portion opening Dm. By sliding the inner sheath 12 relative to the driving wire 13 in the distal direction from this state, the proximal end face of the tightening member 200 is pressed against the distal end face of the inner sheath 12, and the tightening member 200 slides in the direction of the top portions 126, 136 of the pair of arm plate portions 120, 130. As a result, the pair of arm plate portions 120, 130 gradually close in a manner of approaching each other, the circumferential mucosa Md on the distal side (inner side) of the mucosal defect portion opening Dm gradually approaches the circumferential mucosa Mp on the proximal side (front side) of the mucosal defect portion opening Dm, and the mucosal defect portion opening Dm becomes small.

[0132] The top claw portion 150 of one arm plate portion 120 of the suture tightening member 100C is acute with respect to the length direction of the arm plate portion 120, and the holding claw portion 155 of the top claw portion 150 is formed in a manner of returning to the proximal side. Furthermore, the holding claw portion 155 of the top claw portion 150 is longer than the holding claw portion 165 of the top claw portion 160 of the other arm plate portion 130. The holding claw portion 155 of the top claw portion 150 is deeply embedded in the circumferential mucosa Md on the distal side (inner side) of the mucosal defect portion opening Dm by virtue of the acute angle and the longer extension thereof. When the suture tightening member 100C is closed, the circumferential mucosa Md on the distal side (inner side) of the mucosal defect portion opening Dm is pulled in from the proximal side (front side) with respect to the mucosal defect portion D. At this time, the holding claw portion 155 of the top claw portion 150 is pulled in in a state of being deeply embedded in the circumferential mucosa Md on the distal side (inner side) of the mucosal defect portion opening Dm, and thus the mucosal defect portion opening Dm can be more firmly held and reliably sutured and tightened.

[0133] Furthermore, the top claw portion 150 is acute with respect to the length direction of the arm plate portion 120, and the holding claw portion 155 of the top claw portion 150 is embedded in the circumferential mucosa Md on the distal side (inner side) of the mucosal defect portion opening Dm in a direction coinciding with the direction of pulling in to the proximal side (front side), whereby the holding at the distal side (inner side) of the mucosal defect portion opening Dm is less likely to be released when the pair of arm plate portions 120, 130 is closed. Furthermore, the top claw portion 150 of one arm plate portion 120 extends in the direction of approaching the top claw portion 160 of the other arm plate portion 130, and thus the separation distance between the top claw portion 150 of one arm plate portion 120 and the top claw portion 160 of the other arm plate portion 130 can be reduced when the pair of arm plate portions 120, 130 is closed, with the result that the holding force of the pair of arm plate portions 120, 130 can be stronger, and the mucosal defect portion D can be reliably sutured and tightened.

[0134] Furthermore, the tip claw 150 of the relatively long arm plate portion 120 functions by wrapping around the bottom surface Db of the mucosal defect while grasping it from the side. In particular, in this embodiment, the tip claw 150 has an acute angle and a relatively long shape, which functions by grasping the bottom surface Db of the mucosal defect upwards. As a result, when the pair of arm plates 120 and 130 of the suture tightening member 100C are closed, they can hold the mucosal defect not only by closing the opening Dm but also by raising the bottom surface Db of the mucosal defect. Consequently, the mucosa Md and Mp around the opening Dm of the mucosal defect are closely adhered to the bottom surface Db of the mucosal defect, which promotes the healing of the mucosal defect D.

[0135] By further sliding the inner sheath 12 relative to the drive wire 13 distally, the tightening member 200 is embedded in the locking portions 122 and 132 of the arm base ends 121 and 131, and a pair of arm plate portions 120 and 130 are fixed in a state where the mucosal defect portion D is sutured and tightened.

[0136] In this state, by sliding the inner sheath 12 proximally relative to the drive wire 13, the connecting hook 11 is exposed and opened from the distal end of the inner sheath 12, and the grip (engagement) of the connecting hook 11 on the suture tightening member 100C is released. Thus, as... Figure 23 As shown, a pair of arm plates 120 and 130 grasp and close the peripheral mucosa Md and Mp of the mucosal defect opening Dm, and the suture tightening member 100C remains in the body while the mucosal defect D is sutured and tightened. When using multiple suture tightening members 100C to suture and tighten the mucosal defect D, the above steps can be repeated for each suture tightening member 100C.

[0137] The function of the stitching tightening members 100A, 100B, and 100C in the first to third embodiments described above will be explained below.

[0138] The suture tightening members 100A, 100B, and 100C of the first to third embodiments are used to suture and tighten the mucosal defect D of the digestive tract wall W. They are characterized by having: a pair of arm plate portions 120 and 130 arranged such that their separation distance from each other increases toward the top portions 126 and 136 when no external force is applied; a connecting plate portion 110 connecting the arm base ends 121 and 131 of the pair of arm plate portions 120 and 130; and top claw portions 150 and 160 provided facing each other at the respective top portions 126 and 136 of the pair of arm plate portions 120 and 130, wherein one arm plate portion 120 is longer than the other arm plate portion 130.

[0139] According to the above-described structure, since one arm plate portion 120 is longer than the other arm plate portion 130, the mucosal defect D can be easily and reliably sutured and tightened in a state where the suture tightening member 100A, 100B, 100C is laid flat along the lumen axis of the digestive tract with respect to the digestive tract wall W, with the tip claw portion 150 of one arm plate portion 120 gripping the circumferential mucosa Md on the inner side of the mucosal defect opening Dm, and the tip claw portion 160 of the other arm plate portion 130 gripping the circumferential mucosa Mp on the proximal side of the mucosal defect opening Dm, approaching the mucosal defect D of the digestive tract wall W along the lumen axis of the digestive tract. Furthermore, the tip claw portion 150 of one arm plate portion 120 can grip in a manner that protrudes the mucosal defect bottom surface Db, and the suture tightening of the mucosal defect D can be performed in a manner that promotes healing of the circumferential mucosa Md, Mp of the mucosal defect opening Dm and the mucosal defect bottom surface Db.

[0140] As in the second embodiment, the suture tightening member 100B can also have an intermediate claw portion 170 provided in the arm intermediate portion 127 of the above-described one arm plate portion 120 in a manner that extends in the direction toward the above-described other arm plate portion 130.

[0141] According to the above-described structure, since one arm plate portion 120 has the tip claw portion 150 provided at the tip end portion 126 and the intermediate claw portion 170 provided at the arm intermediate portion 127, the circumferential mucosa Md on the inner side of the mucosal defect opening Dm can be gripped by the tip claw portion 150 of one arm plate portion 120, and the circumferential mucosa Md or the mucosal defect bottom surface Db of the mucosal defect opening Dm can be gripped by the intermediate claw portion 170, and since gripping is performed by the intermediate claw portion 170 in addition to the tip claw portions 150, 160, the mucosal defect D can be more firmly gripped and reliably sutured and tightened. In particular, by the tip claw portion 150 and the intermediate claw portion 170 of one arm plate portion 120 gripping in a manner that protrudes the mucosal defect bottom surface Db, the suture tightening of the mucosal defect D can be performed in a manner that further promotes healing of the circumferential mucosa Md, Mp of the mucosal defect opening Dm and the mucosal defect bottom surface Db.

[0142] As in the third embodiment, the suture tightening member 100C can also have an angle α formed by the extension direction of the above-described tip claw portion 150 of the above-described one arm plate portion 120 and the length direction of the above-described one arm plate portion 120 be an acute angle, and the above-described tip claw portion 150 of the above-described one arm plate portion 120 can extend in the direction toward the tip claw portion 160 of the above-described other arm plate portion 130.

[0143] According to the above-described structure, since the tip claw portion 150 of one arm plate portion 120 extends in the direction close to the tip claw portion 160 of the other arm plate portion 130, the separation distance between the tip claw portion 150 of one arm plate portion 120 and the tip claw portion 160 of the other arm plate portion 130 can be reduced when the pair of arm plate portions 120, 130 is closed, so that the holding force of the tip claw portion 150 of one arm plate portion 120 and the tip claw portion 160 of the other arm plate portion 130 can be stronger, and the mucosa defect portion D can be reliably sutured and tightened.

[0144] As in the third embodiment, the suture tightening member 100C can also be configured such that the above-described tip claw portions 150, 160 of the above-described pair of arm plate portions 120, 130 have holding claw portions 155, 165 split into two prongs, and the length of the above-described holding claw portion 155 of the above-described one arm plate portion 120 is longer than the length of the above-described holding claw portion 165 of the above-described other arm plate portion 130.

[0145] According to the above-described structure, since the tip claw portion 150 of one arm plate portion 120 can hold the circumferential mucosa Md of the inside of the mucosa defect portion opening Dm in a manner that the tip claw portion 150 is inserted into the circumferential mucosa Md, the holding force of the tip claw portion 150 of one arm plate portion 120 can be further enhanced, and the mucosa defect portion D can be more reliably sutured and tightened. Furthermore, the mucosa defect portion D can be held in a manner that the mucosa defect portion bottom surface Db is more protruded, and the suture tightening of the mucosa defect portion D can be performed in a manner that the healing of the circumferential mucosa Md, Mp of the mucosa defect portion opening Dm and the mucosa defect portion bottom surface Db is further promoted.

[0146] The above-described embodiments are described in order to facilitate understanding of the present application, and do not limit the present application. Each of the constituent elements disclosed in the above-described embodiments is intended to also include all design changes and equivalents belonging to the technical scope of the present application. Furthermore, structures obtained by appropriately combining each of the structural elements described in the embodiments are also included in the present application. For example, as described in the third embodiment, the length of the tip claw portion 150 of the suture tightening member 100B of the second embodiment can be formed into an acute angle with respect to the length direction of the arm plate portion 120, and further, the shape of the holding claw portion 155 of the tip claw portion 150 can be elongated to be longer than the holding claw portion 165 of the other arm plate portion 130.

[0147] Explanation of Reference Numerals

[0148] 10: clamp device;

[0149] 11: link hook;

[0150] 11a: arm portion;

[0151] 11b: claw portion;

[0152] 11c: U-shaped portion;

[0153] 11d: hook side annular portion

[0154] 12: inner sheath

[0155] 13: drive wire

[0156] 13a: wire side annular portion

[0157] 14: outer sheath

[0158] 15: reinforcing coil

[0159] 16: first slider portion

[0160] 17: base portion

[0161] 17a: finger loop portion

[0162] 18: second slider portion

[0163] 100A, 100B, 100C: suture tightening member

[0164] 110: link plate portion

[0165] 110a: link hole

[0166] 111, 112: wide portion

[0167] 120, 130: arm plate portion

[0168] 121, 131: arm base end portion

[0169] 122, 132: locking portion

[0170] 123, 133: arm wide portion

[0171] 125, 135: base end portion

[0172] 126, 136: top end portion

[0173] 127: arm intermediate portion

[0174] 130: arm plate portion

[0175] 150, 160: top end claw portion

[0176] 152, 162, 172: notch portion

[0177] 155, 165, 175: grip claw portion

[0178] 170: intermediate claw portion

[0179] 200: tightening member

[0180] 210: lumen;

[0181] D: mucosal defect portion;

[0182] Db: bottom surface of mucosal defect portion;

[0183] Dm: opening of mucosal defect portion;

[0184] Md, Mp: peripheral mucosa;

[0185] W: digestive tract wall.

Claims

1. A suture tightening member for use in suture tightening a mucosal defect portion of a digestive tract wall, characterized by, Having: a pair of arm plate portions configured so that the separation distance therebetween increases toward the tip end portions in the state where no external force is applied; a link plate portion linking the arm base end portions of the pair of arm plate portions; and a tip end claw portion provided in each of the tip end portions of the pair of arm plate portions so as to face each other, one of the pair of arm plate portions is longer than the other. Having:

2. The suture tightening member of claim 1, wherein, an intermediate claw portion provided in the arm intermediate portion of the one of the pair of arm plate portions so as to extend in the direction toward the other of the pair of arm plate portions.

3. The suture tightening member according to claim 1 or 2, wherein the angle formed between the extension direction of the tip end claw portion of the one of the pair of arm plate portions and the length direction of the one of the pair of arm plate portions is an acute angle, and the tip end claw portion of the one of the pair of arm plate portions extends in the direction toward the tip end claw portion of the other of the pair of arm plate portions.

4. The suture tightening member according to claim 3, wherein the tip end claw portions of the pair of arm plate portions each have a pair of holding claw portions split into two, and the length of the holding claw portion of the one of the pair of arm plate portions is longer than the length of the holding claw portion of the other of the pair of arm plate portions. ​

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